Tobacco Documents Online

GOIrTTENTS! (The same table of' contents appeare 1n parts 1, 1: and 8) Hearings held! on- PART 1 PdEa Apri115, 1969------------------------------------------------- Apri1:16;,1969'----------------------•--------------------------- April 17, 1969_------------------------------------------------ Apri118, 1969------------------------------------------------- Apri121, 1969------------------------------------------------- PART 2' April 22, 1969------------------------------------------------- Apri123, 1969------------------------------------------------- Apri124, 1969------------------------------------------------- Apri1 25, 1969------------------------------------------------- Apri128, 1969------------------------------------------------- PART 3' April 29, 1969------------------------------------------------- Apri130, 1969------------------------------------------------- May 1, 1969-------------------------------------------------- Text of- 1 83' 193 261 307 453 547 603 723 769 893 1063 1283 H.R.643----------------------------------------------------- H.R. 1237---------------------------------------------------- 2 3I H.R.3055---------------------------------------------------- 3' H.R. 6543---------------------------------------------------- 5 Report of= Agriculture Department on: H.R.,3055------------------------------------------------ 13' H.R. 6543------------------------------------------------ 14 Commerce Department on H.R. 643, H:R., 1237, H.R. 3055, and H.R. 6543-------------------------------------------------- 7 Justice Department on: H.R. 1237------------------------------------------------ 12 H.R. 6543------------------------------------------------ 14! Treasury Department on H.R.6543'----------------------------- 13 Statement of- Abbitt, Hbn. W. 1VP., , a Representative in Congress from the State of Virginia---------------------------------------------------- 59. Anderson, Hon. Glenn 1V1.,, a Representiative in Congress from the State of Calif'ornia------------------------------------------- 81 Baker, Dr. Sol R.,, chairman, committee on tobacco and eaneer,, Ameri- can Cancer Soeiety------------------------------------------ 307 Banzhaf, John F., III, executive trustee,, Legislative Action on Slmob- ing,andlHealth (II.ASH)~ -_--,-_ -------------------------------- 2&3' Bremy Dr. Thomas H., internist, Los Angeles, Calif'---------------- 1063'. Browning, Dr. Robertl H., member, board of directors,, National Tu- berculosis and Respiratory Disease Association---------------- 628,632 Brown1ee;,K. Alexander,,Ouray, Colo---------------------------- , 740. Buffington, J. V'.,, Assistant tio the Chairman, Federal Trade Commis~. sion-------------------------------------------------------- 453 Buhler, Dr. Victor,, pathologistl, Kansas City,, ALo----------------- 769. Carr, Dr. Duane, professor of surgery, University of Tennessee Co1- lege of Medicine--------------------------------------------- , 849

Part 3 aGARETTB LADELM AND ADVERTISING-19% HEARINGS BE8'O= THID I HOUSEI OF REPRESENTATIVES CC'MMITTEE ON INTERSTAH AND FOREIGN CaXMERCE' IrTINETY-FIRST CONGRESS FIRST SESSION ON 11.P. VM ' A BILL ~ TO' AMEXID THE i H'EDEBtAL CIQARH9PTID LABELIN(I AND ADVERlrl$ING ACT, WITH RESPECT TO THE LABELING OF PACK- AGE8 OF CIGABEIIITE&:, AND. FOB' OTHHIC PURPOBES (And! Similar Bille)', IM 1237 A BILL TO DIRECT THE FEDERAL COMMUNICATIONS CONSDITS- BION TO! ESTABLISH REGULATIONS PROHIBITING CERTAIN BROADCASTING OF ADOERTIBING', OF CIOARE'BLEB (And Similar Bills) H.R. 3055 A BILL TO $TREN(i'THEN' THE FEDERAL CIOARETTE I LABELING ANID' ADVERTISING ACT (And Similar Bills) H.R. 6543 A BILL TO ESITEND PUBLIC HEALTH PHO'TECfrION' WIrTH' REs SPECT TO CIGAREE!TTE SMOKING AND FOR OTHEB PURPOSES (Aad,8lmllar Bills) APR.'IL; 15, 16, 17, 18, 21~ 22, 23, 24',25, 28, 29; 3%AND MAY 1 S'erial No. 91-12 Painted for the use of the Committee on Interstate and Foreign Commerce

CO (The same table ot'c> Hearings' held on- April 15, 1969'------------- Apri1 16,, 1969------------- April'17;, 1969'------------- COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE April 18, 1969------------- HARLEY Os STAGGERS,,West Virginia, Chairman April 21', 1989------------- SAMUEL Ni FRIEDEL, Maryland WII:LIAISS'L. SPRINGER, Illinois TORBERT H. MACDONALD, Massachusetts. SAMUEL L.,DEVINEJ Ohio JOHN'JARIGLAN; Oklahoma. ANCHER NELSEN, Minnesota Apri1 22, 1969_------------ April 23, 19G9,------------ JOHE!J~E. D4IOSS, California - HASTINGS'KEITH, Dfassachusetth Aprili 24, 1969------------- JOHN D. DINGELL, 1liichigan. GLENN'CUNNINGHA\f, Nebraska. April 25, 1969'------------ PAUL G. ROGERS',Florida JAMES T. BROYHILL, North~Caroilna LIONEL VAN DEER:LIN, California JAMES HARVEY, Diichigan J.,J. PICKLE, Texas ALBERT W WA'TSON , South Car li April; 28, 1969------------ . , o na FRED1B. ROONEY, Pennsylvania TIM LEE'CARTER; Kentucky April, 29} 1969L----------- JOHN M. litURPHY, New York G. ROBERT WATKINS' PennsSl;vanta~ Apri1 30; 1969;_-- ------- , DAVID E. SATTERFIELD'III, Virginiai DONALD G. BROTZ\fAN Colorado xIay 1,,1969,--- -------- , DANIEL J. RONAN, Illinois CLARENCE J. BROWN Ohio Text of- , 3ROCK ADAMS, Washington. DAN KUYKENDALL Tennessee H.R. 643---------------- , 2ICHARD L, OTTINGER„New York JOE SKUBITZ; Kansas: H.R.1237--------------- .AY' BLANTON, Tennessee FLETCHER THOMPSON Georgia H.R.3055--------------_' , sV. S. (BILL) STUCKEY', Ja.,,Georgia JAMES F. HASTINGS, New York ?ETER N. KYROS,, Maine 30B ECKHARDT, Texas H.R'.6543--------------. Report of- Agriculture Department 01 tOBER!1" O. TIERNA?P, Rhode Island H.R.3055L --------- 'ICHARDSON' PREYER; North Carolina H.R. 6543'---------- merce Department o C W. E. WILLIAMSON, ..('.Ief^k~ KEN~NEETH: Jl~ PAINTEn;., AasiBtdnt'~C1 ef k~ om H'.R. 6543------------ Justice Department on: H.R.,1237, ---------- Pro,/easionai Staff ANnaEw~STEVENSON WiLLI.1~M~J: DIaoN JA]4ESi141~... MENGER, Jr. ROBERT'F. G~i'iTILRIF H.R. 654K --------- Treasury Department on Statementi of= (cI) . Abbitt, Hon.W'. i\T.,a R Vicginia----------- Anderson, Hion. Glenn ` State of C'alif'ornia-_-- Baken, Dr. SollR., chairin can Cancer Societv--,- Ba.nehaf, John~F., III„es ing',and Healt~h' ('L' ASIO BTem~ Dr. Thomas H., ii Browning, Dr. Robert 11 . berculbsis and Respira. Brommlee,, K. Alexander, J. V., Assiats' Buffington „ sion---------------- C) '. BUhler, Dr. Victor, path Carr, Dr. Duane, profe: ~ e of'\Iedicine_---- le g ~ ~ ~ ~ ~

Part 3 CIGARETTE LABELING AND ADVERTI3ING-1I969 HEARINGS BEFORE THE i COAI3HTTEE ON INTERSTATE AND FOREIGN COMMERCE HOUSE OE' REPRESEI'TATIVES NINETY-FIRST CONGRESS FIRST SESSION ON H.R. 643 A BILL TO I AEIEND THE FEDERAL CIGARETTE LABELING AND A:DVERiTISING ACTWITH RESPECT'TO THE LABELING OF PACK- AGES OF CIGAREfMM , AND FOR' OTHER PITRPOSES' I (And Similar Bills). H.R. 1237 A BILL TO: DIRECT THE FEDERAL COM3IiJNIC ATIONS' CObTI.fIS- SION TO ESTABLISH REGULATIONS PROHIBITING CERTAIN' BROADCASTING OF ADVERTISING OF' CIGARETIIES (And Similar Bills) H.R;. 30,55 A BILL tT0 STRENGTHEN THE FEDERAL CIGARETTE LABELING AND ADVERTISING ACT (Andi Similar Bills) H.R. 6543 A BILL TO EYITEND PUBLIC HI::1LrPH PRCITECTION WITH RE- SPECT TO CIGARETTE SMOKING AND FOR OTHER PURPOSES (Aud' Similar Bills). APRIL la, 16, 17, 13,, 21, 22;,23, 2-t,, 25, , 284 29, 30, _YN D.1TAY 1 Serial No. 91-12' Printed for the useof the Cbmmitltee on Interstlate and Foreign Commerce B.S. GOVERNbiENT PR'IiNTING OFFICE 29-236', WASHINGTON. : 1969

Vin Additional material submitt'ed for the record by-Continued Cigarette Advertising Code; Inc. Continued Letter dat'edl May 6; 1969, to Chai'rman St'aggers re legal opinion as to whether the FCC has the authority to ban all broadcasting Pan of'cigaretteadvertising----------------------------------- 1293 Tables showing per capita: consumption of' eigaret'tes, wholesale cigarette price revisions, 1'940 to date, and production workers weekly earnings----------------------------------------- 1319 Cincinatti Interagency Council on Smoking, and Health, lett'er dated; April 14, 1969;, from V. James DeFranco,, M.D., to ChaiTman Staggers.--------------------------------------------------- 1406 Committee of' Groawers of U.S. Tobacco;, list of' organizations sup+ porting statement------------------------------------------- 655' Connecticut Tuberculosis andl Respiratory Disease Association, Mrs: Eben B. Haskell,, president, letter dated April 14, 1969, to Hon. Emilio Q. Daddario,, a Representative in, Congress from the State of Connecticut, with forwarding letter datedl April 23, 1969___ 1376-1377 Cook, Charles D'., M.D., Professor andl Chairman, Department of' Pediatrics, Yale University, Sehool of Medicine, letter datedl March 24, 1969, to Chairman Sta.ggers------------------------- 1384' Crissy, Dr. William J. E.,,Professor of Marketing, Gradilate: Schooliof'Business Administration, Michigan State University, statement_ __ 1331 Dale, Dr., Charles L., Hinsdale Sanitarium and Hospital: "Evolution ofl cigarette smoking technics in: dogs,"' article from International Surgery, November 1966_____________________ 414 "Experimental study on effect of'cigarette smoke condenstate on bronchial mueosai"' article from the Journal of the American Medical Association„ December 15, 1962-------------------- 409' Nicotine effect on the brainy, excerpt from The: Pharmacological! Basis of Therapeutics,Second Edition, 1956________________ 430'. "The illl effect' ofi cigaret!te smoking, in dogs,"' article from Inter- national Surgery, December 1966-------------------------- 419'. DeFranco;, V. James, M.D., letter dated May 19, 1969, to W. E. Williamson, clerk,, Committee on Tnterstate,and Foreign Commerce_ 1406 Evans, «illiamy i<I.D.,,statementL____-__________________________ 1246'. Federal Communications Commission: Appendix A.-Audience Data for network television, programs sponsored in whole or in part by cigarette manufacturers- January 1967------------------------------------------- 196 Appendix B.-Percentiage of television, household' teenagers andd children in New York City market viewing, television-Novem- ber 1968------------------------------------------------ 197 Letter dated 1Tay 16, 1969, to Chaii•man Staggers re FCC's au- thority to ban the broadcasting of' cigarette advertising, treat- ment of broadcast of'cigarette advertising in other countries, and advertising of firearms ini broadcasting_________________ 237 Federal Trade Commission:: Cigarettes andlhealth~ Secretary s intlrodirct'ion to Annuall Report of the: Departmenb: of HEFiscal Year 1968l _--__-__-__ 465 Legal restriations on minors' smoking;------------------------ 487' State laws pertaining,to sale of cigarettles to minors------------ 485 Testing of cigarettes for tar and nicotine content______________ 459. Fiesar„ Louis F., Professor of Chemistry, Chemical Laboratory, Har- vard University, letter dated April 1h, 1969, to W. E., VVilliamsony, Clerk, Interstate and Foreign Commerce Committee, with attach- ments------------------------------------------------------ 1386, Fisher,,FI. Russell, M.D., statement. ---------------------------- 1214! Foster, Vernon, -\I.ID. (See McFarlhnd, J. Wayne, \I.D!) Friends Committee on =Vationall Legislation, Dr. J. Hhiston: Westover, vice chltiirman, Friends Medical Society,, statement--------------- 1365' Fryburger, Dr. Vernon, Professor of Advertising and! Marketing, and Chairman, Advertising, Department, Northwestern University,, statemenL --- ------- ------ ----- --- - --- 1337 Galifianakis, IIon. Nick„a Repnesentative in Congress from the State of \'ortlh, Carolina, statement. -------------------------------- 41 Gantz, George 1., Hialeahi*,Fla., lett!er dated Apri116,11g69, to Chairman: Staggers---------------------------------------------------- 1404' Great!er Winston-Salem Chamber of Commerce, J!., Wilson Cunning:- ham, President, and Norman W. IIearn, Esecutiive V%ice President,, resolution--------------------------------------------------- 1405'

1 CIG'oARETTE, LABEZING; AlJ'D ADVERTISINChr=-1969' TUESDAY, A,PRIL i 29, 1969. HOUSE OF REPRESEYTATIVES,; COMMITTEE ON I`TERS'rATE AND FOREIGN '(ryiOililIERCEy i'ua.shingtan, D.C. The~ committee met at 10 a.m., pursuant to notice, in room~ 2123,, Rayburn House, Office I3uIllding, Hon., Harley Q:, Stlaggers ('chair- man)~ presiding. The CHAiRMAN. The committee will come to order., We are in a continuation of public hearings on all bzlls pending before the committee relatinD to the labeling and advertising of ciga- rettes. Our first witnesses this morning will be Dr. Peri:v B. Hudson, pre.si- dent,,High Tor Foundation,, Inc.y and Dr:. Benedict.7. Duffy,, Jr., pro-fessor of preventive medicine,, Tufts Universitty School of 1Wltdicinei Boston. STATEMENTS OF DR. PERRY B. HUDSON, PRESIDFiNT,, HIGH TOR FOUNDATIUN, I2TC., AND DR. BENEDI'CT J. DTJFFY, J-R., PROFESSOR QF PREYENTIVE MEDICINE,, TUFTS! UNIVERSITY SCHOOL OF 3VlED'ICINE;,` ACCOMPANIED BY PATRICK J. McGAHN,, JR., VICE PRESIDENT FOR LEGAT.A'FFAIRS, AMERSCAN' CHEMOSOL COIi,P1, The CHAMMAV. Dr. Hudson, you may proceed as you wish,, Dr. IiuDSOx, Thanh~ you, Mr. Chai'rman and members of the com- mittee: I am here today representinc medical research from, a private sec- tor of our society, and representing not only myself but my immediate associates and colleagues, Dr. Thomas A. ViceTli and Dr. Martha 141. 11IcG1zff y. The task force for smoking' and health under the Department of Healthy, Pducation,,and Wel arehasrecentlyreported t''otheSurgeon General(: Cigarette smoking; is one of the foremost preventable causes of death in the United States as well as in other parts of'the tivarlti ***. There is clearly much protective and, preventive worh to be done. This committee has before it the question of' ad.~~ertising and label- ing of' cigarette products as a protective measure for consumers. Itt is generally agreed that, regardless of the re.strictions on advertising of cigarettes, almost 50 percent of the adult population will contiir.ie to smoke. They will not or cannot stop. On the other hand, it is in~ the interest of' this committee,, the smoking puulic;, andl the indhzstryy, and' (893)

1I Additional material submitted for the recordiby-Continued Seltzer;, Dr. Carl, C.,, Department of Nutri'tiony Harvard University: School' of! Public : Healtlh; st'atlement and article entitled, "An evalua~ Pdn tion of' the effect of smoking on coronary heart disease"---------- 531 Severi,, Prof. Lucio, M.D., statement----------------------------- 1225 Soloff, Louis A.,, '_\I.D_, statlement-------------------------------- 1207 Sommers, Dr., Sheldon C., pathologist, New York, N. Y., letter datiedl May 23; 1969;, to Chairman Staggers re: Surgeoni General's letterr dated \'Iay 20,1969------------------------------------------ 14141 South, Carolina,, Department of Agriculture, Will'iam, L. Harrelson; commissioner of agriculture,, letter dated May 7, 1969, tto: W. E., `G illiamson, clerk, Interstate and Foreign Commerce Committee_-- 1375 Spence, titi. RI., \I.D., director, Department of Rehabilitation MedL icine, Holy Cross IIospital, letter dated April 7, 1969, to W. E.. Williamson„clerk, Interstate and FbreignCommerce Committee--_- 1406 . Sterling, Theodor D.,, professor;, Department of Applied A1athematies, and Computer Science, Washington University, St., Louis, 3Io.,, let'~ter dated M'ay24, 1969, to Earle C. C'lements; the Tobacca In- stitutle, Inc., re Surgeon General's letter dated \1ay 20, 1969-------- 1418' Stulce, L. Jefferson, Jacksonville,, Fla.,, statement------------------ , 1372 Television Bureau of Advertising,, N orman E: Cash, president, state- ment------------------------------------------------------- 1363' Tobacco Institute: Poster entitled "100,000 doctors have quit smoking, cigarettes. (_\-laybe they: know something you don't) ------------------ 676, Correspondence! showing that, 9 manufacturers of cigarettes offered to test or have tested the compound Chemosol_----- 670~ Letter dated December 20, 1968, from Leon Jacobs, Deput'y Assistant Secretary for Science,, HEW,, to Dr. Perry B. Hudson High Tor Foundation; Inc., re Chemosol------------------ 672' Letter dated \Iay 22, 1969, tto Chairman Staggers re Surgeon General's letter of _llay 20;,1969---------------------------- 1413 Tobacco: Workers International Union, Homer Cole, General Secretary: Attachment 1-Article from PhiPadelphia Evening Bulletin, June 11, 1964, "Lung,cancer deaths:increase at zoo; air pollution suspected ascause---------------------------------------- 389, Attachment 2-Adi from New York Times, Aprill 13, 1969,. "Smoke Watchers"-------------------------------------- 390 Attachment 3-Article from New York Times, April 13; 1969, "Adk-ertising: Publisher, at 72, starts a new venture"-------- 391 Ultrasciences, Inc.,, William E. Rosen, chairman of' the board, state- ment ------------------------------------------------------- 1363 United Cancer Council, Miss Belva; Green, Executive Director, letter dated! April 21, 1969, to Interstate and Foreign Commerce Cbm- mittlee with,at'tachment-------------------------------------- 1i378 United Church, Board for Homeland Ministries, Rev. Joseph A. Howelll, letter dated April, 18,, 196% to Chairman Staggers_----- 140i1 Utahi Interagency Council on. Smoking and Health, Ray Watters,, Chairman, letter datiedi l-farch 26,, 1969; to W'. E. Willia,mson„ Clerk, Interstate andl Foreign Commerce Committee------------ 1382 Utah Thoracic Society, C. Du,Wayne Schmidt, M.D., Utah Nationall Representative, letter dated March 23„ 1969;, to: W. E. Williamson, Clerk, Interstate and For;eign Commerce Committee------------ 1383 Van Deerlin;: Hon.: Lionel, a Itepr~eseirtativeih Congress fron the State of California, extensioni of remarks regarding use of narcotics by students in: Sb,n Diego, Calif'------------------------------ 362'`'incent, Dr. R'onald G., Associate Chief, Department of' Thoracic Surgery, Roswell Park Memorial, Institute, article from the Buffalo Evening News dated April' 17,, 1969; entitled "No switch!for tobacco warningc House panel seems firmly packed'against drastic moves"-_ 29% Winsor,, Travis, 11I.D., statement-,------------------------------- 1232~ OR'G'AriIZATIONS REPR'ESENTED~ AT' HEAR:IN'G' American Cancer Society:, Baker, Dr. Sol R',.,, chairman, committee! on tobacco and cancer., Mandel, Dr. Perry R'.,, chairman of the Nassau, County Interagency Council on Smoking, and Health, and vice president, Nassau~ Division. Williams, Dr. Ashbel' C., former presid'ent.

V fealth, Paee873 Stiatement,of-Continued, Levitt, Dr. Eugene;, Professor of' Ps3+chology, Department of Psl+chia* try, Indiana, University School' of 1VIed'icine Page 1271 tate of' 44 lZtion , ____________________ \ZCGahn„ Patrick J., Jr., vice president f'or legal aff'airs, American Chemosol Corporat'son_______________________________________ 893 - ' McMillan„ Hon. John L., a Representative in Congress from the State State 386 of South Carolina_____________________________ _ ' 21. 70 Nlacint yre,, A. Elrerette,, Commissioner, Federal Trade : Commission, delivered by Hon. Paul Rand Dixony Chairman 458' 1 chief eutive _ 548 __,_____________ nlandel, Dr. Perry R., chairman of the : No:ssaui County Interagency Conncili on Smoking and Health„ and vice president,'Nassau Divi- sion, American Cancer 8ociety---------------- - 363' e, Ill_ 406 ' - -------------- , H!on. Robert B. , administrator, Meyner cigarette advertising code 1284 _\ orth , , , _ _, 1t1i11er, J. R'obert,,commissioner of agriculture State of Kentueky _, 254 -- 604 , __ Moses, Dr. Campbell, medical director, American Heart Association_ 503' 4'53' _,_, Murphy Hon.. Jbhn bL , a Representative in Congress from the State Tufts , , , ofl New York------------------------------------- --- 617 ltion„ -- ------ Nateher Hion William H' a Re resentative in Con ss fr m th St t --_ 893, 904' ' . ,,, „ p gre o e a e of Kentuckv----- - - ---- 64 U tate. - - --- Ober, Dr. ~'illiam B., pathologist, New York, IrP.Y_, ------_-_-_-_-~ 114'3' 78 Okun pharmacologist Dr. Ronald Los Angeles Ca1tf 1115' ite of 74 , , , , ------------- , Overholt, Dr. Richard H., director, Ov.erholt Thoracie Clinic, Boston, _Mass~-------------------------- 445 :tiute,, and ---------------------------- Perkinsi, Hon. Carl D., a Representative in Congress from the State of Kentucky---------------------------------------- 16' - 83 ---------- Pettis Hon: Jerry L. , a Representative in Cbngress from the State of the! , , California ----------- ----- --------- 79 rican 65 Riigdon, R. H.,, -professor of' pathology at the itledical Branch, Uni- versity.oflTexss-------------------------------- 1018 503 ------------- osenblatt R Dr. Milton B. president of' medioal board Doctors tate , , : , , Hospital, ?yvew York, P1T.I------------------ 1255 23 L~ ------------------ Rosenman, Louis, Acting: Assistant General', Counsel for Legislation,, ' Federal Trade Commission _ _ _ -_ _ _ - _ _ -_ 4!53' 986 mis+ Rosenman,, Dr. Ray, cardiologist, San Francisco,, Calif------------- , 808' R'oth, Arthur T., iView York,, PVLY------------- 703 193' ------------------- bIa.urice B. Rowe Commissioner ofi Agriculture Commonwealt!h of' inia, ,, , , . E~~irginiil--------------------- 623 - 623 ----, R oyster, Fred S. chairman Committee of Growers of U Tobacco S 655 'ing _ 1284 , , . . ___ Rutstein, Dr. Davidi D., Riidley Watts prof'essor of preventive medi- cine and head of'the department Ilarvard 1ledical School 725 3es- --- 628' „ , ------- Saiger, Dr. George Lewis;, consultant in medical research, Palisade. (Fort Lee), New Jersev-------------- - -- ---- 11178 453 )rth - 604,607 _ Scott, H!an. Robert, W.,: Governor, Statie of North Carolina--------- Sherman, Dr. Charles D., Jr., chairman, cancer committee, AIedical~. Society ofl the State of New York andl \Iedicall Societ oP ' the 604 ate , y . County of' Monroe (IV.,Y.)'-------------------- 372' - 68 ' ---------------- ydbr, Hon.: M. G. Sn a Representative in, Congress from the~ State of Lnd on, . , Kentucky----------------------------- -------------------- r23 ~ Sommersi Dr. Sheldon C. pathologist, New Fork XLY 1080 - 83 893' aal 2611 , ,, ------------ Steed; F.r~nest, 11. Jl, executive department,secretaryof theSeventh-~ Seventh- Day Adventist Church--------------------------------------- Sterling, Theodor D., professor,, Department of Applied \Ititliernaticsd= Sci ~ Cb t lii Un W ' 890 ' is- 193'. he 1271 mpu er ence, . ay ngtoni iverstt ~_~, St. Louis Stewart, Dr: 1Villiam, H,, Surgeon General, Public Health Service, Department of! Ilealth, Education; and 1L'elfare----------------- Stubblefield„ I-lon. h'rank: A., a Representative in Congress from the 930 ~ 83, n State of Kentlucky'------------------------------------------- 66 _ 503' 858' Tenney, Donaldlli~.,,at't:orney, Federal TradYrCommission---------- 453 ca~ 669' Terry, Dr. Luther I. Chairman, National Intnrn.gencyCouncil on~ Shioking and llealth---- ------------------------------------- Ili ll \L i K Ud ' R ' 261 ' C :e on. a ~ orr s .,,a -- epresentlative in Congress from the State,of ~ 45'. A'rizona---------------- ------------------------------------- Vincent, Dr.Ronald' G., associate chief Departmentt of' Thoracic~~ . 72 ~ , Si ll P k lii Rosw i l I tit RA 83 trgery„ ar e emor a ns ute---------------------- Ware, Dr. George William„ District of' Columbia Interagency on Slnoking and!Dlealth----------------------------------------- 299 ~V. 256 ~ 787 W'asilenski,, Vincent T. president National Association of Broad- 401 e. , ,, , casters----------------------------------------------------- 393 ~1 74 Watts, Hon. John C., a Representative in Congress from the State of Kentucky'-------------------------------------------------- 63

897 In addition, an analysis of theforniulation by scientists in t'~wo+ Government agencies in January 1969, showw that Chemosol and its combustion products are nontosie., The experiinental'I program, as re- quired by tlre.Government, is therefore now completied.Ifl I may at this point,,Mr. Chairmany I would like to sliow withthree charts what is essentially a summary of' this work.. Tobegui •viith, I thinl~it beh~ooves~ ~~ usa1l to lbok at this, struct'ura~1l formula for benzo (a) pyrene. 1`?hen we remember that in these six-sided configurations, these hexagonal red lines, at each corner thereis,a carbon atom, and there is a~ possibility for rearrangement not only of the cj-clesthemselves, thesis~-membered confio_`Urations~ themselves, into different arran«e=ments,, but that substitiitions~ can be made at any point.. When we remember tiiis, we then have reemphasized for us the fact that many, mErnv permutiations of'benzol('a)py.renearepossible. Tliepurposein pointing this out is to delineate cle t~~lytlhat what theCheniosol additi~~e hasclonein the burning~of ci~~arette tobacco .ti-hen it isslnoked is to change t1re! spectrum of hydrocarbons~ like benzo(a)'pyrene toless harmful onesthan benzo(a)pyrenein thefihEil smoke. This has been our objectiv.e.The secondpart'ofthe objiective is to compare these resullts with6iological ex~perimentation. In the second chart,, I.roulkll lilieto~ show graphically the change which is i produced; in cigarette smoke iib terms of benzo (a) pyrene content. You mig).itsayhere, that!thetobacco used in this experiment was~ obtained from the tobacco imdustry in this country, and is a popular brandi of a blended ciga.rette tobacco which is widely used. You willl notice that on this: chart is a green line which has been placed across t'heupperone-quarter. Thisgre~en line represents Dr. Wvnder''s work at the Sloan-Keti'tering Institute inTV ew York Citv. That is the point at which 25 percent of the benzo (a. ) py rene would be removed. The far right-hand side of'the bar chart has red, which represents,the amountof benzo (a) pyrene still remainin.,., even though . Chemosol is used. I[t is found that this is 312percent'~ less than the, benzo(a)pyrene recovered and'identifiedl from the control tobacco of the same blend.. In~ summary, this means that we consiiderablyy exceed the require- ment of 25' percent reduction in order, to show reduction in tumori', genicity. The last chart will show you the skin-paintiii, test which is not only the one most used among cancer researchers,, but also the one most widely respected by our Gover nment.It is currently employed and advocated bytheC.rncerInstitute. You will notice in the far left column there is a gray bar chart showing five percent or a lhttle less of tumors which developed from theacetone solvent, 1lice, even tumor-resistant inbred strains of'mice:, such as the ones we used'~ in this esperiment, are very susceptible to the placinZ of any floreign substance on the shaved skim I:ven the acetone solvent here, which refers to the solvent in 'whir;h both the control an& thechemosol tobacco, condlensatesweredissolved,. will create a ferv lesions. 29-22a_69-Pt. 2. 2

Statement ol-Cbntlnaed par. Wheelock, John N., Executive Director„ Federal Trade Commi'ssioa__ 453', Williams, Dr. Ashbel C.,,f'ormerpresid'ent, American Cancer aocietly_ 307,311, Wolff, Hon, Lester L.,, a Representative in Congress from, the State of New York------------------ 7&, Wyatt, Dr. John P., profesaor andl chairman of the Department of Pathology, Uhiwersity of Manitoba____________________________ 882! Wydler, Hon. John W'., a: Representative in Congress from the State of New York-------------------------------------------------- 702 Zeidman, Dr. Irving, professor of'pathology, University of Pennsyl- vania ---------------------------- ---- -------------- 1047' Additional material submitted for the record by- Abbitt', Hon. W. ML, a Representative in Congressi from, the State of Virginia, ext'rtact from minutes of a meeting of the board of directors of'Virginia Farm Bureau Federation-resoIution_--_,_-____-___,___ 1 American Cancer Society: Dr. Henry F. Hosley, assistant professor ofmedicine, AIba:nyMedical. College, chairman, Public Education Committee,. Albany County unit, stlatement--------------------------- 1364 1968-89 budget and, 20-year research gran-th-graph----------- 353' "Reporting of Cancer of the Lung, Liver and Uterus," article from Cancer, vol. 20, No. 10, Ocf,ober 1967----------------- _ 357 Resolutions and position statements of various health agencies and, professional societies in the United States regarding labeling, and advertising ofl cigarettes______________________________ 321 American Dental Association ' ,statement_________________________ 1,343 American Heart, Association, "Smoking Habits and Coronary Athero- sclerotlic Heart Disease;" an article from the Journal of t'he American Medical Association, September 9, 1961__-____,____ __ ____ _ _ 517 American Pharmaceutical, Association, William S, Apple, Ph. D:,, executive director, letter dated April 10, 1969,, to Chairman. Staggers--------------------------------------------------- 1383 AmericanPublioHealthAssociat'ion stat'ement. _-__ ____ _________ 1345 Associtation, of National! Advertisers, Inc., Peter W: Allport, president, statement-------------------------------------------------- 134'8 Barnes, Dr. Broda 0., Fort CoIlins, Colo., statement 1041 Barahal„ Hyman Sy M.D:, director, IiIempstead' Psychiatric Hospital; letter dhted, April 8, 1969, to W. E. Williamson, clerk,, Interstate and Foreign Commerce Committee---------------------------- _-- 139& Baughnamy Henry, instructor, Department of Health Soiences,. Western Illinois University, letter dhted May 6, 1969; to the Interstate and Foreign Commeree Commitltee------------------ 1398 Beldin, Jefferson A., chief' pulmonary function technician R,ogue Valley Memorial Hospit'al; letter datedl April 24',,1969,,to Chairman Staggers. _______--_ 14C10: Biggs, T. H., M.D., medical director, Kentucky State Tuberculosis Hospit~al; letter dated April, 28, 1969, to Chairman Staggers------ 1400~ Bonneville Internationa,ll Corp:, Arch L. Medsen, president, telegram datled' April 15, 1969, to Chairman Staggers re discontinuance of cigarette advertising; placed in the record by Hon. Lionel Van Deerlin, a Representative ini Congress from the State of Ca,lifornia-------- , 67 Brewer, Dr. Lyman A., III, thoracic surgeon and professor at the Medical School ofl Loma Linda University, Los Angeles, Calif., statement-------------------------------------------------- 1055'. Brinkman, Dr. Geoffrey L., professor of inedicine; Wayne State University School of Medicine, statement_______________________ 1156' Bron•n+ Barbara B!,, Ph. D.,,statement---------------------------- 1216'. Buliler, Dr. Victor B.: Letter dated \I'av 3,, 1069', re age of'onset of' Iung eaneer in patients of' differing smoking habits„«•ith att;tichments. 779 Bttr~din„Penneth H., M.D., St,,HelenaSani:tarism,andHospittil, letter dated April 16; 1969;, to Chairnian~ Staggers___________ ________ 1402' Burnl Dr. Joshua Ilaroldj visiting professor in pharmacology to Washington Uhiiver6itv, St. Louis, 1'Io., statement-------------- 1127 Campbellj Maurice, \T.D:, st!atement---------------------------- - 1049, Carr, Dr. David T., member, board of directors, Sational Tubercu- losis~and Respirat~oryDisease Association, le.tterdated April 28; 1969, to Chairman Staggers--------------------,--------------- 653 Cigarett'e Advertising: Code, Inc.: Cigarette Advertising Code, textlof---------------------------- 1'309' Additional material submittel Cigarette Advertising Co Letter dated' M'a,v 6' as to whether the : of cigarette adverl Tables showing, per cigarette price re weekly earnings - Cincinatti Interagency April 14,, 1969, fron Staggers------------ Committee of Growers porting statement - __, Connecticut T{iberculos Eben, B. Haskell, pr Emilio Q, Daddario,, of Connecticut, n-itlh, Cook, CharlesD:, M. Pediatrics; Y ale Ui March 24 1g69, to <' Crissy, Dr. ~~'~illiam J. Business Administra Daie Dr., Charles L.,, `Evolution of' cig International S, "Experimental st bronchial, mucr. Medical Asso6 Nicotine eff'ect 01 Basis of Thera "The iIL effect of, national Stlrge: DeFiianco,, V. James Wiillanison, clerk, ~i Evans; William, \T•I Federal Communicat Appendix A'.- ! sponsored' in January 1967 Appendix B.-I children, in ivi ber 1J68~____-. Letter dated \1 thority: to ba ment of'. bro.i and advertisi! Federal Trade, Com Cigarettes andd of the Depa Legal, restrictic State laws pert: TestingofciguTieser; Louis F.,, P v,Rrd C.niversityy Clerk, Interstat( ments----- ---- Fisher, 11. Russell, Foster, Vernon, 3D FrieiidsCoinmittcvice chairman, 1 Fryburger,,, Dr. Ve Chair~man, Ad' statement----- Gali6'anakis, I,ton of North Carol: Gantz,, George IL„ Stahgers___--- Greater «'inston ham, President resolution_____

Iv Statement of'-Continnedl Cederiof, Professor Rune,, PHD'.,, National Inst'itute of Ptiblic Health,, Stockholm, St`-eden------------------------------------------ Colielan, Hon., Jeffery, a Representative in Congress from the State of! California_____________ Cole, Homer, generall secretary, Tobacco Workers Internatiion- a1 Union---------------- -------------------------------- Corman„ Hom James C., a Representative in Congress from the State of California ------------------------------------------------ Cullynan,, Joseph, F., III;, chairman of'the board of directors and chief' executiv.e officer,, Philip: Morris, Inc.,,and chairman of the executive Page 873 44'. 386, 70 committee, The Tobaceo Institut'e----------------------------- 548 Dale, Dr. Charles L,, Hinsdale Sanitarium and Hospital, Hinsdaie, IIl_ 406 Denny, Weldon, Speciall Assistant to the Governor, Stlat'e: of' North CarolinaL ----------------------------------- ----- --- 604. Dixon„Hbn. Paul Randj Chairman, Federal Trade Commissioni- ____, 453 Duffy, Dr., Benedict J.,, Jr., professor of preventive medicine, Tufts University School' ofl vPedicine, in behalf of High Tor Foundation, Inc------------------------------------------------------ ,893,904 Duncan, Honi. John J., a Representative in Congress from the State of'Tennessee------------------------------------------------ 78 Edwards, Hon. Don, a Representative in Congress from the State of California-------------------------------------------------- 74 Endicott, Dr., Kennethi N., Director, National Cancer Institute,. Public Health Serviee,, Departlment of Health, Education,, and Welfare ---------------------------------------------------- Farbstein, Hon. Leonard, -a Representative in Congress from the 83' State of New York----------------------------------------- 65 Fillmany Jesse,, chairman, legislative advisory committee, American Heart Association------------------------------------------- 503' Fountain, Hon. L. H., a Representative in Congress, from the State of North Carolina------------------------------------------- 23' Furst, Arthur, director of' the Institute of Chemical Biolbgy,, Uni- versity of San Francisco------------------------------------- 986 Geller, Henry,, General Counsel, Federal Communications Commis- sion-------------------------------------------------------- 193 Godtvin, Hon. Mills E., J!r.,, G'overnor, Commonwealth of Vtrginia,, by Maurice B'. Rowe, Commissioner of Agriculture______________ 623. Goldberg, Daniel B., Deputy Administrator,, Cigarette Advertising Code------------------------------------------------------- 1284 Gompertz, Dr. John L., president, National Tuberculosis andl Res- piratory Disease Associat'don__________________________________ 628 Grady, Thomas J., Attorney, Federal Trade Commission----------- 453 Graham„ James A., Commissioner of! Agriculture,, State of Nbrth Carolina-------------------------------------------------- 604,607 Halpern, Honi. , Seymour, a Representative in Congress from, the State of New York----------------------------------------------- 68 Horn,, Dr. Daniel, Director, National Clearinghouse for Smoking and Health, Public Health Service, Department of Health, Education, and Welfare------------------------------------------------ 83 Hudson, Dr. Perry B' , president, High Tor Foundation,, Inc 893 Hundlby, Dr. James, member of' the: board ofl directors, National Interagency Council on Smoking and Health------------------ 2611 H}•de, Hon. Rosel H,, Chairman, Federal Communications Commis- 193 Jacobs, Hon. Andrew,, Jr., a Representative in Congress from the State of'Indiana-------------------------------------------- 1271 January, Dr. Lewis E., f'ormer president„ American Heartl Association_ 503 Katz, Dr. Leo,, professor of statistics, ~Tichigan State University_ ___ 858 Kloepfer, William, Jr.,, vice president-public relations, Tobacco Institute--------------------------------------------------- 669 Kocli, Hon. Edward I., a, Representative in Congress from the State of New York----------------------------------------------- 45' Kotin, Dr. PauI, Director, National Institute of Environmental Health Sciences, Public Health Service, Department of Health,. Education, and Welfare------------------------------------- -- Langston,, Dr. Hiram T., thoracic surgeon, Chicagot, Ill------------- 787 Lebert,, Herbert A., aeronautical engineer,, Millbrae, Calif----------- 401 Leggett, Hon. Robert L,, a Representytive in Congress from,the State of California------------------ ------------------------------ 74 sion-------------------------------------------------------- Stat'ementl.of-Continued Levitt,, Dr., Eugene,, Profe try, Indiana Universit; McGahn,, Patrick Jl, Jr. Chemosol Corporation. 1VICMillan, Hon. John L. of' South Carolina___-_ MacIntyre, A. Everette delivered' by Hom Pa. 7\Iandel~ Dr. Perry R., , Council on Smoking 2 sion, American Cance Me}•ner, Hon. Robert, B Mill:er, J. Robert, comn llloses„Dr: Campbell, m Murphy, Ilon.,John L~'i. of' New York-------- Natcher, Hon., William ] ofi Iientucky_-__ _-,-- Ober,:1)r. WSlliam B.,~F Okuns, Dr. Ronald, ph, Overholt„ Dr. I4,ichard. \Iass___-- - Perkins,:Hon. CarlD.,. Iientucky_____---- Pett!is, I-Ion. JerryL., : Ch1if'ornia._ _ _ ------ Rigdbn, R. H., profess versity of Texas-___ Rosenblatt, Dr. Milt Idospital, NewYOTl Ro-enman, Louis, Act! Fedhr.til T~rad'eCbmi Rosenman, Dr. Ray, Roth, Arthur T., Ne« Rowe, Manrice B.,, C Virgiitia,----------- Roy~tcr,, Fred S., chai 111uratein, Dr. Davidd ci.ie, and head of tl Sai,p~er, Dr. George]I'ort Lee), \eu~ J( ScotU,, Ilion. Robert 1' Sherm.ui, Dr. Charlr -Zocietv of the St, Counti}- of! Jlonroe Sn•,ider. Llon. A1. G. Iientuck,% - S'omniers„ Di Sheld, Stcod', h,rmestI-1. J., D,tv Adventist Cl c'terliug, Theodor D G C~omputer Scier. ~tetvart,, Dr. Ab~ illis Department of', Il nbblefield„ Ilon. I State of IcentuckTenner, Donald K. TerrY, Dr. Luther Siuoki42g andi Ile, L dall~ Llon. \Iorris Arizona~-------- Vineent, Dr. Rom Surgery, RosIVell W.aric, Dr. George Smolcing',and, Ile W'asilewski;, 1':ineei~ CII.sters------__. Watts, Hon. John Iientucky._----

S99 : h abso- <zlly the middle noduces ich had' ave not initting Ll: 1~Tow nrrobo- formedl temosol al com- 'acture. ,11Iy re- I ma.rette sibility stry to, trettes. smok ardous. mental treated ho will re you,. vou in Jic not ?ments )hy, of ~e that en for York. ?g: sci- IIigh in its, r1to in what Dr. Hu-nsow. Congressman, if youi mean the specific cause in, the language of the modern modecular biologist, I would concur that no~- body knows the cause of'cancer: Mr. SPuwGnx.'. Then what I wouldd like to ask you, beginning, on line 1. is about this st,atement : One of these substances, which is aeknowlbdged by scientists as the most dan- ;erous carcinogen, in cigarette smoking, is benzo (a) pyrene. What (lo youxilean as a carcinogen? Can you tell me wha,t a carcino- •-en is? Dr: HtnsoN. A carcinogen is a cancer-producing substance without regard to the mechanism,, either direct or indirect, amd~ alone or in concert with other thingsshzch prodilcescaneer. In other -,rords, to state that somethiirg is a carcinogen does not even rule out the virus theory as to the pr.od'uction of malignancy. It cannot, in our present state of knowledge.. In other words,, wlbn,t might be called by one scientist a cause, might veiti w ell, 20 yeRrs from now, be learned to be simply a conditiomng fac.tor which triggered t'heformation of cancer,and the actual etiologic agent,, the original cause, mi ghtvery well be something else. In other w.ords;, to say tliat something is a cause demands its defini- tion. When this statea2ienti is made, I really refer to documents like the Surgeon General's P.eport of 1964, Rwhich was a compilation made by, I believe,, 10 dYstinguished scientists, none of whom were working with lung cancer at tlietnne. I believe they were chosen for that purpose:But they were dis- tiilglzashed' scientists around the world' who were eminently qua3ifiedl That report incriminates benzo[a]pyrene in the list of seven car- cinogens given among the liydrocanbons identified in cigarette smoke.. But to go beyond this point,, Congressman Springer, `vould bring me into the world of semantics at which I am far less agile than I~ am in the laboratory. i1fir. SPRINGER. I take it that what you in essence are saying for the language of a layman like me that this is a cancer-indlucing a gent ; is that right?' Dr. HuIDSON. That is correct. llr. Srm:NGrx. You do not know to what extent it is, but just thatit is one of seven; is that correct? Is that; right? Dr. Iluvso-_,~-. That is one-half right and one-half incomplete. It is one, of se.-eu,, but in the uscrihing of potency to these different agents i'n the list of seven, there is an arbitrary system.. But based on experimentation of one plus,, two plus, three plus; andd so forth,. benzo(a)pyrene -winds up by evaluation of scientists in the top bracket of potency in cancer induction, and, second7y, it is present in much largor amounts1han any of the others in the list. So it is a~ cocabination of those two factors which prompt this statement. Mr. SrnixsEn. Let me see if I can get to this. We had statistics y.esterday, and I would like to see if I can put my statistics to~ether with the pht siology and make something out of it.~ Testimony of this statistician was that roughly age brackets had a great deal to: don-ith, it,,and also thereseeinstobecertain factors in

905 nent„ ivtedd maldd bout iedi- n of )rity iigbtt han. _ ate- .ind onal ~king Qcco 'etite ome 'ea ida- rate .a)- ited the nia, tlie .da- an- tor, re- na t'hee wld zo- , ed in- lve ?o- Our task, therefore, was to inspect the laboratory tests designed to measure the effect of Chemosol on benzo (a)'pyrene content of cigarette smoke and arrangp a parallel analysis by the Stanford Resear& In- stitute bv the more sensitive fluorescence spectroscopy technique. I must say that some of us were quite skepticali when we came to th,is laboratory experiment. Frankly; I had not paid enough attention to the specific importance of benzo(a) pyrene. For example, in this definitive text on the subj~ect entitled "Poly- cyclic I+Iydrocarbons'°' by Clar SchoentaT of the highly respected lI'edical Research Councill of Great Britain states: "Three-fourths benzo (a) pyrene is a most useful indicator of the type of compounds present in carcinogenic materials even though it mayy not be responsi- ble for all or even the main part of their earcinogenic activity.'''' Furt.her,, during this time and before that, for esample, some of us had been interested in the question that had been raised here, the rela- tionship of'the: biologicali test to the elinical' area. I-was also verv interested to read a statement in the Journal of the 1\Tationall Cancer Tnstit'ute (34: 490; 1965) in a~ paper from the Roswe]1 Park Cancer Institute in Bu$'alo; \.Y.,, that the "bioa.ssay.s?" ' which you have seen before you today have indeecld given results `"consistentt wit4 epidemiolbgiepatterns." «:e have.theref'ore a stroncr chain of evidence from benzo(a)pyrene, this indicator,, to the tuanor in the animals, to the hunian population. Some of these links admittedly need to be strengthened. These views which I hold now came through association with~ the others in the work of this study. They are personal and d6 not neces,- sarily reflect the opinions of the others who visited the H'i'gh Tor laboratory to witne.ss the test activity. The experimental testing program was beg,un on Febiliaiy 10,,1969, and on April 13, 1969, I1r. Larson and I, as spokesmen for the inde- pendent team„reported the f''ollowing result.s : 1. During our v.i'sit to the High Tor Foundation we had satisfac- torily demonstrated to us the professional capacity: and the scient,ific integrity of the personnel of the Hi`~h Tor Foun~l!~tion laboratory. 2. The: commercial tobacco used for the experiments consisted of three parts from the same batch of tobacco that, we opened: two con- trols, one of RThiclt had notrea.tment at all~ and the other, whic6 R-assprayed with water. I[clentieal tobacco from the same batch was sprayed .vith theCliemosoll formulation undercontro3led conditions. The~ results showed in the High Tor laboratory that therewns a reduction of approximately 2a'percent of benzo(a)pyi:ene, from the trea.tedl samrnplesand theszme, condensates that -we hacll tested wliich, were alsoo analyzed by the Stanford Research Institute which showed. 3klpercent rediietibnsofbenzo(a)pyrene.Although it was not specificalR- oneof' our fact's,I reviewed the, result of biological test7n,: on nuceandl the report of thebioloalce effect and the recorded results of the test indicating a hibher sigmifacant redhiction in concers in mice treated by t'~heChemosolprocess: Photo-graphsoF theanimalsand slidesof'thetumorswer.erevie.ved. I'wou1d therefore~report to you that a.sa result of our,independent~ operatibils, there would appear to be a si(rnificant reduction of benzo- (a) p~~reiueas a result of treatingc,ommercial cigarette tobacco«~ith theChemosoll formulatiom It, is my opinion that such Cliemosol treat-

911 ining all of' your >liysema, -tlance to- ot neces- cry Nrell,. Ly that I' izardous iat there it might )ne more., of 1964.iich you. <e~~ otlier~ well be w.hether ological in any Auction level of resenta- ;inalIy ?' therner orniing: is that emosol, f stock we are, )pment ssarily~ I[n our laboratory,,tiiere is no payment tos officers of'the Foundation, even though~ they may be actively engaged in researeh,, part time or full time. We fall in that category. Mr. WaTsoN. You have received no financial benefit from the ex- herimentation oranythii7g relative toChelnosol upuntiI this point? Dr. HwnsoN. If you would identify the benefit, I will answer that question very directly. The Foundation has had expenses paid to date... I personally ami in rather bad financial shape as a result of'this entire program. Mr. WATSON. I detect that you yourself'snioke. It seems to be a small cigar. Dr. HL nsoN. Yes, sir„I do smoke cigars and pipe only. Mr. «~~''aTSON. Has that beentreated with Chemosol?' Dr. HUDSON. It has not. We haven't tried' it oni cigar& yet. Mr. WATSON. You state on page 3 of your stat.ement, inithe first para- graph, "Therefore, the greatest identified danger to smokers is the carcinogen called benzo(a)pyrene: So that n e might further understandi it, andl you are way above me iii this field, as are many of my colleagues, am I to understand that this benzo (a) pyrene is a product of the combustion process rather thann the product of the. tobacco itself?' Dr. Ht,;nsoN. That iscorrect. Mr. WATSON. In other words, this benzo (a) pyrene, which is the (*reatest identified carcinogenic danger, is ai product of anyy combustion,, whether it be tobacco or whether it be from industry;,.vhetiier it be from the automotive motor process. That is a product of' combustion and not from, tobacco itselfl ?, Dr. HUDSON. It is a product of combustion of organic material which wouldl include coal„ include gasoline, include paper, and, of course, it would include tobacco. Mr. IVATSOrr. S'o we are not dealing specificallW here with something which just relates solely to the tobacco. I am sure with the great iffrdustrialization, the increase in the use of automobiles,, and so forth„ they have produced quite a bit of this benzo ( ai) pyrene, have they not z De; HUDSON. 'I liat is correct.. Mr. WnTSOx. Doctor, what relation does your lab have to the Chem- ical Research and Development Corp. of New York? Dr. HtmsoN. None, except that, we did research forthem~ Theorig- i'nal' name of thecorporation, which owned theori~inall Chemoso1 formulntion.v,as the C1leinical Research and Development Corp. Mr. I`~'nTsn.r. In other words, that was the originall owner of' Ciieirnosol; so there is a, relationship between Chemosol and the Chemi- cal Research and Development Corp. ?Dr. HL*vsarT., That is correct. Thev. were one and the same, I believe. The Chemosol Corp. is, I believe; or the American Chemosol C'orp., is t]iesuceeclhngnamefoi+the Chen7ical Research and Development Corp. 1`Ir., W_.Tsov. This process has beeni offered to the major tobacco companies, has it:? Dr. HUDSON. Idonf''t know to what, extent. The research peolrlefronre t]iemajort~obaccocon2pacieshave consultetl with us, and have helhed . nson numerousoccasions. II hope we have been ofs~omehelp to; tlren,i6, ~'~~"ehaR-ealwnys wanted tocooherate:

Additionallmaterial submittedlfor the record by-Continued Harkin, Dwight E., M:D:; Cli'nical Professor of Surgery, Department of Surgery, Peter Brent Brigham Hospital, Harvard Medical Schooly letter dated May 5, 1969, to Chairman Staggers;, with attachments_ Healthj Educatfon, andl Welfare Departiment„ Public Health Service:, 300,000 excess: deaths among cigarette smokers, an explanation of' methods used in developing the:estimate of________________ Bibliography from the Smoking and Health Report-1965,, of' the Advisory Committee to the, Surgeon General of' the PubIic. Health Service_____________________________ _ Bibliography fiomi the Health Consequences of Smoking-A , Public Health Service Review-1967 _ Bibliography from the Health Consequences of Smoking-19651 Supplement to the 11967' Public Health Service Revien-_ _______ Comment on FDA study on~relationship of orallcontraceptives tlo, cancer -------------------------------------------------- Letter dated: May 1, 1969;, to Chairman Staggers: in answer to dated Aprill 16,, 1969, from Chairman Staggers in which he requests answers to eight questions, as follows: 1. What ac- tivities and programs are!being carried outl by the Department of HEW to combat cigarette smoking (a) among younger persons, andl (b)' among adults; 2. How much do these pro- grams cost;: 3. How effeetive have they been; 4. Have you any suggestions as to any other effective means of' combating the cigarette smoking habit;; 5. There has been comment to the effect that cigarette smoking is "physiologically addictive."' Do you agree or disagree with this; 6. Are any other countries carrying out programs to discourage cigarette smoking; 7. What has their experience been in those programs; and S. How do Page 1390 156 98 121 138 176 they differfrom programs conducted here,in tlhe UnitlediStatles__ 180: Letter dated -May 20, 1969),to Chairman Staggers re comments on tobacco indust'ry physicians and scientists testimonyv oni thee health sigpificanceofsmol:ina, with an attachment dealingspecifically with the testimony of Dr. Theodor D. Sterling,, professor, Department of Applied _hlathematics and Computer Seience,,Washing~tonU"mversity, St. Loius, Mo _ 1407L ung information re bt i th I cancer,, breakdowny caegoryneun, cancer section of the international system: for classification of causes of' death Response to Congressman ~~'atlsonis comment on ratio of bedl disability incidence in relation to quantith• of cigarettes con- 154 sttmed, based on PhIS national health surv.ev---------------- 176. Henderson, Hom David N., a Representative in Conbress from the State of North Carolina, staternent _ 40 Herman, Dr. Doris L., Assistant Professor of Patholo;gy, Los Angel'es County-University ofl Southern California J~Iedical Center,, state- ment'------------------------------------------------------- 1076 High Tor Foundation„ Inc.: An experiment in the learning of bio- logical l sciences _ _ _ 918 Hildebrand, E. W., vl D. Alumsing, lIlrchiga,n, letter dated April 19, 1969, to Chairman Sta.,gers 1403 Hine, Dr., Charles, Clinical Professor of Pharmacolb!2~Nand' Preventive11'Iedicine :in the: School of -Medicine, University of Californiay state- mentl-------------- Hockett,, Robert C.,, Ph. D., Associate Scientific Director tlie Councill 1008, for Tobacco Research-U.S.A., statement------------ I ----------- 1108 Huff„Darrelli Carmel, Calif., stlatement. -_______,__ ____,__________ 978 Interst'ate and Foreign Commerce Committ:ee: Letter datledl April 21,, 1969, from Congressman Rogers tot!heTobaeco Institute, Inc., re comments from the tob:rcco industrv on the annual reports provided Congress under the provisions ofl the 1965 Cigarette Labeling and Advertising Act„ and replv dated ApriI22„1969„from; the Tobacco Institut'e------------- 686 11'I'emorandumfriom the Library of' C~onnriess,, Legislative Reference Service to the Committee re farmers' share of' retaill price of' a packape ofcigarettes------------------------------------- 718 Publications on smoking and health: paid for with Govcrnmentt funds during past 3' years, list compiled by the Public Printer,. Government Printing Otflce------------------------------- 681 Additional material submitted f' James, George, _ll.D., Def University of tiew Yorl. Staggers--------------Jbhnson, W. H'., Associatt Agricultural, Engineerint~ ment___-___ Jones, I'rving, '%1.D. (See:. Jonesi Hion, Walter B.,, a of~ orthi Carolina,, state Iiaplan„ Dr. Sylvan J., st. IsentuckvFarm Bureau F I+;in;sbury, Kenneth,J.,, _\ Koch, Hon. Edward L, a of -_~ ew York: Correspondt;nce dat'et a reply from the February 26i,19691 the FCC proposal television__ _ _ __-_ I:et'tler dated V'Iarch ' Hlardin, re goverrr grams,in Japan, T 25, T969, from Ass. Letter dhted April I additional infbrmfirst arnendment ments,, sotrce forr pcctanc}- of a 2' material for physi i Lasagna, Louis, M.D., ment------- --- Le:rf' T ob .cco Pacl:ers 7ecretar}," letter dat containing resolution Leaman, William~ G.,, J~ Lennon, lion. Alt'~on, a. \ orth: Carolina, stata Leuchtenberger,, Prof. L'e ichtenbergery M.I Leviue, Dr. Ldwin Rr Clucago'Medical Sct IJat*ie, Clarence Cook ilesearch-L S:X., stc Ml!ch' tirland, Ji «'ayne, Pcti.;, Irving Joues, A 1"~ernon~ Foster,, ~I.D' Ph. D'.,School of I Lmda„Cal[f., telegr: j\IcActiir, Illon. R:obmCl.airman Staggers.. \Larylcurd, State of, \1i.1).,, c:ommissioni l_ I1 Lh'm:LOl ~taggers. Melnici:,Jo ep3i~ L., I aud epidetuiolo~~',, U ni.'ersity Collc,u Cliairnrau Staggcrs, \'Iiz(,,ll, Ilon. Wiluier . of \lor~th Carolinai ll;)ss„ lllon. John E., C_Llifornia, sutnma af:the State,of Cali :~; assau Cbtutty (N. II.I) ., director o rnissioner of healtl clerk, Interstate a \ational Congress' c: chairman,: Commi

898' These are not very vicious looking tumors; but in keeping with abso- lute reporting accuraey, they are included here. On the far right,the Chemosol-treated tobacco rate is practically the same as that of the acetone solvent, whereas you will see in the middle that the untireatedltobacco; the tobacco without the Cliemosol, produces better than:2apercent tumors. This completed the cycle of complying,with those criteria which hadl been laid down byt''he~Sloan-Iiettering Insti'tuteand which have not in anv fashion been refuted bvv other scientists. Thecigarette industry, while: cooperating wi'th' us and permitting us to use tlieir comrne.rcial tobacco,, -was understandabLv skepticall Now that we have finished our.'r.esearch and the results ha~ii been, corrobo- ratedl bv independent scientistlsand'' 1'aboratories, I have been informed that serious discussionsa~rebein-- initiated by the American Chemosol Corporati'on, which owns the Chemosol process,, with conimercial's com- panles for the purpose of using Chemosol in cigarette manufacture.. This, however; is bey.ond my scope of' perconal concern. I believetl.iat, sincetheindepenclent corroboration, originally re- quired by the: LT'nited States Government and thetlmerican cigaretteindust'ryhasbeen successfitlly.compUeted, it becomest'heresponsibil'ity of' Government to inform the smoking public and for the industry tloe make available to the smokina public, the Chemosol-treated cigarettes. At a timeR-hen thehealth problems associated with cigr~rette, smok- ing, have rea:chedl a crisis stage, and the development of a le.ssha,zardous cigarette has been increasinglydem,2ndlad by scientists, goi-ernmentali agencies, and the public, a practical less hazardbus' cigtirettetireatedl with Chemosol can now beo$'ered tothe~ milQionsof smokers whowilll never be willing or ablie to give up smoking: I appreciate your giving me this opportunity to appear before you, and hope thattheinf©rmationi I havepresented will assist you' in determining'the proper advert'ising,ising, program to in'folmn the pnbliic nott only as to the hazards of smoking,, but also as' to new developmentss which reduce these hazards. The Cxanr.~rX.r. Thank you, Dn. Hudson. At this time I would like t'o calll on our colleague, John _l'Inrphy,, of' New York. I understand you are a, constituent of his. John, have you any remarks ?. 1'Tr. Mi, Yes, Mr. Chairman. I certainly appreciatetheopportiulityt'oinformi thecommitt'eet.hat Dr. Hudson i.s, oni tllestaff1 of Cohunbia L7niversi'tv and has been for many years,as well as'associat.eel withi the finest hospitalsof New York. Hedevotes a good portion of'histime totlie tramingof yotmg sci- entlists. He has his own ind ependent foundation and laboratory at Hli~hi Tor, in New York. I think the statement that Dr. Hludson hns just made, t~nken in its entirety, certla2nly indicates the depthofreseav"ch lie hasgoneinto in try ing to remove benzo(a) pyrene, as lie so carefulllyy articulated. I certttinly con(rratulate him on his work. The Cir_>,i113sA,•r. Are there an~~~ duestiens ? Mr. S'rsINc>;r.Dr: Hludson, th2s'is cluitea, scholarl1v statement. Do you generally agree that we do not know pliysiolo;icall ~i~ } iaty }iat ea.usescnncer oftlie lunn? ;i Dr. HuI)soN-. Cong- e lan guage of the mode body knows the ~cause~ c 1Tr. Srm.-,-cr.rR: Thei 1, is about this staterr. One of these substa.ncc ,erous carcinogen in cigt What do y ou mean ±~ i I I l s'? Dr. HL-nsoti~~. A ca regrarel' to the mech€ concert .vith~ otller' t In other' «~-ords,~ t even rule out the v It cannot, in our prer Iln othe.r words, « vex•' V ~~ n-e11,20 years factor which trlggel fl~Yellt, the orialn2il ~~ In other wonds;~ t tion~. «'hen~this~statex `urgeni General's bv~. I believe, 10 di!! tivVitll hing cancer at. I beldeve~~ t'11ey~ 'V tiniruished sciientls~~ That report inc cilsogens given am 1>IIt to go bey~al Iue i'Irto the work .uli isl,tlle laborato Mr. '-~II'IZI\GEII'. tlie~ langnage~ of a_ent : is thEit rirl Dr.lTtvsoN. T' Mir. 111 INcI•:I2.. it is oue of sever i, une ul- tl~?'111C.~ IlU tlle~ hs ~1',1tlt~ba~sed orlie <0 ~ forth~,,benzo(: top bnacketof p( ill nulcll larger a~ ;tio It~~ is~ 1L co ~ ~-t;irt enlellt. Mr. ,Pr,rN-~~or:F ye,.terdav~ and 1' ;Vitli tll~ ~ph1'~si( LcAituonv~ ol' a -.uo,lt cUeaf~to~4

XII ORGANIZATIONSI REPRESENTED AT HEAR.ING~-Continue:di American Chemosol Corporation Pa,trick J. MaGahn,, Jr., vice president for legal affairs. American Heart Association: Fillmany, Jesse, chairman, legislative advisory committee. January, Dr. Lewis E.,, former president, Moses, Dr. Campbell, medical director. Cigarette Advertising Code :, Goldberg, Daniel B.,, Deputy Administrator. Meyner, Hon. Robert B., Administrator.. Committee of' Growers of. U.S. Tobacco, Fred, S. Royster, chairman. District of Columbia lnteragency on Smoking and Health,, Dr. George William Ware. Federal' Communilcataons Commission: Geller, Hlenry; Generall counsel.. Hy de, Hon. Rosel, H., Chairman. Federall Trade Commission: Bufi'ington, J. V., Assistant to the Chairman. Dixon, Hon~, Paul' Rand; Chairman. Grady, Thomas J.,, Attorney.. RosFnman,,Louis, Acting Assistantl General Cou,nsel f'or Legislatiom . Tenney; Donald' K.,, Att'orney.: W heelock, John N.,, Executive Director. Health, Education, and Welfare, Department of: Endicott, Dr. Kenneth N., Director, Natibnal Cancer Ilnstlitlute, Public Health Service. Horn, Dr. Daniel:,, Director, National'. Clearinghouse for Smoking and Health,, Public: Health Service. Kotin, Dr. Paul, Director, National Institute of I:nvironmentall Health :+ciences,, Public Health Service:, St'ewart,, Dr. William H., Surgeon, General, Public HcaItlh Service. High Tor Foundatilon, Inc.,: Duffy, Dr. Benedict J., Jr., professor of preventive medicine,, Tufts University Schoot of Medicine. Hudson, Dr. Perry B., president. Hinsdale Sanitarium, and Hospital, Hinsdale; IIl., Dr. Charles L. Dale. E"ientucky,, State of, J. Robert 3Liller, Commissioner of Agricultbre. Legislative Action on Smoking and Health, John F., Banzhaf, III,,executive director. Medical Society of the i State of New York, Dr. Charlos D. Sherman, Jr., chairman, cancer committee, and Medical Society of the Cottnty of. Monroe (N.Y.). 1'kationali Association of Broadcasters, Vincent T. Wasilewskil, president. National Interagency Council oni Smoking andl Health: Hundlev, Dr. James, member of the boardi of'~ directors. Terry, Dr: Luther L., chairman. National Tuberculosis andl Respiratory Disease Association: Bro«-ning; Dr. Robert H., member, board of directors. Gompertz, Dr. John L., president. North Carolina, State of : Denny, V6Teldony, special assistant to the Governor. G;"ahamj James A., commissioner of agriculture. Scott,Hon Robert W.,, Governor.. Overholt Thoracic Clinic, Bost'on, Mass:, Dr. Richard' H., Overholt. Philip Morri's„ Inc., Joseph F. Cullman: Iili„ chairman of'the board of dibectiors and chiefl executive off9cer., Roswelll Park \Temorial Institute, Dr., Ronald' G. Vincent, associate chief;, de- partment of'thoracic surgery. Seventh-Day Adventist Churoh, Ernest HI. JL Steed, executive department secretary. Tobacco Institute:~ Cullnian, Joseph P., IIT, chairman of the executive: commi'ttee:. Kloepfer, NVilliam, Jr., vice president-public relations. Tobacco Workers International Union„ Homer Cole, general secretary. Virginia, Commonwealth of: Gbdavin, I-Ion.llills}ll.,, Jr., Governor.. Rowe, Maurice B., commissioner of agriculture. CIGiARETTR ] C O3r3lT i' The ~ committee Rayburn House ~ main) presiding: The CHAiRx AN. Weare; in a, cc before the commii rettes: Our first .vitnee dent., Hi;hTor Ffessor of prevent Boston. STALEIWIENTS 011 FUU.N7JATION;. OF PR'E'6TENT: bZEDTCINE'; A PRESIDENT F The Cmkittm~i Dr. HhDSOw. ' :nittee. I am~ here tod tor of'our societ, associates and c. .llcGulty. T.he tnGlc for, I{Iealth„ Educat Gezleral : Ci;Garet'te smok'. Unitedi States asI protective and p' This conbmit` n- ot' ei-arett .:S --enel.lltv ag of Giz;lrette9~, a to stnoke. They interest of' this.

915 ntal evidence io7enic effect miponents of l~ thetumori- iemosol' were or 1'0, or 15 pt as a guess.is,, that there th rate from be? ~rs of' people a particular I It `couU ex- from a dis- )out two or d cancer on a of tobacco~ nalysis per- )ur controls condensate ntration of , we would' )uld' it not ? -.he content',, obacco hadd dried con- er in each res. •eadinb ?' rdinary to- performed V'~Ir. '.\L~cmo'XALn. Canivou find tha~t,,Doctor ? Dr. HimsoN. Yes: Ati ould vou give methe number in the left-hand col~umn ? _lfr. CARTER. The first is 1.17 milligrams per gram of' dried con- denesate: The, next ficure is 1.32 micrograms per gram of' dried con~- densate. The: next is .95. Thi~s~is~ water-treated cont'rols~~. And then~ .33, n ater-treated controls:1!.©S'water-treated.. Then we get to Chemosol treated and we have 1.41 micro~rams per (rralu of dried condensate~;~ .88~~ mi~crograms~,! 1L29~ and~~ 1.53, which really cLuesn,"'t show~~ tlre,redklction we would like to see. Certainly, I welcome research alon(y this line and want to see moree of it. B~~- the .tav. I would like to ask vou, Doctor, R-here do you do your banhina?Ij'here~ does~ Chemosol do~ its~ banking?: Dr. Hrnso`. American Chemosol Co.? I don't know. Mr. CARTER. You~donot know? Is your banking done with the Franklin National Bank of New I'ork 2 Dr. Ht; nsoN. ll7ne, y.es.. Mr. CaRTE,R. The president of that group testifiedl on the effects of' cigarette smokin,(,,last week: is this not true? Mr. 4rthur Roth, the prsi'dent of the bank with «honr you do business testified l ist neek; is this not true'?. Dr. HunsoN: I donr*t know. Mr. CARTER. The~record showa~it'. Thank you, ll~r. Chairman. Mr. _l'L~cmo~Ar:n. Mr. Murphy. Mr. IhuPFnr. Thank you, _l'Ir. Chairman.. I~ note~my colleague~~attrzbutled his intellectuallabilit!iies~to~ his birth- place~ ini Georbitt,, but I~ think the record' R•i1t note that he~ rnovedl to: New York shortly. NIr: WATSOx. It is just once you get agood beginning, my dear friend, vou do not lose it even if you go north., Mr. 1Tunrxg.~ Dr. Hudsony, ti-ouisa~ on pn~QS 4' and 5'tlliat t1te~D~epart ~ ment of Health, Education, andlWelf.ire letter to vou stated'that a new technique known as~ fluorescence spectroscopy is 1,000 tiines more sensitivethan the method vou ori.ailaalli~ used for~cliemical testing. How many~ laboratories~ in, the~~ Uni'ted States have that'~ type~ of inst'rumentatiorr availablle ? D~r:,HrnsoN.~Not'~rerymany~,~at~clle~-en fewer when„-~e~s~eeI: ai labora- tor~•~ that~ has~ tlhe, technic}ue~ a~nd~ tlie~ in,trument~s, and the t,raiiied~ personnel,, and also has experience~ witih tobacco~condensate chemistrc~ `rliich is a prime requirement as well. Vem•y few. A search R-as~ made for~ laboratories qtinl i'tying , in both, respects~ by tLe. \'ationall Cancer Institute: for us. I believe there were one or t1.-o iir our geographic region. l'[r. 11UnrFiy. Was the useof~ fl'norescetree~spectroseopw~recommend'ed~~ to you hy~ tlie~ Department of~ Health, E~ducat'iou,~ .Yndl Welfare: as a towans, of~ determining the~ amounts~~ of~benzo[a]pyrene? Pr~.~ Htosox.~ Yes., it was \fr. Mhnrriy. D~id~ you dol any~ occlusion testing for~ t'he, effect's, of~. Q'Iiemosol on tobacco?' Dr., hit?nsoN~. I didiu't hear the question.

908 In the matter of failure ofl people, to give up smoking on a mass basis, I believe we have a living experiment in Britain, in which coun- try practically all the cigarette advertising has been discontinued, and,, in spite of an immediate drop in cigarette consumptiony it climbed to approximately the same numbers of millions of people who smoked before. I doubt that our habits are so~ different from the British that youi could expect a different result. bir:NEnsErr~ It is very possible that more gains could be i made as far as human healtlh is concerned in, the area of developing a lessi hazardous cigarette than can be gained in the adoertising, field by the banning of cigarette advertising: That is perhaps true, is it not,,that the greatest benefit to us~would . be in the development of a less hazardous cigarette? Dr. HuDsox. I absolutely believe that that is true:. 112r: NELSEw. Thank you very much. This has been covered before, Doctor;,but for the purpose of'emphasis, I wanted to bring it up aga,in.Thank you, The CxnMraN. Mr. Dingell. Mt. DrNGEr.L.Thank youy, Mr., Chairman. Gentlemen, I have read! your statements with some care. I find no place where you have indicated precisely what this substance Chemo- sol is that you have alludedl to in the way of treatment. I do not know whether you, have aa patent or ai trademark or whether you are unprotectedS or whether you, might want to divulge tliis: But I think it would be usefuli for us to: ha~e for the record the precise nature of the substance. Is it a group of many snbstances? Is it a single substance that is, ad'ded to the cigarette? Dr. I+IrosoN: Thequest'ion i's. Mr. DiNGELL. What is the substance yoniare talking about? Dr. HuDso-N. Perhaps you woulcl' be able to answer this question for me better than I can do it. I will tell you, if II may, first, what my oblimation i's; Otir laboratory is a nonprofit lhboratory, and I am unpaid in it. I am not a member or officer of the, corporation, the American Chemsol C'orp.. Mr. DINGELL. That is not my qFiestion. I assume you are an ihde- pendent researclier:D>'. H»sorr.Thatiscorrect'.. I lielieveit~isrelhted'toyoiirquestion,, siir„bnt when I began this experimentation I asked for one thing and' I wasrerhtired to take on oneobligation indoin_ it. I askedi completie, freedom in the research. I was given tliat. This agreement has been adherecl t'ol all along. The obligation I took on, wa~snot todivulge~tlle natureof'the formulation ibself,wdii~ch is lieing, pat'ented! priR-atel v.. However, I mctcy add th:Rtt this formul'ation was disclosed by Dr. Edgar Bemnan to two branches of the U.S. Go verntnent, to their scien- tists, who were given the ent'i'reformulati+7n and have given opinions on it. Mr. Dt:,GFLL. Let me ask yoni this, and perhaps we can yet to the other parts that may help tihe record alha-tost as much: Is the: proeess. that youallhid'e to an additive process or an extractive process? Dr: H'unso-~,.: It is : pletely combustiblle to. Mr. DzNGELL. Tlien, to here is one whereb which in the comtbuE is that correct?' Dr. 1Ir.-nso-_\-. That ~ Mr. DT`GELT:. Did whether it has arny hrotlilcts Whichimil~Y, ~ snYoke: so~~ as~to~ a•ssuri t'~reaterl~~lw~this~~substa Dr. Il~bns4~;`;. Yes,: biolo,~~icall~y~„ and ew~U been carriea!out. 'ir'lle results are~~ ~ rneclhntzisnns~~ ina-~olve~ ~•~~ndell~,tte~~ lbecessar i:, conEi(lerablv incn Mr. 1)INGELL. By Dr. Ilit:-nsorr. Fit-l llr. I)I\GELL. C.L arette that is sn>.oh larodttcts~ of~ colnbtv~ tlie presence of'this Dr. IIa-nsoN-. I ca Vou au ans1\•er to t ~~>ne, ,u1ywher.e,~ Icau~ 1'~Ir: I )11 GFLL. Y (Inite (i~illicuIt to~~. i.. I)r:,IlcDsox. T1i, _lTr. lltNGELL. II not,you niad'e an.w proclllcrion,of subs to~ Sonle~ of tlhe~ ot~ vascltl ar disorder Dr. Il~rnsoN. I t't of v~iew ~ N~,ould ha- t`or car<diov2scula l~~Ir: I~)rNGFiLL. 1 n-hilc this might. C;LCCll1iDrt 11 111 clb ;l~:-~c,rtion wit PL'e~Ulll~-~., 1Uld also~~ '1i lier di[liculties liitnnarv disorder .1iu 11 rptCect?' 1101% fIt I1~o~. C witlt:, I,rc,uu~e I tll;nl oile llnrposi h dov,tin t. ~Tl'ht~ citorl hiu it p\~191'~aiilcil previi,

I 912' Mr. WnTSOti. But you state in your testimony, your prepared testi- mony, that at least discussions have been initiated betR eeni the tobaceo, companies and the owners of ChemosolL Dr. Hunsox. I believe I said it like thss, Conb essma.n, that I had been informed of this, andl this is true: The attorney for that eorpora-, tion is sitting on my right at tlhe present time, andVhis information to me is that discussions have been initiated. I have not participated in these dfiscussions: Mr. I`':4mso_N. Is lii's name Mr. Tennebaum ?. Dr. Huilsos. No, sir, it is not. It is _llcGahn. Mr. McGAUX. I am Patrick 'McGahn. Mr. WsTSO-N; :Wliat about Mr. Tennebaum of 1V ew York, N.Y. ? Does he have any interest or has lie ever represented the Chemosol Co. or any: of the:owners of any rights of Chemosol ? Mr: D'Z'cGAxw. Yes; I believe he has. Mr. WATSON. The thing, is that the other &o a letter was put into the file fromi the attorney representing nine of the major tobacco com- panies in Americay producing, as I recall,, some 97 percent of' alll cigarettes, where their attorney offered to submit this Chemosol at their expense to test. "The, companies, aret'hereforewillin; to underwritelhe cost of the proposed independent testing probram~ to have this process tested att the Hazleton ILaboratories in Falls Clzurch„ Va.," which, incidentally,, does considfrable research for the Gov.ernment.. I«as just wondering what happened~ tiot'h~at offerwhiicli was madeoniAu g.ist 1, 1!96'7. Dr. Hunsow. Mav I answer that? I am fiimiliar with it. Mr. WATSON. Yes: If you are nott familiar with it-you handle the medical end and perhaps you could refer the legal processes to the lawyer. Dr. HuDsoN. This dealt with the methods which would be used in analysis. That is the reason I offered to answer the question. Mr. WaTSOx.All right, sir, you goaliead, then.1Y'astherenot theofl.er made by an attorney representing nine of the major tobacco com- panies to have this Chemosol tested by an independent laboratory,,the hIazelton Research Center in Falls Church, Va. ? Dr. Hunsox. Yes; that was,made. I[ did see a copy of t'hisoffer, this suggestion. I was in touch personally with the scientific personnel at the Hazelton Laboratory. I went to their laboratory near Washington and'conferred with a gentleman whose name I don'tJrecall, the chemist who proposed to set up protocol for this testing, which he subsequently did so: His protocol was subsequently sent oni to me: The only difficulty with that, because the Hazleton Laboratory is a fine laboratory,, «as~ that we wanted to meet' the requirements which had been laid down for us by the HEW in the form of sugcestions;, if we wanted tliis informa~- tion accepted by the scientific community, that the fluorescence spec- troscopy method be used. That v-as not in the Hazleton proposal. They proposed to use the same technique -wh'ichi we had used. We went back to the Government and theiiltational Cancer ][nstit,'uteand' a61.ed for a list of laboratories. Among the list:,, we found or 'we felt that it would be desirable to meet the HEW reqturement of a specific request on the types of instrn~- mentation. The laboratory which: met thesereqpirements, and was on~ the iist provi( the~reason the~,~ Mr. AV~ITSa, such an efl'ecti witltyou, and smoke, and I most anxious miaht move j. •1 hank yon., 1Pr. liAc.vo_ Mr. Picicr,L Dr. I-liielsoi who smokes ~ You are en of~ a less~~ hazt T want to: bacco treated to ~34 percent ~ ~ is~ one of tlie~ Ol' caII'se tllm ll5r qtlestio presence of ti ce~rs~. as~vllniur~~ I)r. ITruSas find earlier t iiet;;eeii iliu pared - it11t Mr. I ~~i"Hl. : reduction (d that thcr.e~ %r,, treated. Dr. I h mals~anf percent lek-e How('Nit'r~. benzo~l:u j 1-1 ~,V; Dult'~ ~~~~~ Tl1iy~lia~~~i in t'1te~ l~1ie(li benzo(:r)! 1Y of'alr 0i1c:er esceedL; t 1:e Thi-; liri, bacco c~~nrlc~ amonnt,~ i,~i~~~~ ~~ I't tniu the n-wr, in lh,'nzm:l , initiatt-I I -\ '1'I1ai i, I .ltr.1'1,:. ~ the u:u

927 . _Tt may onow to hazard Everv I want ieve it. aere we •ence. I !earned' nav~~ be~~ smol:e.. Ir dan- t, in a ~oAiuVs~~ we are aphro- tight- te falls - mean )ercent ake. Is rs and ~ them !rmine .ntage ritbe be. a¢ard. incer; r dis- uponn all of ~er to reah Ilsn't itfair to sav that it is danb rous: rather than to say that it jnav be dangerous?,' Dr. HtDsov. Congressman, y~,ou made a 50-percent inj-ersion~ in my thinking just now. llr.DtrrGEr.L. I am not'tryingto do~ that. I would liketlog.et ann answer. Dr: Hunso- . llayI specify what this means? Yes; it isdangerous, butl not if oneextrapolntes beyond the point of siinplysayingdanger-ous in a generic sense.. I'foneshoul'd go on in toincl'udespecific diseases, death, and soforth,, then t'herE is no proof that that danger does exist. Mr.~ DINGELL., I am not s<nyinr yon act fallen arches if'you snoke;, but medically you will get certainthings.. _1Tr., _1Lkcno.; Ann: The ti'nse of the aentIem:Rn, f'romi llaine has expired! I ou say the smoke is dangerous but the cigarette is not. Therefore, «-ou1dyourp~osition be topnt on the packagQ' orwhatlever it!be labeled thati this cigare-tteisnot,dang~erousttnlesslit?' Dr. Dr-FFY. Or eaten. Dr. HUDSON. II didn't say that, but I would have to agree that is true. _lIr.lLAcnoXAr,n. Mr. Hlast ings . Mr. HAsar~cs. I yieldlto.the gentlleman from Ohio: _llr: Bnowv. I am sorry my question precipitated all this, I am, f;isciilatedl by the semantics„bttt I have no desire to get into that untili Nre aa imto: esectrt~ive session. The ~~-ervv act of liArtin(r tlLecitrarett& i'eclangerous; is that rigl'tt, oritntay be dangerous? Dr. Hnvsoti. It may be.Mlr: Bnoav-N, If it mcty bedangerous, it is dangerous, is it not? Dr. HUDSON. \ o: II ntaRy be guilty, but you have to prove it, if I am accused of sometlii'ng. Mr. BROWN. But -uilty is a flrm4 cl'cur word in terms of what guilt n7eans. But danger is something else. The pei•centage, the degree of danger is tltssignificant thing: Mr. Din;geld brought that out• I think relatively clear. \ ow we, aretall:ing, about t~«-odifferentthings and this is theonly: point J would l ike to raase„ and'somebody else can kicltithis ~around as nntch as tliev wish.. For some people it mayy be O5-percent dangerous;~ for other peoplle it inav be 85-percent dangerons; for some people 100-ljercent dangerous, deadly. For some people you could say oni the pack "Smolking this ~•iw~tretlte isg©ing toeauseyou to havecancer,"'or'°maybe'"you could. ~z,tv ~ t'hat. For som.ebod~- else you could say,, "SmoLing a eigarette is not roin-to cause you any particular problem."' The "is" and "maj be" relates not only to the individual involved, <tpparentlk-, butitalsorellatesto this bro4nderquesti:on of statistical evidence which there seems to be some legitimate dispute over between medical researchers in terms of tihe explicit proof' of guilt of this product. Is that correct? Dr. Ht•nsonr. Yes. Dr. DIIFrY. Thisi argument has been ncroing oni and on because of'a partly philosophic question of what constitutes proof.

917 oets that Dr. H>-nso-N. That beuzo [a] py rene causes cancer of the lung, per se ?' Mr. SAzzEr.rrt:r.n. Yes. ).*.t't know Dt-.IIr-Dso--\-. \o: "s of' ani- Mr. SAzTERFin>un. I only have one otherr duestion., i regard- In: answer to the get7tletnan from; South Carolina, yon mentionediad rause in your experimentation that yoni had jottcn into a pretty badl way ~ betlween financi'rallv. rom the "~'ere vou talliin- about vout: houndation or voivrself ? ;nt2. But: Dr. HL-i)so,;-. Thenoitndation «as, begmui i'n.19o9: It waseat2blished! :~ary dis- as a ir enahership coiporation ttnoler the lii«-.s of the State of `~e~: ~ ork. It has tax exemption in5ofar as incotne is concernecl'. It is nonprofit. !aestions, It wase?ta'blished asa t~eachin- experintentori,gine.llv and stillL in the leatnlinQ: of expe.rilnen`all bioio,v. I'r I tnEtv put into A'our reaord. a descrintion of thi~s, h ound.tion~I~«-onld be delig lited tb~-dbso., ~riththe prol~~iso~that.you i-noi:etli:e~Iasttwo~pages which aa•eanalapeal for fiuid-. Vou this: Mr. ll~cna~~~r,n. What i~sthestatement about tltielasttwo?,on that Dr. IIt-nso~. The lilst two p~~-es az~e not, pertinent to a central dz- .~1~d stanci sci iption. Uut thzv are inciud,ed iit it as an appeal for f2tnds,eshecially for rc,ti:•ed protewsors and support of sturients. rT`~, •~ • l.,r~, isa, lilboratot•y ~,-liicii~ is enna~,~ed hrinc,pa:11'yincanrer re- •_is. One searcli. _1s I mentio,iec1 eailier, omcei~s anel! diiectots are not pairl. uwas by D.•. ?,lc~'T itl'~- ana I fa17 into that:cateyor~-. Dtr. Vicel~li,~~N•liohas n-orl:ed e~.tensi~-elh~for3i,,~-ears onthisprob- in_ test. letn, d'oe5 not fall in that caten•orr. He is ai fnll-time, research bio- 1°11rm=-tl flilud WorhPrl n itlits1ca;("ol,~a~' I--Ir;A-e- it-,;a~nd l'aterat, 'I'o.• for a total period of' 16 years., He was the principal in- vestigator. reilnj'ec-T'lieotlher one~ in this pro,~i•nn~is Dr.l~I~cGufiy~. Dr:1TcGuffyisalso my ~.ife. Slie is in c!iarze of'the transplqatati"on hiology Tahnriitory :' for the and, tlierefore, al~o in cliar~;e of'the aninial est~eritnRnt~tio~z for the. aensates prodhtction of'tuinors. nlilde' in It ]s7.' litbora:toi'V' which eS;StsItAhroll,?,11 pii: fftegiifts and, g'r1nts, .om 10 r_ontracts„ althou(jh we han-e never had I foinnal eontraet ontside of; ee times Goz-ernment sttnport:. At the present time and' for the past 4 or 5 years there r:1s~ beenn no Government support in the laboratory. Our board of d::~octorc •tte with or trttstees decided to tr3- ncn;.~•o~-ernmental support for a peuiocl or' :itiion of tiine.. \Pr. SATTExFiur.n. Am I to nndhrstand that the moneys y.on ha~-e ~l'ens_itee el~~endhcl iarthis etFort «-erestrictl~• n7ot~i~•atedlb~-an hone5t .uni1d sincere. ,tnoa,e?eftot•t to -et at wha,t yrru~ would 'hopewoitld lieQome enres o: -nnie, it'paint- disesse; orto, find out the:causesof certain tlhings,spceificallti~- caacer? zsrettes Dt•. hlt.;nsow. That is correct. Mr. SAa•Tr•.r.pirtn. I think that is.an aclhniraule und'ertal.ing, I con- `flipi or ^'tltnlate you. e snicil:- Mr. \LAcmoXALn: Do N•nui offer that to be inserted into the record at this Point z' i1r_ that Dr. Hti-nsoN.Please: „tzo[a] Mr. A~D=~cno~A~>yn. Without objectiion, it is so or(lered. - •0lias a,

901 en the ,rstand . bri:ng )f age, desire _r it is refer- .nd its -ich: as `ironic vchers ,h has 'riiaps aer or of'tarf cience prise. e tively ag at ~ct of mong even n the hat I mney : h,ing neys. A in soot. for 3 he land day, it to are present. There is a higher, ccontent of benzo[a] pyrene ini the tobacco, that is commonly smoked in England and there certainly is a higher incidence of tumors; judged by tlie : method which, the National Cancer Institute uses; and which I have used, and my colleab es,, in the skin painting of the mouse: This work was published' in the Rosewell Park Memorial Inst'itute in Buffalb;, N.Y., by Dr. George 1tloore andl Dr. Bachy who are genuine authorities in this field: They findd the hsghset tumor productioni by this methodl of skinn painting , is caused by English tobacco, using fltie-curedl t'obacco, and I believe it directly relates toe the benzo ('a) pyrene. Almostallt cigarettes manufactured in England' are of that type. MM. SPRINGER. Thank you, 1\Iir. Chairman. The: Ctr Aznat AN. Mr. Macdonald. Mr. MiaGnoti Ar.n, Thank you, Mr. Chairman. Dr. Hudson,, I congratulate you on a very scholarly presentation to the commiittee. I am not sure that it isn't almost ai little too scholarly.. I had some trouble following some of the words. Translated in general~ I take it the main thrust of your testimony is that the present cigarettes are not safe and are inducive to the onset of lungcancer, is that correct? Dr. I~UnsoN. I don't. take authority for that orig' inal concept. Simply as you did,, I read it in the Surgeon General's report. But IR-il1 tell y.on my eaposuretoit..For 10 y~enrs~ at Columbia -when I was on tlliefacult~of the medical school~-I am now on the faculty of puresciencer-I worked oni a dailvbasis with the late P'rofessorStout. I'n part of my time, I served as consult.antt to the LT.S.`7eterans' facilitv at East Orange, irT.<Ti. This is the: home base for Prof., Oscar Auerbach, whose name is known to you. Between these two men I was able to observe their stndi:es as a spee- tatior onlw at that time. I observed their studies on the human respira- torv svstiem. Thev did the: experiment which sooner or later someone had todo, v,-1'iichisto~make serial sections. I will explain that term. This means makin~microseopicsectionsnext to one another so that practically every cell in the respiratorF system from tlie top t'o the bottom, L including the «hol'e lung, is examined. By doing this, they found a, spectrum of chn,nge from normal to pathological butt not malignant and finally to maligrnant and ulti- mately malignant with, cause of death a,t lh'tngcancer.They found this spread' and related it to the cigarette smoking habits of't.he people whose lunas were laein, , esamined'. This was the beninnin~ of my being convinced that there was al relationship be- tween the smoking of cigarettes and tlie deatli: rate from~ lun(r cancer. This preceded, by some years, Surg: Glen.Lut~her Terry'sreporti~n 19~>4.«-hich r~zmmnrized the informat'ion a~~aile:bleand drew thecon-clnsi on,, I believe only in the case of lun(r cancer,, that therei'sacausale relntlionship. This is rnyauth:orityfor believing that this is probably true. lflr: nnnrAr,n. But to go aa step further. I take it from tioiir testi- monytllint you~ al'sofeel that ifthechemosoll process is adopted hv talecigarette i~~ndhistry,, that then there: might be~rhat ~oulld'~ be called a safe cigaretite, is that correct?

923 V.We have )lerns. The ch:oTesteroI, i crease: the ttv tissues. tthat. Are -obacco to I )er carton d be vast- t different f pennies, o the cost at of 3~-I.2 I necessary ~re,,Itself, ometliiilg 1't'he cost at would ~~ reagent i~t Nvoulicl'i ."lse1i Youis R-ould' irion of about a lominal. )ur defi- .ink the rarettes Dr. I-h.:nsoti. I don't think it is possible for me to calcuTate something like that„ because although no major changes in mtiunifttcturing aree required, I' have no idea what minor elnuiges db cost in the cigarettee industry. Mr. Bxow-N. l~~'~e~will tlry~tlo fiiidiout the~precise~fi~gltre: Perhaps we~ can~ put itint~~o~~ the~record. Al1 we~~ need is, tllie~~total number~ofl paclts~ :,old ayee,rand nYultiplfy .~that bc~ a pennyi ou used the term "some peopl_e." in dis ctsssin,~~ t~he~possible~effects~ of~ i•W;lrettes on those who consume cigarettes, and this,is a point we have had recurringl'v: I!s~ it, possilhl6 ~ that some people have no~ ill effect's from cigarettes~ or no perceptible physical effects from the smoking , of' ciga ret'tes ? Dr. I+lrnso ;. I thinhthat is aniobvious factl. ~ Mr. B.ow~~; And some~ peoplle~ could smohe~ rehitivelW~ moderately and subject themselves to a high risk of cancer or some other disease hecause~ of~the i7at'ure~ of their plxysiologiicaI makeup ?~~ Is that what you are su~restina?' Dr: Hrnso--~:. Yes: _l1r B~ur.~w--N~. 'T'.o those of us not medically ~ trained, is that ,vhat you~ n1eIIn~? Dr. IIUnsoN~.~That~is whit' I mean. I tl:~i2ilctliere at:e~ people~-wlro~cZn amohe~ heavih: and not,bee harmediL;-~it. I think there are~ma~nv who do. Mr. I>~i:oWN~. I,et, ine~ 2-o~ to thi.:cinesti~on t'1ixt relaaes to the~ e.change vou 'rive~~ n-~ith lir: Adams. 1'lrat~ i:s the questiion of' his that ciz;arette -r1lohina-~ mav ~~ beliaza~rdou~s,~or diingerous~. ~ f ha;=e a feeling that haza„rdou5 and danaetrous~ a~~re~ ~of't words~ to~ ~-which there is no:specifie consotation~ of tiie~ d'e~~_°,ree~ of pos~~~ibillity. And'~, therefore, there, is a very ~ little difference between the w~ord is'.~~ andl "Mav~ be."' But using the word `'li<n2ardono"' or "d'ancerous?" to health, are~ you sugsestinq that for some~ peopl~e~ ci~~g'.arettes~ are dan- ,"erous an~d for other~people thev~Zre not datt:-ero~us Dr.~i-Irnsos.: Yea.~ sir. To the a~N-ei:aze~suiohei•. Mr. Bitow~a. S~o~~ if we~ put a label ctn the~ pachaze:tliat tries~ to apply the~ degree~ of' dan~er~ of'thnt product t«~ a~.l~ peol~le.~and I am sure~ this is~~ a qhestion we willl haN,e to re_solve~ in this coinmittee eventnnTh-,, then I~ arn trti°ing, to~~ get. it whether tliat l<t~)ell ou-lit t'~o~ snv ~ `is, , d4xn-~ ~erousor ~~mnv be danigerous.'~ depending oni tbe~ lperaon wilo~ read:i ~ i't~. I)r. Ilt.nsoN.VThi the matter of convelk-~.ing the litier<,I truth, it wouldd have to be~ "niati'~ be~ haz~ardons"~ or .`iu~.Tv ue~ cl.ln0lerous" ~ or ~ .:n1n~~-~ be deadla~ "~ Tliere~ ~~ oul~d lie~ a~bsolutely~~ no v~<tR-~ ot~ sa1~~~ing , "tlris ~cill he '~ or `'this is danzerous~ or lethal in y-oiir~~ case..' to ,ti~ spccitic buyer. That is'~ not possible. Mr. Br.ow,,;~~. I;a-en though~ for some peo1Ple it nia~3y be„lint for other peohle~it may not be. '):r.Ih;oSox~.'Ghat is~correct. Mr. MAcnoN~Arn.~The tim~eofthe~Lrentlc~in:uilias ~expinecl~ Mr. Pi•ever ? Mr. PitLiER. I~have~no~duestions. I~ «Rnt tlo~ tlianlt Dr. Hudson for being here,and especiullly ~flor 15uin,- iaYg niv fornier~ classmate at an eiiUtern institution, Dr. Duiffy. ~~~Dv~ recollection of'Dr. Dit$'v was not on1v that he was~an excellent stttdent but was a trerv etfectiv.echeerleader intl.e institution.

903 va,de. :pert' Lt ive of'a may your nbia. ~sed ~, all and iiim I lot -ou, ? be- here and ever iade 1 or , in- )eri~ a on not ;one re- . we eri- r to ^in- iice -ery lem ind l~Ianyof the things that we all enjo~.'the benefiti.s, fromi in terms of preventive medicine were originated ui~ laboratories which experiment with mice„ including the saiue strains of mice that we used... We have been wirled here nlauilti by thet .S. Public Health Service as «-ell as by inst'itutions larger and more widely kiown than our o.rn.. The current program for lung, cancer designed to ~ solve, by its, own statement f'romIhe National Cancer Institute, the human lung cancer problem involves the letting of contracts for -which laboratories have l;een solicited,, including my own, to use tlus same skin-painting process. In fact, protocoll is identical. This is to formi the principal basis ia biologicall testing , for the hum2n lung cancer problem.. To restate all ev irlence in favor of this would take more time than we have. I can assure you I couldn'tbegiai, to remember all the references too these correlations. Suffice it to say for the moment, because this is the best that ca:n be done witli, your qtlestion, -whicli: is a very pertinent questiony that these are the best tests that have been so fnr devisedl ~ Ain. In conclusion, to n-rap up my thinking; andl not to Mr. _l'TAcnoN put .rords in y our mouth, perhaps, your testimony here today is for continued advertising R ithout the .v arnimg, or does your testimony not go att allito the advertiEing? Dr.HL-vso`. The references I madie t& advertising actually are extractecl, tho.ugh Imav not have attributed itt;here, and I might not have used exactly the same .vords, this is extracted from the mandate,, and it was called mandate,, from the task force of'the Public Healtlr. Service to the Surgeon Geiieral. The~ referencesI[made -,,vereii,7; some instances taken directlyfrom that document. :4Ir.MAcnorTnr.n:. I[n, any event, I can't take up any more t.imei Doctor. In summingup„1[ will just say that it was mwfeeling in your testi- nionyt'hat vou felt that if this process Whi6h you seemtohaoe grea~t faith in„ tion~ake a safer, shalll we saR~. cigaret!te; -were adopted bv the cigaretteindiistry, then 3~oufeeltliat ma~~n~-of the problems tliatt are facing both the Con-ress, the industryaiul eigru•ettesmokers~ in~.-enerall.vould be~al2eviated. Is that correct? Dr. Huflso-N. That is~correct. In regard to ad'vei•.tising. I think I canl sav it in onesentence,i'n two halves. I think that lawsconcernimg pro-hibition in our society have fniled, and totelll t'hegood with the bad in genuineeducatlionalprogra-nzs, including advertising, and t'hisisin keeping with the publiclYeal'th service's mandate, is intiel'ligent. Mr.1lTncnoxALn. Thank you,lllr. Chairman.. The CtiAir,__NrAx. Dr. Dutty, Inotiee you havestziten3ent. 1)o you want to ;ive that statement now'?Dr. DUFFY. Yey,,sir. Or I can lrlace it iaitothe recor,d tosav.esome time: TheCHaia-MAs.I believeit«rntld beTmtter,, for tlheconiinitteeif' you could giveit, inow so we calr chie-t icu both of vou.

Additional material submitted for the record by-Continued National Grange. (See North Carolina, State Grange:). National, Liberty Life Insurance Company, Arthur De 1VToss„ pres- ident,statlement--------------------------------------------- National, Nswspaper Association, statement _ __ _ _ _ _ _ _ _ _ _ _ _ ,_ _ _ _ _ _ _ _ _ National Tuberculosis and Respiratory Disease Association, gtaphi entitled "The six leading, causes i of' deathi from disease among males an 1351' 1359 Additional material subt; Seltzer„ L'?r. Carl' C School, of Public : tion of the ell'ect. Severi, Prof. Lucio, Soloff, Louis A., Z'I commers„ Dr. Shel. May 23„ 1969, 1 in 1966and change:inthese diseases since 1950C United States" ___ Nelson, Wilbur K., PhL D. (See 1VIoFarland„J. Wayne,, M.D.) New York State Department, of! Health,, Dr. Hollis S. Ingraham„ comrnissioner, statementl-------------------------------------- _ New, York State Interagency Committee on Hazards of Stnokiiag, Hon. Edward J. Speno,, Mew York State Senator and chairman, stlat!ement-------------------------------------------------- North Carolina State Grange, b7Ms. Harry B. Caldin-ell, master, and chairman, N ational Grange Tobacca Committee, statement------- Pennsylvania: Conference of Seventh-day Adventists, Louis Canosa, ed- ucational, superintendent, educational depart!ment,, letter dated April 9, 1969, to Chairman Staggers--------------------------------- Philip Morris, Inc.: Excerpt from the: American~ bledical Association, Education, and Research Foundation report to the Profession andl Abstracts of the Grants-June 1968,, entitled "The Project for Researchh on Tobaeco and Health,,1964-1968-------------------------- _ Report of' the scientific director, Clarence Cook Little,, Sc. D.- 1966r67, the Council for Tobacco Research-l _S.A__-___-___ Phvsician's Forum, Dr. Mark Abramowicz,, Health Hazards Com- mittee;, st!atement------------------------------------------- Pr••eyer, Richardson, a Representative in Congress fr•om, the State: of North,Carolina,statement------------------------------------ -- Priest, Walter S., M.D., statement------------------------------ Rappaport, Dr. Israei, statement-------------------------------- Retail Tobaceo Dealers of! America, Inc,,, Malcolm, L., Fleischer, managing director,, stlatement--------------------------------- R'osenmanj Dr. Ray, "Cigarette Smoking, Its Relationship to Cor- onary Heart Disease and Related Risk Factors in the Western Cbllaborative Group Study"__________________________________ Roth, Arthur T., New York: Schedule A-Chart showing tax income from cigars and cigarettes aompared with costs related to smoking-------------------- Schedule B-A 10-year program to reduce cigarette: and cigar smoking by 50 percent at a gradual rate of 5 percentl per y ear _ __ Schedule C-Estimated results at the end of' 10 years based on, achieving;a 50-percent reduction in smoking---------------- Schedule D-The economy of tobacco: A case study of North Carolina;theleadingtobacco State_________________________ Schedtzle ETFarm income-Chsh receipts from farru marketingg, 1960-67, and index, ofl farm output per man-hour, 1940-67------ Roth, Erlo,, M.D., associate pathologist andl coordinator of smoking education, Charles F. Kettering Memorial Hospital,, letter dlrted Apri 18; 1969, to ChairmanStaggers---------------------------- Rush, Joseph E., M.D., radiologi'st, St. Petersburg,, Fla.,, letter dated Aprili22, 1969, to Chairman Staggers---------------------------- Rutlh;, Hon. Earl, B'., a Representative in Cbngress from the: State of Nort!h Carolin.3, statement------------------------------------ Rutstein, Dr. David D:,:~ Deathsd'ue to "cor,onary.disease;" United States, 19'05-66------- Deaths due to emphysema, United States, 1'950-66------------ References documenting the statement that those who stop smoking have a lower death rate from coronary disease and lungeanoertlhancontinuingcigarett'esmokers---------------- _ Sachs,,Bernice C., 1'i1.D., statement------------------------------ 632' 1342' 1341 1361 1401 71 559' 1367 42 1229: 1325' 1362' 826' 705 707' 708 710 710 1399' 1403 44 733, 733 737 1198 I dated \Pay 20, 1` South, Carolina,, P cornmissioner o1'. Williamson, clen Cpence, W. R., -~ iciire,, Holy Crc W, illiamson, cler Sterling, Theodor and Contpater letter date& -M: stitute, Inc.,,re' tulce, L. Jefferso Television Burew ment,___-_-_-- Tobacco Institut. Poster entit (Maybe t CorrespondE offered to. Letter, date. Assistant High Toi, Letter date. G,eneral's ~ Tobacco11'orb: ~ecretary:, Attachmen. June 11, suspecte( Atta.chmen "Smoke Attachmer "Advert, Ultrasciences, ment------- United Cancer dated April' mittee with. Unitedi Churc Hov-e11, lett Utah Ihrterag, Chairman, Clerk, Inte Utah Thoraci Representa Clerk, Inte ~'an Dcerlin,. Statie ofCs. by student Vincent, Dr. Surgery, 1$ Evening N warning: I Winsor, Trar ~. Sadtler, Philipy president, Sadfler Research Laboratories, Inc., state- OIt'I ~ ment------------------------------------------------------- 305 San, Francisco: Interagency Committee on Smoking and Health 'Y'Irs. Stuart Dodge, chairman, letter dated April 29, 1969, to Chairman American Cance Baker, Dr. ~ Staggers---------------------------------------------------- Sawyer, John Wesley, Ph. ID., prof'essor of mathematics, Wake Forest Uhiversity, `Vinstion-Salem„N.C:, statement____________________ 1381 960 ~ Mandel, DrCounciL Division. fl', Williams, L

909 on a mass ~iich coun- iued, and; limbed to o smokedl that you. ~ made as ng a less ;, field by us would' -d before; up again. I find no 3Chemo- whetlier ~his. But 2 precise 3 t'liat is (laiestion vhat my in it. I ;liemsoli in inde- Pestion, ingandg tt. This ook on s being bv Dr. r scien- pin:ions to the process. Dr. Hunsox: It is an additive and it is in liquid form. It is com- pletely combustible to carbon dioxide and water. Mr. DINGELL. Then the function of the process that you are alludrng, to here is one w hereby we essentially make an additive to the toba;ccoo whichi in the combustion affects the production of' benzo(a)pyrene;, is that correct 2 Dr. Hunsox. That is correet.. 3Ir. DINGELL. Did you make any scrutiny of this substance to find whether it has any other end products or combustion or oxidiitioni products -which might otherwise affect the quality: and character of the :;moke so as to assure the safety of persons.who would use a cigarette treated by this substance? Dr. HUDSON. Yes, sir; in two ways: One chemically and the second biologically, and extensi'vebiolbgical toxicology experiments have been carried out. The results are consistentlv in one direction. Without knowing mechanisms involved~ I will give an example. The amount of tobacco condensate necessary to kill a mouse, the amount necessary to do this is considerably: increased if the4obacco is treated with Chemosol. _llr. DINGELL. By what magnitude? By what order of' magnitude?' Dr. HUDSON. Firefold. Mr. DINGELL. Can you tell us what t.he end pr.oducts are of the cig- a.rette that is smoked with Chemosoll that are different tha.mthe end products of combustion of' a cigarette that would be burned without the presence of'this?. Dr. Hunsoxi. I cannot tell all of them: to you any more than I can tell you an answer to that question without Chemosol. ][ don't believe any- one; anywhere, knows a1l of' the combustion products. 11fr. DIxcELL: You, run into a large number of higher tars that are quitedifl'icult to identify? Dr. Hunsox. That is correct. llr. DrxoELL. I would like y ou to tell us; if you please, whether or not you made any scrutiny of whether or not this substance affects production of substanees mside the cigarette that would lead, let us say, to some i of the other identifiable effects of' smoking, such as cardio- vascular disorder and things of'this kind. Dr. Hunsox. II think to:answer that question from a scientist''s point of view would have to be that I dbn'tkiow the substances responsible for cardiovascular patholbgy in the present smoke. 1'Ir. DixcEr,n,. Ivhat we could come to would be an inference that while this might affectthe level of one well-knowni and' identifiable carcinogen in cigarettes„ that we would probably not be~ able to make any assertion with regard to possible other carc~:nogens that might be present, and also with regard! to other active a gents which would create other difficulties in human bodies such as emphysema,, different pul- monary disorders, and other cardiovascular disorders. Am. I correct?. Dr: TTtrnsox. On.e-]tialf correct and one-half I would have to disagree with,, because IJ thinkt.hat the overall testing biologicall'y hasmoret.han one purpose.. It doesn't just corroborate the value of benzo(a)pyrene as an indi- cator;buti't gi'wes an overall test forthe total carcinoge.nspresent, as I explained previously in niv testimony.

895 i dvertis - and pro- etiary of he toldi ,tte-and, :arette is hose mi14 o give up rhat t'h:e~~ le Com~ )tionl of' :ie aoodd mrettes. us ciga- use of oes not ~stances l unre- aists aspyrene: for all ie as,"ai defines :• medil -e: Thee hich is clearly ;ens de- ian any useof other, doin(~, •ea son, venessan in- trbons ]early twa5 ~cien- > this ritutle. Task ~. e eon- i ticcmt i This is unusual language for a man of Dr. Wynder's stature. I am sure his stature i's known to: the commfrttee. The use of'tlie word "al- ways" is seldom found in scientific literature.Yet. Dr. wynder re- emphasizes what lie found pr.eviauslyy using the word "always." There is,"always a reduction in the tumori genicit'y of the tar."' Clearly then,, the less~ benzo ('a) pyrene ini cigarette; smoke, the less harmful the cigarette. Benzo (a) pyrene is created as an end product of' combustion or partial combustion and cigarette smokers; therefore, smokers constantly inhale benzo (a) pyrene into their bodies wlien they smoke. And, as explained previously, this~benzo,(a)pyrene act'ivatesother~ cancer- forming hydrocarbons which are concurrently pyrosynthesizecI in the burninb process.I'n other words,,those temperatures and those condi- tions in the environment of burning which favor the production of other hydrocarbons also favor the production of benzo (a) pyrene, the henzo (a) pyrene acting to increase the activity of the others., Therefore, the greatest identified dan~er to smoker.s is this carcinogen called benzo (a) pyrene. Scientists in and out of Government have been constantly trying' to reduce the benzo(a)pyrene in smoke byy va,rious means in their endeavor to create a less hazardous ci;arette. -Although they have succeeded in doing this in the laboratory, the results were only of academic value because the final cigarette lost much! of its fi'avoror taste andl therefore, was not acceptable toe t'he smoker. In other in- stances, the substances used were too toxic. W'einourlaboratoriesh~avealsobeen doing resear& for3i/2 years, continuously, wit'hout publicity or fanfare, on a formulation called Chemosol. The smoke of' cigarette tobacco treated with~ Chemosol, under properly controlled conditions,, eontainssignificantly less,qpan- tities of benzo.(a)pyrene. Chemosol is nontoxic and does not afl'e.ct, the taste; flavor or aroma; of cigarettesiand can beeconomicaIly used in commercial cigarette production. Some of our testing has been done on reb lar line machine, flactory-made ciga-rett'es. ALoreover, the Chemosol proce5s can be used with cigarettes containing , filters and the overall result is a reductian, ofl benzo(a) pyrene and accumulative reduction of tars and nicotine as well. Therefore, Chemosol makes possible the production of ' a less haz- ardous cigarette acceptable to the smoking pnl~lic and the cigarette industry. Durin;,our research: pro(, ~-am,we constantly kept the U.S. Govern- ment scientist's, informed of our pro;ressand souo:httheir counsel and advice. We conducted extensive chemical and biological tests to deter- manetheefl'icacy of Chemosol in inhibiting theformation of'benzo(a,)-pyrene and reciiicing or eliminating the carcinogenicity of cigarette smoke., Our results and progress were also~ reviewed by, and discussed wit'li, many leadYng scientists such as Dr. .1rt.hur Purdv Stout, Dr: Oscar Auerbachy, and Dr. -Marvin Iiushcliner. ThelateIjr.TIarry S, Greene., Chairman of the Department ofPathology, School of MCdi~- cineof Yale University, reported regxtirdiin ;, Chemosol : Theer-peri'ment;s arewelt conceived and tlie results lenvenodoubt that t:hemouse carcinogens areremovedl fi•om tobaccoturby theapplication of' thissubstanee: Thesectionsaerived fromitheinjKction, of'untreateil tobaccotarwereail typical moube fibrosarcomas.

910 saw a painting with whole cigarette residues, containing all that might be present, on the second half of' your I would have to agree. r:r.x of all, we donr't know the substances that. cause emphysema, mr~~ rs~Tin~ has not been dbne in this direction.. I:n-,;r FLL. -So even assuming the addition ofl tlie substance tio while it might affect benzo(a)pyrene, it will not neces- r^~s aF:cr. tae other constlituents in the smoke tliat, might very ~r~~eld',. =r.rt r:r•r,: 7rarav do. cause the other effects of'smoking? 1~.°. I'Ir.-r,=,-,,;. I' would agree with that and go farther and say that I ;, Ilr. Duffy;that th-isproducesa saferoi,• less hazardou~s~ ~te. 1;?it thisisin the comparative., This doesn''t mean tl'iat there- =-a= i.ren prorl.uced ai panacea to preclude all the disorders that might r:any -mrikiinlx, tifr. _1li>>r : Will the gentleman vield?' .llr., DINGELL. I have v ery little time. I would like to ask one more rir,n. and then I will yield. -1 re thr-re other identifialilecarcinogens in tobaceosmoke? I)r. Hr:-n«,>\. There is a~ list in the Surgeon G'eneral's II'eport of 1196»I., Mr. T) rNr,ELL,., Above and beyond thebenzo(a) pyrene to which you %:1 u r1e•1 % I)i'. Ht nsn~ . Yes. 1Ir. IlrticELL, And this substance would not affectt those other 1a:rci nr;_fens ? Dr. I11:rsr,N., I don t knoww the answer to that. They may well be-. r~ rl ha RFrI. Mlr. LiNr,ELL. But your studies make no indication as to whether f,r riot trley were reduced ? Ilr. Ht-.nsox. Only in terms of the overall testlina by biological rrlF~ar,s. If theyy are present, t,hey are certainly not inereased in~ any ~:rnr„rnts tllat ~could make them biologically import'ant.tifr. Illrsr,ELL. Is this judgment based on the-study of production of known, carcinogens, or is it simply a study based on the level of` (;anmr prorlucedlin test animals? Dr.IllL-nso-r~. The] atter in two separate series of tests. Mr. DINGELL. Thank YoA., 'f'hrt Crr:,,tr3rAr. Mr. UVatson? Mr. WeTsoti: Thank you very much,lTr: Chairman. Dr. Hiudson,asothei•s, I have been impressedl with yourpresenta- -tion. You are obviously a learned man. IVlte-re is your home ori'ginally ? f ur. Iili--nsox; I was born in Miacon, Ga~. Iu uur labor.ltory; tli OV0n thourli they may 11111 tiaue: We fall in thf \~Lr: 11~~:.°rsuN. Y~ou' l~1 perirnurtation or any tl' I)i. 1lrn•o~. If yot 4qucstion very~ directly:~ I l,,l l>~~nal'1y am in rat 1~1~,~n tul. I dete 1)r. l I'rusu,~-~~. Yes, sii y~il ~1\~.vcsuz~~.Hias~tl 1')r. ] Tz usu~. It lia. -Nf r.1V.vnsu-N: Y ou : ,_rraplr. `°L~herefore, i r,11'c~1leU+~ren Galled bet -~o tll:>.t we miCTht : in t hiti~, lield, as, are~~ r. tlnisbenzo ~(~a) lAyrene t Iae prurluct of thetol In~l':~IIt:Dson.~ That 3fr_ W.>TSON. In ~~~r~~at~~~t irlentif~ied ca~~~ . wlohthor it be t'obac, ~ rront the automotiV a1nd not from tobaccl I)r~. HunsoN. It ~%llaole would, inclul "Wur e. itIrouldinci' ~Ir. WATSON. So •x ii Wh j,nht relates so I arn sure with. . ;;,f alinulllobiles, an+ ~ henz~ul ,ll~py.reneju 1~ )r. Illr_ nSOti. T11a'. Mr. ~~~ .1T50N. I)1i :,•:rlI I;e-earch and 1)r. IIrvsoN: \o '~il:rl' inanle of the !~; ,rlulllatinlr -,,•.is~tP ti11r.WATSON. I thought I detectedthat yoti would liea southerner wit,h, your great intellect and persuasive presentation this morning. II a.rn del ightetl to knoavthat youiare. h~s I understand,, you were unpaid for your experiments, is that 0.r,r re ct or for ou sts? You do h:u:e an interest in this Cliemosol tl \ f r. 1vxTSox. . C ": i: lrni)~o1i., ~0 tller, ~~ I T,~t. ~e;u ch a~nd I I~ ) r. I~iIt,-oso.N,. T ~l'llo ('lieuiosol C( ~ , , y r e ,rIn youi not?' Itr. II'UnsoN. No; I cani clarifytlhat. I don't own a share of stock ;LI 1:l1 i s t i me, nor does mv wife, in any industrv in the world, but we are,, nrlnel.helbss„nonpartici~ating capitnlists. I beliieve in thedexeloprnent. t lac ;lu•eeding .\TSO_\'~., ' C-1111);I1111-~,.ha5~. it O ~1J (rl' I Irirl rs].ilie this, from the private sector, but wedon't necessa,rilyIl.rrl icipatc in it.. I Ir. I Tt nso~. I I ~Ir~ lu:rlor tobu~cc~ C11 1l-~~ ull~ 1111111erQ1111 ~~ - \Ve I1;1\ e ill\\"avs 0'

9?9. ior some time rssociation of )ulitedd in any ette snokina, ~ point wherez<irette smok - ,v the magiii- %elv low level le Who smoke I's n the 60 to 65 ' icularlyra,pid ties in hea~ ~- most~ specific :?hblic~Health ic, major, and. m. The very ~ar.y to arrive lav cause vou liing ~~ equrally ~ ongmessman ?' -iiethcr or not _nificant it is.. ~; in regard t'o nitlo, and the r satisfzction,. r in this case? ~idemiolo-istsnberculosis in sposition and en,, andsome- leasures sometnismsim~ the q of this conal- )st markedl in .iosphere, and activity prob- ;rretteswh~ose )f'luna cancer nited States.. e. Tse questions: , brounht out As, Dr: Hudson mentioned in his testimony, this is a s~~~stemy, and ini such a multistage systemy if you cani interrupt it Inore thani one place,, it mavbepossible toegtend the efFectiR-eness, to control it notcute by significant prevention. I am sure that is the reasonfor these hearimgs., _1Lr. AV:kTSati. Doctor, do you mean to sati that one reason that the British have more pulknonaty diseases is because, they have less car- diac diseases? Dr: DuFr• v. P'recisely~,, Congressman. If ~-oui let a manIive on from the age of 40 to 50. _llr.IV' nTSO-N. Slow down a little bit. Dr: Durr•y. I have been: working faster because I was under the impression that you were gettinggme off. Itt•akes me longer: _llr., WaTSOS. I ami trying to understand this and. that takes me longer. That is quite an astoundi'ng statement,, that they have more pulmonary diseases because they have less cardiac diseases. That is ai new injection. Slow down a little bit, where I ean; under- stand. Mr. DuFrY. I[ have mentioned that there are a number of possil,le factors in the cause of these diseases in the Unitled States and Great Britain. At the same time that the British have probably twice as many deaths and these figures are not too far off, in males of 44 to 59 fromi diseases of the lungs, including lung cancer, they have a markedd deficiency, compared& to us, from diseases of the heart and circulatory systrem, primrily coronary disease,, and remarkably tcr.the same decrree. Mr., 11".kasoN. L'an ~-~ou factuallj-statet11,.t thexeason t1ley have more pulmonarydhseaseis~ because they have less cardiac disease? There is no relation. Other medical doctors telll usifyou have a pulmonari-disease, the likelihood of ha.vingcardiac diilicultv increases.. Youi are telling us just the reverse. We have had so many of t.hesestatements that are just picked' out of'the air. Dr. DurrY. Your question is very well raised. I would cornment' on the last part. Witnesses have undoubtedly appeared to, speak about'the heartt disease secondary tolung disease that occurs in particul ir1y chronicsmokers: I am not talking aboutt that kind of hear t disease. 1Thatt kiild ofl heart diseased,oes not fibRureprominentlly in the American mortalitv. The kind of' heart dise ise that is the proininent part of our heart disease mortality in youngernlal~es iscoronarv heart disease: which is not secondary to, pulmonary disease at all. Why is it that we have this particular item? I can't answe.r that. Is it because we have less of the other is what Isaiid,and I th inhit was a bit tooflip,and Imeant',bvit tliat• if'youhave thekind of hr:•oli-lenv that vou liave,in Britairu of increa.,ed pnlhnonurv di'Fease it~I m,:~1e~.. orifyou -wzuit,toturn it around and savwliy don't wehaveasmnclle as they have, one reason mitrht be bec,Inrse .r mnrch l<rrRer share, of ourpnbuonarysuscept.ible -roup,,llung, cancersusceptible~ioup, is d'n~in~ of cor~~~ntu•yheart disease than would be: if'ne had the~I3riti:lr rate. Mr. 1V'tTSOw. In otherwords,youaretelli'zr,g, usthnttlre reasoniyn-ediebeforewe get the lung cancer. Dr. Diurry. D'sactlv. Mr. S.kT`rrr.rrr:r,n, Would the gentleman yield an tliat point? itr: AV.UsoX. Yes.. °f7-^19C -W.l-tit 3-4

902 Dr.HLDSOx. That is.my opinion. I think if I may, sir, nott'o evade your question~ but not to exceed my own capacity andl relative expert knowledge, since Dr. Duffy is here, he is a professor of preventtve medicine, at one of our foremost medical schools. He is not associated with this process except as the spokesman of a team of people who did corroborative st.udy. . I think that question may very well be addressed tohim~ after a wliile.llr. 1'I'ACDONALD., If I have the time,, I will certainly take up your suggestion. Dr. HrDso-N,. But that is my opinion. Mr. _lI ACDOINazD: All right, sir. I got alittle confused about your process because the term Coltunbia. Univ.ersity, got,tlllroR-n in there. As~ I recalI, it was just afew years agothat some doctor discus5;ed with Columbia some other kind of process that was going to take alll the nicotine and tar out of' cigarettes and not bother with taste, and Cblh.tmbia joined with: him in, some pecuniary arrangement to go into the process. I never did see anything more about that process after it got a lot of publicity. You are not connected with that type of filter,, are y.ou? Dr: H-UDSOx. Congressman, I aann glitd you a.shedi that questionL be- cause this gi:ves.me an opportunity to point out to you, sir, thatthere are several thousand faculty members, at Columbia University andd most of us, of those several thousands,,have not in any way whtii-tever been~ connected with the process of the filter to which you. have, made reference, eit'lter before or after the publication of their method or their produet.I have nothing whatever to do witlih it and have never met' the in- ventor, who is named, I think, Strickmam Mr. 11 ACDO\TA'LD:Ini your testimony, you make reference to experi, ments, but you limit them: almost completely to experiments done on mice and other aniQnaIs.. Ti was wondering if you had a21y experience in the field of not experiments but exposuret'o liuman beings who might have gone through the same process. Dr. HuDSOx. Ani experiment designed to eli:citt what kind' of' re- sponse? 1Tr: 'MACDrnnr9LD:,Aspointed out in youncharts. Dr. Hrnsox: Do you mean a cancer production experi'ment?' \To, we have not done that. NIr. Jf ACnoxeLD: Do y ou have any correlntioni between the experi- mentsdonewith miee-and,of' courge,1; l:noxryouare notigoin~ to but people in a laboratory and start force-feeding them cancer-in- ducing material. ,Vliat is~thecorrelation bet«-een the experinlentsdoale 1ritlr t12emice as related to human beiilgs?~ I donotithialk thati«-as e~-er macTevery clear in yrnurstatement, Dr: HrDsort., I will attempt to make it ascleai•.aaI' can. This~pi•olaleml arises~ continuously in medical researcla. It basfor nr,n.iy.decades andl certainly will aolon for manyy moie., ATany. of' the tllkii preventive medicin .v~ith~ miu,l iaicludii ~~~"e~have~been (ru, as well as by instit The current ~ pro statement from th( problem invol~7es 1 heen soli'ci'ted, in( process.. In fact,: protoc( in biological testil To restate all e n.e have.~ I can nssuQe~v~o~ tltece: conrelatioiis best that can bee questiony that tli, NIr'. _NT ACDONAL hut words in yoil cotlt~inu'ed adkert~ ~ not.~ gro at all t0't~h, Dr. pIL"IDSON.. e~:tracted., thoug l,a Ve used exactil and it was call'e~ S'e~rvice~~to the~St~ Tlle reference that document.. Mr. AIiacnoNn Iit summing l Il1onZT~ that y'OD~ ~reat firith, in. I ~1)v t;he~ cigslrett, that are tacuag~, irt genE~~ral «-oull I, ~that, correc I)r. IIt-D,oN :. ~a.' it ili one se; lit lnition in our 111,enu:ine educal k(-e liitln with t -A Gr. _l' IiACUON 'Circ t'rt.~l~:~r t 0,~is•~etlrElt~sta~ 1) n. 1)'c FrY: I inle. 1'loe~ ('1r_~~1Rt:

Ix rtment -.chool, Page ments_ 1390ervice: tion of' ~65i of 156' Pub11c --- 98' ng-A. 121 -1~J6S'. ------ 138 ves t'o, --- 176 .ver t'o :ch he it ac- tment )unger :~ pro- tr any I5 the o thee tive." ntries What )sv do tes__ 180 ts on, 11 the ,, ling rling, l)uter 1407 lung: on of' 154 bed con- -- 176 r the 40 geles -~ate- 1076 bio- 918' 1403 ltiv.e. -ate- 1008 mcil, 1108' 978' the trv ions .pliv. 86 nee ,f a --- 718 ent. ter, --- 681 Additional material submitted for the recordiby-Continued. James, George, _11.D., Dean, 3Iount Sinai School of 'Medicine, City UnilversityofNew, York, letter dated 1Tay2, 19I69)toChairman Staggers~--------------------------------------------------- Johnson,, W. H., Associate Professor, Department of Biological and. Agricultural, Engineering, North Carolina State Uniwersity,, state- Pe¢e 1398 ment------------------------------------------------------- 1368 Jones, Irving, M.D! (See -McFarland, J. Wayne,, M.D) Jones, Hion. Walter B.,, ai Representative in Congress from the State of North Carol.ina, statementi_________________________________ Iiaplan, Dr. Sylvan J., statement_______________________________ Kentucky Farm Bureau Federat!ion„statemenU___________________- Kingsbury, Kenneth,J., \T:D:, statement_________________________ Koch, Hon., Edward 1i.,,a,Representativ.e in Congress from the State of' New York: Correspondence dated, February 7, 1969, to members of the House,, a reply from the members of the State of' Kentucky dated February 26i 1969; and reply dated -March 10, 1969, regarding the FCC proposal to ban cigarette advertiaing, on, radio and. 41 11339 1349 1203 television----------------------------------------------- 49 Le,tter dated -March24, 1969, to Agriculture Secretary Cl:iff'ordM. Hardin, re, government subsidy for cigarette advertising pro- grams inJapan„Thailand, and Austria, with reply dated March 2S; 1069; f'romAssistant Secretary ClarenceD: Palmby.-------- 48'. Letter dated April 16~, 1969, to Chairman,Staggers re requestls for additional informatson by the committee members rega,rding, first amendm~ent, protection of' commercial adz-ertlising, state- ments, source for statement concerning, difPerential in life ex- pectancy of': a 25-year-old smoker, and supporting medical matlerial forph3-sical addictiveness of cigarettes____ _ _ _ _ ___ _,__ _ Lasabna, Louis, M.D., professor ati Johns Hopkins University, statP- tnent_---- ---------------------------------------- Leaf Tobacco Packers I:lchange, Inc., Penn T. Watson, executive secretary„ letter dated March :;4,, 1969;, toChaarman Staggers, 58 1371 containing,resolutionL ---------------------------------------- 1405 Leaman, William G., Jr., 3I.D., statement------------------------ 1'242'. Lennon, IIon. Alton, a Representative in Congress from the State of North Carolina, statement------------------------------------ 39 Leuchtenberger, Peofl. CeciIe,, Ph. D., biologist, and Prof. Rudolf Leuchtenberger, ?\'LD'.,,experimental pathologist, stlat!e,ment____-__ 1161 Levine, Dr. Ldwini Rayner, associate professor of' clinical medicine, Chicago Medicall Schooh statement---------------------------- __ 1334! Little, Clarence Cook,, scientific director, the Council for Tobacco Researeh-U:S.A.,,statement----------------------------------- - 1104' LYScFarlandy, J. 1Y''apne, i1LD., Jefferson Aled:ical College, Phila:dt•l:phiay, Pa.; Irving Jones, M.D., Institute of' Rehabilitation, Reading, Pa.; Vernon Fo9ter, ll`I. D:, Loma Linda li ntiversity; and Wilbur K. Nelson, Ph., D., School of Public Health, Loma Lihda, University, Loma I6inday, Cfzlifl., telegra:mdlt~ted Aprd1117,,1069, to Chairma:n Staggers: _ 1404 . 11'SoNa.ir, iIlon. Robert E.,, Governor, South Caroiina, telegram to Chairman Staggers------------------------------------------- 721 Maryland, State of, Department of IIealth, William JL Peeples, M.I):, comtnissioner, of health, letter dated April 18,, 196% to Chairman Staggers------------------------------------------ 1375' 11lelnick, Joseph L.,, pr:of'essor and chairman, departtnentof virology -tindl epidemiolo,gy,: ussoeiated~ean f'or graduate~ studies, Baylor University Col1CMe of XIedicine, ll•tter dated April 11„ 19691 to Chairman Staggers------------------------------------------ _ 1385 11lizell, 11onL 1i'ihnerD,, a, Representative in Congress fromt'heStateof Niorth Carolinay,statement_,________________________________,_ 42 Moss, Ilion. John E., a Representative in Congress from the State,oF C_lhfornia, summation of statement of Department of Public I'Iealth, of the State of California--------------------------------------- -- 665 Nassau County(Ix11.Yi''.)Department ofHaait,h, Dunbar W'. Smith,: M.D., director ofl the tobacco control, program, deputy com- missioner of:healtlhi letter datedApril,2a, 1969, t,o1Y,. E. Williamson,, clerk, Interstate and Foreign Commerce Committee-------------- 1376 Nationall Congress of Parents, and Teachers,, Mrs. Edtvard, F' Ryan, chairman„Committee on Legislation, statement_________,_________ 1350

896 That is Dr. Greene's entire statement. It is not out of eontegt. Those of you familiar with Dr. Greene's life and work are aware that he was one of the world's greatest biologists ever to study the cancer problem. In addition to the mouse i¢iaection test commented upon by Dr. Greene above, based upon: the advice and counsel of the National Cancer Institute, we corroboratedl this! experimentation by a long- termi skin~-painting, test over an 18-month period in accordance with the method advocated and generally.accepted by theNationall Cancer Institute in their current and future cancer research program on human lung cancer as related'to smoking. The results of this testing unequivocally show that where Chemosol- treatedi tobaccoeondensates were used tlierewereless~than 5 percent instances of'cancer,, but where thesaQnetobacco condensat'es, untreat'ed,, were used, 20 percent of the injected mice developed lethal tlrans- plant~able cancers and 25 percent of the skin-painted animals devel- oped skin cancer. These results are quite comparable, one to the other. In order to avoid the wast'ing of time on a topic which IC ami sure y.ou are quite farcniliar, with. I have~ deleted! anyreference~ tlostatistical analysi's. Our injection study, for example; was analyzed by a prominent bio- statistician in New York,, and it was found that it would be impos< sible to discount Cliemosol as a significant cause of this reduction orr elimination in cancer formation. Therefore,, our overall testing, program positively and directly correlates the bio-chemiieal analysis with the biologiieal experimenta- tion in a manner simil'ar to that reported by Dr. «'ynder: On December 20; 1!968, the Department of I+Iealth,, Educationy andi Welfare achnowlecined that our tests were properlv desi ;ned, that we had reduced benzoTa)pyrene in cigarette smoke, andl that the mouse testls sliowed a reduction or elimination of tumorigenicity when mice were injected or skin,painted with smoke condensates from, t'obacco tireated', withi Chemosoll W'ei were, h:owever,advised by the Department of I+Iealth„ Ecliica-tion,and Welfare, to~ secureimdependent corroboration, of our work,, and to establish the nontoxicity of the formulation. A previous De- partment of Health, Education, and «T'elfareletter t~ous stated that a new technique known as fluorescence spectroseopy is 1,000 times more sensitive than the rnethodl we had originaliy used for our chemi cal testing and added that: "Until tests are done with this tecluiique, the absence of'benzo{a)pyrene is not considered proven." Accordin,(ri'v,asa final step in this eztensiveresearch program. a eornpletelyindepenclent series of controlled tests were conducted in. February 1069, under, the supervision of a.,,ronp of eminent and; disinterested scientists-noneof whom were knowni to uspersonallvat the tiane-including a chemist sent f'rom the Stanford Research: Izi- stitute. This chemist personall`, transported the smoke condensates to the institute for analysis by the fluorescence spectroscopy method. The resultsoftheseindependent tests clearlvestablislied that Chemosoly when properly used, effects a substantial':'rediictinn of benzo(a)pvrene of 3lpercent-which considerably exceeelstlie percenta.--Efounde nec- essa.ry as beinl-significant in diminishing tutnorigenicity of tars in cigarette smoke. In addition, an , Governnlent a~genci, combustion product quired by the Gover If'I may at this p~ eharts what is esse To betrin «-ith,~ I~ foriuula~for beuzo ( A~•rhen w~e~ remei he_xa!~onal recl! liiae~ is~~ a possibility~ foi~i th:e sia:-membered . mealt-, but that s, When we reme fact that iunny, Ir The lxurpo~e i21 the Cheniosol adc wlwni it i7~ srnolke~ l;c=rv.o~( a)~~pyrene tinal smohe~. Ths, T14e~ , c:econd paa lfiioloaical esnel±i In~~the second «-hich is~ produc~ content. 1 oli mi1-ht sa obtained from tl brand of a~ blend~ Youl will noti hlacedi icr.oss tl. V'V.-iluler"s~ work That i~s,the p, lie~ renioved-Tli represt•nts~the a~ ('henio~~ol is~ us~~ Lc nzco ( .L ) pvren ~ the~ S~:uile~ blen( In ~4miiiuaryv ment oE~ ?-) ~ hcL "rrI2JC•lM, 'i ho last cli. 0nlv the one I t:,o.1twiclely re I~t~~ i ~ ctirren Ywt willl n, '}1owiliff tive l~ thw acetnne~ so u }1 as the 0I ~loe ~~ pl.ucin- o. Livoni tlie a l,rot~ld tlie~ Crnit will' crrea.te a so-_:,6- ~

918 (The document referred to follows:) cL:S~ F.SPEBIJfE1rT.O\, THE LEaRNI\GOF B'IOLOGICALSCIE\CE High Tor Foundation R-as'founded atl Palisades. Rnckland County, Vew York in 1JW It'i is boti'hi non~profit and tax exempt. By charter, the Foundation is an educational and research establishment. The Foundhtion takes a new direction in bio-medicaI education. Its "product" is, chiefly!, people. Here all ideas are given ample breathing space and growing room. A seventeen-year-old chemistry sthident may work sidlebw' side «•ith a retired: professor of biologg,, an acknowledged authority in his field! Students and' scientists of! many disciplines are encour.agedi to strike out on their own- not to confirm someone else's theories, but to work independently in any area of inedicine or biology that' interests them. One of the innovations is the use of' the enormous resources of thva largely neglected age groups. The very young, are eminently receptive to new ideas and techniques. And those of retirement age are, by then, just approaching the peak of achievement'i in that most complicated of aili sciences, biology. Scientists are giveni a well-equipped plhce to work on whatever ntay interest them. There are no requirements to publish or teac•h formally. For the studpnti, "teaching" is displaced in favor oflearning: And a11~ the staff at Hi;h, Tor live by the truism, "Learning is doing"., Formal Iectnres;, courses,, and seminars- while taught by the members elsen•iiere-are not offered' at the Foundation. The staff have conie from universities, hospitalt`, andl other institutions. Others come to do their personali research, or t!o~ spend a sabbatical leave from their usuall posts. Students, of course, come mainly during,the Summer, when they are free from other studies. The youngest students are eleven years old, while others are Ncork- ing on graduate degrees. The only requirement',for a working relationship is verbal agreement between two or more individuals. There are noiformal entrance requirements or terms of service for students. Nodegriees, certificates, or credits aregirene Members collaborate with one another whenever they choose, and decline to do so at wiil! (Becalise there are currently olos'e to 20 applicants for a single place at: I3i.77'i Tar, many stadent's are disappointed. Hotcever. all l77.c7y candidates are inter- erietived: and aften a sthrdent is accept~ed'on Us,seaonAar,tJrirvlpear of applicatinn ). The "pioneers" at High Tor were recruited by word of mouth from among the founding, professor's own students. In the next'i seven years, the number of students applying has grown to one-hundred each: Snmmer. At presentl, there are facilities for only half a dozen, The Foundation, now owns and operates ai property which includes labora- tories equipped for research in endocrinologs, binchemistry, microbiology, e1p2r- mental surgery, andl physiology,, as well as aniinas quarters and office space:, In- struments and equipment are valued at more t'han. $300.000 and real properts-y at $150,000. The founders of this effort, were inlpressed by t]Ie need for encouraging ori;inall thought Sn students of medicine. They felt that most existing laboratory courses: merely forced: tdte student toprovea tbingalready l:nown: Too, sttrdbntsfire-quentily deplored tlieirlack, of personal cont'act in work with professors. Ilig~h: Tor wasestablisliecl to bring the young and thees{?eriencedi iitto direct wnrkingcontact-one that would ordinarily not' occur during the studentl.,' truly forma- tit'e['ears.. Retiring professors welcome the removal of' burdensrelat'et11 to, formali coursee preparation and administrative work : such burdens do not exist at IIfi,h Tor. \fane have indicated a keen interest in the youngest students' enteri:ni the bio- medieal world-individuals: with whom they commonly have no contactl or joint. work. A five,vearblock of! tiineproves acceptabletlotlSesescientists, and is ~uf- ficientfor amealiingiull contlinuancein aI•~esearch lifeof'qualfl'ty-tlie core of High Tar'-"Iearnii:g,programt'.': The great need iG to create a cliiuate ofl total' scientific freedom-to stinurlate ttuly original research, rather tlian, to provepointsalreadym::fi Studlenta mu~t heeshosed'to front-linerii not tltesecond-hand informntiont!hat is:merelc passetalonr in tioomany conventional unirer_<itl}-cour:4e~4. Cynicismh'nds,noandience at Hn:,h Tor. Le;irniit,, is for one'sown pleasure, and its ultimatebenefitl to a..-tudelrt dhntaQUis nodiscus<ion. The li'fetime~ cus-tomsthusacqnilredform thefound.ftions of trueschoLtasliip: High Tor stands as a: workableaitiernativeto cynicism. Itsaim is to raiseai generation ofsoien, tliststhat istruly alive. The stories of 1 eYrICassoclatlOny st.tir7ent #1. J. Ilowever: liis pe three endocrinol- ofendocrinology I.)iscottra°ed a toIli,-,h l:or at t r,n >ttroid, llormwas a fulOtitne sti ut esperit•nced tvl •ar of'reseaa•ch. .I. I'.. for7neel. the tliree Staif t tllan r ye:n•, thl vr,rlrld f'tmou.,* en \,m-, .I., L. i.: t Wlievl Ile _et. 1. ;,r,l_r:uu Will II:', nr,~ictitii}tuuLlaG iir•imcill;tdly he 11 ~tullcnt"* caney a crllle•a:ato g .:rrrrIrtlt' =lyr,arulll Al:, i. tt. whr•t'e~ ~l,c, fi ,:Itnl,uh: \I, r4f' lillr ti~-tur t ~tllirlr }Ir ~c„rli tiltuce- ps r.,dll•cr.. "r tih, I'mIn,iaai',in L- inr-IniuC' ,1uwr tal,li l, t1 -Itit,•I1 irr Ir r i ur•rlii al lall„t iu•r>r IC ;,nrl' 11 .~i }~ Inahlr/~i~. invin.~'.•1 rolu 1~u::u},rrci>,'ll' ~ •ii•u,,, II„Ilrl qnl ;tr t, n n::I }~t`a•tur~tu Inrl nt rl,r~n,

9301 Mr. SATrERrtEt..n: Iliave justt one question, Doctor. If this be true, then I would like you to tell us what significance youu attach to the relationship betweei~ the decreased incidence of' death from tuberculosis and pneumonia, to t•he increased incidence in lu>ag, cancer. Dr. D=Y. ][ don't attach any significance particuiarly to it. 1Vir: SATrExFrEr:n. Btat voni did betrr,een the heart and the ln.tng. Dr:, DuFFY.Be.cause it~iscurrent. Ii can balance thetwo. The aeerease'in deaths due to tuberculosis has been a steadv decrease since 1910: These two that I am talking about are going. up,Vand they are going up: in a peculiar way. I agree, with you Congressman Watson,, that we db not know a.nv relationship between a coronary heart disease and lung cancer and I would like; to withdraw my tlieory that the reason we do have less lung cancer than the British is because v-.e have coronary heart disease inwounger males in our country. M 'r. nllacno:~ AzD: The time of the gentleman has espired'.. I want to thank you gentlemen for being here. I did nott have a chance ta welcome a representative from a university that happens to be in my congressional' d'hstrict. I am pleased that you have been here.. Thank you very much, . The~committee willlstand in recess until 2 o'c1ocL this afternoon. (Whereupon, at! 12:1S ' p.m. the committee recessed~ to reconvene at 2 p.m. the same day. ) AFTER RECESS (The committee reconvened at 2' p.m., Hon. Harley 0. Staggers, chairman, presi.ding. ) The Cx_'iR_.rAtv. The committee will come to order. tiYe are in a continuation of the public hearings on all bills pendiing beforethecommittee~ related to the labeling and ad.vert'isingof ciga-rettes: Our first witness this afternoon will be Prof. Theodor D: Sterling, Washington jiTniversity,, St. Louis, ]NTo: STATEMENT OF THEODOR D. STERLI;IG, PROFESSOR, DEPARTMENT Q'F APPLIED MA7PHEMAT_I[CS A1'OD! COMPUTER SCIENCEy, WASIiING- TON UNIVERSITY, ST., LOIJIS, MC); The CnA-utasAtv. We are happy to have yo~tu with us. ~'~'eare so~rry that ~s hav e to run these heartnbs in, the afternoon, but we have to do it to complete these hearings. 1CTr: STERLING. ][ nnderstand. 2Nfir., Chairman. The CHAIRMAN. Very R-ell. Youmny proceed. Mr. STERr,iNe. My na.me is Theodor D:Sterlin-; and I ami pro- fessor in theDepartment~ of' Applied -Mathema tics and Computer Science at I`'ashington Unii-ersity, St.Loui's. I have been professor ofbiostati'sticsfor 8vears, ati the~ C'ollegeofb1edl'cine, ~cine,~ at theUni-versity of' Cincinnati.V I am the former chairman of the Biological Processing Orgftnization. I have served for 6 vears on the American Mathematics Associatiion Committee on Underrraduate Pro'rams in Mathematics.. I[ am at present a member of the Cbmmittee of' the _kme:rican Associatior . pmt,ition matters in m( The field in which I research concerns the A T€trge number of' mi on the analysis and i ltoalth probl'ezns such ,~ttect of low doses ~_oopiasia, and the~eff ~'idenrally,~ the~ effect I ,un also serving~~ no, rntbl7c agencies on p ~I•heue incl4idethe~~Na f)f ~~~ciences, the V'et~ :17 ,l nlurtber of' univ ihnlf and at the invi !brhal~fiof~lVRshingtio~ llt is ~ inevitable~~ th I'ttl')lie~ FIeallth~ S'ervi' in di~;tnreement wit~ -(•Wntists. Iit is in t ,1 i~-a (_rt.•eement be res r,-le%-.nnt ai,ilyses b liair rt-olvef by~ tl~ iniltois.~Wllenl wa and Heal i~i tho Division of ? Ilealth Statisti ~ ,t•vevi it.ras agre ~~,illtll he made av; lh(, ~~ iM(lust~ry: Indel =n}mlitted 'to the Pt \~[i\- conclusions i, ili,l,.,4 hedi by the Z'. ~ i''li;lU ;tn,rly~es cot : n rt. .`Ci;a!rette Tiitl~~e concl'nsions~ ~ ntl ~npporting-d; (~'clattq- fi;r~1l`ealtli , -,u!nittee ottthe 1' II(l:ua Ml smoki ~~. ilic11 the Publsc~ ~I \7 ccncern hei, Wi;le -%-2riety o ~~ nd Nsitle the~ pro ~ "V N.-Ilicli morbid i r~)niparin-, sn 1 1~. ; inI these dat ~'1tt conclusions~ ~ ~L t IIOIIo.U_-~]l.lcc ~ l,,lr,icteristies"' 1~9 ut'all rMe

945. 4s a report hich shows in great de- and other . C' glve any . percentage ~llichigan. Center for wed in my ercenta~es. ~ F6'0percent from wives il contends, examining n bv wives. I?oint, that :1 vt~ime sur- "as daytime. ic. Tin goino hired. She ,c>me. If she concerning could come )mplete her iure fortllethe report : v: there were ieNved,nere ,•v-iejved be- ~ would'lfike~ vou would This would ,.ve:~ to sendl me person. populatl.ed by tlle Xa~- I "random"' rinistra,t.ive~ erogeneous JLr. IVATSO_N: So, in an effort to try to capsule your testimony, first,, tlliee methods~ of gai~ning thssinformatlon wered'ublous at best, so faras agener<iI statistical method used for gatihering such data. That Wouldbp -No, 1, because of the high percentage of proxy inforlnation. N o. 2;even the inf©rmation that was gained, 50 percent of it on thee males by proay; even the conclusions that were gained or made on that information are hibhly contradictory. Is that, in essence, the thrust of'your testimony?. Mr. STERLiro:I would sayy that this report contains tables which ;:pparently have been read by very few people. I would suspect that many individuals who have testifiedl concerning this report have d'one very little, perhaps no more than to read the conclusions from cover to cover: But this report contains tables giving exact breakdowns of howma,nyindi~vidua~~ls~ti~erecountled,, who smoked, who, didn'tismoke;and how many diseases were counted. According to the breakdowrls,~ very often nonsmokers showed more diseases than smokers: Former smokers ehowedl uniformly most diseases. 1Tr. tiVATSON.I personally looked at this a little bit. Of course, I havenever madethein-depthstudyo,f thisreporti, as, you have:, But even with a cursorvesamination ofl that, I saw just glaring contradic-tions, and even intormation that was startling so far as contradicting the position of the Surgeon General. When they were queried about it,, somehow or other they attached little significance to those figures that. seemed to repudiate their positions; but they did give a lot of emphasis to those figures that supported their positiomIwas rather distressed about it.. I think it is helpful that a man in y our position would give us y our interpretation from a professional standpoint. Thank you v ery much. Mr. SA=xrrELn.lIr: Pickle. llr. PICKLE. Thank you, i~Zr: Chairman. Professor Sterling, your disagreement with the survey made by the HEN is very revealing, and somewllat startling. You take alhnost contradiction vrith some of their findings. I notice in your test.imony,, and I haven't had a~ chance to read all of your test'iinony, you said', on pab 1, "1 was asked to review the Public Health~ Service publicationn of Cigarette Smoking and Health Characteristics." I wanted to ask you, who: asked you to make this survey?'l~ir. SaE1~rIn~G. These were a number of gentlemen who; represent or at least told me they represented some of the cigarette companies. Mr. PiercLE.How many sampli:'ngs, did this snrveyy represent madee byt~heNational C'ent'~erfor Health Statistics?][ seeit, is fu1T ofper- centages, ,but d'oyou have any idea how many they actually sur,veyed ?' lI'r. ST'Eura!~a. They claim 144,000 i'ndivichlals: However, on closer reading, it turns out that 5 percent ofl these individuals were never in- terviewed nor was any member of their family interviewed. Itwas, simply assumed that if' in, a sampling segment a household w<ns empty and nobody wast'here„ that the people whoIived there had the samecharacter'cstics cliarapeopleinthe zenerall population. Second,these do not represent 130;000 intervieivedl whatever 5: per= centl, less would be; but,actualluonlyhalfoftlrem,, because the people who were interviewed were o~ly some of the malies and most of the females.So your question is diflicul't to answer because the report says 29 -236-69-pt. 3-5'

907 that LCINE, erned •ntive antly rdous. )blem mple, and'. ~ fo1- king' )acco. ,tte.,,, -hose, dent': oun. De- reat- -ien- the 1 as trchi xith lem- noes the Nns' tire ien- Dr. few e of ien- Dr: ter ca- tal :id- )ke uc- To be •nt •et on, is as: ..t ali :e. •n ia re 1f,• <s e ,d that a significant reductioni of' benzo(a)pyrene (more than 25%) in cigarette tars has a1ways so far: been accompaniedi by a significant reduction in the tumorigenicity of the tars. .lloreover, this of' course links the biochemical anal- ysis with biological animal tests and is therefore of' considerable consequence in est'ablYsbing,a relationship of scientific acceptance between the two types of' experimental methods, Therefore, the practical importance of this type of work justifies our accepting the assignment and in determining, whether or not Dr.. Hudson's work would,be corroborated! In: February 1969; we participated' actively and continuously in the conduct of these controlled bio-chemical tests under the conditioni that we would render a report stating, that they were completely independ'en-t: The results then obtained should be accepted entirely on their merit. The esperimental, testing program was begun on February 10, 1969;, and on April 18, 1969' Dr. Larson and I,,as spokesmen for the independent team~ reported the following, results: (1) During our visit to the Hig11 Tor Foundation we had, satisfactorily demon- strated to us the professional capacit'y and the scientific integrity of the per- sonnel of'the High Tor Foundation laboratlory. (2) The commercial tobacco used for the experiments consisted of three parts from the same batlch~ of tobacco that we opened : two controls, one of which had no_treatYnent at all, and the other which was sprayed with water. Identical tobaccof'~rom the same batch was sprayed R-ith~ t'heChemosol formulation under controlled cond'itions., The results showed! ini the laboratory that there was a significant reduction (more than 25r/'0 ) of benzo ( a) pyrene from the treated sample and the same condensates that we bad tested which were also analyzed by the Stanfordi Researe,h: Institute showed significant reductions of benzo(a)py.rene: They reported to us a 34% reduction. Therefore, we repeat that' the independent research program conducted by us corroborated Dr. Hudsonis results and is in accordance with accepted scien- tific lirocedures and techniques. In addition,, I had an~ excellpntl opportuni'tyto observe tHeresults of theE3igh Tor biological t'eotingon miceand tlle dramatlic(,sq 'o)reducti:on in cancers in mice treated by tlhe: Chemosol process. I am,tliereforepleased to report to, you that as: a result of ai completely inde-pendent controlled test, there is no doubt that there is ai significant reduction of' benzo:(;a)pyreneas, a result of treating commercitil cirnrctte tobacco with, the C'hemosol' formulation,, and in my opinioni this does indeed produce a less ha:zardouscigarett'e. It is, in thepublicinterestthat, thiksafer cigarette be m:nde available and the public so informed. The Cirxir.-NtAN. Thank you, Dr. Duffy. Mr: i\Telsen,, have you any questions?' Mr.. NErsEzv.O111y for the purpose: of etnhhasis., Dr. Ihldson, you refer, on the first page, to the statementof'John (T'iirdner,"W'elnust. work toward the development of less hazardous c4rnrettes:"' T1'hishas been iiefel:red~ tosever.a~l times, but forthepurhoseofemphasisI repeat it no~~, and also tl'ieobserc.atinn tlir,t youi make that therewill be many,many peohlen-,ho contimret'~o smoke regardllessof advertisinLr. Ithinhthis is a verv llonest observation.I~ather that in y.ollrtestimon~.you a~reelnphtitic al~otitti~eneedfor develohin- a, less Tliz<zrclous ci-arette, admittiihatthesame time that, peohleWill continuetosnioke,and that advertising aiIonewill notcuretheproblem. Do,yoa believe, mohe mnl~~h,isisshouidl beontlie derelohtitenti of' a c igarette that is l~esshEtz,lydous hazaIlernsox., 1 es, sir :that i's correct. In fact, that relnarh was iaicIuded' inSecretary Gardner's ht•onouncementlin 1967. I-Ies`Lid that some~ small -ains, had been made through advertisin, to convince people not to take up smol;in,- or to :,-ive it up; but that it had become obvious to the Department of Headth, Education, and Welfare that this was not ~oiil~ to suffice.

928' It is a very interesting exercise and has been going on for some. time in outside scientific ci'rcles as y on are well aware. The associatian, of ci'gare,tte smoking and various diseases is no longer doubted in any medical school of which I am aware. In fact, the association between chronic,, heavy cigarette smokiiig, anxl certain human diseases has now progressed to the point where -we now cani actually pick out the sick person to whom: cigarette smok- in; is,absoltrtlelv deadly. «'hen I said ~it R-as~ full of' da~nger, I atn, perplexed by the ma~ri- tude~ of i~t and z-~et~ again liy tli~e~~ pec.2iliariky~ of this~ relati~-eIy~ low ~ level circinoffen.~ Pi•obabl~ only about 20 percent of the people who smoke heavilv actually get into tirnuble even after 30 or 40 years. But they do aet' into ~ t.rouble:.z-.ith an increasing rate in the 60 to 65 year gi:oulp-Thtit~iswhere~you look for,it;.~There~~is~a; particul'arly~rapid onset.~ and progression in some.~ of the5e~ cardi'ac disabilities, in heavv smokers. To compromise with anything short of the most specifie warningis poor public health. The 26nerican l'Iedical _1«oeiatiion and the American Public Health Assoc.iation k'~othi agree that ci(mrette smoking is a specific, majbr,~ and dangerrous~~ health hazard to~ an unideiitifie.cll pop2il~ation., The~ ~-.ery unidentifi<auility of'the populat~ion: would make it necessar.y.~ to~ arri~e at somethina like cigarette smoking is dangerous and' may cause you cancer, heart~ disease;~ and other~ disabilities,, or~ something, equally~ cheerful. ~ I wonder how ~ many people~r,ead these t~hin o-s~ any~wa,.vy Congressman ?~ i11r:~ Br.owti. Ha~y~,be we ougia,to~ niahe a decision on ~ ivhethcr~~or nr,t~ it~ is simiificant.. Ti hat is~not oiar~bnsiness tlo~ de~cide how ~ si~rnificaQit it~ is. It is our liusiness ~tomake a decisiom The analogy was used sometime ago in the committee, in regard to typhoid, between tlhe~~ night air, the. s«amp„ the~~ mosqui'to; and the actual zern that created the disease. Wot.rldl you care~~ to~ eomrnent~on that analoo_-y?~~ Far~you~r sati'sfaction,~ is~~t.he smoking of citraret'tes, identified clearl-6as~the~~germ~ in this~~case? Dr., DUFrYc I bel~ieve, so. I-,i,ould also~point~outthatepi~dem~iolbgistls~ have~ long, known that the tubercl''e~bacillus on1v ~ causes~ tuberculosis in some individuals w~ith~ the appropri'at-e~ constitutional dhsposition, andd body defense~flrom the~onsetof the disease. In that se.ntie~~ smol:in~• cigarettes pro~-ides~t1~e patlto~Ten, and so~m~- th~in ~in~ i'rn that tar,, which we have ea~lled an indicator, nneasures some of the unknown substance that txi--gers dise;tse~~ mechanihms! in tlie~ bodN-. For exampl'e,, mMers~~ w~ldo~ work in t'lie~ radio<let iti-.e~ mi nes of~tl.ii's :eoun- try ~~ have a~~ ha~rtiicul'ar etcess~ of~~ lun,Lr cancer~. This ~~ is niost m<irlc~ed in the smol:ing~t~t•oup~~ who are~ workin- in a., radioactive~atmosphere;~ and in the classi'c terniinolo~-•; ~ ef'c;uncer~produetion~„the~~ radi'bactvttz-~pu:oli~- alslv potentiates the~dcvelopment of the cancer due to~~ci(r~~arettes-wh~ose action probably only initiates the process. Cotlnressman Sprin,g..r asked earlier aboutthe~escess of 'l~ung~cancer~ and lung diseases in Great Britain compared to the~ T.-Inited States. One reason mimht be that they ha ve: less coronary disease. AVO obvin,is' y ~ don't Il~now t~lie Cmal answer~to ~~ any~ of~thesa questionsa I tlrink~ it is ~ because of'tl.ese~ co-factors~~ which ~~ou have brotugh~t~ out in yollr anal'?Zt91~r'. "~ t' As: Dr. Hudson mE ini such a multi'stage place, it may be poss . cure by significantpr( 1 am sure that is ~thf Mr. WATSON. Doct I~>ri'ti.sh have~ more~ p~p diacd6seases?' i)i. Dr,riY. Precis the affe ot'1O to~o0- -IIr.~ WATsoN. Slow . Dr. D>;rrY. I hai i~roipressionthat you ,~ Mr. WATso-N. I a l,)nLrer.~ That is quit pmlmonary~diseases 1 That is a new inj' A!and. Mr:~ Dt-FFY..I ha factors in the cause Britain. At the sai: many deaths and! tl- i'roui diseases~~.of thc d'eficieney, compare, ~rimarilv~ e~ 1'Ir. C'ai pulnionarv ~ disease 1,() relh.tionL ~ Other~ riise,ise., the lihelih You are telling ~tatementst that ar I)r. DrrrY. You rloe last part., 1l ttnc s-~c s have 111ise1Se~ sec.ond~ary <niol:ert., l :um not 1re,iuo d iSease:dc 'hhe~ hind of lie rii-~e,ise mor'tality~ r,1vt tiecunrtaryto~~l~ ctict¢l4u- item?' .~ N it bc(,ause, A)-,I W:ry~~a bit, too~fl'ip,~ lr-nr ih,rt;~yott h;tiv, r Q• i 1' ytoit~ want~ t( ,1, ~ t I~leN- ~ haN'e, one 1~piilln1onEirv ~ susce~ rrf (• re(;ncury hear 1' I r: 1~`..~rwoN., v- ~~ die~ bel'ore~ «n 11~r. '4vr-il:r,t•r1T ~ J{i:

932 scientific procedures. I will endeavor to summarize briefly the sub- st.a,nce of the major shortcominbs which exist in that report. There are three major objjections to the report and to the use of the data on which it is based for estimati2ig the incidence of disability : 1. It is not clear what the basis data actually represent. As an index of health or disability;,the information collectedlby the i`ational Health: Survev is beset with errors. These errors are of such demon- strated magnitude that inferences drawn from such ma.teriall about differences between population groups suc1l; as between smokers and nonsmokers, are, probablyinvalidlCertainlv e' st'iiYlatesthat a particu~_ Larnumber of disabilities-or that anycTisabilities-arecaused b5~~smoking are meaningIess.. 2: The data obtained by the National Health Interview Survey are compllesl1v affected by a variety of confounding variables: ~~'`~Iiat dif- ferences may appear between disease and disak~ility counts of smok- ers and nonsmokers depend! on the manner by which the data are dividedinto~ ea~tiegories according to health, sex, ~age„ employment, and other population characteristics and by R-liiclr observed disease counts are "corrected" according to differences in the distributions of posr sib1y confounding factors between! smokers and nonsmokers. The com- parlson~ of "raw"' disease counts dbes not reall~~- show anything about the effect of smoki'ng; nor would this constitute a proper comparison. On the other hand, it is `sell known that the multivariate data may : be made to show almost anything, depending on how they are dfivided up for comparison and d'epending on what bases are usecl to `'aadjiist"' observed numbers. The analyses perfbrmed on these complex data fail to adjust for so many, sources and factors of confounding that their conclhisions lack conviction. This weak and unsatisfactory analysis of data, lacking alkeady in validity and reliability, does not diemon- strate any health consequences due to smoking or associated with it:3'. F.]ven if the calculated disability rates are accepted on their face value; which they should not be, they do not, in fact, show that smok- ers suffer from more disabilities than: do nonsmokers. In fact,, female smokers for whom much more reliable data are available than for male smokers, have flewer disabilities thnn do nonsmokers. Also, the con- sistent pattern with which former, smokers appear to suffer fronI the highest disability rates is in contradiction not only to the conclusions of'this report but also to the insistence that one of~the mtljor pieces of evidence for the harmful effect of smoiiin',; is that stoppin g, n-ii11 be followed by a reversal of ill eftects. 1. TH'E EXTENT OF ERItORS IN TIIE SOUr.'('E,DAT:1 When two groups are comparedl on sonle meesln•ement, the observed d'iffere~nce~ should be evaluated w~ith~ due~ regard for the~ accnl,aicy of the tool which is used to measure. This is a,i very commonsense rule. Let us~ take~ an instance~ in which we~ are m~easurin,; the~Ilei-lit of in- dividun3s~ by.~ aiking chilklren under 5y.ear,~ of u-=e~ the height of ~d.zddv." _lsstune t~~hat if'we eornpare the heiglit of dacldy ~ ab c,.,timcrtecl bv ~ a5-Year-old to~ dadci'v"s~ real l.ei;rhti,~ a 5-yenr-old is wrong~ on the avera~re~, by~ as mu~ch, as, ~ 3 ~ feet. ~~,~'e~nould hardly pay much at'~.tention~ to~ a I~eport wIlic.h~ clainisAhat the a-verage h~eirli~t of daddies wl,1o~ a~re~ firin disc,inlinaria,ns,~ measured~ by this~uncertain method,, diffcrs by~ ii~ :~ies~ from the avel would insist t1I~, of different ; %era<_re error in, thc. lN"E «--ould be even -criouSl-V if there i: effect on Inetho(I use~~ stleh lnagll. :fflaio~~~y~ is~ not uusuitabl'e,~ thev cotne frc a ei t alo they me I" pularion i I'r,~~sazis inte (dt title' Znf o'9I~ ~ ! ,e rc,port proE~. represent,,~ti-% „1 •I ~,rarettle~Sm ~ ~~_.• of the advan' ;ie -tuul:inr'a L i< ri-,iresenta ~, ru,.-. uha.7allo«-ii e'aimt1la n fuct, tl 11i a~l onI pa;re tLe primnry - •~ri., :!:P1n:S. Uilsel T.I1111tlng the E.',( ---E' ille~e ~tat 1'-1e :~nE~tholl C i~:ure of ran~~ r~ had to s,ul ;c 1_ners c that W'.: cii, srnt] tr ~~,i~: r;t~ttion !1it ~iti'lll~ n ~~t1td1]1i1r1A'ed, 1, ~~rtiti ~ cLi~able : nt lv eju:&V , n u :<r i i 15 t.vn iur~,rJ»aui~n ~ fr rlun=: 1111 tlte I !'r.,m c.,est. !iwld siitpmiow ~ ; ~hc Stitliatic,

900 the physical makeup and there may be a correlation between the desire to smoke and cancer. Do you have any experiments to verify that? Do you underst.andd what I amitalking about z There are two factors., First, the age bracket. His statistics bring out that it is probably, for the most part, 61 to 65 years of age;, roughly. Seconcl, there seems to be a correlation between the desire to smoke which a personi has and the cancer inducing whatever it is in his own systemLCan vou understand what I ami talkingabotit ? Dr. >rIt;DSON. I think I do. Though you didn't say so, you are refer- ring, to the incidence or the highest incidence of lung cancer, and its occurrenceiarthe sixties. Is t'hatcorrect ?N2r., SPRINGER. Yes. Dr. HUDSaN. As an experimentalist, I look at this not so much as an age factor, per se, as I do a cumulative efect of too much chronic esposure.. There are types of' cancer which are regarded bv cancer researchers as bein g, cancers which develop iiii response to substances which has a threshold level; and then the other cancers ih which this is perhaps not true. I-will give two examples. It is highly que~stion<zbleIodaywhetherornot ionlzing radiation actually has a cause in callcer. In the case of tar cancer, it almost certainly does have, both in the human esperienee and in experimental animals. Mr., SFRiNGER: Heseemedl to indi:cat'e~ one thiizg, that R-asa surpriseto~me,,tliatthereisprobablymoresmoking amongthoseof relatively younger ages, more people, percentagewise in numbers smoking at ages below 60, andi it doesn't show up: Dr. HLDsoN. But they would not have had the cumulative effect of exposure over a long period of time to these cancer initiators amongg the hydrocarbons. This is true in industry, where there~ise$posure tosirnilar and evenn i:dentilcali substances. IP'h~ereworkers «orked as cliiiuneysweepsiir, the period around 187 5, theydescribedt'1iefi'rst occupational cancer that Iknoav anytliing a~boutlF~lien tlieydescribed!theskin cancer in chimney sweeps~hn~ch~ ,,cereprobably benzo(a)py~rene ciYncersorsomethi'ng close to it, because of the continuous exposure to the soot of' c.himneys. I cannot make a statement as to how ofteni the Enylishl batheci in that time„ but perhaps there was almost 24 ' hours" exposure ta the soot. But it never developed' in a person who worked at the trade for 3 monthsand'then quit. The same thing is true in the hot tar iitdustrv, lbeated near my home, in Rockhlnd' County, V.Y.,, and which is an institution for the prodhction of tumors as well as pipe. Mr. SrRrrGER. What would you think, for instiance; iir England where, cancer is twice as great as in this countr,v? Dr.Ht DsoN. ZGrhy do I tliinktliat is in~ci~~~rette,snaokers?~~~1Tr:SrRZNCER. Thisquestion was raised bythe statistician yesterday, also: Dr. H'nvsant. I tliQnkthi's is a question~ that I aml not competent'ta answer definitivelry. I would wondcr if anyone is. The iildicators are present., There is a hi, that is commonly smo incidence of tumors, ji Institute uses; and «li paintiimg, , of! themous This work 'was pub: in Buffalo, N.Y., by E authorities in this fie They find the higl paintin= is caused by be] ieve it directly rela. Alrnost a1T cigarett N'rr. SPItS-NGER. Th~ The CFi:XiR_)taw., 39' Mr. 1LACDO\ ALD. rJ Dr: Htidson.I cozi to the committee. I ax I had some trouble 41 Translated in gen, is that the present cii,, of lnnlar cancer, is th. Dr. HzDSO_-S,% Idorzsronl dici. I read ii voii nnv e-po~;ure to fae,tulltz= of the med szcience-I worhed c In j;irtr of myv ti facilitv at I'nst Or: _Liiertisic.h, wlio;ze.naI>enween tlbeseti« tltrnroniy atl th_atti torv ~vsztem. They 16ar't to do, which is I will explain tl, ne\t. to one anothe sycrem frorn the I eti:~nline~t: By doinz this; t pathoio , 6cal but I inafelvrnali`zrant ` 'Fhcw fonnd tlii ]iabits~ of the peop lx,nlnninir ofmv tn een the smakin, 1'liis preceded l 1)elievec rrlatism l~ip: 'I'lrih is my antl. Mr. .l [ACnONALI n1onp rl,nt, vrnl a1: ci'naretteindnstr, safe ci;r:~rette, ist.

939. 'thod: i usted =mok- okers,, resent s., for year. ;ories rnkel:s, ormer d dis• rather tance, to the ~ailsed ird to )arent 'mok- discon- sl data L shocv, ars can. ) smok- ~eases, o stop What based equate. ,trat'es' e data r£erent in;, in a pub« tg and. Vmeri. -d due work, l "due udv- ned~ ln~. phletst LYII. ioking : t that 'v andl o'r'by oi her impeccah]e sources. Snch clh:ims lead to actions that may affect the health and Well'-being of1'arge numbers of citlizens. ftt wouild appearflial a thorough review of'the quality of'data, the quality' of analyses of these data, andi thesound'nessof conclusions liavet'obe most care- ful]restabiashed before theyare,used in support of publi'cpolicy:. (Attachments to Mr. Sterliing's statement follow:) CtrR.RIOL'LII3f. VIThE-THEODEDR' D. STERLING' Eriucation : A.B. (with honors). U'niversity' of',Chicago, 1949. 31.A.. ti niversity of'Chicaga„1952:. Ph. D:, Tulane i''niversity;,195a. Professional AfHliatibns :. Professor of Applied Mathematics and Computer Science, Washington UniL versity. St. Louis, \IiFso+:rii; Visiting Professor in Computers and I3ttniani'. ties, Hebrew Union College, Cincinnati, Ohio; President. 11LEDCO'MP' Researclr Corporation. Cincinnati, Ohio ;~ Senior Consulting, Editor iniCom- pntier Science, Macmil'litnCompany. NewYorla. Formerly Prof'essor of Biostatistics and Director'of the Computing Center;, College of \Ledicine:, University ' of Cincinnati;, Cincinnati, Ohio ; Assistant: Professor of Statistics• Department of St'atistics, \lichigan St'ate Uni- versity, East Lansing, Michigan. hrof'essi~onnlactlivities': , 1cJ6°Z-67 : Member of'the Panel for Biology, \fanagement and' Social Stiences of'the 'Mathematics Association of America. 1963:,C'hairman, Cbmmittee on Activities of Blind Professionals~.of theAsso-ciation for Compnting:llhchinery. 7664-65: President. Biblogical Information Processing' Organization. 1!?66 : Member of' Committee on Radiation Dosimetry, Anlerican Association of PlrYsir•istsin ,Nfedicine. 1J66-67: Chairman. Commi'tteeon Accreditation, Association for Compu'tingSdachinery ; Consultant on computer data management and statistical' prob-lems to the National Science I'oundation; the Veterans Administration; and other health agencies. Professional and Honorary Societfies; II'onors. Awards: Amer. Math. Assoc.. lirzth, Soc.,, Instit. \Tath. Stat., Amer. Stat:, Assoc., Bio- metric S'cre:,, Southern Soc. Phil., A'ssoc!Computing Machinery, Amer Assoc. Univ. Prof'., riT:I'., Acad. Science, Amer. Assoc. Phys. Jled., Sigma Xi, Pi V'Iw Epsilon, Morrison Cressy Awardl in Naturali Science. Pcr.4onat:'Born: 1923, :1Iarried: 1948, Two Children: 19,512, . 1955. BIBLIOG[iAPIIY OF, TItEODOR. D. STERLING,, PROFESSOR. BO(1Ks ~~. f'onrptrt'ers and.,tlec Lije'ti'cienee.9, Columbia Press; December:19fii. Introdatctiotto ,StatisticaZ'Dafia Proccss~Gng, Prentice-PSi1l1, Jnne;196t3: A! Guirtc to PL'/I; PIolt, Rinehart and `T`"inston„ February, 1969. C'oniputin,q, andConup'aterScience; .l'Iacmillan, 1979~ (in,press).Conipntationin, Radiolopp;, (T: Sterling, ed.)ThomasPnbIishers, 1971 (in press)., ARTICt:ES .Cir Pe1lution+-Thelndiistniai Z?ie.1 poiut:A. ' comment'. J'F).1f'. ( inihress). Robot Data Screeninr-_1n L'biilaiitous Autlomatiic'Si:;Irch Technique, Procecdinp.Y on' Conference on Stut'i.etFcol, ('bmp'+rta#~ion, 1'ticUnicrrsit'p of' IS"'i;con,sin, .llarti, vmi =Uprrt'8~:30. 1969. , (in preys). V'1a,uring theI':ffect of Air 1'ollntion on Urban Morbidity, :1rc•k.,Environ. Illcatt'ti„ i iniprc,ss) IDii;play Devic•esfor l"oinpntor T'ranslated Braille, Pro'crrdinR.v ('onf'crencer,n NrtU, I'rrire.e.tcs' far' Itraultr a'14riarj~actrtrc• 1968, Cr•nter for Settsot;c.Vi,tls' I•:valuati,on' andi Development, .l[trssarclinsettsInstitnte of Teclinol(~gy, pp. 14-~2il. Feb. 1068. _1'utoniationof'Radiittion Trcatmer.t L'iannin,gV"1 : At;eueral li'ie:cl I;6ntitiou to Ciilculate1'eucent Uepth Dose in theImradiatcrl VolDiaeof' a Cobalt GoBc;un. I;i•it: J. Radiol:, iQ;463-463: 1!16.7'.

a very or and on the alke is iealth. rward bitual it. just ;or of name: i's the ue the )n at- 1 mer; •Ossed 1'-01d ?51ood tudy- lbwn, n the Iv in _1'Ir. ofes- es too tern s of'. rfill: •Y of ) not 925' think anybody on the committee has suggested that they be outlawed or that there be a~ cigarette prohibition as happened with hard liquor back in the 1'92©'s: But the question is: What does the Federal Trade Commission or t'he~ Federal Communi::ations~ Commission,~ or, i'n the~ alternative, the Cbngress, say to the general public about this product which is using the public airwaves to advertise? We~~ have~ not ~one~ into the~ printed material yet. Is it your position that w~e~ shou~ld~, in effect, j~ustlet t'h.e~ American peopl'e~ (o~ along, and perhaps~ say~ing~ on the package that it may~ be hazitirdous~ t& health~h is~suif'iieient iniliglit~of~your ~eommentsthati,t containsseuen carcinocrens~ and that benzo(~a)py rene placed on mice causes cancerr of the skin ? I am tilrying to gett a medical opinion frozn you because we have to translate the medical opinion of all, of'the men who have been in here into sometihing~~ that the~ public should be~ told'. What is y our m~ed'ica11 opinaon about it?' Just that «e~~ oug1A to le,tive~, itthere~~,~or ~~thatl~it~is~~sutT'iciently dangQroust~o~t~he:population a~s~a R-l:ole~ that we should say something else on that package and say somethingon the airwaves ? Dr. Ht'nsoN: I don't believe that ai colnmun2eation between the Gov- ernnient and its opinions on public health problems like thi's and the publi~couglit ever to be~ stopped. Yet,, I believe that any~~w~arning must be conditional because it cannot possibly apply to all people. Mr. ADAMS. Do you think that there shouId be awarning~ a}~out tlliis procluct ? Dr. HLnso-N~. ~.~es~;~ I do. 11r. _LIDA,is. And do~ you thisik~ you ought to ~ let individual States decide what kind of warning they want to put on itt according to the medical opinion in their ~State?~~ Dr. IrIunsoN, nT© ; I do not. 11'Ir.~ AnAnss: Db~ you think we~ ought to~let the Federal Trade Cona- mission4 which is in charge grene.rally of dangerons substance,. .n;il:e a elecision as thev db with other substances and carry out their func- tion?~ S'houldwe'let~them do~~it'2 Dr. Hunsox. I would give a conditional affirmative answer to~ that because~ it has~~ been my impression that' tliis, is~ tihe~ function~ of~ the Fed- eral Trade Cbmmission. But I~ would not like~the es~taFalislunent in mv ~ country of~ a.ny~ commission that coulkll -o~~ beyond those~ poi nt~s ~ at ~ which our elhcted representativeG want themm to ,o.. This stat'ement'~isn't made~ foi,~t~he benefl't of the~ people here~~. A'1'~r: _LnAm,. I a~n1 j~ust tryiis- ~~ to~ (tet fronn yon i.ietlically-andi this~ i!s~your field-what we do~. You have said itis dangea,ous. You h:lve~ said you think~the,people~sliould he warned. You said you think t1lei,e~shonld be~sonie comments,marle ndhen soulr- thing ~ is,safer~than the otlter. I3ut~then yoil s;ii~~d to~~Mr:~B~~rown t1,at 1>e~- cause~ some people~ maybe could take~ this~ ;li2d it- would not~ 1<il1' tlienl.. that we~ should s2y.~only th.It~it "~may~ be%"h,l¢~ardous~ to your liealtili. I'~ n ant to~ know if' tha t is going to be: y~our~~ final position, 1Secal,se~~ that .~~ill be used as~ a medical fact when tii-e~d'e~bate~th~is ma~tter. Namely, you~i•e.~sa' vin!* th.Itall you have~to say to~tlie~pernf~~l'e is~ that, it `:ma~~~ be~ hazai,dous:'~ k~eca2~se~otherwise~you may~be~one of~ th~e lucky ones~it won't lirn•t. Dr: TTt•nso-_N-~. In intle-rity; tlii5 is as much as anyone ~coiA~ld sa;v:~ Mr. AnA-_Nts. Is that your position. too ?

926 Dr. DUFFY. This is the only time I R-oulrll respectfully differ. It may only bea semantic differenee,Vbut a terribly important one. It is dangerous since itt may cause disease; and we db not know to whom. But the fact that it has danger in it,,the fact that it has hazard in it is beyond reasonable debate. Tt is dangerous. Nobody doubts that reaIly;,do they ? Mr. ADAMS. I do not think so, but I aml trying to find out. Every statement' made by every doctor will be used int'his debate; and Iwantsto be lionest with the opinions that we endup-with. I have heard from others tlia.t say what you say; andl I believe it. I have heard something differentliere and I am try.ingto get where we are -with the medical' profession. Dr. Hunsox, lhRyI comment'?I don't tliiazkthereis a difference. I think the difference is in what we are describing, and' I just learnedl what it is. If one is~ describing the smoke, then the smoke may be calIedl danaerous; but if' we are talking, about the effects of the snzoke; that is a different matter. I[f we mean to carry theconnot'ation along with hazardous or dan-gerous, and if we say it is dangerous or hazard'ous, that can't,, in a blanket way, be applied in terms of damage to the individual. Theremaynot beany resultant damageto theindiividual «.ho btlysthat package of cigarettes,, or 1~~:0,000~ of those pachs. B'utl if we at-ee referring to the smoke from the ci~arettes. it is.dairgerous. Mr. DINGELL. Will the gentleman yield? Mr. AnA3ts., Yes, Mr. Di-Ncrr.L. I«-ant to get into this semant:ic point at' an appro- priatle tiisne: If I go over \Tiagarai Pa12s in a barrell or walk on a tight- rope across -Niagara Falls, that is dangerous. I might get safely to, the other side and I might get over the falls tosafeto: But it is hazardous. The! dan~erdoesnotnecessarilymean, that I' am, 100 percent certain of' getting hilled, but maR=be a 10-percent chance of getting killed. It is a reasonable conclusion thatl a reasonable mani woiild'' make. Is that correct? Dr. Hunsorn Right.. 1VIr., DINGELL. If' youtakea populatibn of' 100tn~illion smokers and put them all out smoking, there will be a certain percentage of them who will smoke safely. There is no ~ medical test y~, et to determine whit'hof those people will be able to safely smoke: Am I correct?' Dr. HUDSON. Thatis correct, Mr. Dr-.\-crt,z. But it i5lstat'istically provablethntalarger percentage of the smokers will be hurt from this than nonsmokers, wli.ether it be, emphy,seinal, cancer,, circuIatory disordeiss, orwliateverit n-ti~;]it be: _Lin I correct? Dr., Hrmsol Correct. Mr. IQrNGEnL. S'o then it is fair to say that e~'en thou,li the:hazardd m~aynot in all instlaircesbereahzed in tet°ms~of eniplYysem~a, cancer, or whatever it might happen to be, pulmonary or cardiovascular dis- orders, atleasttliat entire population ofsmok~ers, depending upon certain local d!i'fferencesor differencll in hereditvandl genetics„ all of theml are inl a certain peril, a certain hazard, so there is danger to them in smoking, even thoughl it might not in each instance be real- ized in the sense that they certainly will die from smoking. Isn't it flair to say 1nay be dangerousz Dr. Hrrnsox. Congi thinking, just now. Mr. DrNctEra.. I an answer. T2r. HunsoN. liay ] hntnot if on;e~~extrap. : ons in a generic sen If one should goo forth, then there~~ is~~ x~ J'Ir. DiNcEr.i.. I an, 1l,nt medicallvy~ou~ «-i, _l'Ir. lL~cno~r Ar.n: T You say the rtnoke ••.1: ottld~ your position, tIi ar~ ~this,eigane~tte~ is~ I Dr. DtJFr•Y. Oi•,eat, I)r. HUDSON. I~ di rlle: Mr. .1LacnonAr,n'.1 A~I'r. HaTZaca: I yi _l'ti•. IKr.owN.~ I' ar t',r-cinated bv' the se: ~vo~ _(rro into esecntiN-e~ I'1~r \-er~•~ act ut l~i n tuaz-~he cLangerons I'r. HrnsoN. It in \Ir. I3noWN-. If it T)r. IIt:i7so-N_ No~; W(Iln~sed of'sotne-tlhir~ '\Ir. IKaowN-~. I3nt. ;,.eans, But danger u:unt<rer is~~ the~ si~gni` relatlivel!y ~ c~lear., \ ow we are talk poi 21t. Iwonld l il.e as thev~~ wish. 1+ 0r some~peo~ple ; :1M V I;e 5a-hercent JPMIlY., For solne~ `;trette is goinm t ~ that.~ Finr ~ some tnn to~ cause Yotu The "is" and "in .Tlr.trettrlly, but it ,+\i (lence Which t.h( 11Ietlir:al researche l~,rnduct. I:y that correct?' 1b.e: HUosotv. Y l )r. Dt-rr•t:. Thi 1mtn1Y phi.losophie.

919 THE ~~ I\ nIVSnL7AL. A1'i WoRIC ~eR- Iork, ;ion is an 'prodttct"' l l g_ ron-ing ie with a~ "tudent's •ir oR-n- any?area~ -o largely :ew ideas nroaclJing,c: interest ctudent; : Tor' live. mi:nars- undation. 1s: Others~ :om their f!ree from. :ire work'- t between ~ ~ terms ~ of' \Iembers o at willl.. "at' Higli Jre~ inter-~ lication). mong the nmber of' ~nt, there~ s labora- :Y, exper- -pace. In- property s, origi;nal v courses 'ents fre- Ilirh Tor Worki:ng y forma- 11 course lieh~ Tor.. thehio-nr joint 1.d is suf- , core of tinntlate nts must y n:erel,y 'lleasure; inJe cus- .r stands off seien- The stories of three students,atl High Tor indicate the different'wa5s in which rarls association R-ithwork-ing, scientists~ has bornefruitL ,ytYtdent #1. J. L., at 22;, had a mediocre undergraduate record at Brown. However, his~ persist'entinterest ini biologicali scienceledl him to, enroll inn three endbcrinologv courses at Columbia. Shortly thereafter. the major field of endocrinology for Ph. D: candidates was eliminated at Cblttmbi'a. Discouraged and at loose ends for a new academic approach, J. L. camee o IIi.;h Tor at the suggestion of one of his professors. Here, J. L: went to work t)n steroid hornrones. Helping him learn the biochemical methods he needed was a fulltime staff'ff biochemist. In additlon. another of his teachers at Cohimbia, an experienced endocrine physiologist, soon moved to: High Tor for a sabbatical year ofresearch.. J, L. formed a clbse personal arrangement for his: laboratory work with the three staff men4 two of his former teachers and the biochemist. After less than a year, the~ tihreerecommended that JL L. gotoSt'anford to: workR'ith a world-famous endocrinologist whom they knew there. Now J:, L: is maiintainiiJg, an A record at Snanford andl has' won a fellowship: When hegets his: Ph. D!, he willi enter medical school. Although his: learning, liro:,i•am will have taken up many years, J. L. will emer:;e as an example of the professional laborat'om^ scientist physician to:whomtliefutur.eof medical sciencelnincipally belongs. High Tor provided direction at a critical point, in this student's career. It seemed to the staff' that acc•epting him quite informally as a colleague gave J. L, confidence and encouragement when itl was most:needed: S#udent #2. Although High Tor gives no courses or, esaminations, seventeen- year old 3laggie managed, to get college credit~ for her work there. At Benning- ton, n•here she was a freshman„ the middle third of each: year is spent at work off' campus. Maggie *vork'edl at HighTor with the plastic surgeon ini cliar_eof the tissue transplantation laboratorc-; Simultaneously on her own, she de- veloped an experimental approach to behavior patterns in theanilnals«itlh; which she worked. As ai result'4 she now leans toward the behavioral sciences for tlief~uture-psychologTorpsschi~atry. Reports on 3Tagaie-which she was given to read: herself-were sent to her college„ so that several months' full-time college credit could be given. The Fonntlhtion looks forward to more student's in this category, as indicated'i bS incoming queries from various coileges and universities. S'tiident #3. A girl barely 14 years of' age came into the laboratory mainly to establish that the areas of scholarship other than science «•ere those best suited to her interestsal:d proclivities. (i:Iheistlie daughter of' aWidely knoai nmedical laboratory research director elsewliere ; hence:, t'he need to satisfy herself and her father)., J'o Ann, began in the intrieate experimental surgery of parabiosi's. This tlechniq;tteinvolvessurgical' cneation of artificiali "Siamese twins" from pairs of' baby mice. This technique alone led her into indivi'clttal~ unsnperviced experimental science and prizes in the New lork, Worlds Fair Sciencecontestl, theV'assau CountsScience contest and elseavhere-all within onecear following her summer at High Tor. Shewil1 enter college next year as' a premedical student with plans for a career combining laboratorS science and medicine. STU.QCST PnOJEC'rS. P!1S'C _1\Il PRESENT Studentshat•.egained knowledge and experiencei'n~rnany areas. yiJnteinstance,~: 1:)Ii1-62-.1'dierobiological research on deep sea coresauul sea Water ( provided. by theLamont Geological Ob.,ervator~v R-hich ad,joill~ the Potmdhtion property). stttdents'searched', for antibiotic activity in these materials. T hey learned tech, niqlJey'and proceduresini both bacteriology and, biilcheuli tm-: l:uderl)aetic•ularstadr arethe biologricaleffects: of steroid horJnones, acluayof' compoundsllre-riuced bgmaleandy fenuale gonadSand' aclrenaU •,tandS: IIonmonE.sre;;ulate hodcchemistrs„ and tilustlleliodk•'s growth rate and strnctJtre. This workcontiuuesinl;'t;7and haeiln'o1ved «elrk'bc many students. 1'Utl:.-Stndents experimented Wit'h, new surgica1 Ilroceclare,, (indo,;;., They learnedaniulal care and oper,ating-rooiu procedur~es, 7ui;ieaU techniques,, :uJd, l)r'e-ot?erative andipasti-operatiire care ofthe anitna.ls. ]lla4-Two: lroblenJschosen, forinve.t'igation werehomotran4plantation in ani:mals, and the useofe ani adhesi;veasa, su,htLsitutefbr suturosin surgery. Nttt-dents„l,gain worlcedi «•ithtlhe aaJinJals, setting up~and tmtintaiilingtheir coloniesasn•ell a5learningsuchsur,gical, procedures as slcin-,nafting.

943 o not lend luencies." ,ses using -st&of the by otlhers show up commoa tthisisa ,rimental :ia-e. It iis that one ce of' evi- )blems of ase been urvec, as. -ontinued surementt ceunless: tokers as is more tionship3s are con- '.zing t'he - of such ose from, '.tow„ one •ase, and ,Aistician 11despiten tmder- )n, of'the analysis _'or us to rect'or: . 19FiS. A report nefr~om, 11 review tNvae b;- reason- in fact:, another and its, ct more~ )malcelunIth iter the Crnrne- irrected. ; of'our IiA.('On- • reporL .,n ('itiarette Smoking and Health Characteristics we will have to accept at the >:unotiineIirebiozih as an established therapy method and many other dtugs~ ~\ Iiich now clutter up~the market as proven medications. Again this dangerexists, •~pecialiy* because considerablle use is being made already of' this report tb esti- iu:ue the "damage" done to the economv: I'misequentlt•I haRerequested from therepresentlativesof the cigarettecom-i,,•utiesand haveobtained their agreementl to my-.d'emand that my critiq,uebe. ,~rf•sentedto the Public Health Service.. 11oNvever, rather than presenting this critique directly to the officeofth~eSur- L~c ut (~.eneral. i:twouldlbeverg helpful,tothePubl;icHealth SerFiceifthe shortr -.uinas of the report'. would be reviewed first by a body in whom the I'ublic ;1o,iit1, Service has placedl ai considerable amount of! trust. I r~ef'er hereto the. ~„nmittee headedlby Dr. Dndieottofwhich you are a member. I wi~ll appreciate:i .bns if you were to draw this critique to the attention of Dr. Endicott and of' ~ Iic committee so that the Public Health Service masobtain tlle opinion of a: iu;iiiGied' body of'ezperts. I think that in this way the shortcomings of the report i<<r.i best be corrected. :ceause of the length of the report: I have also abstracted and summarized my rnfflugs. I am including three copies of the reportl and three copies of thesum-%uary for your use. i: will appreciate anything you see fit to do ~in this matter. Sincerely yours, THEOnoR,.D. STERYI\.G,.ProfEssor. DEPdRTI[EST OF HEALTH;.)JDUCATIOS.,..A\D.R ELEARE. PURLIC HE?.,LTH.. SERVICE... .NATIOITAL CE\TERFOR.H.EALTH.ST4TISTIC6,, Tir'aslaington, D.C:,, February 6, 1969. 1)r: THEODOR D. STERLI\O, Linpartntentofftppdied, Mathr;rrsaticsand, C'oniputerScience„ li'nshiiidton University, St..Loslis'. JIo. DI 4R DR: STERLINc : This is to acknowledge receipt of' your latest project report, "Evaluation of the Analysis Procedures of'the \HiSI Interview Dtlta." As you probably know,, we are all quite interest'ed in reading your report. Would it be possible to acquire some extra copies in order to espedite this process among our staff?' Also we would like to receive a copy of your paper mentioned in thee bibliographyentitledl •`An Additional Evaluation and Critique of the Report Linking Cigarett'e Smoking to General Morbidity and Disability" nnm> ber J). Sincerely yours, Ia:IJ AII L. WIdITE„ Director. Di~~t•inio~n~~of Health hi~ter2;ietG Statlstti~cs~. hir: SATTElu•IELD (presiding). Thank you, Dr.. Sterlinb: _llr: Iiogers ? Mr. ROGERS. No questi'ons at this time„ AIr. Chairman. _IIIr: SATTERFIELD. _lfir. Watson 2 Mr. WaTSOV. Dr. Sterling, as II understand it now, the te¢llni'¢al'l reason that you question severely tlhe accuracy of both the findin~s and the conclusions of' this particular report is based upon the fact that you h:ad, according to your own admission, a 60-percent prosv infor- mation in referenee to all of the males. Would that be Your basicc contention? Mr. STERLING. Iit «-ould be one of tliem yes. _llr:11TAzso-N.. Earlier we had asked ai statistician as~ towbetlierornot a report -would be considered ver~~•reliable; from «hich 60percentl of tlheinforluation wasgained by prosr.He safid thnt inhisj~i~i~gtuent it, wouldlnot be so. Do j,ou know of ani~ credible st2tisticianor member of z-oursoci'ety„ «liatever it might be,~ n howou1d recommendaccept-in" dhta "aiileil from suchia report?

933 lie sub- , use of abilitS-: A s an ; iitional ciemon- .1 about ers .tndi )articu- lsed by •ve.v are tat dif- f smoh- at.a are ,nt,,and counts of pos- :Ie coM- r about ; n rison. ta nmy :livir.led adjust" ata fail. .it their inalysis demon- with it.. =_ir face - smok- female. )r male lie con- om the- . iusions :Pcesof will be rserred •acV of -e rule.. of in- ->•ht ot iinated' on the ention ho are~ by ?, inches from the averaue heightl of daddies who are soft disciplinnrians,. A~'e ~ou~ld insist that the di'~~~Yference~ of 2 ~ incl.es~~ in the~ averagereported hei_ht of different types of~ daddies is triviaT when comparecl to~ the~ avera(ye error in the method bv which the height is actually measured. ~1Ve would be even more~ disinclined to~ take~ this reported~ di'fiference~ ~eriieusly if there is some suspicion that being , a harsh disciplinariiini has soni.e etI''ect on the n-ay a child perceives the hei(-,klt of his flatller: Tlie~ method used bv ~ the: houseliold-inter~~-iew survey ~ produced er•~ rars~ of~ stlch~ nia-ni'tur?e in count3n_o~ the~ incidence of disabilit'ies that, :)ur aibalogy~, is not unreasonable. T"o~ unclerstand! ~ better~~ why ~ t111e~ dat'a, ~ are~~ so~ unsuitable,~ we~ mizht beai~n by ~~ ashing, oursel~~ es~~ where~ exactly (lid thev ~ come~ frorny~ .r~hose i11i1esses~ do they ~ representi,~ and to what ~2xtent do~ they ~ measure accurately ~ the incidence ~ of clisabilitiesin~ the population?' a. Fersans inte~rvieu•ed ~ were~ nb't~ a represent'ative papulatza~r>n and :: ast o f~~ th e in, f orma t~i~o~n ~~ on,~rzal~e~s zvas o b ta.in ed 's~econcl ~ Iiand, The report proceeds from the assumption that its findings are based on tii representat'~ire~ sa:nple~of the~U~.S: population. In fact, l.t is stressed in '~Ci~arette~ Smoking and Health C'haracteristics," on~ pabe 6'i that:~~ One~of the adrantages~of this stud# ~~ i~s~~ that the data on relationships between ,,ie~ iretie smol#ine ~anr1, health are based on~ reaponses: firom~ a pr~obability sample~ wiLii-h i~, re,?res~entative~of the ci~vilirlm noninstitutional populatioaof the~United! Srate.~~. thu~s~allowing~ the data to be presented! in the form of national estiinates, The~ elai'trn that the~ data are repre_entative of'tbe~ TI.S~. population, 1'olris~,,ini fact,~ tlie~ basis on which~ the "Healtlli Consequence of Smok- in~ ~~lse,,its~~.estimntes on the number of disabilities due~~ to~ smokin;. ~1~"e ?ind on page 23: As the~primar~g~ source of~data in the II.nitledi S'~tat'es on, disability, the~ sur~veqy reh srt. being~ based on~ a nati,onall probability ~ :;ample: Prorides~ aisolid liase for Qstimating, the~esces5 overall disability associated R-ith~ cigarette~ smoking. Are~ these statements j~ustlified ? A The~.n3ethod of samplihg ~ usedi by ~ the -Nationa~ll I-Ieal'th, Snrve~.~~~ was a m~ixture~ of~ random and nonrandbm ~ sampling. Cost and cc~n~enience facters had to, prescribe, so mu1), ~~ compronaises~ -with -w~h:it .,re~ normall ruldoln~ sampling ~ procedures that tlle~ fiQllil result: can be called a, hrobz~liil~itu~ sam~ple cnly bx-~ srnne stretch of the inia,(rination. In fact~ t11e designers of the~ __'~ationa.l Health Survev pointed oe~t fi~om the~ Ihe~~inni~i;~~that~ the dil;~ision, of tliee land nlnss~~of'a~ country ~ ia7to~ar.easo for wI.ichisamples,are to bedt.L«•n was~an "nrt" , rather t'han a; science.? The~ snnlpliir,~ proceclure~ resultecll in the~ list of addresses~~ of house-~ holcls 1vhose~ nnerrrbers n•ere~ to be~~ interviewed and not in, a sample of nnnir.=~titaitionalized civilians. But who~ is~ usuall~v Ponndl in the liamse- iiold Ollring, normal working liour_~? Thev ~ are~ 6use«ives., cliiildren, uiien' pIoyed persons,~ retire~dL elderly,, and temporarily ~ or perma- nentll- disabled i,radi'vidual5. The lar~e~ part, ofthe~, male~ and tlie, eu~r- reuth- e~nplo~'ed, fetnal~e popttlatiola could not be~~espeeted to be present in mcAl ~instaiices~ when the iiitervicwer call~ed,~ anu1 thus (tid not l'tirnish~ inforrnZtion about tl7emselves: This,pa~i+t~icu~lar sli,ortc•onaiur~,r~ lialol been~ reco'.~i~zed fronz~ the~ be-i2uniin~. ~~`e~ tind in tbe C'ornaol)ts au~l i)elfi~l>i; tionb in the Health IlouseliolklLIhl,tei•VieNj- Siir%-e}•, page :3': Promj tbe~ standpoint ofi reliability ' of responses it ,ti•ouldl be~ ideall in hous- 1odh1 iuterviews if every adult cou1d be~ interviesvtai~ for hiia.rlt: The coa~t of ' The ,etntistical'Desipn oJ the flcaltlu Household:Interriew Survey, series A-2; p. 10:

894. as the task force report recommends, to "establish responsible advertis- ing guidelinesi which will permit manufacturers to adftrertise and' pro- rnote less hazardous cigarettes more effectively."' This -was also pointed out early in 19F~~.7 by former Secretary of' Health; Education, and «~elfare John IV. Gardner, tivhen he told Congress :, We must work toward the derelopmentl of a less hazardous cigarette-and, concurrently, help develop a climate of opinion so that as such a cigarette is developed,smokers wiII turn to it. Zlhere is no other way to protect those mil- lions of present smokers who probably will never be willing or able to give up smoking. The task force was therefore realistic when it suggested that! the Public Health Service work -with Congress, the Federal Trade Com- mission, andl media groups to permit adIverti'sii:g, and' promot,iion of less hazardous cigarettes, to inform the. smoking, public of thegoode as we111 as the bad~,and to creat'eincentlives to, develop~ safer , cigarettes: Unt'il now there has not been a truly or practical lesshaznrdousciga- rette t'oadvertise.1$leduetion of tars and nir'otinetlirough t-lieuse~ of filtershas: been acknowledged to beof'some.ilnportance,, but does nott falll into that category. The most harlnful or incriminating substances in eigarette smoke have thus far remained uncontrolled and unre- moved.One of'thesesubstanceswhich is acknowledged byscient'i'sts as the most dangerous ca.rcinoben in cigarette smoke is benzo (a) py rene. I think some explanation of benzo (a) pyrene rnayy be helpful for all of us. The new Gould l'Tedicall Dicti;onary deH'nesbenzc~ (a ):pi-rene as~.`~a, careinoaenic substance obtainedl fromitar.'' The same dfictiona>.y defines a carcimogen as "any cancer-producing substance"Theref'ore, bym~edi- ca1' definition benzo(a)pyrene is ai cancer-producing subst<~nce., The Surgeon General's Report on Smoking and! Health, 1964, (which is a compendium of the leading authorities on cancer research) clearly states: Benzo(a)pyrene is one of'the two most potent of the seven carcinogens de- tected in tobacco smoke and it is present in much larger quantities than any of the other carcinogens listed.. The reason benzo(a)p,yrene is so deadly to humans is because of'" its syner-istic nature wherein it aets a, a"t~ri~-er"' activatin- other po1'ynucle2rhyd'rocarbons and cocarcino'crens; and ron~zequentlh-di>ilnL):~ consider.ablemore damag e collectivel,v than byit'self. For thi~sreason, and because of' i'tis~ pow-~erir7 unleashin- tlhepobenti:~l (1iestructivenessof otliercarcino.-ens, benz~o(a),pyrene is usecl! by scientist4 as an in- dicator of the presence of tumor-initiating polynnclear h~~ ~-clrocarbons and the total cancer-producing potency of ci(ra retit!e tRis: Thisisani extremely importantlpotnt, and~ one that was not clharl~delineated at, the time the original Sur~-eon G'enei.ll'~ Report ~~~ass prepared and published, but which is reconnized by tlieleadinl- , scien- tists throu ghout the n-orld, who have devoted their rese,trch to thisl problem L , Tlierefore, as Dr., Ernest 117"vnder of the tiloan-A"etterin- fu5titute~ for Cancer Research and theyU.S, Governnient Luii, Cancer 'I°ash. Force has published':A significant reduction of more than 27) percent in the l„nioi,r)rpreuP con- centration in the tar hahsof'aralwaysbeen fonndl torelatii, to th< siL:nifil;uit reduction in the,tuniorigenicity of'the t!r: ( `cience, Vol. 1t;2; , -Nor. _'', 1'J6S. ) This is unusual lang sure his stature is kno way,s" is seldom foune emphasizes what he fo is "always areduction the less benzo ( a) pyr( cigarette. Benzo (a) pyrene is, partiall combustion and inhale benzo ( a) pyren explained previously;- forming hydrocar.•bon: burning process. In ot tions in the enl~-ironrrr other hydrocarbons a. benzo (a ) !pyrene actin~, the greatest identifie. benzo (a) pyrene.. Scient•i,sts, in and c to reduce the benzo, endeavor to create r succeeded in d,bing ~ academic value beca: taste and therefore, st•ances,the subst.ane- Wein our laboratli continuously, witlioi Chemosol. The smo under properly cont tities of benzo ( a) py taste, flavor or arorr commercial cigarettc reb lb,r line machine process cani be used result , is a reduction tars andlnicotineas., Therefore, Chern ardous cigarette acc industrv. During our resea ment scientlsts lnfo, advice: We conduct mine the. ef}icaev of pyrene and reli smoke.Our result'sn-itlh,lnanv leadin Oscar _Luerbaah, a Greene,, Cha.irmann cineofl Yale Uiiiv The experiments a nlonse. G1T(:inoens :1sub~;tauco: Tlre 5ectio all tspical'iuouhetibr

904 STATEMENT UF DR. BENEDICT J. DDFI'Y, J1t'. Dr. DurFYJtllink I can be quite brief. I thank you for the opportunity of sumrnarizing, this statement, and particularly before Congressman Prever, ~-ith, ~rhom I coexisted at an eastern institution of learning andi. also Congressman .1racdonald whose district includes T'ufts tiniversitv. 12Iany times medical students iti-i11V ask: what can be done about the hazards of cigarette smoking. Our department of preventive medi- ciile and epidemiology, sponsored :ti, semiiiar by Dr. Daniel! Horn of the clearing house orl sniokiilg and health andl the learling, authority on smoking behavior. Following Dr. Horn's seminar, it became obvious that Are might better concentrat~eour effort on chaiigingthe cig~.retteratherthan changing the behavior of the smoker. In looking back upon these matters, I«-as impressed by a stat'e- ment of' Dr. Philip Lee's; Und'ersecietarv of HIEAV for health and science and quoted by,Secretary Glardneariii: the 1967 congressionall hearings as follows : There aregoing, to be a great many people who will never ct'op, smoking and, we must', get going with the kind of research that', will persuade the totiaecoo industry tb pursue that kind of research that will result in a safer cigarette.. Unfortunately, thereh€tsnot been inuch research ona safer cigaretteand those of us who strongly agree with Dr. Philip Lee have become ever more concerned. I, therefore, welcomed the invita,ti:on in February, 1969, tobea member of aI tealn of scientists who would i-isitt.he High Tor Fouhlda- tioni and participate: inian actual exr)eriment designed to demonstrate the effect of Chemosol treatmentof' placesons thelecel of be.nzo(a)- pyrene in cigarette smoke fi•om Chemosol treated and untreated ciga.rette:, The other, mmembers were Prof. Paul S. Larson, chairman of the department of pharmacology of the i1I'edical College of Virginia, a recognized leader in tobacco carcino~ei7esi's~ and clinirman of t'hesmoking, and health committee of the Educational Research Founda-tion of'theAmeriean i'Iediezl Association.. A chemist member of our team w,a.s lUrs. Frances Dehn of the Stan- ford Research Institut'e.Another participant 'was Dr. Gio Gori, associate scientific directorl etiology area, \ ational Cancer Institute. Another participant who requested his name not be used is a re- search director forone of the Iea,diiig cigarettecolnpaniies. The conditions of our program of corroboration were based' upon a letterwhieh had been received bythe4ligh Tor Fou~ndation from the Health, Education, and ~ti~elfare Department in«liiicli: itwasacknow1-, edged that the submitted data indicated that Cheniosol reduced' benzo- (a)pyreneini cigarette smol.e: a2idthe biologicalexperiments showedthat there was marked reduction of tuniori,enicity in lnice skin- painted or injiectedlR-ith the treated tobacco condensates. Theletterfurtherst!ated tliattheHigh Tor results would llaoewideraccept<2nceby thescientlific community if independent corrobo- ration could be obtained. Our task, therefore, measure the effect of ( smoke and arrange aa stitute by the more se' Ii must say that som laboratory egperimen the specific importane For example, in tY cj clic Hydrocarbons _lliedical Research C benzo (a) pyrene is a present in carcinoger ble~for~allior~eventhe~. Furth:er, eliiring, tll had been interested i t;ioluship of the biolc I was al'so very in National Cancer Ins Park~~ Catscer Ina~stiit you have seen befor ~ Nvith epidelniolbgic, We liave~thereflor tlii5 in(licator, to th s'wm oii these linkr These vi~ew's~ whi( otliel•~ in the work saril3, ~ refle& the ~ c labor,ltoryto witine T he~ experiiiaenta~ :rRIL o1L _~prll 15, 1 1)elldient team, repo 1. IJurin:,r our v torilv ~ clellionstratle~ iilte(_,2•it~v ~ of'the~ pe 'I'he commer( t~hrve parts fronr t trols~, olle of wliicl ~,>raVOl with «ate ~~ith tlie~ Chelno~sc. 11e results sho~ reduction ot al>p:~ tro:uiccl s:ail~jples-a r4) :lnalh'z{'., . 1 nouc(-rnt redtlcti .AltliouurLL it~ W: ~ rk-tilt oC hiol~o~_-'i, (,tl'ert~aaltl'th:execc nmluwtionr in com -r:rpli.,o~l' the an I womld tllerei oIwrat~i~oii5t there~ ual IV~ rvnc :is a n ('liemluSoL ilorilitl

913 epared' testi- i thetobacco , that I hadl hatcorpora- .'ormation to~ .•t.icipated in Cork, N.Y: ? te Chemosol ~ as put into obacco'com- rcent, of all! :hemosol at cost of'the ,ss t'est.ed, at ncidentally, wondering 9 6 7. handle the esses ~ to ~ the~ be usedi in tere not the )bacco com- oratory,the, s offer, this ersonnel at Vashinb on the chemist ibsequently ieulty with 7, was thatt down for is informa- :ence spec- to use the overnment boratories. esirable to; of ilnstru- nd was onn the list provided us;, was t'heStanford Research Instit'ut'e: That is the reason they `rere, chosEn. lIr:WATSOa.. Thank you. Imight say in response tha:t, if' youliavesucli anefTectlive product asChemosol„and as a scientist I cannot argue'with you„ and it can reduce: the incidence of cancer inthe people whosnz:oke,, aiid I'donot smoke, it would appear to me that you would be': most anxious to~ haceit tested atanv laboratory in order that we might move forwardl and ~ive this benefit to the American people. Thank vou. Mr. ll~cnoXALn(',presiding),. Mr. Pickle'?Mr.Ptca:LE: Thank you, Mr. ChEr'irnian.Dr. Hudson,, it is refreshing to have a witness appearing before us -who; smokes as hetlestila'es. Iani g1_ad to see it is a cigar. You are encouraging to me, if' iit islea~ding towar d theprodiiction of aless hazardous cig arette., I-want to ask you this question: Your es'periments show that to- bacco treated by Chemosol could resnItin a~ reduction of between 25 to 34 percent of the element benzo (a) pyTrene., I assume this, as you said~ is, oneoftheelements, -w17en cornbinedl with othe'rs; that , m,ighti create or cause tumors. My question is: Though that is a reduction of 9&to 34 percent of'the presence of'that element, how does that relate to the reduction of can- cers, assuming that ci-arette sir_okin'), causes cancer? Dr. Hunso•r4 The work that I referred to, and other -work -wliich I find ear.lier that Dr. Dnff'y has referred to, consisterll of a correlation betn;een the level of'.~ei~zo(a)p~-rei:u'. in thetotla~l' ci~arettetarsco:n- par.ed with the powerto produce turmors,ilnesperimental animals. Mr. PiciLT.E. Let,me restate my question: Iftliere is a 35 to 31 percent reduction of benzo(a)pyrene. by the use of Chemosol, do2s that nnean that there', would be a?.i percent lesspreseneeof cancer if that wnst'reat'ed, or what percent? Dr.Ht?nsoN. ~~~'~eelon't know that percent,except in expe;rinlenta,l ani, mal§ and there it is just statistically significant begiiininn at the %5 percent level of'redklct.ion. However,, I think ibt is~.rorth whi1eto~ remernlier som:ethin- abotttt benzo(a)pyrene tliEit'wasn't stated lierein eitlrer iny testi3nonti°~ or Dl: Duifv's. T1iisIasnot ever beenrefitt!ed int!he vearstliat this fzlctorb<iaueen in: . the medical sci'entifie literature. It is, this: That the coaction of' benzo(a)P3~.rene-with nther nrnrncrters of'calvovr- is Qoo•r-at O;att it i's of an order of 40Lfold, that the ca2•cinogenic ellcct of the combination eseeedsthecarcinogenie etFectof benzo (a) pyrene alone. T'hishas been cloneboth, positilvel~- anc~l ne~~~ati%~cl}-,bvid~ii:~nto-bacco'condens:~testo known an~ciults of benzo (a)'pyrene, we know the amnnnts necessarvta prodiucecancer,, and also by removing it. Itis thereasors~that the stateinent'front the Sloan-Ii:etterinnIn5'ti~- tuteis, a startlinmlv i~nlportaist'statement. The,ir stateinentincluc?edt the word "a1n 23-.5:"Whe'n youreach the level of ?5-percent reduction in 1,en7o(a) pyrene thereis, allways~ a significant reduction in tiuuorsinitiatecls l,v tile tars. l !i«t.istlie estenri of the ]:nmvled~re; Il belfi^ve. -A~L . PYcrLr•.. Do I tuid'erstalbd ~-outiosaa'tlhat if'Chcrrnnsnl ~~~eren~nr1', thecl.ances of produc.ing cancer ~~•ou>:d be reducacl 40-fold'? _tl~

914: Dr. Hrnso-N. I' did not say that. I gave the experimental evidence that delineates a, 40-fold isicrease„ if you will, in the~ carcinogenic ei£ect of benzo (a) ~pyrene when it is combinedl with the other cornponents of cigarette~ tars. The reverse is true. When the benzo (a) pyrene i's reduced, the tumori- genicity goes do«~n:llr. I'rcKrE. Would v.on venture an estimate that if Chemosol were used in tobacco, that cNiances of cancer activity n ould be 5, or 10, or 15 percent less? Dr. HLDso-N. I ci'on't believe I can give a percentage except as a guess. If you want aguess; I will give you one.I't wouldl be this, that , there would be a statistically dhnzonstrable decrease in the death rate from: lung cancer: Mr. PicKnE. What figure ~oul' dd you guess that might be?' Dr. HuDsoN,. That would have to: depend on the numbers of! peoploslnoking cigai~ettes before we could ascribe significance to a particular number. AIr.PicKLE. You would not hazard a guess, then ? Dr. HUDSON. I would guess it would esceedl 5 pereent, It would ex- ceed that. That is a guess. Mr.PicsLn. Thank you, AZr: Chairman. Mr., AEcDOINAzD: Dr. Carter: 1'Ir. CARTER. Thank youy LIIm. Chairman. Certainly, I have enjoyed hearing this scientific report from a dis= tinguished doctor. I hav.ea few questions, thougkt,, aboutitwo or three difterent things. It is true that in mouseexperiments you haveprodilced cancer on the skin,of animals. Have you ever producedi them in the lungs by inhalation of'tobacco smoke:?' D r . HUDSON. '~'~To'., Mr. CauTER. Thank you, sir. In checking on a copy of your report, the resullt of analysis per- formed at High Tor, February 10--18, 1969, I notice in your controls, that benzo(a)py.rene in micrograms per, gram of dried condensatle. 1L1i7and 1L3~2.In the portion of' water treated controls„ the concentration of benzo ( a) py rene R as .95; .33, and 1'.08'.. The addition of' water, of' course, would a:utomatically, we would think, reduce the matter of benzo (a) pyrene~ relatively; would it'not ?' Dr. HLDSOn. Yes. llr.C-.I:TEs: Then further on in the report I find that the contlent,according to voilr figures, of' Chemasol treatment, after tobacco hadl been treated ~vith Cliemo5ol, 1.41 micrograms per grami af dried con- centrate: .88 milligr,Ims,, 1.29 and 1.53;, which are: higher in eachcasetllFln those in ondinnl.v tobacco, according,to your figures. I ani at a loss to account for this. Dr. IIt;DSOs. Are thesebenzo:(a)pyrenefigures youarereading?' lI'r: CARTER. Yes, sir. Dr. IlrnsoN. ~~.nd wlien von they arehig•lierthan, ordinarytrn- bzleco. ~II~e,the~-conlpzlre<l 1'Ii'. (~_tRTFn: Ih~i~-eit right hE~.re. 1P1Ie re~ults of ana~h~sisperfornletl's at IIigh'1"or; February 10-1g„ I9GO: Mi% llAcDON-.a r.D. C Dr. Ht-DSOX. Yes. «~~~ onld vou ciVe m. Mr. CaRTER~.. The dene-s~ate. The~ next : densate. The~next~is water-treated contrc Then n-e~get~to~C~ ;rr,tlii c;f dried condE doe n:t show ~ the re. ( eI tainh•; IC wele~ of' it. By the~ «•.a~y~,J wc banltiiiig:.?' Where d Dr. HUDSON. Ar llr. C AR'rra. You. Is your banking, Z':orh~? I~r. HUDSON. AZi Mr. CARTEIt. Th, cirzrette smoking president of'the bs i t his not true ? Dr., Ht;.DSO-X: I[ _lfr. CARTER. Thf Thank -vou, 1'Sr -\'Sr~. 1'Lbcno-NArI -Alr. -MnRrrQY~.~ 7 I~note m~u~~ col'let~ place~ in G'eorgia,, --ew York shortl Mr. WATSON. I friend; y~ou do nc Mr. 'jL'RPIIY. Z riIent of'IIeai'th; I technique~ knoR-n 4ensitiv.e than thF IIow many I2 i n st rlmaentation DI'. HI'DSOx. -N, torv tlitlt has tI por`Znnnel, and ai Wliich is a primE A searclii was the \iitionai Ca'l iii rn1r reograpl lLr: Mur,I•EIr. tc,\'oubv the I I~1Ptu7s~ of~ cTetern 1)a'. ~ Hr-nSorc.~ -~Cr. 1'IiURP1iiY. ('liemosol on tc Dr. IIc-DSON. : i

931 ,ance you of' death ,~ in lung, it.. n R. • decrea..~e, nce1910., *oin~ up :now any Tr and I have less rt disease . a chance 'ns to be ,~on. )nvene at S taggers, ; pending ; of c>.ga- S terlinb; .RTMENT ~ 'g~SHING- ~ are sorrv e have to 2m pro- 'omputer profes5orthe Uni- 3iologicaT lmericani 'rograms ee of'the American Association of Physicists in 1Iedicine dealing with corn- putation matters in mediciiie. ~ The field in whtch, Iteachandiin whzchI[ conduct t'liemajorityofmy research concerns the collection, processing,,and interpretation of data. A largenumber of my research efforts have concentrated specifically on the analysis and interpretation of' data concerning environmental health problems such as the effect of lead on industrial workers, the etl.ectt of low doses of radiation on the subsequent'appearance of. neoplasia, and' the effect of pollutants on comrnunstv health. And, in cidentall!v, the effect of smoking on the health of the general public. I am also serving now,and have served in thepast, as, a consultant to public agencies on problems related to ditta acquisition and ana,lvsis.. These include the hi ational Science Foundation, the `Tational Academy of Sciences, the Veterans' Administration Hesearch Centers, as well as a number of universiti'es andi industa'ries.I am here on my own be- half and at the invitation ofseverall ci!garettemanufacturers,, not in belialf of Washingt~on Ls niversity. It is inevitable that conclusions mawsometimes be reached by the Pub1 ic Health Service or by investigators sponsored by it that, will be in disagreement with those reached by persons affected and' by other scientists. It is in the interest of the public tliat these instances of' disagreement be, resolvedl on the basis of' merit of'the data and that rel'ex-nnt anallvses be made avaihYbleto alt interested parties, rather than resolved by the clash of' experts in front of' congressional com- . mittees. When Iwas,asked' to revlewthe PHSpubllcationy "Cigarette, Snnok-ingand Health Charactieristics,"prepared by Ronald W>-Tson,, of the Division of Health~ Interview Statli'sticsof the National Centerfor Health Statistics; and based on t1i.eresultsof the National Health Survey,, it was agreed that whatever conclasions my analysis produced ivould bemade-availabl'etothePublic Health Service, as well as tothe:indlnstrv. I[ndhed,three reports dealing with this studyhave~ been submitte,dtio the Public Health Service. \'Ireonclusionsarebased on a deti'ailedstudv of' the information pulblishedl by the National Center for Health S't.atistiics and on addi- tionalt analy~ses conducted on, thevastl, collection of data on which the report "Cinarette Smoking and Health Characteristics"' is based. These conclusions were detailed in threelengthvreports. All reportsand supporting data were forwarded, to the director of the National Center for IIeal'th Statistics. i1Tvy conclusions were forwarded also, to aa committeeof theNational I~nstiutes of'Healthconcerned with evaluat- in,- cdata on smoking and health. 1Iy statement,,then, covers material of'f which the Public Health Servi'ce.lias been made aware some time ago.l' _l'Iv concern here is with recent cla:inls that ci(rarette smoking causes ti~rids variety of chronic and acute diseases as well as disalailities, and with the procedures by which the,source data were collected and by which morbidity and disability rates were produced for purposes oi'comparing smokers to nonsmokers. There are a number of' major flaws in these data and in their analyses that are so serious that clear- cut conclusions should not be drawn. A thorough assessment of the report "Cigarette Smroking and Health Characteristics" mustl deai in, detail' with viol'ations of'statisticall and I Copies oE'a1l relbvant correspondence have been placed tn the record of' thls bearing Isee p.941).

937 ~Aiability co-1„ and if, in of'the meas- imnte of the _ ne for male _iined mostly if their data )tained data., ,tween popu'- )i,ed females n the report, "CLZTSIOriTs ?' ilere is a real. t the conclu- .ales are more' mation about n~ about malesllome during, oyed, elderly, aokers would nces. Yet, the ield a picture lie report. In ,d,, the female iilit'y than' to veen the more es, these ~ com- result of' abe cept the age- i I1 hi her for ,~ort ~iga.rette e. This is true evalence rates aokers' have a lifferences are nparinb'types utd work-loss u of' disability smokers with ,utioning. Fe, a`•.s than non- a higher rate r,rflher curiious oyment causes Lr nonsmokers. currently em- eing suppliedl through proxies' while females who were not emplbyed supplied that information themselves in the majority of' instances. f). %Id3ustmenafs t''orconfoundin'gvariable's: There are annmber of sources of differences in tlhe sample populh;tiom betn een disease andl disabilityrates of smokers,and nonsmol.ers.. Thefi'veobv.ionsmajor sources of difference are: 1, ses;', 2, age; 3, proxy respondsng';', 4, eiil- ployment~ status,and 5',characteristics~ of informantsf'~or proxy re-s;pondents. ,Ldjustments werema:de in tli:e' analysis only for diffierencesi~n t!14eses and age distributions'between smokers andl nonsmokers., The other three maj~or confounding factors ~ere ignored. But proxy responding, employment status, and characteristics of respon'cieliLts, all are: related to~ thefrequencies with which diseases are reported.i Now,, all these effects on reported disease freqttencies due to sex,, a~ge„employment, proxyreporting„and due to other factors interact in a N-erv complex pattern and''may.resuTt in Iar~edliil`~erences'in the, re- l~lorted disease frequencies, dependin~ on, n-hether or not, provisions fbr adjusting for their effects are ineiudedd in theanalysesof tlte (liit.h and on the~ kinds, of adjustments used., Iin thepresent.e lnstance~the_se adjustments were of panaanount importance. Smokers differed very much f rom nonsmokers in the Nation.:l Health Suri-ey sample. They.' differed in thei'r'availalaili'ty for direct interviezv~„in the*ir'employment status, in the clia.:racterist'.ics'of indiviolualswlirn lnformcd aUoh_tthenY, and not only~ iil their age and sex distributions.. But manv of theefi'ects of these confourbding varislbles,are such thst interactions, anlong theln coulcl cause large dit}eielaces infreqqelicies, ofl disabili'tiesto appear for g,roupsaccident.llly,also, related t''osnio?.-i~nl(r and non~moltiih. I'"toper adjustmentsfor'the,'e confoundin' gr factors can be mox'e. The most reasonable adjustment would be to provide~ separrate age~ adjust- nnent~sforellcll 'di'rectness of'inter6ew: elnlzloyment statns,infortner,.characterist:'ir"constellation ~lndl couihare til'tese; groulAuy groi_rp.l:r-en better«ould be to compare agge-specific rates Nvithiln e<ul>: of t?lesz constellatinns: However; neither thesenortulv other appropriate adjustmelltsweredone: Theanalysisonlyused indirect a-e~acljustuients torsmolcing-h-alkhr cate;oryfrequencies. Indirect age adjustment is the weakest oftlu•eeconimonlyused ngeadji.istulent procedlares. T.hi~sprocedureis' lmstt eahily affected b~-confoundul,N-ari,Iules such as,plio~'5~report,iir~'. elii-plon lnent status,, or the characteristic, of informant. It is mosteurious,that the\ati'on11' Health Stn•~,r.v does~ not seem e adjitst~nlent nlc~tllotlt;. llie repcui,;on to care eitller for itldirecta,* ~ ~ ci;aretteslnolting and health cl.:zractu.ist'ics ist;Iieo111y one in a series 1' lfi- report. "Evaluation of' tiie Analysis I'rocedttres of the 1IiS' Interview Ditta' ps- aminesin detaili the different di4tributionsof the sannhle. PoDulhtioni among isax- entploN-mcnt status-direc.tucss~of interviewcaterories, PcofotrndldifYerences,.emerge:d between th.•distributionof amo6ers;and nonsniol.er•: Also, each of these oateqories~ hndan aPPreei, ahle effect on reporrtedldisathilitpfrertuencit : To the~e effecty;must be adtihSthe trins duetostnokini;, and other per~>onal characteristics, of'~ tlieinformant. (for the man}•proi~-y inter-viotcs). Ass a. result, thecomhohitiion ofi thee smoking •tudthe nonsmok'inp, groups nre s~o ditferF,nt that nopood procedure actu;tllg, exists bcwhich an~ unconfounded effect dhet'o smokinR can be isolated. Tfie reDort': neri rred'.to:nns sent to the National Center for ldealth Statistics andlhasLeen.placedon file:with.this.committee:

946 it describes illness and disability anlong 144',000 people, wliile in actu- alit, probably no more than 60,000 or 70,000 were actually interviewed. ~ir. PICKLE. I am a little bit confused now by y~our testlmony. You, said it covered as many as 144,000, 130,000 to 140,000 people;,but these figures were arrived at by taking, groups and blocks and putting t'liem, in by previous studies. You said'i not more than, 5 percent were actually interviewed., Mr. STERLING. N' o. I said 5 percent were not interviewed at a12.. That is according to theseifib res. Five percent were not interviewed' at all. Mr. PICKLE. So approximately 50 percent of! them were actually interviewed,, or in that neighborhood? i1lr.STERLrNG. Let merepeat:~ Ficepercent, «erenotinteruiened nor any information obtained aboutthem. Ti hey were simply added to the sampl'e because tllieyy lived in the s<une saonpling units that «as selected f'or sampling. Of some 13a,000 idldivitiuals wlio remained, only 40 percent of themalbsR-erei~nte.rviewed:Soif'«e assume half of the popul'ationtobem~al'e, which is not unlikely, t1ler.eshoul'd have been about 67,000 males in this population, of' which only 40 percent were interview~ed,, wliiich is rouglily, 25,000 males.. _llr. PiCgLr. Did you conduct a survetiy on a similar set of questions or simihrfletsbased on thePilblic Hl Survey?1Tr. STERLIn G., No. I' used dtita produced by the National Center for Health Statist:ios, it'self. That is, I actually obtained copies of that data, as well as copies of other surveys which were conducted by the -National Center for Health Statist.ics relative to this study. Mr. PICKLE. Did you interview people personallyT? AIr: STERLiNG:'N'o; I did not. There were: two cont.ract'sletibytlienational healthsuroey.to matcii, the accuracy of their counting, pro-cedures against medical counts of diseases. It is these da,ta which I used.. Mr:, PICKLE. In Vollr testimony V~ou say that two preA'1ousstudles ha~~edemonstrated tliatmedieallhr~~ documented illnesses and counts obtained by the methods of thePiiblic Healtll~~ Service survey maydis- agreeasInuchas,20 percent in the case of'some illnesses. 1I'n. STERLING. They maydisa;reeinas many as801per~centof the cases: Mr. PiCr.Lr. That is quite a cliallenging st~ltelnent to the survey mnde by the Public Health Ser.viice, Mr. STERLING. Ti hat iscor.rect. T1lese ~figures calne from thefollowina study. They canle from the National Center for Health Stat'istics study entitle&'`'Health Intervien-, Responses, Cornpared With Medicall Rell 1'ital' H'~eal'thi S'tat'istlcs,"Pirblication No. ll0'00, sezries2, No.l, Public Health Service. That was produced in 1065'. It has direct quntes~as well as s1iowing the actual amount of error. It'turns out t.hatfort some diseases the amount of agreement betweenn interview count and the known countt of'diseases in the populationi was only ?0percent'. S[r.PzCKLR. If vours f><gures and your statistics are correct, and I certainly d'on't challenge them-I would be in no position to: do that- if they are correct, then your statements ought tio be challenged' or they oughttobtiforwardedtolthe PublicHea3ltll, Service for a response. I dhn't. think they have testified in support ofi their statistics: If your statements are correct, this is Rery revealing andl very interestin7, and 11 think, helpful. _~IL'. S'17:I3LIXG., `]i Air: htCIiLE: Tha _~ ~ II'. SAT'rERETII'ufLD Mr. CARTER. Th You are profess Computer Science '. Mr.~ STERLING. ) 1ir. CARaEI:. Th: ;, iu.un should kno- lu SLtc1L 2I position~ brought out (OWeI1 disabilities i i,(, ~ 1'~ubli~c~~Healtl \Ir. S~TERLING'.~I . Ar: ~ CA~RTER. F ~ I lIolcens: NToderate smok rate sniall i tlie Public IIe~ '4r., STERLIbTC3. ot this report, so r nrtiny disease i'enlAe~ smoke ino~tr~ zti~~ hi~;lber~ o . IlIients~ II nial Jir., ( >,:I3TLR:, 'I ,r(i hart oi'it do Mf'. 1T?'.RLI_\'G. \ t r. C'.~Ir rr:>... 11 .N'llp, tiTTRLI\G~1 1~ird17 percent Mr. (- '_~R'rRR. ti ~ ~ iq~et't ~~ of ;u3ol.i~ 1'rr. ~rlau:I~rG r. ~"kI:•rLR. l ~ i'~^A ~('r aud the .'4r: S-i I~:I.Ltsi~ ,,' t'emales: Mr. CAPTER. V+-ould bilse~all 4 i;t~i pcrccnt, ' oyed on only ~ ~ u~tn. I l.~elie \II: ~'m;rr.i:. t- rlt(Itl truc? 1Tr. ~II:RILI~ ~ uUvex conduc Olo ~ fuorhicdi~ty~ ~~om-ect(~,

95& be obtained. 1' wouldl call black report adjustments .lv. does not ,v ridiculous and I have .n theo were en included those who be remotely cding factor.nons in the f these wiU m club feet .:en listed' in )ut that for ali do better in my own ioki'ng and' n up in the. I let, but not _1h;ys due to t Dr. Katz )e dualifned' -h different amplileteer unding• the has blown d that you M received ey'. who: isrnceived ai lies to Dr. fee, and I i are liased' ,p oriminnl "e anrl the National Center for Health Statistics. I have copies to file with the coinmittee if the committee so wishes.. Mr. PrcxLn. Would the gentleman yield Q Mr. PRFyYER. Yes. Mr. PicgiE. When did you receive the reply: from the gentleman y-ou mentioned?' .Mr. STERLING. The correspondence concerning the studies,, inciden.- t,tl7v, is included with my statement. You will fimdl all the Ietters inn t lie ~h zck ofi my statement. Mr.~ Psc.KLE. Was their reply just a acknowledgment of your letter,, or did they take i'ssue with you on some of your findings?'. Mr. S2ERr.iva~. Mr. I~oolsey replied to me and md0 a number of' stacements concerning the actual report ini reply to my first critique of' it. The letter is enclbsed with my statement. :ilr. PicgLU., Mr. Chairman, I wonder if I could inquire of the pro~- te-ional staff if we have receiR-ed copies of anyy of'those replies: NI'r:~ MENGr~R~. ~~~`e~ have~ not. .l'Ir. Prcri,r:. Thank~ you.~ _1'Ir. Pt"EYER~. Along the~lines~ of wh<nt~ l>?r. Pick:le is saving, i't~ d,oes~ =eeiu that there~ ou~,ht:' to be some~ way ~ for~ rev~iew~ing~~ and, evaliiating~~ rehorts such as~ th~is~hefone they ~get to the stag-e where~ youi begin~ to get lniblieitv, and cliiin7s are made~basedlonifacts whichido~iiot suppont~the clnims~ at ald'. Leaving, that for a moment, n e had a man testify rece.ntly~ who was i7crv ~refresluin- in saying~that~lie~ felt snzoki'ng, w~as~~ goodlfor youL, That, was _l'Ir.~ Ho~~ster. ~T~rnulkl'~ llr~. Iloyster~ be right,, if I understand'~ your~~ fi(rures liei~e;, in putting out a pamphlet~ and~~ citing Ptiiblic~ Health tiervice figures and! saying :(1) female nonsmokers hav e less disease in than fem:ale smokers; (2')1 the highest rate for all diseases occursn former stnokers and therefore~if you once~start,~ whatever you do never ~=i~-e~it ul~'; andl (3~)~ the~lhh~-~,est rate~fb~• diseases~~is~~reported~by moderate, srninkers, and therefore, the best way to stay healthy is to smoke mod- eratellv. Is~ t'hat about what you are~ sa!v~~iu,r these Public Health~ Serv.i~ce~ fig- nres~~ support?' l'Ir. SrERLiNc. I am afraid that al'though I am, tempted to say yes, I must,say~no~,~ because~ I don't thiiik~~ tlie~ data~ on which the fi~ ~res are~ baserl'~ are~ reall~y~ anything more~ than a pleasant invention and bear~ reallv only little rela;tibn to reality. _l'~~Ii~. PhE'i-i:R~~. But. «hatl am savi~is!r is that~ that statement is~ridi~culous~ en~ its~ face, which~ shows how mislea,ding ~thisreport~ is and how~ value-~ l~ess~it is. Mr. S-1T,.RLz-,c. The~ report~ is~ only~ interesting to~ those~~ whol readl it, I nni afraid.~ Mr. PRri-ru, In other words, if youi accept the dlita in the report as bein-1 accurate, then tliose~ three~ tliinas that I suggesteel Mr. Roy.ster cmilkll put in his pamphlet would follow~?~ lir. STr•.RniXG: If you accept the data as accurate, which you shouldn't tlhen -you could. AIr. Piu:1-ER., Thank you. \~Ir. S~ATTrRrii~r.n, l~Ir. Hastin-s?~ _l'T,r~. ILAsTZN~cs~. I have~ no: qtiestions. Mr. S'ATTERrir.Ln. Jfir. Ad'ams,

9511 it.h it, but, si d studv. ~r former lifference. , ~ v-hiich~ is -,r smoked: red to, this : in many ronic dis- rnte~~ seetns, emnz: to uF ves- ,)cl~~e 1,1I9. .icaI cases,, es as high )ny or my mortality mortality ' ohavethe i a number J others. I peatedlv is inkers,andi -ho are not t in many est disease etween thee tp concluded' °olina. oronestleps, the black l earlier in conclusions )rne, in the General,hei : a compila- ained fromm lity studies, I think the record will show that. I didn't want to further com- hotmd the problem; but I think it points it up very well. M'r: EcsH_uaflT. Will the gentlernan yield? Mir: `V'ATSOw. I got the tliine from'the gentilleman from Georgia. I think that it is only, fair that we let him make the comment., Mr. Tho-NrrsoN..I yield to the gentleman froul Texas. -1 fr. Ecnx axtrr. I referred to the Hammond report which is not taken from the orange bound volume. I think the witness understands tlrat.\Tr. STERnsNc: Yes. I would like to finally finish my answer. 'I''aere are many problems with the Hammond report. These prob~ lenrs have been pointed out by people who are much more astute than I;lni, perhaps, or perhaps certainly I can only concur with them.. The~e t.hings,, although pointed out repeatedIy andi often, have never been r.eaPlytaken seriously bypeoplewhoclaimrn that lTr. Hammond'sstuclies do not demonstrate that such an association exists. There, are people who are not nff'ectecl'by data. I do not happen to be one of'them. [' believe in going back to the actual information and data. The Ilaznrnond study has certaiil flaws vhich are very glaring. D'r: Berkson who is considered the outstanding binstatistie2an ini this country, and Sir Roland Fisher, who is considered the father of statistics, pointed out niany of the flaws which have never been elarified.. The onl-v way to clarifv them is to (yet the data from, Dr. H'ammon& andtakea look at t'hetTiiilgs that were actually found. Until' suchi tinie,Id,on"t think I would like to; say anything about, thedatapre- except that ~theyarefull' of' questions and <Ontedbvi'WIr. Hammond, not tnl'1 of answers. 11r. WATSON. Will, the gentleman yield further?\ir. Tfro:qrsoN. I will yield the rest of my: tinie to the gentleman fro:n South Carolina. l~Du: WATSON. The book that the gentleman from Texas was makinb, reference to is the very one that the Sur~eoni Generall did say wa~s~ conlpi,led al,ongwithITanlrnuond's rehort,,but primarily the morbidity study,or the orange botin(t volutne, to which you referred. I asked e.irIzer,, theS'urgeon Gener<il and Dr. IIorne„ as to~ how they couldl cate-oricttilTy state as 'theydo, and this is: a Government publicati,om orni hure 43, that. the da~~sof disa~biliitie sties and the days of restricted activity were greater ~1•ith the smokers than. the nonsnnohers, .vhereasi we turn overbehinid the backside cfthat pageai7d fib tre`'?1 show,s~ tlhat dawsof bed! elisabiTity«•ere5,0~ withthose\vhosmoked from 21 to 40 ci~arettes a d~tiv, whereas they were ci.1~ for the nonsmol.ers.. 1Ir. STr•.itLrN-c:If Iniay makea comment; sir \Ir. W_LTSaN.Tloatis~the thing that confiusesall of, us. We just ;et oit figt-viresthat support our coutentlion and then wedisremard tho5e•v11ieIr do not. _l'Ii•., STF:ur.rNo. I«ouId like to: point out that the figures in that report, and the: reason I did not use this report, but discarded it, isbeoause they are based on what is called adjusted numbers. Dr: Rothsteimisays statistics are~simple. You count peopleand count diseases, divide oneby ~ the other andi get rates. Ilowever,this wasnot the procedure follhwed in this report: The reason the tables at the front',. are at variance n=ithi the tables at the back is that an adjustment factor wnsintrodnr•edtoproducctiie~e fi-ure,;.

942' view techniques and methods by' which the Center operates simply do not', lend themselves ~ to' testing hypotheses concerning' differences in disease frequencies:" We wish to make it clear that, we have never formally tested hypotheses usinn: these data and do not claim that they can~ be used for making formal tests ~ of the hspotheses ~ that A causes B. If such tests are made, they are made by others using our data. We do frequently point out whether differences that show up+ within~ the data are explainabie, as chance results or not,, and this is common practice in descriptive surveys of' the Health Interview Survey type, but this is a long way from the kind of hypotheses t'esting thatl one does in an, experimentall situation. Our data are not, even quasi-experimental; they are descriptive. It is only by viewing our data in the perspective of all' that has gone before that one would; in my' opinion; be justified in concluding : here' is one more piece of evi- dence that is consistent with the casual! hypothesis. I think you know that we recognize that interview surveys have problems of measurement' error,, asAo' all types of data collection mechanisms. We have' been the first to'point to these measurement errors in our Health Ititerview Survey, as is evidenced by our methodology series. (We use these as a basis for continued improvement of the survey!), You: have pointed out some'of these measurement errors, but,you fail to point out that none of them R-ouldlhave significance Irnless it had been shown that,itl yielded a differential bias ini responses for smokers as opposedi to non-smokers. We see no evidence of' differential bias. Lacking' such evidence, it is more reasonable to accept than to discard the indication of'apparent relationships reflected in the respondents' replies, particularly since the differences are con- sistent: with those shown in many other studies. Finallk, thedescriptfive findings, of thissurveg:, f'arfromemphasizing the weaknesses of' an interview' survey, seem to strengthen the credibility of snch surveys, because the findings are consistent inn so many phtces with those from mortality studies. For example, judging from what mortality' data show, one would,expect to find much~larger differences for chronic respiratory disease, and this,, in fact„showed up in the Health Interview Survey. Shouldn't the stati'stician be encouraged when such Iogical, information seems to be coming through despite the' "noise" due to imperfections in the method? I suppose it is quite an under- statement to say we were disappointed at the absence of'anv recognition of'the above in your critique. Needless to say, we shall continue: to examine with great interest the analbsis and' conclusions presente& in your report. It is of continuing, concern for us tlo seek' ways of improving the data whichi we collect. Allow me to thank you, again for sending us the report. Sincerely yours,, THEUDOHE D. WOOLSEY, Director. JAN'UARY ' 12; 1fi(3S. C'sEORGE: B. HUTCHI60N', M.D:,. 3Lichaet^ R~ceae Hosnitadand Medical! Centcr, D'epartmciato'f Ft,ad,iation ZVIeraNJ, Chicago, llL DEAR GEORaE,: About three months ago I was aslced, to review a PHS report entitl'edl Cigarette, Stuokinpanrt FI'cnlt3i Cltau•act!erist,ias: The request came from a group of attorneys'representingthe tobacco companies. After a careful review and evaluation, of'thisreport I concluded tliat': its authors were carried awa;vby their zeal and public spirit, very much, to the detriment of'sonnd scientific reason- ing. The conclusions advanced by the investigators simply have no basis in, fact. The report would probably ' not be of any consequence' if' it were just another paper published after insufficientJ review. Ilowever;, cignrettesmokiug, und itaeffects ouhealth are' volatiletssnes aundthefindin,softhis study wilt get' moretlltini passing, attention. Whether theindust'ry f'ortheirrepresentatives) malceuse ofl my reportl or find someone else who is perhaps morecompet'enttlian I to render them the' ,,lme' decision is really lteside the point. Sboner orlatertibe' incredibl'ce shortcomings! of'the report on E'igarct'tc S'mokiwg anrlHealt7s Q'1Par7v- terCsticswill becom:ean, unpleasant issue unles5 properly revieR•edland correeted; now. One other eoncern, which; I amisttre you share with me and many others of'onr collearuesisthatlooseness in reasonia7~in one report mavhaceseriousr°on-seituences in other areas. If'w'e accept t'~hemethodsand procedure;a in the reliort :: t'igarette Smoking a -:,luW nime Iirebiozin ar i ich notv clutter up th ;,eci:>Ilg because consi il c'the °dllmage" done Cunsequentls Ihave~:unics and haveobtailtr•sented to the Public I l'i'oivever, ratherthar. „a General,, it, would, ;uanRs off the report I.~ainlv Service has plt.;nnlittee headf?d by IJhus if you were to (1 ~•committeesothat~I u,litied body of ex',per'' ,; y best be corrected. I;~•cause of thelengtl ~ndings. I am includin ,,:,try for your use. 1 will, appreciate any Sincerely yours„ DEPART i )r. 'fY3EODORDL S'rERL; l , lwrtmeiet of d'ppdiet( tlf,rehiryl!7tbnUniiersitr. Cottis. JLo. 1)7.:1R llR.. 'ST'ERLIV'G~ n,port, "Eva1'uation oi'-u probably know, IN 1 - possible to acquire ' ,our staff? Also'we w( !,il,liowraphy entitled Linking Cigarette Sn ,n•r :)1. Sincerely yourt: Mr. SAZ rERT'IELI Mr. hogers 2 ATI'. IiOGERS. N0 Mr. SATTERFIELI Mr. WA•rSoN. F ix'asoll tlrat-vou qu llle colrclu., iansof Yuu ltad, accordin1llatiDn iI1 referer ~'~~III ellthoI121 Mr. S''rr•:IZLISG., ~ .l'I i.•. W_vrsoN. E linri, tl r('pOrt wGlll: ()P the infnrnicrtio- ii wo;1lll I'I(]t be so vour societv~„ v 11`~ 4l~lta ;,.''11121e(L f

® 976 ' AIPPEtTDI% E (I)' MALT.,ES'. 0 Percent oL Sample From Each Age Group PERCF.NT OF, S 501 u5 40 35'. 30 0 Ran AM 29 -C;;(~-O-

. ~ r~a`9~;t:rn~_~pCt r »a X J O .O6'~+ . m' ~= V rp p ^" p J R pp7 r C ~- .. g p i T ry H t rt ~ ~J C,..' G C- y~ a~aw ~ ~ , 0,, a.~•~ APPENDIX B TABLE 1.P. 23.-DEFLATED TO ACTUAL SAMPLE SIZE -- [This table in its deflated fonn is subject to the same percent error as is table 1 in the morbidity report] Smoking status Number of cigarettes per day Sex and age Total population Persons who Unknown if neuersmoked ever smoked cigarettes cigarettes Total smokers Under 11 11 to 20 21 to 40 41 and over Unknown MALE Ever smoked-heaviest amount All ages, 17-plus years_________________ 63,204 18,690 156 44,360 8,165 18,549 12,481 3,204 2, 141 17 to 24 years_____________________ 10,934 4,825 71 6,038 1,644 2,594 1,197 205 337 25 to 44 years-____ ___ _________ 722 23 5,407 32 18,283 2,816 7,655 5,790 1,341 681 451o64years____________ _______ , 20 197 4,836 35 15,326 2,410 6,355 4,587 1;221 755 65-plus years--------------------- 8, 352 3 621 17 4,714 1,294 1,946 908 258 308 Former smokers-heaviest amount r'D Allages,17-plus years_________________ 63,204 18,690 156 12,156 3,217 4,506 2,614 868 951 ~ W 17 to 24 years_____________________ 10,934 4 825 71 727 319 226 105 18 59 25 to 44 years _________ __ _____ 722 23 5', 407 32 4,218 1,091 1,571 989 266 302 ___ _ _ 45 to 64 years___________________ , 20,197 4;836 35 4,869 1,072 1,878 1,128 429 360 fi5-plus years--------------------- 8,352 3;621 17 2,342 734 831 392 157 229 Present smokers-heaviest amount All ages, 17-plus years_________________ 63,204 18,690 156 32,204 4,948 14,044 9,866 2,156 1,191 17 to 24 years_____________________ 10,934 4,825 71 5,310 1,325 2,367 1,091 189 338 25 to 44 years_____________________ 23,722 5,407 32 14,064 1;725 6;084 4,801 1,076 379 45 to 64 years--------------------- 20,197 4, 836 35 10,457 1,337 4,477 3,458 790 394 65-plus years_____________________ 8,352 3,621 17 -2,372 561 1,115 516 101 79 Present smokers-present amount Allages,17 plus years_________________ 63,204 18,690 156 32,204 8,289 15,107 6,868 871 1,068 17 to 24 years--------------------- 10,934 4,825 - 71 5,310 1,858 2,522 592 50 --- 288 25 to 44 years_____________________ 23,722 5,407 32 14,064 3,043 6;785 3,458 445 331 45 to 64 years--------------------- 20;197 4,836 35 10,457 2,410 4;817 2,528 342 361 65 plus years_____________________ 8 352 3;621 17 -2,372 978 982 290 34 88 Z 6S1,G ( C

..,.... . ~r.~u. ,~r.~.e~ APPENDIX B-Continued TABLE 1.P. 23.-DEFLATED TO ACTUAL SAMPLE SIZE-Continued [This table in its deflated form is subject to the same percent error as is table 1 in the morbidity reporiq Smoking status Number of cigarettes per day Sex and age Total population Persons who never smoked cigarettes Unknownif ever smoked -cigarettes Total smokers Under 11 11 to 20 21 to 40 41 and over Unknown - FEMALE Ever smoked-heaviest amount Allages,17plusyears-__ ------------ 70,795 ------ 41,443 333 29,020 9,960 12,242 5,519 727 - 571 17 to 24 years------ - - -- - 12.443 5 -- -- - 7,425 123 4,895 1,824 2,002 826 114 128 to 44 years 2 ___ -- -- ------ 25,997 - -- - 12,094 60 13,843 4,279 5,909 046 3 432 177 45to64years-- - - ------------- - 21,727 12,867 63 8,797 3,107 3,825 , 1,475 175 215 65 plus yeais------------------- __ 10;628 9,055 87 1,486 751 505 172 6 51 - - --- -_-" - - - -~ - - Former smokers -heaviest amount - All ages, 17 plus years ---- _-_--- 70,795 41,443 333 5,531 3,069 1,567 617 95 182 ~ 17 to 24 years _._----------- ._- 12,443 7,425 123 682 394 210 60 4- 14 25to33years ----------------- --- 25,997 12,094 60 2,515 1,339 754 304 57 ~ 60 45to64years.-------------------- 21,727 12,867 63 1;856 1,044 490 212 32 78 65plusyears__--- __-__-____-_- 10,628 9,055 87 479 292 115 41 -2 29 Present smokers-heaviest amount Allages,17plusyears_--------- _------ 70,795 --- -- 41,443 333 23,488 6,892 10,674 4,902 - 631 390 17 to 24 years--------------------- - 12,443 7,425 123 4,212 1,430 1,793 766 100 ~ 114 25to44years--------- ------- -._--- 25,997 12,094 60 11,328 2,940 5 155 2 742 375 115 45to64years--------------------- 21,727 12,867 63 6,940 2,062 , 3,336 , 1 264 142 137 65 plus years_____ ----------- 10,628 9,055 87 1,006 459 391 , - 130 4 24 Present smokers-present amount All ages, 17 plus years---------- -_---. 70,795 41,443 333 23,488 9,404 10,461 3,041 - 207 375 17 to 24 years--------------------- 2 12 443 7,425 123 4,212 2,015 1,732 338 21 ~ 106 5te 44 years--------------------- 25;997 12,094 60 11,328 4,075 5,241 1 759 122 132 45to64years------- _____________ lu ea 21,727 12,867 63 6,940 2;731 3,151 , 880 63 116 65 p s y rs------------- -------- 10,628 9,055 87 1,006 583 338 63 1 21 ew.,...rarnue,.rrw~w 0 0 CMssEo

944 Mr. STFRLrNc: This is not a matter of opinion. There exists a report published by thei Natiional Center~ for Health Statistics which shows what the error due to proxy reporting is. Errors are giveni in great de- tail and analyzed according, to different types of diseases and other factors. -Atr. WATSON. tij~'hat document is~ that. Does~ is, specifically ~ give~ any percentage~ratio~ of reliability or unreliability~as it relates t'~o~percentage information ga.ined by proiy?' Do I make myself clar? llr: STERLiNG. Yes., Mr. WATSON. Does it give any dleflnitive percentages 2' _llr. STERLrNo. Yes; it does. A study performed by the JI'ichigan Research Council under the auspices of the National Center for Health Statistics giv.es many tables, many of them reviewed in my report submitted to~ the~ Public~ Health Service~ of exact percentages,~ llr. WATSON. Doctor,, do you know wliether or not of this 60 percent of the information relative to males, whether it wasgained from.vives or gai~ned from children?~, I~ believe the Surgeon General cont'ends~ that most of' i't was gnined from wiv~es.. Do~y.ou have any informationas to~how~it -was gained?~~ Mr. STERLiYG. I have the data from the actual report. Tin examining these data, -we found that most of'this information-was given by wives. jjrATSON~ T~ th~ink~ you brought out a very~ interesting~ point, that of'.the~m,en «ho~w~ere~~actualli<-~interviewed, since~iti.vas-~a ciaytinie~sur- vey; itwas~only 40~~perceiit. Do~~you know~w~hether or not it~ was daytime~ or evening, or R hen the survey .ti~-as made ? llr. ,STr•.ut.zN-c. The~ survey~ procedures are~not that~ specific. In going ~ through the: technaque, uc~ed a..•~om<ini intervie+l-er~ R•.1q~ hirAd. S'ie~e went to~~theneigtiiborhood ancl she~tried~ to ;Znid soi_ieone~:lt horr,e. If she~ found someone~ at home alie~ would intervie~v ~ thati herson colrrerning all other adults prese»t iili the household.~ S'ometiines!5he would come~ back~ in the evening~„ buti most of the tiime~ if she could complete~ her information during ~the~ dav~ she~ would do so. A~«ain;1 it~ is cl~early ~ statod in a olescripti'on of~th~e procedtlre, for the~ household surveys, tlris was~ felt to: be~ a big pr.oblem~ n itli the report but.~ budoet lfimita~tions-~ ,cozid~d not permit a nio~re~ exact stim-e.N-. llh. WATSON. In the so-cadled morbidity~stndy; of cour.~7e;~ ther~e~«-ere no~citizens of'the~mil~~itary~or~zny other institutiotis~intervieWed, _ Ncere~~ there~?~ So~far~as~~I can recall. llr. S'r:;iiLrNcs. No. These were:on1'y~noninstitutionry~~li~zed iitdivi'dh.ulls.~ I may menti~on~ that~ tLere~ R~ere a~~ lot of people~ not interviewecl be- cause~of t'lie~selection of'the primnry samhling tuiits. If~vou woulcl like to interview ai representativesampl~e of the~t7LS: popul~.ztion, vou .v.ouhll seleet~ ind'nvidualsut,ralclom,~let's,sav, from the census f~;le ~~ Thiswould l_'ne~ extremely diffieult to~ inlhllenlena;~ becniise~ you n-ould have~ to~ send an inte,rvie.ver~~ let's say, into~ the Ozarks to~ inter6o« one~ person. Therefore, adh7iinistrative units, counties and usuallvy populated ~lnunt~ies, w~ere sellectled. The~ selection procedures are st.ited by t lie -N2- t'~ion.tl IIealth Survey, incicler.tallly, and do~not~have the~wotd-rand'om" in them. The~ basic sttimplin~ units «ere~ heterogeneous administrative units,~nsua.lly~counties, R-.hichhave~as~mu~ch as ~p~ossible a hetero~reneous, l~opul.ltion. ~ _lTr. Ati'ATSO`. So, in an t'tie methods of g~ining t nsa general statisticall 1 Would bp -N~o:t,liecause4 _No, 2; even theinforme i,iales by proxy, even the information are highly c Is thatl, in essence, the t _llr: STrRrLiNc: I woul . ;vpparentlyhavebeen rc, niany individuals, who h very little, perhaps no i to cover. But this repoi how many individuals • and how Ymany diseases very often nonsmokers ~mokers shoaved nnifor- lir. JATarrsoN~ I persi havenevermade the ii even R ith a cursory ex,tions; and even infarm the position of'the Sur, _otnehow or other they -cemed to repudiate th, to those fig<tres that su I was rather distre~ in yourposition would' st andpoint: Thank you very muc llr; SA7 i'aRFIELD. A1 1Dn PicgLE. Thank Professor Sterling„ llRW is ~ very reveal eontradiction wit3i so<<nd I haven't had a c Epage 11, "I was asked' of'C'igarette~ Smokin yon~ who asked you t 1Ir: STERLi`c. The ,itleasttoldmethey1 _llr: PIcIiLE. Ho.v lwthe NationalCen! UmltaLres,but''db,you ,\Ir. STERtaN-G. Th reading, it turns out tervie;wed nor was -iniplyassumed, thad;1aicll noliocl~wasthe 'iiaracteristicsofl th S'econd,tlresedovc-nt less would be,NDilo wereintervie« fema.les.Soyour'qt ^q-?3G-69i_Pt. 3'

,g77~~ APPEN'DIX LU2 ~ PERCEN'r' OF' SIuMPLE' 501 45 40 3511 30 $i$fffs 101 5 0 FFMAI.ES. A I _ 24 2 .' 4 5+ -Percent of Sample From Each A'ge'Group 29-23G-69-Bt. 3'-7

955; i -when V data ritness liat, in clr cani al's ane i 'curate an e$- _ itique, -otu are nt in aa would «'ool~ lport. and he~ scatter ve used' ",4lli not get itlv the dhsease sidered rv kind :1 kinds it types levance V ahoutfiK,ures ~ ? You, 80 and t setof' f'smok- mt and ire two or some, 1- by as nz into the age of 65, and we~Itaveiiad patholo-ist after, pathologist testify~~ the,v- ~ can lhok at the Iun us~ ancllwee if the~man smoked and how ~muchL, He~is~ dead. IIe is dead at a partiiculilr age. He either smoked or he didn't. Those factors don't involve surveys, measurement errors or anything else, do they ~?' J1r.ySTERr,rN.G. Yes,, thev do. You still have to ask somebody whether or not this person, smoked. Since he is dead, he is unable~ to answer for liimself. _llir: AnAms. The pathologist came in clearly and' said you can lookk at rhe: ltmgs a~nd tell by~ the~inipi,ernation in them. We~ had tlzree~difl'e,r~-~ ~ ent p<?thol.ogii;ts tell us they ~ could noti, only tell you .rhether~ t'hey sinoked,~ but how ~ many ciga~ettes he~ smoked per d'a~~y;, after~~ he is dead. Mr. PICKLE. Vi"ould t'h~e-~entleniaii.yieldd? Mr. An A.is. Yes. Mr. PicKLr~. I rememben ~ testimony the other dtty when one witness passed out lung tissue~ of a n1an~ w~ho~ had been smoking for 35 years and (iied at the~aue:of 65'.~Ilt showed heavy~pignientation or~discolorati~on of'' t lte~hui-s. I+Ie~ also passed out ai tissue of'.another~~ man ofl 65 wiio~had not <in0ltied. Bothidiedat 65, -1'I1•., Ana~--Nss. T1iis~ is precisely~ the~ point I~ am making. Wo~ are ~ talkin ;~ about statiistics~ and~ matQtemati~cs; th~at~ you, didn't have~~ t'~o~ survey~ or lr.lve a iueasnrenient error or anything. I~igree nittl3 my ~ collea(z~2ie from Texas. The two~meni are dead. One ~Zmolted atld one didn't:~ You can tell that by ~ looking, at^ the~ biopsies. Mr. PICKLE. If the gentlematr -,A-~i~ll yield, I~ w~as~ goii1g, to add that it looked t.o n1e ln te one min enjoyed smohing flor 35 years and the other had ibot,. Mr. 4nA-3rs: I don't deny ~ thata'., B~ut st'atisticall'y~they are~ ai fact;, with- out any~measurement error at all'. Mr.~ S'TEar;iNG., I ain not a pathologist, sir, and I cann~ot~ testif5.~ as~ to «~het ier~ or,not ai ptithologist can telli whether ~ or not the ~ lung~ belongs, to a smoker or nonsmolcer. However, it is~ nYy ~ tuiderstanding ~ that tbere ! are inany pathologists who cannot make that statement. Mr. A~n_»is~. «e had one~in here~R-ho said that he couldn't tel1L but we~ had a series~of other~who~said they ~ conlldl I have one last set of questions-~ _llr. CARTER. If the~distin~,uished genetlenaaji~'would, vield~ I will! say we~have~ had an edua]l iiumber~Rho,have~ said they: could not. Jir: _tin AM& . We had, Dr. Carter, one, and I asked him af'ter~~ he~ fin-~ ished wlietiier or nothe could. and 1'ie said he did'di~"t know ~ «-hether~cig- arette smol:inr was good or ba.d~ and I', asked. him if as a thoracic ur~eon lie told anv'bod'v~ who I~aid a~~ chest in~-ofi~•.ement,~ irritation or otlteiwise if~they shoulcl~continuesmokinla~. Mr. CARrr.ER:1 hat is not sayint whether he eould tell «-hat aismolter''s l'unr~~r.1s. One~ was Dr. Chrr anid't'~here .vas:.one other pathologist-andd tliere n as~oue~this~morni~tig w-1io said lie cocil(In'ttelL l~~Ir. _~n;~~.cs. _Ul rirht;~ I)~octor,,I he~l~i~d oiie.~ l~~Lr~., C:»;i,ra~t:~ There~ h~i~ve been sewerstl' whole:-tified to that: etfetTt, arndl IDt-_ Buhler. 1Tr. AnA~3is, On your point th~e~ otllet,~ one,~ a~s, . Ii understand it, yo~ur criticism of the survetiT or the study is that ~;onj believe there are too n1ann-~ factor.s,~ I thii~tk~~z-~ou, mentioned five that sh~onld h~ave~ been ta~ken.

it correct?, o account?' or would I vou not? ,tatus and -our testi- ors-we11;, iat wasn't the data, arge dif- large age affects of , then, as _'J a largehen com~ iokers to svhat has !1 cancer, isal's and in their nlar age. 7 cancer, ^is all. at more ' I have er mor- , with. lseavily Cr some is con- i have, •s. and. I lting y asa, 1' relh- )eopie ether f you could make a causal statistical relat'ionship~ between the two, or you would deny it existedl? Mr. STExLaNG. Could I have, the question clarified ? I am thoroughly confused, sir. Mr. AnaMrs. You hav e ;a group of' people who are smoking, and a group of people who are nonsmokers, and comparing, the number of people at a~ particular age that die from lung cancer or heart disease, and you find that a much larger number of the smokers die than the nonsmokers, do you say, as a statistician,, that you can not make a, causal statistical relati'onship betv-een the two?. Mr. STEnmINc. Not necessa,rily; sir. Let me point out that the worldd is fu111 ofl coincidences of various sorts. The very fact that two statistics have same peculia;rities in no way reflects a causal rela,tion between t'heni:. For instance; the divorce rate in this country is higher in States with' water, that is harder than az~-erage than in the soft water States. Does that mean that hard' water causes'more divorces'?iklr. A-DA2Nss. I am asking you if you are aware of the relationship be- tween the two, llr: STEPrarG. Some questions cannot be ansn•eredl with a yes orr no, sir. Mr. -A-nAats. This is your business, Professor'Steriing, Your business isstati'sticsandlma,thematics. Mr. STEr.LiNc. I do not understand your question. :1Ir. ADa__Nzs. You take a group of people at 60 years of age under the mortality statistics and you have, we will say, 100 of'them smokers and 100 nonsmokers. More die of lung cancer and' heart disease at age 60 that are smokers than are nonsmokers: I am asking do you deny that you can, make a causal statistical relationship between the two?' We will worry about whether they are accurate.. We will ask some- body: else. But do you deny that there is causall statistical relationship ? 11Tr. STExi.TNo. Under the case you mentioniand no other infonna- ti'on, I would say "'No.'''' ATr. ADAMS. There is no causal relationship, or there is?'' 11Tr. STEuLIxc. Si'r" if' I am clear that you have said in the event I had twoi populations of 60-year-olds with higher death rates from lung cancer, imi orzegroup ca1led'smokers, than in the other group: called nonsmokers, could I from that dhta itself determine that there is acansal relationship betw'een. iCSr:AnAT%Is, A statist~ica'1' relationship thatlcould lead to a causal rehitionship, you as a statistician. l'Tir.SznRr,r*'G. Are you talking about a statisticalrel:ltionsliipnc~w'?Mr.AnAars. Yes;Ihat is what you are here to testify about, isn't it? Mr. S'rEr:r.rNo: I'11n professor~ in a department of appliel'mFlt~he-matics,whicTr doesnotne.e9sari~laxnakes nseastatist:ician,tobepre- cisee y1 stntisticall rel.ntionship?' fdon't knoR-.whart a sta.tistical r,el,i- tionslYi~pis, sir. Tliere are certain tests which «•ecan perform. I+hriii4ance, Nve could comhlite the valiiernfsonict!hin!,r called tlle Clri-Sipnared.l~et,us: . say, and give you that value. TIii~s v~ol'11e is not a r~~l,iticnshiTp in itself. Tlse~'termst~atistical relition,iiip, is4onaethin, ii-l6irh I s~im1?1y donot'graSh, It isiaot a term Avhirl! Iv on1d n~e hrefz•ssionill y imdcr any crn1cTitions.Mr. AnA'-Ms: Any kind of relat'ionship? i1 i il

921 'ment with tobaccoo zarettes. , A visitor ,raduates tending have been treated': is collected. This r signs of tumors, mical with which = most dangerous i private projects earn the reasons N is eleven years ~Iling, mice to try summer of 1967. teehnicali person- 1i is fine. h3'ow- _'ofit mot!ive in profit tnotive litive. I don't research were grants, t is your spe- )t want to go or the lRst 23 ogettoistlie e smoking is he testimony ut Correcting at you thiiak some peonle, itiaT positioni ; a warning, 'tte snzoking )iv R°e ntiglit it.ion that a tte smoking sClteniosoT 34 percent. rcentt clieln,- al animal5. In other R-ord5, I agree with you that I think the cigarette-smokinn population is, goingtloremain, roughlythesame,, and a, tremendousnusnber of' people are not going to~ be automatically turned off ' i'f' ad- vertisino- stops: I th.ink the indlustry might stop its expansion among the young, people, but I[ am trying to get from you what the duty of this eom, mittee and the Con;ress is towardl the general public in telliilg them abonttlsis product. From vour testimony. I gather that, first, th~egetaeralpublic, should l~e told' that cigarette sanokit:, is hazardotts.and second, some kind of a statement with regard to~ thei'ngredhentsof the cigarette should bemade to either indicate that it rniglit be safer to use filters or to apply ChemosoT to tobacco or to any one of'a number of treatments so if_ they treat tobacco in a particular fashion we should tell the public about it, if it is safer. Isthatrigh0 Dr. Hunso_v. That is correct.. Mr. AnA.rs. Sn in the case of Chemosol, we would have to link its effects to cancer,, because your testimony has runi to cancer, and say thtiT ChenlosoT will reduce the cancer-producing ingredientis; What'& you say about it?'The word "carcinogens" is.too big a-word to >>ut on a packaye. What would you say about it if yan no out and advertise it '? Dr. Hrvso-N. I can't ealll on nd~-~-ertisingesperience. As a matt'er of vomnzonsense, Iwou1d advertisethat• a Chenlosol-treated cigarette is le,s hazardous becauce of chetnical Iaboratorv tests ancll in research: on ccxn-imental aniirrnals: JLr. An~~_»cs. We would have to tie it to cancer. becanse I want to «o iiit~otheheart effect's~ in a moment and Iunderstandl thev are not in- volvedL This would reduce the cancer-producing, effects of the cigar- ette in esperiments with nhboratury animaN. Dr. I$t-nsoX. That i~s theprincipal demonstra,tedl phenomenon, but it' is notthe only om-: _llr. 4nnzss. I! just want to know medically what is proper to say about: this. D~r.Ht7nso.N.Tba,t it is less hazardous. Mr. ,LvAus. That it is less hazardous in producing cancer., Dr:, Htinso-N. 'IPhisli asto be final ly a matter of opinion._l'I[r. 1:vAus. Of cour-e: Tliat is «-hv vou are here. Dr.Hunsos,. Itis~niy opinion and other scientists that,the cigarettee smokecond~ensatsfrotna1 Chemosol-treated cimn•ette iel~esshazardousaccording to several lcinds of test's. 1Sr. _1n_»ts. Notv IWill sltift You over to the heartt effects. We have had a number of doctor.scome iLand' testifv and the information that we ret is that in their opinion there are t.vo possible heart efTects ltro- duced bysmolci ng ci-arettes. One i.sthnt thedi~ssc,lvin~-of nicotine into tlhebloodst.ream, as~ one doctor describes, it. is d,eleferious~ to the tone of' the eentrall rtervous: syst'emand,ther.efore, p2,oducesai constrictive, effect uponi blbod vessels and arteries.Cl6eniusol, as far asyoul:now, .a=ottld have no etfecton th:it,wouldit?Dr. HtinsoN-. As far as II l~:no«-, G`1ieino~oT d~ ~stlus :It retluces*tico-tine. But v-Jietherthererluction iil~ nicotine issibnifncant„ I do not];now.

935 iol[1 are to([ that, that is tta are: Tarette ^Which Y only esa In ciC,~recl or the Errors twice wS are social idivid- popu- in the ilf the female favor -4pecial ; e ince= _~atiovt, tnedi- -ead, aOndent iom he sy.mp- laimed .~e they - taken A«•een iection or im- linical I.rview )ndent cr:x:s. ,rnf'the proxies. rrvnt of •re later nQ selY-I nnder-Iyinkinitr ds com. least likely--such as diabetes, asthma, high blood pressure, or heart trouble-only 44''~~ percent were reported correctly. Agreement between loss clearly defined diseases sank to as low as 20 percent. Relatively tlia.matiie medical events„ such as a contact with physician during 2 weeks preceding interview, were not reported 36 percent of the t'ime. O'nly 49 percent of' the population reported their lenb h of hospital ;tav correctlv. The fact that hospitalization occurred was incorrectly :v}iorted 13' percent of'tlie time.. Even an event which might be con- --idered to be the mostdramatic medical experience in a family, the ilirtlii of a child, was reported With a 3 percent error by householdd surVe~-s: ~1s.inaccurateas, interview data~ area:,, they becomedoubly so~wheni : iieV uSe prosz•y respondents,l Oise~tndy'fotuid that erl,orsfrolnprozY respondents Wereoverliti-e titnes liiaher t1lan errors from, self-reporting individuals. Hosv- Ver, in most cases errors from proxies are rotighly twice that of errors from self-reportimg,One study found that for hospital stays + ior, 2' to 7 days. proxy respondents made errors approximately 24, lpercent of thetime where self-responclents nlacle such errors only10hercent of the time. When: the -weeksbetween liospita1 discharge were 11ietween 21 and 4(1„self-respond'entsmttdea5-percent error:prosyre-~hondents niade a~ L'-percentt error Rhen tlie~•repol!tedl for their spc,use: alitl ai 22-percent error R-hen theFr,eportled~ for other relatives. With respectto delii eryof a child,, self-responclentsfai,1ed to report delivery:>herceitt of the time, proxyr.esponclents failed torep~ortthem 8per-Rent of the tioire:'' Errors are not limited to theconntofdfiseases. The:count ofiwhosnohed and R-ho did not is, algosubjecto toconsider.tblc doubts.Thereare tn-olailge-scalesurveysthat havefitrni4hedae pattern of'tlhedi,sr tribut.ion ofl smokers and nonsmokers in~ the >iT.,C% . popuLition.Tllese 5urrevs, agreewith each other but disazree with~ n2tanberof smoI.erse4inlated l>ythe National Health SnrVev-~ by as,mucll as33~ percent for some m2le.,aiid 2 311ercentfor sontefeniale, a' ureg>•onps: `, In view of the largeerrors and the uncertaint.-ofthei'rbase; i'twoul'dl be speculation to estimate thenniullerof clii;en=es that occttriai the U.S. population to say nothtng of.iscribing, a(ris..eirnnmber of these to a particular population group. Certainly we cannot justify a: comparison betweenn smokers~ and nonsmokers. Any comparison between groups has to bedoneIvi'tll~ clne regard for theacctiuacy with -which~ disease rates are estimated. When a ~,mnple is ai truly ratlclomsamplie„ and when t'hentethocU of ineasure-nlent is :`i°elfiabfe,"then the accuracy of' estinnates, can be inferred. Tllenl: <tsurewe tlseto;describe the accuracVis the :'atandal•d ert•or."Mi:en dealing with random samples and reliable iuethocls of ineasure- meilt. tlie estimates ofstandardlerrors; or oft11leliossibllevariability of thh crstimate; ignore t.hecoetlicient of reliabilit~•. However,, ~~-hen~ tliereli'stk~ilith- of themeast~tre iskno«,n~to be lon~:. it~iSilecess:n•y toicorrectt tl1se, usual estimate of the standard err.or by the size of the: reliability lpd~ ' I or i1htShca.and,referencess seee my report "4nEtraiuation and Crititlue of the ReEordIAnktnet.i;;areotesmoking toGenerai -Morbidity andi. Disability:"on tilt) .n•itlt thiweotnmittee: 'iraaten.. - 1 h~e are- IlatnwonJ, I•C. C...Ftnukinr inlI',plationtwthel:)wtth R:ateo[ One 'Million \[enaea. andandl Women, \ational. c'nncer Institute Slonograph• No. 110, . 1:14i0!., and Haensz~el. W.. et al.. 'onnt of 'Pohaeco Smoking Patterms Ln theLlnited States. Public noulth Monograph, No. 43;. 1956. .at'~ cueri1Rrlecant tahles hacehe;en extracted In ntgdetnilHdireportto the P] I6~.

959 ied wnl lip I rc P 11 azrd itt is the first time I have seen it,a, point which has not been raised thus far. I-wonder if you might make a quiek comment on it.. Briefly,, you state, '•I~f' we accept the metliod's and procedures in the report~ on ciganette~ smoking~ and health cl7aracteristicsj~ w~e~~ will have~ to sccept"'-and I don't agree we will have tio accept but you say so- `.Nve .vi111 have to accept at the same time krebiozin as an estlablished ti.erapy~ method'I and many ~ other drugs,~ which now clut'ter~ up, the~~ naarlYet as proven medieations."~ That is~ an interestin(r ~ obserr~ation. I wonder if~ youi might~ expound j ust ~ briefly oni that. In other w~ords„ youi are trying~ to sa,y~ to~ him, and i(rtie-~s since you attach, it.t here, that if «-e accept this report' giveni by tlie~ health department as factualL,~ then we~ are going to~ have~~ to start ~Yiz-ing ~ some~~ credence~~ to~ this report in reference to~~ krebiozin and to~~ r,)tlier~mat~ters,such as~that? , Mr. STnxLi`G. I have manv friends in the P'ublic, Health Service and II have done a goodl deal, of'work w ith them. I have always pushed this olie,,point. This is~that the~truth of a~ connection between enviroW-~~ mental factors~ and health is~~ a~ d7fficult~ problem to~ establish,~ It is not~ to the ad's-antage~of'the ~scientiific community to1oosely ~~ attack to~,such l)roblems because we wish them: . tlo~ be~ true~ or liecause~ we a~re~ con-~ v inced that they are true.. Scientific methodol'ogy is a difl'ienlt process and ca~nnothe violated'with impunity. If we~ open the door~ to aceept the findings of tliis~ study~,, we also open the door to accept tlie fiizcl7ngs of ni.any a, lunatic who wishes to niake particular statements concerning the effects of such unlikely factors~ as~~ radioactive chicken fat or lcrebiozin~~ is~ good, for~~ the~ treax- ]llellt of cancEr., Mr. jV-kTSO-N. And it could verv~ well result in a~ f2dlure~~ to,explore~ furt-lier~ experi~mentaIl'y ~ the~ real' causes of'' cancer andl these, . other~ diseases, because~ we have 1'at~ched upon a theory and n°e~ are goiaig~~ to~~ ride this ~horse~~ for ~a while. ~ Could that not be the result?' Mr. SzERLia~o. We~ have had manv~ cuch~ demonstrations in inedicine. Yea Mr. IS'ATSO.-. Thank vou.. Mr. SAaTrTM-IELn: Mr. Adams. Ur. AnAMs. Referring to a letlt'er. Mr. «'atsony, just referred to:~ dated .Tanuary.~12~~, 1968;~ 1, want to find tld~e~point~ in~ statistics that~you~ think is invalid. It says :. About three months ago Dwas asked to review aPHS' report entitled "Ciga- retlte Smoliing and Health: Characteri5tlics:" The request came from a group of attlor.neys representing the tobac:co! companies. After a, careful review and eval- uation of th:s~ report, I~ concludpd~ that~ its~ authors~ R-~ere, carriedi ativ.a,m bp~ their zeal and public spiiit, very nnach to~the~detrienent of'sound'scientidc reasonin,;: The.~ conclus~ions~ advancedl bg~ the~ inv~estigators~~ simply~ have~ no~ basis i~n~~ fnctl. ~`~ow,~ is~~ your criticism tliat the u~i~.derl~-ing~~ i~iformationy tlie survel~~.. is~~ at fattlt,,or~ the st~~tli~sti(ral~ metliocls tl ur t~~ urt thev nplflfi~edi to~~ the~ ns1rler=~ 1'yin-material i's,at fault. or~botlii?'~~ ~ Mi•. STF~ar:rNG'.~ All tlrree~.. Their andi'ulgs, ez-etr~ iif we~ forgive~ thenl~i the first two errors; do not justify the conclusions whieh were reached. This is a. point ~tihat oughtnot be overlooked. Mr. _1:nA~us.~ Would you~ sav~ that even i'f the~ tuulerlyiirg~~ materi,ill «-<is~ v.tili~cl.~ you di'sagree~ with' ~the useanrl! I have~ to in~s~e.~ ~tatistical

952 Therefore, there is more than one incidence that may be olitainedd . here, or more: than, oneratewhichmaybeobtained here. I would call these figures cornpletelyinaccurate that you have in this black report becausethev -werebased on, a peculiar method of age adjust'menI which the National Center for Health Stati'stics obviously does not like and has never used before in any of its other studies. 1'1r. WATSON. You are right. In fact, to show you how ridiculous this thing has gone, according to the moribundity study, and I[ have, made a little study of this, the report that you have: when they were makingtlie study and askin g about chronic illtnesses tlieyeven, imeliudedI those who wore glksses, those -who had hearing defects, those who had a missing , finger, alll kinds of things that coul'd not be remotely related to the smoking of'cigarettes. That is,another misleading factor. Is not that , true ?Did'not they list tlrecllronicconditi'ons~ in the back of that study which 3~~ou made? They included all of tltesewild things that couldn?.'t remotelvberelated to smoking. EVen club feet R-ere listed in, there as a cllroilic condition. Was not that even listed in there? Mr. STERLING. It was. Perhaps it should be pointed out that for both arthritis and hearing impairment,, smokers rn, general do better, than nonsmokers;,according,tothe figures, publish~ed here.. Mr. SArrExFrEr,n. The g~entleman's time has expired. Mr. Pteyer. Mr. Pr;EYErt. I am trying to get these titles straight in my own mind sincethey all sound a, lot alike. You are cliscussing the original report, "Ci~arette Smoking and Health Charact.errstics,."' known as the morbidity study?. Mr. STExr:rNo. That i's correct. 11Tr: PREYER. And then the findings from that were taken up in the pamphlet on the "Health Consequences of Smoking?" Mr. STERnaNG. That is correct. hTr. Pnr:-FFn: That was ~ 1967: ItR-as iiYi that latter pamphlet, buti not intheoriginaL study; that the77millfion excess l'ost work days duetosmohin,(r was mentioned ?'. :YZr: STERLING. That is correct. Mr. PrEvErt: So it seems we have an example of v-hat' Dr. Katzz was testif-vingtolvesterdh;v; where the ori(rinal f'aet might be qualified and ;-lrarded and stRted properly,but as it passes tlrrough different stages d'nstort.ionsenterinto it. I3vthe tiimeit nEtsto the pamphleteer stage, we have lbst track of the ori`innl qualifications surroundinn the fa ct. II wi11' jilsti say it seems to me that your teetimony here has hloR-n the morbidity study riOht olrtt of the water: You mentioned that you sent tllesereportst'otllePublie ITeallthi Sprvire: TTave youi receired anv reTnTv from: tl.em?ItR-onld seem to c,lll for arenlh~. N1r. STErr.aNc. I have sentthesereportsto Mr. Zfi"onlscyv., R-ho i'sdirector of thehrlationa-T Center for Health Statisti~cs. I recei'ved aa verv cotirteous replof'rom him. Iha~ve ad, z:o ~zent tlleseQtudieI toDT: F.nclicott:'s corrrrnittee„ through, a. me.mber of that committee, ;lncl I linve received no:replv. I have copies of three roport,s whirlr are bnsed on a stndv of' the National TTealth Cl,n-Pv. as well as the nrininal dhta, wllic3'r «ereall' f~orvard'ecT to the Pnhlir TTenltl~hServirerRnd' +Ihe ; : t ional Center for : 1u irtee if'the comrr Tr. PrCrz<;::r,E. Would ~ir: Pnnym. Yes. '•Gr. Prcgr.E, AN"hen %,„I'libentioned!? ';; r. STERLING. The i N., is included wi1 I , .wh of my staterr. 1ir. Prct;r.n. Was 1 did tl i ey take issue ': ir.~ S71ERLrti G. MT ~ clnents concerni~r The letter is `.I r: Picr;r:r. _l'Ir: (' _<in:nal staff ifl we `II. ~fi:.cklrrt. We "~11: Picrr~.i7. Tha~ 1!n: Piu:lr:r.. _110 -•,1a rlhaz ther,e~ ouz1 rt : ,uclr a~ this lI'llN",.111(lchUlll. ;it all'. 1,~'A1"]II_"'tllat for I'1 1't' 1 !'e~lLilb~r'ill - 1Tr., I'.,>~~ster. h ,' rr ~ ere.~ iu p' ll''tlres~2UrU ~~rnt i'emulL, ~~ snYok, iuW1, ~-1;1„kers an d ( 3 l:~,r~; atl,l tllerl iiN-~. 1,~ t 1'I:ra ali„ut. -%c ,,,,, _,IlPlPorr?~ I I•,II-r ~ :~\- no: l~ef 1-,•,1 ;lec~ re.lllv I lll ~-~ onk• l;ttle~. ~ ~lt' i-.. I nn~ ,I1,~1l1a~ikll ,1rvIrt•ate, f ~~ ~~I161' pliti111ltis~ r- -)rr, , r,r:r~~ c~. M,1.. syl..rl:r.r•r. \fi•. IT_~:rt~ti: Mr. ~.~~-rladrn

922 Mr. An_»ts. That is why I n as trying to gett your specialty. We havee to: concentrate with Cheniosol jiist' on possible~ cancer problems.~ The~~ other effect, asi I understand~ is that interaction bet'ween, cholesterol sertuns and nicotine within the blood suppIyy which may increase the constrictive effect on the arteries by the buildirclg up of fatty tissues. Cliemosol -would not-as far as you know-would not effect that. Are cou saj•incrthat it has any effect on that possibility?' Dr. Ih;.nsoti . Only by ~ reducing nicotine. Mr. IIAcnoN A~cn. llr. B'ro«n'?~ Mr.~ BRoWN, How ~ muchi Chemosol 'would be~~ added to~ tobacco~ to~~ accomplish this 3I percent reduction in terms of' the cost per cartonn orcost~perpack'? Dr. IIrnso-N.~ Anv legitilnate~~ to the cost ofl eiaarettes would be~ vast!- ly~ less~ than the~ difference between cost of cigarettes~ between different cornmunities! . in _tilne~rica today. We aa•e~~ talI:ina in terms of pennies.. This is not ti expensive process: r. BRo~rx~. How many penni _~L es R-ould it redtiire to add to the cost of a pack of' cigaret'tles to reduce this benzo[a] pyrene content of 34.2 ' ? percent? Dr. Ht;nso-N. Do yon mean the cost of the originallmaterial nece=s2rv todo1hi~s~ or the cost that might finallhr~ be~put~~on the~packabe, itseLf; wliiicli I im really ~not~able to~answer?~~ ~ I~ -would say~~ we are~ talking ~ a.bou~tt a nenny~ or 2~ pe:niies; sometliincr like that. -Mr. BROw~N.~Forth~e,eost of~materir:il? Dr. Htirnso.N. No ;~bvthe~~tirne youigot all the~way throu-li.~ Mr. Br.ow-~-. In other words, that includes the~~materi<rl and the cost~ of the process of adding it ? Dr. HL7Dsov. That is my b ess: llr: BROWN. `io~~ we are ta101ing ~abont ?pennies a~pack. 11'hat wo>'_ild~ the materi'ni cost be? Dr.~ Ht:vsov. I~ don't~ know ~ that,. l~~'e~ >>urcha~sed it as pure reament~ chemical~sand the cost.~R-ouldn't~bear any relationship to what it i~-o»Id~ cogt~inldltstria3l~~t ll!uch le~ iui qu~antity~. I[ would have to look it up but it is vastly more expensive when yon buy~in quantities you do for~a research lab:~ Mr. Bnoec-NT,. I~1sas~trving to get to what the~econon-li'cs of this~«-ouulal be in ease~ t'he~ Federa.l Government -would require~ the~ addition of~ Chemosol to: tlobaceo~ in, citarettes.~ whether ~~.r~e~ are talksn;, about a multimillion dolla~r~indnst~~rv or mulitibillion doll'ar~intdustrv~. Dr.~ HLDsoN. Sir.~ I thin4 tlie cost ou th:1t~ bnsis~~onght~to ~~be~nom~inal. Mr. Br,ow~a~. That i~s~~«h<atI am trying to~ determine; what your~defi-~ defi- nition of~ nominal~ is. Dr. H>rnsoN~,. I~ think if this~ n-er.e~ p11t into all toba~cco. I t'hink~ tlie~ fi~~-iYi,•e~ I~ ~~•<i~~~e ~-ou ~~ould be~ hi~;~h. ~ Mr. BRo«rN-~~. Let ussa~~a a penny~~a p<~ck. Dr., Ht nsoN. I.r~ouldli`t think it would exceed that. Mr. Br,ow-N. What is the~ economics of a penny~ a~ pac);~~ of cirrarettes~ a rear'?~ Dr. HL-ncnv. If.ord.I have no idea. Mr. Bt;ow~ti~. Mian-bemy~colIea,ues~mi-Iit be~able!to:assist~mee llr. M_ecnoti ALV. Substantial.. . IDr.~I+It;nsoN. I dan'1~ i ilce that, because alt rV1uo;red, I have noli, ;udustrv: Mr. BROwti. We w put it into the~ l" -olcl ,r ~-ear and multi]; i oi~ ~llserl the~ term ~~;:uetites~on tliose~~~ ~ ~ldL•ecnrrin„ Iy. Is it possible that ~ ~,r no~ perceptible pl ')r: KUosoX. I thin 3Ir. B: otv-_N-: And :ul(1 sui5~ject~ themsell ot the~natur( i)r. 1lrnso~:. Yes. J~iB~:, ,i;~N.~ To~tI I)r. I~lIUnso,~~. Thai -itl') 1•llea~vll.va11(11T ~ !.11 1';r,OWN~. Let I __Ilvl?'. A1'lth~ 'M1:~. 711~"111f1~'. 1~e~hFI7~ -~y i f:a•; e a ,.eelin- ~.~iliv:r t1l i('re is ~ lio~ sl _l~lld.~ aC.°refore" t~. " anal "nlay be:"' 1~~u1tll.~are~'Valus _o1°ous .n:~d i'or ~othe~ T~) a•.1 I~t-.uso,,~I l es J.T 8:,L)W,~. So i ~ hr~ dea~~ree~~ of dang~~ i- a cIue~'tion we ~ !! u I :un tr ;•.ing _~oi:ous~~ i>t :-ma°~ ~~ bi 1)t. HL-nSo-\-~.In1 a~~} 10 he .:m:iy l. ~ I e, r~ 111~-~..' "i'tierc "-ozll~d l)e~ dail!.''el'oRal ol'~ 1F .,oople~it luav ~notl )~. ill n~oh,. "GI6~ \1r. MAunoNALn~ \[n. P1^Ever~ Mlt, PI:1~YI:R. I Il, I «,rnt to~ th.ink iolL, nlv foi•m~er c eecoll~ectiolr of~Di I,lot Nti-as a verv eff

906 ment would result in a safer eigarette., It is in the Inublicihtlerest that safer cigarettes be made a,vailable' and the ptiblie so! inforlned'. (I7r: Ihlffz-'s prepared statement f'oTlo«s:) STATESiENT OF DR. BE*7EDICTJ, DUFFY, JRi, PROFE$BOROF PRE4ENMEJISEDICI:tiE, TIIFTTSU:PIVERSITY .SCHOOL OFITEDICINE Thank you for inviting me to appear before this Committee R•hichi is'concerned with the smoking and advertising of cigarettes. As a Professor of Preventive Medicine and Epidemiolbgy at a University medical school, I am, constantly made aware ofthe cigarette smoking problem and the need for a less hazardous •cigarette to be made available to chronic smokers. Thisi is not a new problem but it is one which has been dramatizedl to 1 the American people. For example, testifying bef'ore Congress in JIarch, 1967„ Secretary of Health. Education, andi Welfare John W. Gardner quoted his Undersecretary Philip Lee, ET:D., as fol- Tows :"There are going to be a great many people who wi11, never stop smoking and we must get going with the kind of research that will persuad'e the tobacco IndustrS to pursue the kind' of research that will result in a safer cigarette." Unfortunately, there has not been much research, oni this problem and those of us who strongly agree with Dr. Lee have become very concerned. Ii was a member of a team of scientist's invited by Dr: Perry Hudson, President of the High Tor Foundation, to corroborate the laboratory findings of the foun- ~dation which had been submitted to the Health, Education and Welfare De- partment as evidence of significant benzo(a)pyrene reduction through treat- ment',with Chemosol. The other members ofthe team who also agreed to participate in this scien- tific investigation were:~ Dr. Paul S. Larson. Prof'essor and Chairman of the Departknent of Pharmacology of the Bledical College of Virginia. as weIll as Chairman ofthe Committee on Smoking and Health of the Educational Researchi Foundation of the American DTedical Association. Dr. Larson co-authored with: me the final report on, the, resultsi of' our investigation, In addition, another mem- ber of our team who was with us during the entire experimentl was:Dlrs. Frances Dehn of the Stanfordl Research Institute. It was our understanding that the Stanford Research Institute would do the final' analvsis: and therefore it was important that someone f'rom that laboratory be present during the entire experimentali program. Another participant was Dr. Gio Gori, Associate Scien- tific Director, Etiology Area, \Tationali Cancer Institute, who, was senti by Dr. Carl, Baker of that departmenG. However, Dr. Gbri only participated for a few days because of other appointments. In addition, the Research Director of one of' the large cigarette manufacturers, who requested that his name not be men. tioned„ was presentl during most of the experimental period, as well as Dr. Edgar Berman, private medical consultant. The conditions of our program of corroboration were based' upon a.letter which had been reeeimed' by the High Tor Fottndation from the HeaIth+ Educa- tion and Welfare Department in which it was srtated that the experimental program condilcted by Dr. Hudson did indeedi show that the use of a tobacco ad- ditive by the name of Chemosol reduced benzo(a)pyrene in ciharette smoke and his biological experiinents showed that there was an elimination or reduc- tion, of'tumorigenicity in mice skin+painted or injected with the treated tobacco condensates. The letter f'urtlier stated that for Dr: IIudsnn's results to be aecepted!bytriescentifiic communitwit wouldbenecessarytohave an independent corroboration of his work. Our task. therefbre, was to do this, We were to inspect independent laboratory tests: designed to measure the effect of Chemosol on benzo(a)pgrenecontent of cigarettesmokeandl'telp arrange a parallel'analysis by the Stanford Research Institute which uses the sensit'ive fluorescence "'Pec- troscopy technique. The report from the Stanford Research Institut'e then was to he consideredi by us to he of prime importa.nce and incorpor;ztodl in our report. I must confess that I and uiy co:llt asues in this esperirnent were very skeptical when we tool.onthisasAenment becau5e t'hereduction of henzo(a) pyrene: while it had already been accotnplishecl' many tiiiies by sciE ntists: haii never been reduced with ai non+toxicfbrmulation whichivouldnot affrct theflavnror nroma of cigarettes. However„ we all agreed, and therepresentatives of the cigarette companyhadi personally told: metliat if more tliani 23rloofl the lwnzola2pyrene wasi removed, then this was iitihed significant and, the result would be a less hazardous ci4Taretite. This was tlherefore a scientific chalhen;re. In arldit'ion, we subscribed to the findings of'Dr. F.rne.t L, Wynder who has consistently reported that ai significant redkic tar's has always so fa tumorigenicit'y of the t: ysis with biological an in estlabTishing a, relati experimental methods. justifies our accepting Hudson's work would1b4 In February 1969, R! of these controlledbio-a report stating:that tlh, ,honld be accepted ew The experimental te Ap,ril 18, 1969' Dr. Larsi the following results : (li i During our visit strated to~ ustheptrofi sonneU of the High Tor ('-'I The commercial from the same batch had no treatment at a tobaccofirom the samc coutrolled conditions: The results showed l (n7orethan 25%)' of c-onclensates that weIR.esearch Institute reported to us, a~ ~40/ Thcrefore, we rep( u~; corroborated Dr: titic proi+eduresand In addition„ I hai Iliuh Tor biolbgical tin ini're treated by't Iamtlierefore plepenclent controlled t .,fh,,nzota)pyrene: tllcr c'bemusol, formu haiz.u•duusci-g-arette made availableand The C1LmInt:k-~ \lr. hal Mr: 1I LsLS.( nafPI•. on tiiefirst work t'cnwarci t l le T{iIs has been entpliasis I repeil tlietre will i')e Intr :t(l vert ii=illr. I. t'li I ~~-atlier that for elcvelopitt, a : 1l1,it I,eoI,loNvil, uot o Irt~ the hrc di•veInlutdclir ofiI 1r. I Irn•«"'. iiwIhnl(A in secI~It• -;titl that to cotviilc•e'pec in had becotne ( 1Vl f,Ire that tl

9316' coefficient. Ilf,, as in the present instance, the size of this reliability co- efficient is not kno«n„ although it is known to be small, andl if;, in addition" there are considerable doubts aboutthe validity of'the meas, ure and the' randomness of the' sample; thentheusua1l estimate of thest'aiidard error is simply not valid. This is even more true for male smokers and for working females for whom data was obtained mostly through proxy interrie~:s.Therelia~bility and vadidi~tyaf their data~ is knoR n to be smaller by amagrsitudethan for directly obtaineddata., Tihus; it is, simply not possible to evaluate differences between popu- lation groups, especially among male~and currentliv employed' females agii2~st the estimate of'the standard errors as, g'iven~ m~ thereporta'"Cigai,ette Sniokin;' and Health Characteristics." ^_:, DOL•'S: THE DATE REALLY BEAR OUT TIIE PUBLICIZED CONCLUSIONS? Be,ides' the uncertainties about the data themselves, there is a real question if such data that were collectedl really support the conclu- sions v'hich vere'disseminatied.. a.FemaIes: It -was pointed ontbefore thRtdata,on females are more. reliable than those for males. While most of the information aboutit females came from self-responses, most of'the information about males'e came from proxies or from males who were found in the home during working hours and whoinchldedi, therefore, any unemployed~ el'derly,sick~, and disabled individuals. Tltecompnri6on between female' smokers and nonsmokers would appear to be of'special i¢nportance,under theci'rcumstances.Yet,, thecolnparison of femalesmohers tononsnol:ers'o does, not yield a pi'ctuliethat is at alll in line with the stated conclusions of' the report. I[n almost alll instances where' age-specific rat'esare compared, thefem~,a,lenonsmokers show a higher rate' of disease and disability than to female smokers. When a~ comparison was made not between th:e' more reliable age-specific rates but between a=e-adjilsted rates, these com- parisons, changed slightly. Iwilll discuss this peculiar result of age adjustment more fully in a moment. Butl„ even if we accept the age- aeijustedl rates, then disease rates for females are still higher for nonsmokers for someof' those diseases for vhicIr the report Cigarette Smoking andl Health Cllaracterietiesc'laims't!he' opposite:ThSsis trueespeciallty for heart, conditions. Where dill'erences in prevalence rates are' reversed by tlheageadjustment used and female smokers have a hi`her age-adjusted disease rate' tlhan nonsmokers,, the differences are trivial. Alinost'exactlV the same resultsare found In, comparing,t:ypesof' disability da,vs, f©rrestricted activit'y,, bed days, and work-lbssdays. Ingeneral,~ fema:lenonsmokers show a liigherra'tleof disability c1ays than do female smokers. There, is onepeculia~r' manifestation among felnalesmokeLswitly respect to work-loss days which is especially worth melitioning. Fe- malesmol.ers are restricted to Ttome or bec1far fewer days than non~-smokers. Yet, currentlyenxpToyed femalesmokers sholva;,higIlerrate of worlt-lhssda.ysthan doo nonsnbol:ersi Ti his reversal is rather curious siIlce it would inake little' sense to conclude' that employment causes a larger increase', in disease among', smokers' than alnong nonsmokers. Anotlier,amd more obvious, esplanation i&tTrat femalescurrentlyem- nloyed had data~ concerni:_ngtheir health and wel1, beingsuppllied. through proaie: information the ~ 1). 11d just~inF,7 ~-()urces ofl diffe i isability rates =; iurces of diffe 1 dayment statu Tondents~. _:.djustments : (,x and age dis three majpr~ co) But proxy I i,-~honcients al' ,-el)orted.i' tiow, all th( 1!rC~~ empl Dylne~ ;i N-eri-~ ecn)ple: 1i)ttrted di~:ease~ i'or~~ad~~jt:sti.ng~~ ;tnd on the ki: :L ljnstmellts v 111ilcli troIn nC~ d~~ifferedl iir the~ -tatus; inn the (I ;Ind not only i. l;~ut~m<Iny' ~ni ]nleliactl(3lls a of'disabilities i'id(_, ~ and nons~ 1'roper~a~dj Inost rea5onal n1eitts,f~or eac~ ,•1i,tl acteri4 ic. l,etter w~tnuld constell.It'~ioni ~ 1 ion•e~-eir,, r uat'(=(rarv ~ i'ret~ ortitnonl~- u. all'cctc~~ It. is nro-t k -,t.•v e :i!i, ;;irette -In

938 of 42 reports on t'hesarne or similar data that uses this indirect method. All others compare age-specific rates or rates tlrat were age-adjusted by direct methods. c. What happens to f ormer smokers ?'TIIe report' on cigarette smok- ing and health characteristics contrasted all former male smokers,, those who quit within 1 year and within 5' years or more, to present smokers and to nonsmokers for one or more chronic conditions, for acute conditions, and for restricted actiivity days per person per year. A consistent pattern is qtlit,'eobviouslvapparentFor all categories, present smokers have a'i much 1oR er incidence thaa do former smokers. Although no detailed eomparisons were made for females, former' smokers show also a consistently higher incidence of disease and dis- ability than do present smokers: The fact that the incidence of'disability did not decline, but rather increased, for those who stopped smoking is of ut'most importanee. These results stand in direct contradiction to other findings and to the expectations that generally morbidity would decrease if it was caused by smoking. One of' the maj,or claims that smoking is a hazard to health is based on the argtiment that stopping results in an ap~arent increase in life expectancy. In fact, "The H'ealth Consequence of Srnok- ing"'goes so far as to state that : Previous findings on the lower death rates among those who have discon- tinued cigarette smoking, are confirmed' and strengthened by the additional data reviewed... The findings ... supporC, the view that' epidemiological data show- ing lower death rates among former smoker than among continuing smokers cann not be dismissed as due to selective bias and that the benefits of'giving,up smok- ing,have probably been understated Yet, the one finding consistent for all sexes, categories of diseases, and types of disabiTitiesof'thehational Healt6 Survey was that to stop smokinb was associated with an increasing, inciden.ce of illness. What findings are we to credit?' CONULi7sIOYS' The report on cigarette smoking, and health characteristics is basedd on most uncertain and inaccurate data, it is based'''' on very inadequate analytic procedures, and it lacks conviction that it really demonstrates anyy dzfi'erence', between smokers and nonsmol.ers.~ Yet the same dwata from tlie same report have been used to estimate a number of different types: and categories of disabilities supposedly caused by smoking in. "The Health Consequence of Smoking.vhich i:s a 1967 follow-up pub- lication bv~ the ~Publhc~ Health Serviee~ tlo t'he ~~ 1964 He'port,, Smoking and Health. II'his report mal:es specific claims about the~ total days~~ Ameri-~ cansaresupposed to l~avelost~from work or spent at~home or~~in bed, due to smokin-. I:hese fi~ures are liirge: 77 million davs lost from work, 3S 'rnilli~omslpent in bed„ a0t'>~Ini~~lliou elays~of restricted activitv, alll "due to" smoking. -None~ of~ these. figures even appear~ in~ the ori'gZn~ll stuols~.- they~ are~estimates~ said to be~basedon rnucli sm4tiller~figures contained in that studv: These~same~fi'z;'ures~~also~ are used continu~ously~i'n pam17h1'ets~ circulated bu 1he ~~tt~l~~~nal C~le~arinahouse for~ Smoking and Heal'tih.~ Ilf tn~~ lesson is toIhe iearned f~ro~n tltis~ i~:~sue ~ it is not that smolci~ng, c;uuses untold diseases and d'isabilities and loss~ from woI•k.~ but that cl,rims~ about such corntlroversiall topics need~ to~ be verv~ ca~retully~~ andd intelligently reviewed even if't'heyf are made by public agencies or by n!her inlpecca~ the health and that a thorou~ of' these data, fullv estahlisl- (Attachlner i:(lucation : a.& ( w,ith.lliA., T;nivE Ph, Ds, Tul Professional AfProfessor (i versity. Eties, He Researclprrtrr Sc Pormerly~ ColTege 41 Professc, versity, I'r~fissi~owrUai 1rJ6?-67: `oftbeYi 1963:: Cha cihtion 7 1!1di-E-r9a : 1"16R:\fer of Phvs1`JIiG-G7 : \lachinlems to other I Profession:ll : Amer. .l'i:' metric Univ. i~ Mu, rp l'm:•eonad:l3o r

965 hieh; the dical. li css ,O„IG ,d iCdl' raw- Z the rrevr ,lth ions hich f the. ?nm- , r de- 'I hese isto , t lt rr' „ror- -, ter- ~ria? i, as- been tiona page ,'at- hold not .J81- ined tion.. ther the ness cian ain- C no :tin ions !ical ibii' tion '.iiedl ter- f ion , de- ter- ieaS "'of' be •rs : ire, .1:f ! his tnr i. t ! ~-e In the tabulation process on the Morbidity Report, a clerk many miles away was forcedi to interpret what the personi interviewed said in order to assign the proper numericali code. In effect'y the interview gave a symptom, and a clerk made a diagnosis ! The Morbidity Report also provides an apt illustration of the problem of cor- rec:t reporting, from interview dkta. The Report conceded that the reported: cases of bronchitis were "not necessarily the same as a physician's diagnosis of bron- chitis. It is quite possible that'some of the self'-diagnosed cases may in fact be `smoker's cough'."' (p! 12) The problem thus was recognized but apparently no attempt was: made to verify the answers received with the family physician or with available medical records. The earlier "Health Interview Responses Compared With Ssedieai Records,"' however, made such a study. On page 59 a table gave the result of: a comparison of interrien• dlita with medical records for many categories of illness. In par- ticular, for bronchitis, only 16' percent of reported cases matched known medical records. Of all respiratory ailment's the highest percentage of' matching, that for astbma and hayfever, was only 49lpercent. The "Interviewer'S \Ianual"' for the Morbidity Reportl directed that, after report of' a health condition; the question :"Did you ever AT ANY TIME talk to a doctor aboutl your... (capital: letters for emphasis are theirs) should be asked. (p. D-58): No apparent use of this question was made, however, to dis- tSneuish between self-diagnosis and true meclicaLhi'story.. (.reat, emphasis was placed upon symptoms. Thus, the Manual pointed out that when a person had sSmptoms,, he wassaidi to be illi Consequently, a disease or condition was more or less arbitrarily assigned to a reported symptom by the aforementionedl clerk:, s3LOPiIxC3 HaBITS~~ Questions were asked in the survey about the smohiw,q' habits of the respon- dents and members of their households. Information was sought, as t'o ~ whether these people smoked now, whether they ever smoked, and what was their highes rate of'cigarette consumption, No effort was made to establish the length of time d'uring which a person had ever smoked at a particular rate, or when he had smoked~at'this rate. The futility of any attempt to draw conclusions from the type of questions asked is ap- parent from the fbllowing esample :! Consider a fifty year oldi man wha smoked for one year only while in college, but, during, a part of l that time, smoked in excess' of! one pack per day:, This was. 31 years ago. He has not smoked since that time. However, he was classified in the study ' as a former heavy smoker because, the study diil not distinguish be- tween, long-time exposure to smoking and casual exposure. It contained abso- lutely noinformationi aboutl total exposure. Further,, assume that, this man, classified' as a former heavyy smoker, lost time from work last year after, being scalded when a safety valve f'ell from ai radiator,, allowing st'eam to escape:. This unrelated event would have shown up in Mor- bidity Report statistics as work-loss davs by ai person in, the 45-64 age bracket under"Fver Smoked"~ and "Former Stnokers" in the 21-40 cig-arettesper d'aycate,gors. He would have been a statistic in Table 22'„ page :,2, of the Report. In effect, bytheimplied interpretation of tlhistahle, his injury, due to a wholly unretatedl mechanical accident, would be attributed to his smoking 31 years earlier ! T.1BLTLhTION.YVD WEIGICISGQFTIIEI n1TX On page36 oftheMorbidityReportl, in ai discussion ofthesamplingpliin, t'hestaternent was m.Ide :"The overaill samplewasd'esigned inisucha fashion that tabulation could be provided for each ofthemaj,or geographic regions and for urban and rural sectors of the United States." Howex•er, sxxch atabul~ation was not provitlcdYYerhaps such ai tabulati,on,with lack of consistency in results,, would have weakened the position of the anti-smokers? Or,, perhaps the poor sample design precluded any meaningful analysis of such data?' A pas•tiall answer was provided on page 6: "The main reason for restricting theanalrsis is the lack of sutjicfcrntcascs to fi11i the appropriate cellsin suclih ero4s-tabulations;, p2rticularlvin terms, of the nunlber of'~ cignrettessmoked s per clti;v:" (Emphasisaddedl)ln otherwrordsr asear~lier disclosed, the sanlplemasnotl good enough to do what haQi been intended.. After obt:nininRthe raw data f~xomthesampler hown-as it tabulated if not in the mnlmer originally intended? "1'heshockiil,, ansNver is that itawas, not'taBru- ltrted'! Thisrawdatia,was notevaluated.Instead~ it wasstretched~ conipressed, weighted, to fit a, predetermined mold, just as one would attempt to put ai Vo!kswa°enfendkr ou a Cadillae!

97& .u~o-. i ~ N. I APPENDIX C: EXCERPT FIROM T'A'BLE'1, P. 23, TOGETHER WITH ENTRIES SHOWING EXPECTED RANGE OF VALUES, BASED 014 RELATIVE ERRORS'AS FOUND FROMIGRAPHS ON PP. 60-61 OF MORBIDITY REPORT' Ever smoked- heaviest amount Number of cigare'ttes perday' ~b~ AII lages; male; 1'7 plUs years Never, smoked Total s'mokers Under 11 11 to 20 21 to 40 1 41 plus `:alue'projectedfromsample--------- 17;028,000 40,416'.000 7,439;000 16,900,000 11,371,000 2,755;000 PPrce,nt's,tandard e',rror______________ 1.2 0:65 1.9 1'.2 1.5I 3.2' Value,of 3standard:errora____.______ 612;008 788L112 424,023I 608,400 5'11',695 264,480 Lo;rvadueofrange------------------ ,16;415,992 3%627',888: 7,014,977 16,291,600 10,859a305' 2,490;520 a+oM Highvalueofirange,----------------- _ 17,640,008 41,204',112 7,863;023I 17;508,400, 11,882,695 3,019;480 3pread:ofirange-------------- _______ 1,224,016 1',576;224 848;046' 1,216,800 1,023,390! 528,960 Expla'nation: Table 1, p. 23 of the morbidity report, asserts that 17;0281,000 males have never smoked. Actually, one can assert with a high degree of confirdence only that the true value lies ih the range of 17;028;000 plas or minus, 3'stan'dard I =rrars, that irto say;,17;028,000 plus or minus 6'12,008. Hence the true valuei should liesomewhere between 16;415,492' and 17,640;008, that is, somewhere within a spread of'1,224,0161. APPEIDLS;. D! GRAPH SHOWING OY--d1.AFi-~IRG ~. HAfiGES, 0R ~ VAI.IIFS'~. 5I0 52'. .54! 56. 58~ 60~... 6'2.. 64. 66~. 68~. 70 72'. 74~. 76 78 l 1i 2-2 3 4 4 5- 5 ., 6 6. '11hM Dt009 -o V N.~-+ .1 • 50. ' 52~ 54~ ~ 56~. 58~ 60 ' 62I 64'. 66 , 68 70:• 72 • 74 , 76,1 78 • Claeeificatlione. NUmbeir Smoked . Per, Uav~ 11. ~~ Pereons who never~smoked 3. Under 11 2~. , 2ot~al.~ ever eimoked 4'.. 1.1"20~ 5'.. 21w0 6., 4'1' and over~

958 Mr. S=LrnG. A statistical relationship? The only way I can think of' it is as between husband' and wife, who are both statisticians. \'ir. An~--us, lk:ny other kind of relationship ?«'ould more die i'n one category than another ~ It doesn't mean' ~iny thing ? Mr. STER:LING. You know, sir, a number of terms have been bandied around during these hearings: I can only test!ify ial terms of my own competence. I can tell you that such a term as statistical relationship isreally not among,tlie:vocabul'aI'vwhich Iuseimt'heclassi,oom. 'Ir. *S!3XTEitrr.ELn. The time of the gentleman hascxpiredl Thel'eare others n ho want to ask questions. Dr. Carter:tilr. C_~~xaER. I hav.ebeen velymuch irYlpressed brsonleofthe testii- mony, particularly some of'therefereilces tonmortality tables. I believeI[ ha~e tlre only copy of' mortality tables in this house today, the one that is issued by the U.S: Department of Health. Here it is. It is not in ,t browaI bool't.Ilt, is not in a broacn book or nnywhereelse.Ifwe check~~ iti, we can look there and find the number of people who diedd from various diseases, alll the diseases; On this list nhirhis based on receipt of certificatleof' deaths~ from the various departmelltsthrouglioutl tliecountry, islabeled tlliecause,age; and sol olb., On none- of those does~ it, say whether this person who died was a smoker or was not a smoker. Soi if' we refer to true mortalitvtables, we have no basi, on, the real mortalitytlaiales put out by the~P'nblicHealth Service, What we are doing with the mortality tables we are talking about is lool-ing nt a compilation by Dr. Daniel ):Iorne and others in tllat 2-roulp. It is true that R-ecan drnR statistical relationships alld many hnvee been drawn and have shown t~hemselves to be faul'tu. That has been brought ont. So many times throughout the South pellnzrai n-asnsso- ciated -,viththeing~estiion ofcornmeziT for many, many~-earsy~ iilgestiiont of cornmeal was supposed to have been the cause Imtil it «-asfound out that a deficiencvin tlr,ei diet was the cause of pellagra. Then thtttstatistical relations~iip.~as dispr~oa-edco~npletely,, totally„ then and for.evermore: Then we haveyeIlosfeveraidd nlalaria„ which liu,~-ebeen related. st:rtisticalIytioi lowg,rolnld, marsllyrround,~ over the years. There wns:l areat relationship. Everywhere in marshes you lived they had these diseases: But'finnlly,through research, some~ of our scientists found out the actual cause of malaria was thebite; oE' the rnosquitoa,nd., likei~-~i~e, thecnuseofyellbw fever. There ag•ain thisstatistical relation-slli l) was proved false. PY•ofi'esser,doi yonagree with, this, that statistics are often mislead- i.'n~, and have been in these two cases? ~~r: STr:ru.i-%-c. I'es,:, statistics~are often misl'eading, but so are all other,methods~liy~~lii'ch wetrytla obtain infornlation .rbout what goes on in nature. U.ilfortunately„ nature doesnot publishtetitbool.s. It v,~olild save us a great deal of R-ork.. Mr. C_~r.Tr•.I:: Thank ym sir. 1Tr. ;~_~1rrt ~ur,LLn: Aie~ there other questions_' -NLc. Ai aTSON. Mr. Chairmran.11r. 5A2-I-nllr. IELn: llr. Watson. \Ir: WATSON. In one of your attachments you give. ai letter under the iil•tte ot .T,nnllari12;sianed by you to Geor~e~Ii: Ilutchisony, 1'I.D:, N1Gi4,l~,~~~~ II I:ee~eI~espit;tl.in Chica,o, There n asone question you raised, ..ncl it i~sthe first t. n;nis far. I wonder. Briefly, you sta, ;•"l)or-t on cigarett. ~ .Yccept"-and I will, have~ to, t !:era~py~~ method i:ir:tet as proven. Tli.it is~ an inte~ i~t briefly ontli - _ut~s siilce youl health, de~har~ some erer :nat-ters~suc `Ir., STERLING., I have done~. :; I i; one pointi. T r10n(a:l fiictors a1 tl.e advantag~, , 0"Ohlems~~ becau, 'inced that the) :; i2dd cannot be vI. If Are open t the door~ i 1, uaahe part~icl~ ~wtors as~ raclic( i.loiu of'cancer. . \,[r. "'3frSON '~iirther experi ~1~~ear~es, becaus~~ ~AEy.~tllis~~horse~= (:ould,thait n A11'. 17~F?I{LI\ ~ \Ir. ~`"_~'rso~ '~ l r.,1_~~rrTRF Mr. AnAMs. ~~, ~l.lunu.rr~. , iirl; ie invalii vi,u,it three~ n. rucc s ret)rQ, :,nl,.u f this t ~.A aild pt,~biuo \~„Nv~. is vol~ :ui C:ullt. 0t ~ ~i11ar ~rnat'~eril~~ A~Cr. Silr:r.r,: t hw hir-t~ two Thi=~i~,lupo~ir CTr. _\im-1r i~ %ulid, v

966 A vali'd, sampling, plan must be representative of the population it purports to portray. This study recognized the fact that its sample was not representative. Consequently, a procedure of weighting each response was used in an attempt to force the sample to be representative. Actually, the data was adjusted at least three times !: Engineers frequently refer to this type of' adjustment as using "fudge factors."' If this weighting technique were perfectly valid, one could start with a sample of one individual and weight it to fit the general population Here is what was' done :! The United States was divided into elr?ven tabulation areas by geographical di's- trict,,ranging,from three to eight states in each area. If' Area Five,, for example, was' not sufficiently represented in the sample data, instead of getting more data, from Area Five, this': study simply multiplied the available data by any necessary factor tobring,the total, in line. This,:of course, assumed that, any addi- tional data obtained would be exactly like that,already obtained. No justific•ation was given for this~ assumption. To illustrate what could result from application of this~ principle, consider a mythical, survey of United States Senators': from the 91st Congress, asking the simple' question: "Are you Democrat or Republican?" Suppose that;: with a random selection, the following Senators were' obtained as a sample: Boggs ('It),:D'el:aware;':Dominick (R),: Colorado; Eastaand(;D')', Mississippi; Ellender (D), Louisiana;, Gore (D), Tennessee; Harris (D)~, Oklahoma; Jordan (R), Idhho ; Thurmond (It'):,, South Carolina ;': Williams ( D).\ ew Jersey; andl I: ar- borough (D'), Texas. In keeping, with the technique used in the Morbidity Report, the results of this Senatorial Survey are tabulated by the geographicall areas' defiuesi in "Health Statistics:" Numberof' Se,nators. Number of selected Senators', fiom each Sample data results inthisn area byArea area, the survey Democrats, Republicans: N~ote tliat the Itepublii ",40/100 ! The weighted 1'. :,lajpritS in the Senate a majorit'y:' In other word artificial weighting,similt' Furthermore, the data a ^eses-color as, well as For example, in the resi 4tandard met'ropoiitan onmtted at onlr 0:38'ofi t tnin states were multip~ v:alned• and coruputed. as Similar adj'ustments c The adjusting factors rr the 7G classes coming za The American public these muddled stati:sticsAfter the two weightt type of review adjustec -pevia'1 d'n-ellingpl'aces ; transients. Apparently" to the procedures emplo: When data is' manig :ire open to nuestion• it ~:o that others maQesar I3c~re. the 'Morbid:ity Re. "technical" "adjustmer made. Allowing the d a:,enr-•y w•hich isf'arfu was'r~eleasedl tio ~ the pu romplete and objective sions ofif the 3Torbidity ll Mid-Atlantic---------------------------------------- 61 1 1 0 Keeping i'n; mindl t] uth'Atlantic-------------------------------------- --- 16'. 2 0' 2 analysis was made on Eastsouth.centra,l ----------------------------------- W'estsouth+central--------------------------------- - 8! 8' 2 3 2' 3 0 0 the face of the Morb M'ountain------------------------------------------ 161 2 0 2 si:ons it advanced. Raw,tbtals---------------------------------------------------------------- 6 4 Note that the raw totals; with~ six-tenths of the data results, indicating Iiomo- crat's, give the approximate distribution, of party representation in the `4enate. Now, watch what', happens when the data is weighted. The sample was 10' out of 100! Each Areai will be weighted so that its samplevill.' be nYroo of its true representation. This, then,, according, to the weightinl;' techniryue irseeli in the Morbidity Report, should equalize the samples selected fromi the various Areas. For example, the l<ii&Atlantic Area incltided one: of its six Senators in tlho sautpte, or % of's its true representation. To convert it to its'"proper share" of thy S~;tmple, that istosav, i(A,oo; we must multiply it:sresults:bpo'°,ioar. That is„ ?,;mttltipliel bv 6%oe gives 10im, the desired "proper share." Similarly, each other Area isweighted'in thesam:e fashion. This:proves~ yields: Sample data results We:igh'tedldats W'eight --- Area. Democ'rat Republiean factor Democrat. ft~publican. Mid-Atlantic-------------------------- 0 0 60'100 610,q00, ~ 0 Southi Atlantic------------------------ -_---. Eastsouth:central--------------------- -_-. 0: 2 2' 0: 80,1109 40~100 0 . S0'100~. 160,'100 0. Westsauthzentral--------------------- 3 01 80"300 80,100, 0 MounitainL.--------------------------- ---. 0'. 2' 80:t00: 0 1607100 Weightedltotal!------------------------------------------------- ---------- 220;'100 320:;100 Probably the mostl parison between two compared must be d'il survey comparing' twc tn-o' categories' havee nor a doctor toapprsiin'pl'y have more illm In recognition of' ` Report arbitararily tocover theimbalanr persons in,the survey The fiasv: in this teei groups ma;,c resemble and expanding of v. sample age group wi the same age group. does not make itl a Vc Several tables we and after this "age-e Tlie~.ratesfbrtnorb- categories., Undpr tY were decreased in 5~ for the "Ever :±mok increased in,5G~,I2i. rates,more favorab]

934 such a proeedure,howecer,, is quite high~ since more reealls t'o the househoidi are required. The rules adontedl represents ai compromise between the method that is least expensive,, i.e., one respondr'nt for a household, and the method' that is most reliable, i.e., every adult responding for himself. It is, important to heep in mind that larbe parts of the data are really seeondhand,, or proxy, information. The report "Cigarette Smoking and Health Characteristics" indica!tes the extent to which proxy responses were used. Information was collected directly only from 40 percent of the males but from 83 percent of the females.T In a~ddition,, iti islil:el1v thattlzosemales«IIoweredfirectlly intervie,redcame mostly fromtlledisabled, t'he'i11, the elderllyand retired,,or tlieunemployed. Errors in survey salnplin(r are known to be lar?e: Errors in inflormation obtained' from proxyy interviews average about twice as great as thoseobtlained by directintern=iew.?Proxy interviews are a1eoknown to'oe,Inuch Inore eaEily affected bya, wid.eranneof social and psychological fictors.3 Thus,, the method of' samplin- obtainzed information frolni individ nals who are not representative of the U.S. noninstitutionalized popu-lation. Also, the method~ended upwithtwolerels,ofreliitbiTitly in the sourcEdat'~a, Data a'bout,'fenlalesprobabTyhave less than half the err.or' as data about niales. Tile fact that differences between female. sm~okers, and nonsmokers for most duseasesa7•eeitliertrivinl or f:>;vorsmohei,s,aswesha',11 see htter' onyoii,;).lt to liive receivedspeciaL attentiom . b.L:'rrors in.datn,o~bta~neclby intervierrz .stri'vey,s coneerriingt,heinei- denceof di•serrse or' me,dical ' ez,enzt•'s, z'Wt:ctocl~octor, ho.spitaZizratiow, lor,i'th, etceterai nreimme1t•se~ itt tT,er~~ maqn.ihrde: Bisellseor disabilities counted ilith~e~report wereirot based on rnedi- cal examinations oron records rnf' Inedicall examinations. Instead, ai medically untrained interviewer queried an informant or respond'ent about, whetheror not therespondent„or tlheindividllal alboutn-homheinformed, suffered from a di'sease or showed particular signs or s5-mp- toms,TIIe tabtalation: of disease depended on indi>;-iduals-who claimed! to han-e a disenseeitherl3ecttusethe doctolttold theniso or because they: imljrinedl it, rnrreli'ortetlr certain signs oi° sti.mhtonzswllich were tnhen toindicatethat a specific'disease was present. The ao•reetuentsbetween coiults of disease obtained bysuch interview surveys and by inspection of inedfical recordsure small indeed. A number of studies have compared eond'itions, reported in or in- ferred from the -Nat'ionalIlealth S'urrev with those from clinical records. Cf't1.Iose dzsenses that were coverecl by the household interview in terms tliat made niisund'er.standing , on the part of the respondient. 1 In~ the report "ReportinL ofni,spitalizntion in theIIeatlt'h Imterview Slm•et•"' (P.I3:S. Bu~blication.No.ten0 9lrrde., 2 \n. Ii) wetind that inn s,imf+lrstud' y only a.(Iuarter. of'f the malbs and threequnrtersaf't11ee femnlrsw•eresrlf-re~itondent:~ andi the rest t<creprioxies. "C'iaarette ",mokinqa and Ii'enltb CllnraateriatBr_s" indicotes thatia mnnY .t,C(1 pu•rce•ut ofl malesmokerse hut only 17 pr~r~cent.of'frmalesmoke•rs were prosil+:v. Thesee hg-urestvere later verified as correct. A number of'validit' v studies have compared tlteratesoferr~ors: fnr.prox;- and.self-respondents. Toascribeo onlpy twice titerateof errors too proxie~: ia mast lll:eiganunrler-estimate. Por details, see mcy report "_An 77valuatlion andi Critique: off the Report Linking Cigarette4mokln~z , t'oGeneral \,forbiditpand Disability.," nltlelt~ Iss onfile ni.thtHis com-mitteelnnti hAs.been.madravailablhtnttie Putllir_ nealttt S'ercice).. I Therelrort "]deportinQof I$ospit:ili+r,ation.ln the. T[ealth-Interciewsurve,p" (No. 1'000--- Series ^-Nb. 6),com{rare.c accuracy off rrpnrttn>;illness.es thatt are in vomr tcny "thri~aten-1nQ"and findsvast difF'erencec between theaccuracc nfl reporting different disabintiesands evpnlitrGern diRerenceshetwren velfl andprinNy rr-ItondentF.. Considerlhyr thevast amount of: . Putllicitycpncerninc thehealth e1Tect'F of sntokin:. It isnnrea.onabletos suppose that. ~ucih •'psccbotocical"f'~actaris were not aperntlnndurtnCthe lnterview, '" ;tst!, likelv-such as d'ia ronbler--onl* ~ 44 percent !. >, clearlv defialed dise: ,il~~;uuatic medical e'vent:: 'xveks preceding interai, lOnlv 49! percent of'the t,iV - correctly., The fact~ .•;~wrtied 13 percent of' itPrell to be~ the most ;•rll nf, a child, was r 1~~ in:rccnrate~~ as~ inte~ ~,,'",-,~l.z.,~e, proxy respond(~ ( ~IIw ~t,a~(1}- fbulitl'~ t17:~ ',~,it~ 1 inles ' hialler than, ~ vI'r., in most cas~es, er f~~roni self-report lr~ •?~~ t/) 7 ~ days. pltoV~. r( nr t1f tlte tiRlze wb ;~:on•,'t,lit~ of tlie tinZe~. AV 4t•t w~cen , '>l alldl-lf);, 5elf _I'tlndents~~nl.ule~a, 12~-pi ~,IIri a~ •!_'~-porcellt,~ error r,"~puect tsl~del'i,-,ery of a~ ~' i,l•ro(rnt oti~~ the~ t~iine; ~~I'll,:rnl'tili('~tillle.". l~:r rll :tf.e not~ l~imi I~,InkncL :ai(1 wllo~ di~d~ 1! r'.1'(I, lal'~~t sn ' ~'iltt1tGon 4 smokers :r--t,oe with eai ~~ t~~i~nl;~tell 11v the 1~at.i,t 1"1~it1~1("• IUn'(l.. _._)!; l`/erc lu~ vit•o.•.~ of the lar ~~.' r~~lllil l,(, ~,4llecnlatiotl~. t~1i i il,: hopnlati~o~ I }1-t, to ~ :t p:lrtticular ~: ''()inllzu'ihon lletwee~ 111~• t1onlT~arisol7 b t ~I IO~ ac['ltracY .'ci. I,ill)I(' a trillC ral ~.n•Itt I~4 . ••T•e11:Lblh.", t. II1:•;lir~ilre~ NGe' 1'lEe i•tl d('7tlili_(, .Nv,ith~.I. nU, i Ile, e.,;tiilna'tes 0~ I1-IIi11)i1'itv ~of the nne: tT]I•~ Il~llall estinbarte o~ 'I"nr .I.qailsand refrret l.LikinL" . ci,:arette.timokiny;'I'L~•>~•nr~. : Ilatuwnuil ~~n-l \1'nrnwn,.\ational C9n.f.,,l:nrru..ti'hinkin{7, PattPrnt. L-c.:urt tulil- ha% -e beew(

916'. Mr. MURPHY. Did you do any testin:•y on )nice as to the effects that Chemosol!-treated eibarettes~~ would have~ on~ coronary~ occlusion? Dr. HtlDSOti . -Not specifically oni coronary occlusion. We don'ti know the substances to test for, to begin with. But injection studies of ani- mals ~with e ondensate were done and~ results has-e~ been recorded regard- ~ inb the~ power~ of~~ the~.total' condensatle~ to~~ occlude artleries~~ and cau~se~e the tisstte tolbecome dead. There is a considerable difference between the Chemosoli-treated condensates and tlli.e~ untreated ones f>_loill the~ same tobacco in that the ChernosoI offers a margin of protectiion. But. Iwou1d not want to eitlrapolate~ from that toiiuuiali coronary~ dis-~ ease. I know of no «-a~.~~ of doin.-- that. Mr. _lLLrarny. Thank y.ou,,Hr: Chairman. I h;ive no other questions. at this t,lnle: Mr. _l'LAcvoINAr,,D: ATr. Brotzman? Mr. BxoTZUAN., I R ill reserve my time;llTr. Chairman. Mr. JLxcDOVAnD: lIr_ Sa tterfield. Mr. SAT•rFRr1rrLD: Doctor,, the one thing I wanted to ask you this : You referred on page~ 4 of~ your report t6 the~~ esperi~rnentationi that you apparentay conducted iaii terms~ of~ si:in painting,, as~ I~ und rstand it, of mice over a;:2118-month periodlto produce tunmors. Is~~thatl what your 1h'uora~toiy ~ did?~~ Dr. HuDSOrr. It did t'wo biological tests f'or tumoriLrenesis. One was by i'njectim.i, of material from, cigfirette smoke. The other was byy paintiaig the skin. ZPhe~one~ for which I~ gaFe~the~chart~tlodia y~n-as~~ a skin-painting ~ test. Mr. S~~1T._:ri,:.L.>: 1ax1.r.;o::!-~, uUI, t1h.u~eir") ~(2l«,.t. Do you mean up there on the easel ? Dr. HUDSON. Yes. Mr. S~A~zn;rzrirLD. To~ what extent or iui -v,-ii[t;t~ qnan"tities were inj~ec- tionsi?7acle~or shixzipaint'ed? Dr~. Ht:Dso:;~. The~ shin-painting ~~ tests seems to be~ pertinera for the moment~ so~ I-willL refer~~ to that qu[intit2tivelv~~. The~ total condensates from 110 mecham'ca11y smoked cigarettes with tlhe~ collection ivi;rde~ in dry ice cold traps, glass~ apparatlus,~ this rotnl~ conden~ates i'~ro[n 10! cigarettes was~ painted on, the~ d'orsal shin ol~ CI'LI mice~ three tii¢mes~ weekly. Mr. S.»zr,Fit:rD: IIo«. was this condensate olbtained?' Dr. I+IUDSON. Through the~mechanieal sr.nohiita of t1.:e~ci_-nrette~wi'th, the~ 3~,i-millimeter puff and with the~ standard interva3' in durati'ion of puff. _l'Ir.~ SA=z;FIEnD: ~~~~:as~ any~ effort made~ to relttte~ tl[is~~ c<r.ulensate.~ t:o~ tlie~ equivalent number of' cigu!ettes that a, hturtan ~ronlhl' s~n7o?ti~e$~~ «'e liave~heen giren flr~ures~ch riiig thes~e~hEarings of t'1ii6 type,of haintr~ in- on liiice skini being ~ the erluivnlent~ of smolcing, 1~0'0.ioa ci-~arettes~~s a da~v. ~ Did you malce any kind of t study ;is t~o n-htit the relatiota~hip or the m[n~lntities you used on these miice nni-,rl>t be as relatedl to the smol.- l~nr 1111)i~'s~of a mAn 7 Dr. HrDSON. -No,, sir, and Iwou1dI know~ of no~ way~ of i~[rtllcing ~ that colnhfft'i' YoIL, Mr. Svrrr.rtrr:u:D~. A-~chtally.; yolt are~nc[t~~really~s;t~y~in~ th.it, lbt~nzo(a]~- l~i, rc~ne t1;,it cn~nes~ about th~ror,r,•h, tlm~ ht1 nin r, n~fl the~~ tob,tcco: h~as~~ a e real ca?a-~,td eouuec~ri~>n ~~-itlr cancer of noe~lu[s-,,are~~yau ~, ~ D 1•. Ht DsoN: That bi _llr. tiA•i°rr•.r.rtrt.D. Y( Dr. HUDSON. No. Mr. S~ATZ•t:uru:LD. I! C In answer to the ~ in -%-our~ etipet•imentat Iin.7nc,iallz-.. «~'ere~vnu taikin.ff i:ll ' I ) i• _[• 1:-:)so-\-. 'rhe I' , a:,~ :r n nena')er'hil7~ corp ~ lit 1[a • t.a~etemhtio[n It. lv~ t~~ c•-~tuli3~isl?<eoI tlie lk^,ir[[i[tp~ of expe[~ a de~c'ritation o~l'this~ t~he~proi ~iso that y,ou i fuurds.. lll'. MZCboNKALD. I1i th': IIUDS(i--\-~. The :-cr.ilPtio~n.~Luttlue.y .~at for rn:,ti,~ed~~profe~sore. il . ;~~s I>- ]~aborat, As I nlentic~ D~i•. Vicel'i;, -,171[o~~h 1cn~[~~, does ~ iictt~ t.[11 i E"'i_~~ii Ii,r.~ a tot v,,<i i.--.or.. Th:- nrliec ~one in ~ [n\~44;e is inr ;tirrl. tlirrefo[•.e,, also 1?rouluc tion of tumol It is q 1aL5ora~tor "[,utr.[ets„ ,1~llthou_h (1~o:'.elnlnent snr)spo _\r the pre,ent t. i1n~ G overno[nent sn~. W* ~~ tinAees~~ olocided tiiie. Mr. SAmTnr,rir.r.r o\~per.oiec!I inith~is e11 f ll n t to L,ot at wl o r rio fu1d HuDaon~~. T~ Aj['. 1A1^rEPi•IliLl -r;inalilte~ -%-ou. ~Ir. _li.u•ixnxALr. ,1T tl7Qa' po1nt~?'~ 1)1. T,-I~i n~zo-,-~. P~ 1[[. \I_~cno~_~nt.

963 hoose 1s,, in ' con- tualr arac- can- ar- ntire r ea- tlhnt linle. ealtl7i <Prs tte~. rtion .1 as Y~z a. 1i~er1 tt of This eris- con- ar.;ee ries. hieh This •cer„ '7Si- ar;ze _1p. :us11l r, of' -ime , of Vere ions ttes in the in- un- on_ the. ,ing to the be i.<e- the ect ~ey from those households notlinterviewed. The Bureau of the Census which acted us Collecting Agent for the U.S. Public Health Service. in its "\atiunal Health Surv ey-Interviewer'S Manuall,"' definedi "Type A non-interviews!" as those con- sisting of'households occupied by persons, eligible for int'erviews, but for, whom no interview was obtained, Thi'sJIanual then stated on page D-15a,"Ty!pe A non- interviews must be heldi to an absolllte minimum. Every Type A non-intlerview means that we are losing, valuable information ; and, if the nnmber is large, our <anii,le returns may not be representative of' the entire population." (Emphasis ,idded: ) Is five percent Type A non-interviews not a large number? Is 2,100 of 1°'.000 households not a large number." Is 6;i00' persons out of 13d,000:not a large uumber?' PEO%F~,EESPOaBE~ If the interviewer found anyone over nineteen years of age at home in one of ,he selected households, he was able to avoid the problem of non-response. How- ever. another serioua source of error was i,ntroduced when members of the house- hold who were at home were asked about the health and smoking habits of'anv abseut adult member., The inadequacy of this method' of prosyresponse is demonstrated by the fact thatt oizly 40 percext of' ail, males incPuded, in this surveywereactltallMinter-vien-ed. What aboutl the other 60 percent? All data forthislargemissing, gxoupwas supplied, fflrequentlq from, supposition, by proxy by those who were at home when the interviewer came. How many women know exaetly how many cigarettes per day are smokecl,by their sons?'By their husbands?'How many women would report a sliglit cough as bronchitis in their, husbands or sons when the same slight cough would be overlooked by the male reporting for himself?' How many nineteen year olds know their mother's and f'ather's vmoking, habits and diseases Wltich may have occurred before t:heir birth? As an example, eitreme perhaps, a young bride living in the home,of'her husband'..s~parents might be asked, if'~ she were at home alone when the interviewer arrived, to report oni the smoking babitls of her mother-in.law and' father-in Iazv, as well as their health, histor5;, incluclin; habits and healthi conditions of many years ago, perhaps: even before the c-ounyladv was born. The magnitude of the error caused by this use of "proiS" responses cannot be precisely determined f'or the Morbidity Report, but it was certainly significant, particularlv with respect, to questions about behavior many years in the past. \Ioreover„ the effect of'"prosy" responses in health intler~views, has been st'ud'ied' andreportedi in other publications of the Public, Health Service. In a JulyI963 public•ation, "Health Interview Responses Compared with Medical Records;"' a c•omparison was made between interview responses and actual medieali records.. A table on page 19 of thispublieatiion included alistlina ofl.32 heal'thcategories., together with information as to thecorresponrlence between aaimentsreported by relatises and those reported by ai self=respondent: In 26 of these 32 health categories, includi'ngall t11eillnessesconneeted with~ ciaarettesmoltingbF tlheMorbidity Report, except asthma and hay fever, there Nvas a difference of at least~ 2a~ percent when reportsbyr~elativesancl -elfl reslrondents werecomparczd with actual medical recordsi There i~snoreason t~o~ believe that the "prosF" responses in the Morbidity Itepor~t were any moreaccuratetlhanitho.aein"i-Iealth Interview Reaponycs:Cola-pared wit11 Jledical Records."' tiUGGESTED: RECALIlED. AND P6O.SY SELF-DL1'G\pSIS Tho methotl, for obtaining data in theAlorbiclitTReport can:=ist'ed' ofllavin::,tn interviewer visit those households selected'. Every member af'tlie houseltold oveu nineteenth yeaz'sof: age«ho haplened t'o he at' liome when theintorviewercameway-atildecl q}testionsabouthisor her health. I'fsome ler,onsin thehoii,N- hold ocer~ nineteen years of age were not nta' home, the remaining membersof the hou5ehold were, asked about the health and smoking li,ibitsof theab~,ent niembers:, .Yll health conditionsreported'in theaurvec werehased strictlly apon sellf- (lin,,tiosis;7The major inaccuraciesintrochlr.ed bc,elf-diagnosis reqiurelitCle (liscttssiort. Theditferemeesbehveen meditmi fact :7ncUself-dia;;nosts,arc•.!pp,trent- lEven the Morbidity Report; on page-5; states tliatr ""Chepre.'alhnceestitnates of clrrntic,conrlirions used in this,report are ttthjoet't~o ~peciaU litnitationtinherent, in data c+illhr-ted in householdl health intercieu-s~.

97'? 1'arge to permitmeaningful'.conclusions; at the same tiine'conclusions'from these resu'ltswere advanced. This type of' approach is notl scientific, but shows bias and desire to reach pre- deternlined eonclilsions. I"or'anv valid result to come from a study such as'the'Jibrbidity Report,,it is necessary to have itl conducted by an independent, unbiased, w'.ell-grounded research organization. Only then could one approach such a serious question w'ith an unbiased attitude in an atmosphere of,honestv., It would be well to k'eepin mind, that even if t'he' statistical computations in the' Morbidity Report were valid,, the "Interrieiver's Manual" on pabe' A-4 recognized that:"Study of data showing associations between eertain, ... factors and the various diseases indeaateraew avenues o',fexplorcution rcndsuggest li ypotltexes'for naore precise testing:" (Emphasis added. ), In view of the'various deficiencies poiilted out'in this Critique, the only incon- testabie, concl'usion which merit's~ support is that more testlingis needed., The Public Healthi Service has unfortunately disregarded this soundl scientific' approach with the conclusions contained in the 3lorbidit'y Report. It has gune' even further in using portions of'the \lorbidity Report. oft'en out of context, as' the basi's fdr a condpnsedi propaganda pamphlpt entitled "Smoking and Ilhtess'." This pamphlpt boldy ignores even those inherent limitations acknowledged imthe Dlorbidilty Report. It flatly, andl without qualification. asserts precisely how much illness and disease is due to smoking. Nowhere does the pamphlet disclbse thati the basic dhta included no'medical diagnoses by dbctors but' onl!v self and': proxy diagnoses' by laymen. In light of this' Critique, the further use an& compression of'the Morbidity Report in this pamphlet eani only be regarded as a dangerous and,misleading deterrent to further scientific study. APPENIILY.. A~. S£LVCTIONASPD SURVEY OF. HL.ILTH'. S:PSLr.'S ~3'57Units (18.8 percent) Are Selected 90 Uni.tsFer' Week . Are . ChosenRandomly One Segment of'.9House«o.1ds.Is~Chosen In~EachUnit . 5.percent-No Rgsponse' ~I T5'43.Unitls (81.2 percent)i , Are. Ignoredi Completely I 95.percent--IntervSexed ' l percent '~ 1i40 pereentl I I17.2 percentl ' 82.8 percent 5.prcent Cf All I 60 114, Data,Is GrP.nd. I1 0f ..1I Data'I Of AQ1.Datla Of A11 Data /I Il Of A11.Data HSamplers. On Y,alesOn Rales On Females'. qn Femalss qotaiued By,'i Obtained In Obtained.Hp Obtaine~d InP3roxy1 Person FroxyFerson. Cne-tentih of.Cne percentCfFOVul.ation,IncIudeO In.TbisS.tudy 9 N, J I ~, l X ~ C'. J G U. Q O ' d r- o m = e ~ ~. 0 I Is' a N ~. © ¢ r- i

960 causal relationshi'p, I don't know what elsetiou would call it, or mathematical relationshtp--factor is not a proper' thing to apply in terms of making decisions on public health?' Is that right? BZr: STERnING.This report goes out of its way to state that it makes no statement about a relationship between smoking and health. There- fore, this is not a probl'em thatl arises here. I am s>,mply, sayin that the conclusions reached on the front cover of'this report are not~orne out by the figures given in the tables in the body of this report. Mr. ADA~+ra. So you say their statistical methodl or applieati,on, iswronx, but you don"t question the f'act that vou can usea statistical methocl' f''or applicatipn to matters of'public ],7ealtlh?llr: ST>wRLl,;wG. Certainly. AVe do this all the time: -AI'r.. A-n:x-3Ie.Thatiis what I thought. So you don't question thef"Lctl that we do that all the thue; «e nse thestatisticall approach t'olargeamounts of people, and if certain things happen you draw a conclu- sion from, that. llr: SY>:RLlNG.That. iscorrect., Mr. -kD~-urs. Thank you. No further qtlestion~. .l-Tr. SATTERFIELD. Thank you, Doctor. I think you mentioned tv, o reports there. Was it your intention to leav.ethem witlh the comnnn~ttee? Mr. S'rEUr,LNc: I would like to leave all threeof'them with the coin- mittee, if I ma.w. AZr. SAnrExiIr=:Ln. If there is no objection, we will accept them at this time for our fiIes.Mr: STEr,r,INc. I wish to thank the commi'ttee for hearing my state- ment. Mr.SATrErYmi.D. Andl we appreciate your attending today, Doctor, to give us the benefit of your vlews, 1VZr. STERLING. Thank you. 1VYr: SA°rrEliFiF>Jn. Before I call the next witness, I am informed that two witnesses who would have appeared at this timellave offered!their statements for insertlion into the recordl at this point. Without objection, they will be receivedi for that purpose. Is there any obj ection ? If not,, these reports will be entered into tlre record at this poiilt.. (The statement of .Johni Wesley Sawyer, Ph. D.,,follows r) STATEMENT OF JOHN, WESLEY stiWYER: Pn. D., I'ROFESaOR OF 1tIATHENSSTICSi WAS:E If:OREST' U1VIVERSITY,. WINsTON-SAI:E.~f,, N.C. I am Professor of 3Sathematics and the Director of the Computler Center at \Vake Forest University. ATv fields of specialization are Statistics and, Opera• tionsiResearch. I have taught, nri'tten, and lectnredestensively in these iiuld,; and in 1lnthematics generally for more than twenty years. The following CritYque; based upon my knowlpdne and esperience in these fields, is submitted for the consideration of thiti Committee. As part of' its continuing campaign against cigarette smolting: the United' States Department of Health. Education and `V'elfnre, through itls Public FIoalth Servi'ce: published in iVfa,v1967 ai volumeentit;led "Ci,arett'e Smokin,b and Health Characteristics, United States-July 1cJ04-June 10G5."' The work was suhtitled "St,ntisticson theprePSil'enceof selected chronic conditions. inridenceof'selea•tled acnte conditions; and daysof dicabilit,vby cig0,rette smokin; hahits, ses,,and age:Based on data collected in household interviews cluring: the~ periad' of, Jirly1pG1- Jiine 10t1.i:" Thevol'umehas been sometimes ref'erred to as the "Morbidity Report." The conclusion of thi to health, hasreceised . ;ls important evidence o; Lecau.,e of the sheei liiie.d' tb accept, with( l,eport. Under these ci ICuport to a careful and eds employed to collect In doing so, one poi wa5,a statistical analy :-auiple with 100 percer rn1lulouy aualSsis of, ihepo!,sibility of an e: ,•an bepofi•erful toolsi:one, any inferences d The methods ofl sam 'Jorbi'tlityReport arelinreliability and extri in. tlie Morbidity Repp opinions supplied by1 clinical data was coi Indiridhial who happe ()wn medical, diagnos; the household. Simila obtained from those w, In addition, the an~ .1ndbiased. Compar_ "\ever 5hiokedt') we i„noring, the fact th conditions. Total! disii permitted conclusion the Morbidity Reporl ,o as to be wholly mi, It is axiomatic tha, accurate than the d proper methods of s conc•lusions~. For tB methods of sampling A completeanalyination of variousti ,+r •ll as the compb lilnwever, even R-it'' for this survey, ar di'trffled acc•ount,of iic lteport emerge a Tho ch:irt in K~ 1ainpledesign of~ I fn •ts about the s :'i•c5ai thee facts cl 4awera 1 succesyi l:orl,itlitY Report. Iiotinod aroascalls-~re soduch•d' for 11il~C :;57 I':'+T"s'r t!u•,e 357 `. im, ,th4~G"-Nveel: si l",V \ras not ~:elec ^o, _., .-r,a-

967 urports lt3tive. !ttempt =ted' at s using ~iample :aldis; : ample; r more ~,y any y addf- ,ication ,ider a i:l° the with a P.oggs Ileader (R,)', d" Yar- ults of ued in, ;ults apubl ica ns 0 2 0 0 2 4 Iieluo. nute: 10 out `ts: true in the _Vrea s: ,.1 mple; -:1mp1e: !tiplief]I c•ield§ :' '.•'_publiaan 0. ! 5'0;'100 0. 0 1&'0I100 320;100 Note that the Republican count of' 320/100 is norv 5Jlpercenti of' the t'otal of 540/100! The weighted Survey results now would show a 59 to 41 Republican majority in the Senate after weighting raw data showing a 60 to 40! Democratic maj,ority: In other words, a relatively geod, result R-as, conlpletel'Srerers,edl by ; artificial weighting similar to that in the Morbidity Rpport: Furthermore, the data in the 3lorbidity Report was n•eighted by residence and age-sex-color aswe'll, asgeographicsectdon, "Health Statlistliesl'(pp. 12 and 17). For ezample, in the residence adjustment, responses by ruraU 1Vegroes within a "°s,tandard metropoliti•an area"' in Missouri, say, in the vicinity of St. Louis were counted at onlY 0.38 of t'he raw dat'a, while responses b,r white farmers in moun- tain states were mu'ltiplied, bv2.5, In other words_ the 1'atter responses were valtied. andicomputed. as about 6.6 of the former ! Similar adj'ustmentsmeremade for 76 age-sex-color cl'assesi of the populntion. Thea'd'j'usting factors ranged from 0.61 to 1.36, «-ith, •'I''HS, estimates for 62, of the 76 classes'comingic.itli.nnl2 i,ercentof ttle:control's." (I7mphasisadded'.)The American public may have been brainwashed and misled on the basi's of these Inuddled statistics. After the two weightings for geographic region and for age-sex-color, a third type of review, adj'usted the sampling fraction for households and persons, f!rom ~peci.zl dwelling, places'such as a ref'orimatories; homes for the aged„or hot:elsfor transients. Apparently this: adjustment n•<assubject'ive. No: details' weregiven as to the procedures employed in making this adjustment. When datai is manipulated in this fashion using statistical techniques whit:h, are open to question, it is elementary that the raw data should be made available so thatl others mapexami'netnis~ data and perhapsd'rawotlier inferences flromit., Here. the iiTorhidit'c Report cantained only the data as: it appeared af'ter several "technicai'." "adjustments" and' "°weightings:" No tabulation of raw data was made. AIlbwing the ditta to be "n•eighted"' and "adjusted" bc a government arenc. y which is far from neutrall iD~ the cigaretlte-healt4u controversy beforeitl was released to the public introduced a bias into the stiudy which prevented any complete and objecti'me analgsis, oftlies#uds. For this reason alone, the, conclu-si'onsoft11ewlorbidity Report are open to serious challenge. Ai+PALYSISI OF~. DA:'hA~ A\D~~ CO\iCLUSIOICS~~ Keeping ini mind that the original data was not tabulated and that the analysis was made on so-called weighted data4 there are severall points which on the face of the Morbidity Report cast doubt upon the validity of the conclu- sions it advanced. POPULATIdV OF DIFFEREPCT. AGE3. Probably the most important single item in making a valid statistical com- ~ parison between two categories of persons is t1lat the two categories being : compared must be: drawn, from the same or, similar total popul:ations: In any survey comparing two categories' as to heaith, conditions, it is essential that the ; two, categories have the same age distribution. It takes neither ai satistician nor a doctor to appreciate thati health, usually depends upon age. Older adults simply hase more illness than younger adults. 1. In recognition of' the importance of age, the architects of the bTorbiditq Report arbitararily "age-adjusted" the data, that is, weighted it in an attempt l' to cover the imbalance by age groups, to try to make the age di'stribution of a11 persons inl the survey resemble the, age distribution of'the population as a whole. The flaw in this technique is that, while the nuulbers of! persons in various age groups may resemble the age distribution of the entire population, the contracting and' expanding of' various age groups assumes that all characteristics of' the sample age group will beifl'enticali totihoseof al;tr,ger or smaller sluuplefnom thesame age group. In other words, compressing a Cadillac t'o Volkswagen si~zedoes,notl make it a, Volkswagen. Several tables were given in the 'Morbidity Report showing, results before and after this "'age-adjusting:" Tables 7 through 15 eachcoutaiuedi eight,ent'sies:, The rates for morbidity were given for "Never 3iuoked"' and "Ever Smoked" categories. Under this weighting process, rates for the "Never Smoked" g_ roup were decreased in 511 entries, increased' im only nine. Oni tlle other hand! rates for the "Lrer Smoked"' gr~oup were decreased in only nine instances and were Increased in 56. In many instances, the "Ever Smoked'." group had incidence rates more farorable than those of the "Never SYnokedl' until tlie "age-adjtrst- y , 1

920 1965-66-The biggestl project currently undLrwaS is an experiment with tobaccoo to try to eliminate the major cancer-prodtrcing, chemicals in cigarettes. A visitor dropping, into the lhboratorc any evening mighti find two undergraduates tending the smoking machine. It daily "smokes" 1,000 cigarettes which have been treated' to eliminate benzopyrene, believed to be a producer of cancer. When the cigarettes have been smoked down. the condensate i's colAected.,This condensate is then inject'ed into mice. The mice are watched for signs of tumors, on the chance that another carcinogen R as created: by the chemicaI with which the tobacco was treated to remove the benzopyrene, about the most dangerous of the cancer-producing substances: The students at work on thi's experiment are also involved in priwate project's of their own. One is experimenting in parabiosis of mice to learn the reasons why di~ffleringblood types cannot be given in transfusion ; slieis eleven yearsoP age. Another student., a junior at Cornell in genetics. is breeding mice to try to determine how color is inherited. He will continue this im the summer of 1967. Meanwhile, his animaI colonies are:kept intact', and thriving by technical person. nell at High Tor. ltr.1'IACDOtiALD: Dr. Carter. 1Lr. CArtTEx: I should think that certainly the research is fine. Ho-w- ever„ Il shottldn't besurhrisediI there is not ai little pirofi'trnotive in this, t~oo. Is there not,,sir?Dr. Hz-DSO--\-. Iwouid say.tlhat there is a cbnsicler2lile profit motive in the entire promotion of Ctieinowoll asai tobaccoacldithve. Idon't ' think thereie~ any doubt about that. All the fiu2c1 sforresearch werexnacle privately and not fi•oln any(Yovernln:entl or public grants.. iYir. C AnTT:r.. Thank Von4 sir. llr, llacDaNAr:D. ilr. Adams. ni A Th h ll is• Ch r. DAars. a,n you, r. a mai. Doctor, n hat is your spe-cialtiy or discip3ine~?I havesolnequestionsanct did' not want to~rointo an area tha.t is not your specialty. Dr., Hnnso-N-. In the laboratory it is cancer re-searcli for the last ?3 years. In clinical medicines, neurolo_7icaa', survevs. Mr. ADAnss. Thank you. Doetor,thefirst th2n- In.anti to get to is the essential, and that is, Is it yourtk:.stimonv that ci~arettesmohiia- ishazardbus to ti-our health? Dr. HunsoN.I didn't make that statement, but this is the tlestinxony of the Federall Government and the scientific comInunitv. 11Ir. AD»is. I nlean vour opinion. We haretalhedl aAout correctin;r these things,, so I thi~nltthe otliersideof the coin is that you thi~nk the.v are extremelti dangerous t~osmol:e-Iis that ri L:~ht .<' D~r: HIIDSttN . Tiletirare extlremel~ydan~ erous to 4moke far solnel rcol~le,~ and I can't teill~ti-liiah heopie. ~ ~Ir. ADA-Ms. But', because of all tlhis., y ou he;~-eIln oririnial po~i`tionn that theG'wrernment would be j~lstifiecly then, i'ni placing a warning on cigarettes that go out to the g¢nerlill public, that cizarettesmohin ;ishaz~ardous aud c;lnhurt yo1i. Istllat ri!rllt ?' Mr. He•DSOti. That i; correct. Air.z1DA-1ts. We havei1Fee11tallCin~ tliis~~lnornin~' llbout hoR-tiC'euli-ht mak~ethese. 1rsshazairolous. ITro~~Ild it be ~-nur n~edicnL I osition t1 I;'a h , jitsti~tiahlestatemellt mi~~htbe sonlethin,Ii1,e this: Cig<irett'esniolti~nir ~ isl~,vnrdouS to yourl iealtll, andl thi.~: . ci~aretitecollrains~Chenlosoli which will reducetlle cancer-hroducin- in~redientlsby34 percent. Is that correct? Dr. II'r,-DCo-N. The lbenzo:(,ti) hyreue was reduced by,Ihercent!chenl- 4' iieallv. The treated condensates were al~lplied'~d to esl~erinieutal aulitmtls. ~ .l'IIr: ~1D~~~re, In experimental a1~1imals. Pine: ~ In other -words, II a ;re( population is going to r number of people are no vel'tIslng stops. I think the industryy people, but I am trVlurg Initteeande theConbressa i)out- thisproductl. ?. rom vour testimiony,. lie told, tliat ci'urarettes.r ;1 statement with regnrc made to either indicate Chemosoll to tobacco or 1 treat.tohnccoin a! parti( . if:it is safer.Is thatsi1711 Dr. Ht•Dso:v. That is c _lLr: ADA--NLS. So in, th: etfects, to, eancer,becaul t11.1~t. Chemosol will red AVhat do vou, sauabo to i;ut on~ a p lchl_g. V acd`-ertise it? Dr. HUDSON. I carn't con:anoi =ense, I' would lc :., iiaz.Zirdoiis becnu-e (~Xl)(-inlental aniinal". Mr. _1:Da.cs. «'e woil inltn~the heart effects-,-oived. This would iE ette iin etperinlents wi Dr. Htvso:r.Th:it iti.,- nottheonlV one. Mr. 1DA,ts, I ir.st .11)ontrthis.. Dr. Hi<DSON-. That i Mr. _tD:\'3LS: Irhlltat. ?~,r. HL:DSU-N. This 1 ALr. _lDA,ra. Of r('n T)r. IlrnsoN-. It,is 1I11+Ihe crnn(leusatie~ fr( aki'irl~Y,to sevei1a1, . llr. ADAMS. NoW ]naul znuml+er ofdoc Nre-etfisthat i'nthe ~luue,l bVsulo1:~iII KZ cil, (.):Ilels tllat, the. l1~ doctor describesit.sv~telu1 tind~ theret \:e-.-els and arterier etrerrt on that, Woull: I')ir: IIuDSC7Nr. As- tine. But wllether

949 idies, one of , and'. one of :und doctors' -ina that the r.viewer, con- seases given :n frequency Aes, asthma, y tables, the pared to the iblic Health to me to : be -fectly frank a this survey use I haven't ions? rring t'o this :istics, 1964''? it of' Health, mr exatnina- for the con- lung cancer, -om the ques, ;, yon db you Lsuch source tatistics that ered with yes n here. This diseases and -mentls made •t. They just isabilitiesl or spect to this n the report, id not select )n in this re- auld support y in the:case Mr. S'Tr:FUaN_-~c. Let me quote to you the f'ollowing':~~We~~ have~ on page~ :;~;~ table~ 5,~ eight specific deatli~ rates~~ f©r~ chronic~ conditions. Heart~ r,nditions inelkzd7n(y rheumatic heart disease~ for~~ males,, persons w~ho~ never smoked, 4.6 percent; persons who ever smoked 4'.6, percent; pres- ent srnokers~3'.5 percent, I can't see how you can from that malte a state~- i; icnt thatt rnale smokers have more heart diseases: Former smokers have 7.5 pereent, but former smokers are peculiar. I mean former smokers afl, through this report have the hibhest, disease rate: On table 5 it -t;ities that heart conditions includin(ri rheumatic heart~ disease forr loersons~ «~h,o~ iiever~~sm~oked, tlhe~ incidence rate~ is 4.6 ~per,It10~; ~ for ~pers~ons~ ~%ho~are pre-ent smokers, theincidence~ rate is! 3~~.5 ~~ per.~1010~., lk;ain,, flor~ 1,i,,pertension, the incidence rat'e~ for a~ person whM never~ smoked is -l. ' per~ 100~,! the incidence~ rat'~e~ for~ pre~sent~ snirn~:ers~ is, 3.~5~~ per~ 10f1~. Mr. i~'crji+:nwT: Is~ that the~ only,~ place you fiiu' an,y~~ inforn:ation. ,Ihoi~i t heart condfitions in ~this report ? Mr. STERLiNo. No; t'here are other places. There is a breakdown for-we12, I v-as here vheni Dr. Rothstein was here and he said statis- f1iis~~ 2re~ simple. You count the~ number~~ of smo~kers~, you count the n;imber of nonsmokerss; you count the nurnber of diseases and there you are: Well, this is esact!1y what I am doing., This is the wavthese figures& n-ere derivedL This was the incidence actually observed in the data. I ani not testifVing to my opiniion, sir,~ I am testifying to what these data ~ say. ~ llr.~ FCr.uAxoT:~ II real'ize~ that. Of~ all~ chroni~c~ conditions,, t1se~ data would indicate at least some rise between persons who never smoked ,ml presentt smokers ati~6~5~:4 as~cotnpared to the present smokers~ of'S(1.3~~. So at, least it' would bear some testian.ony of' an association: betweeni smoking, and all chronic conditions, I assume: You would conclude that; would you not? Mr. STEmaTC. No. If you look at all chronic conditions;, Mt. Fckhardt, where it sa.ys all ages 17 years and over, a person who never ~ smoked,~a~rat'e~~of~1112.3,~the~~present~ smoker"s~rate is 111.6. Thesediseases! d areireported for~ 1(DQ~individuals. I am not. saying thatl~these~ data s11,ould be~takeni that, seriously~., But I~ am saving ~ even if you take~ these data. seriously;~ even if yoni forg-et ahouti tl,e errors lioth, of't11e estlimate and~ 1,cuuts which oecur~ in thes_e da~tn,~ they ~ do~ nrntt irntleedi bear ontt t1he~ claii7i~s made. Mr. I?~CKxA~rcirr. Fi•anl.lv~. I don't see~n-heretlrey get those~all~a~re~fi'r~- "res~ «hen,each of~the specific a~es~seein to indicate a~coi~rsiderable~rise: In the case~of presentt smol.ers overpersons who never smoked,~ that,is~. I1'tit~I supposethatis:something,I~would have to laok~ iuto~~mysel'f.~ I~ no~~- ~~. ticc~17-4~4 ~~ea~rs~has.a rise~ f1.•om~ 60.5 to 30, ;y~, 4,5~to,6-1, 1124 to,14L., and 65 an(l oz er ?:?`)~ to 23!i : In each case there is a substantial rise. Yet tihel overall figures don't s~eetn to sliow it. I don't know v-hv. Mr. S~rrnrLrxG. There is mucli in this report' which has pu•r.zled me al,o: Mr. EcrrIaRnT:~'Tl'here~ are~ also other report:Q: For inst'anre~ in the~ facts on Smokin- Tobacco and I-le.ilth„you. h.rve U.S., Department of IIe.ctlth; I:ducation, and «'ellfare, x1-hich is,n compilation of informa- tion frcin mthersourresr there io~reference~toithe LIaTiinzoncl st,~irlv~. and there~is~a t,abl~e~inithatdoctumnt~on page 38! I d~on't know ~wliether~y0u are fsmilfi~a~r~ generall~y .v~ith~ this~~ vrnlnule~ or not..

979 ator ath- iate ien• 1.;3s- 959. - of'~ ited NCZ: IPa, tpd K'i3. ons: nal uth =ity nal :er, ral :er, :er, ter, m9 ~ce ]ci-I ile, 'es, tes~ ~t » llp: ,en of' 1v, a t. nd he fly rrd' lias been translated into German, Portuguese, Japanese, and many other Ian- 'nTties. These six basic questions are: 1. Is the sample biased? °: Is,the sample Iarge enough to mean anything? 2% How rood' is the reporting behind the datai? 4. Are we dealing with,semiattached figures? .~! Dothefiguresfullysupport,t:hewords?' 6. Has causation been assumed without proof?? Toestablis:h, thecital importance of each of these questions; I shall give, fromiavariets of fieid6,, examples of how seemingly respectable st'atlistical stud- irs have misled us in the past. I shall then apply each, oftlhesesix questions, to the statistical material in '•l`i'Lmrette Smoking and Health Gharacteristics." As I do this we shall note how bias has entered the sample through failure to et responses fromi some households,from the acceptance of proxy responses inn uthers; and by the presence of self-selection in the sample. 1Ve shall find that, as the sample in this study is broken down into its cate- cories, its size often becomes disturbingll'y small. This fact is acknowledged in theboclpof the report but unfortunately notl im the summaries that are all mostIreople ever see. In respect to our thi:rdi qpestion• that of'reporting, we shaIll note serious weak- nrsses in the study-matters of self-diagnosis by laymen, and proxy diagnosis withno d'istihction made between fact, and second'-handl recollection. tiincemany of' t'hefiguresreport'edl in the pamphlet aresemittttaehed in nature, it follows inevitably that there are differences between some of the con- clusions and the actual dhta: Our fifth question, that,of relationship between the figures in the report and the words: usedi to summarize andl interpret them, will reveal interesting, dis- crepanci'es. In~ dealing with the meaning of stiatistieal association, our sixth key question `oes ~ to the heart of most existing statistics on smoking and health. We shall see howdangerousiti is-and hasbeeni ilnmanvestabli~s~hed instances-to assume that R•heni tlwoeventsoccur tbgether, oneha:s necessarily caused the other:. The important principle involved is actuallyst'atedi in the pamphlet "Cigarette Smok-inr'and Health CharaeterisGbs,"' if only in passing. But little at,tentiion i& paid' to it; in the subsequent pages. We are now ready to apply our firstl test' question : Is there bias in, the sample? Ideally if we wanted to know something about the health of the American people, we would study all of them. We can't, of course, so we study a few people and hope they will represent the many with reasonable accuracy. This method demands t'hat we use a random sample,, which is defined as one so chosen that everyone has an. equai chance to be in it. If: our sample is selected in a one.-sided', way, we may fall into:the trap of'the psychiatrist who announced that practhcalls everyone is neurotic. He was misledd by a sample that consisted: of his patients. For another example, I am indebted to the magazine, Jledfcad: Economics. A study showedlan average hospital fatality rate in~Iobar pneumonia of 14 per cent. For patient's who stayed home it was only 7 per cent. This wasi tlaken to provee hospitals dangerous for such cases. But of course it was just another example ofla biased sample. Thehospital;sgot the serious caseswhilethe, mild ones stased' home. To make this important point about self-biasing- samples very clear. consider mhat' woul~dl happenif'vou shouldl send, to a purely random sample of the popu- lation, a questionnaire that included thiiz question :, "Do you like to answer ques+ tionnaires?" Since most of that large group of people who do~ not care for clues+ tionnaires would have t'ossedAhc=things i intothenearestl «•astebash•eb, :Vou would be able to add, up~ the returns and announce that', "a survey of a t.-pical cross- ~'ection of thepopulation, shows most people like to answer rluestionnaires.°" This particular kind ofdis:tortion„ whichmakes allipollin,g difHcult--and good polling appallinglv e4pensive~is commonly referred to as nonresponse bias. I'nn reference to house-to-house pol'1ing,, as with the study on w]rich "Lri.Znrette ESmok-ioz and Health Characteristics" ic based, itmeansthat in somuehousesnobodb«-as home and in others noboclv would talk. \onresponseinthisst~ud';R amounted to 5 per cent, and t11e assumption was made that if' these people had been home; or willing to talk, they would have

948' Mr.STrnLZNc: For some di'seases. There were two studies, one of' them comparing population with known medicall records, and one of them apopul'ation with known doctors'' esaonination:.s,, and1 doctors''I records; The interviewer walked into the house not knowing that the, information about this population was known. The interviewer con- ducted ducted a survey andl the responses about the report of diseases given in those interviews were then compared to the actual known frequency of'thesediseases in the household. From this it was found that for such diseases as diabetes„ asthma; heart trouble, only 44 percent of the cases a~greed.. Mr. C-knTEx. Doctor, I have here some of the mortality tables,: the latest I could get, for 1967. Iwant to tell you that as compared to the extrapolations and interpretations which the U.S: Public Health Service has placed upon their survey, your figures seem to me to be approximately correct,, or even modest. I want to be perfectly frank in saying that most of these fi.b res liave been magni$ed' in this survey far beyond the basis of'a true extrapolation. Thank you, sir. Mh+. SaarrElmtEZV: Mr. Adams.. 1WIt. An-Ams: I willl reserve my time,llTr.Chairman, because I haven'tt had' a chance to read the witness' statement yet. nTr. SnTTER=r,n: Mr. Kuykendall, have you any questions 2' Mr. KuYxEr,rnaLr,. No questions, blr: Chairman. AZr: 5A=RFiEnn. nlt. Eclt=''.liardt,b'Zr. Ecs:FrAxnx. Mr. Sterling, you are, of course,, referring to this orange volume, Cigarette Silloking and! Health Characteristics, 1J64?. Mr. S~~nixa: That is correct. Mr. EcgIIAlzI)T. It is the report ofl the U.S. Department of' Health, Education, and Welfare. Do you conclude from all ofl your examina- tion of the studies in that there is no statisticall basis for the con- clusion that there is an association between such things as Iung, cancer, coronary heart disease, and smoking amongmen$ Aside f'romthe qu.es- tion of whether or not this is valid testling; I am asking you do youu conclude from all the eaaniination of thi's document and such source materials as may be available to you that there are no statistics that wouhll bear out those conclusions'?Mr. STERLING. There are questions which eannot be answered with yes or no, but I shall use three sentences. 11Tr. Ecgx .k=: Answer as yonl think proper. Mr. STExLiWG. Informationi on lung cancer is not given here. Thiss deals only with certain clironiie di:seases, certain acute diseases and disabilities. The tables given here do not bear out statements made concerning disabilities and diseases based on this report. They just I. simply do not beartllem oiit. I have heard testimonyaboutsmokingcausing mored'isabilitiesor more chronic illhesses: IIrnwever, I am, testifyinb with respect to t1lisreport, and this report only:, These flgures are slmply not in the report, or tlieyarein thereonlyif you select certain figures and not select other, fi ;ures: ~ZM. EcniL ~nDT. Is it yonr observationi of the information in this re port that t'liere, is no ~ basicstatist.icall information that would support the conclusion that heart condit.ions occur more frcquent'ly in the case of ma1esmokersthan in the case of male nonsmokers?~ t abl'e~ 5.~ eighl .!~~. litio.Is incln~ ie1rer~sm~oked,~4.(~ ~niokers~~3.5~ p~~ ~,ttliatmale~~sr percent, but tllrough this tlw.t liea~i. ~~ WIio ~a~iev, „~ ;~re pl,e-ent. !'0•:,ontensi~ou, tl I. iret• 1(1O: tllre~ l r: i: r,n. Itt 11,110 lheautcoIlc Mr. STTI.C.I`t Lor-we11, I Nva: ~ t ~- ;uu:~ siinple~ wuilloer of nons~ •i re: -1Ve11, th~is~ i~ V, (qre derived.,' I ;>>si not testif~ data say. ~ «-oxild indicate~ ;1u(d ptesent~sllI ~ `o st, least it~ >inoking and ; tli2t; would y( Alr. STERId': l;(•khardt,,ZVh( .~n1ohc d', ~ai rate. ;1re reported f( l)e~taken thatl~ Vven 'Iri i~m5, ~ made. 'ilr:,l:~ Iii.(- Nvllen eac I nt iiec~a~e of I;n^Ivnphow~ ~,l'i-1-IYe:+~ u "d m7oi• .)~'t91 1111 eachl ca: ~vemito~sllow 1ill: 5-i-T7I1r: ak(). \'Ii. I7cicu. f:1(-ts otI Stm 11I 1,,iltic. h:clut iois froj1l ot thc'reis :r tal ;urc familiat 11

964 Chronic conditions reported in interviews may be described as those of whichi the respondent is aware, and' is willing to reportto the interviewer. The diag- nostic accuracy of reported conditions is dependent on the information the attending physician has! passed on to the family, or, in the absence of' medical! attendlince, on the previous experience or education of'the family: For thesee reasons, tlieprevalenceesti,matesprod~uced fromiitteruieau daa`a, will; for soauee conditions, differ markedly from estimates based on medical reports or clinical examinations."' (Emphasis added.) 1Tote here the warning so explicity stated, but so completely ignored, in dtaw- ing conclusions: This same warning, is repeated over and over in other publie;itions of the Public Healthi Service. For ezample; in a 1964 publication, "Health Survev P'rocednne-Concepts;,Questilonnair~eDerelopment, and Defi'nitionsin the lICalth: Interview Strrves," the foilow.ing,statement is found,on page 1: "The emphasis in t~heHealthIittervieo Surrey isupon, tiie soccn:al d'imensionsof morbiditjt.. This means that morbidity is measured along an axis for which: the scale is in terms of the impact that the morbidity has upon the lives of the people concerned. Such a scale,,it should be pointed out, mav differ in a nnm- ber of ways from the scale that medical science uses;, which can be broadlv de- scribed as,a continuum ofpatliologicalf change. 'Measurement alongg both ofl thesescales is useful for different purposes. The \atiional Health: Survrey intends to supplgstatisticsbased upon both typesofs measurement,, but technique4~ other than the liousehold'-interviev survey must be used: to otbain statistics on mor- bidity in terms of medical criteria." (Emphasis add'ecL) Is it not obvious that,, in the .liorbidit'S Report, results of the household-inter- view survey were, ini fact, used' to obtain sfatistias in terms of inedical! criteria? Is it not true that the dire warnings as to use of cigarettes were: based on as- sumptions of continua of:patltologi:cal change? The unreliability of the basic data employed in the Morbidity Report has beeni conceded by other publieations of'the Public Health Service. A 1965 ' publfl:cation„ "Health Interview Responses Compared With Medical Records," stated on page 29,: "The results of' the current study illustnate the complex problem posed' by at- tempts to interpret data on chronic diseases collect'ed'thnough the household interview process. They suggest strongly thatl the survey, iinformation does nott eonform even moderately zaell to the universe of: conditions inferred from physi- aiam reporting. It would' appear that this lack, of conformity cannot be esplainedi by, simpie population attributes and characteristics of the interview situation. Age, seY, soeioeconomic status, respondent' status, ethnic background, and other conventional' demographic attributes eaertt surpni'singTg little infltrence on the degree to which the knowledge thati ai physician has abouti tihe: existence of illness is reflected in a household~ interview. Furthermore, the fact that a phl-sician has recorded a diagnosis of'a disease usually thought of as serious, or contain- ing all the elements of chronicity (for example, diabetes or hearti disease), by noo means gives assurance,that the condition will'.be identified by the respondent ini an interview."' (Emphasis added. ) This 1965 ppublication concluded thati only 40 percent of'all chronic conditions reported byy respondents were matched tb conditions inferred from actu:al', medical' records: The 40 percent figure was confirmed by another Pnblic Health Service publi cation; "Interview Data on Chronic Conditions Compared R'ith Information Derived From :lfedical R'ecords,"' published in 1967. A table on page 3.1 contnined! a figure of' 37.6 pereentfor the match between conditions reported in an inter= view and conditions reported in meclical records. Page 41 of the snme pttblicationi gave an even, more striking result. Even in cases ini which a physician had' de- scri~bed, the condition toi ttiepatient in the exact terminology used ini tihe inter- view, only 41 percent of the interview-reported conditions matched the medicaU records. This publication eoncltrded withi the statement that: "The number of chronic conditions a respondent hns in his medical record does not seem to be closelyrelatedlt'nhowwellhisconditionsarereported." (p.:i) \ecessarilF, some measure of training,is needed to interpret interriew ansn ers,;, "In obtsinin,g the, answers to certain questions rpecified by the on stibnuaire; the intervien-er performs a fttnction that is simply one of reportin, what shce hears. Thisfiinction does not includeanpelement, of: . interprrtiltlion. h:or thisreason„ lay interviewers are generally preferred to medically trained' inter- viewers~. despite the nature ofsome, off the information, tih;It is being handlcdi A, person with a medical educatiion is tr;tined' toilnterpret what th(, p;ztient savs,, and ti'iisinterpretation is difficul't'to st.>.nd':ardizefor statisti;•allpurposeq,'+~°IICa1fh~ S Surve,v IPrnc•ecLure:" (ip. 111). In the tabulation : was forced to interp r)roper numerical co ntade a di:agnosis !. The Morbidity Re : rect report!ing, fromi of bronchitis were " chitis. It is quite p4 -moker's cough'.'," ( uttempt was made I with available medic The earlier "Heal however, made sucb ,.G inter.•ic?w , data v tioular, for bronchil reconIs, Of all resp asthma and hayfere The "Interviewel report of'a a health c a doctor about You D-Jt3) ` asliedl (p. i'in_ruish between se Great emphasis th:ctwhen a persol or condition n'as' ni aforementioned ele Questions werelents and membei, t!hesepeoplesmok,i rateof cigarette cc-No effort was u ever smolted at ai1 of any att'empt, t, 1!arentt firom the fo Consider a fift1y but, durilig a par 31 years ago. Hetlie stucly as, afci tween lone-t!imeIntel!v no inf!orma. Further, assIIafrom work:last Y, atloNvinr steam, tbicllty Report st:nncl or ..I:ver Sma c:uegury: He we Iii eifect. by theunrelated m,ecbc oarlier' 0t1 pat; e 56 of' S;a;ilti-1rnenti w;ts I llubulittion conli nrban :uul mira lt,ifprueirbed!, 1 wunbll have we sanrplo clc si;;n p \ pat*ttal. ctM~ tho :ninlvsis, i., , - ross-tabulation Iwr1 I:n11 Nv:j:Lnt~notU ( .1'ite.i otbtaini in the mnuner - ralcd" This n.n weighted~ to fi

.Mr. S^rizi.zi.I.Nc. I have skimmed throtlall it. II am familiar with it„but not to the point that I could' testify concerningthe Hamnlond study. 1Zr: EcKIataliDT: Withl respect to overall dea.th rates for former smokers versus nonsmokers,, there is rather remarkable difference. Those -who smoked 20 or more cigaret'tes seem to have a rate which is somewhere around double or more than that of'those who never smoked regularly:. Mr. STExI:I.rc. Iwouldfind itdifficult to jttstifv t1lis compared to tlii'ss report„ because in this report it is fairly clearly shown that in many instances those who do smoke moderatelv have na smaller chronic dis- ease rate than those who do not smoke at alL Mr. Ee1sHAaD°r:Soi't, is Ilard.theil, to know why the death rate seemsto be higher. llr: S'TFazi-No: That is a question which I think neecdsnnswerinQ. _l'Ir: EcXEIAnDT., I notice in this report that %ras presented to Ius ves. ' terday,I think,by1TrE~osenman„thereis~ an indication on page 1i,11I-9 with respect tochronic heart condition,and these~ were clinical cases, actualltv eYarnilled' andi kn~owny that they raIl about three times as highh among the smokers as the nonsmokers. Mr. STExi,ISC. I' find it difficult to~ cornpare.11Iytestimonyor myamount was concerning this study, sir. The problems with mort.ality studies. I have not said' any,thina a.bout problems coneerning mortality studies. There have been a lot of astute mathematicians who have the respect in, their statisticall community, who have pointed out a number of'faults -%r•ithl the Inortalitu dataeollected hvH:~nlnmond and ot1lel~s.~I would; sayt;hat one of thehointsthat was rnnde and maderepeatedly is that heavy smokers are probabl~ also heavy eaters, heavy drinkers, and in factitis known tllzt': they are, and also perhaps peopden•.llo are not taoderatein otherwnys. Iftind i'trather interesting that in many instances in this report moderate smokers Ilave the lowestt disease rate. _NIr: EcKriAr,DT. Do you s,Iy there is no correlation, then between the two: between smol:inz'and the diseases? Mr. STERLING. Not as it appearedi in this report.?!IPr. EchIr aRnT. Do you know any report that shows t'hat a' Mr. Sa•I:ItnlNc. I know a number of reports which have concluded tlia#t such an association has been demonstrated. Mr. S.c=xrIrl:D: Tlie gentleman's time hasespired:. Mr. Thompson ? Itir.WATsoh Willi thegentleman yield? Mr. TFlomrsoN. I y ield to the gentleman from South Carolina.. Mr. WaTSON. I thank thegentlemian. Just to have this, matter in proper contexta',pursuing for one step further the line of questioning of'the gentleman~ from Texas, the black bound volume to n-hich he referred is the, one that I used earlier in pointinr outsome tableswliich absolutely contrad'i~ctedthe conclnsionsthatweremadebvthe I"ublicHealth Se.rvice; byDir: H'orne, iinthel'ittle pamphlet which received such wide circl2liation.. As I recall the testimony of Dr. Stewart, the Surgeon General', hei sai'd' of the black bound volume much of it. n-as~taken from a compila- tion bv: Dr.1i-Iorne. and much of that information was dained fromm theloranryeortheyellowboundlvolunle, the so-called morbidity stildiies,, upon which your assessment was made. Il . tiliink~ t1le~ recoi I ,;,;x<1 the, problem. •11 r. I''. (:I.u:1RDT. V '4i•. ~ AVArrsoN~. I I I that it is only mt•. 'L.IIO.-NiPSoyT. ~' [~ i-. I;cvzr AxeT. I :: ur the orange bc ~•li•. -~-I-rrtls-Nc. ~l~",c~ix=~ are many ~ ~ iulve~been po 1 :1~:11, perhaps; on l',,,_e tlhi'nas, a1tY r(,all~~~ta~ken ; t ~,s:iics~~ do not der . :oj,le~n-ho~are no, f ~llieve in aoin~ I ~ :i<<unondsttidy ~I~. .~,, 0 i_~ c•onsi<ler.ed~~ "t• liol,tnd Pishe~ iunnv of't.lle fl. t 1; r ;i:e a loak ~. I ~i„n:t.thir~ I ~a- AIr: H: T Pil jt:InswcI `ii•. W.~.rso-,: V I t~i~~arso~ << utli (.'.lro V „i,.. i„ist ~)I• tlle <,.: ta Ia', tha i ~ NVO re 1_~n ~, winr: of lae( iiettes l~at:I 'Iu I«ot. I ; . , '~ n;iti.tN( 11-i,n. :nid the ,,,;-t- i hov aI ~ ,. l:~ rli~teir r tl •~it- I:)wocedt .QiR arc ut ~,1

969 status for various of'' the conditions listed ini the Reparti; that is;, whether there is a reasonable probability that age and/or smoking'status: contributed signifi- cantTy to the chronic' condition in question. The results of such a calculation are shown in terms of the sa-calledi crit'ical F-ratio. This, simply, is~ acalculated, value which can be compared with, standardi table values, If' the F-ratio value is no higher than the appropriate table value,, one is not able to say that the variable truly affects the chronic condition, that the effect is no more than could be ex- pected: by chance. For'the calculations made herein, statistical significance would be indicated by an F-ratio value above 18.0. F-Ratios Analysis of variance Age Smoking status: Hypertension------------------------------------------------------------------- 117 12.4 Sinusitis----------------------------------------------------------------------- ' 0!03 t 0i28'. Peatic uJcer-------------------------------------------------------------------- 13.9, t 9:0 Arthritis'---------------------------------------------- -__ - - ----- 282.3 t 4.6' Hearingimpairments~------------------------------------------------------------ - 1 098.3 c1.9. Heartconditions----------- --------------------------------------------------- -- , (')' (2). Bronchitis/emphysema------------ (1)~ (?). Acute conditions (table 16)- -, -,__ - ---- --- -°-, -____ ---- -----_ 13.7 ' r 4.3 RestrictAd activity (table 20)------------------------------------------------------ 167' 1 1Q.0 Bed days(rtab!e 21)------------------------------------------------------------- 84 12.0 Work,loss days (table 22)-°------------------------------------------------------ r 17.81 1 1.35 I Insignoficant because value is less,thain 18L0J s: Insuffi¢ient data foranalrysis. This analysis: shows a statistical significance between five of the conditions listed and the age af' the persons interviewed. Thus the age differences' in the smoking,status categories not only are important-they arevital! The above table also shows that there was no statistical significance as to the smoking, status of the person~ interviewed for any of'the conditions listed. In, short, as t'o these conditions, the Morbidity Reportl simply did not estabii'sh even, a statistical relationship between smoking and the illness. ERRpREVhLIIATIODT' An inherent' part of any samplying study is control of the sampliug,or esperi- mental error. The error in turn depends uponi the size of the sample employed.. In: the, Morbidity Report standard error' evahiations', were made which simply assumed that eachi of the approximately 134,000 persons in the sample was ani "independent observation," that is, unrelated, random observationsi As interre- lationships emerged, the number of' independentl observations decreased, thus causing error ini the results to increase. Thatl was precisely the situation in the Morbidity Report!. The 134.000 reported! observations certainly were not' independent. These 134,000 observations came from only 42:000 households. Five percent were guessed to be like others.: All flamil;v members 17 Sears~ and over in a single hou-,ehold' were included; these certainly were not iad'ependent as to healtll characteristics. Su~sceptibill'trtosome illnesses is', a matter of heredity, and contagious diseases may easily bee communi'.catedtloother member'sof thesamehonsehold. -Norareslnokiilgliabitsof fnmilM members independent. Yet an independent sample size of 134,000 wass assumed in making error evaluations. The error analysis used! in theltlorbidity Report was also inatitxtuate for an- other reason. Standard errors were approximated t;o cover' a wide variety of statistics rather than by attempting to make individual calcul'ations of the pre- cise error involved in ansindirid'ua1 figure i~ni the surveg. That ils adnmitted on page 58 of' the Report;,which stated:: "In order toderivereliitiveerrorswhichwonhl' be alsplicableto ai wideVarietlvof health stn tistics and which could be preparedl at a moderate cost,,a number off approxim:Ztions~ were required. As a result, the charts provide an estimate off theapprosimaterelativest'andard error rather than, the precise error for anyspec.ific aggregate or pereentage." In other words, a careful eva3tration of accuracy ivar; not carried otrt. With- out such an evaluation, a stati'stical summary based upon s.zmpling has aL'ao- lrrtelll 110 validity.

997 Dr. Ft;asT. First to answer, your question in terms of' protecting the public, I tliimk the public al«-ays should be protected. At the same time,, however, we are speaking so much in terms of a conjecture here rather than anything wliich bears on the problem. _lir., Av_»rs.. Then you thiulk as ai matter of command decision that this committee should just say nothing about smokingand let it go~ on just like it is now in the hope that sometime you will find some- thin- or one of t'heotherIaboratorymen will? Is,tI7atwhatyou think we should do ? Dr. FU.isT. If think, sir, the commi't#ee has saidl that a label warning, already exists. \Ir:AnA-3ss. We aretalking thongl7i abontadvertising warnings w-hirh is effect would!take the label varnina and wouldlmake it appear wherever the advertising i's carriedl on.. That is our precise probl~em, right nos~.Dr:FtinsT: I am an experimentalist and I work with data given too me which makes sense. At this particular moment I', have no informa- tion whatsoever that there is any real relationship between what we are talking about, and an experimental model,, nor are there experi- mental data which indicate a relationship;, so I really, can't biiveyoue advice in that respect., lTr. SAzTurr•rErn. Thegentleman'sti~mehas expired.1Tr. Bzroyhill?Jfr. Bi;orxrLL. Thank vou. Doctor, I gather wliat you are sayimg is that the new evidence which R as presented to this comm:it#ee in 1968 aand also before this committee in these hearings this~ year reallvsheelsnonew light on the cause of cancer or the other diseases and what you are saying is that there may be a cause but yon as a scientist have not been able to prove one?: Dr. FURsx. Sir,, I hear the term "new evidence" alll the time andd mayI now qiiote,from VanDuurenentitled "Tobacco Carcinogenesis" published for the scientist'~sin Cancer Research ~?By t'heway, this is November 1968'., "It is surprising that in spite of efforts in several laboratories no newcareinogens~ have been isolated from tabacco or snolkeeondensate since thei appearance of the U.S'. Surgeon G'eneral'SIieport on, timohinn and Health." So, I have not as a,scientist, as~a l'aboratoryman,,anynew informa~ tion. lI!av I al'so point out somethin~ "'hich perhnps makes me unique: I thinikI have had mvhandson evervsing,lbpulili'eation that wascited in theSui;geon General'sR'eport,, and eveiysinglepublication cited in the two supplements. j I have been (,oing ~ to~ the~~ library. I have indexed and codedl everv siii;Ie~ref'erence~anrd I am still loohinz for new information. But I tlitumb throu-b card after card after card~ and I~ am l~ookin(r ~for~new ~ information. I haven't found it. lh1. Br,oYn1Lr.. It certainly~ seems to~ rne : that i's~~ whe.,e~ we are ~ now,, .lir. Chainnan, the progL+nm that this committee enacted ve,lrs a,o: which said ci-arette~ sm~oki~nLr may~~ be hazardou~s~ to~ health andi so~ i~~,zbeled ci~,arettes. ~ It seems, ~ t~o me~~ that R-e~ shonikll continue~ that approach until such aa time as~~ «•.e~ have a findi'ng fronz the~ scientists. Thank ~ yon very mnch..

989 nlore s anel must o~say -atiorr tnriels then, iso be uman ivself earch i : we. .Tay I aat it. .o es~- s was~ iiiiti- ' that. :s are. _n:iin, ed in en to `ions, :'ian a, hines ~iould i sub- I rette llclng ily if n re- 'haps e.ta.ils i thee hztilee and y are other ~ urnts •t.1nt. ciga- G; Sonien-orkersclaiin thatth,estat'~eaf'~ nutrition, of'the aninlal may be important. Vitamins may play a role in the etiology of cancer. 7.. I f'eel that studies of lo« level earciazogens must be made., S: I feel that tive must study combinations of carciizogens andl sn:oke onianimals. 9. 1 feel we :must inv'estiigate the signifi'cance both of differences in species of experimental animals andi differences in results depending on, the species used. 10.~~~`e must determine that we are adniinistering the agelits in the proper form and on the proper tissues: I am, not eonviiiced that the placing of tars on the~ skin of' mice shows anything, Techniques, for appropriate administration must be developed'y and then; the agents can be evaluated. I cannot investigate all these myself'-many other research scientists must be involved. Ihavegivenexamples,onlyof'experi.mental problems that deal with the smoking aspect of the lung, cancer ql.iestaon. Similar problems must be faced in regardl to many suspected enviornmental cont:iini- iiants-aar pollution, smog, and occupational hazarcls--and even too broader probTemsof' urban living and genetics-basic constitutionall differences between iaYdrividuals may be involvedL And„ constantly,, it must be kept in, mind that experimental research will often producetotallyunexpectecl andl surprisingre.sults. Let me, . I 'ivevou an example from our work wiilt the Air )i'orce, on toxicity o trochet fuels. Two of'threechemicalsco.Ytprisinm tlie,vitain in 13, " roup . conl'd sommv..hat act asantidotes to~tliet,cxicefilectsofther:ocke~;~ pro- pellant,',1G D1V2I+I. Logicallythe third',shotiTd'bethemost e$'ectia.eanti- •ige.nt. Yet, when tested, the surprising resullt was that it made the f'uell 10 ~tiznes more toxic. Who can anticipate and predict ? AVe: needl more and more research. 4nd~ to be candid, I must point out that not only money is needed, but so are time and'people.I cani tell you wit'hin a montlr if a, chemical can be a potential a,nti'cancercompound. In contrast, the study of formation of'ca.ncer takes time;: each experiment takes bet«-eeni 6 months and! 2 years, and involves the efforts of several scient'ists,. I am concerned that publication of premature conclusions has lielhedi to crente an impression that the answers have already been found. This is most unfortunate, because it is not eorrect and', iit makes it more diffi- cult'tlo get the necessary research done. Scientists are generaIlydisinter- ested ininitia.ting,studies of prolillems which, they are told, are alreacl~.• solved. C'~'rant'ing agencies themselWes are reluctant to gi've funds for projects that are apparently solved and furthermore, these agencies may feel that they would be subject to criticism for conirnittiiia funds to such areas.. Therefore, I hope my statement has conveyed to you my conviction that the problems here hraa°enot been solved. To summarize : lfuch more research is necessarv.Otil~ a beginningha,sbeen made in the answers to t4iernany questions about th~evarious diseases with whiclt snoking has~been as.yocia~ted. Whether smoking or other environmental factors have anything to c1b.e-ith t-he,can.tsationof~tliese~ disea,ses arequestionsthat renlain to:beanswered by future work in tliel'abor.atoryand by other scientific investiga tion.

924 I am~ gJad to~~see that~he~is now~not only ai fine scientist but a very ~ articulate one. It is goodto have you withius. Mr~.lTAcnoxnLD~~. llr. Skubitz. "NIlr: SgIIBITZ~~: I have no questions. DZr:1T AeDOrnn.D.~ Mr. Watson. 11I'r: WATSON. I want to say again that I appreciatle your c.andor, and frankness in ansn-erin, these questions. You have hit it right on the head when `,ou said tIle onlv honest statement you coulkll Inake is that~~ smohn~, , mav be~ hazardonsor deadly, or~ so~~ forthy, to your~ health.~ I commend -vou for that. I liope~ that th:e, owners of~ Chemosol will be~ able~ to~l move forward with tihe inclnstrv and bire some protection to these habitual smokers; I anree .vitll you. We have tried the esperiment of prohibition in the past and it Just did not -work. I hope that we can move forward.~ As I understand',, according to your brochure, you are prof'essor, of'f zoolow. That is aniln:Yl l'ife~?~~ Dr. Hu-DsoN.~ That is: . correct. We~ have recentliv ~ ch.anged the~ name~ of the department to t1le department of biolol-ical sciences. It is the same people. N'Tr. WATSON. Who is IV, illiamA.lTetz ? Dr. HuDSO>`r. He is an attorney -Nrho resides in the countt. R-here the lakroratory~~ or foundation i~s~ located. Ti~ think lIe is, ~ a co6oration at- tiornev. His offices aie ini _\"'ew York City, with the firm of Palmer, Surrels: : i.VIr.~R'ATsorr: '1s~I hastily~~peruse your 1rttle~brochlu•e-I~am irnpressed with i-aur uye~ of~ ev.enl yount;, people. I~ notice~ .vhere au il-year-old girl is involved in~ e1l7erinaents on: t3ie~ reasons~ why differin~~~ blood types cannot be given in transfusion, and a 1-1-y.ear-old' girl is study- ing, inn another area~, II t'him1: it ~is qni'te~ remarl~-~ble,.that )•oiu are using ~~ these~ students., I,%l'v conch.de~ bv~ hoping that ~~ou will not. get liogged, doR~n,, or at least the owners of Clieulosol will not get boLxged do~-n, in the fi'nancinl arran-ement but can move forward if tllere is ef.~'tcacv itl~ this~~ particuhar product'. ~ Tliank you. Mr. MAcnolv ALD.1'fr: Iivros. Mr. Iiirzos: Thank yc~u,~ Mr. ChairmanL , I~ Yield my' t.iiiYe~ tol Mr. Adanlal Mr. AnAars~. D'octor,, you are a medicaLdhctor in addition to~a profes~- sor of znolo(rv? Dr.~ HrDSO.Ni. That i's correct. 111r:~ADnMs. Foll~owiilrr Mr. I3rown's,qi,e4ians,, because tla.ib~ ;oes~ to~o the~essentiaI of what~this~ consroitt:ee must do., oiY~ the general pa~ttern! . of smoking, in other wor.ds; ii~ihal~iihT~~ this sinohe~ ,nad the eitects of smokil7~r can you snv~~, meclicallv, rt~ is~ -ood for anyboxlw ?' Dr~.~ HLrDSON. Psysiol~o_ic:Illv~ or psYcholo--~iea~Lly l'Ir: AD_»ns. One at a time. Phys~olo~icall'y fi'rst. Dr.~HrDso-.\,. Plivsiologic;illy, I beiier.e not. \,[r.~.Y:D_t1ts. And psycholoErically? Dr. HUnson ~~. P~sy~cllolo~ical'ly? I am a,, sibject myself. Ilt is wonrl'enfnl. _l'Ir., _1:D_L~~zs~. «'e ha.ve~ the pi•oblem, that there .ire~ .I l~ar' ae n~tun1)er of~ peop?e~ in the 17nited States~,that this prodnct~is availabl~c~ to. I do~ not think anybody~ on or that there~ be~ a back in the 1920'= Commission or tll alternative, the C which is usin;, th We have not g that we shoulkl', i' herhaps sa.vin~;~~ c~ is sufficient in~ li--l atld that benzo (a I am tryin ;, tcc transhYte~~ the~ Inet into something , t What is vour : it thele. orr that ii tLat we should s on the airwave, Dl'.,IIrD30--\-., : ernnnent and its public ought ev, be~~ conalitionali I wlll: _~D»is, I prodlIl~ct' ~~ I)r. HUDso'N'. `, I r. :,uA ,IS. ~ . dcciKle R'hEtt~ ltii mledical ohihao- Dr. rI>;DaoN. Mt': _1D_11LS. Inission, n hich :t~ Jeciion as~~ tl tinn ? ~:llouldl 'v I ~~r: ~ HL DSON l cc.In=e it has,'' i•r:nl T~ira~lc~ Co; c•onrtltrt- of an3 ~~tu alreted~ rel i.-;'your tiel(l- id ' vou tllinl',•~~ 1"ont ~;lid yc~: (111ll~_ 1S ~~~.lf'er. C,~n~ onie~p( tltat \Ne -houl I \ti',t;it to . t \a~ill't~)e It . tc >a~'it?[t I~~tza~r~lotas's' b It~iirt.. 1'. )r.~ McD,go~~ N ~I tt. -k nA.Ns~.

990. We should not presume to predict the answers that will' emerge from that: work; because experience has constantlW shown us how wrong such predications can~be. And, in the meantime, we should refrain f'rom publicizing prelna- ture conclusions which can only discourage the inltlat'lon and carrying out the important researclt remaining to be dbne. (The ati aelllnents to Mr. Furst's statement follow :) Ct;RRICULC\t VITAE OF AETIIUB FI(6RST. Perso» ai r Born Minneapolis, Minnesota, December 25, 1944. _liarried. Four childrem Ed¢tca tiorya: Los Angeles City College, 1932-35-PsScholbgy, chemistry, A.A. Universits of California, chemi'stry, psychologs, at Los _1.ngeles (UCLA) 1935-37-Pliysics, ed'ucation. A.B. UCLA, 11937-39--Chemistry„mat'hematics; CTtFD: UCI A.1b40~-Chemi'stry, '_NI.A. University of California, Chemistry. Stanford Universit'5,,1937-Chemistry, ; ,Ph:. D, ProfessiolaaZ experience: 1937-39'-Teaehing,assi:stant,U'niversity ofCalifbrnia at Losangei'es. 1939-40-Teacher, science and mathematics, Pacific Military Academv:. 1940-47-Instructor, chemistry department, SanFranciscoCitFC'ollege, During war, part-tinle at : U niversitF of California war training; San Francisco State College ; II'niversitvof San Franciscoi 1947-49-Assistant professor of chemistry, University of San Francisco. 1949-52-Associate professor of chemistry, University of San Francisco. 1949- -Research associate, Mount Zion~ I3ospital, San Francisco. 19.52-61-Lecturer, chemistry department, University of San Francisco. 1952n57;-Associat'e professor of', pharmacology (medicinal chemistiry:); Stan- ford University.. 1957-61-Professor of medicinal chemistrv, pharmacolbgy department, Stan- ford Universitv.. 1V961- -Directlor,, Institute of Chemical Biology, University of Sani Francisco Membcr of: American Association for the Advancement of Science (fellow'36)., American Association for Cancer Research. American,Chemieal Sbcietq (member,exeeutive board~ three years). American Societyof'Pharmacology and E§perimentallTherapeutics. Californiai Chemistry Teachers (;organizer, first president). New York Academy of Science (fellow, 1966). Phi Lambda Upsilon (honorary scholasticchemieaT society). Japanese Pharmaceutical Association. S'ocietySi„maXi (,lifemember). Western Pharmacology Society (charter member). Listcd in: :lmericanillen of',Science: «'ho?s Who in American Education. 'Who's Who on the Pacific Coast. lVho's Who in the West. World's Who's Who in Science. P'xblicrationsc See attaclied list. As of this date :,10 S3arch '69: 122 papers in print. 5 papers accepted andlin press. In fields of : Chemical synthesi's,, cancer research, psychopharmacology and chemotherapy of tuberculosis. 1. "Balancing Oxidk "Safety GuardT'~ J~ 3. Improved Di 4:, "An Adjustlable~ .,, "Su~ggestions~~for S~~.N.' Civilian I 6: "An, Outline of' 1942 ( pri~vate~ 1 7. "I,ibr,try Project (1h-12) ~~. `.T.lie lI'ighlights~ (private printi tt. ` 1'v'atier is, Gulorl 7 74 (1943) 1 10. `•A S~urvev~ofl La~ 1944 ~ (iprivate~ 1944 ; ll. "l'adcularions~ of' ( private print' 12: "The :S~~ue1;-Sea1"' 11,. "Q:ualitatir~e ~ ur1', cate printing) 14. "A Semimicro, 11 (i194S)~ With J "DiMplacement i. 1t;. '°The~ Reduction Soc.. 71, 3550 17. "The Lecture I \1Tork"' Z'ortex N. '°A~ Aliodified Co: 11!1451) With ( l.r, "The Effect of .\rcli., Biochei Neve. -'!1: "Chemieal Inve, _1. "The Effect of. Laz•tobacillus' (111-50) With. "-. "A Convenientl " With Carl JL i ~. "The I'reparatii of Some Acr, 1".101 (1951)~, \lor~ris,~.and P -l_ `°Trisethvlene-l: Treatment o V'Cichael B'. S~ T>owenhaupt '5: "'The~ Ultraviol l'Irtnpolurds". "Chemotllerapy .1~ciil _lmides~ AVitll 13. L. E ~., `•Plrettylphosph Ilorv,at. "Inu1•tive Coml Q. `.('homotherapy W ['roc. Soc. Ir7~' V1 D: ].alcom, rlro- \ction :i rcoma~37" 1 ffert of F ttr~ I;irll . 10, 310 ~ ~',

iM i,e I al I .rs i d. if e . v t i, 1007 Dr. FtrRS2:~ It is~~ a niekel compound. It is called nickel carbonyl. Mr. Br,orzar~r,,~ ~.. 'Nickel carbonyl? Dr. ~ FLTRST., Yes, Slr. 1'I`i-.~ BROM-IrAX. Did they use~ t-he~~ same~~ device to~ keep the~ animal 1"~~rom moving ? Did'tliey~ use a smoking device ? DI i:~ FURST.~ -Noy they~ j~~ust',took an open cham~ber~-I ami sonry, it is,,t closed chamber-and j~~ust allowed some~ of~ the ~ gaseous~ material t~o~ -~~o~ into~ tlhis~~ environmental chamber. The~ animals~~ n ere~ there movia7g tree~. ~~~~eihave~ done~ a li'ttle~ work on this project. We t'~ook~ a~, $'ve-galloni clrum which is adequate and had a current cf air going iiato it'. Then it is possible to inject the nickel carbonvl into the drum. The anima-ls will breathe. Then.ce 1ook for lung cancer. Mr. BhoTZ-MAIN. Do you think that there is another type of'etiperi, mental animal that might~ liave~ tissue~ more sim~ila~r~ to~ a.h~uman being, th:znithe~ mice~you are ttsing,now Dr., FURST., We are using mice, rats, hamsters. Mr; BxoTZacAIN: Mice, rats, hamsters. Are there others that would be perhaps more~similar taliumanilung tissue? Dr., FLZST. Well, here II am refering to what friend's toldi me. I am, quoting Dr., Joseph Gast of the Veterans' Administration of Long Beach who says that tlre ! horse lung is ~mucli closer to~ the ~ hunl~aiv's l'ung„ the way it is set up,thanmost any other animal. Mr. BROTZ-NrAti . But it is impractical to use horses.~ Dr. FirRsT. That is right. Mr. BxoTZ-Ni_w. Harder to get ? D~r. FURSx.~ Very ~ difl'icullt.. Mr. BROTZ3ra.N . Tliat is all I have. Mr. Sa7.rER:FrEr..n: Any other questions? Mr. Eckhardt ? Mr., Ec$Hnunr. Just in order to clear up this point which may be minor; in t'he task force report, narcotics adid, drug abuse, it is statedd cocaine and this drug is includedi as a narcotic under Federal and other laws, "but unlike the opiates is a. powerful st'irtnula;nt and does not create tolerance or phy.sicall dependence:'" I believe you will fiiYdl that to be correct. ~ Dr. FURST. Thank you,,sir. As.I say, I may stand corrected on that because, I was~ goinb~~ throubh my pharm~ocology~~ book in~ my mind rather~than tlhe~esaet details. ~ Mr. ECKHARDT., I`vould like to ask `-ou one other tliiIlig about nickel carbonyi=this is an extremely potiverful toxic agent'„ is it not? Dr. Ft;RST. Yes" sir. Mr. EeKIrnROT. I think many times nlore powerful than carbon monoxide ~ andl has ~ verv ~ much the~~ same atl'ect on the blood sti:ean7:, Dr.~ F t:rsT: Yes. Wis one of t!lie~more t'~oxic~gases, yes, sir. Mr. Ecr.H<LRDT.~ I[t contains an irritant that creates~~ faster~ absorp+- tion, sometihir.~~ v.erv~ simil~zr to~~car.bon~monoxide;, doesn't i~t'?~~ Dr. FURST. ~Yes~~. It is~~ actually ai compound' of one nickel atonY, and four carbon monoside~ uni~ts~.. Mi ~ E~cKIrArtIDT. So, when it att'zichs the hun7nn bod~v it~breahs~ down so to sheak, then releases~ this tremerrdous~~ do:,e~ of' czirbon monoxide pl~u~s~the nirhel~ ir.ritlation., Dr.:~Fur,sT. Tlnit is~correct~, sir.

aile in actu- ntervie«-ed.. imony. Youu e; but these utting them ere actually at all.~ That e«-.ed at a1d.~ -re actually :nterviev-.ed! Ahly added ts that was : ained,only half of'the have been. ~rcent were Ifquestions Center forr f that data, ie -National' let by t'he, inting pro- lieh I used. )us studies lnd' counts -y may dis- ~ent of the ;rvey made ~foIloaving St'atisticss h Medical us 2, No. 1, rect quotes ' it betwee.n. I lation was I ~ect, an& I j d'o that- ' ''lenged or response. i s. If your, sting,, and. 947 .l'lV. SiTRni-Nc: Thev, were forwarded to the. Fublic Health Service. _l' i r: P~re s~Ln. ~ Th a nk ~ vou L . 1Ir. SATTERFIELD. Dr. Carter.. Mr. CARTER. Thank you, Mr. Chairman. Yow are professor of the Department of Applied Mathematics and. Computer Science, Washington liniversity, St., Eouis, MaA Mr:, STERLING. Yes, sir. 1ir. C:aizTar. That is quite a position, ani outstanding position. I think ;i iu,lu should know his statistics and computer science very well to be iui sucli a position. I was.qpit'e interested ini several things; which you have, brought out here,, in particular about female smokers having, fe«-er~disabilities~~thati do~nonfen7alo~~smokers. I believe the fngu~res~~ of tile Public Health S~ervice~ bring that out. J Cr~., S-rrrzni xc~ . Yes. Do,vou~ mean female smokers and nonsmokers? Mr. CARTER. Female snokers have fewer disabilities than do non, sTnolkers. J'Ioderate smokers and males, among males, for instance, have a dis- ;il,ilatvy rate smaller than that of nonsmokers. Youi found the~statistics, oothe~ Ptiblfic~~ Healith~ Service to bea-r~ tlxis, ~out, is that true ~ .llr: SzExUixa., Yes, sir., There are tables contained in the latter partt of this report, some 23 or 24 tables, which simply verify the fact that for many diseases,femnle~nonsmokers~show ~ a higher disease~ rate~thali. (.o~ feinale~ smokers;~ and~ that for~ some diseases~~ male nonsmokers also ~Iloiv a hi'L)Jher di'sease rate than smokers. The various other state- ments,I made come directly from an inspection of these tables: Mr. CARTER. The~ Public Health~ Service~ in obtaining their statistics~ ]i;id part of~it'~dolie~by proxy, did tlieynot?~~ J[r. S•rrxziNc: That is correct. A-Ir. CARTr•.ra. About what per.centabe?. Mr. S'nrnr;t-Nc~~. Sis~ty~l,ercent of the males «-ere obtained by proxy ,uid 17 percent of~tli~e fem4zl~es.. Mr. C'_~xTnn. Sixty perceit. Thatt is, a second pei•,on testified as to the t-tfects~ of'smol.ing~on 60 percent of these~people~. I,~ that not~true'?~~ A'Ir. STEnLt-Xr. That is correct. _1Tr. C~ARTnx. Only,~ 40 percent of this~ evidence was,betweeii the infer-~ Vik ~u-er~ andi the person concerned'~~?, lTr. S°rifar,i-,\,c: That~ is~ correct. But~this is only~ for the~ males, not tlie~ females: JIr., CAxTEx.~ Yes; I noticed' that. But that seems so weak, that they would base alll their statist.ics on an interview of 40 percent and leave oti" ttQ percent, and say that the "conclusions we arrive at are true," basedi on only a 40, percent response: Eighty-three percent of the ~~~~emen., lf beliet e ~~rnr state, di~d respond direct'1y. Is,.that true? 1~Ii•.. SsrExr.isc, 'IThat~ ie~~ correet.. l'Iir. C~_~a^rr•.r. Of the~ men who r.esponded., I belfieve~ -,-~.ou statedl that a I;",,-e percentage of't'.heni were elderly, sich,~ disabled, or unemployed. 1t rhattlrue? JIr. STERLItic. That,ib correct. \L'r. ~ CAs:-rrR. ~ And,~ furth~er,~ yotl state that an a: reement between the ~lu-vey conductedlb3the Pnblic H'ea.lth Service and the medfcal records, ilie lnorbid~ity~ tables, which Ii have: here;~ is only 44~ percent, is thutl rorrect'?

961 ,U call lt, or to apply ini t? hat it makes ,aTth. There- ~ say~in- ~ t-hat~ :re not~borne -ePort~: pplication is~ aU statistical tion t'liefa~ct -cYch to large: u1v a conoTu- intent'ion to' -ith the corrl- ept themi at n` my state- day, , Doctor, -formed that offered't.heir ~Se: this point. s :,' SATICS„ WAKE I ter Center at. s andi Opera- a these fiHids 'he following is submitted :% the Unitedi 'ublic Health. :; and Health was subtitled. ce of'selectedl sex, and' age.. ,~f July 19G1'- ~ "Morbidity The conclusion of the Morbidity Report, that cigarette smoking is harmful to health, has received extensive publicity;, and the Report is widely regarded': as important evidence on the relationship between cigarette smoking and health. Because of the sheer mass of numbers used', many persons have been in- clined to accept, without further, question,, the conclusions projected in the Report.. Under these circumstances, it is appropriate to subject the :4Torbidity Report to a,careful and criticall analysis; and particularly tio'scrutinize the meth:- ods'employed!to eollect,and to'analyze data and to'report conclusions. In doing so, one point must be kept firmly in mind. The Morbidity Report was a statistical analysis based upon sampling. It is, of' course; impossible to sample with 100 percentl assurance of eaactitude; although careful planning, andl scrupulous'anal,rsis of data, with no preconceived outcome inmind„can minimize the possibilitp of an, erroneous conclusion. If this is done, sampling techniques can be powerfal toois for drasaing, inferences about a population. If this is not done, any inferences drawn will be misleading, unfair and even dangerous.. BUMMMARY The methods of'sampling, collecting data and reporting, data employed in the Morbidity Reporti are inherently conducive to wide variationi and therefore to unrelilabill'ty and extreme' error: Not asingl'eitem of clinical data was, included iai the 3torbidity Report. Rather the Report was based entirely upon medical opinions supplied by Iaymen, The enormous error intiroduced by the absence off clinical data was compounded''by the large incidence of proxy reporting. An individual who happenedi to' be home when the interviewer came performed his own medical diagnosis and also a medical diagnosis for all other members of the household.. Similarly the smoking, habits of absent household members were obtainedlfrom those whom the interviewer found at home. In addition, the analSsis'of'the dh.ta in the Morbidity Report was incomplete and biasedl Comparisons of different groups (such as' "Ever Smoked" andi "Never Smoked") were based upon populations of! different average ages, thereby ignoring the fact that age is a highly significant factor in analyzing health conditions. Total disregard' for error analysis, whichi is fundamental to statistics,, permitted conclusions which were simply not supported by the data. In short, the Morbidity Report was based uponi a survey loosely conducted and interpreted so as to be wholl'yy misleading and'i unreliable. sA]SPLIVa~ 9ND~ REPORTING! It is axiomatic that the conclusions drawn in a statisticali study can notl be more accurate than the data upon which they are' based. Poor data, based, upon i'm- proper methods of sampling and reporting, can only lead to poor and unreliable conclusions. For this reason it, is necessary to examine in some de tail thee methods of sampling andireporting data used in the Morbidity Report. A complete analysi& of'thebTorbidity Report couldi bemad'e onl'vaf'ter exam- ination of'various materials which have not been made available to the public, such as the completedquestionnaires, on which thedata, was~ first' recorded.. However;, even within~ the \Lor.biditp Report itself, the "i:nterviewer's manual" for this survey, and a booklet entitled "Health Statistics" which contains aa detailed account of'the survey design, several major deficiencies in the Morbid- ity Report emerge as ineseapabie: SA\[PLE: DESI6N~ Thechartl in Appendix A to thisCritique' sets fort1v tlhosedetailsoftlhe sample design of the survey described in the Morbidity Report. Many critical facts about the sample design were not, revealed by the Diorbid;ity Report. From, the facts disclosed, serious deficiencies are readily apparent: Several successive selections n-ereemployed in choosing thesamplef'orthe Morbidity Report. P'irst, the: LTnitedStat'esn-asdivid!ed' into 1~JO0 geogrriphi'callgdeflned areas called I'rimary Sampling Units (PSL s):; :;57 of the 1,900 PSU's we.reseleete.dfor use in tlie'survey: TheJlorbid~ity Report did not indicate that these ?,:17PS'U's'representedl acrosssectioni of, t~hccountry, VinetyP~SU's from ;unon,cr the ~e 257PSU'swere randomi;vselveted', for each ,ceekofsamplingdnr- ingtheG?-week survey. The.llorbidityReport did not reveal thatonc particnlar PS7;' was not selected' many more tinies:tban the other PSU's. 29 --23 (1-69-pt: 3'-F, h k i; ra (` I I

962' «'itbin, each selectedi PSU further random selection were made to choose "segments;" that is to say, clusters of' six to nine neighboring households, in, which interviews were conducted. Each, bed' of a. "flophouse" would be con- sidered as a household for these purposes: There isna demonstration ih the Jlorbidity Report that the household5 actuaP- 1y selected were representative of the entire population in demographic charac- teristics. Based upon the facts disclosed in the llorbidi't,vReporty iti simply ean+notl be said that the responses received in this small number of households ae- curately reflected the responses which vvonld have been received in the entire PSU. and ultimately 'ih theentireUnited' States. , Moreover, one extremely significant' flaw im the sample design n•as the eg- elntiionofall militarspersonnel, even thoseli,vima, at home. It is probablethat the health, of military personnel, isbettler than that of the population as a whole. particularly because militar~cpersonnel mustmeet: certain physical and health standhrd; upon entry into the service and periodically while ini military serv- ice. Also, it is n-elli k;nowntha't this gronpsInohesp ai large number of cig~aret'tea. Consequently, theelinarnution, of thisrroup, likelptocontain a largeproportione of healthy sniohers. biased this survey w11ic•h: purported to g~iveconclnsions as to smoking and health for tihe population as a whole. S_YILPLESI¢E It isfitndamen'tal thatthesizeofthesam,ple used in a survey is aln•aysa critical f'actbrin cieterminingitls accnracy: The overall .si'zeof'thesatnpleused by the Pirblic Health: Service was 134.000. or about one-tenth of' one percent of the population whoNec•naracteristlicsthe survey tvassupposedi to de't'ermine. This overall size of survey mighti have been adeqnate to determine some oharacteri.;- tics of the people of' the tnited atates, bnt it was not adequate to dl•tlw the con, clusionsin a19; su~bcategories,reportedi i'n the Morbidity Report. Thie sample was, not', adequntefor tihesepurpoyesbecaweit n-asnot large enough to yieldi a sufficient number of persons in variou~, iinportant categories. This is clearly shown by an analysis of Table 1 of the Morbidity Report which projectedl the survey finures, topopnlhtion fi'guresfor thei"'nited Statles. Thiss table, with its figures in the millions, i.s quite impressive at firs't ,l,•lnce. IIotvever:. it is:also of:ihterestto project bacltw:ards~ from this table to determineapprosi- mately what theori~ainal sample looked like. A three-page table giving tliedeflated fintuescorresponding to aili Ihe lut,,e figures in Ta'ble1 in the1Lorbiditti•T'ieport in attached to this Ci-itique aslp- pendix B. The striking fact di'scovered' by an eiantiuation of'.'`ppend'i'x B is thesmaSl ntunlierofentriesi'n~ someimportantl oategories. Foresample, thenunlber of females in the entire sample who smol.edltwo,pacl:s per (lay or more at the time of the survey was only 207. Only 21 females in the cantple between tlle ages of 17-24 gears smokedit«•o packs of ci,,,lrettes per dam or more:,Onle .5)0~males were found,, between the ages of' 17 and 2#',, who snml.edl this much. Yet, conclusions n ere drawn as to each of these categories. klso;it is ittt'eresting'tonotefrom _1ppend'it~ R that, thenaimberof ei_arettes smoked per day was unl:nozvni for a sizeable percentage of' persons. Ini fact, in several cases, the entries in this categorv of' "unlinown" were lar,cer than the entries in some of! the number of cigarettes smohed, categories. Thelintited! size of manvof these and othercategories, together %vitdt, the in-completeness, introduced by those persons who4esmohingfi•e+luency was tiit*knoxvn, suggest thatthepro,i,ectiions of' these categories and the r~esultinr con«clnsionscontained substantfial error. Such limited' data is:noproperbasisfor tlie tnammoth and dire projections made. Clearly. s lltt~,ersample; thenebsincreasingthesizeof these cri'ticallcategories, should have been used. ti Ol 1:A]SPO\ SIE ~. F'ive, percent of all households selected for a householdi intervieNv failed to respond because no one «•as at home when the intervie«•er came. What was the disposition af'these?, Did the survey designers thenaclll otherliouseholllsto be surveyediin, place of these?'Sbsolhtelr not'.'The re..ponses from the tnt,"ing hciu.e- holdsn ere gxes.sedon the basis ofl the responses of the other househelds; in the same PSU r~ It must,beassumed that thePtiblic Health , Serc•iaecti•asco;nizant of thecfl'ect of the inaccuracies int'roduced bc,guessing what tvouldl havebeeii the~ responses Ci;otn those households. not ;,yCollectiingAgent for tb . survey-Interviewer's Ma .~L~tling of households occu o interview was: obtained ii,terviews must be held t l: eans that we are losing ,nniulcreturn,smaynot i:,,illedllIsfibepercentT-_,;Oh0 households: not,a lf uuiber'' lf t'..e interviewer foua. :Ile soiected households, I cer„ anotherserious~ sou linid' who were at home jo.-~ent, adultmember. The inadequacy of thi: •I,nt ~njljj }Gpercant of ed. What about the o, aK~upplied, frequentla a' 11Linn the illt!erviewerca: ;;orclh;v are smolied by i a slighti cough ' _Ili~ii't Oc)u_h would beoe ..:13-te"11 year oldS. 1:noP mac have~occurr, ~ hride living ~in tl ~ ore at honte alone ,N ui her~ mother-~ii~~ 11iclncliiie~ habits~ and li~ ~ :cc young ~~ladp~~ti~as~bar,i i The magnitude~ of+ th. ,.rec,iselc determined~ f- nrtil uliudy w:itli, reshr \[nreover, the effect. .iindi reponted~ in other ,"V,ii.ation„ `.Hellth I ~qllparlson AC'.ls illlPde. \~ tahle on page 19 of -_c•tl er with i,nform, ici,utivesand thos ~ ~ ~., n~eories, including `~hprit~,lin, Report. ex :j<t. _.~ pereentl 11'he7~. ~ith~;lct~ital medical rc Ct ere is no reasot 1!Zt•til)r: R`ere' IIIly ulor ~•a~~rccl ',rith\leclir'a4~~,R Tl:'• wcithod for 01 tt,rviewer visit ..ineteenth year ~,vor nineteen li~~n~,~hold, were~~ .A lionlth cnndflt •~ uix~J 'I'lik ~; M-~ion. 1'he~ ditrc ."\,us the \lorbidity i,revalenc•e c~ -~l,c,,•ini' liiuihitiol

1003! Are vou busilvy tryi'ng to do such as that and if so, duringthe experi- nient that produces lun(y cancer regardless of who is pay~in- you will you get the~ government and t'he~ A~merican peol~le into~ your~ conchisions ?~ ~ Dr. I+'trr,sT: Oh, certainly. I am doing this. We have~ developed a~ machine -which is not a hundred percent perfect: We readt vhat we can about ho.ti~ the human smokes. He takes~ a puTand it lasts a few ~econ&~~. When he~~ takes the cigarette out of his~ mouth~ that smoke is~ nnt~ being ~ inhaled. It~ is up~~ in the air. Our machi'ne permits~ tlhe~ smoke~ to~ escape~ during this~ interval of~ time.~ IV, hen the: smoke~ machine~ is~ operating the~~ animal has~hi's~~ nose~~ into~~ the main stream~ and is~~ forced to breatlhe.. \:ow, l[ hear that the animal: holds his breath during smoking so that is~ w1iv~ machi'nes~ are~ no good,~but when you test tlie~~ animal 1'ie~ is breathin~~.~\ ow~, some of~ the problems:: If you throw smoke on the animal you may findl that the nicotine and tars, or~in reality~~ the smoke~ condei7sates,, fn~lll on the~ fur. The ani-~ nsal li,cks~~ himself'so therefore may~ be e~at,inp the inatlerialL To~ avoid this~ onr,ansmals are placedi in gi'ass, cassett~es. O'nlti; ~ the~ nose~ pnotrudes~ i'nto ~ the ~ main stream and then he~ has, to ~ breathe. Our ~ animall is~~ a! few inches from the end of the cigarette so if there are particle size chan-ffeshe~rets the~ same thin-~a human gets: If there:are free-radicals lie~iretst'he~same~t'hinaae human.-o-ets, This has already been done: This is R-hat we are doing now and it is available to anybodv: \Ilr. IV,,TSati. And thus far you have not been able to produce lung crancertlhroubh theinhal'ati'on of smoke agents? Dr. F`UrsT. ~ And no: animal gets lun«~~ cancer. I~~Te~ do~ five~ aniaTa,als,~ or 10 anirn2ls; at a time for everv day for days, for months. AVe take an equal nurnber~~ of animals and' subject them, to~ air so~ we have~~ adle- qnate controls. This is extremely important. You can see nothinR different between the animals~ exposed to the smoke and air. Then,, I hear somebody say, o`Welly they won't breathe the smoke."' We test blood from the tip of the animaP's tail. When they smoke: there,e are~ certaini rnaterials, that (yet, into~ the~ bloodstream and we~ can pick these up in, the blood of the tail of the aninraT. Therefore; we know thatl t~he animal is breathing the~ smoke and yett at~ the~ end of~ the~ experiment you check ~ the~ anima,ls; and all t~he~ anitnals~ are acconntedi for. Animals~are sacrificedland the hm`s are esnmined microscopically.~ We~ also have pathologists who~ can verif'',v.Tl7at we see: no lung cancer has ever been produced by smokin(n NLr. W'ATSoN-~.~ But your lhboratorv,~ at the~ expense of~ the~~ toba~cco~ industrv ~ itsellf, is stilll seeking for an answer to~ thi's~ critical problens ?' Dn h'r,r,sT Oli, yes; I am ver~ persistentl. l~Lr. ~~':~TSON. ~1~.nd, of course. you are~ gQttin, grants from the~ C'~ov- ernunent in reference~ to other~ area~s,bt~it y-on have not received a~ grant fi•eul the Ifedei:al' C;'evernment to help you speed along yyur, study i nAhis,pnrticnlnr~field ?~ Dr. FrxST. That~is cor.rect., sir. O'n the~other.~~hnncl., in all~ f,i inness, I liaN-e~ not asked for~ a ara~ntl to help~ me on the sn7ok:ialt-t . and a; ain I' R.ant; to m~al:e~ veryy pl'ui2r I~ ami not here~ to criticize. I~ have~ no ax to: ."rirnd at all.

954 1Sr: AnAturs, Mr. Chairman, it is obviously difficult t'o questionn when you are, going~ into~ raw ~ data, and we d'o~ not'i lia~ve~ all t'ihe~ raw data before us. I ha~venotieed,~how~er.er, that the reply~~ that came baek~to~tllzs~~witness~ from the Department of Ilealth. Education. and TT?''elfare says that, in effect, "I`'e note that you have pointed out differentials which can esist.~ in this study,~ but have not established that these differentials are relevant to the study tha,t-we rnade, andl tllerefnre; our study is accurate based upon the fact that Four, differential bias is not relevant." What do you say to that? ~~fr. S~RnL~~G.~ If I~sere~ini~Ir. ~~"aolsey~'s~pos~ition, and h:e~is an eg t~reniely~ competent person, I~wou1cU Ilardlh-„ a t t1le~ first ~ si gn of a crit ique, fa11 over backward and say, "'Good Giod,~ Professor Sterling, you are abwolintely correct." IR-~ouS'd m1ke~~a statement saying. "'We dis.7c!ree~with you.",~ Nfr. ADA.cs: You would say that certain factors~ were: relevant in a differential and he would say tliat they ~~ are not. So the t«-o of you would then disagz~ee;~ right ?' ~ Mr. STERLING. No. llr: AnA--Nis: That is what he does. Mr. STERLING. I think that the~~ lack of~ justification for 'Mr~. Wool~- sey's reply is clear from many of the tables which exist', in thi's report.. Mr. AnAaTs.. I~ meany that ~ is your opinion as a~ statistician a~nd he~ says that these differentials are not relevant to the st'atistical scatter alid so:on that was used~ and t.herefore~, "R?e in our judgment have used them" and you and he have a difference of' opi'nion on that.. Mr. S'rERC,I-NG. Vlo~~. If~ I may ~~ point out, sir, ~IIir: Woolsey says, ~"A11 rirht, these large errorswould be of a consequence if you would not ret constantly the same resuiIts;''''buthe does not in fact 9et constantly the same results. He does get very often that nonsmokers have more disease than do smokers.. 1tlr: A;naINzG.~ You keep usin~ the word disease. I haven't consideredd that we liave.been trying to est.abli'sh across: board that every kind of a disease~ was~~re1'ated to~ cigarette smoke., You could have~ aIl ~kind's, of different diseases in the population andl all kinds of different tvpes of smoking in the population, and they milulit not have any relevance one to the otlher. When you go to4he mortlal'i't'iy~ tables Vou ckrWt h2ve to~ worry ~ nimntt your measurement factor or your differentialG at a.lL that set of'fi~u~-es and statistics i's~ pretty solid,, is it not, the mort tlity tables? You~ wou~ldn't, disagree at~ all if vou t'ake the a~re~bracket~fromi 60 to 80~ andi hoR- many people died anel hon- many people smokedi, and that setl of statistics is a:bsolutely~ valid, isn't i~t?~~~ ~ Mr., S"IERLITT~G. Nb., '.Nfr. Kn:a:Nis. Why not? Mr. STERZInG. Eor instance, I[ compared tlie :>,etual number of smok- ers~~estirnatled in this report with other~~ reportls.. Peopl'e, went. ot2t~ and asked. "Do ~ yotx smoke?Does: your husbandd snnoke?"' There~ are twoi reports, one by Haenzel and one by H.iinonond. I found that for some age catezorics, these reports disacrree R-itli, the morbidity study by as much as 33 percent. Mr. 4D:%~rts. You~ aretalkin- ~ abol~It survevs. T am not, nnin~n~ into survevs. I am talkin` about a niortalfity report. A mnn dies at the a(e of'. 65 and ive have ha at the luulgs and : l Iie is dead:t at~ai parti factors don't involve ~in they?~~ 1117. STERLIIG. Yes. ~ not this person sm Zi¢Itself: Mr. AnaMs: The p :;T rlle Tungs and tell 1. ~_~tit~ pttthologists tell -itlOkedL buti ho''R-~nna- JTr. Pirr t,E. Woulc. sTr. 1n: as.1 es. 1Ir. Picai,E. I[ rerr pas:=ed out~ 1zuig ti~ssu ~ iied ;it th,e are~ot 65. rhe~lun~s.~Iie also~pa~ -nlr~lsd. Both died a7 1'tr. ADA\iis. This ] ibout statistics~ andl !j,n•e a, nieasltremeut [' a at'ee nlith my o _1nclke(l ,Ind one~ cTic. J~Ir., PirsLE~. If~~ tl' ~,~()lced to we like~or 1'~;tdnot.~ \Pi: AnA.rs. I don ,ill't 711ty ]lle3lsurenleT~. _NIr.~ STI;RI:ING.~I 1~ %dlotliei•.~or not a p:~~. 1 o .>a snloker or~nons: 1ratiianNr pathologgi. _llr. _lnaacs: We 11 11:111a~series~~o~~f~othei I htiveone~l'ast se~~ _lIh•. CAR•rER. If t- we ~lrave had au eq AI'r. ADAMS. We i,lhed n-hether or n a~rette~~ stliokiil'-Y ~~ Nv~t. :~lirreo11 lie told ar t}i~t~~i e tfthe}•~s' llln('r w-as~. U)ne~w~.>,e t 1lerc# w,isrnwthis.: _N~Lr: :kD.\sis: All ~X[t: ('.~icrnt;. 1'lr. 1)'1•. B~ulilcr., V'Ii.•. ADA~MS.. 01 ~ 0riti~cisnY, ot~ the S iilatiy ~ liict~~or.s. I~ tl

999 ll by [,,ess ?S.~ car-~ ctlr- 'f'hen~ yottsay; "Well, he~~ has improi-~ed more." I~ am not comfortable~ ivith these figures~. ~Ir~. Ecvii:i~r,nT. I~wLderstand and I~th,inh y oui are~perfectly ri~ht in looking at this thing, objjectivelhr:~ A scientist~ n1«-ays must observe re- lationships Iatioiisltips betiweeni one~ set of data and another set of dzlta~ to draw coiiclusions~ as to t'he~relation, is tli~at not,correct ?' Dr. Ft-RST. That is correct, yes; sir. _llr.: Ecziri_rRDr. And then the: further lie groes, the more- lie can es- r:lblish, a, relationship~ or establish~ tha~t there~ is none;, albd we presently are at the stage~ n-here, «e~find an association bet~«-eenvaRious diseases and smoking but w~e know; la~s many of t1tie~witlnesses~ have~ ind'7cnted; that ~ other~factors~could kie~inaolved. rces You would like to eliminate some of these other factors and nrnke 141 Jllr: ,e at ~ ~--ht cn:t. nzli- t it your data accord with other d'ata received, Ii assume ? Dr:~FUssT.~ Yes.. Mr. EcrEiArnT.~ But in the interim when we find 2 nunlber of various c~nit:ces followed, though some of them may be faulty in their tech- niques, andl «e~ come out at generally ~ the ~ sanie ~ conclusion,,ma,y~ we~~ not lo-(Y~icalllv warn the~ public that the~~ conditiom wliich, we haR-e observed isassociated with hazards~ tothe~ health a,nd that pending our~ fitrt.her~ 1I Ihi De- in- Dr. the ons. on~. iber ll 63 discovery ~ of the pre,ci~se~rea~son for~the~ihjury~ t'o~ healtlh that the publi~c~~ should be~caut~'ioned that~thisxeliitionship~exists? Dr. Fr nsT. Sir,~are~you not dbin~g thig~riblit now~?~ JIr: EcKFiARvT. I think we aie but I wonder if' we are doing it stronb~ly enoubh when «-e~ rnerely~~ say ::n~ay~ be hazardous~ to v~our~ lteal'tli~"~~ Don't we have~ en.ough~ en-.idence~ now ~ to~~ indicat'~e~~ that ~it is hazardous~~ to~ health thoug)_YI we~~ may not know ~ exactly how it i's~ hazardous or.l-hy? Dr. FLrtsT. If' I«-ere to be a real cold experimentalist I«-onld say, no, you do not have sufficient experimental evidence. Mr. Ecaiz AxoT: Do~ we have~ any~ experimental or statistlical evi-~ tsedl ndv 's i,f. °ars lip rses, ites hat nld 'ri- ltl- my na tnril :ure.. l ve . dence~thatcibaretteshac.e~nothin;,to~do or~that they have~~ a favorable~, affect on health with respect to the field of' coronnri~- diseases,, or, cancer„ or emphysema,, or anyy of the lung diseases ? Do we have any statistical evidence~ in opposit~`ion toI the evidence I~ refer~ to~ here in connection with the~ Surgean General's, examinations, th,e~ Hauuliondl Report, the report I referred to by ~ Jenkins. Rosennian ~ and Cyltasisky ?' Do w~e~ have any~ contrary ~ evide~nce~ statistically or~ otherwsie ?You~ have es!nmiined agrea~tnumf)er of~studies as ~I~unde~rstnnclL Dr. FuRsT. Yes ; but I hope you appreciate the fact that the statis- tiirs are out of' my field'.~ I say I feel not~ comfortable «-ithi them. I use~ st;atistics~ in the 1way of askimg "is~~ m,y experiment valid~~ or not, andd what is~ the possibility~ of the results~I[ find .tre~ due~ toAhance~'?'" I~ use statistics for that.~ But when it comes to these statistics, and I sat through 3' or 4 days listening to~~ stat'isticians, I really have~ to defer to~ them. I~ camzot~ honestlv~ give~ you a real answer. \Tr. LcKiIAr,nT: II am not ahk~inn for~ youi,~ jplcl~~ni~ent with reshect~ to the statistics~, btrti~ db: yrou find any report wli<itsoever, that~ comes out'~ with statistical or any other.~ type~~ of evidence showing 110 rehi- tionship tionshiqr between snlohamr ~ and the diseases that I have elescribed x~ Dr. FURST. Right.~ Mr. EcKHAr,nT. What are thes?I

983 .iug at all. ver honest R arranted I number of impressive i he victims 'I ere riding, v ~ alll 4,712 T•e is-and tic Health niattached ~ady been ler family is weeb or -me of the rt without ~ortl cities pears no- -iosclerotic described, trette con- of't'obacco °itg of' the ;, smoking smoker- he qualitl- edl atl best hat "brom same as a f the self- vithin the ~entences: ~ informa- tbsence of' imily. For a will, for al reports ih only to •n. Neither Oe Inosti nf about this :uidl news ~avhi themi one «-ay: t'-etnpty. inentl. But of fiA•e. -;al deathh ~; ui i za tion. +; patients o a differ- he deaths t s res{lon- that~phrt-~ ovicty ~... ,utc1 thusmacbeespected, to: show ~ upprominentlsin al2yfigu:res concerning chisdbi'rth. ~ I Through emphasis, seleetion,andl omi'ssion, of contradictory figures,, reports! , of >t atisticall studies can be made to point to conclusions that are not' in fact ~ I naa•ranted! Contradictions within the 1967 report on smoking are a case in point. I'resent smokers of up to a pack a day-nearly two thirds of the smoking llaI>ulhtion-were found to have no more of the ailments Tumped together as "all, hrouio conditions" than people who have never smoked at all. This was found: tirne for men and'l also for women. To learn this you must go to the tabies ; no !iintii of it reached the summaries:or the news reports. `:Ien and women now smoking whose heaviest amount ever smoked was up tb ' two packs a day make: up some 95 per cent of a11i smokers. The report fails to ~Itotv higher incidence among these people than among those who~ have never ~ uoked, for such ailments as heart conditions, hypert'ension;, arthritis,, hearing iw,,airments. and "all other chronic conditions,"'' ~ The report itself points out that for heart,conditions "the presentl smokers who ~ ,~mokedl up to a pack a day had a rate about the same as that for the 'neverI~ ~ ~innkerc.' " Here, then, is an instance ofl the data in this reportl contradicting the ~ coualusions, in it. ~ l.lie data show that people who have given up, smoking have higher ratesfor. u.t,ot theaa:lments covered-both chronic and acute-than do people,n-ho have CO mttilued tosmoke: This, the author notes; ".appearsto be contradictory" to: c, snlts~ from other statistical studies of smoking, and health. Thisklrinn:,~ us to the1'ast of our half'~dozen, q,uestions~:Hascausatlion been "i ,,-umed without proof?~ When it is fatmd that t«-o; things t'end to happen together, it is! acommon9 hnutani failing to assume that one is eansing, the other. We all know better, but: n'estill d'oit. .\ populhtion study, such as the one behind "Cigarette Smoking and Hea1t'hi Characteristics;" can at mostl produce indications of a correlation or association. It cannot produce proof that the relationship~is one of cause and effect. In therecent, I?ublic: Health sthidy clear warniilg, is offered against' assuming, c,tusation .- . offered, but un£ortunatelgburied and forgott'enso that ithaserept intofen-" if anic, newspaper or magazine reports. Theauthorof "CigaretteSmol.ing and Health Characteristics" puts it this way : "ThemoNt thesed'ata can do is,delnonstratethe lack of or tJheetist'ence of a relationship between cigarette smoking andl various health characteristics; it cannot establish any existing relationship as a causal one:"We all accept this fact cheerf'ully when an! inferenceofcausaiitgleadsto an, tmpalatableor absurd conclusion. But it isinlportantto do so equaIlywith con- clusions that we would like to accept. Let me g~irean example. In a 19G3study, two thingswerefloundto beapproxiinatelF eqtrallpassociatedl with mortality rate: the use of tobaccoando the useof', tranquilizers. Comnion, senset'ellsustodoubt that theuseoftlranquilizers~ really eontlcibut'es to a heavyrdeath rate.. It i'h more~ reasonable to assume that people i~n, bad health are mocelikely to use these drugs and also are more libels to die. So how can we assume canse-and-effectin the similar fi~guresrelatinato <utnldinh7'Dhe evidence~of causality i's equal for bothi assUciations. That is. it'isnil. The rule is that wheni events A and B occur together we must consider four Possible exhlnnatliou~~. The associationimay be pure clianc•e. Or A mawhan-eeaused IS. Or Rimty have caused A. Orboth: A and B may be~llroductsof an out'sideP;u•tur. Itl iscery common for this last possibility to prove to be the case, as sonte insthnu•eswill shmv. The 14nrvicrtn Jurrnnalof'Curd~iology reported tliat31outof.;Q angina patients'iml?roved after lisation of certain :u•terics. a surgical procedure in vngueat the tiine; Surely thiyprovedlthattlieoherationwas usefhtl7 Two subsequent surgical surveys answered that' question. Controls were used. patientswhoweregiven,shatn operationswith onlK-s14inincisions; These pattients found equal iutprovementii2 their anainaL Theoutsi[lefactor this time wasthatl a;;e-olcT ,ource oii confusiont the pl.webo effect. The llatie_nts~had reported feeling better bec;luse they thought:tlieY ought to:feel hotter. -lnd what would you Inaite ofl studiesshoaving associationsbetween,a woman's ohvtces of bcaring tlwinsanrl such r:urpri:in;,; tati•torsas her cdneation. her rldiciun, hur Ltt~b:uttl'vincome?' Tlere, the oiitside factor is: aL:e of cliildbearing, trhichhupltens to be associated rr,ulairly both withqwinnim;cutd NvithithoyeotherEtrtorse ii I P I

941 Arch, E'n2•iron;. lnentation and. omputer' Work,, in the Biologi S'ci., 125:7.55- Uutions in Ec,- ('1f, 9: 27Y-2 i 6,. 1 Visualization 66. t:crs a nd di¢t to+, Report of the- . d: Assoc.. 193.• n., Hcalth, 13: ; !)rs. 1r2S:110's--11'16',. 'ntions: in. ES- , Sensor Aid4;. o1ogY, -Novem- !1 Predictions, )'). Computers Ver 171. irchers in the ,oh Qulrt:, 9.: e Blind. 1`1F:~:. Acad. ti'ci., Scietace. 115:•. 96-I. !1r, Se,~~3=3181 :44--.i1. 1964. , Iathemn tical. and 11sttali- } 4--.i:iQ. 1!7('14.. _1',cTt,tli,CitYlll!• 1:;-111'. 1964. <Scnetics~ lucutinn ancli r, Cc:l,,-ce of 'rl. E'r,t'ii-ori.. ~--2,-2:, 1913.3. ien-, II.•,r1tT;. .]ntomationi of Radiation Treatment Planning. III. A Simplified System of Dizit- izing Isodoses, and Direct Print-Out of' Dose Distributiony Brit: .I: Radiod:, Jr; :5i_'2-527, 190'. la.iracenous Slethotresate (Amethopterin) Therapy in the Treatment of' Acute Leukemia, Pediatrics, 31:834-539; 1963, (with, J. Perin, senior' autlior)', _1nto~m,tion of Radiation Treatment Planning, II : Caleulation of \on-Cont•,erg,entl Field Dose Distributions. Brit. J. Itadiol:, 38:63-67w 1n631 Rohot Treatment P1tlnning,;,Proc. oft7leltochester Conf:,onData; Acrlnisitionand'ProccssinrJ in Biology and Medicine, New York, 1962, Pergamon Press, pp. 299--319, 1963. P~~bot Data Sereening,Proe. oft1i~e ILoehesterCbnfs on DataAcncuis°ition' and Procns.iinp in Biology aazd Medfcine, \ew Forl:; 1062, Perbaanon Press, pp. 231-242. 1963: Oecupationall Exposure to Organic Lead Compounds, Arch. E>I2iron, Health, S:S12-,536; 1962. (R. DeTririlIe,,senior author). S'ewDerelbpmentsin ChronicDi'seaseEpidemiology; Competing~Rislts andl Eli- c_ ibility,,Anter. Ii+d: H'Jyicve,.assoc. d., M3':433-446, 1962. A Practical Procedure for Automating RadiationI Tt•eat7nent Planning, Erit: J. Ratliol:, 3a':726-733, 1961. Epidemiological 3lethodfi, and Community Air PolIutions Arch. Environ. Health, :°_6i-',~.. 1961. (J. Phair„senior, author)., Competin, Causes of Death iniCoa1 Tar Workers; Kettering Report, 1961'. Cesium-137 Retention and Distribution in S-Irradiated Rat's, UiS! A'rmv'=\Iedical Ri°search Laboratory, Fort Knox, Kentucky, Rcport' #504, 1960:, (G. Iieriabes, seniar author). Ccasonal' Variations in the Birth of'the Mentally Deficient, Anaer. J: Pxb'. Health, •;/i :9n;r1165i 1960. What i: so Peculiar About Accepting the Null Hypothesis?, Psychol: Peporta, :663-364. 1900. Senll:r~ia Following Therapeutie Irradiation for Benign Conditions in Childhood, It,rd~ioln,ny, i4:9SD-904. 1960. (E. S4nenger, senioraut.hor). Pr.!1liratSnns Deoisions ontl Thpir Lff^et'con IilferenaosDrasrn from. T(.st of' Signific:wce-orVice-Versa, J. Alnrcr. St!at'. Ais.soc:, 5~:30-:;,1, 1959. PaimonarsF'unction inChildren I andllI, J. Allergy, 3Q~:5111-533, 1959:, (iL. Bern-' tein„ ,eniorauthor):. Taib:Es of! Normal PulmonaryFnnction Va~luesiiI Children A'ges6-i-4',, KregerPrintingCo:, Cincinnati. Ohio, Il),ia~{L. I;ernstei~nl senior nuthor).. The_YnorexigenuAction of: D~cxtro-AmphetamineSulf,lteullon Feeding' I?'-ponsesof Diflerin,Str'engih, J'. C'orrtp. a;ld' PTtysiol: Psy,cltot, 62:1179-152, '9,59. (P. Sie/,el, ~cnior author). Cources of Contcxtnal Constraint upon Words in Sentcnres, J:, E:rp. Pxitcliol:,1 I1 .17'1-j~lO1fi5i1. ('H. Aborn. senior author')., 1:1'fect of I'rrc'tvantDr re on l:,stinction, Ps;rclloL, Repm•t 1957:_1, Central Sulseii:ance S~;stem 'Measurenlent \Todel, P.nrt I, III, Proj. _ll6:chi,ganZS4.;! Z914, Unir,ersit,rof AIiehi~an, 119;i7i. _1.(&eneral tinryey of Statistical Decision Theory, Proj. ISichiganZift.i; University af' _lllicliiaan{ 1957. (Copies of relevant correspondence tcit'hI the \ational Center' f'or' Health Sta- tistics and Dr. Endicott's commitltee. ). DLPALRT_lIE\T OF HEALTH,EDliCATI0N, AND AVfiLF.1RE;, Pt;.BI1ICHEALTII 8FiRi'.ICE, N'3TIasAL CLxTEILFORIiT':AllTII. ST_YTILTICB,. 1Vas7iingto'n, D,C., Jlarc/t 1'5,1DG9. Prof. TflEOnoRE D. STEnnIVC., Dcpartn.cntofAppl~i-vd3litthenlati.csand, ConaprttcrSciencrs:, Shhool, of L'ngitreer- iilq and Applied Science, 1Lasliin'rlton, University, St. Loztis,, Mo. DEAR PitoFESSOR STEnLI~G: We appreciate the opportunity to see an e,trly cope of' your recent critiqneof' the Center's report on the coincidence ofci5,ln•ette,~mokinghabitsand selected healthcharacteri.tics. _lithott,'h itl wouldlbepossiblet'o reply ' in >reaten'detail, I would li!,e tloq'rresentonlr several reactions of amore general nature. im, ii:st of all, one ofi your major criti~cisms seemed toimplsthato wrearein theliusiness of testing hSpotheses.. For' example, in your hetter you : a~"the inter-

996 Dr. FUr,sT. As far as I hnoR-, no. I think there is more monev now from the Council for TobaccoPe~zearch than ever before., Surprising to me is II am the onlv one on, the west coast, that I know of, who iss actually involved imitai.is problem. I tlhinbthere aremanv people inter- ested in cancer but they shy away f;; orn the smoking problem.. 1'Ir..XnAsrs: But'thtis~iswllatIi am trying to getat., The: wholetl7rnst of your statement isthattlh~ereshould benlore research andl that thesethings should be happening and they are not, andl I understand that thevwere and yet you are indicatimg to me that,therearen't ai number of scientists~ involved in this covering all of the things that you men- tion, and~ I am trying to get froru y.ouwliat the facts oftlre situation are. Either money is flowing in to do this research or money is limited. In ~our opinion mone y~ is limited, is that correcti 2 ~r. FUnsT. Well, there is certainly some limit'ation of funds but I think the problem I have is that most of the cancer scientists do not feel this is a fruitful area because I think they hear too often thati' it is already a fait accompli. tiTr., A>3A--Nts. In otlierwords, you liarehad a numberof caneerscientists say to you that theybeheveit'lias~ already been causally,connected between smokin(y and lnng cancer and they don't want to bother spending more time researching it; is that it ? Dr. Ft;asT. Thatis the gist of some attit'udes; 3~-es„sir. Mr. AnA3rs.And thatl, incidentally, reflects some of the testimonvthat we have had here so I don't question that. ~N number of people db feel the causal connection has been established and they feel it ia over. I[ gather now what you are saying, is that we should determine R-~hat specific factors or how this thing n-orks or do you disagree that there is any causal connection shown or established between smoking and lung cancer?' Dr. FuiasT. Sir, I haF e no experimental eviidence to show any rela- tionship whatsoever, and this is the agonizing point. Iwislr I could quote anyy specific reference. Now, when the scientists talk to other scientists, and not~ to the general public, theypublish papers. I am not reading, out ofcontextl.sir-I just want to read one statement that Dr. Wy~,nder wrote and published in Science, November 1968 :, "That cigarette smoking, is, a cause of squamous-cell lun;;g cancer has yet to be experimentally est'atllished:" Mr. AaA-Ms. I thinltthe men that have come in have stated tliat tlieydon'tknowwhat frictorscaused these things butthevsee that it 1lahpens and therefore: itlhaving, happened th~eythinh~ sonaethingshciuld be done~ about it and that is .~hy~tTris committeeis l'oolcinginto it no.v. I am trying todetern7inefromi von w.hetheryou thinl:that we should ignore the studies or t1iestatementsor the position of'these cancerscientlists that there is a connectionand' wait until son7ethi~nghappens-you indicate that researchi is going vei,v slb«-ly and that people aren't moving, intoiit-orwhether«•e should trvtodo some-thiirgr now to protect thepublictuitil suchitimeasreseareh can develop~ what is haphenm g. What is your position on that ?. 1)r. FU>zsT. First c ptiiliIic, I think t1` ~~ ~:-:)e„however,, we at~ Aur1>.erthan anything :4r., ADA°_Yi~s. Then : i., committee shoui ,„I: i',1tst like it is no, ~ ~ iI I-- or~one of'tlle c ~!ionikll do ?' !~1tii. F~a-r.ST. I~th~inh t c tclv e.lists. [ r. _ln.lats. We ~ ~~I i-.h i'seifect~w~oulc ~i:(,rever~ the adverl n0w. )1'~., la L"RS71:, I~ am makes sen !1rs 1s-1Satsoej-er tha !' t.ull:ing about, a. 1~irr,rll data -which ~ ~ i~~ ice~ i n that ~respec~ t.r. ' -~.v1°rLr.r1);LD. •li: l;rovhilI? '~~{~1•:, P~P.oT1~IILL. T] J1>~I(~•ror. I n~ather~ ~~~l«as~ ni•esente~ ,!1~1iir4ntc'e in these .11 lr.ru'~e of cancer ~ It tire;!e nnav ~be~a ee one<. ~ h'T-r.sT:, SIlr, . ~ 11 ;lo.r quote fr( ! -iiccl. for the s :Pua6e~r 1J68: f i,:~ cuQh,i,ising, ' c;t9v~jn(>STrlds~ha. ~ r;ir, ilj);xe€LI.a] lilealt [ ~~i.:N•e~asot as I.~ a~Lo: po~~ i~4,orc ha( 1111 ( he~ sul',e( t!i~~~tn-o 1:('l'ii !ti"o11. ar ' rlh r•rnisr::'li cail thr ci,--arel ~tol~nic~~t a.

,f~~ data;~ ; in the i of the ion by -r each undle- ir ownn elves." ,an be llSiOn. ibility ,bably -A for Inatess ttisti. tiiottt 'alled. The . hich were this iven `.iizh ility ireee hle, an ere ion of ity a ies ngg utt ng ~n- 971 logicali conclusion would seem to be to try to educate the populhtion not to know ~vhether they had smoked or not! i Of course, this simply is an indication of' the looseness of'. the Public Health Si,rvice projections. in fact, one may question immediatelvy the accuracp and applicability of'tech- niiluef which lead to direct contradictions as illustrated by t.'tvo examples from, anot'her publication by the Public Health Service: In "The Health Consequences of Smoking;" also published in 1967, the follow- in, statement was made on page 7: Ttie death rates for pipe smokers~are little if at all higher than,for non- smokers, even for men who smoke 10 or more pipefuls a day and for men who have smoked pipes for more than 30 years," (Emphasis added.). The very nestl page of the same publication statedi: "Currenti smokers of cigarettes, cigars, or pipes experienced a, mortality risk significantly greater than that for non-smokers if' they smokpd, more t7-(ni jorrr pipea or four cijar.s dailp, or more than an, occasional cigarette." i,Etnhh z.yisadd'ed. )lI"itile~ this Critique is concerned with conclusions as tacigaret'tesmoking; oneuiust not forgetl that the same interviews, saaneanaly,ses, and thesamestatisti-rcri appraiaals as applied to cigarettedat'a led to the quoted contradictory con-clhsions as applied to pipe smokers. RaTIOSAND~ PEaCE\TAGES Consideralile attentionnas~gicenin the JiorbiditpReporttlo,theuseof! ratios. Any statistician: knows that figures can be distorted, disguised, and made more alarming by using ratios. The Morbidity Report went, further and used ratios of' ratios, that is. ratios ofl rates. Thus: an incidence rate of 0:50 per hundred persons for "_'ever Smoked"' and' 0.75 per hundred for "Ever Smoked" became. 0 75/050 or 150 on sudilenl th i ide te f "E " . c e nc ..,, i- nce ra or ver Smoked s 1u0 per cent of' thati for "Never Smokedi" This„ of course, disguisedl the very small num- ~ ber of occurrences and the difficulty of' measuring a true differential between the two cat'egories. +!~ The statement is: madethati such ratios then are directly comparable. In tlie~~ 1~J 6t3 Presidential race. Delaare waid b tiiid Yok ws carre,yon an Newr was carried by Humphrey. In Delaware the ratio ofl votes for Ni'son to those for I Hhmphrey was lll. In New York the,ratio~of tlie Humphrey vote to that of tiixon also was S.1L are these, ratios really meaningful when compared~ considaering the vast disparity in electoral votes in these two states?' Conclusions intialving, percentages were dramatized by the carefull choice of'f base: For esample;mentionn°as, made that. "among women who smoked 21-40i cigarett'esa day at their heaviest rate,, the number of those withi 3 or more chronic conditions is 51percent, higher than that for 'never smokers'." This result, was achieved by projecting the percentage of"'_\'ever Smokers" with three or more chronic ailments at 20:2'. while the 21-40 cigarettes per day smokers were listedl as having 30.6' percent in the same eate;or~y: Csing the: "Never Smoked" percentage as: the base; the ratio of' the two percentages, is 1.51-hence the 511 percent "hilgher" figure. Now, if the problem statement is ~ reversed. that is, expressed in terms ~ of'. those who do not have three or more chronic aihnents, we find 79.8 percent of "Never Smokers" and 09L4 percent of' the 21-40 oi„arette smoking group in,this category. Then the ratio ofthepercent'ages is0:871 or 1.15. depending upon choice of base ; i:e:, a, difference of 13percentl or 15'percent of the selected base insteadi of 51 percent derived from the same data!' CONCLUSION There are nranr ()tlumcommeuts one,conldl make abont the Morbidity ReportL Qnecould point out theunfor;ivablesinofstatistics, that ofdran•inAe:onclu-sions f.rom, datal knon-n; to have much t'oo great an error. This was done on page 11. footnote 3, of the Report :"I:ven though the asteri.ks in this column replace figures with large sanipling, errors, each of the six of the replaced ratios were larger than the ratios for the lower smoking amounts." In other words, the 'Mor6iriithrIbeportl etpresslrconceded th:it errursiii some of the retiults were too

998' Dr. FURST. Sir, once again may I point this out im, terms used by scienti'sts to scientists. This again is `''2n Duuren, Toward a Less Iflarmf'ul Cigaret't'e; National Citncer Institute. `Tonograplr No. 28:~ Listen to the word; scientists use in talking to scientists.. He talks about aromatic hydrocarbons: He talks about their car- cinoo;enicity. Now, I have listed the exact wordi'ng.~ "'Th~ese~ findings imply that noncarci~siogenic tobacco, tar hydrocar- bons may be tumor~-initiating agents." This is 1968 k This is R1iat I mean byno new inforlnation. Mr. BROYrIiLr.. Thank vou,,llr'. Cllairman. Mr.~ tiAa-rnltFIULm. Thatrk you.. Mr. Fckhardt ? Mr~.~ FcKtzARDz.~ D'octor, Iwish~ to call your~att~ention to~ three sources here. One is the cigarette smoking article introduced here by Mr. Rosenblatt, and;, incidentally,~I think lir: B'~osenblat't appeared here at the~ insistence~ oI~ the tobacco~ i'ndustry,~ and, as I relmai'•hed,~ I thought was one of the most candid witnesses n.ehase had.. On page~1140~~ of'tiliat report there is~ an analysis of~ coron2ry~ heart~ diseases bv~ smoking~, category ~ and several behavior types, which indi'- cates~ in behavior type~ A, wliich, is the rzther~ frenetic~person, that it occurs about three times as frequently in smokers as nonslnokers.. In the~ rather calm tlype~ B, this same~ percentagE~ relationship~ exists, about three to one, for the smoker as compared to the nonsmoker. In the~ report called cigarette smokialg, health characteristi'cs,, U.S. De- partment of'Hetilt'~h, Education, and Welfare, there i's, ai table~ that in~~ cidentaIly was not referred to by one of the previous witinesses, Dr: Sterling, which is~~table :3„showitig,a~; rather~marked increase with t;h~e~ amount of cigarettes smoked respecting percent of chronic cond'itions. The nonsmoker figure runs around 54.3' percent and then among smokers of all ages, 17 years and over, 5S.7'.. Then,,you take tlie number of cigarettes and y~oui get an~ increased percent~agQ,, 42.4„ 47. 57, ~ and 6:' percent, indicating an increase of chronic diseases with increased smoking.~ Then, the~report that was referred to~earlier a-, ~~ the Hammond Studv shows a marked decline inithe overall d'etrth rates for former smokers if they have quit smoking a good number of years ago, IiTnder, 1~ year it is~ fai~rly~ higll. If they~ quit from 1 to 4years it drops off; if they~ quit fiotn 6~ to~ 9~, even ml if~ they~ quit up~ to 10 vears they are nearly to the nonsmokers level and so forth. No«-„recogniz~iilg that there isno identifioation,of the~ ^ause,of'diseases~ related to~ smoking, do~ youi not feel that all of the literature indicatles~ at least a.i .~arning that'~smoking ca2ises~~injury~to your~health and that~ the increased amount of smoking as~ indicated by ~ these stu~dies~ would increase the dangerr to health caused by smoking?. Dr. Ft nsT. I am~ not goii7, to~~ erade, tbe~ cluesti;~n~. I a~n an e~;peri~~- mentalist and my field has been cancer.~ «' liell, I liear~ statistical iilt-~ formation I' really~ am not comfortable, so I have to ro~~ back~ to my fill tlaat I~ would like to~~ see biological models sho«-nag , th~is~ ou a quantitative basis, somethin,z «-hiclu I caar sink~ my teeth~ into~ and evaluate. If'a doctor slaps a patient ot~t~ the bacl: anct says. "Hl are you feelialg,?" and lle says; "I feel better;' this mav lnea.i tb.i~t a~ man l~lEis~ itnproved. If he~ slaps himi barder aiud lower he~ may.~s.iy~,~'`Yl I ]iavc~ i mpr.oved more." Then you: say, `41 ~ vith these fil Aj1'., EC'KH.1~~RDT. . I,,ok!ialgr at~this thit~~ ~itionrh~ips betneei~ I )i.ul'~RST sThat II l'., I' . C. h I I_ 1 R D' r; l,li lr a relationsl : t'e ~ at t~iSe~ stage wI ~uioking but iv her~factors~could You would like "uir data accordlw I~rr:~FuRSZ:~ Yes~,. I'.CIiPI_1RD"r. ~"i,i r~es~ followed, "IP"~. anQl R"e~.colli ~_~ic alpt~ warn the 1~,~ociated with of the~p, ~ '~'ioi(111,e~cautioile~, D~r: F't l..sT. Si~ll, 11 r. Ii, c li l I-YRDT. rI)nAy enoug~l I)on't~ W.a~udous to~ hea ~ ~i.rr.dous~orwhy 1Ui : FuRST. If I. \ 011 do not hav ~~l 1•. P;C1.H:\RR'r:. !ll ~I hat ci'garet fr c ou ]lealtll. r,lr elnlpby: ~c~ith~ t tlierepora ~ ~1l° 11a\-e an r 1> t': 1?'t-RSr. Y e` are ont of in-, ~i ticy Iiiclr that \N'hen, it co t~o~ -stati~ -H0,t'1IY -•~ire ti-ot 1[~. l;cl~tt:~l:nz

980 given the same answers as the persons interviewedl did: That such an assumption is bothi arbitrary and unsafe should be apparent from the preceding: examples. The presence of this nonresponse bias is a criticism of the results of'this study and of' the conclusions that have been drawn from it-not the statisticians or others who peruiit'ted,it. The fact is tliat, such bias cani neither be entirely pre- vented nor compensated f'or by any known method. It is,! simply an unavoidable weakness that should' be Lept in mind by anyone looking at reports of' surveys such as this one. In tliisparticttl;ar stud'yof smoking, the, pictttreisf'urther clouded by some-thing that,i:s described' by proxy-response. It seems that more than ha1f-60 per cent, in fact-of the replies ascribed to men who had ever smokedl were not' given by these men atl all. They were offered by other household members in the absence of the men themselves. We'll look at this problem, further ini a few min- utes when we take up the question of reporting. A third kind of selection, to which studies of' smoking, are by their nature particularly prone, i's self-selection. This factor isi so important and so prevalent, that it is in itself sufficient to cast substantial doubt on aill the: conclusions that, have been drawn fronl, studies of smoking. Self-selection refers to this factL Jlembers of a sample of smokers: differ from a sample of' nonsmokers in at least one major respect other than in having smoked: theyhan-echosen to smoke. 12I what ways a man~ or woman who would choose t'a smoke might differ from one, who would choose not to do so is something no one really knows as, much about as we'd,like to. However, we do have a great many scientific studies suggesting thatl a number of differences, esist• To see how this factor of self-selection may have distorted the results of not only this study of smoking, but of all similhr smoking studiesi as well, we needl only mention the "stlress type" hypothesis. This says that some people tend to live faster, hardpr,, and' more recklessly than others,, that sllchi people are in consequence more likely to beconle illl or tlo be, injured or to die, early ; and that such people are also more likely to smoke or drink heavily even in the face of warnings that it may be dangerous to do so. If' this is' true, or if something else of the same kind is true, it i:s inevitable that any statistical study will show ani association between smoking, andl health. Yet there may be no cause-and-effect relationship at' all. Our second question asks: Is the sample large enough? Whether a sample includes enough people to support a given conclusion is not only vitally important but also extremely difficult tb judge except by statisticaltechniques; For example, when an early testl of' polio vaccine was made with a sample of 450 cliild'ren,,the experiment was doomedlto worthlessness from the beninning- Becauseof' the, lbw incidence ot' tlhis disease, even during what turned' outl t'o be an~ epidemic, a samplle some twenty times that large would have been required to produce signiflcant results. In thecomplessamplesoft'eni found in studies of popullitions itl is~ iniportantt to disting,uial between the size of the totall sanrple ancl the sizes of various subnroupings., In the survey of smoking and health characteristics, the sample isdescribed as being made up of "approxilmtel!v42;000householdsaont'aining, about 134.000, persons:" But when some situpl'e calculations are applied to the tables it is found that the subsample of females said to be currently smoking two or more packs a dny must have consisted of only 2108, women. Since 17.2 per cent of the interviews with women were obtained by pr.oxy;,it,appears that- in the entire United States-only some 172 women listed as heavy smokers were actually spoken t!o by interviewers. A warning both thatl this condition of'inadequate sample e.si'sts in the smoking study and that it is of'printe importance is actually to be found in the published study. U'nfortiunately, warni'mgysuch as, tlhisd'id notahpear in any oftfiesuln.maries andlreports that reached the public. "Particular caution must be taken "' says the author of the pamphlet• 'inn int'erpretinn, the followingretiultsrelatingspeciiicacute conditions to~cig;trette smolkmgbecause ofl therelatively.lalgestnlpling erI'~orconncctedlwlthi the estiLmates for the several types of'acute conditions-, Although many of the ratios in table E (which deals with: snlokers and nonsmokers in respect to diseases)' would seem to indicate a subs:tantislldifference bethveen personsii'n tile different smoking cat'egm•iesaa1dthe 'neversmok'ers,' the actual nttmberof'reported cases involved R':eree quitee small and, ini mast casesy: sigil.irlcant: differences:' \Vere: not: demon- strable:,' :r tltirdlquestion,ask, a recent: writer a ~ .-:'•.iox thatl the~averag, ~, ~lie l.alies)" A~ phenomenon is n •!:~~ widely~ accept;cd~ y, ~ •Jht: t of~ fau~lty~ report ~ha~~tate~of Iowa fbur. 1 ,tnd the following ; = ic;d beeni introduced :onwetiicu~t found tha~ ~ r t1Lat (>eorgia repor~~ ~~i-nuly methods of ~ iiiaic<on virus~en •, r:ners bezaat pac that although ~ ~ vir,u~;~ IPealc year;~ the~ l t'l:at four tea ~ ~ ~Jri',u They had unc ~ ~~n sl,otted at a~lll ino un,a had had "more~ u`the<e fiINN' cases ~ ~rrinc~ n_,nsinst trr.Ytio t~u-Ci arette~Stua~ ,i;•ro~~ue~,ire~ dealing _Ai •vi orience of the I :•: nt< :tnd disahilitit~ I~ritlil! c:lSes~~a "ubst ~~ P~„ do ,v~ith males v ~~ a1rihors of the stu introduced errors • roporting of' m~( :'-uie l,eonchitis (wit' and third-] -u inoL~:- Thus the . (~t the nten "•lto~ I <<clfl-diagnois~~ 0 ~ 1 1rorthe ~otQterGOp~ ~' ,'npo~,cs~ one ~ further inio thestLltistics 'n would have to, tI The persons whai ~r v.•Iionl other~~a_~, did tl' ~ 1.11 wouid ha~ aware ~ '-~V`lcipel'r and'd ma°az ~.~!11; llr'ir~~Mhvays-im,pr' ~''19' i0nl'ti1~,Ihlestlon' h ~:istu-ing , ~one Thi7t1, u .C tlie Inost c•.o ~' ';o:'tn-tlr liatliolor tik,itl %%hite St1:,L: [ ~~~ mu:inc complrte them becaus~ uni,c fi;;'ures~ in tl !:ildon. nfl Inetropolit iY no•d~s to be tal W u t' is~ el..e h:1ci o C1l::n,cil its defin ~. lurritorC,. ~ l,een report( ~ ~' 1Slitl thP truth i: So a

1005 my small . to go off ing given oIle hun- lIe R.ron~ 'rene R-hy ,sand ci`- cinogenic is consid- m't ltno«- t you are this qM1les- •search i2r sciientists dL :dite than Iretumns" ind them, i Ines conY- tlth Serv- ie general nd them,? American q in S'an. many is ~ not ail organiza- y orthyof' ~:cer ~ritli ;ulr,ecl ; (I yrou are _n anvone i that ap- iozce~ 1f)t4: ._~rimental. ~ ~Tcanrer., tllis„ but stroiIffer Dr. FURsT., I~ really~cannot say,, sir.,I don%'t~ know:. _lIr. Pr.EYnR., Let me ask one fiiiaLquestion. This is a very impressive list ofl papers whiclt you read' here with ,;~ore names that I can't pronounce~ than I think 1 have euer~ seen in "ue place, and undoubtedly ~ some of the longest names in the~ English ii.i,i(ruaL~e, but I thou-lit with perhaps that~ background yo,tr mlght~ ; ii,,t lielp us on one question which n e discussedi some here in the com- ~.: littee~„ and that is~ the question of is, smoking acldietive~'?~ We haU'e~ ha.dl n-itness who testifiecli that it is addictive like heroin. Dr. Ft'asT. No, I findi as~ a phai:macolo;~st, just to~ put on another~ )at;, w1ien w,e~ talk about ~ opiutn addiction we have in mind a physical .~Lependbnce~., If you suddenly ~ remove opium, or~ its, ~ chemical rehitlves,~ ,.:oui ~~ila have a~ f~antastic~ reaction to~ that sudden removal-y ou har~,e~ t iie symptotns of! nausea, vomiting, etc. It i's not somethin, to be done at home or by holding iiancl's. It is a hospital procedure. Death ma~y~ensu~e if y~oui a~re notcareful when you remol.e~ opium suddenly. Smokiilg is not~of that nature at all. I ha..e a child «ho~~ used to bite~~ her finger nails; it was~a ddifficult habit to break; this is similnr to: a person who has to quit siuokin1g. In no _ense, pharmacolobical sense, can one talk about smoking as being addictive~, The addiction goes through the dependence, tlie physical dependence. 111iere~ has been soine experiment with tissue ~ culture. One took simple cells and then addedl morphine~ to~ t!hese~~ cells~ and one~ couldn~t see~ anti,~ difYerence, but when morphine~ was~ withdrawn t1t.e~ cells, withered allcl t16ev were broken. 'There~ was an actual physical dependence.. Tlii's is not the~~ case~ with sniohing: Mr. E]cKfr Anm. A'Vill the gentleman yield for one questlion ? lLr: PiEvER. Yes.. Mr. Ech=raxnT. In this sense„coeaine is not addictive eiither, is it? Dr. Furs,r.~ Well,~ I have not hadl fii•sthand' experience with cocaine llr. EcKIIARnT. I unclerstand that these are not from the medical doctor~who~ directs the Federal institution at~Ft;.,Worth~ where~ addic- tees are treated. 'No.c; of course, it is consid'eted narcotic and it creates certain situations,n-hich result in pe.rsons~~ wanting it agra~in because it is attractive to use, but I understand it doesn't liave the vomiting and witlidh•am al symptonis of the type~ yott are talliin(_,- ~ about.~ Dr. FtRST. Well, Ii have not had first-h.1nd experience with cocaine LnIt~I' arn~alnnost n,illing- to~bet that~it foll'ows~th,e~opiunx t5'pe~of addic- tion and in the pharmacology ~ bo,oks~it is,linked with it. In any~ mlmber of pllwrm.icolor~ical books;~ Sohnann, Solomon, Csootlpiany ~ Gillnan,. Carr, ILranz~~,, z-ot1~~ willl not~ see~ tobncco listed as, ad,dictive~ for the~e pliarmacolo_.isb',~ but you will se,e, I think, and I may~ stand corrected, I thinik I c.in find coc,,~ine~ lhsted!«ith the~ opiates. .%Sr. S.x-rrEarrnr.ro. The o-entleman's time has ezpired. l',Gi•. I3'rotztnan ? .lf r. T,etoTzacA`. Tust one question. You mentioned if' I understood yotu correctly that there is a very l:irnitiedl ann~ount of experimental effort being, put forth to~ try~ to~ deter-~ W. C11' ,uiil~e~ v;~hether there is a relatibnship~ bet~s~een, the inha~lat'ion~ of smoke andicancer. ET~. tJ .C~

issumption, exavlples.& this study stieians or' itirely pre- navoidablee of surveysl I by some- tif-60' per U were not Uers in the a, fewmin- :eir nature. r prevalent isions that liffer from, in having. :iaht differ knows as ific studies tilts of' not 11, we needl ;lle tendi too iple are'in ; and that n the face : inevitable' :ind, healt'h. nclusion is except by :i; a sample • beginning. -nedi out to en required ' ; i:mport:ant ' of various j the sample containing ' lied to the ', ly smoking Since 17.2 ears that- i okers were he smoking e published )f the sum- ~ nphlet; "in ' ocigurett'eththe esti-teratios!in ses) would nt smoking es involved not demon- t tnr thirdl question asks : How good is the reporting? `;iys a recent writer on sampling techniques:~ "It is a well-known stlntistical l;:radot thatthe average age of«•omenover~ forty, is, under forty (as reported b3• the ladies)." ThiR phenomenon is more than a joke. Let me mention a few things that have L~~en widely accepted, yet have no basis' in faet, whatsoever. Each of these is a i,roduc•t of faulty reporting. The state of Iowai found a shocl:ing; 300 per cent rise in, traffie acc:iilents between ]"t7 and the fbllov.•ing year. Why? A more complete metlhod of accident:report- ii!ehad been, i¢stlroduced. connect'icut found t'hat3'per cent ofit.sautoaccidents~ lvere f.1ta1 in the'same year that Georgia reported' 17 per cent. But it was not driving li.lUitsthat dif-for:•d-onlsmethodsufclassifying;, St:itistics oni virus enceplial[tis, beeaane so'alnrmingonesuwmaerin California t':;tt farniers began packing their families off to distant resorts. Then someone' noticed that although, ther~.~ported i'ncidencewas nearly triple that of' thee tprcviou~4 peahssar, thenurnber of deaths, was about normal. All that had liap-l,t ae1', was~ thatfourteaursfrom~t.heNtlLlic Health Service had beenponred into~ the an•ea. They had' uncovered hundredyoflow-grad'ecnses, that would not have heen spotted at all in other cears; Asa medical reporterev'entuall,r,poiiated out. tl o area had hadi "more an outbreak of sleeping s-ichuess,reports than of sleeping, "?Pl:ness:" i±'veutllesefe«'casesoutl of the hundreds on rec•or.di should constitute asharpv,-:irnin,awainst treating r'eports~ ~asfncts. It is a warni'nethat ampliesin, two \%n}•s to "Ci'garette Smol in^ and Health Characteristics:.` IIere ne aredealin;_;v,•ithtwo kiiidsof'r;enorts. One i!son thesnioltin;: 1'tabit,sand etperienceof; the members; of thesample; and the othei^ i's on thnt peryon's ;iilmentc4 and disahil,ities: Iu both cases a substantial part of the reportling is second hand: of that hav- iua, to dowith, n•iales who had ever smoked, 00 per, cent wasolttained bv what the authors of' the study call proxy. That ic. someone else supplied it!. That thi,s introduced errors is acl.nowledgedl in thestudy: Thereport'ing ofn:rdicall conditions, from arteriosclerotic heart disease to chronic bronchitis (with: n-hich, ie lumped emphysema) , hecomes a curious blend of second- and third-hnnd! information, with none of the data coming from Physicians:Thusthe ailments. we findi tabulated and analyzed are. for 40 per cent of the men who have ever smoked, ailments they thini':, they liave, either through self=diagnois or as they remember having been told by their physicians. And f'or the other 00 per cent of' the men who have ever smokedl proxy reporting interposes one further step between an actual medical determinatonand wha.tl wentintbtihestatisticsofthestudv. You wou1d, have to readl the report with some care to realii'e that this is the case: Tlieper'sonswho gave their ownguessesi or recollections! and tlieper~:onsfor «-hom others did the remembering or estimating are lhtmped together iu thiss report. 1ou would be aware of none of this if you iuerely rend the conclnsJnnsi or tliee nowspaper and mn,bazine articles based on them, or examined the manc taldes witli their always-impressic-edeciinals. Our fourth question: Are we dealing-,cAth cctninttaclied fianres? Measuringonethiilg,-howe.,ver accurately-and then d'escribiniz it:?s,noiother i-, ~ cnteofthe' mostl common source!sof error in st!nc?'iesofpo,ntlations. A German patholbgiFt has brought tb inpattentienai stvdw' diaploring tiiefnct that while 70!5 per ccnt of Americans finish 1!i_h school. onlt.3'par cent, cif' Germans complete' ILoclescliatln. P't1tthe~zesohool, are not comparable: and oquatinothetn because they sound as~ if they are call produce no mcaniiigful resrtlts. Census figures' in this country , have shown an enormous increas.e in the poh- nlaUions~ of metropolitan areas in a single ton-yenrl;eriod. :Iomarkeda trend ,,nrely needs to be taken into acaount-or so it scented until it was noted that ~omethin,g else had occurred in that same period: tlheICuree'u oftlie Cha<-us~ ]utdl changed its definition of a nietropolitan area. The r.cw onetool: i1i mnx•h, ntore territory. Ithns~ beeni reporthdi that premature birth is more common imn;, '\criroesthan\F'hites ... whether for raciulrc.t~:ous crrsimplc frc;miufhriorprenatall (°:rk•. Pnt tlhetr.nth is that the studieshan-ensed birth n•ei',ht ais theeriterion of prematurity. S'o-all thattvas acfiua]7k-, discovered xcsthcttN'<~;roes iu tlie MdW !

978'. TOHM WESLEY SAWYER Born :' Raleigh, North Carolina4 November 2, 1917. Ed'ucation : Raleigh Public Sthools ; A.B'., Wake Forest College, 1938 : A'.JT:, Wake Forest College, 1943; IAA.M., Uncversity, of .1Tissouri, 1948 ; Ph:D.,, Unimer. sitp of Missouri, 1951. Teaching esperience : North Carolina Public Sthools, 1938-1946. Instructor' in blathematics,, University of Missouri, 1946-1950. Assi'stant Professor of~ bTath- ematics, Georgia State College of' Business Administration„ 1930-19n2: Associate Professor of ~Iathematics, Georgia S'tat'e College of' Business Administration. 1952'-1953: Associate Professor of liathematics, Universitg of Richmond, 1953- 1956: Associate Professor of Mathematics, Wake Forest University, 195G-1959. Professor of aiathematics,, Wake Forestl Unimersity, 1959-present. Director of Computer Center, Wake Forest University, 1963-present. Other esperience : Lecturer' in Statistics and Operations Research::~ Invited speaker„ Operations Research Around The: World, Madrid, Spain, August 1067~ Invited speaker, National Convention, Operations R'eseareh Societiv of America. 1966. Speaker, IBM Computer User's Group, New York City, 1965. Invited speaker, National Convention, Association of Deans of Business Colleges, 1963.. Invited: leeturer, IBM Executive Seminar on: "Management'. Science Applications in the Textile and Apparel Industlries;"1964L Invited, lecturer, IB'1ii Internal Seminar' on "Industrial Processes."' 1965: Invited: lecturer, University of' South Dakota Faculty Convocations, 1964. Invited' lecturer, Wake Forest U'niversitq Management Seminars;,1964, 1965; 1966'. Invited lecturer, Southeasterni Regional Conference of'the Society for Advancement of 1lanagement, 1960. Invited speaker, Piedmont Section, Certified Public Accountants, 1960. Invited speaker, Central N:C. Chapter, Americani Institute of Industrial Engineers, 1965:, Invited speaker, N.C. Chapter, Data Processing, 'Management Association, 1967. Invited speaker, Winst'on-Salem Engineers Club, 1960. Invited speaker. Centrall N:C. Chapter, Systems' and Procedures Association, 1967. Speaker;, Northi Carolina Acad'emy of Science, 1957. Invited speaker, Associationi of 3Tathemat'ics~ and Science Teachers of' North Carolina: Baptist Colleges; 1959, 1966. Statistical Consultant, North Carolina Advancement School, 1965-1967. Busi- ness consultant' in Statastiicsi and Operations Research since 1958 in testile;, tobacco and banking industiries. Direction of' nine theses for graduate degrees, Publication of' various Industrial Research Reports, and Lectures in BTinutess of various meetings. A paper,, "Simulation of a Radio-Dispatched Truck Fleety"' will' form part of' a book: Operations and Spstems Anadysig: A Simutation 9.'p- proaciti, to be published by Allyn and Bacon; Inc:,, in: 19 TA! (The statement of ' DarreIl gIilff; follows,: ). STATE'_t[ENT. OF DARRELL HUFF,. CARSfEL,CALIF. I am Darrel'll Hilg; of Carmel,, California. As a writer and editor I have been concerned for many years!abouY the widespread misuse and misunderstand'ing, of statistical!information. Thi's is a subject about which I have written extensively, as indicatedi in the, attachedl biographical summary. bTed'ical'statisticsareprone to dist'ortion, more often by accident than by intent. Those statistics having to do with possihle relationships between smoking andd health conditions have proved to be especially open to misinterpretation. I had the privilege of' speaking abont' abused stat.isticst'o members! of theCommerceCammi!tteeoftheL'nited StatesS'enate in 1905. Itook some of my examples from the report of tihe: Surgeom General's advisory committee and from conclusions thati had been drawn in and f'rom; it. Rather than repeat thrrse esamples andl comments that remain as valid as they were four years ago, I s1Ia11 today include couie instances from t!he more recent major report called' "'Cigaret:te Smoking: and Health Characterist'icc." Here again a, numherof inferences11avebeeni drawn, p;Irticnlarlv in widelppublished, summaries and news reports, that are not jirstiticd' by the dhta in, t'lrissurvevbghome interviemof'health comhlaintsand their possible statisticall relationship to smoking. We can most easily look at these, as well as at avariety of'etamnlhs from thehistorv'ofl statistfical errors, by ashinrsis nnesfiions: Thesearetest qiies-tions I have evolved in, writing about statistical matters for JCcrlfr•ol' Eeotrmi!i'r.r. Rosirtc:rtt P1rlisi'vian, IZarpcr's, the Scru1 or 9;. Ti»re.eJloilazinw. andi other spcrial- ized and general pnblieations. L 2dswused this approach in my book "Hna•t'n Lie Iti'ith Statistics," wlrieh is cnrrentlpini usc In niost Arneric:in uniicersitihs and' Ikeen translated into !'hese~sis basic~q',uestiorc the~sample~biased'i '. Is the sample large er. :.. I,Iozv good is the repor Are we dealing with e :: I io tlre fi?;ures fully s 1 i;rs causation been a ~!'1- t•stalilislr the~ vital ~r ~iu ,i var~ietc of'fields,f i9:rve misled us in the I I liall then apply eat ~ri~~:ir~a~tto~:`rmokiugandl I do tlhis~ we shall t no~aronses~ from~ senre~ : ;inrs; and by the presen, '.A"i- shrill tind that, as~ cic'I its~~ size oflten be( *;It, Uorl,r~of the~~rehort~b~ ~-.Ijil• ever see. !.r respect to our thirc ~ °>1'1 ~ inn t1le~ Stnd`"-m~. I'rll~ no~~ cliBti'nctiion marl ?~inre man}- of~ tihe~ 1~ ~ i ure, it folloevs~ i~nec•it ~ ~ n~.-iun, and the~actual d~ "htr fifth illlestian, th - words! used to sum r-hanci:e.s. 1% dealing with the r tu t'ihtr~ ]leartl of tni): dan;;enotts ~ it i5 t. when two~ events c ~:iI!nrtsnt principle invr .; :null llea7tlt Charac it in the~subsequent p 'Xo :re now ready to ISI~-;rl]c•~ if~ «-e Nvantell we would stud I,ll• and hope the}s v Thi,~ Iuethod dcmand (•hosen that every-on lii uur samplp~ is sele ;-~, ihiittri,st, wha~~ annau. V +t-ample~thatlcansisi 1'or~ another egampl<~~ n~Ih~.~how~ed an am~erat. Patients who stayc ~zlritals dangerous fo ~~t~:1 htaseaUsnmple. Th>- . -iue. To uialie ~thi's: impnrll I::it wnrrhl happen if a iluestionnaire~ ldini:urns?" Since mo- "1nntnires wouldl have - :d"'r t r adU up the "'1117Un of thP popnlati. 'I'lii'h tr.irtieulur'ki~ud~ ~:lliu, alll~,:rllims 1~~ eti? i','rvnce to ~~house_to4 ~ ~ ;rnul IIealth, (!;hara, W ~ av Iroine andl iht othe \-,nrespQUrse in thiS ~ ;II:ide~t7ctt if~ th~ese~pe~ ~

1006 Is it correct to state that this doesn't mean that it is not going, on in other areas ? Dr. Ft RsT:, That iscorreet.Yes, sir. Mr. BxoTZ.zAw. What is being done in these other areas relative to environmentallcontamo:nation, for example d D!r: FURST:, Relative to t'heenvironmental contaminants? Mr. BROTZ-3s AN., Yes. Dr. FURST. There have been experinlents were environmental' chambers have been used; in these, environmental conditions such as nitri~cotide; sulphuroxides,,areadd'ed to seeliow the animalsresponds tothatand just l~et . ltr.BROTZ-.Nra-N-. Take one of those now. Have they determinedi if there; is any relationship between some of'tliese others? For instance I believe you mentioned nickel ai moment:ao-o. Dr. Ft-xsT. Yes, sir. Mr. BnOTZas:aw. Tllis «-.oulil' be what you refer ta: in your testimony as a trace metal ?Dr: FiIRS'T: Yes, sir: Mr., BROTZ-NtAr.: I would understandl from your remarks, ho.vever, that theretca6 not a determinable causation factor there either because you said it was induced by injection but perhaps not by the smear on the skin, is that correct? Dr. FURST. That is correct but if you take tlie gaseous nickell conr, pound you can ind'uce lunb, cancer in rats, so in this particular, ca6e it has been shown that lungcancerean bemade, orcanbeinduced, pardon, me, byinhahitioni. Mr. BuoTZ_%tA.N, You can do this by inhalation of something else, is thatcorrect ? Dr.FURS'r., Yes: 11Tr: BRO•rzanN . Inhalation of what aaain ? Dr. Ft RsT. The nickel compound which is in a g;lseous form. It is a compound called nickel carbonyl. Mr: BRorzanN. Did you.conduct that particular experiment?' Dr. FURST. No; tliat was done bv Dr. William Sunderm,an. _llr. BROTZafiaivi. But it'hasbeeM imdhlred byinhala,tion of somethineelse. Dr.. FrnsT.It has not been inducedl by any component of smokeoranve aspect of smoking. Mr. BRaTZ.zrw. From a broader standpointt are we as a nation moving ahead experimentally to, determine if there is a causal rehitionship between other environmental contaminants-smo, for i~nstia n cO I)'Ir. FURST. 'Now, for instance.Slanford' Research «-as mentionedd thismornin(r. Stanford ReQearchhasah iaill'y lar-e project tl;ying to, simulate smo- and air pcollution, problems and exposetheaninnalsto~ see«•fiat wulll happen, yes. TheTI`niversityof' SoutherlT California i'sdoi'nrgo, . it;.ILr t1lisp.Rrticu7itrcasetllere, aire, manTlaboratoriesstndyinm these smo, problems. «r'llat the ma-ni'tndeisII clon?t know. I do l:nowthat theInstitute c>f' I:nN-ironnlental! Sciences is very concerned -witht11i~y so, I feel there is nlncIr Inore. ~Oil1g On. 1'Li•: Ih:nTZ3iAX. «"hatwastllis'cr~asa lnoment ago, that you men- tioned that «-asusecl tooansecancel• bvilihalltion ? i )1. FURST. It ~ is ; , \jr. BI;oTZ_1IA_\'. r i)1'. FURST. Yes,~E illr. BRarZMAIN., I ~"')II1Inoving?~~ Did t. 1 )t'. FURST. N0, t]: ,)sed chamber-ar into tJlis envi~rot '~17e~ haVe~ done~ a ~lrn s-hich is adec ~ r~<t>ossible~to iizje( i'lie animals wllQ -'')rt'. BROTZ_1IA'V`~~. . !,-ut<1-l anilnal that rdn tlle lnice you a, , i )r: FrRST. We a %Tr. BROTi ~~11(1lhalps, mol'esi'ni f )1 : FURST. Well ~:nutinb~ Dr., Josep~ : ;e,lch .i ho says t:ha w,lvv it is set up, AI1'. BRO1L_ILAS., . I11': h I;RST. Tihat \I1'. BI;OTZ_1IA_\`. . I )r: I' L'RST. Ver3 . AIL'. BROTZMA:V.. \ I r. .,'~ A!PrE1, RFI E L D AIr. Fckhardt? 1Ir: hcr.ii AR:vT. 1!iinnr, iu, the task ,ii-aineand'ithis dr :m-s„ "but unlike ~ro,ltne~tolerance~or I Ilel iev.e you wil 1)r.~ FURST. T1Ia 1r1~SB I was go ~ 11 Iwr~tllaiithe~exII AIr. I:cKrrAr,vr. ~ i nl',()2ls-l-thia is : I )r.~ I+'~ZrRST. Yes~, 1~1 i'.:, I'.( KFLV~RDT. ~ ~~:",Ilo,ti(le and has~~ 1)r.i~its'r.Yc~ 1[Il~.~ I",cli;lr:YltD:r.. Ft-IaT •1"i,~ ~~ ~1W ~c.1rI>oii 1110110; ~~ to :hwrl!:~. tlre.n ul~c lriclcel irlr I~i. i,`~u1.sT:~ Thu

1011 an-ail- ,,pped L' COn- aption ymok• sugar irs op- those Lcalth. tegens: o,enic : poly- ,ratory ;rising; uple a Iherent which ~nzypy- Vvnder iulental •* from :ne ani'- ,.quiTed, a func- :omples )duce a it may i to car- )sphere. mpts t,o sources' e litera- -inations trauma. not, and ) potent quivocall ogenesis imber of 'oilowingd agents •inogenic : ts: It is •inogenic 'Inogens.; an ubiq- ;ted to a ino:Leni touces;, ancL ~o may ~ be > of tars \ ICOTISE! COV1'EST' OF, TOB :'.CCOSASD TH:E' ESStiISGPHAR'_\P3COLOG'aC EFFECT. -Nicoti:ne has been indicated asi the most important constituent of tiobacco: The tlryer the tobacco, the greater destruction of nicotine during the smoking process. The smailer the moist area behind the point of eombustion, which means the cooler the smoke or the more complete the conlbustion, the less likely it is that the smoke which is inhaled will contain nicotine. The condition of the tobacco :Lnd the form in which it is smoked are more important factors in determining the amount of nicotine in the smoke than the amount of nicotine present in the original tobacco: Nicotine can be removed from tobacco by solventl esti•actlion or other de-nicotinizing processes. Haag showed that 10% less~ nicotine was found in the smoke of low-nicotine cigarettes, but that, cigarettes made from such tobacco are likely tb transf'er a greater amount of the alkaloidl than regular cigarettes ; in addition, nor-nirotine is present. By decreasing the: amount of nicotine in cigarettes, a measurable pharmacologic effect such, as that producedd ou blood pressure can also be reduced, but the amount of nicotine available is '. snf3icient:to exert a positiive and measurable effectL L3BELI\ GOF TOBdCCO: PRODt: CTS Compounds' which are intended for internal use and ivhich are to be used by ill persons should contain a complete description of possible adverse eflects, TIIe Hottsehold' Labeling Act exempts substances which are not injurious unless aii4orbedl in excessive amounts. Alcoholic beverages, cocoa, tea: and, coffee do not require: warning statements ; all of! these materials contain active drugs ;uld excessive use of any of' these substances cani give rise to disturbances in Iuay lead to coma and death. The potency of an alcoholic beverage as expressed iic.rmal body physiology and biochemistry of varying degrees of severity. Some uL terms~ of' itsalcoholic content is a sought-aft'er factor' since'such, beverages are consumed principally for the drug effect producedi by the alcohoU they con• tadn: The theory of' the labeling of' alcoholic beverages, however, is not derived from warning, of its potency. Similarly;, other stimulhtory substances do not require ai statement of'tlhe percentage:of the active ingredient present. It is my opinion that, labeling of cigarettes as to the contentl of'nicot:ine or tars does' not serve a useful purpose. Its relevancy to: health is questionable, in: any event. Furthermore: the content and the absorption of' nicotine as shown by: a smoking machine is only one of the: f'actors which determine the aulount of nicotine absorbedi and the formation of "tar" in a, laboratory smoking machine is completely unrelatedi to individual' smoking, patterns. CONCLIISIOPIi 11 , I~ ~II il I There is a necessity for an unbiased evaluation of the effects of cigarette 3moking. The majority of the publications' on smoking and health have f'ailed t' io indicate the extent to which smoking, is: beneficial. There is no: question but, that ( a great deal of pleasure, and certainly much: tranquility, is obtained from the smoking of tlobacco. It has not been established that the tar and, nicotine yield' of cigarettes is related toi human health., No safe level has even been claimed to be established by those who say there is a relationship.,There is clearly no proof that'a label' showing the quantity of tar andi nicotine, asdeterminediarbitrarily by a smoking device;, would have any relevancy in terms of' human smoking. It could be: mis+ i leading torenuicesuch a label. THIIPROFESSIOP7hL QIIA:LIEIC 1TIO\S OFC..II. HItiE„ M.D., PILD. Ftl tLc¢tion St. -Norbert College, Cliemistry, B._l.-1J.37 University of Wisconsin, Graduate School, Chemistrr;,JZ_1.-1935', tiniver~-itvof' Wi'sconsin, G'raduate: Sthool, L'harm;tcology and TosihologT, Ph:ID:-1042 University of Wisconsinj Jiledicall School, AIedicine,,lLD.-1043~ Intern~hip(R~otatling) L.S. Navy, S:LniDiE~go Naval Idospital, 1J-43'-1-1Pesidenry Medicine, 1'.S. Navy-19-15--flS

985 tested their upacity and alth article r concTuded al capacity: n any way. ,_•rate in the gh physical ~a exercise ueemcaused'. . danger in 1' health. lmost every it. One of -;cuss what th matters. Astance to~ t to snloke, rhis choice •en st~udiedl ier. If per- tend to be g andlpoor ~,lationship~~ :ni no way A,ers as a. 11 not con- uchithincs ineconomic 'ndencyto .-h;tn resid~ -:nokers:to `,Iore such °enotcpes olcingandi ' n;, tmeap- there is aa uludes iit- ypes. On,e ndl among crtians ber -ail group )ns, it ap* . prostate. ier condi- -hese.con;.I. It is at person t'o, then, but zeation it: . re of the rattted in iaorou.sl° rt.,I hopeof Xvlic it u f9r.st to , ,<t doubt on the conclusions about! health and disability offered in the pamphlet .,,irette Smoking and Health Characteristics." .i o.ct such material as we have discussed here-publ:ic-health studies of smoking :A health-led, Ronald Fisher in the British 1TedicdtJozern¢lasfarbackas 1:~:-,7'to warn :"It will be as clear in retrospecty as it is now in~ logic, that the data u iur do not warrant the conclusions based upon tbem."' ?''_iat warning applies equally today. The temptations are great. As\Iark Twain >rrved about some similarly questionable statistics he had come upon, "One :, such wholesale returns of conjecture: outi of such ai trifling investment of I! I BIOGRAPHICAL SKETCHOF DARRELL HUFF 1t-idence:Lincolu and Third, Carmel, California., iburn July 1i5,1923, Gowrie, Iowa. Father, school superintendent; mother, .oolteacher. Married Frances Nelson (writer and teacher) 1937 ;, four ~, a,hters.. :clucated pttblieschoolsin Iotva, Idlinois;Californin. B! A. (R'it'h, Distinction)~ ..ii l Certiflcate in Journalism, 1938;, and .II.A., 1939, Stlate tiniversityof! Iowa. ~.; I s,e year of additional work on graduate scholarship in,child and social psycho- z. State University of Iowa., ilicted toSiguiai Delta Chi, (professional), Kappa Tau Alpha (honorary j,our- ii~m)„,andPhi Beta Kappa. ilehorter, Clinton (Iowa) Herald, 1936. PPublicity director, Department of Iowa ~; :, c•rican Legion Convention, 1936'. Reporter and feature writer, Cedar Rapids i, I-m-a) Gazette, 1937. Associate Editor and Housing Editor,, Look magazine;. Editor-in-Chief, six Davidl C. Cook interdenominational Sunday-school it;azines. 1`J40--4?: 3lanaging Editor, Bett'er Homes & Gardens Magazine, 19d3- -4-I. lixecutive, Editor, Libert'yy magazine;, 1944-45. Partner in Caveda.le Craftsmen, i r,anization producing technical manuals (e.g.,, Eastman Kodak,Data Book) in I,. lir.i4-e]J: . I , . Feee-lance writer and editor since 19-15: Traveled in Europe two gears-1957-"a8, (: Author of articles in newspapers (iBoston Herald, St. Louis Post-Dispatch, I'Itilhdelphia lnquiTer, New York Herald Tribune,,\ew York Times Sunday btaga~ {! i. -r.ine): and magazines: Harper's, ESquire,, Reader'sDigest,, Redbook, Look,i Woman's Home Companion, American Pho- { i 3IcCa11's Post i ~ t Ei d , , en ng :I ur as tography, Intiustriall Photograph5,, Better Homes & Gardens, The American t k~ tIume, Saturday Night (Toronto), Woman & Beauty (London), London Daily Ilerald and other British, Dutch and Australian publications, Popular Science llonthly, Science Digest,, Christian: Herald,, VFW Magazine, American Legion 31a;:azine, \Iedfi'cal Economics, Resident Physician, Womanzs Day, Think, True, 11'riter''sDigest,, W.riter'sYear Book, Americas,, Authorx JOurnalist, IIousehold, t,ood Housekeping; Catholic Digest,, Journali of'Liking,, Parent,s Magazine,~iPPLIVaR-.5, etc.. Book columnist: C1licagolS'un, Iowa Publisher. Invited to speak on interpretation of statistics to meetings of American Statistical Association, NewF'orkSocietyflorGenerat Scmantics;, OfliceExecu-rive5:lssociation, of V'ewYork„ American 1Tarketiitg, Association4 American Chemical Society. Rwceic-ed 1'963National School Bell Award "fordistsnguished servicei:m the iiiti•rprehltlion of'education:" Mo,raphibal information in «'ho's Whopublicattons V'IonthlP Supplementt to\1ho S Who 7ltiuatv 16)1~:,: Who I.nows1S'h tt,1i'ho 5 R'ho i.n the\j"est.. L` <ays oni st.ttu.sticall subjects reprinted in ntany anthologies andl textbooksf'orcollc-;;eEhglish, and communications courses;, reprodnced: for course ,t•orkat. Frii~no st.lteCollege;, Augustana College, BlackIIillsTeachersCollh;;e, U.S. . irmv Financeticitool, Boston University, iS AirForce_1LOna:,cment and Statistical l:i•anch, San JoNe City Collcge;, Flortdl Stl,tte University, I;rtiiversityof' ('adiforniai School ofI'1lblicI3ealth,, Iiarvard i:nicersity School of Public Health t-urae' in, Lio tati.stics, etc: ; reproducecU f'K>rdi5tribntion by TennessceCa~llhy,.Alithoritc, -Nor2hern I1linois, Gas Company, i:S, _CirI'oree Pacific Air Forces, TrcklersFin:ince Corporationof'Toronto, National Shoe,'Ni'anttfacturzts 2lssocia-ti,-n. Rockefeller Foundation, Allstate Insurance Company, Nas-:v' Bureau of' c)cil!iance: and! reprintrd'in such specialized publications asHospit:Il Topics, l'iuiaircommentary of, Royal Canadian Air Force, English Di;est,, R~,oevntree

1000 Dr: FURsT: 5 years of my work trying to indnce llung cancer in animal's with smoke and not being successful; Drs. Wynder and Iloff- mann"sbook; -whichi'sreal'1y a remarkable book, very helpful to~ ald'l the people;who -work in the field : Tobacco and Tobacco Smolce; Studi,es in Experimentad' Carcinogenesis, about 3 pages of detailing smoking experiments fromi all over, the world. -No one has shown experimental tumors can lie induced. So it is al>ll negative, sir. Mr. Ecx1IA:nDT. In other words, you are saying that the attempt to show that smoke directlv causes cancer in an experimental situation ha.s not been established? Of course, voui recogni, ze that this is a rather difficult area in which to establfish experimental data with respect to humans. For instance, you can't take a child 18 andl induce hini to smoke heavilv until he is 65 and'i take another identical twin and not permit him to smoke, and compare these two flacts. You can't get ideal clinical data in this field,, can you? Dr. FURsT: I agree with you,, sir; and this is what I said before; it is so agonizing. AZay I take amoment to talkaboutbiologicali models? Now, it has been~ known for many years that miners who work in nickel mines get lung cancer at a rate roughly 10 ti'anesthenorrna~ll popnlation, Scienl papers havebeeni written, on the subject. There is a paper in the Britisk Journal o f Cancer which says, "Well, no wonder, loo1: atthe high arsenic content of this nickel ore." Some- one can draw all sorts of inf.erences,, I am now going, to talk about biological models. Doctor Gilinarl ini Canada injected somenickel ore into tlhemnscle of a rat and got a tumor right there. Dr. Sunderman exposed rats to a gaceorls nickel compoimdl anell he irot metastasyzine lung cancer. In our l rboratory we took finely divided nickel powder, injectled it into the hind leg muscleofa rat.Infourm~onths R°egotl'ar(re~tumors at the site of the injection.A1t the animal's-wetested hndl lung metastasis. We transplanted the turnors iiito:othei• rats and they died. We took another nickel compound and injpctecllitin the muscle of tlie rat in~t'heriyht leg and we got no tumor at thesite: ZVe gotia tumorin the face. I am talking about brological rnoelels.. \ ow, wetook some Iniceandi injected nickel powder ortheniickeL compound and we induced tumors. We then spent a year painting the. backs of these micewith ni'ckel compounds and: . got ilothing~ ICelookat humans. Thev get Iunz cancer, and fltilcial cancer.We1'rave~. been ablet~a duplicate thisin the lliboratorywitlr both mice and rats.Hoxvever,, when we painted the: backs ofl the animals: .vegot notliing.Tliis is wbatI mean by expei•imentall eviclence. I knoR-Il can induce. .ung cancer in miice.I cannot dait with smoke. Usin g otllrercliemic^ Ish I caniinduce schrnmous-cellcancerinthese:u?ima~ls. Mr. FcrrrAr:DT. Is one of the factors whether or not you h€rve to the jprie:~enttizrbe; ancdthis,iscertainly no reflection on your research because always thereP-a qpestion of sutlicient innovation in researeh,,ha~-.enot quite~hit t1ie formula far your experiment'ation ?For instance, suppose that when we observe nrore cancer iii, the IiritishIsle9tlian~ «e~do in the United Stnteswitlli less smol:~ii7n,snp- pose v.e were to discover that smoke in not mm-imgtbe mncnr in the throat at a sufflcient rate permitted some of' these solid'-like„ for in- ,;~•cs particles of n_ ~: 1'"ou could have~ ~'~~r•:~Fi rrsT:~ That is~~. ! 1•. l:c$IIARDT: W ~ ~~Ilititical indication _ i~r,rrettes you cer, ;o re experimentat .~ ~ I -rsT. Absoln~ r',t . S'-vT'rERI`IELn. ~. ` n. Wutson? r.1i"A~TSflrv. Tliar. n~t have lilcewii dlv that usu; ~ ~~1i~lhtecI~rhena~~n ~ ~:tl~Ve ,ind,, namely i 1 i e;idy deterrr~ ~ 1t o{ iSe<<ses.~ club f ,,I, ~fainther~~researl ~-onsayar: : c ienti;ts are h v-hiclr, th , ic> thenrselves I i~iu•tls~er, too,,-we .rttirisbagbadt il] l'nouLYhitlo~soi lii-heurtened u r enipliasis.. ,i:1r1~ retand , F~ursTr. Sani~F i i•. Ai"ATSo-,. Th ~~-t(•rnI:tueci 1hlbor. ~ ~ •rnrer tluongl il P : V~l 11ne~n' Or At t' \1''\-~nder'sl:rboc Tn (',imbrid, : I i11S ~ t rVill' ~ to: sl ~~ i'ili:;iIiietliueeor i f v°ozt t,tlk ~4t•ientist i.. ', i iii tlriS ~ ,urc~~ e~.:s Vi~~ld di(l Voit not ~~ ~'1'•~~l),~~~ro T~ lwne~. D~o~.

968 ing" took place. A good example of'this is in Ta.ble 13, page 40, which reported prevalence rates for arthritis. Before adjusting After adjusting Never Ever Never Ever smoked i smoked smoked: smoked e ---------------------------------------------- 7. 7.3 6.9 6'.8 7:3 ---------------------------------- 15:4~ 9:7 12.9: 1218 A very crucial fact is that the average ages of the persons'in each of thee smoking, categories in the survey, i.e., the populations which were compared„ were not the same., Age brackets presented' in, the Morbidity Report were mis- Ieading,if the reader assumed that each, bracket represented'an equal or com- parable group, atl least,asi nearly so as can be accomplished with sampiing„ Em- phasis was placed upon smoking, stntus by age group, but the Report ilneludedl evidence that the age of groups'of diff'erent smoking status: were indeedl not equal! The average age within grou:ps;, as estimated from data in Table 1„ page. 23, when weighted' by the number of respondents in each group,, iudicatedl for males'the foilowing estimated average ages : Yeare Total population, ---------------------------------------------------- 42•c!! Ever smokedi -------------------- ----------------------------------- 42.7 Former smokers ----------------------------------------------------- 47.,5 Present smokers ----------------------------------------------------- 40;,9'. Never smoked ------------------------------------------------------- A similar tabulation for females gave : 41.9: Years Total population ---------------------------------------------------- :}2.8 Ever smoked -------------------------------------------- ----------- ;t1.7 Forme r smokers: ------------------------------------------------ --- 42.2 Presen t smokersi ----------------------------------------------------- 39.2 Never smoked ------------------------------------------------------- 44.8 Note that for males, the "Never Smoked" group averaged 5:0' years Sounger, than the "Former Smokers." It is to be expected, and can~ be so shown, that 5:G' years added considerably to the rate of chronic conditions ev.en if proxy report- ing were remotely reliable. Appendix Elof this,.CYitliquecontains two graphs~ of the various saniple.q, «-iththe percentage of' each sample failing within each age group, Note that forr males the "Never SlnokedP group had a,Iarge proportion of'17-24 year ages and a small' proportion of the 45--Ei41 veargrou:p,: "Former Smokers"'found them- selves with almost no 17-24 year olds and a large group of persons over (ifi. ©bviously, the "Former Stnokers" had consi:derabl,vmoreillness-but, obviau'slybeeause of a,ge:alone and not differences in smoking habit'6'!', At various placesi in the 'Morhidity Report; attempts were made to rationalize the f'actl that': female "Former Smokers" had a smaller incidence of disease than "Never' Smokers" in many compilatiion:c. It ,vas not necessary to rationalize this result:;' one need only look at the graph of these samples ini Appendis E:,Idere the:"Never Smoked" group contains a disproportionate num- ber of 65+ year old persons ;: hence, the health eondit!ions of thi's group compare unfavorably with those of a younger group. This is due simply to the difference in averare age, not to any difference insmoking,hahits. The A2orbidity Report did contain statements which indicate that there is a definite effect of age upon illness. However, this was glossed over and not't analyzed. A careful study, without a specific axe to erind. would have containedi an ana'lysi!s~ of tlhe effect of' morethnn onevariable: such as ani analysis of'variance for age and smokinghabits. Thisisai welliknown statisticali technique for deter- mining which; if' either, of' two variables affects significantl,v a third variable. This techniquemav be extended to a larger number of variables. TheanrthoroC'this Critiqnedid just this. iCsinh,data ft•om Table 5'rrf'the3[or-bidity Report as to the threP lpvel4 of age and the three independent smoking fnctors of "Never Smoked." "Fhrmer Cmokers."' and "Present Smokers," he cali- culated by standard methods; the statistical significance of age andl of smoking ~ztatus for various of't is a reasonable probal r,antly to the chronic c <iion•n in terms of'the : which can be comparc 'tigher tihan the appro truly affects the chrori pected by chance: For. l,e:indieated by an F'rc. Analysis of variance H vpe rte,ns:io n------------~--~--- 4iitusdis.----- . ~ ~ -- --. Paotrc ulcer---- -,_---- -----_. Arthritis_.___._ . Ha~aring impairments~______~___ I i ea rt conditio ns _ _ _ _ _ _- _ _ _ _ _ ". ro nchiitis/em physerna, _._ _ _ _._ _. Pc.,te.conditio:as (table16)__.__. Restrioted activity (table:20),_. 3ed days(table21)'_._________ 14ark loss:days:(table !22)_,. _ _. I lnsignificaet because value ^ ! csut'ic entdata for analys This analysis sho li,ted and the age , smoking status catet' The above table a smoking status ofl shara, as tothesecc a ststistical relatior 1u~ inherent part mental error. The. Iii the 'norbidity nssumed that each -in , dhpendentobset lationshiips emergf ca2lsing,error in th That A-v;ts precisr observations certa frotui only 42.000 famil~ n>xmbers 7 certaiuly «'ere nt =umeillnessesisoonununicated'to of fantilymembeiy a:r.,tuned in makin 'lthe error' annll nt'iher reasan. St; stiat'istic., rather ui~;e ernir iitvolv pase5y,ofthe Re "In order'to dt of' health strrtisti ;tpprozimations, theapproximate ala•itiv a,gre;;;tt. In other wortaut snc•h an ev: l'utc]yi 1aaawlfdit

1004. When I point out all the research projects going, on in my slialll university,, l[ indicate we have adcqziatle research money. But to go off the beaten path, II hear people talk about', benzo (a) pyrene being, given. in milligram quantities: I know that there is less than one hun- dredth of a mierogram per cigarette-maybe we are d'oing the wrong thing.~ Perhaps ii7stead'of evaliiating massivedoses!of fienzo(a)~pyrenewhy don't we look at small doses~~. A ~ human doeszrt s~mohe~a~ thousand ci--- aret~tes a dilv: lle smokes a few. Why don't we evaluate snbcarcinogenrc doses on a~daily bases-when I propose a project~like~that it is~considl-~ eredlodd balI. \Ir. IVAasor~. Thank ti'oui very mueh~~., Mr. S'ATTERFIFLD. Mr. Prever? Mr. PREYER. Thanh you, Dr. I#. urst. I think it ~w~as~~ Mark Twain that said it is, not what w~e~ don'ti know that hurts us. It is what we do know that isn't so. So, what vou are say i'nr I gather is that many of your fellow scientists think this ques- tion, has been answer.ed. DD r: FUR9T. Yes,~ si'r. Mr. PrEYER.~ And therefore~it is~ difficult to get~tllenzi to research in~i this area while if y.ou could (ret themi to look at the facts as scientists thev~ would then, recoo~~iPe that adklitiional~ research is~~ needed. D'r. FU~asT. I think there are mnnv scientists far more erudite tlian I,, «ho ~ really sl ionikll be~ in tl ie~~ field, btit~ are not. Mr. Pxr~z-ER. S~o, j~ust~as we see~that~jir2clgQs~ "read the~election retuQ~n,r~"~ and~are affected by what goes~on~in the~general socie~tlv around'thern,~ would you say it is~ f2ir~to~~ say ~ seientists! also listen to sometisr~.es~ coln-~ merci'alsabout~smoking,~read~pamphlcts~from tlle~Public, Ilealtih Scre-~ ice,tlie~ American Cancer Society, and so forth, and absorb~ the~ genernl~ ide.-s abou't~stnoking that~ are~ circulating in the~ world around' them?~~ Dr. hUxEx. That ie~ correct. A ~ couple~ of w~eehs~ ago the American Associat'ibn for~ C~ancer~ Research had its~~ national meeting in S"an F i•aneisco: Iiras a little concerned. and Iw.ns amazed to find liow manv of~my ~fe11_ow ~scientists in this or;anization-rememUei, this~is not ear or.ganszationto~joinibecause~~"Il do~cancer research'.~-it~~is~ an organiza- tion where you have to prove by vour p,lblications You are, wortliy of membership+-react~e d-react~ed «-~hen II sa~id~~~I 16a~~-e not indllceal ]ru7z cancer «itln w~liole~ smoke or~any~ part of' itl, nor~ has anybody ~ else: They gtlll,ed;'~; thev~are~aniazed6 Mr. PunY-Ex: Ju~sta~because~ you are~ a~~ scientist- or jiust becau-.e ,-~ou~~ a~re~ a doctor doesn't hut,you in nzuclli better position to~o kr~o.~~ than ~anyone, . else i'f vouidon't, Iool:~at~t~he~fncts~?' Dr. FrRsT. That is correct; sir. Mr.-Prr•.,yEr: You are oneof~tlLe~fe,.-~ witnesses~ I~147n-e~ s~,1(1n th~at at)-~ parentlb~ ha~s! , gone~ through alll of~ this lnatleri2~1~ plu~iblishedl siirce~ 1()(;4 and I take~ it~ that you state~ ffat'lly~ that~ tlhere. is~ no netie~ eu-lleriicient>il evid~~euce devel~oped~ since~1lnr4-?' D~~r. I't RsT. ylnd I liinit it in n1y field of'sn:oking~ and lung ~ canrer. 3'~Ir.Prry~rr,~.~ ~~~moltilz;n~nnd'Iim~calecer?~ Dr. ]_' rt ST. Tllatt is r1-}lt., Mr:. Prr~lrr,. PerhEZh9~-ou~ ~~•.ou]di~i"t «-nnt~ to~~ co:~iu»ent on tllis~, L,it in tlle~iicld of~~st~rtis-t,ical relationsfiips, 11as~the case been nlarde~st'rOil•T~i,r~ from 1hf>4by auynew informatioll ? Dr. FUr.sT. I ri `tIr., P'r.LYm. L This :s a very ,tore~ names~t'hart~. ~ ~;w ~pl'ace,,andl uli ;wzliage, but I i~~t help us on, o ittee, .nd that ~ itnE,s who tc I)r. FLZtsT. N4 ~ ~ t. wlier.i, w~e~ ta1~ Xp~epence.~ If' -i ~ . ~ ~~t «iIl have a. ~ ~e s~•~~~rzl~toms of~ It is~laot some ~ ~:o~pir~ai proce(i "inO.-e~ ohium sri I ]laN-e~a.chilci. 1>reak:~~ tiiisi: pliarmac( itdictiN,e. •Clre aElcliction If!iere~has been ,•i1:7 ulod tlien a. ~ u tllereuce, but i~ ,Ery Nrere broke "1']iere; w as an .~~i r: I}.CI"~Ii.YM A I r: 1 ~ Ti]ll'ERI. 1lhr. I :ca~i~~tcr .-r.s-r. ~" JDr. Eclc.laru i: rr o N,-~ho clin ~l~r', a1'e.~treated~ "~rr,iiri ~~ilnatio~ ~ :rrtracti~'e to svi ~ FL-r,~~T: ~1~. r I ;ia•) . alluos u u»(l in the p;,al•nlacolo, l ~l: l ,•au iiT [Ir. ]~,'rotz~ina ~ ~~'"u ;~~eutiru~ i~l; od~ av,lolnt ii,1• %, i'letlier i n dr; r l lE'e1'.,

991 %-ill emerge vi1 us how ing prema- id carrying • chilt3lren: le.s (UCLA) ~-les. (d'emy: 'ollege: mining ; San rancisco. rancisco: a:, icisco. , ietry)~,~Stan-~ Stan- tment, Stan- ity of San irs), es. armacology PuaLIOAT1aNs' oF ARTHUS FtJRST 1'. "Baiancing Osidation ReductionEquations!" J. Chem. Educ., 16;,387 (1940) . "`afety l=uardT' J. Chem. Ed1tc:,18, 1-17 (19-11). ' "An Improved Dilatiometer" J.,Chem. Educ:, 18, 3.35 (1941) 4. "Ani Adjustable Safety Shield" Ind. and Eng. Chem.,, 14, 158 (11942). .i: "Siirgestions for Lectures" A chapter in book for Air Raid' 1F'arden, Service, S.F. Civilian Defense Council, 'March 19#21 (private printing) G. "An Outline of Laboratory Operations" Syllabus, 118 pages, September 104'?.~ (privateprinting)e i,: "Library Pr~aject in, Junior CollegeChemistlr;v"Calif: J. Sec:Edue:, 17, 426 (1942))~: "The Elig~hlights of' Organic Chemistry" Syllabus, 123' pages. October 1948 ( privateprinting)tl: "Wiicer is Colorless" (A lecture demonstration) School Sci;. and 1Dath., 13; 77 4 (1943) :10. "A Survey of Laboratory Operators in the San Francisco Bay Area'." (1941- 1044I (private printing) Sani Fransiaco JuniorCollege; 80 pages, Aprill 1944 11. "C'al'culationsofAnaistical Chemistry" ASyllhbus, 137 pages, August 1944! ( private printing) 12. "The Suck-Seal" The Chemi'stAnalystl, 34, 44 (1945) 13. "Qualitative Organic Chemistry" A , Syllabus, 116 pages, October 1945' (pri-vate printing) 14l "A Semimicro Boiling-Point Test Tube" J. Chem. Educ., 22, No. 114 531 (1945) With John W. Bohner' L,i. .'Displaeement in the Halogen Series'"J. Chem. Educ:. 24;,445 (1947) 16. "The Redtrction of 2-Acetylpyri,dine to 2-Et'hslpyridine" J. Amer. Chem. Soc., 71, 3550 (1949) 17. "The Lecture Demonstration-Its Advantages Over Student Laboratory Wor,kP'ti'ortes;,10, 412 (1949) 1 1SJ "A \Iodified Continuous Liquid-Liquidi Extractor" Chemist'Analyst, 38, 88' (Q'949)With Cecil Lacy19: "The Effect of N-Substituted Amino Acilds on the Growtlhi of Lactobacilli" Arch. Biochem., 24, 4,47 (1949) Sl'ith, Harold A. Harper and Richard A. ri eve. ?0. "Chemiical! Inventory Form" J. Chem. Edue., 27, 44 (1950) 21. "The Effect of Phenyl-Siibstituted Phenglalhnines on the Growth, of a Lactobacillus Leuconostoc 3lesonteroides, P-00" Wasmann J'. B'io., 8, 299' (1950)~ With Ha,rold, A. Harper and Manfred DL , .l'3orris~ 22! "A Convenient,Synthesis of:Zanthurenic Acid" J. Org.,Chem., 16,,412' (1951) With Carl J. Olsen 23. "The Preparation and 'Miicrobiological Evaluation of the Inhibitory Effects of S'ome<lcrylic Acid Derivntives"Arch. Biochem, and Biophysics. 31,. 190 (1951i) 11'ith Harold k. Harper, Robert J. Seiwald; Manfred' D. Morris and RichardA. Neve. 24. °TTiset'hylene-Imino-s-Ariazine (Triethylene i•Ielamine or TEM) in the Treatment, of Neoplastic Diseases" Calif. XIed'., 75„ 26 (1951) With Michael Bl Shimkin, Howar& R., Bierman, Iieithi H. Kelly and Elizabeth Lowenhaupt, 25. "The' Ultrav iolet Absorption Spectra of Some Heterocyclic Phosphorous C'ompounds" Science, 11~„330 (1951)Wi:th Robert J:Zlorvat 26. "Chemotherapy of Experimental Tuberculbsis with Derivatives of Furan. Acid Amides and Related Compounds'," Wasmanni J. Bio:,, 9,, 355' (1951I) With B., L. Freedlander 27~ "Phenylphosphine" J. Amer. Chem., Sbc., 74, 562 (19:32) With Robert J. Horvat 2S: "Inactive Compounds ini Tumor Chemotherapy"' Cancer Res., 12, 241 (19,i?) 29. "Chemotherapy of Experimental Tuberculosis R ith Quinoline Derivatives" Proc. Soc. Exp: Biol. and liedl., 81„ 66 ~ (195v)Wi'th B. L. Freedlanclcr and D;B'alcom 30. "The Action of Aminobiphenyl Derikutives on the Growth of \Iou~;e Sarcoma-3Z"Stanford Med. Bu111, 10, 308(19:>'?) W'ith, B. L., Freedlander :31. "Effect of Furan Derivativeson Transplhnted Sarcoma-i80" StanPorcil \Ced. Bull., 10, 370(19:u2)1 With B. L. Freedlander

. 970 With the many flaws in the compiling and' reporting and weighting of' data, it should be difficult tio calculat'e standard errors for each of the results in the Morbidity Report. "Health Statistics." which described the survey design~ af the 17orbidity Report, attempted: to justify omitting, this essential operation by stating: "Eiven with high-speed computers, the cost of' calhulliting variances for eachh separate estimate would' be prohibitive. Further, such a step would be unde- sirable in that': it would yield, estimated variances which because Of'their own sampling error, wouldi appear at times to be inconsistent among themselves." (pp.26'-27) As a matter of fact, with high-speed computers, calcul:nting, variances can be very inexpensive when compared to tlhe cost of! acting upon a wrong, conclusion. The reason for calculating,variances in the first place is to estimate the reliabilitg of the apparent results. If'thev appear to contradict themselves, it probably means that the sample is too small or is badly chosen or poorly admitlistered' f'or the resvlts to be conelnsive: To ignore that fact, and to use only error estimates which: fail to reveal flaws in the sample, suggests either'ignorance of basic statisti- cal principlesor, an unwerthyattempt to achieve "favorable°results: . without regard to the true facts. The only error analysis in the JTorbidit,v Report was based'upon,some so-called universal error curves which are supposed to fit all samples of thiis type. The use of such curves is not val:id' unless the sampling plan of the survey ini which the curves are employed is identicat to: the sample for which the curves, were designed or drawn. There was no denionstration or even any claim that this was the case for the Morbidity Reportl. OV~ERLA'PPI~\G~ RANGES In any st'atistieal analqsis'based upon sampling, particular care must be given to error analysis. To project an imputed value from the sample with a hig3ih degree of confidenee; one can~ say only that the true value has a high;probabilitv of' falling somewhere within the range between the imputed value utinus three standard! errors and tihe imputed value plus: three standard errors, For etample, if'an imputed value,from a sample is'10: and if'the standardlerror is 2, one raa say with a high degree of confidence only that the true value lies somewhere between 10'minus 3'times2 and 10 plus 3'tiines'2l or between 4 and 16:. This, is illustrated by thet'ableilnAppendii C tlo~this'Critique:,Tlieconclttsion taken from Table 1 of the Morbidity Report that 17.028.000 males 17 years of' age or older have never smoked, means only that there is a strong probability that the actStal, number falls within the range from 16,413;992 to 17,610•008'. a spread of 1.224.016, In a comparison of stlati'sticaidata, by a careful and'unbiitsedigroup; two values are not'consideredl to be different if' their ran,e, of values overlhp: Yet: using even the inadequate, error analysis of the Morbidity Report', one eam point out that certain results, in many places within t1le study; were considered as being differentl when actually their ranges overihpped, and hence it could not be con- cluded.that,there was a real, difference. Appendix D to this Critique shows clearly the overlapping, of' ranges; and hence the lack of' true difference between the values concluded to be different in the Niorbiditq ReportL A similar an:algsi's could be made for many of the other valus reported in the Morbidity R'eport. LOOSEYESSI OF TAE'. DATA. One effect of 8.11 of the weighting and adjusting of the data was a~lboseness',in the figures of' the 3Iorbidity Report which is disturbing in a study of'sucll po- tential importance. A rather amusing example, yetl annoying in disclosing that such looseness could exist, is found by combining Table 3;, page 27;, °Percent of' males' 17: years and over, with one: or more chronic conditions," with Table 1,, page 23, "Distribution of the population by smoking' status." This: combination demonstrates that 37.3percent of the total populhtion had one or moreclironic conditions; and corresponding figures for persons who never smoked andi those who hadever' smoked were :r#.3 percent' and 59:7 percent respectively: ln: con~trast, the percentage of'persons having nne or more chronic conditions for whom it was not known if'they had ever .mulced wasonlv! 18.2 percent C%'ence:, the 1 ieical conclusioni would riiether they had smoke< ()Ccourse, this'simpl; ~-rvice pr:oj'ectiona.. In fact, one may que: !~iqueswhich leadi to di n uther pulilication bR t, in "The Health Cons' i:_, statement was made ••Thedeath rat'e. ':uohers,eveW forwllo have smoked Thever'y next page'oi'.Cttrrent smoke, r1~iC: sigplfic.llltly 1 ]'71i1 j 0.H/7 pf(1e8o/ , l:lnphasis added. 11-ilile this Criti ltte ;uust u,q forget that V ~ :1 at:lrrais:rla asappl clasiuny as applied to l Considerable attent :iS1C' st£Lt~istieian: know :rlalwi'neby ' usingra; uCrttt~ios, that is. rati !3ersonsfor' "Never ,5.'~;;~/O. U or 1.50 or, sE cent oi, that for "1ev ber ofoccurrencesat1le two categories; Tlie statement isn latiS Presidential ra carried lisH''umphrEPIumphrey. was 111. I also cvas 1.1. Are tl thevast', disparitviny c'o~,clusiuns involi hase. H`or e.xample, ci_ar(•:tesa davat cht•~oniccondit,ions is Ncas nKrhiet'ed by 'pr more chronic ailntel listed as~ havi;n"g 30; percentage as the b percent "higher" fig 'ow, if the probic who dn not have tb Smol:ers" and 69'.-l. 'l'hen the ratio of! t a tIiPference of percent d:erivedfror. 'l'here are nranF o~nenouiil point u. ,ion>frout datakr 11, footnote 31 of't li~_ures with large larger than the r \forbiuitc lteport

986 Technical Library, New Jersey Busiiless, Supervisory Management Magazine, Bell Telephone Company Blue Bell, Dndustrial Editor, the Copenhagen newspaper BT, tinited Automobile Workers Ammunition, Trustee-the Journal, for Hospital Governing Boards. Books: Pictures by Pete (iDoddl, Mead, 1944). The Dog that Came True (2NIcGraw-I4'ill„ 1946; also published in France). How to Lie W-ith Statistics ('\orton, 1954)'; also published in College Edition and, adopted for use in most major uniirersities ;, published by Gollancz in England and ini Pelican paperback; andl in German, Dutch, Danisb„ Swedish, Spani'sh, andl Japanese editions. How to Take aCliance(Nlorton: 1959) ;: also in \artbnLibrary softcover. British hardcover and Pelican„and Swedlish,editions. Score: theStratedy of Taking Test's(Appleton, 1961) ; also in Britishi liardcover and Pelicani paperback editions, Ballantine edition. Cucles in Your Life (\orton, 1964) ; also in British andl Swedish editions. How to Be t7ie Parelctof' aS'zcccessfut CreatzreC)iild(MagnaZR.esearch;196S). With Frances Huff: Twenty Careers oj' Tomorrow (_lleGraw-Hill, 1945; also Armed Services Edition)., How to Lolcer Four Food Bills (Macfa+:3den.Bartell, 1963). .l'Ir. SATTERFIELD. Our next witness is Dr. A-rtliur Furst', di'rector of the Institute of Chemical Biolbgy; University of San Francisco. STATEMENT OF ARTHUR FURST, DIRECTQR, UF~ THE INSTITUTE OF CHEMICAL BIOLOGY, UNIVERSITY OF SANFRA'NCTSCO.llr. FURsT. Thank vou.Before I[ proceed, Vi1'Ir. Cliairman, IwouId like to state that I[ am here at the request ofl representatives of the tobacco industry.~'Ir. ~~'ATSON: il'Tr:~ Chairman, ~s earlier tried toq'~u~estiou witnesses about how much they made and all of this kindl of thi'ng. I don't im- pune any mam TheyareprofessionaI men and regardless of who pays them they «-i11 tell the truth. Because they represent the tobacco in- dustr~~,; to think that their testimony is tainted is just as wrong as to saythat the testimony of the Surgeon General is taimted,,because they are paid by the Federal Government, or some of these other doctors' testimony is'tainted because they receive grants from the G'overnment. I hope we will not explore much further about who pays -what and how muchL, _1Ir. SATTrrFIELD: I am confident that your statement is one that we can readily agree tio.We accept all witnesses on their face value:We know they g1R=e us the benefit of t.hei'r best efforts. ti'Ir. EcX1TAnmT. llr: Chairman,, I would like pa'rtly to: disassociate myselffrornI that statement. I don't impune any witness''testimony,but I don't think that a person coming from theSurgeon G'eneral's! Office isiQli preciselythesaaneposition with respect t'obiasas onecomin- here for the ci~arette companies.~ -Afr. Futts^r. llay Ime.kethis relnark ? I am not'being paiKll afee, farthis testimony. lfm. SATrE~FIrLD. Tliank you, sir:, l1r. FunsT. I am Arthur Furst, Ph. D.,, d'i'rector of tllie, Institute of Chemicall Biology~, Uni'n-ersityof SaQr Fi incisco, San Franclsco, Califl I[ have been engaged iu~ cancer research since, 19I7,and have publi'shed over 50 papers ln the field since then.. lfav I present mybackgroundi 1Lyunii-ersi'ty education was received prim.lrilyat, U.C..L.A. and Stanford:mybachelor's and irlaster's de- gree wereobtained in the former institution„and myPh. D.,isrchein-istr~.• from Stanford University. T have held aca( rnom IJ37 to the pr wIllistrr~at~Stanfi tlre~only~pers -;/' lacllltv ot'the -i,oilltrly, I have ~ deoree~ou. ,enll,er of't'he t 11 ('alifornia scil : ,~irience. _V detai] At, `italltord Un 1,~ l I)resetltezl thec ` ! 1 1'.fhi, I left ~ _cirt ute o;'~ C;lien7l ~I lli~ is luot San . 11 li rilllely(_1o;, an. ~ ~ ~~~nlt}1 tF~u.tlill~~ a ~-U~IIt, il)r eStllll' :1t~ir,ua1i Aeronau, ,~~, I)s>-,_relt on bra Iwfll)1111.i(r of ast! ~~ IIonG. lor tiltlt i i' tihev ~ are,= 1111 .lclditiiol: ~ :d conlpoualds~, r oai, Aioon. L,w ~ tl le A~ir.' I+'~ 14?umisnl of' ~ tor- <litnte ot~ ll'en!~ ~ 'T1.le~ I1. ar~~lr ill the 1~ie~ ~-I' r! e ~~ \~ati0nall (~ u l! !xeen enage- ~i'!ic• lllc~rlkh:.r prc nleritl con; ilrnt in~ so h'1*l,clate<L w~ith. ~ .I1 ,ii bllt~ rcllate<l t 1'oz- r. ~i~;,tl•ne ~N• ll~lv,lt il ()lai1v ~~ a 111~rk , ,irw t ~ ~ niliU La~ tlolp ot•t . CD ~ ,^.~11d llrn- C!1

988 But in order to determine the answers toltllese questions,,much more must be known about the basic nature ofl the diseases themselves and the 1nec11aniEm by which they de~-elop. Additionally, much more must be~ laio«~n a}~ou~tl what eftects other ~ factors, in~ the environment„ to~~ say nothing ofi internal factors iiil human beings, may have in the causation ol these diseases. Experimentally, it is necessarv to develop models by wlii:chl the diseases may be prodh.iced in the laboratory, andl then to test suspected factors~ by use~ of these~models.~ Then,, it will also~be, necessary to determine whether the findings are applicable to human beings. As an esampletol help clarify your thouglits, I slrall address myself to one aspetl* - of the problemL We need much more.~ organized researchh in the ~ expe:'imentall aspects of'the sm~olting-liing-cancer~~ problem;~ we need~ much luore~ data before~~ -we can make intelligent~decisions. May~ II detail sonne~of tliese~~thoug)zts,:~~ The 6~urgeon Gleneral"s report on smoking and~ health states that it is not possible to induce tumors in mammals by smohe:. But no ei- planation for tho!s, fa~ilure~is~~ offered. In the 1967 review emphasis was~~ made~ that research is needed to "'idientify ~~ and separate~ thetnmor initi- atinc, and tumor-promoting agent in tobacco smoke and that it could not be said that "human squamous-cell lung cancer(s) have been esperimentallylpoduced" (p. 3i)~. T]ie~ 1968 ~ s,uhpllement~ sliects ~~ no~~ more~~ li ;ht; no new ~ eaperiments~ are~ cited that relate~ the direct~ cause of' lung, tumors~ by ~ smolce. ,1-nfin,~ "inorz research is~ needed to elucidate tlie~ biomecha~l~iisms involved in~ the pathogen~esis~ of lunlrr ~~ cancer eausedl bv ~~ tobacco~~ smoking."' ~~~~'el must conclude that between the years 1961 to~ 1967 ~ and then t'o~ 1068~ we got more compilations of resesnrch, but no~ good es~aluat'iions, and' certainly ~ no~ correlations,~ and no insights~~into causes. «''e know muc.h more about fnndamental aspects of snlolzin(r than a few years ago. Therefore it is possible to constrllct smoki'ng machines that~cani cl'osely~ miin~iic human smoking patterns. These~ units should' be ~ built and evalhiatecll _Yre~ mice~~ and rats which are t1ie~~ common si;b- jject~s, ~ the wrong ~ test' animals ?~~ Can a si-nific,ant dua,~ntit~y~ of' cigare-tte~ smnke~(ret into~the animal's ~ li.lngs?'If it does,it is~c:ipablb of'prodileinn human-type ttmzors at all? These duestions can be answered only if research is done. There are additional problems~ wltich must be~ investigated in re-~ gard to~~ smoking ~~ and lung cancer. These~ are~ urgent., and perhaps~ specialifundsshoul~d be allocated. I shall'be~happy, to~~i~'e~more deta2l~s~ about any~if requested. 1. Som.e work shows that trace metals may be important in the cnncer problem. ?:~ Some scientists have sn;gested the~ pos 1'bility~ that vol'ati'le anlines-especiaTly~ the nitrosaimnes--esist in ci~aret.te~ smok~e~ :uid should be~inR~estiaated tlo~ see~ what sicnificance~ thev~ have: i~f~ t~hey~ are there. Lre~the~-~reallW~arti'fiacts. Can tLe~-be~coc:,~'ci~no~enic N'.-ith other aUr e11tS') 3. ti'om£M~-wOL'kers ('1a7m that free-rLl(1](':lls are 1I:9,2(DL'ttillt. lin~i l'llnli'llt:7 are ava;ila:ble~ to~make preciRe~ measurments.~ 1`~onlc~ ~ro7hers~clai:n tlist p,lrt r le~~ii1~ ~af~cn~ol:e l,ul~ 1>e i~no1)ort,lnt. o. '.~o nc~ wo1!.ers~ rl<lim tilan tlle 6l~4,lnce fronr the end of'tlle cig,l- re.te to the lun-s of~~ t]leaniPnnls inay ~be~importantl.~ I i (".. Some workers cla lle important. Vit,arnii n: I feel that studies S. I feel~~ that w~e~~ mu on animals: J~. I feel we must ii ,nec.ies of' experiment r Il the ~ speclesusedi 10. We nlust detern p;'oper form andl on pl acinb of' tars on th :IT)propriate admini~stl ;lll be evaluated. I cannot investigat4 must be~inv~olved. I have :.=iren examl tlle~ smoking, aspect lnnst be~~faced in reg i,alts-air pollution. llroe,der plrobleansof~ (iiil'erences~~between irr lnd.~ constantl~y~,~ it w~iJl often produ~ce tz --~iv.e~ you atll ex~alnple W L IxW~keti fuels. T«o~o ,mnhl ~~wuewliat tlct.~~ loellant, -C,~D.11H. Lf o~~, . ,c nt. I'et, when te. Iilel~ 10 times more to:~ ~. We ~ need' more an( mut that not only m( liell'~ you within a m, ('0rnpou~nd. In contr: (,ach ezl;,erinlent talY, i•tl'orts~of severallscie I aln concerned th.. 1~1o create an impressi i:~ me,,tunfortunata.~ (•Illt to~zet~ the necess: ~~stod in init'natinc, st. ~()lved. Cr.antiilg at l~rrnjeets that are.a~I~e iu;l~' feel that they ~ V . :nclin7~e,rs.~ '1'llerefore. II hope i hatthe~ problems lle~ TU sllln7narize:~. ~ J'Iucil more resear ( )nlv a be-inninm , ~ c ,Il )muCthe~ various Whether snlokinil .~~ (1o wit~h the causatii ;ins«-erel bv ~ flit.ur, ~ ~ iilvestig,ltiunL ~ .

i' 1025 6& , Fisher, Sir RonaldA, : a6 Dangers of~cigarette-smol;ing.,Brit'. \Iedi J.,,Ju1y 6, 1957, p.43: li: Dangers of cigarette-smoking. Brit. \I'ed.,J., Aug: 3l 1©5i.,p. 29S. c: Lung cancer andcigarettes: \atlure: July 12, 1958. p. 1108: d: Smoking-The Cancer Controversy. Oliver and Boyd. London, R):,9 (Includes 1ectures, deliteredlat JIichigan State I;iaiversit;r), G!l: Fishbein, Morris. Editorial. AIedieal World \ews, Obt.13.1'J6I. p: 120. 70. Horn, Harold F:,, andCutler,,Sidney, AIorbiditp,from~ Cancer in, th'eUnitedl States:,Ptiiitie Healt'1rJlonograph _'s~o: `_'9. I'ttlilieHealtli Service Publication to, 418. I:.C! Government PrintingOf&ce: Washington. D.C.. 71155: 71. GSlliatu.ATesauderG: Sbme aspects of'thelungcancer prot;lem. Military 3Sed., 1L6; 1(i3. 1J3o. 721. Huepe:% A1'. C., and Conwar; IV. D. Chemikal: . Carcinogenesis andl C'ancer.. CliarlesC. Thomas, Springfielfl, Ill., ],46I. p. 144., I3. Stewart; H. L.,and Herrold, K. AT. A criticgueof e1periinent.5~ on attemptlstoinduce cancer with tobacco derivatives. Bull. Inst. Statist. Inst. (Paris):, 39: Rept. 131.5, 1962: RAY\iOSD.H.1'RRIsox RIGDOS .cer:, car- m t'e i of! ius: I ma I ute: ga- ' of' :ger, ing air 27: ice, tic: of en- \ o., tii. t) g )re of ~7:. luuce : li1e. l_nLN'erslly; oD 1 exas_ueuicai nPUncn}. tra1Seston;,1: e1as. Home: 1t3_,;iBall, Street:Galh•eston.Texas. B~orin: July-3Qi,1905, JTusella; Geormia: Edatcation Gordon Institute. Bar.nesa-itle,Georgia, 192?-2I. Emory University, Atlantia„Georgia, B1S,-19'9: AIlD:-1931. Intern, Duke tiniversity-Hospital, Durham, AorthCarolina, 1cJ31~-3?: Assistant Resirlent„Dul.-e ti nii•ersit,y Hospit2l, 1932-34. Resident, Duke University Hospital, 1934-35. Acadcrnicaaid~ professionad :experienceProfessor of Pathology. The University of Texas Medical Btanch, Galveston,1J:1S-:GraduateFaculty,16G1- Senior Consultantl in Pathology, M.D. Anderson Hospital and TttmorIn- stitnte; Ilouston,19J7- Consult~Rnt in Pathology;U.S'. Public Health Servic.e, IIospital, Galk•eston,. 1954-6.0; , Clinical Professor ofPatholbgy.Post'grauuate School of 1Tedlicine,, The Uni;- versity of Texas, Houston, 1958- . Dii:ector of Laboratorcof Experimental Pathology, Thetiniversity ofTexasMEdical Ptanch: Galh-eston,19LI,- ~7. Professor of I7;;pEi.iniental Pathology, The University ofTexas1Sedical Branch; G1liest~on. 1tJ-i7-48. ~ Professor ofPathologpandi Chairman of' Department of' Pat'drology, Uni- ~ versityversity ~ of'Arliansas~~ Srhool of JIed'ihine, Little Rock. 111I,4-17: ~~j 3ssociateProfess~orofPatdiolog3;, University of Tennessee AIedical College, JTemphis, 1cJ3."3: Instructor and Assistant Profe~4sor of' Patliolo--z; Vanderhiit' University, _\'ashvllle, 1035-39. 11 r 1'iccnsedtopracticemedicinei Georgia,1J31i; Tennessee,,1JI3 ; Tesas,1Jli, ; Spccialist boardsDiplom.ite, :lmericaniBoard of Patholbgs, 19-1-I' Ftx.llow, College of American Pathologists, 1955 Certified in Forensic Pathology by American Board'of'Pathologs, 1961 Fe1How,, American Cbllegeof Legal JIedicine, 1962-67 2D: 236-r9-t,[. a-10.

1017 Qnd i:D. -llifl,~ , nsl- !1.;6 107. A study of' the effects of air pollutants on the eye. (S. R: Mettier, H. K. Boyer, anii' W. K. 'McE'wen), A_l13 Arch. Indust. Iiealthy 21;1, 10W 1i!a!, The~ effect' ofc.rbon tetrachloride on isolated perfused rat liver £unction, (with G. L. Plaa~) AldA _lrch; Ind. Health. 21:.,114, February 10G01UJ: Eye ii•ritatlion from air pollution (with JL J. Honan, W. K. JIeI.«•en,, F: IIl Meyers; S. R'., \Iettier and H. K. Boyer). APCA J_10: 17, 1w60 110: The toxicity of allylamines (with J. K. Kodania, R. J. Guzman, and G. S. Lo iuvam). Arch. Env: Health; 1: 313; 19W ,h). 111. Hydantoin and' barbiturate blood lerelsobserved ini epileptlics~ (with: G. L. Plan). Arch: Inrt. de PharmI etdeTher. 1?8: 375 1060 . :+ac: „ , , 112. Studies on thetosihitvof glycidaltl'ehyde(n-ith~R. JL Guzman, JIL K. Dunlap, R., Liina and G. S. Loquram) A3I A Arch. Env. Health; 2: 2;', 19611 113 Lff'ects, of di l cid l ether on blood f i l i h Ii J K ]th„ : g y y o an ma s (w t ~ . . odan:a, R., J. Guzman,, SI. K. Dunlap, R. Lima and G. S, Loquvam), :>,;tl 1?irch: Env. Health, 2: 31, 1961 i56, 1114. Some effectis of epoxy compounds on the blood (with J. K. Kodhma, R: J. Guzman, _lP. K. Dunlap; G. S. Loquvam, R. Liiaa,) AITA Arch. Env. Health the 2:50;1961 edi 111.3. Myocarditis produced by- allylamines (with R. J., GuzmI Gl S, , Loquvam, I I J. K. Kodama ) AMA Arch. Fnv. Health„2: 6?-73;1961. ~ ,.:t- 116. Toxicology of epoxy compounds ('«-ith V. K. Rotce) chapter for Patty's ed. Industirial Hygiene andlTosicolooy, Iiitlerscience Pulilishers I L. :,.y 11I;,. Survey of occupational health needs,i:n:anurban area (with A. G. ChurchiIl~, F. RL Holden„ S. K. Collins, \I. K. Dunlap, S. S. Sherrill, C. F. Bambino, E. D. Sox. and E. S. Harris), Thirteenth International Congress on Oiceu+ pational Health p281, 1960. ( 113: Toxicologic inve ti;ations of1,3-dibromo~3-chloropropane(n-ithT. R: Torkelsons S. E. Sadelt, V. K. Rowe, J. K. Iiodama, H. H. Anderson, and G. 3. Loquvam ) Toxicol. Appl. Pharutacol. 3: 54.5 1061 1 .I: er n. , 119. The effects on the eye of air pollutant mixtures (withI S. RL \Iettier,, Jr., H. I%. Boyer, W. K. 1SaP:wens F. Ivanhoe and F.:, II. \Ierers)_ Arch. of I:nv:,Health, 4:,103, 196? 1_'f/: Toxicology andl oecupationalhealth. J: Oceup: Med., 4:457,, 1962 1121. Studieson theeffects of NW an anianal and man (witln F. H. Slerers)., i Proceedings of the airPollution 3I'eiical Research C'ond'erence, Deceniber 1'3611 122. Someexperi'ment'swith tlie~liuman subjectl in airpolliition research(Iwith F' H. AI'eyers)~. Proceedings of the Air Pollution 3iedical Research Con- ference,, December 19011 123. R'eseareh, regulation and reason with reg.nrdsto ai'r pollution (with F. H. Meyers). Proceedings of the Air Pollution Medical Research Con- ference, December 1961 1'_'4. Studiec, in detoxication bFmeansofi the isolatedl perfused' liver (n-ith; E. A. Evans:and G. Eisenlord. Tosicol„Appl! Pharmacol, 5:129, 1963 ' 125. Fstimationof the absorption andielimination of volatile solvents bs; analysis oftheelpired air(R•ith C. Coryn, _11. Gardner)',, _1..bstract, AIHA, Cin- cinnati, Ohio, .l3ay 7-10, 19691'?G. Forensic Tocicology?and the practicing physician. A31 -A, abstract, meeting, Los Angelps, November 196`3 127. Epoxy compounds (with V. K. Rowe), Indust. Hyg: andi Tosi., 2:, 1593, Interscience Pub., 1962, 1?$. Phs,sioiogiceffectsan[i' human tolerance, Cli2pt: in Symposium on Toxicity in the CIosed Ecologic SSstem; Stamford Press, 1963 .1`_'9l TheFiffectis ofsolvent;sand tranquilisero on coordiatationa jirdgneut and reaction times (with F. Iranhoe. S. Walker, B,' A. Lt•ans)~, E'our.teenthInternational Oceupat'ionnl IIeaith Congress, 1963 130. Research (ofthe scientific literatnreand~ reports on theeffectson niani of alcaholi.aloneand in combination n•itihlotlierdru;s, 19i; 3: . 131. Studies on theBiotransfor:a7tion of_ -Nitronpbt9inIene (with 'M. L, IDewe' V, E. A. 1i',hhrcnbroch and J. H. Prince), Abstract, J. Toxicol. .,A1:pL 1'li.:r= ntncal b: R 1ki 1961 1:1^: A Si ipih -Metliod fiorPvalttatiin;l;f7I of'1''iilmominc Tiritnnts eu t?:eT'ir tI,ll.e of Soirent 1'apors i t1-iR'h .l'1'.. I•:. G,tr.dner„ R. N. 1'i"eUlk antl I:. T: I71-ens)1.-1'hstract, .I. Toxicol. Appl. Plmrntnt•ol'. G: 3.;(l: 1064. 13u1I.oeallzetion of the site of'conrulsant action (if ~-rlhrtc~l hydbra¢ines On•ith F. W. Wei:; J. II:A'emenzo. W. I'. P,;utoug aud B, L. Wise), .lbstrnct, J. Toxicol! Appl. Pharmacol. 6: 36_>. 1!9f.},.

1 L 1! i 1001 ~;tance, particles of nichell to remain in pliice over a given period of ~ inne. You could have these compllex relatioibships.~ Dr. FURST. That is ri~ht.. J'Ii:. EcRxAxnT. `V, hich might induce it., But as long , as you find ,t,ttisticall indication of a, relationship between lung cancer and smok- iu~ cigarettes you certainl~ do have a stronb red fla~r,that there should Le more experimentation in this direction. Dr. FL1xsr. Absolutely, yes, sir.. Mr. S aTrExFrELn. The gentlleman''s time has expired. Mr. Watson? Mr. AY aTsoar. Thank you very~ muchy,'-NIr. Chairman. ~ I first hav e likewise been~ impressed with your testiillony. I might initiall'vthat usual(<y~a personin~h,is~vanitv and all of us~ have some, d'clighteal ~hen a~~ man of'your espertise~ ~a ~ill confirm a suspicion that we have~and,~natnei'~3•~,~7[ was apprehensive:th~at maybe~tlie~powers that have already determined that cigarette smoking causes lung cancer,, lienrt diseases, clubfoot, and alll of these other problenis, that itwould cleter further research, and although in vanity I mi ght like to have heard v~ouisay~i~t, I~am thorou~hlv~disheartened that ~-ou~ st'~.te~ on pa~e~8~ tliZt scientists are generally disinterested in initiatin=; studies of the . problems, which, they are~ told, are~ already ~ solved and t~~he granting a~encies themselves,are~ deterred fromi making~ (rrants for solue studies, and further, too, we are not in a partiieularlyt popular field here as we look at this bigbad tobacco industry and so fortii~ nnd'~ altl:ou~h 1 miri]it be vain, enou~dh to say that you have eonfirn~ed im-~ suspicions,~ f~~rau~hly I am~ disheartened to~ liear that this is tr.u~e; whilch l~ead~y, me~ to ~ tliis~ further emphasis. D'o~I~understand correctly ~now~that so far as you ]c~no«~as a liiI)ora- torw~ scientistl,~that youiand ~-~our ~la~boratory wherever it is Dr. FUrsT. SanFrancisco. iV'Ir.W~ATsoN. Thatyouare~the~only~one so far as~~rou lcno.v~mal.k~~in;~ a determined l~;boratorysti'udy~ in this~~harticnl~rr field trying, to induce~~ lung cancer throughthe iQlhnla.tion of cigarette smoke. Dr. FURST. I mentioned on the west coast. Mr. WATSON. On the~ west coast. Do vou; . hnow~ of anv.~ oii the~ enst coast?~~ Dr. FrRST: At this moinent I don't know wltat the sitha::tion i, in Dr. Wy nder''s laboratory, whether he~ is~ continuin, ~his smol:i'nrn ~e-aperi'- ments. In C'ambriidge, Dr. IT~arriburffer is doing ~~ some work mr inhalation studies try~,inb~tlo~ see~~ if he can find h1nr tuon~ors but it~ secros strange I' can name three or four in the «•hole coiurNrv. '\'ow,, if S°.ou~t;ilh about Jrrolecuiar biology I can spend ?~~ hou~t's~~tell~in;~ ~-ou «-hich seientists~are doin" it~. I«-on~14=r~ n•liv~ ~~-~e~ ~ llr. ~ti''~:~~TSO~. But this! is sucli~~ a: seriou~~~ thin- wouldn't be~ abl~e~ to na~~»e~ Li laboratories riwlit~oit tiih~at are~ i>>;rlcing stucdi~es~ in~ thisarea, but you mmnot ott'liand tell ine auv others on the -,vest coast, east coast,,~ iniddle of the c.onntiv„ any Aabd didyrnu not telllmetiiat yours~~is~bein,- shouaoi.-Ocii ~b.N'~tlie Tol)aceo~ R'esnarch, Council, iy~it?~ Dr. Fr.r,sT. Tliey~ have: 1?aid for this~~ 1'='n}eo't, N-o-~. sir,~ tLe G'6it11cil~~ for Tobacco I:esearch,,Inc. Mr. WATsoN; Andl tiliey~ are~ the in<Tustr~-~ that~ is~ trying ~ tlo~ be ~1~.~- stroyedlhere: D'o,~~ouihno~a•~ of any resenic~li~l'aliorator, ~ :cn~,t~«•~liere~ tiuit.

995 iAssn, , Is atment h H'un. , Kypsri', and L. Oxide" ,r andl llouse. 1FJ6"~1.), ti sing estern n; 1a2 -rols),. u.,, 28, u and Slouse a and Proc. 11. B.. 1963)! 'etion th N. Xane- L963 )' : 1009 i eane- ' )n of' I !_ and cinia With en•s,, .lbgy 'ting, ,ept: Am. aol, ical' and' IY~ ns!° n ns!' 'ith 109. "F.ffect of Analogs of PhenyIalanine and Tryptophani on Kinetics of DOP..~ Decarrioxylase in Rat Brain" Brain Research 2, 3?3~ (1966),, lti'ith, Robert'. S. de Ropp 110. °S'iriation of:Rt of Vitamin Bs Group with pH" JL Chromatog., 2/, 288 (1966) 1111. "Effect of Hydrazines'of Vitamin B„ Levels in the Mouse B'rain" Aerospace Medical Resch: Labs.. Wright-Patterson A.F.B. A\IRL-TR-66'-135 (Sept. 19GU), With Waldemare R: Gustavson, 112. "A Comparison of Alkylhydtazines and Their Ba-Hydtazones as COnvulsant Agents" Soc. Ekper. Biot. & Jlpd. 124, 172 (1967),, With Waldemar Rl Gustavson 113. "Inhibitory Effect of Hydrazines on Brain DecarbotSlases~" Proceedings Western PharmacoL Soc. 10, `?.3' (1967 1111 "ResponseL Time Cbnsiderationsand \LathematicalAspectsof C'onrt-ulsionsInduced by Hydrazines" Proceedings Western Pharmacol. Soc. 10, 61 11967), With George Ledin. Jr. and Waldemar RL Gustavson 11J. "A \ew Nickel Carcinogen"Proceedin,sAmer. Assoc., Cancer Resch.9; 2S(119t;J) ~, With Richard T. Haro 116. "Studies on theAcnt,e Toxicity of -NicLelocene"PtoceedingsWestern Phar- macol. `ioc: 11, 39: (196S), With Richard T. Haro and Hans L. Falk 117. "An Atmosphere Exposure Chamber fbr Smn11Xnimals" ProceedingsW'est-ern Pharmacol Soc., 11, 136' (~1965):,,With Herbert B. Chermside 118. "A 3Tathematical AIodel for ConvulsionsImchieed b,vAlitiylhydrazines7 " The Pharmacologist, 9, No. '',196I), With George Led'rny Jr. and -Waldemar Gustavson 119. "in Vivo Staining with Acridine Orange" Wasmann J.,Biol!, 26, 1(1968)y «'ith~ Adriana Bond 120. "Preparationi of Al);ylidineand Alkyl AminoAcitl Esters for the Gas Chrom= atographic Analysis of:_Lmino Acids" Analytical Chem., 40, 190 (1965). 121L "Higher Fatty Acids in Bloodi Serum and Liver Extracts from Rats Deficient ini Vitamin B, and Essential Fatty , :leids°."Wasmann,J. Biol., 26, 2671 (1968), With B. R, -Najii, D. E. Boggs and J. Wriston 122. "3tathematical' Considerations in the Carcinogenicity of' Multiple Slibcar- cinogenic Doses" Proceedings Amer. Assoc. Cancer Research„10, 28 ' (1969),, «'ithi George Ledin, Jr. Mr. S':= r.rzELD.Thanh you, Dr. h'urstl., llr. Adams'? Mr. ADA.>;s. Yes. Dr. Furst, I gather the tlirustt of your statement is that you are involvedl in projects and that you think that research is beina cut off beca.useof'statementsthat have been published. You mentiion on page ?, :"For the past few years I[ have personal]y ."' been e.n-a-ed in projects which involved smokino- «r'ho are youi involvedl in these projects for and what are tlley?Dr:Et;RS'~.IV, eharebeenattempting formanyyearstoinduceluna cancer in experimental animals. We have develcped our own smohinb machines. We have(rone throubli a lonw, evolutionnryprocessand are tryin-to build machines which wi111 simulate thehiunan mechanisms of smekin- . The research in which I am en;aced in in this particular aspect is an attempt toproduce lmig cancer in animals with smolre. Mr. Aim-its. And )-ou indicate that there is a problem with the fact that peopledors't .v<lntt to researc'hin this. W91o is sponsoring this'?D'r. Fur.sT. Thi'slsarticular project .cassponsored by the C'onneill for Tobacco Research. _l'Ir. _YoA ~cs. There issolned~uesticrm~ that perhaps t11e fact th.Rt there is difficulltv in this ar,ea andfactorshati-ebeen raised tllatttiu industry that has tlhis muchat stake mi~:ht be interested in doino, it,, putting monev intoresearclr. Several men in the course of thehearinfr , on the comniikteeand of'theconimittes ha:venlent'ioned that they]iad. Illiis this sont•z~eof f~iulrl~been drying up because of the public statements that h,zvebeen made'?

1019 th F. M coL Soc. e United Sept. G),,. -Induced _Ybstract,, tures on nd K. CJ of Nar. h K. D. (i.;. 1'J6i6. ;.~ Hal'1)~, :g in the L'sPHS,, is~Purine~~ 1I:Y:49 fane and in Rats )I. Phar- ~lyphasicc iith and (19G7)., ?red Air )i. AppT. m Range ;Itaneous :iF (with l19(i7 ). ofl Po1y- h 3 r. B. 11. 1W.19J. Roche), F, nzy mes i lSh6S). subjects ol. 2:11 Iail, and' ,r. Ri,9- -epared .T THE iments, at the exas. I . ' 3 fll. II)•y hostgi•acluat'e~ training was,obtained at Duke University. I have been on t'~he! medical~ staff at ~~'aiiderbilt L7niversi'tv. the L-ariversit~v ~ of~ Ten- uessee~. the~ L'ni~versitv ~ of Arl:nnsas,~ and have been at thE~ medica~l~ hranch at Galveston since 1947. ~ I am certified by the American Board of~ P'atholoav. I aan int~erested in patholocry~~ andl resezrch. In 1965 ' I reported on the~ subj~ect of smol.ing ~~ andl h~ea~l'thi to~ com~mittees~ of~~ the~~ llouse~ of~ Representatives and the U.S. Senate. Ftnr~~y~our~ infcmnationy, ;~nav I sav that I h<ive~ been interested in Iunz cancer for manv~ vears. [n 19I~1; I published niy first paper oni the frequency ~ of c~ncei ~ in~ 10 acitopsy ~cases. Since that time I h~aR-e~puhlished 19 papers (?~-20) i nohulinza du~!cussion of'cancerf the smokina habits~ of colle-e students,~ ;uird' a discussion of smoking and di:ease~.~ In~ three of' these, Ti hat-e~~ ie~redl the prolalems~ of lun~ ~ cancer before~ 1900: (~10)1, tlhe~ second to ihlng ~~ cancer from 19001o~~19:30 ~(16)~.~ and the~thi'rd to~lun- ~cancer~ froni I~);014o~119613 (18). "l.he~ f'irst~ case ~ of lun~~ cancer ~~-~as~ reported from~ France~ in, 1810 ~~ (21)~., ~torer (?3) published a case~ of lung cancer in _lmerica: in 1851. Ac-~ rorcding to «'olf' (23), lung cancer increasediin~ frequency ~ifi Germany ~ trorn 1852 to 18S,5: I3onser (?-1!)~,~ however, did not find an~ increase~ inn the~ frequency of! ~. this~ lesion at postmortem at~ Leeds~ betR-een, 1891 and 192 7. King ~ and Newsholme (?5)', in 1893~, expressed the opinion that ~ this increase in the fi'eqpency ~ of cancer~~was on1v apparent, being~due to iinproved dia(Tnosis and neore careful certification of'tlie causes of' Ueat~16. 'L'be diacrziosis and etioloErv of hui- cancer were frequentlv d'hscussedd before 1900. ~ BBoyd (76)1, in 1887, gave an~~ excellent' discussion~ of the differential diragnosis of cancerr of the lung. Adler (2r )',,iil 19112, how- ever, commentedl that "even the~ diagnoses~ made oll the~ autlopsy~~ table are~~ not~ a~lnti-avsreliable."~ WFll~er~ (28), in 1939~., after reviewi'n;, a group~ of' 89 ~ cases, fioudld' that tllie~ correct~ clinical diagnosis had been made~ in oniti.~ 10~ cases~ and suffcested that "with the additional aids~ now ~ avni1'able~ the proportion of diagnosed cases should be~~ very ~~ mnch increased." Wells~ (71J)~, in 192i3, found~ ai d'haanostic~ error~ of ,6~.6' per- cent in agroup~of ~i~s cases of cancer. Fried~ (<",6)~, i'~r 19?5;~ found only two cases, ih~ a(rrou~p of 111 cerrectl~~.~ diacrnosed clinically at the~ Peter~ Bent Brigham Hospi~t,nl in~ Boston. After~reviewing the~~ problem of~~ c,tncer~~dia~~g~nosi~s,~on deatl.iicertificates~iuithe Pi•on•ince!of Saskatcli~ewan„ Barclay ~ ancli Phillips (:;1), in 1962, ~cconcluded that "death certifi'cat~e, rliairnoses are~ insufiici~entl~~- accurate~ to~ permit'~ their use a~s ai reli~~~ble~ indication rnf'the~~ ibcidence~of cancer." The~ establisliment~of the ~frequency ~ of czncer,of t'1ie~liu7r fcom~ T~~ital~ Statistics ha,9,been and still is ~~ a probl~em~. A statement made in 1255~ ~ b, v o(licialis ~ of' the~ Ne«-~ York, State- Flealth Department (;?)~ is i~m, pctrtant~to kno.1°~ ii<rt.he~~ evaluation of death certificates used for~1 7 i~tal Statistics~:1'esy th.ln, one-half of'the d'e.iths attributedlt'~o pneiunonia in ag~r.oup ot~ cases theti~~ re~°ie~~-ed actuall~y had l~neu~r~oni~a. ~Tlie D~~irector~ ~,f~ the B'~ureaa~ of Vital Statistics~ ofl the W~isconsin State Board of~ Illealth (~3:3')~ said ini 1960 that ~ `tur estima~ted'tl~percent of all records~~s in tllie~I3~u~reaiY of Vital Statistios,contain errors~e~r omissions~.'~W~aaler and C'rinnstvedt (aI),~ in Sclndinavia,~ imi 1938, usi~ng tlie~ alitops-,.. foundl that the clinical diagnosis was:correct in 62 ~ percent,, «-ron.g in 15~~ percent, and doubtful in 10 ~~ percent of' the~ cases. There~ were~ -1".1~~ cases n~~E UnrecognlZedl ca~Ilcer' lni their group otl -},L04 aIIt~opsies., Korns a11Cll ! I ,

1010 who voiuntarily stopped smoking cigarettes and om whom weight data were avail- able for two, years prior and two years after the: year in which they stopped' smoking. Experimential observations on the inhibition of gastric hunger con- tractions by smoking and the accompanying increase of tobacco consumption among, individuals: who maintainedi a, reduced caloric intake suggests that slnok- ing tends to depress the psychic need' for food. The increasedi level of blood sugar which follows smoking may also decrease the appetite. A11I of these factors op- erate in ai positive direction to maintain a more optimal body weight in those indiRiduals in whom increased body weight is detriment'al, to the general health. TARaSDSSCOTISECOSSTE\T OF CIG_',:RETTES Analysis of cigarette tobacco has not revealed the presence of any carcinogens. Equi'vocal findings have resulted f'rom the study of the possible careinogenic properties of tars obtained from tobacco smoke condensate. Occasionalls, poly- cyclic hydlacarbons; which in their pure form can be demonstrated im laboratory animalsitoprodtrce cancer, can be identified in these tars. This is not surprising, however, since these materials can be produced by combustion of as simple ai substance as methanegay;,arefound in, thesmok:e of'barbecues; and are adherentl to both roasted and barbecued' meats: In fact there has been noted onlr a weak co-carcinogenic eff'ect in, mice which liad, previouslYbeeni painted with the highly earcinoaenic, material, 14-benzypr- rene. Thesereportsconfirmed t-hefindingsofPasse3• ini Great': 13ritain< <ti'yndhr, found' a marked difference in the percentage of animals affeetedl by experimental cancer tests,, depending on the strain used, when he tested tars in cigarettes from American manufacture. It is possible to produce cancer of the skin in some ani- mals«•ith smoke condensate; hon-ever;,the amount:of smoke concentrate rerluiredare enormous anfl'not,comparable to whole smoke. The responses of'animals to snloke and its components do not vary , as a funcr tibn of the dose. The qualitative identificationof'a particular agent iYr a comples: mixture cloos not mean that it is present in sufficient quantities to produce a . biological effect; neither,doestlheeffpct in a particuhlrspeciesmean, that it may occur either quantitatively or qualitatively in man. It has been suggested that tobacco, smoke may serve as ~ a co-earcinonen to car- cinogensftom other sources such as! thoseoccurring, in the generall atmosphere: Experimental evidence for thi's hypothesis islacking: Sritish~ investigators have been especialN, unsuccessful ini their attempts tpproduce skin tumors in: animals wheni tars: from cigarettes from British sources were applied overlong periods of time. St'einer ancTFalkhas'e reviewed the 14tera- ture: concerning data elicited from experiments: involving variousconlbinatiiansof' chemical carcinogens, tumorl prodhcingviruses, radiant, energy andtraumad aonle of these experiments showed summation of' effects, others did not, and . ai third group showed inhibition.. Simultaneous adkniniFtration of two potentl carcinogens, when injected together;, sometimes were inhibitory. These equivocal effects suggest the desirability of reviewing the problem of' anticarcinogenesis and compounds tested in combination atiTIC1RCI\ oGE\~ICITY IInhihitibn of theaction: of'potent carcinogens has been reportedlb,v a nntuber of' itn•estigators. Retardation of' the rateoftunlorindtrction has resulted fiillowing; application of non-carcinogenic agents, cisoely reluted compounds and agents f'ound, in tobacco smoke. Falk has demonstratedl the iilhibition of carcinogenic activity by administration of crttdesamples, of cigarette smoke extracts~It isapparentfi•om the experimental n•ark of'nlany investigators that thecarcinogenic potency of crude, mi,xturesis less than thesum total of anticipated carcinonens; anticarcinogenicitgas well as co-carcino„enihite must be recognizedl as an nbiil- uitousphenomenan. Inhibition off etperinlentall carcinagenicitc,is relhted toao number offactklrs, including, thevehiile us4l. ilieratioof'tlie, anticareinoaeni to thecnreino,ene therelatis•e structural relationshipof'the-etwosubstances,anrl the time of'administiratlion. '. The above is-cited to~ emphasize that though carci'norenic sttbstlances ~ mam ho~ t identitied in~ tobaccostnolte and tars, the presence of other <•nnst:ituenus of tars mny themselh-esbestronglh• inhibitory of d:Glua-in:;'or toxic effi~ct. \ LC.O`1I'SE~. CONTENT OF Mcoti:ne has~ been indi I qver the tobacco, thegF ': he smaller the moist r - „oler the smoke or the :iu• smoke which is inh: ::ncl the form in which i Lle amount, of nicotine : z-iginal tobacco. \icotii, ~dier de-nicotinizingpr,.': the smoke of low-n. ~,,,bacco a4elikelgto t: ,garettes; in addition,:icotline in cigarettes, a ,,ii blood prec_surecan : -niHcient to;eiert a posi Compounds whichar:1ti persons should conii : i;e Hbusehold Labelin :~~,sorbed in excessive uut requi:rewarning s1 nd excessive use of a ~1iny lead to coma and, :,crmal body physiolog, i'i terms of' it'salcoho; :iie consumed princii?a, uAn. The theory of' th, irum, «-arning; of its! c1c,qttii?ea statement of i It is my opinion thi , ra rsdoes not serve a:Any event. B`urthermo1,v a, smoking, machine nicotine,absorbed and i~z completelyy unrelatec There is a necessit =tnoking: Themajorit~~ indicate the extent to a great deal of pleasi ,moking of' tobacco. It has not been es- related to hum= hea 1,Y those who sag the l,ow,ing tbe quantity ,levice, would' have ai i0,lding to require sue TIIEPROFEd L'llucation St. \orbert Cblle University of Wi: ~ l'niverkity . of W ~ Ph: D:-1cJ42' ~ University of' Wi Internship(R!otc ~ I:csi,denc3 V't;eclic ~ ~ ~!

ental. aider. 11 un Iire'" 1'. T. ,)era- cites .. H., lack ,eed- andd tin5 ora- inn- t'ith. 'rne. IudE :snn I roc. a'•.. L. ate •(W. F. ns- ;7) A,. of'. uc. in B~, er: 993 57. "Reductions with, Hydtazine Hydrate Catalyzed bv Raney Nickel. I)D. Aromatic Nitro Compounds to Intermediate Prod'ucts Amer. Chem. Soc:,, ?'9, ,54cJ'2 (1957 )I'jVilth Richard E. 1I'oore53: "Development of a Strain of Ehrlich Aseites Tumor Cells Resistant' to N- AIethslformamide" Science12Ltj 926' (1t}37)1 «'itliH'udil S. Gross ond S. R.Gnoss :;z1: "Chemotherapv of Spontaneous Mammary Cancer ini _ltice" Stanford Jied: Bulletin„1u', 316 (1957) ZWith 1\'indsor Cutting,and Hudi Gross 00. "-1 -New Method for Preparation of Dialkylaminostyt?rl Deri<<atilves of PyriHineand Quinoline and Their N,Osidts" J. Org. Chem_2L, 201 (,19JS)~ With Elizabeth D: Parker cil., "Quinosaiine-2,3 dithiol as a Colorimetric Reagent. DD eterminatuon in Am- moniacal Solutions" Anal. Chem., .30;, 365 (ISas) With D: A. S&oogg and \Iin-Gon Lai G'2: "Similarity of Action of' N-Jiethslformhsdrosamic Acid to N-methyIforma- mide on the Ehlrieh Ascites' Tumor" Proc. Amer. Assoc. Cancer Res.,, 2, 3''7(1958)WithJames H.AIiller 63- : "Drugs Affecting the Psyche'." Aaiser, Foundation \Ted. Bulletin, 6; 128' (19-58) tiVith,Windsor C'uttingGl: "Antiviral Chemotherapy,:~ Currentl Stiatus" 3ntibiotics & Chemotherapy, b; 441 (1958) With Windsor Cutting d:~. "Tests of Compounds Against the Ehrlich Ascites Tumor"' Cancer Res.,,18, 417 (1958) WithR'indsorCuttineandHudi'S,Gross. 0. "Reductions with Hydrazine Hydrate Catalyzed by Raney Nickel. III. Ef- feet of the Catal,r. stl on the Reduction af' 2,2'-Dinitrobiphenyl" J., Org. Chem,, 23,1504 (1958) WithRichard E. Moore l i. "DL-3-g-=lminophenylalanine. -Nitrogen 3fustard and Ot!her Derivatives" J. Org. Chem., 23; 1568 (1958) With G; E. _llcCasland, Robert Horvat, Joyce Korntvedt 68. "Furoyll and Furfuryl Dericatices, of Pyridoxamine (Kinetin Analbgs)" J. Org. Chem. 23, 1570 (1958) With, G. E. \IcCasland and Erwin 'i,'lanz„ Jr. 69: "The Use of Fish in the Etalution of Drugs Affecting the Central Nervous SSstem" J. Clin. and Ei;p, Psyehopath.,, 20, 26 (19a9)~ With «'indsor Cutting, Morris Baslow andiDorothy Read i0. "Phenyl and Chlorophenyl Derivatives of 1,4-Dihsdi•o-2-PvrimidinetliioI'." JL Org, Chem., 24, 999 (1959) With Gl E. Mc Casland and Erwin B1auz; Jr. 71. "Some Urea and Picrate Derivatives of Pyridoxamine" J. Org. Chem.,, 24, , 1000 (1959), With G. Es 3lcCasland and Erwin B3anz; Jr.. 72. "Evaluation of CompoundsAffectine tlhePsyche"Arcli., int. Pharmacodyn:, 121; 14 (1959) With WindsorCutting; Henrietta Parh-man,, George Read,. Dorothy Read and John Cutting 73. . "The Use of Fish in the Evaluation of Drugs Affecting the Centrall Nervous System" ( Seetion in boolt):19a9 With W. Cutting 74! "PhenazineDi-N-Oaideas aCarcinastatieAgent"'Nathire, 184, 908 ~ (1959) «With Claire Klausner andl Windsor C. Cutting 75: "Structure-Action R'elati'onships of! Phenazines as Carcinostatic Agents" Proc. Am. Assoc. Cancer Res., March 1960 With Cluire Iilhusner 76. "Chelation andi Cancer-A Speculative Review" Chapter in .1CctaG Bi,tclina, in Medicine, ed_iwfiarvin J. Seven, J.B, Lippincott. 1960. 77. "A New Carcinostatic Agent for the Ehrlich Ascites Tumor" Acta Union. Int. Contre le Cancre, 16, 625 (1960) 1Vit'hi James Miller, I'Iudi Gross and. Windsor CuttingZ8i "Comparison of Excited Phases aft'er Sedatives and TranqniIieers" Psycho- pharmaeologia, 1, 346 (1960) With George W. Readianzl' Windsor Cut!ting 79. "Circling Syndrome Producedl in, Aiice by Diinethylaminohetiose Reductone. (20844) "'Proc. Soc: for Exp. Biol: and ]Sed.,101, 381 (11160) ~ ~ti~'ith,Winds,r. Cutting, Dorothy Read, George Read and Henrietta Parl:man. 80: "Effect of' Chlorpromazine and Thiouracil on tile Circling Syndrome Pro- duced in Mice by Dimethylliminohexose Reductone" Stanford, Med. Bull. 18, 12d(1960) With D'orothyRead' and! 1Vindsor Cutting 81. "Antiviral Extracts fromPropionibacteria" Antibibticsand Chemotherapy, 10, 624'(,1960) With Windsor Cutting, Dorothy Read. Da1eGrattt„IIclmuth Cord,4, John Megna~and Earl Butteracorth: 82l "Effect of Phenazinedi. -N-oside and Phenazine on TotalCOlhilar Dry DliZ ss Mouse Ehrlich Ascites Cells as -lleasured, bpIntcrference Jiicroscopr" J'. National Cancer Ittst., °G; 431' (1961), Il'itliPIun Lee and', Victor Rlicharcls^_D: 236-69-pt. >'-8

1022' -I6,,discussiiig~lung~,cancer~sta#~~ed: "The~~principaIagentst-hatliaie~~beelr suggested (as the etiology) are cigarettes, air pollutants, and special occupational hazards: Much more work needs to be done before the precise:roie~ of these or~other factors~il7 the rise in the ii7cid'ence~ofi lung crancer~~ cani be definitely ev~aluated." Gilliam ( 71), ch~ief~ of the epi-~ demiology~ section of' t~lie~ National Cancer~ llnsti'tute, in 1955,~ said: "Prior to1 19~301 the: term bronehogeni'c~ carcinoma w~as~ Iumped with~ 90 other~~ cancers'~ of various sites .~ .. It n•as~ not until the~~ Fifth Revi'sion came into~ use in~ 1039 ~~ that deaths ~~ hieh~ pliy sici~:ns~ charged to ~broncho-~ geniccarcinoma were separately identified in official statistics." Gillinln stated that "the rate of increase in recorded nlortality was greatest i'n this country between 1914 aand 1930 aand that it has been declini'ng~since~~."~Heuper and Conwav (72)~,~ in 196'1,, in comn2enting on tTlis~~ problenl, sald, `'A1'thou~gh it has: . been claimed by~ these~ and ather~ investigators, mailbly~ on the~basis,of statisticall eti.idence, that cigarette smoking,is the principall cause of'ltulg cancer accounting for up to 95 percent of all pulmonary cancers in nnale,, an objective and sober analvsis~ of all information on the epidenliolbgy, etiology, and path-~ o,oErv ~~ on this~ subject scarcely~ upllolds~ such far~-~reaellin_,~~ a1legatiions~''' Harold Stewart andIsaterine~Herrold (~i ;)~,,fronsthe\Htionlul Cancer.~ Instit'~ute;~stated in 1962~: "Were i~t possible regularly to~iild'uce pulmo~- nar~~'~~cancers~in laboratory~ animals by ~~ exposure~t'o~ inhalation of ciga-~ rette~smoke,this would canstitutle good~ evidence that cib~aretti~e~~smo~l:i:ig could cause cancer of the lung in men." In"Tlie Health~ Consequences of'Smoking " published in 19~67 ~ (~6u'),~ We find the statement~ that "an unprecedented anlotult'~ of hertient re- search search has been completed,, continued or initiated ...~ This ~~ research has been reviewed and no evidence has been revealed «hich brings into question the~concl>_isions of~the 1964 RReport." Resei~rch, carried on: since, 1964~"adds to tlhe~understanding of'the precl e~-ways in~~whicli slnol.in~, aifects the bodly~."~ It is true that~ a: , statistical association beween cigti-~ rette~ smoking and lung cancer~has~ been demonstrated:~ lIo«ever,such an association does~ not~ constitnte~ a~ "cause and et1'ect"~ relationship. Experimental attempts have failed to support this statistical associii- tion.'D'here~~ i's'far~too~ much «hicli~is ulle~pi'ained to~be~dis.riissed. Tli~e~ consensus of all inrestigators~~ is to encourane~ and to continue~ scientific: studv ~ of~the cause or~can.lses of~cancer~ and es~pecia~lly that~ of the llings. Lilti1 we~ can obtain experimental evi~d~ence~ t~o~ support the~ stat.i~stical~ association, t'~he~~ relation of lung cancer~ to~ ciLTarette smoking will~ remain a "statistical a~ssociat~ion~."' Every ~ etf~.ort., however, should be~ made~ to scientifically~ est~a~blish ~~c•~hether.~~cig^rette~ smoke~ is or is~ not casually~ related to~~ l>_mg~ cancer. CertainIy,~ no~ such relationship b1~s~ been establish~ed to~ date. This,sci~enthfic effort should inclncle~, «•lthrnrtlt fail, a broad investiLration of' the eifects, of constitutional factorson the development~of lunr cancer. Thank you forr this opportunity to present thc~.sedkita.. (Tlie att'achmentstlo~llr. Ri~gd~n's Stlatenlent follOaV:)~ REFERE\QER ;'. Rigdon;, R. H:,, an, malignancies stb' 4. Rirdon, R. H. ano Iishing the frec Med., 9 :, 6.52; 1t'Ii 3; Rigdon, R. H., an relative to the. Med., 10: 76; 19: 6: Rigdon, R. H., Ki in the white ai 1949 atlthe Me 7., Rigdon, R. H., ai revie.vtlhefact S. I+;irchoff,, Helen, Texas: Texas R :>: Rigdbn„ R., Hl, K: occurs in Tesa: 10. Rigdbn,, R. H. C Rept. Bioll,ltec 1f1. Iiirchoff;, Helen, Texas. J. \atl. 12. Iiirchoff; Helen, negro :astud Ri ;don, R. M P review of'the 14. Rigdon, R. H. Ct 1Proc. of' 1957 1U» 7, p:,56. 15), P.ig<lon, R. H:,, npon 12;050 it 1i;. Riii~don,, R'. H., : 5ttrg~ Gyn. Ob: 17. hirchoff, Helen; of tlieproblem1~. Rindonl R. H., a Texas Rept. B, I'). Rig gdon, R. H.,d,isease. Tesae°0. Ri;;doni RI. H. 41 rel:ationship. E' °1. Ba<<le, G. 11. R& lated,by Willi Storer. Carcino thorax: Am.,J '_'3: «"'olf. Itinrt's I'r. ls')5 P,'onser. Geor;j: Lt•ed~. J.,IISg'':,: King, George, : Proe: Royal &°_tT. ISoyd,,AT., A. Q'a. 27. _1,dler, I: Yrim Longinans, G 2,. Weller. C. V. P: ':D. \\'i•1l5. I!P. G. RI exii;ting '.canc °1). Fi•icd„ B. 11. 1 :11. Iiarclay. '1. IL certificates. 4, "'?. JCUaes, G. et a I'ub. Health::i.. Sasa, L. I:. II ' 1:1ti(1: 1. 2 Riedon. R. H., and Kidder, L. A. Frequency nf cancer in 7500 routine autopsies performed over a period of' 43 years at TheI:nii•ersity of TezasMedical Branch. TeSasRept. Bioli Mezl..7: `a 37; 1949. Rirdon; R'. H., and Brindley, Paul. Primary carcinoma of the lung in Texas 3 1., «'aaler. I:.. :1n rc,li;ibility. ~, ': Iiurns. R: 1P., a " . . Texas St. J! Med., -tli : c8.i.1'J.i0: orl., S _Xu«' 1

-1J46 boratory, 1 Center : -1352-64 edioine - nd Tosi- s'-1cJ4!7 119a2 LCOIOg,C leld of -1 ti:iC -1 9f,1) Recipient ofthe St. Norbert a1n1a mater award given to outstanding gr,adu- atesfor successinprofes:sioual achiecenientsund Cliristian licinn-1961 Founding member of the Society of'Tosicology-19W PtiBLICATIQNS 1. Some obserrations on the determination of soap iilrefined oil (with H. A. Schueitte ),. Oil l and Soap 16: 13. 1039 2. Study of the cumulative effect oftliiobarbituric aeid'derivatives (with F. L. Kozelka). J. Pharmacol.Esper. Therap:66:,20; T339 ~' 3: A method for thequantitlative determination ofdilantin in biologicallmaterial ( R-ith; F: L. Iiozelak)., J. Pharmacol. Exper. Therap. 69:290; 1940. 4. Distribution, rate of disappearance, and excretion ofl Dilantin («-ithi F. L. Kozelka). J. Pharmaeol. Exper. Therap:G9:292, 1940 5. Studies on themetabolism of diphenylhydantoin (withF: L. Kozelka). J. Pharmacol. Exper: Therap: 72: 20. 1941 G. A method for the determination of 5;5-diphenylh1-dantoin in biolbriral ma- terial (with F. L. hozelka). Jl Pharmacol. Exper. Therap. 72: 276. 1941. 7. Diatribution and rate of metabolism of'5:5-diThenvlhgdantoili (with F., L. hozelka).J. Pharmacol. Exper. Therap. 72: 230; 1941 a;AIethodi for determination of ethyl alhohol for medicolegal purposes(«ithF. L. Kozelka). Indust. Eng. Chem.,,An:zl. Ed. 13: 905, 1041 9: 'Metabolism; of some derivatives of Dilantin (with J. 11. Holinan and F. L. Kozelka). Fed. Proc. 1: 153, 1942 10.lnticonruNant properties of the metabolicprodlrcts and somed'erim.ntii-es of Dilhntin (with F. L. Iiozellta and! M. F. Breiber). Fed. Proc. 1: 156, 1952 11. Denrecl:Ition products of Dilhntiil (with F L. Kozelka). J. Pharmocol~ Exper. Therap. 77:175, 1043, 12:Iletabolismof hydantoin derivatih-escloselmrelatedtolDilantln (with F. L. Iioz(,ll.a). J. Pharmacol. Exper. Therap. 77,:1S0; 17143 13. The effect of peritoneal irrigation on met1M alcohol tozicity (with W. S. Blal#emore). Fed. Proc.1: 310, 1947 14. An accurate colorimetric method for the determination of methanol in Llood (wit11T. E: Shea„Jr. and W. R:.llsdorf). Fed. Proc. 1: 335, 1947 15. Respirat'orR excretioni ofl methyl alcoholl bywhite rats ( withT. E. Shea Jr.). Fed. Proc. 1; 37L 19147 16: Influence of some analegtics of obstetrical importance uponi respiration of maturehumani plhcentai in vitro (H. P. JitmesandE. W. Page). Fed. Proc. 7,1948 17. Thetosicits of polsallvl!alcohol (T. R. R". Barnes). Fed.Ptoc. 7;134S 1S: The effectls of 2',4-dinitY"ophenol and thiourac.il on chronic methanol poison- ing (with T: N. Burbridae). Fed. Proc. 7. 1048 11): Thecomparatire activitgofsome a-substitute& glycerol and g1lgcidy1 ethers(tvith H. E. Christensen).Fed. Ptroc. 7l, 1943 20.Cmnparativetoxicitlies,of fivesubstitutedglycerolethers (with P. C. Loeb) Fed. Proc. 8j1J4J 21.Comparativemuscle-relasingactirityof seven glycerol ethers on ii;olated nerse-musclepreparations, («-itih, H. Davis: and F. J. SIurph3•). Fed. Proc. 3;1949 22: University instruction in toxicolo,,y. J. _lssoc..>,tu. \Iied:Col. 31arch, 194f1 2:1,Aivodifiedlultr.nviulet spectrohhotometricntethodfor puantitativedetermi-nation of barbiturates («•itlh, T. C. Gould). J. Lab. Clin: \Ied: 3~;: 1462, 104[1 24. Thecomparativemuscle-paralyzingactieityof some substituted gl~-cerolethers, (with HIE. Christensen, F. L Ahtrphy, andiH:Davis).J.P11au•macol. Exper. Therap. 9 7: 414, 1949 25. An analysis of the comparative toxicities of related allyll and acrylic com« potmds (with H. C. McDaniel a¢IdhI! li: _'inderson). Soc: Pharmacol. Exper. Therap.. April"19,-i(l °_G!Pharmacology and toxicology of~:ome important econonticpoieons, Adv. Chem, Ser: No. 1: 39, 1cJ:;0 2I:4omeob,ervations on theeffectsof small do~es of alcoholl in patients re- ceiringtletraethyltihiuramdi4ulphi(le(.\ntabuse)', (vritli 11. H. Anderson, E. A. Mncl:lin, A. `dilnon, T.N. $ttrbrid;ce, and' K. M. Bowmnn!). J.Pharm.rcoL Isper. Tlierap. 98'(11). 1950k

i loctor, tllllolly InI(ro Ilectof I mtlcli !iollght ~ir. `llarles. )Ie-ssoL` TeC11C21l of the t is so !GY~ -4ND~~. e UR\S.i )zS and ia, San ion for ngg and :edicihe :icologs :d post- edieine, reas of Health ;encies. gy and ocieties rcology, -,ademyy welI as tnd am re area 'S' Com- accomplished with substances', which~ carry ~ minimal hazard to~~ t'he~ individual and to~ society ~ as~~ a nhole:~ In summarr.~then, the~ Commitltee~ concluded that medical perspectilve~ requires~~ reoog~nition of the siglriticant beneficial effects,of smoking; primarilp,~in the area~~ of inentlal health, but tliat~ benefits~ were measurable in~ terms of' indivi~du~~al, be- ~ havior; and that since tlhere~ isino:means~~of~ qiuantitatling~these benefits, it was~~ not l,ossible to jil~dge them i~n terms!of the~ possible hazards of smoking as~ tlhey, apply~ tu~ the~ general poptllationi While a~ scientific committee may ~ not be~ required twevainate, vvei,ah~ and judge beneficial versus~ possible non-beneticia~t effects, it rlj~es behoove~ those «-ho~ are considering~, restrictive legislation, to: evaltlate~ these~~ naatters fully. SO.\-1DDICTIV~E'. EFFECT~ OF. S\[OHI1~G~ Benefits from smoking occur prihcipal.'lyin the areas of inental health. The hallit itself' originates l~argelyini thesearchi for contentment. A rapid tolerance levelopstosmokingsothat those acute effects oftobaccosmokiilg, (asseeni in the novice)R•hieh, are d1tealmost entirely tonirotinecontent, aretransitory; not , I,~ rmiilg, and notl seen in the habitual userOf' t'obacco. IIabituationmagoccur Nvith smokinr. but not addiction. i'h,rsicaldependenced'oesnotdevelop,either to nicotiheor other constituents'of tobacco. Further, there is no withdrawal symptomfollowingt'hecessation of'~ .cnoking which Iea(1s to anti-social behavior. \IOnF heavy smokers who cease ,Doking: abrnptlemay retain the desire to: smoke, but do not esperiencesig.-nilicuru signs or symptoms:pointing,towardsphysieal dependence. PII aR1IACOLOGIC EFFECTS FROM . S]L:OIiISG All of the idlarmaeologic, effectsfromsmokingaredtletotheabsorption, of the .o•tive,a1k.21uid. nitotine: Smoking in Ilormall people does not le;.td, to nervous dis-turbances ; on: the contrary, it acts as a, sedative and tranquilizing agentl. TRBNQUILIZIM1GEFFECT OF TiOB21CCO Iit is difficult to categ'orizeorezplain:all of the actionsbPwhich smok~ingni'vesrisetocontentmentg satisfaction, andd positivepl~easure.,. Contributing to, these m:l,rbe~ the ritlual associated with smoking and the, element ofrliythmwhich, pluy~ its part. Itis, recogpized that many people operate i~ni rhythmic movement ~:hirh facilitatesthout;ht and gives satisfaction. Si,g):It andl smell are alsoilm= 1?ortant fhctors:;~ the fragr.antl tasteandsmelll of good tobacco are stimulating, snd the amrmnt of nicotine is not the~ detormi.iii¢i., filctor of thispleasur'e. The total pleasure depends~on,thereflesstinnllr_tion oft(Eie mucous membranes'of the no..e and throat. the rh3•thluic compleses in which peoplecngage, and the tn%urcluilfi:zim, andsti:mulh,ting, efectlofitlrenctivealkaloiil,nicotine: Supersensitik•e l~t°ople bec•onic' callu and lose their ir.ritabilitiy„ and thednll: and apathetic are ;tinutlated l;f: Tliron.gli the psychological evidnnceclearlvpoints~ tosuch. :rl)aiaitiveeffoz•t:tlieli6y~ioo„ical explanation~is'yettoheforthcomiir;.In theclull. ~iad listless. trie~ stiinuLrtion~ oft1lot~,llt produced by 4rnokin;;, is elearlr)rene= tli•i;11, tihlokersn•<<nier-tinetocombat haniger, thirst, rain„ lieat, colfl, irritation, ;ui(l lonelines::. If't'~his adtls~ to the a,reearUIenessof life, such a fact should be -ln,;ideredlinanT evaluation ofsmolcing and h~ealth- t,;- and .eneral to the vas re- reficial l ,rature nainte- redhc- tter to tspects: ltrsi~e, ientific. ,ver as PERSOxanIT]: OF SM.OKEP.S~~ Analysis: of'thepersonalitsofsmoldersby F7ysencltledk toJ9reconclu~4ion that ~mokersaregenerallgesfrovertsandl liseaccelerated l,ires. SCackenzienotcd that~urok~ir!gprosidesa senseofl relaxation in leisurehoursand helps a person Nvlioo isen-agetl in~ intellectual work concentrate when he is working. I:unes and Rosen- tli,it state tlhat smokerachoose tosmoke tobaccolmodncts because oC'the pleasant:u•oru.IS and reuhaticnisprocluce.d by thesmol.e: aswelll as the psychological and 1•mutional factors: in~ varcing, import'anceto tlieindividlral. EFFECT ON TIdE 11'EIGUT. W ~ ricans _As,mokin.qfi•er7uentlc' decreasestlhe appetih , itl oNerts ,t positive forr.(• in ~ dieted, ,earch uid'be rrei;ht,reduction:,It is a courmon esperienceinpersonswholhiuve stoppeil sn,oh- ii^ to;-arn N1-ei;;ht rapidly, sometimes toundesir.nbleleveli;. A st'ndyb' y I;rozeh :urcll Keyes res-ea1Ld a s.tati;tically signilicant increase in bodtweight in men ~ _0-^_;;6-(itN-pt.,~2'-J

1024 36. Editorial. The Lancet,,1: 270, 276, 308, 1857. 37. Garrison, W. H. A brief'fbr the cigarette: Jiedieo-LegaT J., 15 :280,1897. 38!, Sold American-The First Fifty Years. The American Tobacco: Co.,, 1954. 39: Ewing, James B., Neoplastic Diseases. A Treatise on Tumors. Philadelphia, W. B., Saunders Co., 3rd ed.. 1928. 4'0., Pi1ot„Roger. Le cancer primitif dIU poumon.,Imprimerie Bosc Freres & Riou, Lyon, 1927: 6S. Fii;her; Sir Ronald a. Dangers of b: Dangers of c. Lung cance: d. Smoking-' ( Include:W);, Fisbbein, Morris. ll 41. Berblinger, W. Die zunahme des~ primareni lungenkrebses' in den Jahren tll. Horn, Harold F., 1920: 2-1,,Iilin. R'chnschr., 4: 913, 1925. States. P ublic 111 42. \TcI'ienzie, Ivy. Epithelial metaplasia in broncbopneumonia. Virchows Arclu No. 418. U.S. Gt path. Anat:,190: 350, 1907L LI. Gilliimr. -11t1.nrd! 43. Duguid, Jl B! The incidence of intxathoracic tiuniottrs in Jlanchestler. Lancet,, 11(i : 10;1. 1NJ.;;i 2~: ,1111, 1927. ~-''. IL1trl~e: 1V. (J.. a 44'. Jlorrison. S. L. Occupationali mortality ini Scotlhnd. Brit. J. Ind. \Ied., 14 : CimilLtiC. Thon 130, 1957:. Stuwart. iI. Ib., a 45. Wahl, Stephan. The increase of pulmonary carcinoma. Ztlschr. Krebsforsch. 25 302 1927 to induce c.nce! ; : . 39: Rept. l13o,1t 46:, Hudson; R: V. The so-called branchiogenetic carcinoma ; its occupational incidence and origin. BritL J. S'urg.,,14 :250, 1926-27. 47. .lI'arse,,W'. Correspondence. J:A.3I.A.,127: 120;,19-I'.5: 48. Brockbank, William. The occupational incidence of primary lung, cancer. Quart. J. n2ed. n?.S:,1I:31,1932: 49: Brinkman, H. From Simons, Edwin J., Primary Cancer of the Lung„ Year- book Publishers, Inc., Chicago, 1937, p. 86, Ottire: T;ie ifniversII6uie:13'_'I;IS~a11 St Iior'n: Julf,30,,190JL' l ti 50:, Neubauer, 0. Arsenical cancer ; a review. Brit. J. Cancer. 1: 192, 19-17L r wca on. 51. Public Health Service Publication #192, 1953! Health of Workers inChromate Producing Industrv. ~ Gordon Institute 1•Cuiury Universit 52:, Lynch. K. \L, and Smit'h{ W. At. Pulmonary asbestosis. III:. Carcinoma of Iiit•rn~ Duke lini' the lung, in asbesto-silicosis. Am. J. Cancer, 24: 56, 1935:, .1ssiz,tcurt Re~iiIe 53: Fine, 31: J., and Jaso, J. Y'. Silicosis and, primarl^ carcinoma of the bronchus:, J.A.M:A.,104 : 40; 1985. Resident, Duke I _lcath~rnia:aud profcs, 54. Katz, Karl. St'atisticai contribution to the knowled; e of pulmonary carcinoma according to the autopsy material of the Heidelberg Pathologic•al Institute. Ztschr. Krebsforsch., 25 : 368,1927. 55. Probst4 Robert. The frequency of'pulmonars carcinoma. Statistical investiga- Professorof Pat 19-I1,~.- : Grad SeniOr(:Ontiulta . tions on the material of the Pathological Institut'e af, the Uni'versity of' Zurich Ztschr. Srebsforsch.23::431, 102'Z. stitute. Houstb Consultant in I - 56, Schwyter, %I. Ueber dhs Zusammentreffen von Tumoren und MissbildUnger der Lungen: Frankfurt Ztschr. fl Path., 36': 1-)0, 1923:. 1 G: . 1J5i. Cli rical, I'rofess 57. Riella, H. G., andl Cannon, P. R. Primary carcinoma of the lung following versity of Tex trauma. Arch.,Path., %: 869;1930: Direutorof Lab, " 58. Mills, C. A., Occupation as a frlctlor in the community health hazards of' air pollution. Am: J.1Wied., Sci'., 226 : 177, 1053. 59. Ask Upmark, Eric: Bronchial carcinoma in printing R-orkers. Dis. Chest, 27: 4n7 195"a. \h'clital L ra ns I'rnfessor of 1]' l:r.cuich. Gl;tlvf L'rofc.'.Inr of P: , 60. Cancer Morbidity Series. Federal Security Agency. U.S. Public Health Service. versity , of _1r1. 1~40; 1950-52. Associ;ttePrufe 61. Passee.,R., D; S'omeproblems,of 1ung,cancer. Lancet:2': 107,,1J62:. \lernpllis, 193 62:, Schaefer, Ott'o. Medical observatiutrsand protalemsin theCanadianArtic: Instrntctor and Canad..lT..I.J., Sl : 386, 1959. \ashville„1:1: 63! DolL,Richard. and Hill, A Bradfordl A stud'yof the aetiology ofcarcinoma~ of tlielunr: Brit. A3ed. J., 2: 1271,1952. 64., Smoking and IIealth. Report of'the AclvisarpCmnmitlteet'n the Surgeon Gen- L iccii.tc<ltb practice (scorgiu4 1931 ;, eral ofl the Public I$ealth: Service: Public Health Servicei'ilblieati~on -No. 1103. US.GovernmentPriating Oflice.li.asliin.~ton. D:C 1965. Struei ili.+fi Loru•ds Diplomatle. _1m~ 663. TheHealt'lr Conreq uencesaf Surolting. A Public Healtli Sc: vice Zev,iew: 1t1GI: T'ullo+ti, College Public HE,alth Serv,iceL'nhlication No. 1696. L].S. Government Printi,n;;Oltic~e. Washington, D.C.. 10G4. 66'. False and Misleadin;;, kilverti:,ing (P'ilter-TipCizarettk's). Ilearinzs before Certified iu l?o: T'ollow,. .knieric ,i Snbconunittee mi theConrmittee on Covernsnent Operatious. FIoureof'. Rehre:?entativE,: E:i:aity-1?iftlt Con,re4s; first sovsion, Jiill-.18-_'6, 10,57. i'.ti. (=orernnneut 1?cintir7,_Otlice;,lbrnvlling-ton. D.C., 11/.ii. ~ R7. Berkson. Joseph. E~hibit::3011 in STearingsbefore,i Snlicotnniittiee mi the1'ounnittee mvGoverninerrt I1lieratirnis: I3onseofIteprecentatt'n-e., I•:i-,hty- ~'. Fifth CongFeys„tir.st session, July 15--26. 1957: .i1 29-2:.6-1;9- ~

10?0! Lintz (35), in 11955, coneluded from a review of 500 autopsies recorded from five~Hospitals in -New York State that~there.vas~an 111 to~20 per- centa~cliaaaxeement between t1i:e~medical statement oni the~death certifi- cate~ and the~ pathological findings at autopsy.~ In 1963, we, found in. 194 cancer~ cases a difference of~ ~0 percent in the~ diagnosis~ made by the pathologist at the autopsy table and the diagnosis given on the death certificate, which of course was used for Vital Statistics (19). Kiio.ving , the profl I'eins in the~ diEZgnosis~ o;>: lh!img cancer, I[ have~ no other choice but to be~ critical of the~stati:stical data ohtaiiled ih, ques- tionnaires from surveys~ made~ bv noiu.aedica.l individuals~ in ~ which the diaanosis of'lung cancer, einhliysenia,I and the~ like is obtained fiom! patients and family for statistical purposes. The merits and h<nrmful effects of'smokino- : have been frequently dis- cussed since Columbus first observed Indian chiefs, smoking ~~ toliacco~ l'eaves (,36). In 1.70?, apparently the first tobacco controversy occurred in England :"half of the town was on one side and half on the other." In a second controversy in 1857, it was said that tobacco acts on the mind by producing~ ina:biIit~S~ tio~~ think,, loss~ of' memory, insanity,~ andl an irritable temper. It acts on the respiratoin- organs by causing con- sumptions, hempty sis, and an infiamnzatorv condition ofl the mucous membranes, ofi' the lungs, trachea:, and bronchi.~ Others contended that srnol;in~ :: was a usefizl st:datl~ive~in,cases~of i'nsanitw~.. The word "cigarette" wns~ first used as~ an ~English~ .;-nrcL in 1842~~ (37). T«-~o~ years~ later~ it was~ stated~ that the ci(rai•ette~ hasbut little ~ stren;th, it. can do ~~ou no iiarlnL Cigzrettes~were~fi'.sb mnde~i~n~Lme~ri,ca al5o~ut~ 118G4. Shortlv ~~ after 1881, a~ ~"ii•~~inian. Jiznies~ B~ons.tclz,, invented a niachi~ne~for~nlaking ci~garettes(33~). Tobacco has been considered as~ a possible~ etiolb~ic~ a,•entl~ in cancer~ ofl the hm~~ siaice 100'~01 O't-her~~ abents, conditions,~ and occu~hations~ considered to~ cautie luncr ~ c:ancer~~ hav~~e~ been tuberculosis (39~)~,, syphilis (10)~,, influenza (41), diphtheria~ and m~eusl6s (I2)~, chronic~~pulnionary ~inf9aaTnration (4"3)1, occtnhational exposure~ by iron workers (44);~ road cittst~ (4a),.~ dust from groom~ing, horses (46)1„ motor exhaust (47), n-ar (yas (48~~)~,~ working ~ as~ a ci.mar-~ mtaker~~ and sorter~ (IOarsenic~ (50), chroinium~ (51)~, asbestosis (52)~, silicosis (a3), metaplasia (54), tar~ (5'5),~ heredity (156),, tratuna (a7);~ a~ir~ pollution (58)1,~ and inhalation of printer's~ ink n-hile~ readinb, the~~ morning ~newspaper~~ (59). There is awide variation in the differentf studies referable to: the percent~a:ge~ of the~~ population that smoke and tlhe~ frequency~ of Ittng ~ cancer. The~ Ul.S'.~ PitbIia~~ Heallt~h, Sei.-eice~~ (60)~,~ in 1950-1952, reportedd a study on the~ incidence of cancer of tihe~ bronchus and lun<„s per 1100,000 pol>ulation in 10~ American cities for,the years 1938~ and 1948. It i~s~ d'iflicultl to~~ account for the~ w~irle vari'ationih, ths~ fr.equei2ey~ of cancer~of the li i„ ii1~ these 10 cities. In S'outlhAfrica, wherethe av-era(re zrhite~malle~ is~one ol'~the heaviest smokers in the world„the~abc;-specific death-rate~ f'or~ cancer of the reshiratory svstmn is, if anything,~ l'ess than in venmarl:~where~tlLe~avera~•e ina~le~ smol-es less~than a thi'rd of the numlier.~of ci:;~~arettes~ (61L). _1n~article ~ iit the L~anadian Medical Asr soci.ation JournaU ((iL)~, iu 1950, said: '-If smohi~nLr ~a~lon:e~causes~lun- cancer,~ «e~slioulci es~pect~ to li.id m uiv~ case,~iar LI skinros and~ In(lGans~ ~~ lio~,rlmo~t al suloh~c.~quite he,t~ i1y~: n.o._tl~ ~o~,~;inet e. ~~, in recentl dccaales~. No lbronchogeiLi'e cancer~lias been fo7~ind, however,~ in -Norther.n natives~~ by our~ X-ray ~~ survey teaans:" There are some tlie~ statistical assr in a group of smc t Ihose with lun ; ca I tc.6 percent did i 1 ieng-cancer relati -' 51i permill7on, .i Iri-lrettesper adiu 1? a1-Irl,lnd. 'll'he Su 'I~~he Ile>=, t,itisci ~iI associa : i,ci•e aa•enianv sc ; io«-n hy the ~. ~lr•rto11 in 1~6J~(~ t I iesenren areinc C l l e] ll n't-a n d smol .P~oselPli Berksoi ('o»,iplet, told xne. t l e evidtence that 12ut,, cancer . . . i liee evidence, tah. -oienti3ic basis, tI i rctrv. I have four ~ir Ponald A. P ported iu detail ~~lnicer" (68). Fil t i'it recent wars, 'modern devices , of and surs .:ii(l' suothin7, wi :ularni. A conuno ;t~ the increased t ones to what',isila the presencc ceni to have clo: intLe place'' see. practice of escal eltoio-1d to re(luil• -Alo~rrisf rishbf p;irticud'a l tKlliii authoLUi 4oes,llolJ neCessFti: I'iirt] iern:ore, nnu'A conA l,tii'41i,li all tlie iitcani-i4ontwitl il li:ve1>celt t';eueral's AR'el)oi. .'1Plie I ilc.r l,ii!'oli.~lie(lt repor ;ine outAandliu2 1 n;t it tlte thEttt d tI'n[lvr ( 70), in

1032 141. TbtopTnsmosis in Texas: Report of a ChEe R•itlhAutopsy. Corpening; T.,:A':, 1'118. Cbn~ titembrid,:;e: \"'. A.. and Ri_dou. R'. IL. Texas St. ,I. Jled. 48: 469, 195°_: in. t,l 142. Pathologic Charact'eris.tios of: Fungus Disease as Observed at, Autopsy. Ri,gdon. R'., Hl. Texas St. J. Jied. 4S':ANi6, 1'9,-)°_. lf~;~. Spor 143, Frectuency of Cancer in the White and Colored Races as Observed at Autopsy between 19'?.0 and 1:J49at the_lledicaS Branch. Ri;don. R: H., 170; A C Iiirchoff, Helen, and Walker„ \Tary Lee. Texas Rep. Bioll & Med. St 10: 91-4, 1952. 144. A Consideration of Cardiac Hypert'rophp in Sickle Cell Anemia. Stlembridbe;, V. A. andiRigdon, R. H.. Southern _lledl J.,46 :94,9: 19.12. 145. Tumors Produced by _lIethylcholanthrene ini the Duck, Rigdon, R. H., Arch. Path. 54: 469; 19-i2. 146. Blood Volnme., . of Ducks L'sing Human Serum Albumin Lalielled «ith Radio- iodine (19953). Portman, Oscar W., JlieConnell, Kenneth P., and Rigtlon,, RI. H., Proc. Soc., Experi. Biol. &.l'Ied. 81: 599,1952. 147. Effect of Phenylhydrazine Hwdrochloride on Plasrnodium Lopliurae Infection in the Duck, Rigdon, R. H:, 1licks, Don W., and Breslin;, Dorothy. Royal Soc. Trop, :1LedL & Hyg. 47 : 70',11J331 145. .lIorphologic Changes in the Dog's Adrenal Gland Foldowing Anoxia (20038). Rigdbn. R., H. and, Swann, H. G., Proc. Soc. Esperti Biol: & 3led. ~2: 111,1953. 149. acute Anemia Produced by Phenylhydrazine Hydrochloride in the Duck : Ob- sercations on \u,cleated E'rytlhrocytesI7tiV'ivo. Rigdon, R, Hl, TesasRep. BioI. & Med. 11: 1Y0;1953. ~ \ , 171. «"hE ax 1;r'. Atyl. R~ 17,^,, A1',;1 a7 174. Tliic P 175: \etti D. 17G. A I T 177. Can T 17.~. A (° T 1k,0. Fibromai :lrising from, Feather Follicles of Ducks Following Local Appli- ~; cation of -Methylcholanthr.ene to the Skin. Rigdon, R. II.,, Proc. Soc. 179;, Cat Ekperi: BibL &,Sled. 83': 3-1, 1953 i; 151. Intravascular Life Span of' the D11cltRed Blood Cells as Determined riv ' ;,, McConnell,, Kennet~hP,.,, Port'man, D. W., and RadioActireSelenium R~igilon. R. I$.,,P'<•oc. Soc. E-xperi. BioL &l'Ied. 83:140; 1M1-553. 1,40: Sin T 1521. . A Review of'the Effects~ofSelenium on the Hematopoietic System. Walker, 181. Ti•~- \Inrv Lee and Rigcion. It: H., Te1a.Rep: Biol. & Med. 11:547;1953, 153. A Radio-Transparent Post--Morte:n T.ible: Rigdon, R: H., an& F1.eund, A., P.,, I 1S2. Fb. Tetas Rep: Biol. & liedl 11: a12;1953, 1 1e4. InhilzitionofJialnutritilon of DuckErFthrocytesbgSodi'um Selenite. Rigdon, 153i Fr( R. H., Crass. G.,, and _l'IeConnell, I€enneth: P.. Arch. Path. 56 : 374, 19-53! c. 155. Smoking and Cancer oftheLunn=het's Reviewthe Facts. Rigdon, R. H: 1S4L C:n: and KirchofE; Helen.,,Te.as Rep. BiolL &_lI'ed. 111: 715,1953. . I'. 156. Capillarp, Permeabilits iii 3reas of Iuflammation. Rigtlon, R. H., Reeue Tu Uanadienne DeBiolbgie 1t'.: 227, 1953'. I', 157. Primary Disease Processes as Observed at \~ecrol>sy in 353: Pediatric Cases 1,ti6. I'd'eEtamihed between 1945 and 1952:at the Medical Branch of the University J of TeYas: Thomsen, SI: and RlicTgon, R: H.,, Texas Rep; Biol. & Med. 12: 157. Ii.y S&2, 19a4. t'- 139: Spontaneous Regression of Neoplasms, an Iaperimental Study in the Duek. 1,ti,C. Tb Rigdon, R: H., Southern \fed. J. 47 : 303; 1954., ] 1:.,9. The Physician, Crime;, andi the Court. Rigdon, It'. H:,, Texas St. J. Med. i,a!): ,> 3 : January 1954. 160: Spontaneous Occurrence and Re;;ression of Hemangiomas in, Chickens; Rig- 1N)(l; IIii don;, R. H:, The Southwestern Vet. 7: 311, 1954. ~L;.. 161. SmokinT Habits ofl College Students in Texas. Iiirchoff, Helen andl Rigdon,, i R. H., TeeasRep. Biol. &;<Iedl 12: 292; 1954. 191. 162: Anemiti Produced bvChloramishenieol (;Chloromycetin)intheDuck. Rigd'on,, thi R'. H., C'rass, G., and 3fartin, A'ormtti.,, Arch. Path 59:~ Sa, 19,41, I'. 1G.i:,Iii'stologic Study of theBoneJiarron-ih V'ormal R''hitePekin:Duclts, Crass, G, and Rindon, R. HL, Arch. Path. 55: 1.19, 1954. 192: Ca 16-1. I:rPerihnental Production of 5quamous-Ce11 Carcinomas in the Skin of' Chickens. Rigdon, R, H. and Brashear,, Doyle., Cancer Res. 14: 620,, 19,i-1. 1!13. 31f' 16:~. Scientif:cProof of' the Reaction of tlie Body to, Injury. Rigdon, R'. H.,, Law and Medicine. A Symposium, Jburnal of Public Law, 3': 615;, 1954. 1166, , Roleof .,1nociii in t>.ie1''Ritho,-vne,is of the Lesion in aeutellal'ari.n. 1(lfl SI Ri_rlon, It. IIL. 1'ines Con,-,ress, Internationausde AIedouino Trohicaleetdu haliulisme. II : 1S6, 1954. 195. .1i1 1'G7. EACfuctof Vitaiuini B'„on Selenitnn Poisoning in the Rat. Rl,'(Ion, Ii. 71., Couch, J. R., Brashear, 7-)oyle, Qureshi, R. Taher:, Arch. Path. 59:, 66,. n 1955. ~

~~ 1002 is spending or~has~ a Government grant trying~to,~prod2ice these~cancers~~ tlirou(rh the~~ inhalation of'ci;arette~~ smok~e~?~~ Dr.~FrRsT. `~"i'r;, ][ doir't 'kno-w the answer to that. That doesn't mean they ~are~not. I[ jitst don't~l.now. 1'~L'r.~ WATSON. Do~you~ know ~ ofl any ~? Dr. FURST. I do not.~ Mr., j``_>,TSON., I dbn't recall any contentions by the Surgeon General!~ You make the statementi on pa,e 5' where~ you question,, "Are~ mice~ and rats~ «hich are~ tlie~~ com~mon subject the~ %t-.ron.(r ~ test ansmals?" As~ a~ layman I have been sitting ]iere~ asstuninb~~that the~ charact~er- istics~ofl the tissue of'thef lrm0' ~of~a rat are siiliilar~to: that of the human andlins~that~been established or~not~? Dr. FrrsT. It ha.s,notl., Mr. 1V~ATSON-~: It has not been esta:blished' but ~-et all of~ it hear.en~ help' u~ ° Dr. FtTST. I arni sorr~-„ sir. Did I~ nlisunderstand' your question. lfr. «'ATCoN-; I meaii~ has it been established' that the tiissue~ char- acteristics~of a lung of' a rat are the same as a~httman? Dr., Ft-$sT: I would say there i~s~,a great~sianiIarit'~~~;,3-es.~ Mr. WATSON. There is. Dr., Ft-zts"r: Yes~. Mr. WATSON. G'ood.~I thought you said no., Dr. FtixaT. I thought you asked has~~ it esta:blished~~ that they ~ got~ lung cancer. NIr. WATSON. -No, it has not~ been. I think everybodlv~ agrees there. At least we are tovrnb around and plli`in< around or somebody is, playing around n-ith maybe~ the right animal and~ solforth. ~~ our second recornmendatiolly on page 5, tlhnt,~ "Some scientists have suggested the possibility that volatile amines;, especially the ni'trosa- mines. exist in cigarette smoke and shoulkl, ~ be~ investigated to~~ see what signipicance they ~have;,if~they.~are there. A~re~tlrey~reaillv~artifa~cts? ~ Can they be~~ carcino~enic toother ~agents!?"~ Iisthat of ni faniily of a benzo~(a)pyrene~?~~ Dr. FURST. NO; srr, it is a corrnpletely different type of'carcino~enic a~ent and it has been alluded to. It has~ been~ mentioned~. There was'~ a d~iscussion~ of that in this bool:~oii~"TozcarcL (z: Les.s~~llarinfu•l~Oqa.rette,'°' a~ndnhnt thev~~said was this: "To establish tlhe~~presence~of~nitrosamiiies~~i~n inlialedcignrette~smoke~ andi to predict tlhe~ possibl~e~~ h;uzards~~ from, their presence~ it is~necassary~ to~ create~~ experimental conditions simulating ~, as clbsel'y ns~ possible ~ the conditions that exist when a man stnokes~normally~."~ Tli~e,y, a~re~ jiist telling ~~ ns that «-e have to~ cro to work. Then it~ say~s, "Even if the nitrosam~iQies are identified and unequit-ocallv~ estah~~- lished~ as lbeing, present in ci~at~ett'~e~ smche at aa certain lerel,~, then~. it mttst be~ inve~4igated whether they contribute~to~the total toxic a;ct~iv~ito~ in the tobacco smoke." ~ All th:ey are d~oing is sa>.Rrin',, the sanie~~ thing I~ ani~, mrnre~~ research nnustt be~~ doire: I think~ the~ beuzo~(a~) pyrene~~ thiin;~r has been blo«Tni out of proportion. There may lie~ others .a•e~ don't ha~ve. ~~~~e, have~ to find otatl., Mr. Wvrsox: Maw~ I ask yon this!onee final qnestion?~~ Ynu~ stat~e~ ou~ page i;, paragraluh ?;~ second sentence;, "Tlierefore, it is, possible~ to constructt smoking machines thatl cani closely ~ mimn:chutnan smoking lqatter.ns:'" Are von busily trvir ;,icsit t1tat Prod~irces'~lu .,~uu ret the gocerr ~•~mclhl~ions? ~ Dr. Ft•RST: Oh, cer iwrchine~wh~ich~ is not. ; ii)out how the hurna. -~o1°ond's. Wl.7en he~ tall uot~ beinm inhaled. It to escape durin-(r thi<.~ fqperatinm the animal ro 17reathe. 1 o„-.~ I hear that tliati is why machines l)reathinZ:~Now, some If you throtii= smol. ,) nd tlnrs, or~~in~ realit nnal lichs, himself' so tltis our animals are i nto the main strear. t'ow ~ inches~ from the~ (-tuin~res~he nets~the~s: lle,nets the sante~thrnj This 1ins~already~k: n~1-ailable to anybodN ~ APr. A' ' ,'.>;TSOx. And I (-dncer through the in I)r. FrRST. And n M znirnals, at al tiin an equal number~ rnf' flutlte controls.~ Tlii~ (litibrenti~between th laear somebody ~ say, We~ test blood fro~ tliere are~ certain m,, ~ picl: these~up in the ll i h;rt tlio- anional is~ .~ oxleriment you che. 14or. Animals are,sac~ j'~"e~,ilso haz-e~~patho Ila~s ~eti•.erbeen prodna XIr_, "'.1TC(11~~. Bu in(litsh•t~- itGelf~. is'st 1)r. FrnS•r. 011. 1 11 Mr: '1V~.vrnsoN-~., _ln t'I'lllllent ill t1C?'l;el'en(~ f i•oikl t l ie he<leral' I in tll~is p.)rti~rlil;ur fi~e~ Dr. Fvrs'r. That. I~ l~in\-e~not asltrd f( v; vt~t to1uake t.et•y ,,;.niud at ttll.

1038 \'Ir. SA=~RFrnLD~. Do you lrave~ any other~ questions? Mr. ECIiIL1RDT. No questions. _l!Ir., SArTExFIELn: _l'~I~~r. B.roa1ii11?~~ _lfr. BltoyrQIl:r., No dllestions. Mr.~ S_>,TI-Br.r• IEr,D: Mr. Pteyer? llr. Pr,Elrx: Igatlier from that you don'ti put a Iot of stock in sta- tistical associ%tioni as~ hrov~iiia~ the cause-and-effect relationship be-~ t«-een cigarettle smohin'a~and disetlses'? Dr. RIGDOa, That is correct. Mr. PizErEla,, Of what signilicance is itl~ t1lat esperiinenbal attempt atl anim~nl inlr~alations, have constantly and consistently faiTed~i . to s~up-~ port~t~he statistical associi~ti~on~7 ~ Dr. RiGDO-N. Well, we figure that if we cani prodnce experimental lesions that willl hel~p~us~ toward the~possibilfity of sonzetlliing,occurri~nb in mall-it cannot }3e predicted that }.iecausee it occurs in a Inouse or a; rat or~ agitinea, pig tliat it is goinw to~ take plizce~~, but it is~ just ai link in tilie chain that helps us mov'e forward. That is all it niellns.. llr., PnE-i-II,t;: But' you have~ listed a~nAUlrber~of possible cases~ of Iun~ cancer, I-ather, to Inahe it~ clear that votu feel~i d~~efinitelv ~ thatt cig- arette smol:ing has not~ been shown to lie the cause of lung cancer. Dr. R'scDON~. Tlhat is~~corr.ect. Mr.Pr,ri.,l'.. How about a cause 7' iJr.~ R:GDO-N.. It Ilnsn't been proved to, be a cause~ as~ far as~ I am, c",nceluied': lli: Pr.ri-rr.. So~~tlrat~ an-,, ~etil)erimentinl eff©~rtis would help usto~elimi-~ nate one cause out of these many possible canses of cancer? Dr. R'iGDO-N. It would help~~ us~ and tTle~ revers~e, would be~ Inor.e sib-~ nificant. If' we~ could get~ tliese~ thines,~ don't you~ see, then that. would . Ove~~ u'y~more~leads ~ to~~ work~on in tryinb to esta,blish~ these possibilities. Mr. PIRES-Er.: Thank you„Doctor. Let mejust'~ask one more. Do you share., Dr. Furst"s opinion: that assuming that tTlese~ problelns~ are a~ll l settled that that interferes~ seriously ~ witii progress wit~h~ tlle~ research that vou sav' we need. Dr.~ RIGDON.~ II do. Mr: ~ Pr.EYEr;. Thank vou. JIr_S:LTTERnEnD:~ ML , Watson ?~ Mr. AFATSO,,-. Thank you,~ _l'Ir. Cl,lair.nlan, ;nid thank you, Dr., Ri ;d'on. I~«-~as quite~ impressed with t1ie~~ luanC pa~ges,.Iisted of the various puki~- liclti'ons~, that~ y ou either inclividuttillv~~ or with otli.ers~ have prepared andl I~ note tlaere~~ are~ so~me~ ?9& difi'erent~ publictttions and' so: fartli, in -wh~ich~ vou llave~~ eit~her~antllored tllhem~ or~~co'llaboratled wi't-hi otlrers,, one'e a study of tlle:fred~u,ency~~of cancer~in7,,a00~r.outine autopsiesherfnrmecl os-er~a period of 43 Sears~ atl~the Unive.rsi~tb~ of Texas Med~ieal Branch., So, it is~ quite olbv'iou~s, that tilirough~ exposu~re~ alone that you have~e liad~ considerable experience~~ in this particular field. Doctox;,durlng ~ t'tie~~e ea2,lie~r~h.i-es of'your~testi'lnony~,,you scareel me~a bit when you pointed , out where the del-ree of~death~anel the attributa6le!cause of death was~ wron,r in so~ lnanv ~ instances ., ..~ I w~as~ he(rinninr to~ wonder~ whether tlhe~.nnediual~ ~rience~~ was~~.ex~act enoll:,''li relilly to acconlplisll its~j~ob~~.~ 11r'e~~ ave~ doiu-a lot lietber iiow ~ todiv ~ in dcternamin- the ca~u~z~e~ off death tllanl we~did bach~«-1'ien yriu cite(fall tlle.~e errors.~aren't Ive?~~ Dr.~ R:Gt plio) l)leln to lll(DI1 tlllllr~'., ltnve~ cance in thebodv 'L'hh.:cliu 1 Ictlow tda fbundi ai 20 „Te found a~ ' I1: 15~..v :llld tllere N D)r.~ ILIGI see: I~ wonn in cancer, Irlcl: side si,;1 a cle<ii 1)atlioloiric 11r. 1~~T.% takes ,l~~nrl. I t1le}- 1)I': I:SC:I 11r: ~1'e t'l lind in Iljealth Dti that less ~ -'L'o4ll)' of C~. IJI,_r 1>ercel~, of two~cas', I)r: Rlr,l helpful hc earlrer on, ,ll'e~ 1Jer!9n1 11`eTe~ ca:lli tru puslr tll illakinr'st A~"oui n•c I1r: Iac:! tlle'~e lun~ tio~ M titatlstlcti linie~~., j~~~e~ 1S!ti9 ~ in ti 1Ir., 1~~' al'~4o wllo~ conotradi(•I dcatlSs, in. al~l oi° tlie~ :ul~v otllel 1)i.1:'~u c~llr tl~~«~ t:llh~ :1h1lki

1030 S6. Effect of' Oxygen om P. Lophurae Infected Ducks. Rigdon. R. H. and Rostorfer. Hl HI, Proc. Soc. Experi. Biol: &'Med. 63!:16-5.1946., 87s Effect of jTit'.zmin A Deficiencson PZ'asrnoditrtn, Lophurae. Infection in Ducks. Rigdon. R: H., J:,Inflect Dis. 79:27?, 1946. SS. Blood Oxygen in Ducks R ith lI'alaria., Rigdon„ R: H. and Rostorfer, H. H.,. ., J. _\'at1 3l:alaria Soc. 5':2:.i3; 146, C9:, A Physiological Studgof Etythroblast'sini the Ducks. Rostorfer, H:: H. and Ridgpn. R. H., Blood, The,Lof Hematol. 1:75, 1i947. 90! Effect of'Ocygeni on Jialaria.,Ri;;don, R. H. and Varnadoe. \onai B!, J'. Lab:. & Clin 'Med. 3'3:57; 1947: 111. Observation;oni theAnemia in Ducks Infected with P. Lophurac. Rigdon; R', H. and Rlost'orfier. H. H.. Blood. The J. ofl HematoL 3:244, 1947. 92. The Relation of Blood Oz,rgeni Transgort: to Resistance to Xnosin in Chicks and Ducklings. Rostorfer. H. HL and Rigdan, R. H., Biological Bull. 92:23. 1947. 931 Blindness in Ducks Accompanying Hypo_Iccemia. A Clinical and Phtih+ ologi:call Stludy. R~igc3on, R.:H. andl Fletcl:er;, D:E.. -km. J. P'ath. 23:?'?7,, 1947. 94. Effect of Insulin on PlasnroilFxan Lop7iurae Infection in Ducks. Rigdon, R'. I31. and Marvin. H.:V.. Ant. J. Hygiene.:45 :195. 1947. 95. Transverse Myelitis Accompanying Tuberculosis lieniitgitis. Rigdon, R. H., :1m: Rev.,Tbc. 3S':333: 1947: 96. An irz Vitro Study of the \fechanism Producing Rapid Diminution im the Parasi:temia in I)uelss Infected witlh,Plasniod~iii:» a,L'opli iv-ae. Rigdon, R: H., Am. J. Hyg: 46 :254. 1947. 97. Some Faetors that Influence the De~ree ofl Parasitemia iit Ducks Infected with P. LcipPiurae. Rigdon, RL H. and _lIcCain, B,: E.. Atu. J. Trop. Med. 2 7:67 3. 1947. 98:: Effect of 3'. 3'Metlirlt:nebis(4 Hrtlros;vcoumarin) onV'itamin A Defici:ent. Duc,ks. Rigdon„R. H. and Fhrnadoe, \bra: B'.,, Ji Lnb. & Clin. 'M'ecL 32:d3'?, 1947. 99'. Effect of 3; 3?3letliclenebis (4 Hydroscconmarin): "Dietunarol°' on P., I,op7iurac Infection in Ducks~ Rigdon. R'. 111 and McCaiu. B. E., J. .\'atlL Malaria Soc 7,:38; 11448, 100'. Tularemia in Arkansas. Rigdon. R. I'I: and!CltesnttttL C. R.. Jr.. ,I. Ark. 3IecL Sac.:44:153, 1948. 101. Chronic Ahsce"es Secondary to Cholelitheiasis and Perf'oration of' the Ghllbladder. Rig(1hn„R. H..,3tn. J. Surg. 77 :1°4, 1949. 102. A Consider.atibn of Glomerttlar \el?hritis in its Relation to Sulfn, Sensitivity. Rligdon. R: Hl, Sidrlen, A,'. H.. and' Ftetcher: D: E.. Am.,J::Jllod. 6:17i. 1949! 103. Neurolo:gie \Tanifestations Associated cc,ith Vitamin A Deficiency in Young Dueks, FIeteher, D'. E. and Rigdon. R. H.. Arch. Neurol. & Psych. 61:199, 1949: t'nicer.citj~ of'Tea~as-G:al!iC.0o)a: Te:r. 104. Clinical (lbsercationson, Vitamin A Deficiency iit Zoung' Ducks. R:igilon. R. H.. Texas Rep: Biol..C: 31ed: 5:4.,438. 19-I7~ 105;: Diffuse Xmploiil'osi's of tlheSI.itt AccnmPauyin;Priinar}• SystemicAiny:loidb-sis. Rlgdon. R. H.. Am. Practitioner?:423. 1948. 10fi: A ConsideratimtoftheUaeof'B'Lood rnd Oxygen asSnlsPortive~'llherapy in theTreatment of 'Mnlu•ih. Rigrl'an. R. II.. Am .T. C'lin.,Path: 1`n:485; 1949: 107. Tulhremia. Rligdon, R' H:.'Lesas St. J. S['ed. 1'4 :1°: 1:1-1c. 108. \TultiltleLymph:osarcomatouc; U1cer:,4in the .7ejtulum :', Report' of a C'ase: Rirdnn. R. H.. Rogers. F:, F.. and hirksee;, O. T.. Texas Rehts. Biol. & \Ied: 6 : 414. 19#R. 109. I:ffect of Blood and Orygen nn P', Tiiiau9n.•i Infection in -'lonltess. Rigdon, R. H:. Srn: T. II'ygiene 48':1-I7. 19~~-18. 1'10. ('liniraPathnlbgiY Canfaranre Rigilon, R: IL, Ant. J:, Clin. Patli.: 19':': 357, 1'940. 11'1. lIemoglobinnria (Blaekwater I•`ever)in 1'lonlce,rs, A Consideration of t'heDisease in\Ina: Rigdon. R'. H.. Am. J. Patihi ? i: 193. 11149. 112. Macroglos+:ih Accompanying Primary St-stemic kanyloidosis, Ri,clbn„ R. HL and \oblin. France4 E.. Ann. Otol., Rhinol. C Larcn ol.. :0 +:470. 1949. 1'I- Frequency of Cancer in75dl0 Routine Y,utnhsies Performedocera Period of' 43 Years at' The U.nicersity of Tesac \fedical Branchi Rl,don~ R. I-I. and. Kiildpr, L. A. TesnsRhgt,,. Biol. &JCed.. 7:'37,1949. j 114. Effect of' Ant Treatled! arc 71 :6 37, 1949 11i:,. The Electroca Arthur and 1'10~ Lethal E8'ect: DihTdrocbh Arthur, J.:L, 117. Effect of H',ur, Ri ;don.R. : 11S: Slttldeni Deatl. Southern 3I 119. Thrombosis o R. H. and Ln 1'U;, Stulden Deail andlWillefo 121. I'ulntonaryA Braclfield, : Dis. 34:?36l 122. Chorio-EpithE R: H., Am. : 1'_'.',. A Considerat_ R: H., Am. : 1?4l Sudden: Deat Insurance :, 125. Observations cytes. Rigd 271, 1950. 126. Effect of' Ph, tion, in the Am.,J. HS,g. 127. Pi:itnarvCarPattl„ Texa . 1'_'S. Observations ~ titudCin. 11 Malariai S( 129. Il:einz Body R:igdon, R. '-I' 195 1., 1::0. Nec tocis, of' Nvith Strel 1L3 1., Frequency o Rig-don. R' 1C;'_y: Acctu•acc ofaa: Shown P,io1..C IIe Sninc, Com:hl Nvith Strel' 1:t4: .Ln _\n(mal c'ronk, E. 1951. 1 > ; St,lne Toxic Rt; dbn, I T hsic CoContcr.:IS' IC:G; I:1Tei•t of 11 i Dnck. It' 137. PttholoTicI)oilcient1'Tti. A Consider Tncid'ence T.ehts: Bii 139. \'I<<otic An C ise Nvit] 4tili; 1952. i140. P.tncre.ntic lili;;don. T

1014 2,"r:, Sonte pharm,acnlogic comparisons between 3'-tolosspropan-1, 2-dio1' (\I•r,nne- sinY and! 3-ethoxs-l-isopropotc-propan-`?-(Iiol (with H. Davis,, If. Neal. F.' JL -llUrphy). J. Pharmacol, Exper. Therap. 98 (1), 1950 29: Semi-micro determination of ethcli alcohol and acetaldehyd'e in biolnric fluidls (i~vith T.' N. Burbritl$e, K. P: Bon-man; :><, Simon, E. Jfacklin, and A. Schick). J! Pharmacol• Exper. Therap:,98(1). 1950 39: Action of a series of glycerol others on froz i5ol'tted muscle preparationc (with Ii! Davis and F. J: 1fAtrphy):• amh: int. Pharmacodpn. 81: a9fi, 1950 31. A cimple cpectrophotometrib methorlif'nr determinina nf'tetra-ethy1' thittranr- diculfirle (antabuse), in blood and' urine (with K. J. Dii-iata),. Fed. Proc. 9.1950 32. A simnle spectrophotomPtric method'for the dptermination of'aretaldehyde iniblood (with T. N. Burbridge and A:. F. Schick). J. Lab. Clirn Jted. 3:;: 9C3. 19:~0 33. Compartive toxicity of five glycerol ethers (with P. Loeb and H. H. Andirr- son ).Arch,, Indust~ H~vg:,nccttp: Med. 2. 3-4. 19T9 '.4. Toxicology education in the accredited collezeR nf' pharmacy of'tlie tinited 35. Stat'es (with BL Rice).,Pharm. Admini 1:Jr41, 19i1 InditPtrial hFgfeneand toxicologv(trithL. LeNvis)~• Encyclopedia of Ciiemi- ca1Technologv, 7: ,",47, 119:i1 3(3': The in ritro metabolismiof ethanol by rat tlissue slices Ovith T. \. Blrrhrirl'ze: H. W. Elliott' and V. C. Sutherland). J. Pharmacol! Exper. Therap. 101' (1).1fi31 37. Comparative toxicity of a series of derivatives of phosphnrtts containing , acidt (with Ei L.:•'Iapo andT:.\', Bnrbrid'ze). Fed! Proc• 10(1). 111 :~1 34: PrevPntinn,of'injitrT from x-radiation (with F. R. Holden, E. Toc•hilin, ancl. J.. Lewis). Calif. Medi 74: 1Lcc•,1971 39:, Clinical eralttation of tetraethylthiur.qmdisttl.c"ide in the treatmentof'pt•nt lhm (lhinkers (with K. 11. Bowman. A. Simon. E. A. 'Mt'tcklin. G. HL Crook. T. N. Burbridge: and K. Hanson). Am. J. Pcychiat: 1~0,:A32; 19iL 40. Distribution figures onblond and brain alcohol takeni from post'mnrtetn apecimenq. Proc. 3cad: Fhrensic Sei'. 1':,1ft1, 19n1 41. The toxicology of'some of' the important economic poisons. The Vortex 1'3P, 30. 1951 42. Toticni:oaic stnd'ies on synthetic glycerol (with H. Hl, Anderson and \I: ITorse).,7. Pharmacnl. Exper. Theran. 1,0•1"(4'). 19•;l 43. ChtdiPS in the metabolBcm of' ethanol excretion of (]"=lahellhd CH,C;HX)H i'm therat(«•it'h T.N: Bnrbrir>'ge)~. J:, Pbarntacol. Exper. Therap• 10Af4), 1951 -14. Roamrl'-tabl'erli:sr'ussioni on "T1ietnxicnlhzi:Yq annroaeli totheanalcsisof ni gener:il unknnwn,"' Proc. Am. :\cad. Fr,rensir Sni. 1: 373: 19.-)1 45. Some aspects nfthe hnman phqrmarolo,y of tPtr~ethclthiitnamdicttlfitlP(~n+ tnbuse),al'cohnl reactions (mitli T., N. Btu•bridge:, E. A. Afacklin: and' A. q;mnn).T, Cli'm Jm-est:,.31: R1i7• 19•52 -}tA Toxicity in rodents anrl' antirlinline,t.ra,a artivitv of nrzann-nhncnhnrna emnpmrnds («-itli E• RI. Rliack• J. K. Kh(I;tma, and 1T., S! \Ihrse). Fe,l' Prnc: 11(1)_,1f1:~2 47. Cnnversinn nf' eth;tnol tn acetaldehcrle in r•t±y7o (with T. BtirLriilre :tnrl! 1': C. autborlattd). FcrZ.,Pnnr;, 1'1'(1 ) ~, 1!1 7-2 -3v: Tlie ectiinntion and sicnificance of narnIdehyrle levels in hlnnd and hr"in (with P. P. Figot and E. LeongRTap): Acta hharmacoli of toxicol. .`a:• •'!ln: 19•i_>' -!`.); Some nli9rmacnlnr,ic cmnp;lrisons of 1-rthnNc. •^.'-i,ottronoc-`?-nl nndl 3. -('- meth•rlnhpnnxy) nrnpane-1. 2-rlinll (\fcnnesin) (with I,i. Dnvis: \i< W. \pnl'. T31 E. C'hristlensen, and 1'. J., Vurphy.) Arch int. Pharmacodyn. S!1':• 14'Si 19:32' •;o. _Csimnlemetlindlfr'rtlie(1eterntinntinn nf'tetr~t'ethclthinr~mdi~nl~~le(:>nt~~bnse) and hlhnrl!lecels ohtainecl e~ne im^ntlllc in animnlq nnd' clinicall, in ninn (with K:,J: Diir.ltiir, and T. N. B:rnhrid~re)'. J: Lah; C1in. SfrrT. .1!/: 974. 1IIl•i2' : 11. Effects nf' alcnhol in cmnll dn~PC and' tetr;tethrlthin'r.qmrlicnlt 11ir1- (,-1ntn- hnse) on t9te cerebral blood flnn•' ;tnrl' cerebrqll metntiol6.c,n (with A. F. '''vrhipk, L. lrarznlic, T. \, Bnrbridze. and A. Cimon)• Jl Pharmacnl. Exlier. Therap. 1'0f?': 2~--.I. 1952 .,2. The effhrts of adrenglectnntv: ACTH. ^nd cortisone on the t'ncicitp nf'a hnl- mnnar, v iiritnnt (CBP-55)' (,n•ithi (`. E. Peters. S. Nn,Tamo;, and •J: K. Iindama) J. Pharmacnl. Etpcr: Therap. 1a6(i-t)• 1n53 •i•.r,xicoloa;vancT sa lu•nr-11 (with El \. «`. J:tcobsen)\'•ntW tktxicitcof3.Ml'• K. Dunlhp):. 11'InnparatiV•e toxic l;n(lamaiand \f. t'nmparative toai< <.nn. Hl D, I1oo 3led- ^r'f 2'Ci,sir•olbzical app Inrluttry Regiol ,stiulii•s on the to: l. I• inlec, and •l lC:, creenrry treatn ~ h„liott~tera~e-ini with .1I S: 3fc ~(i:~. 19af •1'lie toxicity of g ,liim•nallyl alco •J. 1'hartnacnl. I 1' si<°it} studies o .1. I'hnrniacol,. I , 1'Innlparatin-e to3 lindanta. A;IL ti Il;v_": (Iccup. A'Ii \rntw• toxicity of' II. .lans;.:)Fed. ~omeefYec•tsof'cV'. ('. :,tttherlar-~;it•e haaullii g, p iniltstrc 1 tt•iti. .. Toxic•oloricral st-Andncson, .J• ; 1ndnat.H;)-g. C \ r:taii(l nnetatorl C_ wa~.•). J. L<. '.~. Studies ontlie r~ctno-phovph `(-licm:tn unrl AIi,•t'llrnlfur., sir hyd;nntoin in l. ~i. AlI-I;iLolic stiuli'slic•es ( N1-ith .1. '11nxii-ilc ofallc' , . 1~:Ilbctof'aneta]V. t'. ",nt)serl:' -_ lnl:ihi'tion, of r. Comr~ey andl] ~ - r',•ntinL uervou: Malfiu1ud. 1;.. 1, lit,iu:l eva' ~ T: , . r :~tuu+ut: f 1Cci laiht•, li.: ' \~1~liitiunh I Ae•nruhntl~aing;twliicne Orit lP:ith. UqY:13!) ~ 'I'osioitvnP ar~in :, iatiiual, W : ~ I ranlal l. -\rc 'I'lu'nrnrutnxie lrLnn}-1phow, ~'. V. ICru,:s, at. ~ Pl.ili ~'

Dr~., ItIc.ooX~. T~~: es, we~ are~~ doina~~ a lot~ better,lint it~, is still a difficult problem to~di<i_nose clfinical0_y, some of~t'1Lese cases. It ismotan ttrY~com- iiaon tbiii~~~ for us~~to~fi~nd a~person tliat~clinicall~-~~has~been dia~gi~osed to li~i~-e~ cancer of t~he~ lung and renlh-~ and tru'ly~~~h~.ce~ can'cer~ elsewhere in the bod~-t'1dat~ spread up:there. 1Phe eliiiici'aii di(ll t1ie~ best lie could do~ iiv diagnosing ~ it but still n•hen. I Ia,iow that, I ha.ve~ to~~ he~ cautious~.~ I[ reviewed a group~ of~ cases~,andd f~~otuid a -)0~~ percentl error in; «-liat «-as~~ oil ~the~d'eath certificate~~ and what Nve~ frntt4at~the~~autopsy. `.lr. W;cTsoN;~ And tliat was~as~ late as~ 1963: tliat~ ~-ou~~ had tliat~st-ud~r~ :uad tl~iec•e.~-as <~ ?© percent-error at t~hat tin-~e~., ~~ ~ I)r: Il.unoti; Ye5„and it was in a hopsital that specializes, don?t youu see. I~ <<: onf*'t name where it was, but i't~ was~~ x! hospital that specralizes~ in cance.r, I~ hare~ to think ~ about tliese~ people~ that'~geti~siclti~ out, on~ the~ biclk~side~of tlle~countiy~„and don't have~X-rays~. A doctor just lias~to~ si_n a deatlrcerti'ficate~ as bestlhe~can, and at autopsy I find a different l,atlioio`ric hrocess., JIr.~ WAs.soN. That i's~ right. j~~`elL they say~ «-e~ lanryem mahe~ nri;- talties~.ind our mi'stakes go~ to~ l~rison. You doctors «-1i~en you make mi's~- trr~l,es tlter.~~o t~o~~the cenlctery~~. ~ Di•. IbzcDO-N. Y:es„we bury t1SemL . 1'~tr. AVATsox. You bur~ yours. I was distressed on~ the same age~ t() find ini tllie~ first paragraph that ofiicials of the ~;~e~~~ York ~tate Flleadth Depar.tn7ent in 1655;, andl tha~t waslrt too lbn- ~ ago, found out that~ less tliali one-~liailf of' the deaths~ attributed to~, pneumonia in~ a~. rroup of cases they~ reviewed actually~bad pnettmonia.~Th.Yt is~ a, pretty bi-, percentage of error there,~ «-hen you miss it' in better than one~~out of two cases; is7''t it, D'octor.'?~~ ~ Dr.~I:;rcnoN. I would thinlt~so. Mtr. WA•rsoN~. I ahpreciate~your testin7oisy.,I think it'~Itas~~been dttite~ liel pftil here and~~ should alert us to the~ fact taiat there is~~ as I mentioned earlier~one eminent tl~lioracic surgeon~ that statetl' that perhRhs~~now n-e~ are ~~ begiinniniff to~, dia~gliose~ tliese~ cases~~ as~ Iun~ ~~calicer «~here~~ earlier ~~-e~ .rere~ caIlin- ~theni soniet~li~inr~~ e14e, avld tlte.re~ is no need' for eti-erybodu~ to~ push the~ panic bntlton, rig'h~t heire;~ that perhaps~ we doctcors'ha1g~ been mal:~in,(r sotue~ mistalc;es~ in our diagnosis in the~ earlier cases. You wouId probably~ a-~eee with that rntlleuian,, «~ouldn't you ? ' Dr. llzcvoN. I tlcinlti that correct,but not: only~dia~nrosin~ but codin~~~ tliese~lhni ;, cancer~casesr-they~ were not coded as~~specific lesio~ns bef~ore~ 19~;9 so .1-.e~ j;iist put all of tlfi~eini in agroup: We~ j,tist dbn't lirtre~ any statistics before 1~940~ as~ we becin tlo cllissify.~tlleini speciff~cally~at that time. We ~ ba~ve to, be cnntions in interpretin,(~ w-1in,t~ went on before in, tri•in~,r to ~ eiraluate~ the frequency ~ of' hino;, cancer. Mr. Wx.rsox.~ And as~ a hatfiolo;,ribt I i2n stire~ it~ concerns a maai also~ who~~ i~s~ i~nterested in t'Ihe~ trutlu that Ave~ bave fi(ures that are tm, cont'~radicted «l0ere. as~ youl point. oitt, the incidence of lun~,r~ cancerr deatfis~~ in En-l,ind~ is ?A pei~~~ ~~ril~l ion ~~-laile~~ in _1'rner~ica it is~ 11~ a2id all rnf~ tlrese hialds ~ of thiiu-s,~ and the~~ conie up~ wit~lih no~~ la~boratory or au~y~ otl~er~ information to ex~plain~, tliese great disc.repa~ucies~here.~ (',in1 Vou eX~~plain tbcni? Dt•, I:n no-~,. -No~., I c tn1rt. Tlie tlilim_'tlirrt 1>oYilSet s~ trIe islhEit it is~ d~i~a7i- cul~t to r e'trrbl islil e.;tctlv ws lcat the~ ]ritii i,t had I-1'ien lhe~ dicd.~ -Noa-. «~e tailli~ Ab(/llt~ lleart d.!i.-e<1~e3 1).nt w11llt~.lIIte~. ACI' saiv1n;.,C w~.lleni wee s41F.~lleartv

1012' Academic and researclu positions held Wisconsin Alumni Research Fellbtr-1938'-42 HeadofToxicologg Activity, Nati~onall -N'aval Research Institute-1916' Chief Toxicologist and' Acting, Head' of Radiologicall Defense Laboratory,, U.S. Narall Shipyards, San Francisco-1947 School of STedieine;, University of California, San Francisco liedieal Center : Lecturer in Pharmacology-194'7-4S Assistlant Professor of Pharmacologs-1948-52 Associate Clinical Professor of Pharmacology and Tozicology-1952-64 Associate Clinical Professor of Preventive (Occupationai) Jiedicine- 195u-64, Clinical Professor of Preventive (Oiccupational) Medicine and Tosi ao logy-19(i-1-present University of California, School of Public Health Assistant Professor-1948 •-52 Associate Clinical Professor-1953-62 Lecturer-1963-present Board certification. Industrial Hygiene (Tosicology)-1962I Preventive (Occupational) Medicine-1956 Military service U..& Navy 3Iedical Corps: Ensign (TiICVP'),-1'942-43 Lieutenant ( j;g. )-191445 Lieutenant (s.g.)-19-1G-47 M'em bership in professional'societiesAmerican Academy of Forensic Science (Fellow 1957)-19i0' American Academyy of Occupationali Medicine (Fellow 1J60)-1957 American Chemical! Society-1950 American Board of Industrial H~•;iene-1i9G2 American Board of Preventive Medicine-1h56 American Industrial Hygiene Associatiion-1949 American Jiedical' Association-1iJ46' American Public,Health Association-1954 American Society f'or Pharmacolo.ey and Esperimentall Therapeutics-19-17, American ThernpetrticSociety-19G5'California Academy of Preventive 3ledicine--1957' Calif'ornia _lledical Association-1918 College of Preventive Jlet3icine-1956 Industrial atedic2'1 Association(Felloxvlil5S)-11151 International Association of Forensic Toxicologists-1963 DIedical Advisory Committee of tdie American Petroleum Inst'itttte-10,521 San Francisco County Medical Societ}-19-IS Sigma Xi-1N7-12 Society for Experimental Biologc-and lledicine-1">47Societpof'Toxicologs(;Foundingmember)-1961 Western Industrial Medical Association (Certified)-1952' P'rofessionaluctiz;i,tiesIndependent Jdediaal, Examiner for State of California Workmen's Connpen- sation Appeals Boardi Practieine, Physician, licensed 1944, USN`: 1p:16~ State of California President. TheI1ineLaboratories, Incorpot;ated. Tosieologist to theCoroner. CitcandC'ountly ofSnnFranciscoConsuitant in Occupational Health and Toxicology Consultant toCaliforniti State Department ofPubl'iQHealth in Toxicology b'pecial h;onors and election to:special'me7nb'ers7rips~in sncietiesCertifiedl by tihe American Board, ofP'reventiveJI'ecdicinein, thefield of' OO ccupatioval _llledicine (;Fottnder'sGroap)'-lA:iGElevat'ed toFelLow in the Amerioan Col]e~enfFrecontive J'Ihdieine-10.~G IElevntedlto Fellocvin theAmerican\cademp of'Occupation;ill_l'Icclicine-1GG/IEleratedlto Fellow in the Industriall\Iedir•,rl _Association-lPuS~Iioard of'Inclttstrial Hygiene, certified iaiiTOxicologp-1C)G2' Itecipient of'the at.es for sucee Fonnd'in,~ , memb, Some observati. Sclineltte). 0= ": Stu<lt-of thecu li~ozs llca ) . Jl I A tuethod for th (with F. L. N =l Distributionl ra~ hozellca)~. J: 1! Studies on tlhe~ Pilarmacol. E 1;;, A~ method~ for~~ t! , ' ~. teriaI (with I Di.c_tnibution an Iiozellia). J:,I. 3lethod for det F. L. Eozelk: _ll(tnbolisur of ~ Iiozelka ). Fe4 _Anticonvu14a[1t (-fISiiantin (I 1 ':):,'_" •;redntion pni Estrer. Thera ~. Alrtabolii~m of~ I 1:~ozcllcai)',..7L 11 '11ir e1Tect of p 1SIal:~kmore ) . 1 IL .\li aocurate col i witlr T. E. S 1@evi,ira t'~ory ~ ext Fed. Proc. l: ~t 1G:, IS,Ilnunc•e~of~so~ Inatul'e~huma~ . _ t-1~S ~ : "1'lie~tox~ic.ity ~ofl~ The e111ects of ing (Xv,it11 T. : 'ilho rumpuiratii ~ i',witli lI: E. C Cmnp,tratici., to, Fed. Ptoc: 5~, _ norVu-auuscle~ S. 1949 1 uicersitv ~insth \ uinili(ied ullti u:ttion uc~ ba~ 1') I't _III '1'Lr ,-i'ntpaa;tti etlters(with _ 1~'xl)er:,'1'hera. _1~rr auult.sis of li n~uil.v 1~~•iti I'lli r: l :. .kl,r:. ('hom. Sen: N, ~~`iVlnL: ~ t0ra~ 1;. \. \i': t•lrl t'liaruuu u1.,1

it )r :t a it lt ct )t n ie :e 't .e t'- Mr. SA=IaFIr,L>D. I hat-e been infonmed,, aaain in the interesti of tilne., tllatl Dr. Broda D. Barnes,apht-sician and medi'cal researcher of Ft. Collins. Coloradb; has filed a statement with tlte' committee and withont objection thisstatements will be admitted at tliispoint. It -will be included in the record of these hearin gs at this point. (The statement of Dr. Barnes follbws':) STLYTEJfIINT.. OF. DR: BItOn:t , O. BA~RSEH, , EORT COLLISS, COLO. \Ir name is Broada O. Barnes; I practice inediciue in Fort Collins, COlorado;, but' devote over half of mc time t0 medical''. research: JIy undergraduate work was done at the University ofl Denver where I began my career in research in 10"u. 4:3' years ago. I taught Biochemistry to medical' students f'or t«•.o years at Western Reserve University where I received a~ 3laster's degree in that subjcet, in 1930. I taught Physiolog5y to medical stud'ents for five years at the University of Chicago where I earned a Ph.D. in Phrsiologrin 1931. My medicaldeareewas completed at: Rush Medical College in Chicago in 1937; , hence,, I have prac- ticed medicine for over 30 year~s. tiniversitirappointmentsin theinterimn haceincluded the University of Illinois School of -Med'icine„the t;niversitS of Denrer,, and COlorado State University in Fort Coi:lins~ Since I have been engaged inn both research and the practice of inedicine, I belong to appropriate societies in both fields and have contribute& over ia publications to the medical literature. For many years Public Health officers andi others have been trying to con- vince us that cigarette smoking is very dangerous to health. On the other hand,, ni numerically smatler but equa1~.1v capable group of scientists has been stating strongiy that the evidence against t'obacco is general and cigarettes in par- ticular is inconclusive. Whenever there is such strong disagreement' among scien- tists. it usually means(1)', that importantl andl necessarvevideneuis lacking, or (2) that the' evidence presented is, not consistent, arboth. This statement rela~testomy personal att'empt to resolve theqtiest'~ions, involved in: the si*cttlled cirarettecontruvetsp- s,i that I niipTht decide «-hatt'~o' tell mp, patients. A'ocl:ear answer n,aspresentedl in the medical literature. If' I were going to learn about:lung cancer, it seemed necessary to know something about the natural history of the disease. Iwent, therefore, to the medical centers, of' Europe, especially to9ustria whei7efor 200 yeaa•sa law has required an autopsy on~ each: patient dying in the hospital. My studilesR-erecouducted in Oraz~ Austria, a citrof 230;000inliabitantswitltonlsonemajor hospital where all hadl to seek medical attention. There one can get across-section, af' the population comingtaautopsy eac•h, rear, sinceabout:7:ic/oof all,deaths: occur in the hospital. Theseareall autopsied in thelargest, Pathological Instlitutein the«-orld., This figurefarexeeeds the percentage of' deaths coming to autopsy in the United States. I cannotoveremphasizetheimportlance af'autops_r diagnoses. T1iisis especiaSPrtrueregardinm Iung cancer;,whieh can closely resembletlttberculosi'sin location. onset, symptoms, physical findings, cliniicaU courseand terminal death. Stu'dies~ show that because of' these similarities between tuberculosis and lung, cancer, physicians oftentimes are unable to distinguish, between the two diseases withont't aartiopsy,, I1`orexample,, in 1913. Dr. Weller, the pathologist at the tiniversitc, of \Iichigan,, collected'J0 cases which were known to have had lunn cancer because they hadi been microscopicallyesamined. Only one case out ofl nine had been eorrectlic diagnosed before autopsy. OO bservationsoarried out during the lastten }•.e,irs on~ the autopsiesatl Grazh2ve ledl totheconcIusi~on that mos~t. if not all.,of the reported iiicreases in lnngcancer, heartattacks,a~ndemphysemai have not resnlted from smoking cigarettes.. diet or other envitonmentaI factors. Rather, they aretheresultof'a decrease insome diseases which therebcallowssusceptiblh p.itii ntstoli've long enourhto contract those diseases showing ani incrense. While the eridenceagainst the theory that,eigarettes cause heart attacks is even stronger than the eeiilence a,ainst the theory that they causelungcanccr, 11 shall limit mr;diyoussion riida}-to lun; cancer.. At Graeeomparison was made between the incidence of' tuberculosisanrl ttlno incidenceo£ lung cancer from 1030'througlf 1Ati0~ Over (;4:O1N)'.nitopwies ocounr~edduringtliis interval. 7,'her.earetliree periods which deserve slx.cial attlention. The first ia1930 when 1677 out oE'each 1.1tt10 deatli,, «•eredue totnberculosic. Thisi's ai .•erFhigh figure, Uein; atl least twiceashirh astihat seen in either England or 29 23Fr-G9. [1t.:r-11. I G

1023 3. Rigdon, RI. H,, and, Kirchoff', Helen., Frequency of cancer of the lung in alli malignancies stiudiedl at autopsy. Southern 3led. J., 44 : 506,1951. 4. Rigdon, R. H. and Iiirchoff,, Helen. Accuracy of' death certificat'es for estab- lishing the frequency af' cancer as shown by autopsy. Texas Rept. Biol. Jled., 9 : 652, 1951. Rigdon,, R'. Hl,, and Kirchoff,, Helen. A consideration of some of the theories', relative to the etiologp and incidence of' ltrng cancer. Texas Rept. BioI. Med., 10: 76,1952. G. Rigdon, R'. H., Kirchoff; Helen„ andl Walker, 'Marg Lee. Frequency of' cancer in the white andl colored races as observed at autopsy between 1920 and. 1949 at the 3Iedical Branch. Texas Reptl. Biol. _liedl 10 : 914, 1952.. 7. Rigdon,, R. HI, and' Kirchoff, Helen. Smobing: and cancer of' the lung-let's review the facts. Texas Rppt.Biol. 3ied., 11 :, 715. 19:i3! S. I"iirchoff, Helen, and Rigdon, R. H. Smoking habits of! college students in Teias; Texas Rept: Biol, Died.,,12: 292. 1'J:,4: `?. Ribdon, R. H.,, Kirchoff Heleniand \Iartin, \ orma. Where cancer of the lung occurs in Texas. Texas Rept. Biol: JSed.. 13: 1G:.;195:,. 10. Rigdon,, R. H. Cancer, of the lung before 1900: a historical revie-w: Texas Rept.BioL Med, 13': 993, 1955; 11. Iiirchoff,, Helen, and Rigdbn,: R: H, Smoking habits of 21LG12' individuals in Texas: J. Natl. Cancer Inst.16c 1287,1956. 12: Kirchoff, Helen, and Rigdon, R. H. Frequency of cancer in the white and negro : a study based upon necropsies. Southern Jled. J.,, 49: 834• 1;t5G. 13: Rigdon, R. H. A consideration of smoking and cancer of the lung, with a review of the literature. Soutihern Jled., J., 50 : 5'?4, 1957: 14. Rigdon, R'. H. Cancer of the lung and smoking. A review of some of the data. Proc: of 1957' Seminar,, National Assn. of Coroners, Louisville, Ky.,, Aug. 1957,, p: ,:i6'. 1:,., Rigdon, R. H., and Kirchoff,, Helen: Smoking and disease., A studn based upon 12,050' individuals. Te.as, Rept. Biol. Med., 16:~ 116, 1958~. lr;: R,igrlon, R: H:, and Kirchoff,, Helen. Cancer of the lung from iJ00 to 1930. ytrrg. Gyn. Obst., 107: 105,19 58. 17. Kizchoff,, Helen, and! Rigdon R. H'. Cancer of the lung-sex ratio: A review of the problem. TesasRept., Biol. 3ledl, 17 : 2ff;,19.59. 1S: Rigdon, R. H., andlKirchoff, Helen. Cancer of the lung 1930 to 1960! A review., Texas Rept::Biol. i1Ted!, 19': 465,19611. 10. Rindon,, R. Hl, and Kirchoffy Helen., Vital st'atiist~iesand the fs:equenncyof : disease. Texas St. J.,3Ted., 59: : 317,19691, 20. Riadon; R. H. Cigarette smoking andi Iung, cancer. A consideration of this relationship. Southern Med. J., 62 : 232,1969: 21. Bayle, G. H. Rechershes sur la Phtisie Pul¢nonaire, Paris. Gabon, 1810. Trans- lated by William Barrow, Liverpool', Longman & Co., 1815. 2 2. Storer. Carcinoma of right lung, with s,rmptoms resembling those of h1•dro- thoras. A'm. J. bied. Sci.,,21 : 46,1851. ., 23. «?o1f; Kurt. Primary pulmonary cancer. Fortscher. dL \Iedl, 13: 725, 73fi, 7G:,, 1893. 24. P,onser, Georgiana M. The incidence of trunours of the respiratory tract in. Leeds. J. HSg:, 28 : 340; 11928. 25. Iiing, George, andl \ewsbolme, Arthur: On the alleged iirc.rease of cancer. P.t•oa Royal Soc. Lond':on„ 54: 2011, 1893. 2fi'. Boyd, _1L A. Cancerofbronchial gland'sand lung: Lancet, 2: G0, 1857. 27. A,cller, I. Primary Malignant' Growths of' the Lungs and Bronchi. London, Longmans, Green and Co., 1912. 28. Weller„C. V. Primary carcinoma of thelhing. Aroh. Path.. 7.: -178, 1929. _°9: Wells, H. G:. Relation of clinical'to necropsy diagnosis in cancer and valtre of existing cancer stZtistics. J.A.3i. A., 50~: 7ti7;192:1. 30! Fried, B. _lI. Primary ca¢cinomn of the lun s, +,rrri: Int 31ed., 3:;; 1',, ]92.~. 31. Barclay. T. II. C., and 1'hilli:ps; <1'., Jl, kccuracy , of cancer diirgnosi~ on death certificates. Cancer,15 :5,,1962. 32. James„G. et a1. Accuracy of cause-of-death statements on death certificates. Pub. Health Rept., 70: 39, 1955. .',3. Aasa, L. E. How meanine ul are death certific:ntes?' Wisconsin \Ied., J., :,9: 38: LitiO. 34., Wfialer• E., and!GrimstTedt, M. C'linical'din; dia,-nocauses of death,and their reliability. Acta Path. 3lierobioL 6cand.. -13':~3; 0:1'958. 3.;. Korns. R. F., and Lintz„«'. B.:Deathcertitionte-.iu~topsy noncorrelatlions studs,Ne-w lork ! StateDept: of Health. I"npubiishedl194'1:

1045: 26. The Excretion of'Iodine in,Esperimentlal Hyperthyroidism. Aim: Jour. Ph,dsiol: 103: 699, 1933. 27. Studies on Thyroglobulin. II. absorption~ of' Th1-ro; ;obuliu anti! Related Sub- stances from the Alimentary Canai. Am., Jatrr•. 1'Itysiol: 103::,i0', 1931 ((with Bueno). 28. The Feather Germ Test for Thyroid Hormone. _im. Joztr.Phd.sM. 105: 3. 1933.29., Further Studiies on the Excretion of' Iodine in Etiperimentali Hsperthyroid- ism. Am< Jour. P)t;r/siol. 105: 3;1933. (with Chang). 30: ParathSroidlTt'tany in the A:lbino R!at. Ana. Joeu. Plilt.eiol: 10:,:3; 1933. 31. Studies on Thyroglobulin. III. The Thcroglobulin Content of' the Thyroid. Gland. Am. Jout•. Plilr,xiol 105: 336:1J33j , (~with Jones) 32: Influence of Thsro-parathyroideotomy and of Parathyroid Hormone upon the State of Calcium in Serum of the Cat. Proc. Soc. Erpt(: Biod: and l1ed. 32 :253'. 1932. 33J The Effect of the Endocrine Glands on ChrbohSdrate 3letabolism: Ant. Jonr. Pli,t{siol:, lOS:5, 1934: 34. ThePirsinlb.-ical a'ctivitrofthe Thyroid' Gland. Am., Jour: PTzysivl: 10S:a; 1934, ((with Bueno and Jones) 35. The Effects of' Partial and Complete Adrenalectomy or_ Esncrimental Dia- betes., Am. Jour. PhysioL IOS':35, 1934. (with Ferrill. Rogoff. and Scott) 3(i. Further Studies on the Effects of Partial Adrenalectomy on Esperimentall Diabetes. Am. Jour. Physiol:,10S:89;,1934: (with Roroff, Scotit, and Ferrili) 37. Effect of Adrenalin on InsuIin Sensitivity of Partially Adrenalectomized and of Hrpotbl-sectomized Dogs. Proc. ,Soc. E.rptl. Biol: and Med. 31:11i45;. 1934. (with Ditand Rogoff) 34: Effects of Partial Adrenalectomy on Esperimental Diabetesi and oni Sensi- tivity to Insulin. Proc. Soc: Eaptl: Biolk and Ited. 31:524, 1934. (with Scott,, Ferrill and Rogoff) 39. Implantation of Dog Pituitaries into Immature Rats. Am. Jottr., PTiysiol:, 113. 1935, (with Fowler)40; Diuresis of HyperthSroidismt Proc. Soc. Eaptl. BioT. and', Jlcd: 32':616;,1935. (with Rogoff ) 41. Experimental Diabetes Treated by X-ray :';ppliedl to the Pituitary and . Adrenal Regions. A'ma! J'oatr Plidsial. 113~, 1933: (with Culpepper andHRrtton), 42: Influence of Thyroglobulin, on, Basal ltetaboli'sm. Ant.. Jo:er.PhysibT.. 113, 1931 (with Bueno) 43. Some OO bserrations, on Dogs Following the Administration of Prec_ nant Mares Serum. Am.,Jbur. Pli.ysiol; 113, 1935. (with Bueno). 41. The Influence of Posterior Pituitary Extracts: on Eaperimental', Diabetes., Ant. Jour. Plialsiol: 113,1935. 45. Further Studies on~ the Influence of the Adrenal Glands on Experintc'ntal. Diabetes. A'rn. Jour. Ph~ysiol, 113, 1935. (',with Farrill and Ragnff!). 46. Studk on Specific Dynamic _lctioni Fo19owingg Rereoc,al of Various I:n Tnrrine. Glands of Dogs. Ant. Jour. Phtlsiol: 1I13;,1933. (with Ruenol and Itogoffll 47. The Relatlion of the Parathyroicl Hormone to the Stateof' Calcium ihr t'heB1ood. Am: Jotrr. Plt!tsioid 1131 1-F1. 1935. (with~.lIk•P.eanand'Hastinns)', 48. The Sensitivity to Insulin. .3nt.: Jour. Phy.~iol. 1'Oc:O:,, 19f111 (with'S:•ott, Ferrill and Rogoff) 49: B~itterlinz OaiPositor-LengtheningProducedl bvadrenalEit ct':a. ScinsceS#:21179;,Oct. 2, 19:36: (with lianterandl Iklan•ans)00. On, the Origi~ni of the Substance in i;i-i~neChmsing, Eloncctio:r of the `_;itter-]in;, Ovipositor. Aan.. Jbur: Ob's. andr tytntr. :3 i: n84. -tl. Jtme1928. 51. Observations on the Adreno-Genital Syndtome: Proc: :tm: I'Allsiol: Soc.. Apri 1., 1939. 52. Rapid Recovery from Type SIIILobar Pneunionia treated with P,I,rllbit, Serum of a Patient n-ithAdxlison?sDiseasennder Trentiment! Nvith Desoxy•corticosterone:,.L-1J1:1113!: 18I5'. 1739. (with Ford K. Flick)33. Hormones and Acne Vulgaris, Urinary AS~ap for the '1'herttepntic T'~~n of' :',ndrogens. Arch:. Dcrntut: and G11hlt. 46: °4f1, 1t1311: ('with C(irnblf•et) .5-1. Experimental Oliesity: Proc. :Lttt. Pb1r.~ioL ri'or. 1'./-1w1 (with R. `V'. lirotnn) 55: _YrulrnRenic S'vbstaneeand Sn-eatl. _Irck. Dcr»1, and ' S1rl;kil: -t'1:(~ ~-3: 1010: (xvith T. Cornbleet). 56. Factor:~in the Controlof the Httman Appetite. P)-oc:,:lnt. Phli-~irjl:, Sitc. 1fT-i1., (with I:eeton) 5 7- Basal Temperatvre versus Basal :Tletabolism. JA1f_1 110: 10i": 1942.

982 sample tended to weigh less at, birth, which may not be the same thing at'~ all. iwieasuring, one thing and reporting it as something else;, with however honestt intent; has again~ produced from a statistical study a completely unwarranted conclusion. A case against rail travel was once made on the basis that the number of deaths chargeable to railroads in the previous year was 4,712. Itl is an impressive figure, but a semiattached one: A breakdown showedi that almost half the victims were people in cars that coIlidr'd with trains andl most' of the rest were riding , the rods. Only 132 victims. were what, the statement seemed to imply all 4.71'2 were : passengers on trains. These examples are intended to show what ai seminttached fi;ure is-and howw misleading, it can be. That the figures: produced' by the Public Health Service on smoking and health characteristics often fall into the semiattachedl category is evident from the reporting, methodJ3 that have already been, described: Thus, each statement by a respondent that' he or she-or some other family member-suffered from hypert'ensioni or peptic ulcer, during the previous week or tR-o is treated as if it were an actual medical finding of'that,condition. It' should be noted that a further odd change has occurred with some of the chronic conditions tabulat'ed in the: study. They appear in the report without having been mentioned in that form in the questionnaire. The report cities "bronchitis and%or emphysema," although the: word' emphysema appears no- where intheduestionnaire that was used. What the reportIists as "arteriosclerotic heart disease" apparently is a lumping of ailments or symptoms described by respondents as "hardening of'the arteries~''or "heart trouble." On top of that, in.formall estimates of smoking, history or current cigarette con- sumption are treated as if' they were precisely ascertained amounts of tobacco use. Someone's recolleetioni of his smoking habits-or., with the majority of the sample of male smokers, someone''s recollection of someone else's smoking habit's-is all that actually lies behind such categories as "presenti smoker- heaviesti amount 11-20 cigarettes per day." It is a111 t'oo easy to forget the quality of the data from whichi that neat box has grown. That the basic figures which this survey produced are semiattached at, bestt is not denied' by the author of the report. FIewarns~e foresample, that "bron- ehitis as reported in the household'. interview is not necessarily the same as a physician's diagnosis of bronchitis. It is quite possible that some of the self- diagnosed cases may in fact be 'smoker's cough'." And contained witbin the section headed "Source and Limitations of, Data'," are these two key sentences: "The diagnostic accuracy of reported condition is dependent on the informa- tion the attending, physiciani has passed on to the fnmilh-, or, in the absence of medical attendance, on the previous experience or edtrcation of the family. For these reasons, the prevalence estimates produced from interview data will, for some conditions, differ markedls from estimates based: on medical' reports or clinical examinations." The unfortunate thinq, of' course; is thati t'hiswarningis: available only to those whorea~dtheentiire report-and wl'iodoso with care and attention. '-\''either the summaries nor thetlableshint at' this, vital qualification. And, since most ofl the many newspaper and magav.inestoriesthat haveheen published about tlhisreport have depended upon the summaries, thegoz erlookittoo: Thus the iuany who meet the report on1y in the f'ormi of articles and news reports cannot evaluate it properly. The essential warning., never reach theiu. Our fifth test,is: Do the figures bearoutl the words?? A single mathematical fact maylie vet•~bally expressed iii more thau: one way. A jlrg- describedb,r oneman:as,halflfull marheseen bpanotheray h.ilf-ciulytc-. ";I'ivecan ride for the cost of one''exlaimsa cir-rent,il advertisement. latt a solitary customer may remarkthnt in his c:ise one ispayin,a the cost of five: A study of the comparatively ra,rephcuouienon of preventable maternal de:;t}ls produced sonmesensationnl ti:;rrre.;, as presc•nted, by a niidivires' ortt,anization: 1'1r. y siciansWere found responyiblefvrBS.i percent of the1,343deaths; p:ttientsfbr 36.7. and midzcivesfor oni,r2!2' perreuti. From the saune:data, the New York Ob.Ntetrical Societcproilttced!qnitle a differ- ent Ilicture:, Tliephysicianwasfotrnd re,,~llonsihlefnr 47percnnt of' thecleatha: occncring among patients attended b,vny doator; whil~etheniihviifeWa4rospon- sihle for t,6A percent oftliedeathsin Woiuen attended by a midhv,ifc:, 1ZThv this stt.il:ingdifference? Thefi'rstset of }i„ure.~ ignored the ftrt thatphy-siciitns liandlefar moreobst'etric.al patients thnni midwives dho inoursocictp... ~:,.i rhu,•~ mav~ be~ eilr 'illurtll. ~.~uugh emphasis, s till studies~ can 1~-rarttedl Gontradicti ,In,sent~ smokers~ of~ l iilution-were founi :%aiic conditions" th "., ~fon~nien and alsai ,t r,f~it reached the~~s "!i•n andl women no, I,aK•ky ~, a d~as~ makf -W ~ hinh,er incildenec ,ked, for su~ch, ailn ",airmeut's. andl "all lie report itself~ poi ~,,,laed up to a pack " Here~., then ~n,,ht,ions ~ in' it. I'!ie datai •hoev~ that 4 of the ailntents c •~itinued, to smoke.. -Tilts~ fromiother st:~~ 'his~~ br~in„s us to I! ~-nuit~d n-itlhoutl pro~~ Whun it iy~~ found ~ '~,auan: f'ailing, to assi tilll do it. \~ population st!udis~ ~ ,i:iracteristics.,, can, 1;~: rumlut produce~pr In tlie recent Publi ~~ ~1n.;ition . . offerei "'IPt into few. if an5, ~-T~luoIcing~~ and Ilealth~ ..The~ most these~ d: inti'r nxM'ip between ~ :i~nnnt estaLlish any \V'o ~ a1L acceptl this~ ~niikalatable or ahsur~ ~~.nVioun~ thIIt. R'e. wrlL 1u ;t 111G3'~ stndy,,tNs li mortalitc-~ rate: tcilv:us to (loul~. >•:rth rate. 1',tl is ~ mo~ luol v to~ nsr tlhewe~ (11 ~~ how ~ can We~ : ,iu~ 1-iiig ,',,The~e<<iden P1if•~ nttle~ is ~ tbat v -ible ~ esplanation: ()'r R iua} have urtinn: It is N-cr}- c•or ua:1itlcns ~willlshow: ~ '1'lic :1luwu•ivrnt~ Jr,rl n~;ru~ d after li.:at !'iuu•. Snrtdp•~ t~his pro 'll%N~n~ s~illrs•qtncut s ;sI i•nw,ccli ~~rrcg '-nn t nilnal iiul rosi _e -ultl smrcV of co lk•i Nor lirr,rnhath( , yt .\inl Wli:;t wunlYl ; ~"uince.s of Ileariu;; +•li:Tjon ]i er l:ushai. Iti-•li h:ilil uus tai he lii,tors;, ~

992 32. "Effect of Substit'uted Hydrazines and Reltited, Compounds oni \Iceloiil Mouse Leukemia C-1498" Proc. Soc. Exp. BioL and Med., 81, 638' (1:Jr:2)~ With B., L. Freedlander 33!, "How \tuch7"' (A letter to the Editor) Science, 117; 438I (1952) 341 "Inactive Compounds"' Cancer Research, Siipp. \o. 1, p: 12 (1952)~ 3i'it1i. W:, C. Cutting 35; "Chemotherapy Studies of Various Jiouse Tumors and Several' 1fyeloid Leukemias" Cancer Research, Supp. No: 1, p: 23' (1952) With B, L. Freedlander 36;"\-Phrenylps,rrolidine" J. Amer: Chem.Soc:,:7..5; 3026 ' (1:953'): With Carl J. O16en 37., "Reductions with Hydrazine Hydrate Catalyzed by Raney Nickel. I. Arn- matic Nitro Compounds to Amines" J.,Amer. Chem. Soc.,, 75, 4334 (19,53) With D. Balcom 38. "p-Dimethclaminophenylquinaldycarbinol" J. Amer. Chem. Soc.,, 7u, 541,~ (1953) !~Vith F. W. Bergstromi 39. "Derivatives of' 4.4minobiphenyN in the Chemotherapy of Experimental Tuberculosis'." Wasmann,.I. Bial., 11. 267: (11953) With, B1 L. Freed'lander 40. "The Effect of Azo Derivat:iR-es of Sulfa Drugs and' Relatedi Amine: on Mammary Caricinoma 755 and 3lpeloid Leukemia in C-57i Black: Mioe" Stanford Medi Bull., 12, 33 (1954) With B. L. Freedlander and Pet;er P:,T. Sah 41. "Device for Measuring Changes of' Optical Ti•ansmittance: with Tcmpera~ ture" Analytical C'hem.,2:Q; 1082 (1i)54')with Justin J. Shapiro 42. "Effect of Fitrrfuralacetone and Relatiedl Compoumds on Ehrlich: Ascities Tumor" Stanford Med. Bu1L, 12, 190 (1954) 11~'itlhi W: C. C.utting,and R;. I3. Dreisbach 43. "Effectof' Acetic Acid Hsd'razideon;_l'Iammary Carcinoma TM) in C=:17 BlankMice" Proc. Soc. Esp: Biol~ and 3Ied1, 86, 788 (1954) : With B: L. Freed- lander and F., A. French 44. "Tests of' Compounds Against the Ehrlich Ascites Tumor" Chncer Research. Supp. No. 2, p. 73' (4955) With W. C., Cutting 45. "Retardation of Growth of Ehrlich Aseites Tumor by Formamides and R'elated Compounds"' Cancer Research„15, 294 (1955) ' With W. C. Cutting and'.H. Gross 46. "Concepts! and' Techniques in Teaching the Organic Chemistry Labora- tories"' Science Counselor. 18192 (1J55) 47: "The Nonadditive Effect ofl \icotine and Nicotine N-Oxide on the Carcinn- genici~tv: of! U'1traTioletl Li.ght"Proc.Cancer Research.:2„109(19.i6) 1'1"ith B. L. Freedlander and F. A. French, 48. "Some:Yf,ercaptodihydropyr,imi:dines~ as Possible Antitumor Agents" Prrnc: Am. Assoc., Cancer Res~, 2, 109 (1056): With Windsor Cutting and Hudi Gross 49. "Qitiinoxaline-2-Thiols" J. Org. Chem., 21, 470 (1056)~ With D. C. Morrison 50. "Inhibition of Mammary Carcinoma 755 by Malonic Acid Derivatives" Proc. Soc. Exp. BioL Med., 92, 533' (1956) With B. L. Freedlander and F. A. French 51. "Combined X-Irrad6ation and \-lietbFlformamide Therapy of a Tran.s- nlanted 3iouse Ttrmor"Stanford 11I'edl Bnlletin; 15, 21 (19-57) W'ith, B. L.Freedlhnder, S. B: Reich, L, Felton, J. Levitisand F.,A. French 52: "The Carcinostatic Effertl of p-DietlhAlaminoethyl Diphenylprop,rl Acetate Hydrochloride (SKF 525A) on Ehrlich Ascites and Otlier Tumors" Pror. Amer. assor. Cancer Res., 2; 202 (1057i) With B. L. Freedlander and F. A., French. 53. "Combined t-Radiation and N-lfeth.rlformamide Therapy on a Trans- nlanted , 'MouqeTYimor"' Proc. Amer. Assoc:: Cancer Res:., 2: 203 (195i:) R"ith B., L. Freedlander, S. B. Reich, L. Felton, J. T.evi'tiol and F. A. French. 54. "Absence of' Effect of '.1Tyosmine and Nicotryine on the Development of Spontaneous Pulmonary Adenomas in Strain A Mice" Proc. Amer. Assoc. t'itnner Res., 2,,203B (1057) With F. A.,French and B. L. Freedlander. 55. "IS-Ethosc-a-F`.~etobuteraldeliv:dti(Kethoxal): as: a. Carciiiost.nticAhent in, '_lionse Tumor,s" Proc: Amer. Assoc. Cancer Res.,, 2, 204 (1957) With~ B. L. Fteedlander. F. A. French, Hnidi Gross and Dolores Demsher :,fi. "An F.brlich A:scites Tumor Resistkant to N-I1lpthvlformamide" Proc. Amer.. Assoc. Cancer Res.,,2, 209(1957) With, Hudi S. Gross :. "ICeductlions, wit'hIlromatic Nitro C( )-la2: (15a7)' Wi "I)evelopment of a ', _cLethylf'ormamide' c. ross ~. "Chemotlherapgof! S I3ull:etin, 15;,3116~(] A, \esv . Method f( P}-ridine and Quin ."ith Elizabeth D. ~,otiuoxaline-2,3-dit: i_.un,iacali Solutiot unil liiu+GonLai •~iuiilarity of Actik :nttie on the Ehlr ,_7 (1958) ': WithJ I ru , Affecting t lU:,S) With '"'in " lutusiral Chemotl. '. 1-li (1958) Wit"1 ~s of' Compoun ; 1 7 (1955): With' '•.;f• itrctions with I !~-t ofthe: Cat'a: 13, 1504 (1 ' 1.,11-1?-:~minophen lpr,. ChemL, 23, •I-vcc liorntvedt "11,1n~oy1 and Furfi .I.,4)rg,: Chem. 23, : "1•hotiseof Fish, i~ --~Y:tetn,, Jl Clih 11'~ttriita„aiorris I"1'liony1 and Chi:ornc. Chem., 24, t •'4nu:etireaand I ;1 N 1O(1'J59)\i'itl "P:%'ahtatlion of! Cor. 14 (1959) V : ~„nachy: Readi ai 1'Le l':e of'Fish il (Sectio~ "1'lienazine Di-N-( WinlcCluire Iilat '"'~1:PRctnre-.Lctlon i'. uc. -1[n. Assoc. .v,•llk•lution and Cc Ilcdir•inr. edl, ••A -Nt'w Carcinost, 1:1t. Contre le C: \1'ihtdsor Cuttin; ••C'"ulr.in:son of'E ~ -i -r:n:u•olop;ia„ r c I itt~ C'}-nd'ron - " Proc. t "ntt:in,~: Dorott uf C'hlorp~~o'~ ~I in \Iihe I 1'~:1_5 ,(1t160),N . • .Aiilti'rii•a1 E'stra(1!0. t~2a (10ti0)' 1. . "r l•, John \le l:ft'ei•t uf 1'llena~ \INni t1F.-hrlich. I. \atii:n:~LCan

994 83l "Change in Dry Mass of AscitesCelis'af'ter HN2 Treatment" Proc. Am. Assn. s < 1 .'Eifect of Analog 1 Cancer Research,, 3, 24 (1961)~ With Hun Lee and Victor Richards _ . vlktse in IDecan•Ilos 84. "Inerease in Dry Mass of' Ehrlich Ascites Tumar Cell's Af'ter, Treatment h i Wi " , N: deRiollp t N trogen 3Tustard Cancer Research, 21, 1108 (1961) With Hun. Lee andl Victor Richards ! FarilltionofRrofA ! I. "Effect of Hydtazin 85. "4',5-Dihalb and 3-Amino Analogs of Pvridosine: New Route, to 4~Deogrpyri- doaine" J. Org. Chem., 26, 3541 (1961) With G. EJ McCasland and L. Kenneth Gottwald 86. "Change in Ehrlich Ascites CelI Size Induced' by Phenazine di-\-Ogide" J'ledical Resch. L: 1M!i!ti)', With W'aldi "_YComparison of1' _\_ents" Soc: EYl Proc. Am. Assn. Cancer Research, 3,, 320 (1962) With N. Barker andl G. Hl \eedham 87. "Drv---XTass: Distributibn of Bone Marrow Free Cell Population in the Mouse asDetermined by Interference ATicroscopy•,"' N'atlure; 194, 784 (1062) With Htin Lee and'Victor Richards' 88. "A Simplified' Procedure for Obt'aiming, Flnorescencein Tiimor CeilsL'singthe Cbnventional Laboratory Microscope and Lighting" Proc. Western Pharm. Soc., 5; 25~ (1962) With N. Barker and G. H. tieedham. GnNtctvson"lnh'it,itoryEffectl \i-e:,ternI!harcmac ,. "Ittsponse-TimeCo~ 1 auced by Hyd 1 1;u;T). With Geo ,-. '•A -Now Aickel Cali With R~icl 89! "Antifertility Effects of Guanvlhv!drazones" Stanford Med: Bull',, 20, 152' ' Stu iies on, the Ac (1962) With Windsor Cutti d F de i Fr h ng an re r c enc 90. "Synthesis of Sulfur Analogs of Inositol (Dianercaptocgelohesanetetrols), . wacoi. Nhc. 11. 3! '. 7. A,n Atiuo.~phere E: Nuclear \Iagnet'uc: Resonance Configurational Proofs" J. Org. Chem., 28. 456 (1963)~ With G. E. MklCasland, Stanley Furuta, L, F. Johnson and J. -N. Schoolery ,,rn I'ha:mucoll Sa . "2" Jl.tthematicall J' 1'h;t rma cologist, 91. "Inhibitory Effect of Antiviral Compounds on Viruses in z.iLo, and in Jiouse Ascites Cells in vitro" Proc. Sae., 112, 617 (1963)),, With E. Furusawa andi W. Cutting t.n>rivson. "Ini7iro Stainin,?, Witli Adriana Bc 92: "The Esperihmentai L'se ofl Streptlococcus as an Anticancer Agent" Proc. Western Pharm. Eoc:,, 6, 27 (1963) With 3I. H. Fertman and JI. B~. Fertman :! i, ••I'cellaration of Al: :Itn_raphie Anal3: -P "I Ii h kcic r Fatt 93. "Chemistry in Chelation in Cancer" C. Cl Thomas Co., Springfield, 111. (1963) 94. "Direct Ehrlich Ascit'es: Tunlour Cell Diameter Measurements by Projection ' . e y _ in \"itamiu BR ano 1S'~itIuB. R: -Najii', of a Microscope Image" J. Royal 3licros. Soc., 82. 51 (1J63)1 With, N. Barker and G. H. Needham. -11~;itbematicall Coti -,inn ,rnic Doses" 95. "Anomalous Reduction of an' Epoxycyelohetanet'etroI to a: Cyclohexane- - WitiiiiGeorbe Led tetrol by Potassium, Methyl tiantlhate" J. Am. Chem. Sbc.,, 85, 2866 (1963) SVith, G:,E. AIeCasla.ndl and Stk n1eyFuruta 96. "Synthesis of 5-Halo-6-.lTeth•vleinchomeronic Acids" J. Pharm: Sci.,, 52, 1009 (1963), With L. K. Gottwald and G. E. lIeCasland 97,, "An Inositol Analog Containing One Sulfur Atom ( 3lercaptocyclohesane- ' ~ Ir, ti_VF tZTrlE 1.D., ~ i c. _l dams ?. ir. _Ur\»'s. Yes. ,t rou alle~ n1voTrr. pentol). Synthesis and Nuclear 3fagnet flc Resonance Characterization of Derivatives"J.Org: Chem., 29; 724 (1964:),, Withi G. EL McChsiandl and. St'anley Furuta 98. "Inhibitory Effect of Antiviral Compounds on Columbia SI{„ LCM, Vaccinia, and Adeno: Type 12! tiiruses, in. vitro"Ch:emotherapiay 8, 95 (1964'),, With Eiichi Furusawaandl Windsor C'uttlina99''. "Trace Mt?ta1s, Chelation and C:ancer"'`'ortes. 26,58 (1ll6oi), 100. "Hydrazine as~ a Reducing Agent for Organic Compounds" Chem. Reviews, 65,51 (1965)', With R!obert C. Berlo and Shirley Hooton 101. "Studies on the Growth of'Ehrlic.h Ascites Cells" Amer. Cancer Soc. Biology Experiments for HigliSt?hool Students, 1964:, Wit;hWindsor Cutting102: "Methods of Producing Depressant Effect'." ti.S. Patent to: 3;190,800. Sept 1961 '' 1 I l; ~C11t:oil beCiIIRSe~ 1 ~ mi Tlleldti1011 o11, I r e!L~-"t"et1 illiprojI :t e,~ VOIt ill-\-c F~ti It5r. 1`~Te~11: ~~ !Wt'1•~ iilt c^S1)e17t1TeT I ; I i l c.~. ,jTe have: ~ ~'Yi'~nL, tolbniillllna:cl '~rhE'~ resea ~~ ~ t i~ alu littcnipi 103. "The Study of Nickel in Relation to Smoking and Lung Cancer" Proc. Am. A ' ' _L~ldd ssn. Cancer Research! 7. 86 (1t166 ) ,, With Waldemar It. Gustavson ~ t o~~n ll d 't - 141:"B1ue Li;ht Fluorescence Microscopy for Cell S!tndies!'\S'asmann J. Biol.,. l lr on %I , ~ I ~ ' 24, 1(1966) , ZFit'h, Nydia B. L uths-3leyersand, George e II. Needham, !I: r Ul;S'r., C1Iis, 10a~ "Qva'1ity Testing of Chromatogs•aphicData with the Aid of a Statistical Criterion" J. Chromatob., °2, 3a6~ (1966), With George Lodin, Jr. and, Waldemar R. Gustavson lli l i th 106. "PaPerChromatographe of ,:Substituteff Tryptophans" " J. Cliromato,;:,, 2', 493'(1966) ViritriShahtnt5ai Saxona tt tv u is Cl ~ i luts r111a~~ lilnrlr W „ 10i: "In>;ieoStndiesof Ht-drazines and BS-HydtazoneInduced Conx•ulsions" 111tb~11('seaLc ~.11 Proc. Western Phart•m: Soc., 9. 29 (1966),,With Waldem:2r R. Gustaa•,son ~~'Il~nnilte~l',~ ;1nd of i~ 1;OS. "Biochemical and Behavioral Effects of Some Substituted Tryptophans" _I ()'L 'ri111c1 ~ Arch. Internat. Pharmacodynamie et de Thernpie, 163, 149' (1966), With Robert S. de RopIM I tf ~I;i\'(':l,ee11in321C1~ N W.

1034. 196. Spontaneous Hernias in the, Ati:lla of the Turkey:,Rigdon. R: H.. Ferguson,. T. M.. Feldman, G. L.,, Stel~ner,, H:, D., and Couch, J. R., Poultry Scii 37: 169, 1958:, 197. Tumors Induced bv liethyleholanthrene in the Turkey. Rigdbn„ R: H:, Texas Repts. Bioli & Med. 16: 232, 1958.. 198. Cancer of the Lung from 1900 to 1930. Rigdbn, R: H: andl Kirchoff, Hpien, Surg.. , Gyn. & Obst. 107: 105. 1958. 199. Effect of Dinitrophenol on Lens of Chick:Embrco:,Feldmani G. L.. Ferguson, T: \i.., Rigdon. R: H., Reid., B. L., Cross„ M. S,, and, Couch. J. R: Proc. Coc:Experi. Bdol & Med98':: 6=I6,19:,8. 200. A Study ' of'the \Iechanismi of the Experimentally Inditced' Pendulous Crop in the Turkey. Rigdoni R'. H:, Ferguson., T: M.. Feld'man, G', L., Wheeler, H: O:, andi Cotuh; J. R'., Am. J. \'et:, Res. 19 : 651. 11158! 201. Fungi in the Ci:op of the Turkey: '-NIanfre, A. S., Wheeler. H. 0.. Feldman,, G. L.. Rigd'on, R. H:,, Ferguson, TJ \I., and Couch. J. R:, Am, J. Vet. Res. 19:, 689:1958. 202 Trauma and Cancer :A Review of the Probleim Rigdon„ R. H., Southern Med. J. 51: 110:5, ,1958. 203. In Vivo Production of a Ceroid-liko Pigment in Chickens Given Gossypol. Rigdon, R: H.. Ferguson, T. 31:,, \Iohan{ V:S'., and Cbucli: J. R., Arch. Path 671: 94, 1909. 204. Cataracts Produced by Dinitrophenol. an Experimental Study. Rigdon, R. H.,, Feldman, G. L'j„ Ferguson. T. 31., Reidt , B. L., and Couchs J:, R'., Arch. O'plithaL 61: 249;19'.,9 1 205 Iieratioacanthoma: Experimentally Induced witli:3tethylcholanthrene in the Chicken. Rigdon. R: H., Arch. Dermat. 79: 139. 1959. 206. Cancer of the Lung-Sex Ratio. A Review of tlie Problem. Kirchoff, Helonn and Rigdon. R.H:, Texas Reptsl BaoL .C, JI'edl 17: 29; 19591 207. Mechanism of the Removal of Flni:di andl Particulate '-\faterinl fronr the Respiratory Tract of' the Duck. Rigdon: R: H., Arch. Path. 67:,'21 50. 19-)9: 208, TheRespiratorvSyst'emint11e Normal White Pekin Duck. Riedhn, R: H., Poultry Scii 3S c 196. 1959. 209: Recognitibn of Trauma as a Cause of Cancer. Virginia Law Weekly 11, # 15, '.\farch, 1959. 210. Erythremic Myelbsis. Benschi Klaug, Rigdon, R.H:,, and Phiilips;, Charles. Texas Repts. Biol! &\Sed. 17: 267, 1959. °211. Cataracts in Chickens with Lymphomatosis. Rigdon, R. H. Am. J. Vet. Res. . 20: 647, 1959. 21'2: ThePharmacologicaU Actibn of9ut'onomic Drugs on the I7yeofFon•lc. Clouse, JSelvin E,, and Rigdon, R. IL Texas Repts. Biol. & Med. 17: 305, 19,59: 213. Spontaneous Cataracts in Turkeys: Rigdon, R. H., Ferguson. T. \1.,, and G'ouch. J. R. Am. J. Vet. Res. 20 1: 961. 1959. ''14:, Effect of'1lethylcholaathrene, on the R,espirator,vTract oftheWhite'Pekin! Duck. Rigdon. R: H., Arch.6S: 57g. 19;9. 2'15j Effect of', Tobacco CondensqttP on Respiratory Tract ofl «'liit'e Pekin Duclcs; Rigdon. R',. H., Arch. Path. 69:: 55, 1960. °_16: Amyloi:dosis-Es,periment:ll Production in: with 31ethylcholhnthreue: Rirdon. R. H:-Tesas Repts. Bi~o11 &\i0d. 1S~:97;: ](1('10:, 2I7. Ylistopathogenesisofl "I£eratoacan,thoma"ihdirce(l«•ith methclhhol:lnthrene. Rigdbn„ R. H.Arch. of' D'ermatologs. 81 381 :NZ. 1060. 218. Histopatholbgy ofaniYnal' reaction to~ pirment comhound's-cy.hicltens. Thechemistry of' gossypol. Rigdon. R!. Il: Natl. Cottlonseed I'rodircts ,Uysn, Iluc.. Dallas, 1960. 219. The effect: of' methvlcholanthrene on tllr gastre+intestinal tinnat of t11e duck. Rigdon. R. H~. Tex. Rept. Biol. S.A[ed. 18 :"a 5-'?a3; 196f1 ~ 220. Esperiment.ali studies on cataract formation. Fergnson. T. SI:. .-C. .1. Clran- som .T.R. Couch: G. L.Fel'dman and R. II Rigdoiu a i: J. of Ophthalmology. -19 : 7!1L C1. 1la;r 1900. °"1. Bloodl and bone niarro~c diff'erenti'nl cmuntc on the r.it. R,den: T1 H. G~rnn- -- dolyn Ctassand L. R: Rir•hard'son. TecasRipt>>. Bioli .CA'1'edl 18,:~ 4,~0r -tSi; 1960. '^°: Concretions i'n~~ the~h1hdtler of mal'erat,, Rii;don. R. 11. The.Toin•nal of--- Urology, 84 : 30:r-310; 19fi(1: ''''^:, Pendulous crops in turh-ecs-an anatomie and' patholo,in stndv_ RiZdrm., R: ° Ii:. T. \I. Ferguson. J. R. Cottch: Amerii•am..Ti. of Veterinaa•y Res, 21 :979~ f15F,: 1960.1 224. A long-term fe animals. Ric] Proceedings. '?25,, Muscular dyst, andi Med. 19:, 2261 Pulmonaryneo duck: Rigdbr. 227. Tumors after : Syed Omer. :. _'_'8; Spontaneous n American J., 229. Spontaneous (. turkey. Rigc i (i6'-771, 196 230. Pendulous crol Journal of'X 231. Amylbidosis, . M.D.. Ameri. . 232. Cancer of the. Helen. Texa 233. Lesions in Du ~. M. Arch. ci 231. Trauma and R. H. South 235. Spontaneous~ 1 Ferguson, 7' 236. Fatal Chickei~ Rigdon, R. 1962: 237. \fuscular DT: Ferguson, 7. 4,53. 1902. '238. Spoutaneuosl~ Pekin Dual. 239. Effect ofl tirei Itigdon, R,. 2 4 0. Pulmonary L. (br•sen. Gt 241. Carcinosarcoi Gastrnent:. 242. Vit:,li Stlatisti~~~ IIelen. Tea. 2+:3; Absm•bi:ngan alouseand. \Iedl. 21' :,._'-(1:, Cliuicoprit7iol \1cClure : State .T.,SI( 2-}:,. f7hl,tctosU I'nt J. R.. Creger. C •21ii:, Absorption t:lmericanal Ri; 247. Porosis SccoRi-don, R.,Il. .a. "IR: ]:ffect of Vit of Ducks. Rigdc 2-19; Flonrescence(°c~vstals. R'i;reio 1' 9(i3. '! ,0:, I:ft'1 ct of C'aj, (.i;tnnuk o , N'ic!' "'.~l'..A,hanrr)ti'on : and Neal. Jsck2•,L: M,nscnla r 11#, and Dtager„GT-

Ie Scientific history ColIege : U: of P'., 1934,3Z-A.B:, Medical SchooI:, U. of P:, 1K'J37-41-M:D. Internship: Cooper Hospital, Camden„ \ew JerseS-1941-42'ti:S. _1rmy:~ Pathologist'r-1942-46 StafE::, Department of Pathologv, LITL , of P. Jledical Schooi'-1946-present Leave-of-absence :, with Dr. Shields Warren,, Cancer Research Institute, Boston, 3iass.-1952-a3' 1955-1961 Associate Professor of Pathology 1961 Professor of Pathology Principle interest Cancer Research. Problems in metastasis; particularly the spread of cancer in the lymphatic system. Boarclqzinlifications -lle.uber of' the American Board of Pathologs-19-Ii.' Society mcierbcrsliips American Association for Cancer Research Amelican Association, of Pathologists & BaeterioIogists Fellow. American Association for Advancement of Science A1pha Omega Alpha 'Member. \ew York Academy of' Sciences American Society for Cell Biology PU>:LICATIOSS ranspu monarc assa#ce o umor m o :. o-au or- nne - ., uss. Cancer Research 1.2: 731-733.,1t)52. S. Experimental Studies on theSpreacl of' Cancer in theLyn!phatlic Svstent. I. Effectiveness of the Lymph V'oileas a Barrier to the P t:sageofEmbolicTumorCells. Co-author=Jo_'<nneJl. Buss. Cancer'lT~esearch 1>s:. 403~0-": 1954. 9. Experimentlal Studies on t'he Spread: of' Cancer in tho I1,ynihhatic ak-stem. II.Absenccof' a Lymphatic Supply in Carcinomu. Co•autliors-Biadley Colieli :lhieldsl'<''arren. Cancer8: 1273'-1'=7: 1955. 10. EJtperimenta 11 Studies on the Stu•ead of' Cancer in the Lymphatlic System.. ISI. Direct Passage of Tumor Cell Eiuboli from Thor.ncic Dtwt to Lx•mph. Nodes. Cancer Research 15 : 719-7211 1!lziu. 111. Immediate Plss;if--e of Tumor Cell Emboli Through the Liver and KiilneY. Co-autliors-WalterJ. Gambleand William L. Clovis. Cancer Research 1G : tili_'-G1 ~. 1,1: 6'.. 12. A'I'F tasta: is : 3 Revien•ofl Recent Advances. Cancer Research~ 17: 157-1rd2. 111.;,. 13. Exherimental Studieson thelpread of Cancer intheLyiuphatic System. IV. Retrnai•adeSi~reed. Cancer RCSrarch 1J: ]11'-1-11117. 1'I:,b. 14. The Fate of Cia•rulzting'1'tmlor Cul1s.I: . PilssageoE Ce1Ls throue~hi Capillaries. Cancer besearc,h '13S-:;91 1'Jt;1. P ; f T CeI11 E 7: T b li th C Jo l \I B' 3; Factors Affecting the Number of Tumor 3Ietastases. Experiments with a. T'ransplhntable\LouseTulnor. Co-authors;-JTorton -McCutcheon and Dale R. Coman. Cancer Research 101:,3u7-359. 1950: 6+', The Significance of LowCalcittmand High Potassium Content,in \eopia sticTissue. Co-authors-Robert P. DeLova and Dale R. Coman, Cancer 3: 718-721., 19-50! 4. Effect of Temperathire on, the Mutual Adhesiveness of Epitheliiil Cells. Science 109: 396;,1919: ~ 1. Chemical F.actors in the Mutual Adhesiveness of Epithelial Cells,Cancer IFesearch -,: 3,~ii4S9. 1947 : 2. Failure of Hyaluronidase to Increase the Ilnrasivenessi of Neoplasms. Co- authors-Dale R. Coman and Morton 'McCutcheon. Cancer Research 7: 383'-3S 5 : 1947. 3; A Simnle Metliod! of'37easuringthe: Surface Area of Small Objects ofl Irregu+ lar Shape: wcienc.e.1YI8: 214-215, 1948,

1050 d'isappear:, This brings us to the fourth observation quoted earlier, the decrease in incirlence of lung cancer in those who give up sniokinIz.. (4) A majorr bit of t,heevidenceforae deCrease in rate of lung cancer in es-smolters is found in a British studv of Doll and Hill.. Here is an important quote from tiheirpublicatlion :"ithny of the rates, however, are based on small numbers;, and' althouglii thevrnav contribut'euse- fully to the generall picture they cannot be relied on individuadlv." This statement would certainly~y applyy to the decreased lhlng , cancer rate in es-smohers., The"decreasing rate" is based on 11Bdeathsfrom relia~blydiarnosed lung cancer over a 101i-ear period. This number of cases is inadequate tojustifothe: statement that cessation ofsmohing leads to decreased rate of lunz cancer. Even if, in the long, run, enough, data accumulate to support the above trend+-there is still no proof that smoking causes lung, cancer. Those who wereableto; 9ii-eupsmol~ing may beconstitutionallvorhumoraIlv different-and so: mayy belong to the group: not. dlestined to developcancer. Or did a similar,cliangrein another habit, asdrinhina,, occur, at the time when smoking stoppedl?There is a fairly strong cor- relation between smoking and heavydriithing.Various~liquorscontain a variety of complex compounds of unknown carcinogenioitv,, andd some of these, compounds are released from the body through the lung and breath. Perhaps ai decreased consumptioni of liquor may accountfor the decreased rate of lung, cancer in ea-smohers-presuming the decrea:secll rat!eisreal. With thistype of'evidenceforcauWation, the.n~ it would. seem reasonable to aR-ait more data andi to explore chanmes in other habits coincident with the arrestt of'smol:ing. In the~fiilEll sifting of evidence for smoking as-a cause~ of'lun,Lr cancer we fitldl much suggestive evidence R-hich can be interpreted in a variety o£' wati-s. Ther major point of the proponents concerns the. correlat.ioni between heavy cigarette smolcinz aaidi lung cancer. To repeat. it is wronz to presume that'correlation is equivalent toca-use and, . effect. As . mentioned abos-e,, there is good correlation between heavy drinking andl cigarette sn-ioking. No oneinhisrig}it mind would assume that alcoholism is causedi by smoking rather than by: alcohol. Both condi- tions are probably products,of a ,psychological' ~o1r constitutional type. Likewise, lung cancer and: heavy cigarette smol.-iIr« lnav be prodncts of', a third, as yet undefined, situation. In view of't.he existence of alterna- t~ive.nonincriminat~ing explanat~ionsfon much of theevidencelinkingr srnokin~, . to: Itur" cancer,it isdifficullt to accept tlhedirect cause-and- effect pronouncement of ot.hers. In my opinion, one can: talk only in, tern-ds of possibility.(The attachments to Dr.Zeidman's statement foilow:) Scientific histK College : i. Medical S I nternshiI U. S. Arm„ Staff: De ILeare-of-a Boston,. 19»3-1i161 1361 ProB Principle inte Cancer R cancer ` BoarrTI q¢ra]itiie Member u .Socicty In.e,nb ' American Alneri[:an Fellow. A Alpha O1r 3lemher- : _1'nlerican 1. Chemical Researcl 2. Failure of': autliors- -3,S5: o. :L Sar.lrle : lar ~Shah 4. Effect of `cienue_ 5. Fhctors A Tianspl. I:'. Conu: 6'. The Signif hissile:, 71-721. 7. Transpuim (:' :nccr I a: ExheriiuerI. I+iff, Ianhol. -I(C,-1c 9. Experimrr II. Ab Coli(~lr 10. E'sperimer III. D _l"a le.c DAT4. VITAE OF IRCIC\G~ ZE~ID3LkN,. M.n., 4'ocialli~istory Born: 'March 17. 1018, Camden. \eR Jersey Married: 1953 to~ Elinor Sleeper, Boston, Mass. Childlen: Two, 11. Immet9li'atc Co-aut~ 12. AIet,i:.ta:;isExperanler. ~ t . S. :1rmy : 1942-46 I1'. Iti 111:, TheF,itc o C'ancer, P W ~ ~ ~ 2)

1057 During World War II;, tlie Writer took part in setting up the firstl Chest Center in the, United States Armiy Jletlicall Corps, in Bizerte, A'orth A'frica eontributing to studies to improve the treatment of chest a•ounds. This esperience, was rec- orded in, N'olumes, I(4963)and II i 1'.ItiS)ofS'urd,eryinWorlcl' 1'V'ar II, lled'icalDetrartni-ent: L°Ote!l States dr7n;dc Thoracic Surdery: Since World War II, efforts have been: divided between teaching, practice, and research in thoracic, diseases. At tlhepresent time,, acaclemi¢appointlment'sin-clude: Professor of Surgery, Loma Linda University Sclioollof 3Eedicine;',Cl:inical. Pzotessorof Surrerv; University of' Southern California School of Medicine, and. Il-nirer~wi,ty o£' Ci'alifoi7tiaCollege of' Medicine. Los Angeles. Additional actflvities, ane: civilian consultant totlie Veterans' Adminstration. ti!Sl Armylied~ieal Corps;: consultant forvarioushosltitals;f'ound'er member, American Boardof' Thoracic Surger_v, serving six yearsas aniactiire esaminerand„f'or thepast twoyears„ as an emeritus member oftheBoard.*Jlem;bershipis held in siY medical .ocietiesd'evoted exclusively tostvdy of t'11eprobiems of thoracic diseases, with serviceaspresicient in three of the~e: Contributions to themeciica'1 literatureine additionito the two volumes mentioned„include one other book and approximately 70 scientific articlesirel:ntedl to problems of tlhoracic diseases. CURRICULUM VITAE-LY\fASAUGUSTti Sl BRER'ER: III, M!.D. Pre'an edical cdu cation:', Amherst ,College-B; A. 1923. _lledicabedttcation: ti'niversitsofJlfichigani37ed'ieai *~cllool-_lilD,1'037. University of JIicliigan _lledical School--1T.S: 1"J18! I'n ternships:3LeresHospital, Toled'o. Oliio--Surgery-1/1J33--3/1933, Boston City Hospital. Boston, _llass.-Internal, \Iedicine-Harvard 3ledical S chool-4/1933-10/1934. Bellevue Hospital~ \eR Yorli City-Surgery-\en Iork tiniversity 1:/1936 -6/1936: BarnesHospi~tal, Stl. Louis, _llo~-Surger5-~ ashington Unice'rsits-6/ifi36'G to 6/1937. Residencies : University of ltichigan Hospital-Pathologsr-6/1b32=1/1933. P,ellevue IIospital:, New York City-Thoracic-CoIumbia UniRersits-1/1936 -1l/1936. Barnes Hospital, St. Louis;, ;IIo: Surgery-Whshington University-G/1936:- 6/1p3S. iGniversity of'STichigan HosPital-Thoracic Surgerc-G/193&-6/1'039: Boa rd cert ificat fon': Founder Member American Board ofl Thoracic Silrgery: 1948. RRepresentative of! ilmerican, Association for Thoracic Surgery on the Board :. 1960- Teaching appointments:: Assistant in bfedieine,, CoIlege of' Phcsicians and Siirgeons, Columbia L"ni- versity,,1/1936: :kssistantin Surgery, R"ashingt!onIIniker,sity JIetlicall School„6/1937-fi/1J3Q: Teaching Resident ini Surgerc,, University of -Mit•liigan, 6/1935'-6/19391. Instructbr in Surgery,,IIniversi'tc of Michigan. 6/1939-/1940. Instructor' ilnSurgerv, 1941, Assistant C`linicalPtofessor,, 1946, :.lssociate. Professor of Surgery, 1952' to 1961, College of \Tedieal Evangklists, Los. Angeles:. Clinical Professor of Surgery, Loma Lin(N : University (Formerly Colle[;e of3fedica+l Evangelists)Chiefi Soction, Thoracic and Cardi',acSurgerF,,, 19ui1964. Professor of' Surgery, 19G.5). Visiting Professor„Anierican Uiiiver4ity of Beirut, 1962:. •Consnltnnt'f'or the State Depart'ment US:1ID' Cinllian IIos:Rital 4letnam 1967, 29'-^_ 3(i-6a -p t: 3'-12

1061' 1 I 51. Brewer,,Leman A., III: In alemorium, Frank S! DoIley. Transactions Pacific Coast SurgicalAssn. 33rd Annual Meeting;, Page XVII, 1962. 52. BreR er, Lyman: a;.,, III, Coggin, Joan C., Wareham, Ellsworth and Hinshaw, David: Elective Cardiac arrest in open heart surgery n•ith, cardiopulmon- ary by pass. BuIletin de la Societ6 International de Chirurgie. 211: 522 ( Sept. - ct. 1962: 53. Hinsha«-„ David, Sg-phers, C. E., Feikes, H. C:, Coggin, Joan C., and Brewer, Lyman A. III: Experimental studies in coronary blood flow employing a square-n are electromagnetic flowmeter. Bulletin de la Societe' Interna- tionale Chirurgie.,TomeXkI,,1962; 6 : 667-674. ;~4: Carter, Richard, «-areham, Ellsn-orth; Brewer, Lyman A. III. Rupture of'. the Bronchus following Closed Chest Trauma. American Journal of Surgery, 101: 177, (Aug. )4962'. 55. B1•eNver., Lyman A. I'LI. BiologicaL Basis for advances in Thoracic Surgery. ~?urg. G,rnec. & Obctet. In Press. Cc--rtler, PR. and Brewer, L. A. III. Subphrenic Abscess in the AnitbiotlicEra. Am. J. Surg. 108: 165,1964. . 57:,Brewer, L. A. ITiI. Coggin,,C., Jl, and 1Fareham, E. E.: Phl-siological problems following openi operations on the mitral va1ve:,Bhlletin de la Societ@ Inter- nationale de Cliirurgie: In Press: Z,S. Brewer, L. A. III: Chapter on Tuberculosis EmpFema and Bronchopleural Fistula. Handbook on Tuberculosis. American College of: Chest Physicians: In Press. ;J. Brewer. L. A. III, Co-author:,'_Cled. Dept. L'.S'. Army. Surgery in, World War I'I. Thoracic Suraery,, Vol. II, II.S'. Government Printing, Office. In Press. TheCxAIRMAN. The committeew~iI1 stand adjournedL ~~~'~~ewonld like to go on and accommodate the other three men who are on today lit2tI lielievethis is long enough to meet at the moment,, and sewill adjournn until tomorrow inornina at 9:3ti and take up «•herewe left off.. (~ Sl~o, theco~rsmittee standsac~journed until tomorrow morning, at iJ :JU. T(j~Thereupon, at 5:35 p.my, the hearinb adjourned to reconr-ene ~~~ ednesday., Apri130;1969, at 9:30 a~~..m. )

I The~ error~ must be~ far~ greater forr the~ many ~ pli~ti-siieinns practici¢Ygg without adequate hospital and laboratory facilities. \ow, it happens that the~quoted ineidence~of lung cancer is obtaitied hirgeiy from death certiificates, specifying a cause of death as~~ deternlined~ by tbe~ attend'~~ ing~hhysici~.n. ~Iany.~of such cases~~hEi~-e~not~had chest 1-rnys~or~ antopsy~ confirmation. Yet, t'he~ modern phy-sician,, a«~are~ of tlie~ presumed in-~ creaWe~ in ~ lung, eancer;~ is, probably ~ more likely to di'agiiose~ cancer~ in-~ stead of~ another condition inchstin-auislrable~ fronb cancer.~ sat-e~ bv hospital and laboratory ~ tests.~ ~~~'hat lpart~ of the increa~.e~ir.i~ lun~- cancer is~~ dtze~ to~~ t.his~?~ In a s~iniiIar~ vein, oiu•~ cUiag~nostic~~ f'iicilGties luire~ iin-~ hroved tremendously and more~ patients~~ aiie~ tasing~~ them. T~wentiy yearti. <iao. the~ phvsician may ~ hav~e~ dia~gnosed l.ias~~ case~ as~~ pnennron>ia~ or lttng abscess; Now, stt5liicionin~g lunff~ cancer, he~ hospitaliv.es~ the pa- tient and'y with the aid of X-iiavs and other tests, the di.rgiiosis~of~~ cancer is~~confirmed.. How much of the presttmed incr.ease~ ini1'titip; cancer is~~ attributable to~ these~ changing~ circunzstances~?' Tben~, canrer is: a, disease~of~tlie,age&and «e are~living~~ longer.,How much of tlke~~increa~se~~ in1'ttng ~cancer~is~ related to~an iiicreasedlifespzull? Ho«-~ much is a~ttribii~~ table ~ to~ottr polhuted atni~osphere~?- IV, e~talk~ glabll•~ a}aolzt the~incidence:of lnng cnncer,~ but for nba~n~ 'n~' cases the~~ onlv ~ ceitaintv~ in thisdiRgl7osis comes~ with aii~ ~autopsy~. Ho«-ej er; on1Z- about, 10 percent~ of all deaths~~ are~ followed by ~ autopsy. The~ incidence of lung cancer maj ~rell be increasing, but in ~-ie~~~ of the above~ considerations~ I would certainly ~ not specify ~ the~ degree~ of' increase. (3) ~ -N©.r~,~ we~ consider the strongest reason for~ incriminati'aig, ciga- rette smoking as~~ the~ ca2ise~~ of lung cancer. There is an undeniable correlation between heavv cigarette smoking~ and incidence of hung cancer.~ It should be~ emphasized that a correlation is ~ not a proof ofl cause. Three~~possibiliities~ex~iat.. (a)~~ The smoking~mav: , indeed,~canse tlhe~~lung cancer.. (b) Hothi heavy smoking and hing~~ ea,ncer, ma~~~~ be, caused by an~ associated thi rd cond ition-su~~ch as,a hornlone Ai stlnnbance: (c) Fintilly,the~correl~ationrnaybesttictl~y coincidental. A scienti~st tisttal9y ~ establishes the~ cause of 2nv disease~ in the~ fol-~ lowi2lg, way. First; he notes that the causativee agent and the disease~ ocettr together. I[n~ the~ ~~tlobacco~~ controversy-the first step~ is, at least~ pa~~rtially,~ fulfilled by the~ correlation between~~ snlol:in_- and ]king~ can-~ cer: Secondly, he~ isolates~ tlie~ agent. Third'., lie~ applies the agent~ to, eil7erimental~ anima~ls~ and r.eproduces~tlie ~ disease. Here~ is~~ tlie~ missing li¢ik in the~ tobacco~ cause-and-effect relationship~. Animals lnive~ beenn exposed to~tobaccoismol:e~in avariety ~ of ways over long periods-;tncl the tYpe~ of lun~(r ~~ cancer said to be assnciated~ with, sinolk~~in(r ~ has~ notl developed. Indeed,,in nll~ hiit one expernn~en~, no~ cancer of any ~ type developed. _llai.iy ~ excuses for tliese lie,,.~ative, esperiinente~ have been offered. I~ find alli these exciisey~ ]anle~. [-ntil' itili:d,ition of e~i(nirette sntolce procho~ces~, ex~~perimentally. lhingr ~ c,incer as seen i,r inan.~ the~ case flor direct cattsatinniha=,~a missin~.;•~linl.. '-~'o; the~ scientist, in e~z~tablishi~r~tlie e:uise of dise,ise,~pas<tliron-~~lr. the~ aloss~ tl,ii•ee~ steps. To satisfy t16e.~ scieutifnr~ comimutiits-~ that a true~ c.uiSe hais~been foxtnd~, th~e~re,sitIbs: niI itit be positive in »>ost c,iscts. ;are~ int rare~ tiituatinns! After obt'~ainiia' ~Z ~su~cli positive~ resultis,~ tlie~ scientist then removes t1i~e:agent~ froin the population and n-atclies~tilie~~ disease~

1 1058~~ Hospital' appo ivs hn ents : Chairman of Staff' 1956-1960, Chairman Departiment, General Surgery 1953'- 19W ; Los Angel'es CountyGeneral Hospitiah Chief Consulting Thoracic Surgeon-Olive: View Sanitorium and San Fern- ando Veterans Hospital. Consulting,Surgeon-Orthopedic Hbspital~ City of Hope and U.S. Navy. Chief Thoracic Surgery, California Hospital, White Memorial Hospital, Queen of the Angel~. Staff Surgeon Hospital of'Goodl Samaritan and St. Vincent's Hospital. Oivilian Consult'ant-Thoracie Surgery-ti:S.A. Jledfcal Corps-Surgeon General's Office, 1959- a''fenaL'ership medical societies :, American Surgical Association Fellow American College of Surgeons (Gbvernor 1959- ) i'merican Association Thoracic Surgery ( Council' 1"J61- )' Pacific Coast Surti cal Association (Reeorder 1960- ) SOciete Internationale'de Chirurgie Pan Pacific Surgical Association Excelsior Surgical Club (President 19Gu): Los Angeles Surgical Society Los Angeles Trudeau Society (past president) Los Angeles Academy of Medicine Svmposium Sbcietp American College Chestl Physicians (past president, California Chapter) Los Angeles' County Medical S ociet'y California Medical Association (Past Chairman, Section on General Surgery) American :liedical As sociat ion Association of American Medical Colleges Medical Research Association of California American Association of'Uniiversity Professors Honorary Member: Sbciety of Graduate Strngeons of Los Angeles County General Hospital Editorial Board American Review of Thoracic Diseases Int'ernational.Cardiovascular Society American College of Cardiology Nat.ional Association of Standard Medical Vocabulary Frederick A. Coller Silrgical Society Society of'Thoracic Surgeons Military record: Rank: Lieutenant, Colonel. Active Duty, : U'nited , States Army 3Zedical' Corps 9/4'/42' to 12/2a"/4a. Overseas Duty : 2/37/43 to 9/17/43;, Mediterranean and European~ Theaters of Operations. Principal Assignment : Second AusiIiary Surgical Group, Surgeon in Charge Thoracic SurgerS, Team #4. Various assignments, including work in chest, centers at Bizerte, Tunisia, 1943 and Jiirecourti. France, 1944. Also in forward hospitals in charge of chest, surgery, 1043 to 1943. Beach head landings' Salarno, Italy 1943, Anzio, Italy 1944, San Raphael, Southern France 1944. Awards and' Citations:, Bronze Star ;\IedaL Chmpaign~ Stars (\orth Africa, Sitrilp,, Southern Italy,, R,ome, Arno. Southern Ftance; Rhinelti.ndl, Central Europe). Bronze Arrowhead. Unit Citation. BIBLIqGBAPHY-LYSLASA'. BRLR'IIB~ . IIr 1. Brewer, Lyman A., III`., The occurrence of parathyroid tissue in, thymus- Report of'fotu eases,,Endbcri nologT 8. 347~.193-l. 2. B'rewer, LF,man A., LLI: Routinepracticesofthe' I"onrth \Tedical Service, Harvard Medical School. ICost'unCity Hospital, Edhvard Brother, Aim. Arbor, 1'Iichigan. 125 np„1937: 3. Do11eF, F. S! and P,renf r. L. A.. III : Chesti:nj,iirie:s. Ann Surg. 1116't G6S! 1i112. 4, Dolley, F. S. andB'rewer L. A'..,III : C'hetitii~j7nV --~'. S(~nihs of t~~eL~i;:~ Brm.. a~, Do11eS, F. : intratho 61, Brewer, L. U.S. Arn 7. Samson, P'R wounded! 8 Burford, 7 hemolyti therapy., 9. Samson, P' managen 5urg:, 15 10; Brewer, L in var c; 11. Samson, P Indicati4 L: Slam: on, P tracheob Surg. 15 13:, Brewer, L A prelir Medl 65 ' 14. Breirer, L thuracicc cases.J( 115: Brewer, II bronchit. 16;, Brewer, I. monary Dis. of ( 17. Do11eS,, F: ical Tul Philade 1C:, Dolley, F. patent del toro 191 Brewer, I of the otomy Jour. S. ^0i Brewer, II tracheo ^1. Brewer,, 11 upper t 22. Do1Q~ey. F. _lledico ordinar _'Sa 111-1f 23. Brener,, I. Panamr 10419. .,4. Brewer, : nlia gnis 25. Bi•ewe.r:, I A disci-:21i:}i. _li. T'r[`\1"Cr;, 1. sion of! Ni ith 4- .,7. hfie«-e.r,,l of chrr and,tn 1 67-]'9- color movies usedl at U.S. Army Teuchinel`cirter?. AI"orld' 1l ar If: Made at', _S. the request of -National I.ese.irrn-hi Council, 1942. 29. harliey. F Snontar Brower, I County

10-13'. e in ree te TI in i's is lle •n r. in, er rdA he rs tn. ,stt ng , obvious that a hi_h incidence of limgcancer preceded the popular use oftheci,garette:,Ihr fac•t. it is possible to have a high,incidence of ltln; car.cer in modt!rn time.sin the total absence of' cigarettes. From FiistPal:istan, comesconclusiveevideneethat cigarettes orothenenvi;ronmental factor,s~. ailegedlocauRinalungcancer, are not necessary for a high incidence of' this di'sease:. From ai rural area fneefromtarred roads, gasoline fumes, modern: smog, etc., Ibrahimi has reported an incidenceofcon- finmed lun_q cancer just as high as in heavy smokers. In his series 70Cjo had never smoked, and the other 30% had smoked pipes in which the suiol.-e bubbled through, water before being inhaled. This is probably more efficient for removing nico_tineand tar~~ ~ than any filtier on the American marhet:, Yet. without any of the environmental fact'ors~ allegedly causing lungcancer, Ibrahimreported a rate as liigh~ as that foundl in the United States: Further proof that the ri'sein lung cancer is not a re:~ult of' a rise, in ci,gria•etteconsumption is provided bsai comparison of the history of the rise in lun_ r_ancer,ind, the ri~ein cigaretteeon5umption: The tremendous wealth of autopsy reports from England, Germany, Polhnd,, Latcia:. Au~4ria. Hungary, Gzechoslosakia, Rus. ia. Stti-itzerlhnd. Ilollanch C'an-uflo. Japan and the>iitited Stnteyclearly indieatesthat a great'rr rise in Itrng cancer occurred beforathecigarette era thznhas occurred sin,•e. And, in each of the?e countries. lung cancer began to appear at the time tuberculosis deaths fell below a critical level. Autopsies from: a11ot-er the world; i~neludingmanc, reportsrcom tuherculosi'ssanatariumn in the United States,, have proven that much of our rise in lung canceri:n~ the last 30:years has resultledfrom prolon;ingthe liresof patientlsn-ith, tuberculosis: If certain people are susceptible to tioth tuberculosis and lunsg cancer, it shouid' follow that those who contract tuberculosis and survive «ronld have a hi;-her incidence of lting cancer inT:2ter,lif'e than thosewho~hadneverhztd tuberculosis. This has been found to be true:the iircid'enceof Iung cancer in tuberculosis sanatar~iuims nrtsbe ?0tiinesgreater thani in the general population. Very stlrong evidence in support: of the adsumption that the S.nmesuric•eptible people get both lung cancer and tubercnlosis is found in reports from Meyer and his collea ues at Yale University,andl from Westergren in SkvedLn. Both in-vestigators~ studied cases of1'ung,cancerf'or past evidence of! tuberculosi,sinfec-ti'on: a, high percent~ageofpathientssurviviitg, tnberculosi~h,tvepersistent.posi- tlve skin tests to injected tnberculosisproduets; Some show evidence of healedd sears,onis-raysof'theirlungs. lleyer found! that J9°'a of the patients with proven lung cancer had been.infectediat one time with tuberculosis. The theory that cigarette smoking causes lung cancer is founded on the fah:e assumption that 1'ungcancer was a rarediseaties ini the United Stat'esin 111u0. It istrne that in thedeathcertificat'esonly3',000!caseswerereported at that time. I3owever; autopsy reports leavelittle doubt that clinically about 141rya of thecases of Iung, cancer were recognized at that tinie. If one tuuItiplies 3M0+1 by 10;, it is found that 30,000 cases would have been a~ more re;tl4stic figtrre for the trae inridencein1t1i,0: Autopsy st,udios1eave nodoubt that lurg cancer was aeormnoni disease in the United States in 1.1.;0'. Itl is apparent that some of the rise inhtnncancer ~incer1!730hasbe.n cliutoe better diagnostic methodsres~ttitin,g: inrecog~nition of ]rtur; c?nncrer whiah 1r,ld been missed in m:rny casesprior tothatt,imeo n seconclPa,•tnr inthe riseha, been additional new cases developimz in thesurvivorr:of tnherenikr:is reawhin-7 thecaneer age. Proof of the second factor is found in patientasnfferingf'romi both diseases in our tubercnlosii;sanatarinms~. Both sourcesof"netcrar:e, ofltmx can- cer could account for tlieriseindiicat'cd in t1le,deathcertiftcatrshetween ltl):;iYand0 tliepresent. There is no concreteevidencethat smoking or rnny otlier er.viron-mentalflnctor ha scontri!rutecl mlterillll.v to this Whatl would happen if we suddenly abolished all aigarettes~ tomorroxr? I motYldpreclict that the ce=sc,~tion of' all ci arette smokin,, would 11;tce nn ~~~uific;»ib ei'tFct on our death r:rtesfrom Iungeancer, heart o.ttacl.s;, enrphcsema auzl' ~nost other diseases alle- edlk~, caused by ci:garettesrnol:ing.,Tlrerates for t]'u,~edlaeasess have risen hecauhe pr~ematnred~eaths from msn.v infectiousdr-eusc•y occnrriu:* at aul earlpa,ehaceheen stopped. People live longer;-and'therec•an hc•_no(diinlit tli,It mancot thccasesof liurg cancer havecomefrora thesnrv,ib•ors ofl tiilwrcnln,issince both: di:;ertsesareoft'en prc•sent' in the suntrpatient. Itwill hefenn& thnt some ofthr other disappearin;, diseases have contributed to the rise in heart attacks andl emphysema.

Ioa8 Mr. :~'_.TrE1trIEr.D. Are there any other duestions 7 If' not; doctor, «•etllink you •rorcomin,- toda~~~and fortliebenefi't ofyour testimony and Z'oir r vle;llC.s: Dr. Fu-r,sr. Thank you, _llr. Chairman. _l~Iay I say as a citizen I go back to California with >.1>uch greaterunderstlanding and respect afw1iat the committee has in the wayof'probl'ems. I alsol'<avebeen~ mucTr inipressed b%, the penetrating questions asked me. I sometimes thought I%1 tsittin_ «-ith a(Troup of my fellow scient.istis; Thank you, sir. M1. S.1T":ERFILI:D. Thank youy sII':. I am lnformeCll that Dr. CC,harles I+Iine'hastiled a statement w-itll, the convnittlee.Dr. Ifine'isa professor ofcli~nical pllarmocoi'ob ~,and preventiv-eIaed'ie'ineat the1Tedical School of t1ieL-IliR-ersit3- of California atSan Francisco. If there is no objection this time «-e' will accept it as a part of't1le recorcl and place it in the record. There is no objection and, it is so ordered. (TI.e statement of Dr. CI:iaI:lesHine follows:) STATEVENT' OFDR, CHARIiES HI\E;, CLINICAL PROFESSOR, OF PH4RySA'COLOOY.'IND: . PREVENTIVE MEDICISE'.ItiTHE.SCHOOL OF -MEDICI\E, , I1NIVERSITYOF CALIFORNIA QAALIFICATIO:I& \Tc name is Dr. Charles Hine. I am Clinical Professor of' Pharmacology andl Preventive Medicine in tiie School of Miedicine. Unia-ersit'y of Calif'ornia, Sani Francisco 'Medicall Center. I have been a st'aff' ulember' at that institution forr the past twent'y years, during which time I have engaged in teaching and research in my areas of specialty. I am Board-qualified i,n Preventive Medicine andl Tosicologe. I aln the Program Directbr' Of' a training grantl in Toxicology sponsored by the U.S. Public Health Service andl have predoctorate and post- doctorate stu~dtrntsundermy directiom It'each i'n~ the S'chools, of 1ledicine, Pharmacy, and Public Health. Ini addition, I am Consultant in the areas of'. Pharmacology, Toxicologv, Occupational Medicine and Environmental Health toi a' number ofl industrial concerns and to, several State and! Federal agencies. I have published over 150 papers in the fields of pharmacology, toxicology andd environmental hea'ltlhs and have been a member of the various scientific societies organized for the promotion of scientific endeavors in: the fields of pharmacology, toxicology and environmental health. I am a Fellow of the American Academy of Occupational Medicine and of the Industrial \Iedicali Association; as well as holding membership in 1a, other scientific and professional societ'ies, and am Consultant to the California State Department of Public Hpalth in the area of Toxicology. I: am a fornler' member of the \ational Research Council'.s:Con2- mittee on Toxicology. BESEFICIAL. EFFECTS OF S\fOIiI.SG Tlie SYirgcon, Crenerafe Report U.S' Public Health Service Publication No. 1103' entlitledl "Smoking' and Health" (which is a report of the Advisori• Committee t!o the Surgeon General of the Public Health Service)~ in it's337 pages has dex•oted 1.5 pages to the possible beneficial effects of tobacco. As comprehensive as this study was re- ported to be, abviously,verslitltle' effortl was spent in researching the lleneticihll e.ftects ofl tobacco, althoughther'e are a number' Of' references in the literat,urewhich describe these. The obvious beneficial effects'l:isted therein are the Iminte'- nance of intestinal tone andl the anti-obesity properties resulting from the reduc- tion of appetite. The monograph suggested that, it was noti an easy matter to reach asiml;lle'and reasonable conclusion collcernin;'the~Inentalhealt'h.lspects of smoking since these purported benefits were reputed to be itlt'angible,, illusive; controv<.r.rsio1 in nature, and, so,diffieu'lt to evaluate medically that' fewscientific groups had: atltenlptedl to study the su'bj;ectl. A~dtnitt:edly theret<-as no answer as't'o the method of satisfying the psychological needs of 70 million Americans were they suddenly to be deprived of their acaess' t'o tobacco. It n-as': predicted, moreover, thatl man would continue to utlilize' pharmacologio aids in a searchh for contentlnent, but that in the best interestsi of public health these should be ~ -romplished~ with aratl to~~ society a'sa In sum.nary.,then ~ (."o"Ilitioit~ of'tlie si., 4 ' luentlal health. bi :,:tvior; and that sim tlo~Jutlge~the the general popl~ evaluate, weighit' ,'< behoot-.e~those~ ~ , ittors'ftlllr~. Ttenefits from sm n!,it itself ori<-inat ~l,.velopy to~smolking ~ l,ioe~) ~ n•liich are~ l t lnin;,, and! not s 11 ,nlrikint;, but n 1 t ,ic lll dependel !~!i,lutcc•o. Fhrtlier., t~ -n<<,kin„ ~vhieh 1ea4 ~I!u,l(ilis;'~ :1LlruptlT' I 1=i•allC:sl,t,`,1Ls~~.ors syn .V1 of the~l~harm~ ~ +.i'n-c ailltaloid. nie( '. ~~~ tclVa~nces : <mitlie et ~ L t i.< (1itGeult to c•: ; o contentmen, i ~,:i}- I,e tlheriri:al trs its llau't ltl is rtaiit fnctlur.s: tll ~ " the:uu,onnt of1;:t1 l,ll•astu•e (tElpe c,nd titi-n:lt: :tudist .!,t1atedJ;v l li4 tlnss„ thr st . n i. S.niulci•rs tt=(• ,--llll~Ct•l: '.n a117e _Jtt rtvlirt•tiun. n ~:uin tcri;_h l 1Ci-}-es' t•t•tra!f _;1 ~. -a01---11•I -

1054 . Dr. ZEID3rnrr. Sir; I think your question to the prev~ious witness was or at least his inference was what, percent'age of autopsies are done in hospitals. Mr. W~TSOx. Y'es" sir. Dr. ZEID--%rarr. When I say ten percent I am talking about percentage of autopsies done,in all deaths in t'hecounttry and many of tliesepeopl.'ewho die outside of the hospitlal of course do not get any. autopsy. Mr. IVATso.-r. That -wa:sthe real fia-ureIwas inter.ested, in. Thati'syour fi.Pure and according to your statement onllv about 10 percent of all deaths, including both in and out of the hopcit<tTs: arefollo«-ede by an autopsy. You certainly make it mi~htv clear here that while we first, have the relationship or at least tlie fact that the agent andlthe disease occur together, the other fact'ors are clearly missing and that is the correlation between smoking andl lung cancer in the actual ex- perimentatiion, and the proof of that andi to me you have presented a In>_ghty compelling and conoincing , argument. I~•ould only note or take exception to one' stat'enient on your last paragraph on pa~e 6. In the second sentence you sai-. `'`First, be notes thatt.hecausati~-e a~entandt the diseaseoccurrind to~~etlher,"Ithink if you .~ould ~sant to be, totall'y objective about it you wouId say first he notes that the suspected' causative agent. If youi know it is the caus- ative a,gent why proceed to the neYt' step ? Dr., ZEID.iA\i. Yes. sir. 1Lr. WATSON. Thank voll,,l'ir. Chairman.. The CrI hir-MaN.3ir. Prever ?' Mr. PREYER. Just two br'ief questions, Doctor. We have had a discussion here earlier of experts on, the subject of whether you can tell smokers from the nonsmokers by esamining the lung-,You are professor of path:ologyat the Z'.niversity of' Pennsyl- vania 2 1 Dr. ZEID~r tiN. Yes, sir. Mr. P1EYER. I would beinterested in getting youropinaon on that. Dr. ZEIDMAN. As I understand it, you~rave two lun' zs in the hands and you look at them and by the pimnent and. so forth you, can say thi's uelongs' to ai smoker and this does not. I also understand several people said they could tell this. I would estimate that of'a thousand pathologists in this country 008 would say; "I could not tlelL" and the other two would say„ "I[ couldd tell,'°' and that those two who couldl tell either had sonae.; divine in- t'ultion or were not'tlelllin; the truth., NIr.PRE-.-Erz: You say of' a thousand pathologists you would' g1less. 998? Dr. ZF.IDli:1Ir7. Yes, sir. Mr.Pr.E-.=I::u.So there is nodiscololratiion «-hich.-.ou sin•„ no, t'uIniing bI'ack.hr. ZErn~t_kx. Discoloration isnot• related to ;niokinz. but is related tio dust. ini the air._l'~Iir. PkEyiae. 998would say you ean't tell,, and then ~-~~rr npecl sotne nire words to call the other t«o liirs.The onl~, other qilesti'on I h:id is th:it on the bottom of page 1 you state whFit i -ou think is'proper to state. Would you sav this would be a precise litbelin; of' a cig;ia•ette pack- aine oradvertising: G6Heavycigra,rcttesmoking may be a weak cancerproducinz agent in alsnsceptible herson:"' Is that vo warninl(,,?' Y( Dr. ZFm.T Mr. Pr,EYE Dr'.ZEIDIIi made alt'hou, JIr: PrErF Dr. ZEID3f NIr: PREn The CI-rAn DI1. ZEIDlf, The CiiAr, fit of ti-our tt almost have'. ac«omrrnodat Dr. ZEIDII TheCHA~n At this tiii L`°man A. B Scl.nol of L. statement to If there iE this 1Pointin It isso~orc( TIIe statF sT1'TESLEti T' oF' THEMEDI As a specia, thousand casz a great iiiteres Because mani'n9ection of va tory animalb introduction c utilizedi ",•mol'lThe , e suUstar cniiei •nh:ntiontUyritzarebte s sLin nf esperii 'llhiv oLserv aGroacl, us a ( etta Smolte pr tist 1c11o 1001: tiiat very hie} 1he~liine mav Pollowinr' t mentnt'l anima -~mohe: furthe carcinoma of mats by inst: earnest' and c produce bront residues into uienta i evi[ler., (liieti from ciu, tr.lcLeoUronot Ilnses of these tihe4uLstance

1021 )rded V per- rtifi- i id in ie by t the e na ~ues- ' irom. - olis- )acco 1'red, ler.'~ i the and' con- COUS'. tliat~, 1S42 ittle rica ated cl as ther ucereria. _)na1 iing ,7a,r_ .5•?), 57), the the ung -tedd per )4S. ofl :ime less : of. Ls- nig ins , es. S'es There are some interesting problems that have arisen referable too the statistical association between cigarette~ smoking and lung cancer.. I:n ai gioup of slnokers, Doll and Hill (63), found that 34.4 percent of' those~tiviitii, lung cancer did not inhale,,but~ofthoee-witlrnol~ung~cancer 66.6 percent did inhale. This obseiva.tion is contlrary to the smol.ing- luno-cance.r relkationship. The~ lun(r cancer~ death rate~ in~ England is~~ ~'Gi per miillian,~ ~-hile~in America tlae~ rate is 11) : The~ consumption~ of~ ci'varettes t>er adult~ ma~1e~ is higher in the~ Uni~ted States' than it is~ in~~ Eir^land. The Surgeon G'enernl's Report in 1064 (64)~ and the 1967 evort~ • Th~e, Health Consequences of Smoking" ('6:,)~ su'1?port the~ <tatistical association between lung cancer and cigarette smoliing„but there~ are~ manc~scientists tlzatde~~not accept this reliition3hip: as~ caus<iL as slio«-n b~~- the comments given at ai congressibnall hearing in ~`~r~ttsh- iijqrtnn in 166~5 (66). Biographic data and the opinion of'severall of tllese~~ me~n are idiclhzded in~ my last publication referable~ to cancer of~ tlie ~ tun,- and stnolt':ing~ (20). Joseph IBerltson (~6 7~),,a stlatistici an: and member of ~~the~ 1Tay.o ~Meelic a1 Camplles,toldmembers'of the 8at'h Congress: "I have studied cnrefully: the evidence that',has~beenadvanced for~the theory that smohing~causes lung~~ cancer~ ..~ .~ I find' no reason ta~modify~~ my~ previous~~opini~on that the~ ev.idenee,~ taken as a whole;~ dbes not establishy~ on any~ reasonable scientitic~ basis,~ that cigarette~ sn7olzing~~ eauseslung cancer. On~ the~ con trar.y, Ii have found more and stronger reasons to daubt this conclusion." S'ir~ Ronadd A.~ Fisher;, a~ statistician of' u~nquest;iiona~ble~~ reputation, re- ported in detail his, objections to, the thesis~~ of~ "siuohing, and lung~ cancer" (G8). Fisher, in an, article published in July~ of 1957, sa;i'd, ::~In recent wars,, for example, we~ have se.en hoav~ unscrupulons~ly~ the 'modern dev~ices~of~publ'icity'~are~liable~t'~o be~tLsed under th~e~~iQnpulsion of fear,,and surely the'yeldow peril''of'modern, times is not the mild and soothing weed but tlie~ organized creation of states~ of ~ frantic alarm. A common `device'' is to point toa real cause for anxiety, such as the increased incidence of' lun- cancer, and to ascribe it in nrgent tones'to tirhat is possibly an entirely imaginary cause ... The phrase in the~ presence of the painstahing investigat~ibns~ of' statisticians that seem, t~o~ have closed every loophole of escape for tobacco as: the, villain in the place" seems~ to~ be pure~ political rhetoric, even ta~ the eurious Is not the matter serious practice of escaping through lbopholes~~ . . enou ghto require~~more~seriious~treatnientl?~"~ 1Torris Eishbein (69)', in 1967, ~ said that~tllde~ use and abuse of~ sta, tistics, pnnticularly~ln.i medical research, w,is~~recently discussed by ~two~ leading~~ authniities'~ %-,-ho~~ pointed outl, thnt~ the~ statistical relationRhip~ dbes~not necessarily establish~ a, cause-and-effect LeliitionFlrilr. Furthermore, these statisticians emphasizedthat medical iavestiga~ tors~ muYt constantly r,eviea.,-~ their material witlt a criticall eye~„ and publish all the datlay including~ any~ results~ or observatibns~ t~liat a'~re~ inconsistent with~the benerallv accepted point of'view.. I have been clisaphointed'in mv flailure to~~ iind iu the "S'nraeon General's'Ii~eport~ of'1964°7~ ((b4)~ and iic the 1967 IIIF;1V iepor.tl to C'~on- 41res.4; "")Tlie~I To.cl l~ld Consequences of Srnohin("~ ((,.,), a di .(it.aion of the published reports of'those~ that disn;ree vitl.i tib~ei~~r conchdsiol.s. There~ are outstnisd~ing~~ memUers~ and past membery of the~ -Na~tlibnnl Cancer Institute that (tb~ not accept the Stn.•gecrii General's~ report. l)ni•n and Ciltler (~70)!, in 1',~955, in t1ie~,"1 iiblic Illealth _l'Tonog~r,ipli N~~o ?9, ~ page ~ I

CIGARETTE LABELING Ati~D ADVE&TZSTNGr-1!9i0 WEDI+7ESDAY,, APRIL 30, 1969 HOL'SE' OF REPRI-ISE_\'TATIVES, C.03I3LITTEE ON INTERSTATE AND: FOREIGN COSI_IIERCE. 71'asliinytnn, D.C. The committee met at 9 ':3Q a.m., pursuant to notice,, in room 21`?3, Rayburn House Office Biiilding, H'om Harliev 0. Staggers (cliairn7nn)i presiding. The CtrAiRMAN. Tliecomnlit'tee wi11l come to~order. SV'earein acontinuation of the public hearin;s'ons1ll bills pendinabefore the committee relating to the labeling and advertising of ciga- rettes. Our first witness tliis' mornin(~ is Dr. Thomas Brem, interniet, Los Angeles,, Cali'f. STiATEMENT' OF DR. THOMAS' H. BREM, INTERNIST, LOS' ANGELES;. CALIF. The CHAIRMAN. We welcome ~-.ou to the committee, Doctor. You may~proeeed as'you see fit. Dt. BRnsc. Thanl~ti~oa.,Jlr: Cb.rirman.. Gentlemen, I~am Dr. T'liornas'~II. Brenr.~ a~~ (YTadunteof .T`olans,Hopltiins~ Universitv~~ School of Afedicine~in 19,3~7. I hnve~been on tlie~fa~culti'es of S't'anford ITniversit'~ti S'~ehool of' _lfedicine; LT'niven-itv~ of California at Los Angeles, and am ctu•rentlh ~ 1lrofessor and chairman of the~ depart- ment of medicine in the Univer-aty ~ of' Cou'~tlierm Calfifornia; Schooll of~ Dfedicine~and'directolrof internal inedicine~of the Los AngeIes~ C~ounty-~ Uni~,ersity ~ of Southern California -ATeclical Ceitter: I lrave~ been enl(raQed in~ clinical medicine,, research, medical educa- tion, and administration in tllese~fields for n1y..-.holp professional life. t~'1'y~ principa~11 areas of'int'~erest hai-e ~been in dise,zses~~of tlie~ hear.t'.~ 1i1a19s.~ andiliver, :tnd neoplasia-or c.lncer,Jni creneral. I have~ w~atcbed w~ith~h interest~ the~ controversv ~~ over smoking ~ aiid~ health aibd'~ hav~e~ fol''lowed~ fairiy comhrehensiv~el~y t9ze~~ scientifi¢~ litei°ature~ and the reports of variozls~ concerned agencies and iilstitutior7s. Althonali I~lrnve not can- t~ribnted' to tll'ti6~~ area! of research. Il have had considerable~~ experience~~ ov'er~t4ie,yee,rs in eualnating clinic2l and experimental eviilience and in~ judging ~concl'tisions drawn from it ns~ to their' jiisti'tication and lt>~•ir_. I should tell vou tlltrat I~ anr~ Lere~ at the re fitiest of ~ tlie~ tobacco ~ in- dttstry, lntt I clo u-nnt~ tn~ eirnlplh~.i~z~izn~ t1u1t.~ .Zitv otmnions. i(deas: and tliottgl~its~ tliati I[ expre~s~~ Zre~ strirtl~ ~~~ my~~ owat. Thev~ 1)a ~~-e~ benn fortnecl lon;,r, before I ever~~ liad ann- ~ idea II «-onlct lbe~ tostifyin- ~ before a conr lnt.ttee~of CO]]-ressl~ i 1f1C3'~I

tion in stases. >. 1962. 1'coR•th -search, ,ntablee helley. ~iQ111am, is ob- th, re- ; tliat ering ) Ionb some t. We trs at nd of and h that velop say 2 t ypes mt of out 6'1 1,, the, -nnd. ion it ~ ex- )ke is I 1)rent nloke ental I-was 1-elop pro- some itinr 1053' 100 percent. This appears without any known environmental manip- ulation. llr. EcrraAr,om. Well,~isthi's different ialvarious~~species? Dr. ZEiDMxN. I think that different species do have different sns- ceptibilities~ to~ cancer, but to~~ my k~~now1ec1'ge cancer has been found in every ~a11in7a~l species ever exnmii7ed «-itli the~~ possible~ exception of cer- tain tzin wild ones who don't live lbno- enough to display it.~ Mr. ECRxsxnl. Thank vou.~slr~. Tile Cli_uRM_t-Y. -Mr.~ Watson? Mr. WATSON. Thank vou. \Ir: Chairman. I ais~o~ appreciate i-ou~ statement, Dr: Zeidnlan,,the~ obvious olijective ofit,~atrd~on~pagelneartheLottom~~oftlhe~page~youdhav, ~~ou-,, Rtte;lt~ion t'o~ your use of tlie~ v.-ords safe~:t aal~d~ assume and asstl;nption and so~ forth, so~~ actually a p_~.esent requiren,ent oft'lie~~ law ~ , s~ passed b~~~ tho Con~-re.~s sa~-ing ~ tllzit~ cl-tiiretlte, ~ smoking ~ n7au~~ be liazarclbus~ to~ votlr heaitlr is prouabIy~ as~ elose~ as~ you can conle to~ it so far~ as~ the state of t'he~ medical art is concernecz~?~~ Dr. 7'rtr,-.ra~~. `t es~-siroh: t~is the -way I feel~ about it~.~ 1lr. WA~zsoN~~. That ;s tlie~~ 1; a,v ~ vou look at~ it. I thinh~ it is~ a rather 1ntF:F :aln; oi)?eiil"21*]O?l thllt fl 111111 n'11o s'13olies I11a11V r!ya1'ettes had hncl discolotletllhis fin(yers and so4~or'tll but vetno~~cancer liRs~~ developed on tlle~ finlgers.~Is tliat,only your conclusion orr have you hea:rd of'a1iy, such,? ' DrZnzoir. A-_\-~. A~o~.. I have~ never iieard of a ~ case~ of cancer~ of t1i& I g fiai~e s i~ : llere~ they are dlz:colo>.ed in a llea• y smoker ancly of' conrse,, ~ la~ C'ott . I$ollld lleilr 01 lt oftelT, ]uClg752ons,T~LnIlI t:le w'a to/bacCo prOdllces~ cancer of the skin of the mouse. Mr. WATSON. I haven't heard that point brought out before and the Stu•geonl Gener a1 di'dii't allude to~ it in his testilmony but ~ you know ~~ of 'no instance R-here we have had cancer of the fingers? ~ Dr. 7FinMAX. A ever ~ heayd of~ it. Mr. «:As.o-N.~ I haN-e seen solne of them just literally sup~po~zedh, white shin but thev ~ were, alnlostl~ tota~l2v ~ blach there. You state otYl page 4, "The lnottse skin is cliemicall'N, ~ different from the mouse lnn(V or~ lun'. ~ of~ lnan." so tl]_tit you attach little~ signnifi~cance~ to t'he~ produc- tion of~cal>.cer throu:-~lt the ~1z n sinear; is~ thatl~correct'?~~ Dr. 7:ro.m-v. Yes; sir. Mr. WAzsoN: Again vou., too, are,1>i^al7e: in a(1hitittin, ~that~tlie,nYecli-~ ~~ cal science has not li~gen :;,~es~act as «-~e~w~onld li7:e itl and I~ag•ree~yott are ~ the~ best we 11ave~ and I really ~ rel~-~ on ~-ou. ~~ But you point out, too,, that in ~t'~11e past perh~tps~ the~ diagnosi:s~~ p<Yr•~ ~ ticu~lair proced~ures 112i,e not been adequate eno~u,-h and as~~ a: conse- ~ qnence~ votil malv ~~ hare~ listed th~e~ c:iuse~~ as pneumonia or~ lung absc.ess~~ wheli, alll the ti'ane~ i~tl~ w.ns~~ luna, cnncer:~ Is, that about it~? Dr., ZrmMANT~.~ Yes, sill. Mr. ~~~'~ATson~. Q']r pal-e~6' volu sort~of fallI into ~nlo~line~ of beli~ef~ wheit y.ou~ say, "ninlV ~ about 10~ percent~ ofl all <leaths~ a~re~ fo10owecd lay~ att tolnsy~.'°' I have heard otliers; even tlle~ one~ wlio, prececlecl' yotu~, say AMA mav have sotne requirement that yonl must have: an autopsy on 2'5 percent. ~ First, I think the doctors ~~nre nlore ac_ctlrate~~ than ~ thatt v>d~.,seconcbly~, II just can't see!,L greater percentaLre thani 10 percent as~~ you ind'ic.nte here.

940 Urban Hospital Morbidity' and Air Pollution, A Second Report, Arcli. Environ.. Health,,15: 362-374, 1967. A New Direction in Rehabilitation Through Advanced! Instrtunent:ntion and! Computation„ J.4.DI'_q, 200: 625--629;, May 15. 1967. Final Narrative Report, Trainin0 of the Blind for Professional Computer tiFork,. Dept. of' fiiE.W., RD-1y8.5-S=67~C2;,19ti7. Robot Data Screening : A Solution to ;<Lultivariate Type Problems in the Biologio cal and Social Sciences, Comm: ACM, 9~ 529-532, 1966. !A Biolagrically-Oriented Computer Language, Ann: 1".Y. Acad'. of Sci.,,128r;3:r- 763, 1:166. Cancer Therapv-Computation andi Visualization of Dose Distributions in EZ- ternal B'eam Therapy, J. Cliron. Dis:,,19:523-539. 1966: Use of the Computer to Teach Introductory Statistics, Comin. AClf„ a:°_7Y--276,. 1966. Automation of' Radiationi Treatment Planning, V. Calculation and Visualization of the Total Treatment Volume, BriL J. Radio., 3S`906-913; 1966. Computers:,No Longer a Big Bargain,for Uneducated Users, Compute-s and 3uto- mation,,15:i,1cJ66. (With S.:Pollacltassenior author).. Selectio-n, TYadninp ancl'Placementot BlbidC'oniputer Programmers,,Report of the~ Association~for Computing,3lachinery,1966'.. Is _1Tedical Diagnosis a General Computer Problem,, J. A7nerican,Jled: As:soc., 198:. 281-256,1966. Urban -Morbidit-y and Air Poll'ution; AFi~rst R':eport,,.4rcli. Ehzil-on. H'e,al Ti, 1.3:~ 15S--170,1966, The Ll,indlas Computer Programmers, Rch,abilitation Record;-7-10: 1966, , Roleof,Statistflcs,inthe«"orld of'Computers, Ann: X.Y. Acad. Sti., 125:11:h.9r1116,, 1966. Cancer Therapg--Computatlon and~ Visualization of Dose Distributions ia Ex- ternallBeam Therapy, J. C'ltron. Dis.,19:523-a39, 1966, Proceedings on: the Braille Researali: andDerelbpntentConference, Sensor Aids, Evaluation and Development, Massachusetts Institute of' Technolony, Noc-eui. lier, 19G6. Robot; Data Processing; Techninues for \Iultit-.ariate la iaemiological Preeli .tious, Proc. N.Y. Acad. Science;,126:779-79-I'<1965'. Compntation~of: Radiation, Dosages,Stacy,; R. and Wasman. B. (ED)!.C'o?oputers, in Bionaedica:l Resea,rch~ Academic Press. NeR'T,orh: 1960. (Chapter 17). To«•ar:dl an Und'ergraduate Jlatliemat'ies, Program for Future Researchers i,u theFielk3s of Biolo--y and Medicine, Fed: Proe ~,? fr:r-9, 196:i. Careers for the Blind in Electronic Data Processing, Occup. Outlook Quctrt'., 9:. 1~--1;,1263:. TheBlind:inE,DP, ACai C'ommi~tteeoni Professional Actisitiesof the Biind 1`16:). Design and Operation of aMedicalC'omputing Center;, Ann. _l`.Y. A'ca,f' Sni.. 11a:a91~-rSl')~ 10frI. (iWithi E. Saenger assenior author). Planning Radiation Treatment on, the Computer, Ann. N.Y. Acad. Scierice; 1'lric 9.7('Y997.1064. Professional C'ouiPuter W~or14f'or theBlindl Comm. _1'C7f. 7:2'23-2'1,,1961'. Computer Work,fortheBlind,.1:R,eliab,.30:6:_0-21.11kiA. Epidemiology of Disease Associated with Lead, Arch. Eni:iron, Health, 5:.: ~-31S; 1964. Mathematical analrsis: of' Lead , Burt3ens, Arch. Enriron. Ilraltli, Ci4l---11. 1'~fll. Automatiion of Radiation Tireathnent Plannin;, IV. Derivation ofai JI.ZthE-rnatical Expression for thehercent Dept Dose Surface of Cobalt 60B'eamsa:ril X'i~;unli-zation of'\;Iultiple Field DoseDistributi(ins.,I;rit: I. Rar-lio., .31•.5-}4-.-,.,i):, 11f111,. LocatinT, Placenta Praevia, Proc. of the Rr,r_•bester Con:f: on I)irta .lrriris;tirnand, Processing inBioloOy~ anrt, TI'edieine, Per--amon Press. l;p. 103-11L 1:H11.Do 'Malizanancies Result from Diagnostic and Therapeutic Rnrliation'r, ci:c?icli+1N and.: t'Ji'eEgid'cntioloOJof'Chronic Disease, T a:Dept. of Ilnalt!hy Ialuu:rtinnandl Welfare. pp. 355-371„1963. ]LEDCOMP; Part I. St'atiYtioal' Srlstcmm. AIerhi-a~l Comlltrt7ngCenter, ofl Medicine. U'niveraityof Cinciatn tti , Ohio. Boron. Chalmium4, Chrornium. andl \i:ckel in t1huBlrrodand L:rine„ {rc•1r. En. rii•orr. IiealtJi; (i :28C~-295, 1963. (II. Ianbus:as senior autlior )i. Potential I3tizard of Exposure toLead. 9rch. Fririrou. IPrzaltb. t; :25,;, 2-2. (It. Kehoe as senior author). Carcinogenic Effect,of 1-131 Compared xvith X-Irradiatir,n-a I?eviecr. II• :It/5Physics, 9:1371-113S4, 1963.. Autmuation of' Radiation Tt izinfi lc~odoses and Dire( .;n :ci22-ci?7; 196 3. intravet,ousMethetresateLe;~k~mia, Pediatrics, 31 _iut,,m;:tion of Radiation T Pield! Dose,Distributions hnliot'Lreatment Planning, Procrssin0 in, Biology a 'C19-311.), 1963. r.:-owt Data~ Screening, Pr Rr~crs..i~~!Iin B'iolo0,y~ a _ ;1-2-12: 1063. 1, -ruhational Etpasuret(. :: ,"2-:> 3G: , 1962. ('R: Die' Se,x Developments in Chi _iiuar;v, Amer. Ind, Hygi .L Prricti~:aL Procedure fo Itad io1,. 3I~ :726'-733; 19( l:,piclenriulo,ieal Slethods 1961'. (Jl Ph Causes of,'Deat. r•~ium-1:~7 Retention an,i :i .,2arc11 T.aboratory, I -vaior author). SivhoWaI.%ari'ationsin.tY 1(1G0: i_- so Peculiar Ab~ 19(i0: `~al l:r i:u Following The. i, i:SY1-9Q}T ati,,,rsDaciSintnaof ;nifluance- l';i~n,nar~1?'im(otion in ~eniorau:thor)r .~f tiurui:d Pitln _: -.._-` Co., l'idici0.rn: ~'"".jrex.x;'enic -kc~~ ~ a<c. of Diffcrii~i :1:1~1.r1. 1:)~,11. flI ni 1I,•rc•luv:0ut~Dri~, A ru•n-c~F of S; iligun„ 1115.7. of' n Ievant~ -.ics:nnil Dr. Ehciieol DL: rasTAt i.. T;IEOOORE,D: ~ ndrti~:ctti~of,~9ppli, r-q ~tnd A1i1llied. I ~' 1L 1'.1:oBESSOK S'~ r.-Cirnt critic h:rbits~ and. n_h it,svonld. Ul ~ `~t ,)f al4 . one. I~i ~ ~ VI r >i,:r s uf' tr-sting ~ ~'

1036 2.i3: RadiologicLesibns1nwhite Peki:nDu'cksR-ith Slus~cularDc.sti+ophr. Rindon; R. H. and Schreiber,, \f. H. Jour. of Comp. Path. & Therap,,, 7-1(2) :200-204, 1964 254. HiStologir Changes of -MAiscles of Chickens with \Ialformed Feet and Legs Rfgdoni R. H. AIn. Jl Vet'. Res,, 2i :768-773;19G4., 2:»; Effect of Feeding Benzpyrene ou Reproduction in the Rat. Rigdbn„ R'. H:,, and Rennels, E. Gl Esperientia, 20?21-?29: 196-1'. ?36, Ruptur~eofSpleen inD'uckswith amvloidosis. Rigdon, R. H. Arch, ofPath:, 78':66-67 ,, 1964. 2a7. Spontaneous Occurring, Muscular Dystrophy in the white Pekin Duck. Rig- don.R. H. TexasRept.Biol. &'_NIed., 221(1):930-939, 1964. 2:i8. Effeetsof:Feeding Benzo(a)pyrene on Fertilit,r. Embryos, and Young Mice. Rigdon, R. H:, and \ealy Jack. J. \atl., Cancer Inst., 3#:"fi7-30.;, 1965. 2vJ: The Arthrogryposis Syndrome ihi Chickens, Clinieal, Pathologic, and Roent- genographic Study. Rigdon, R.H.,, Schreiber, \i.H., and Levy, Abe. Arch: Path., 79:3S,S-393. 1W. 260. Torticollis. Spontaneous Occurrence im Ducks with Consideration of Its Relation to That in AIan. Rigdon, R.H:,, and Schreiber,, M.H. Arch. Pathi, 80 : 58-G2 . 1965. 261. Effect of Intratracheal Injectioni of Benzo(a)pyrene on Ducks: Rigdon,, R',. IL, and \eal, Jack. Texas Rept. Biol. Med., °_3 :494-:,06, 196:i. 262. Testiisin theSteril;e Hybridl Duck. A Eliatologih andl Histocheinical Study., Rigdon, R: H., and JSott, Charles. Path.,vet.,,° .;.i3'-565. 1;165;. 26?'. RickettsiaT Infections in Texas. Case Report: of'Spotted FecPr. Ri'gdon, R.Ii.,, Box Q. T., Irons, J. V., and Waggener. J. Di : Texas St. Jl -Med., 63 :#3'--1!), 1966. 264. STfontaneous, JluscleNecrocisin CliicltsFetl Adequate and Deficient Diets; Rigdon. R: H., Schreiber, lrl H., and Richardson,, L. R. Am. J. Vet. Res., 27: 383'-587: 1966'.. ^6'-5. Gastric Carcinomas' and Pulmonary _Ydenomas in _1TiceFedPenzo( a)pyrene:Rigdbn,R: H., and Neal, Jack. TexasRept.Bial. JTed_ ?'1!:19:1~-207, 1966. 266. Tumors Produced byMietlivl'cholantllrene in theRlespiratory Tract of'theWhit:e Pekin Duck. Rigd:on, R. H. Lung Tiimours in Animalk. Proceedings of the, Conference held at Perugia, June 24-29, 1965, edited by L. Severi. The Divi- sion of Cancer Research, Perugia, Italg:267:, Hereditary \iyopathg inn t1le White Pekin Duck. Rigdon, R: H. Ann. N.Y. Acad., Sci.,,138':28-48;,1966. ?FiS:, 'Non-Nutritional Abnormalities im theFowl! Rigdon; R, H. Proceedings 21st Annual TesasN'utnition Conf'erenee, Oct.19'-21, C'olleget'Shti'on, pp. :i9-66. 269: Effectof'Feeding Benzo(a)pyrone on GrowtlTof'Foung \Ii,e: Rigdon, R. II., andteal, Jack. Texas' Rept. Biol. J'Ied'.,, 21:473,-478, 1966. 270. Effect' ofnihcin on, the spontaneously occurringmvopathy in tlieditck: Rigvlon. R:H. Texas Rep. Bib1. 1Ied.. 24: 6.,"r4:,8,1966. 271. N'eoplnsms in sterilehybridducks-amelanoma and two teratomas. Rigdon, R. H:, AvianiDis:, 11 : 7f)-89,1967. ?v2:Theniitritirevalue of moldy grains and proteinconeentr;ntes for growth of ponlts. Richardson, L. R:, S. Hares and R. H. Ri,^,dbn. Pouitrc Sci., 46: 16S-176:19f'i7:, 273. Amylbid in th e liver of' ducks, ,Rigdbn, R. H. PoultrpS~r_i., 16 :: 674L 70 5; 1967. ?7#l Glonadsin hermaphroditic ducks: A pathologic stu'dy, Rigdon, R. H. _1m.,J. Vet. Res, 28':,112:i-1131,,1967:. ?7u!Glyeosade effect upon rnembr.ryneenz;vmec of erythrocyt'esandl muscles in dlrckmyopathv. Brow°n: H. D., S,Iv. Chattopadhyay: A. Patel and R: H.Rigd;on. Eaperientia, 23: : 52? 523,,19E7: 27.6.Lettkemi'.n in mice4ed benzo(a)pyrene: Ri'gdnn, RL FI:, Jack, Neal and Jhhn .%iack. Te:easRep. Binli tiie,d'.,2:i: 422'-431,1967: 277._±<cutemroopathy in embryos and newly hatched chicks. Rigdon. R', II:, #rch. Pa th., 8-k : 633-637. 1967. : °_7s: Pipping, muscleofthechick: Clinical., pathological, and onzymatir' studr. Ri;gd,on: R. H., IL D., Brown. S. K. C'hattopadhT.npancL _N. Patel. Arch. Path.. 8.;': 2~4'-312. 1068. 279. Gastric tumors, inmicefed' benzo('a),prrene: A qu:mtitativestndh-,. A'r.il, Tlc.l.-aml It. IL Rigdon Tex;~sRelit. 13io1: Slcd.. '~ ~?r ~ 1967. 240L Aenplasmsiumico, nromitqll,rinoc•ul}rted with, r tt th,r,innv anti~:ernmi andfed benzoCal!1);-rene. Ri::don. R. H.. .I.ick -A'o,il. 1). audI.. .Cnig- st'ein. Cnacer Res:, "_'7 : 231i~-23_':;. 1!)G7. _'~1. 8pontaneonsl~ ~'Ir, li» cAos ~) , 11968. _s2. _1ffi1forination:Diy., 12 . 202 _'i7,',, Aggravation~2 : 14„13EiS; _'S4. Amyloidl in th R'.H.andL'il _"~5. Spontaneous,( Mack. Aviai 286. \ecrosis in tl' s,on, J. L, T 377,1965. '5 L ChromoSomesandR.H.R'. _'~`;•: Relationship '!SJ. hyrene: Rig,. 1.J69: Effect, of hor Med., 26: 58: '1!)0: C'.igarette sm Rigdon, R, Mr. ti'_11?f I: R tT I Mir: F:chl~ial'di Mh: Ecr iIrAl:i Aucly~. Conldhrt cancer and tli.o:~ I'tlte ,? ' Aabollt ibi th1l them~ «-itliout aT I)~r: I:1Gnro~.. ,uiS jt17t- ~p1ll; r ~1 Mr., Ih:c?:1 G-\P.. peroent of' r1ic=~ 11n~ 11t1I,- ~calticGl iu,w1tat is inl, 1111'0 MUW slt?'JIIf )i'. Rlc.nON. an ~l Ga.6s~ llI1'~cl~ 1Ir. I:cICfI_u: ~RIC)li(,rS folll?d v,-lio c?id Iiot itI ifI Votlr ii0'tlre \~~oaV, Ivhy n (Ti11'Rrellce actll I)i•: Il.rcnox: tluit iilhaLttioi~ to 1ind I, lot o iM, l.;u-e ~ Tton- ~c;ul it' frrri l'otii~~-i Thcr01 ~ i: ilci Vr. Ect.~'IA :~loil't,tltinktla P L': ~ Ri(: n01T. ,

1055 Is that your~ juelg2n.ent~, of~ what; isthe~ most exiictl~ label t'o~ put on a' warninc,'?' Trou: quote this in your~ te~stimonv: Dr. GFID.rA-x. For warning: purposes ? Mr. PnrYER: I do not mean that-- Dr. ZnimrA~NW.~ AV'el1~, I think that is ~~ the~ fairest statement. that can be~ made although you are concerned here only with cancer. Fes, sir. Mr. Pr~ErER. TIi.2twould be a fair statement? Dr. ZEIWtA`: Yes', sir. Mr. Pxr~YER: All riaht. Thank vou,, Doct!or. ~ Tlie ~ Cx~AMMAN~., Thank you~ very~ kinclly,~ Doctlor.. Dr., ZFID~IA`. Thank you, sir.~ The'.C1-rAiR1Ea-,,-~~, We~appreeiate'yolzr~comin- ~.andg~ivi~ng ust-he~bene-~ fit ofy~our thinking. You know ii is~ awful late' here ~ tionibht~ and we~ almost have to apoloaize for running so late but we are tryin~ to' accommodate evervone that~we can and«~e appreciat'e'your~testimony. Dr. ZEIOMA~~N. I appreciat'e your~gi~ving me~your time. ~ The C»raIRlr_\ti, Thank you. _1t'~this t.ime~I~R-~oudcl like to~~place in~the~record a statement by Dr. Lyman A. Brewer IIII, a thoracic surgeon and professor at the';1lfedieal School of Loma~Linda, U.niversitti in Los _1n(reles. He has providedi a statement to t.he~committ~ee~olrmedicnl aspects~of tar~and nicotine. If there' i.s no obj'eetion, Dr. Brewer's sta#iement will be inserted at' this point iil, the record.. It is so~~ orderecil. ( Ti'he statement of Dr. Brewer folloR-s :) .~f'TATE3L'ENTT oFDB. I.YILAx A. BREwERIII, THOR3cI0. SURGEON A~ND. PROFESSOR, AT THE. 1iEDICAL.SCHOOLOF IA:11A LINDA 1'JNIVERSITY, LoS'. A\GELES;, CA~LIFsAs a specialist in diseases of the, chest, the writer has treatledl more than one thousand cases of primary carcinoma of the lung. This experience has generatedi a areat,interest in the tremendous problems present'ed by bronchogenic carcinoma. Because man cannot be used as an experimental model for the intrabronchial' injection, of'various possible carcinogens, there has been a natural use of labora- tory animals to determine whether or not lung cancer could be prodnced byy the introduction of'various substances'thought to be carcinogenic. Early experiments utilized "smoking machines"' to collect tars and residues from ci,Marette smoke:These substances were then, applied to the s~kin, of experimental animals'in high concentrations, much, higher thZnitiseverpossible toattain in, thelung, o£'man by cigarette smoking. After the application of these smoke concentrates on the skin of experiment'al animals, skin cancers were observed! This observation has been unduly emphasized. both in the L;nited! States anrl abroad, as ai demonstration of'definite proof thatl the tars and'residiies ih ci,ar- ettesmokeproduce priknary broncho;enie carcinoma. It' is obvioust'h any scien- tist who looks at tlieseexperirnentsobjectivelp!that, the only factprosed isth:rt', very high concent'rationsof cinarettesmoketars and residues, if' plheedl on thp skin, may produceskin cancer'in eiperimental'ani:mals:. Pollominnthisdemonstration thatsk'in c.ancercould: beprodueed' in experi-mental animals by the esternal application of tars and residtresfromei'garettesmoke', further experiments were carried out tb attempt to prove siiuilarlk- thatt careinoma, of the trachebronchial t'reeseouldbe produeed in experimental ani-mala by instillin,' these tars and residuesdirec*1y intothetirachea. Despite earnest andi careful efforts, tlierepeatedatitemptsbycarious inve,t'i;ator_,to produce bronchogenic carcinoma byt'he instill;ntion of' ci;arettesinoketa2:: :md residues: intothetracheobronchi:ll tree have been nn-4accessPul. Tliu~. cs7nerii- ment'al evidence is,Iaekingthatthe inh7atracheal admini.tration of tar., and iu'si~dires from, oi-,arette smoke will result in,consist'rntan+l definitive piroom<-tion ofl tracheobronchial-pulmonarrcancer in experimental animalsi,even when niassived'osesoE these substances are employed. These resuttshaR-e been the snmn, whetlier the substances have been, instilled at intervals:of twiceweelcly orara period uf'

1069 which approximately half of' his group of patients had the artery ligated and the other half'had the skin incisionmade but no litigation. ialalvsis of the results clearly demonstrated that there wa-snoslgriifi cant difference wliatever' bet~veen the two groups. q'he popularltyy of thei operation quickliy faded, and virtually none are being performed today. There are in medicine any number of similar examples of cherishe.dd belief''s based on uncontrolled clinical observations and supported by pres>`imptin-eorcircumstantial evidencewhi'ch have been destroyed by objective scientificscrutinv. The Report of the Advisory Commission to tlie Surgeon General ' of the United States Public Hlealth~ Service on "Smoking and Health'" properly st'~ates(p. 175~)that because the incidence of'lungcanceris --rel'tltlv ely low" and the inherent difficulties in controlling environ- ment, and so forth, of'the large groups of young people over'manyr years of smoking and not smoking renders a~ controlled experiment ilupossible. Therefore, we are told, we lnust make a judgment on pre- ciselythekind of evidence that has, beeil so fallible on somanyo¢ca~-sions in the past. My contention would be that one should not feell under any compulsion to make a~ scientific judgment if the evidence does not warrant it. A person of true scientific clfiscipline tivould never make a final judgment one way or the other on the: type of evidence presented. What is reaIlv neededl is not a conchision based oni uncontrol2edd statistical survevs, but rather continued and vigorous search for hnowledae into the nature and'true cause of'hulnan cancer. Iinowledge is increasiilg rapidly in thi's areay and there is irlcreasing likelfihood; that some of the answers at least will be forthcoming in, the: y.ears aheadL Until this time the wise course is to hold final commitlments iii abeyance. Thank y.ou very much. (The attaehments to Dr. Brem's statement folloR=:); CANCER OF THE LUN'Gr' Percent increase perperiod White. males, Cigarettes2' NonwMite per.capifar males per year 1330', 32-1933-35-----------°-----------------------_--------°---- 10. Z 20.8 1~3651 1933'-?5-1936-38------------------------------------------------- 11. 2'. 7.9 -------------- 1936-38-1939-41------------------------------------------------- 8.7 11.4 1i828' 1939-41-1942-43------------------------------------------------- 7, 0. 8.1i----.......... 1942-44-1945-47------------------------------------------------- 8. 8', 13.J -------------- 1945•47. 1948-50------------------------------------------------- 8. 5I 12:0 3,322 1951-53-1954-56------------------------------------------------- 6. 61 7.7 ----------- - 1954-56-1957-58-------°----------------------------------------- 5.0 8.3 3, 888 I GiHiam, A- G., Cancer, 14: 622, 1961. 2"Smoking and Health," Report of lhe Advisory,Cammissson to the Strrgeon Geineraf of'the Public Health Service, 19641: p. 45.

1033 168: Consideration of the Mechanism off the Anemia~ Prodiiced by Chloramphenicol! in the Duck. Rigdon: R',. H., _llartin, Norma. and Crass, G., Antibiot. & Chemather. 5 : 38, 1955. 1691, Spontaneous Regression of Hemangiomas:, An Experimental Study in the. Duck and Chicken. Rigdon. R. H..,Cancer Ree: 15:77. 195-5. 1I0;, A Consideration of the'Mechanism~ of' ReticulocStosis : An Esperiinental. Study im the Duck. Rigdon, R. H., Smiley, DaridJ Crass, G., and Martin, \ orma., Texas Rep. Biol. & AIed, 13: 170. 195 5.. 1I1. Where Cancer if the Ltms Occurs~ in Texas. Rigdon, R,. H!, I€irchoff, Helen and Martin, _A'or'ma., Te1asRep. Blol: S ATed. 13: 162:1955~, 172. Atypical Cirrhosis in the Duck Produced by 1Yiethsicholanthrene. Rigdon, R. H., Am. J. Path. 31: 461.1955. 1I3.lIi-xosporidia in Fish inWatersFmptcing into Gulf'of'liexieo. R'i,zdon. R.11. and Hendricks, J. W., J. Parasitol. 41: 511, 1955. 144. Thiamine Deficiency in Sea Lions ( ntk2ria. Calflfornia ) Fed' only Frozen Fish. Rigdon, R, H. and Drager G: A.. J. A. V. M. A. 127 `. 453, 1955. 175. \enrogenic Tumors Produced by \Iethslcholanthrene in the White Pekini Duck. Rigdon. R'. H., Cancer 8: 906,1455. 176. A PathologicStudgof Vitamin B;_Deficient Chick Embrros;F.erguson,, T: 3I:,,Rigdon, R. H., and' Couch. J. R. Arch. Path. 60: 398,,195.",.. 177. Cancer of the Lung before 1900. A Historical Review. Rigdon, R. H., Texas Rpts, Bio1,,.C JI'ed. 13: 993, 1955. 178. A Consikl'eration of tlieJSechanism by which Squamoufl-CelU Carci.3nmatoiil. Tumors intheChickea Spontaneously Regress. Rigdon, R., H!,, and Hooks, Murray D:, Cnncer Res. 16: 246,1956: : 179. Cataracts ini Vitamin E Deflciency: An Experimental Studs in the Turkey Embryo. Ferguson, T. 3i., Riadon+ R. H., and Couch. JL R., Arch. ni?hthnl. 55: 340,1956. 180. Smoking,Habitsof 21, 012 IndividualsIYrTeias. Iiirclioff: , Helen andRiadon, R'. H:, J:,\at'l Cancer Inst. 16: 128I. 1956. 181. Trauma and Cancer. An Experimental Study in the White Pekini Duck. Rigdonf R. H., Arch. Path. 61:443, 1956. 182!rTibroelastosisin Adults. Guraieb, Samirai R. and Rigdon, R. H._ 3m.. Heart, J. 52: 138, 1956. 183. Frequency of Cancer in the White and, Negro. A study Based upon \ecrop- sies. Birchoff; Helen and Rigdon, R. H., Southern Med. J. 49: 834, 1956, 184. Carinogenesis in, the White Pekin Duck. Rigdou, R: H., Texas Repts. Biol. S;1WIed.14 : 508. 1956. 185. Tu:morsImduced': in Skin without Foilicles. An Etperiment'aI Study in the Duck. Ribdon, R.,H:, Cancer Res. 16 :!804. 195G: 186. Hemangiomas, An Eaperiniental St'ud}- on the Duck. Rigdon, R. H.. Walker, Jack, and Ted'dlie; A. H. Cancer 9:~ 1107, 1956: 187L Lymphoid hyperplasia Produced in the Skin of Chickens by \fethylcholrtn+ threne:,Rig_don. R. fl:, R. E. S. 2C 40, 1956. 188: Thyroid in B'-12 Deficient Chick I•7tnbr3•os, Ferguson, T. al., RiddoD{ R. H.,,and Couch, J. R'.. Endocrinology 60; 13. 1957. 189. 3 Consideration of Siuolang and Cancer of'the Lung with a Review of the Literature. Rigdon.,R. FI:.,Southern:Med. J. °,0: ,`?4.19:rZ. 11J0: Histologic Study of the Skin of Hairless American DeerV'iice(Pernmyscus3Laniculntus gamheli). Rigdon, R., H. andi Packchanian, A. A., Archi Patii., CA : 210, 1957~. 191. Shectrophotometric, Examination of Ciirhot~icLik-er.s for .',-SIethylcholan, tihrene f'romi White Pekin Ducks Treated with this Carcinogen. Rigclon, R. H., Eason,Haroldl and \eal, Jack, Texas Rept's, Biol. & JId. 1a:911G, 1957. 192. Cancer of the Lung and' Smoking. A Review of someof the Data. Rigdon. R. H., Proceedings of 1957 Seminar. _>;u,-„ pp. 66'-67, 19.557, Sationall Asso- ciation of Coroners, Louisville, Kentuckr. 193. Effectsof' Gassypoli in Ionnr, Chicken.xvSflt tliePrnd'uction of'a C'criod'-liltePigment'. Rigdan. R: H.. Cl•ass; G., Ferguson. T. 3I:, and Couch. .I: R:, Arch. Path. 65: 228. 19~~S. 194., Siuolcin,b and Dsease: -C Stucly Bahed' uponi 1'2:050inrliviiluals:, Ricdon; R., II. and h;irchoff., Hrlen. Te.asR'epts. I3iu1. & Med. 7G:Ilkt. Irl'3& 105, , _lii:Gac. in theTurkey. I:ig-don, I't. II.. Fergukon, T. M., Feltimvu (U. L_ and Couch, J. R. I'nultry S'cii 37`. ,-,3. 19 --,R: I I i I .

984 University of Toronto investigators chose men at random and tested their phssical capacity. A significant association was found between this capacity ancL the amount of exercise the man was accustomed' to taking. In a health artic.le published in two of our leading magazines, a prominent science writer concluded, that this r!elntionship showed' thatl regular exercise increases physical capacity. However probable that conclusion, the study hadi not proved it'' in any way. If there is a cause-and-effect relationship here it may equally well operate in the opposite direction. People who feel strong and healthy, because of high' physical capacity mag be more incl:i.nedi to swim, play tennis, or otherwise: exercise regulnrlc. iCnsuspiciousTS believing that when one thingfolloR-s another it has been caused by it~--t!he ancient fallacy of post hoc; er,go proptcr koc-i, a major danger in evaluating populhtion stludies;, such as those dealing with sntoking, and healt'h, The principle that association is not causation is so important that almost every man who has ever written on statistics at any length hasrepeatedl it. Oneofthese„ the eminent statistician Sir Ronald A. Fisher, went on toi discuss what this outside', f''act'or might be in, the case of smoking and various healthimatters. It appears, he pointed out4 that people may differ genetically , iu resistance to specific diseases and~perhaps to disease in general. It is also true that people differ in respect to choosing to smoke or not to smohe; i~n, choosing, tosxnolce moderately or tosmokehearily. The fact that thisc•hoieehasbeen mczd'evoluntarily by the persons in each sample that li.ls been studied leads to the kind of self-bias in the sample that was mentioned earlier. If'per- sons who fall into the group having lower resistance to di-,ease also'tend to be among those who choose'to smoke, then an association between smoking and' poor health isbonnd to crop~up i~niancstkntistical studcof theriwo: This associationwi1l appear even if there is no cause-and-effect relationship whatever between these two things-in short, ereni if' smokuig isin no witgharmful.. Now it, happens thati we do have a good deall of evidence that smokers as a group differfnom nonsmokers intvays~ that the act' ofl sanolcinrcould not c•on+ceirabllrhacebrought about. The report totheSurg4on Gener:!l listed snch thiat,~s as these as having been found to be related to smoking patterns: socioeconolnic level, in botliP7ngl:nndl andtlieUatited States ;~ type of occupation : tendency to change johs: of"ten; race: religion: income;,marital status: rural or urban re4id4 ence; and such psycllologirab differences as~ the tendency found for smokers to "live fasterand, more intenselv, and to be more sociallToutgoittg."liore such associations have been found since thent I mustremiitdl•ou!that we have no~prooE:that this differentiation ofgenot~ypesis' truly responsible for the indications of an assoc:intion: between smol:iitg , andd certaanailnlentsor days off work. R"edo not 1lnoxt-ifthis is: producinrthe ap-parent association, or contributing to it, any more than we know if there is: a causal relationship between t!hetwo f'act'orsthemseTres: Curiously enough, however, thePitbli'c Health Servioepamlihlethtclndesin, formation that may point i:m this direction of differentiatiom of genotypes. (1nepiece ofsucliinfiormat'ion is the differencesin health patterna'founrt among present, former, and nes-er smolcers. Another is the reported as,;ociations be- tr; een smoking and such thing, asinju~ries; arthritis,and the catch-alI, group called`all other chronic conditions,"Although the survey doesnot~slleciflcall;t*.list these~ "other''cnttd'ations; it sp-pearsfrom the questionnaire itself that they include epil!•psy; hernia, prostate trouble, mas:sing 11n!,,ors,andtoes, elub feet;cleftpaiate,and nta¢ly other c•ondiitions pres(•nt siiree liirth. Since it is vi'rtuillvintlwssible tl>azt,smol.in.5,has prodiued, sonteof'theseconr ditions, tliealYernntive.explanatior.amnst be:givencareful considhratiolt. It is at't least c•onceivabletliatl havi:n~suc•h conditions as these could l:esd, a person to take ttp smoking or to~ smol.-e' more heati-ily:. Smoking is not cause, then, bntl et•fec't ->,ld this t, simply speculation. It's importance lies ini the stron!* suggestion it ntnl e. : tlint if can sali:t~-~isimhrohablc~ orofttncertain ddtoction in soncc ofthc' su„„,tsted a sociations, thencants,-'lity surely should: not h, tahc'ni for, grantcd in theot]tera Fltr the evicience isofPt.ecisely t7:ecanic kindl Ly applti t'n'- six t('vt clltc . t,ionstt c haveseen,liow statistical data notri_~orrntvlv etamined can lead to conclnAonsforwIiicli thereis nc:t, aderlputt~"sttpport'~. Iltope that a1l this will helj) to answer onentajor question ... tl'te'(Inc-stiouoftvhY it iy,thatsome ofthepcople most t-ersedin the' use'of 4atistics h:u•e bc't'n1ir<tto ; :lbnlit oni the conclus,:trctte :4moking and I i_-t such material as v, i tw:tlth-lcd Ronald to warn : "It will be j:, r do not warrant,t'he !tnt \rarning applies E -rvei about some sir' . ~uch wholesale reti B>:oar ..~~.~ril/l'nce': ~. Li.ncoln~ anl :l:,fn J ul1'~ 15 , 1913, :'.,,1,1 teacher: 3larried! ~_liter±. ~iitcane& public schoc~ ~ 1 Ccrti7i'cate in Jourl cur of additional! " state University of tl'd to SIgma Del'~ t i>~al t.:tnd Phi Betai K ~ :..-t,orter, Clinton (Io~. _.~,-rican Legionl Convc~ Gtzette, 1J37!. ,: a)-1YJ. l:ditlor-in-Chiet _aziuo;; 1:)JQ--1;?~. 3Ia, 4_L:'xoctttive Lflitor;,Li ,anizatiou producing „1-: ,5. I'~n,c-l..nce writer and Author of articles ir :ilaclelphia' Inquirer;,~ and manazines~:~, .',ttundtry Evening Pos ,r:apiiy, I'nduytrial I Saturdayl~ -NinJit -tald, andl other: Brit ~;~,,nrlllc~, Science Di,:e: _;tziuc', \ieclical'. Eco : it r's Di';;est, Wi•i'ter. IIousekeping, C IS6-k~uolutunist: Chi( Imi1cd to speak o1 ~:utl.:~.rical. A,~;~soc.iation, ~, _1ssociationi of . 1la'tnii•ul Soc'ii'tti-,. .:rrrived 1~)ti:i~. -Na:tio~~ ...t;•rprctation of'educa inform, Ito~. Jiutuar. u stiatistical ~ ''Il"Lc I:nt"lish~ and~ c . 1':no1 Ntate l'ollel e; .A-,nV 1•1u:rn,cc `ichoo ;tti•ul ltr:tnc•11, Sm t'Aiiueni;t Sehool of:lP "-I11'5e~ llll i?lo:'.tatl9tic:'~ .A~nrt~liim~itp, -1'~oet'bcrn 1~ I.inance~ Corp~ ti,~nt I{uckefellcr~~ Fot: nnIhisuce: aud, repril t':uaii•conitucntars~ o1!

5. Early Lesibnsf'ollowingIntrarenous AdluihiNtratibn of'a,Filtrahle 5taphy- ~ lococcus Toxin. Rigdbn R. H., Arch. Path. 3W: 201. 193z;. ~, 6. Renal Lesions in Staphylococcus Aureus Infections andthei'r Relhtion to Acute Glomerular \ephritis. Rigdon, B. Hl, Arch., Iut. Med! 57 : 117, 1936. 7. A Gastro Intestinal Lesion dssociated with St<2phl,tococci Infection inMan. Rigdon,, R. H: and Leff, I`T: 9., Arch. Path. 21: _'98~ 1936. S. The Age of Sexual 'Maturity in 250 Albino Female Rats (.lius Norvegicus 3lbicus, Wistar Strain)., Rigdbn, R: H., J. Lah. & Clin. Med! 21 : 11„ 11S'1, 1936. FanderD'il~tL;ni^rcrs{t,y-Yastzvill'e,, Tenn! 9. Effect of StallhylococcusToxin ontlre Dogy Blood P'ressure:, Rigdon, R., H., Arch. Path. '3"::806i 19,341 10. . Inhibitory Action ofSodinm Chlorideon S'kin \ecrosisProduced byStaphy-lococcus Toxin: Rigdon,,R, Hl, Arch. Nathi ''? : 763, 193(i'. 11. Inhibitory Effect of' Hypertonic Solutions of Sodium Chloride on Stapliy,lb- coccu. Hemotoxin. Rigdon, R.,H:,,J. Infect. Dis. 60: 25. 1J3Z:1°'. Production of COlitis in the Dog with Staphylococcus Toxin. Rigd'on, R., II., Arch. Path. '?3 : 63-1',,1937, 13. E*Yec.t': of'Staphyl.ococcus Tbiin on the Knee Joints of'Ratibit!s:, Rigtlon, R: Hl, I Arch. Path. 24: 215; 193i. 1-I. A Study of Immunity to tSaphylococcus Toxini in the Albino Rat: Rigdon, R. H.. J. I'.ab: & C1ti1. STed. °__'::,11, 11-1!11. 193i, i 15!Staphylococci: Immu~nityr--Resume of Experimental and Clinical Studles. Rigclon, I3•:. H:,, Arch. Path. ?3 :?33. 1037. 16: Effect of'. Various Sfilts on Hintolg•~is and Skin Necrosis Produced'. Ly. Staphylococcus Toiin. Avery, Roy C., Rifidon, R. H. and Johlin,, J. M. Proc: Soe F:xpetri. B'ioI. & Med. 37:~ I31. 1937. 17. The EPfect',of StaphR-lococcusAntitoxin onR3bbit'agicen BrotihXulttu•esofStaphylococci' Intravenously. Rigdon, R. H:, J. Lah: &Cliit. -lL'ed. 23:•?~, 1.59~ 1937L 14: Observations on Doltnan'.tiTe9t f'nrDc,termining, the Presence of Sta2dt,r;o- coca•al Enterotnsin, RigGlon, R. H., Proc Soc. Esperi. BioL & Jled. 38: 8'T, 1t13S. ~ 19. Deterioration ofStaphclococcal lbsin in Saline. Rzgd'on, R. H. andHariis, Henry.. Pror. So~. ExperiiBioll & _lled 3'1 585, 1`13fi. 20. Eflect of Heat on, theHemol}-tic and 1,Itan\ecrotiztng Factorsin Staphylo- coccus Toxin. RStrdon: R H, J Lah: & Cliit. AIed.,21:'?. 1'r1'2, 1928. 21. Capillary Permeability in the Skin of'theRahbit. Rigdon, R. UProc Soe. Experii Biol. &',_l1ed. 42: 43, 1t13). 1 22. Faiinre of an Acute InBammatoi;y Process to: Extend into Area previousl~,' ~I Inj:er,tied~ with India Ink. Avery, Roy C:and Rigdon;, R.H.,, Proc:, Sov•. Experi. Biol. &aled. ,42 : 67.1939. i °'1 Experimental Nephritis Pi•oducedi by Staphylbcoccus Toxin in the Dog. ; Rigdon. R. H., J. Lab. & Clin. 3led. ?-1 : 61. 113a. 19:;9: 24. Local Lecionsuroduced i~n~ A'Iieeby Sthphrlococcus Toxiln, and br Toxinand\an-toxin Producing Strains. Ri_clbn. R: H., Surg. ti:1, Jll, 19310. 25:Someof'theEfiperimontali Lesionuprorlucedliy Staphyloeoceus Toxin. Riy-dbn,,R, M. Southern 11cd. J. 3°_ : 79S. 1939. `3ti:Hemoly,,ikprodhced by StaphylococcusC.oloniesand Toxin on Agar 'Medi;r containing various! Animal Bloods. Rigdon, R., H., J:LaLj &Clin. AIed. 24 : ! l?~. 1264. 1939. °_7. C:apillat;c Permeahilitlr and Inflammation nn_NsnrcotizedRabbits. Ci:essman, R.ilt?h:D. and Ri'gdbn, R'. Hi, Arch. Snra: 39:356, 1939. 28. Effects of Intraperitonea~l Injections ofStaplitlbroccusknt'itoxin on aulir eu:taneon~~ StaIihylococciInfect'ion in\lice: Rigdon, R.H., J. Lab & Clin. 3led: 2:; :3. '3"~1. 1939., `?9: Staphclbcoccu5 Tozin. A Resume. R,i.,don, R. II:, 3tn. J. _Ifed~ Sci: 199:d1°, 1940. 30'. Denronstratinn of ai Capiilare Permeability Factor isTissue,Eatractsf!rom Normal Rabhits. Rigdon. R. H.. Arch.Surg: 4(1 :.16! 193'0!31. Capillary Permeability in:Sreas, of Iiifliimmatios produced bvt'ylene. Ri,gdon, R. II',.. Arch. S'nr,,,,. -11 :101. 1940! 3°: TheDetoxification of Sfiaphpl.ococcal'lloxin liv AAsorptlion on Organic Liquiils. dktliiin, J. J1. and Ri1-tlon, R. H., J. Ilnmunol. 41:°.13; 1941.

1016 80. Evaluation of procedures used in,d'et'ermining tlie cau'se,of unexplained and violent death : A toxicologic approach~ (with F. Hall. H. Turltel, and, H. D: 3loon )., J. Forensic Sci. 3pril : S1L 19513 81. The effect of etihanol on cerebral cortex metabolism in vitro (with V:, C: Sutherland and T. V. Burbridge). J. Pharmacoll Exper• Tiierap. 116: -1GSi; 1956 882. A method for the simultaneousdeterminat'ion of phenobarbital and di'phenyi-liydantoin~ i;n~ blood (la•i~th G; L. Plaa). J: Lab: Clin. _lled: 17':, G49,, 19fiW 83. Toxicity of 1.2-dibromo-3'-Chloropropane(Jl K. Kodama and -1I. K. Dunlap). Fed. Proc:1.; 84L BloocL levels of hydantoins and plienobarbital (R•ith G. L. Plaa). "r'ecl, Proc: 1J:(1), 1MJ.56 ;. _\ ~tlurdt- of t i;'~,}ur, an( 'iaLC• e:i:ect o~.•,itL G; I ; e irritatio iI. -Mevcrs ~ 'Glie tosicitv1:o' Iut"anl ) . IIj•rlarltoin a P1:rri. _ln -1t~uuies'orl t] :':., Li'ali,u : ff(,ctsof d (:n'/.nl:rn,. . I Iealt'11;, 2: ~umeeifeet:cn.rLan, :. ?: '50„1NJ61'. AIvoe,a¢•ditis.i. Ii. Kod: 1'oticology! !l1,Instria 1-~nrv •t- nf o. I . ItL 1IOl ~;.. ID:, SocI),itionalll I:oq. ','lir,r•tYectS_., P,(;rv: IIea 'I'''si-,14n[Y oT1l ri, , edil l n11 etpe: 1': II: 3Ir f ,rrunce. I I': ITl \il ~ . I:van~ i:-tirnution of. thee. '-irmati, 11 1'nn•lisii• Z 1'., i. An LIi 1:) wrcy cnl; Intersr•ii 1'bY.iollr;i 8ai Thetoaicology of'giycicl'ol and someg,lacidyl ethers(«it'h J. R.Iiodmma, J.,S., R'ellington;M. Ii,.Dunlhp;, and H. H. Anderson). Arch. Indust. Health, 4: 250,,1h-5G' 86. Opening, Address, Proc:First -N; Cnlif. Air Pollution qsmp:,, 7 Sept. 1'O-5G; p. 1 87. , Joint Report of'the Panels on the training of Physicians for I2ldustry at the undergraduate level (member Panel A), D. W. Clark reporting. JL \Ic'd. :. Edue. 31,: 47. 19511 ' 83. Method for micr~odetermi nation ofallrl alhoholand estimation of circulat-ingblood leFelain the rat (w,ithJ. K. Ii;odama and A. J. ~~"alprga)~ Fed. Proc. 18~(1) ,, 1937' :. 89. C'o:nparatiwehepatotox,icity ofsesen halogenated liydrocarbons(«vith G'. L., Plaa and EL A. Ex-ans). Fed. Proe.1G(i). 1957: 90., Inhibition of rat cholinesterases by tritolcllphosphates (with li. _lI. Cbursevand \I: K. Dunlap). Proc. Soc. Exper. Biol. 1'Ied. 96:• 673, 1957 91. Differentiation of barbiturates for clinical andlmedieole„al purposes (Avitil. G. L. Plha and F. B. Hall). J. ForensicSci! 3:'01. 11-5892~. The oncogeni~c activity of' tR-orepresentativeepoicresins(R-itl'a It. .I.. . Guznlan, -.NIL '-NIl Coursey, J:, S. Wellihgton, and H. H: Anderson). Cancer Res. 18: 20; 19,58, 93. Thetosicology of epoxy resins (with J. K. I%od:una,, J. S. Wellington, D! W Silnonson„ and Hl H. Anderson). Arch. Indust. Health 17: 1''9., 1`J5,y 94L To$icological' evaluation ofepaz;rresins(with H:Hl .>inderson anrl, R.. Legge). Int Cong: Occup. Health, Helsinki. 3:•'268, 1959 95. Effectl of carbon tetrachloride on perfused-liver function (with G. L. 1'i,na). Fe d P ro e. 17: 403; 1958 961 -Neurotoxicityof someselected hydrocai•bons (with D. W. Furnas). Arch., Indust. Health1S: 9, 195897L Relative hepatotosicitvof seven halogenated hydrocarbons (Nvith G. L., I'laa and E. A. Erans)., J. Phnrmacoli Exper. Therap. 1:'_:3: `_'24„19:;5; 98. Toxicity of allyll alcohol (with M. K. Dunlap ancU J. K. Iiodhnla), Arch. Indtrst. Health 18: 303.19,58 ' 99. PharmacodSnamic,aspects~of ad-lcl alcohol toxicity (with J. K. Kodama). J:. Pharmacol. Exper. Therap.1~'~ ~: 97, 19n5 100. Report on the toxicity of' primidone (\Ipsoline) (ns-ith G: L. Plaa and J. Fujimoto). J: A.AI.X. 168: 17G9:-193& 101. Chemical injursofthe helnopoietic system induced by eposgalkylatingy agents('wi'th: J. K., Kodama, R'. J. Guznian,, H. H. .Yndrrson„ and' G. S! : Lo2n><•am) F'ed: Proc 18c(1) 1f1.~9 . , . . 102. Sonle aspects of the, metabolism: ofalcohot in 'vitro (with T. -N: Burbricl:;o; V. C'. SutllerlandJ and A.S'iinon). J. PharmacoL and Exp. Therap:12b•:. 70, 1959~ I 103. Discussion: Health control in the ceramics industry:, Indtrst. Med. Surg. 28: 104, 1959 104. Cardiotoxicity of allylamines(tsith R: Gitznlant J.Ir. N:od'aina;, G; Loquvn1n: and I'I: H. Anderson) Abstracts of'papers; Am. Imd. Hyg. Assn:, page 42, April 1959 105. Industrial toxicology. I. General principles and new derelopments(witltJI. h.. Dunlhp and J. K. Iiodhina). AMA _1,rc11: Int. \ledl , 1(I -~: 816 \o• , , vember 1959 1 ' 106. Anevalu~ation of occupational healtll services and needKin thecity and county ofSanFnanciNco: («ith A. C;l Churchill. F', R: Ilolden. 5. K. Collins, SC:, K. Dunlap. S. S. Sherrill, C. F. P,ambibo:, R:. Dj Sox; anrli 17. ti! Harris). Report to t11e State of:California, Departmentofl Pnblic'He:lltht December 1959 iu1 diheC '1'hr laf •cl r(•ar~tii~rli ln1rcu:rl 10•1an,b lr lli~l: Nutalii•s w :. .1. \i' W,1(•nl. ri, \ S iiu10i, fL~~,aliza9i 1': \\'. ' .IL "I'.,>yic

103? 15. The Fate of Circulating Tumor Cells. II:,?i 3lechanism of Cortisone Action~in Increa~sing,lletastases. Cancer Research 22: 501-503.196'?. 16. Rlelntion of' Glueocorticoid Aetivity of! St'eroids to Number ofl JIetastases. Daniel Xlbert and Irving Zeidman. Cancer Research 2' : 1267-1300, 1962. 117. Fate of~ Circulat;ing~ Tumor Cells. III. Compari'scn of '-,N'Ietastati~c G~~roR-th Produced by Tumor Cell Emboli in Veins and Lymphatics. Cancer Research 25: 3°_i-3`?7, 1965. 1.S. Serum Protein Changes in \eoplasia. I. Studies on Mice «,ith Transplantable andl Induced Cancers. Co-authors :.I'. «'. Dempsey and Peter B. Shelley. Archives of Pathology 85: 481-486. 1968. 10. Experirnental 'Metastasis Via L;,mph and Blood Stream. Irving Zeidman and Isainh~~J. Fidler. Federation Proceed~ings•19G4 (abstract). The Thank yon very much, Doctor. Mr: Echhardt? Mr. EcILIIAnDT. Thank yon;1'Ir. Chairman. D'octor, I cotrgratulate~von f'or a statement that certainly seems ob- iective~ and fair. I would like~ tlo~ ask about these~ experianelits, «~i'th~ re- spect spect to rats and mice inhaling or tahinz in smoke.~ Do vouitiliinh that we~ are ev-er going ~~ to (yet any ~~ valne out~of tlliis kind~ of test~considerino- the fact that II assume that a rodent couldn't be examined for too long a period of time? Iwonld assume its life span is not very great anrll we do find some relhtibnship~ of' cancer with a lbn~z period of time~ of development. We don't, ltnow~~ what causes~ it but we~ db,fhnd that~ it frequently occurs at middle aze~~ after~the h~.lman~~ beinZ ~~has~ been subjected to some~ kind of' environmental fix over a lbnr period of time. IV, oudd that he a, consideration iv~ith~ resnect to, these laboratory ~ ex- periments with mice ? Dr:~ ZEIDas Ay~. Well, sir, if ron take-a rodent, a~, molIse or a rat,~ and watch him~ as lie goesfrom~~biirth to~the end of a lifatime~ you find that he tloo~ will sponta.neousl1v ~ develop~ tnmors andl lIe too~~ will alevelop, them in his mldclle age even thouall his total life span is only,, say 2 years: ~ 1VIrs~~. Dch~IIAr.DT: That is the~ question I R-anterll to ask you. Dr.~ZE~mMAN. 2nd1i'f''ive~~use~earcinozeni'c~alments~of a varietv~of types and apply them, t'o~, an animal,~ .~-ee find that it~takes~ about 25' pe~rcent ~of~. the life span of the animall to develop the cancer-that is, about 6 months: ~S''llen m,•In, has been accidentally exposed to~ carcinoreny the same~~ percentaize of' his lifeti~me~ goes by before~ cancer appears-and the~ la~t'ent~ period~ is~~ about 1~5~~ years. From this t'ype~ of' infbnma:tion it~ would seem reasonabl'e~to expect~hu7g, cancen~~i~n rodents following ,ex- posnre~ to,smoke over a~period of~ G lnontlls or longer-if the sm~oT:e~~ i:s t.rull-y a carcinozen. Yet, cancer fails to appear. I don't t,hirrl: that the~~short lifn~sha~~n~of'ro(lentsan(1~the~conseqnent~ linYited time for esnosnre to snlol.e is the answer as to «-ll~= the sinolc;e ~ does not produce~~ the~ lun~ eancen~~ in rodents, or other e~perilnentlal aninl:•11s: Mr: EchIrA~rznT. Wel~l, T think ~v'nu answered thesecond wnestioniI n-as~ ~oin- ~ to~~ ask and that is~.Thether~~ orn•~ not rodellt'~s~, sometimes deti7elhp~~ cancer in a~~nat'ural enaironmentallsi'tuatiom Dr. 7.t:ID.T:VX. R'i nht. lfr: I:crrrARDT. Thnt~has been oloserve(1 anclJis~~l:no«n. Dr. ZF~IO:~c:~~~N~. Yes, A~nd in the~ laboratory, where~ 1ife. ~ spall~ is pro- lon' zed by ideal environments, cancer; are seen frequently. Some ~ strains~ of~ rodents mav~~ display ;1 e.incer ineiclence, approx~ima~ting 100 percent.~ ulation. Mr.~ Dciiil_ Dr. lEID1Ii ceptibiliities 1 every ~ animal~ tain~wi7ld one ~fr~• 11:~ ~CxHl Tile : CiroIi. Mr. W_1Ts I Ri~eo~~appl of ir,and oil, to -%'onr use for.tll, so: act. Chn".ress sal IIealtIll is prc . of t1le~ me(li( ~ Dr. : rlp,.f_ lLI A~~"_MS" inteF r~in' (r C h[i(1 (ll-,('o1or: on t1ce:ihlll(rer snch ?~ De. 7_riD,iI fiII;re's wller -"oi.=:~~:io1~11(T I cancer off th. 3Ir. IVATSi Surgeon Ge) of no~iaistanc D1,. Zi;ID-M -A i r: W_1Ts n hite sl.in I pal-e I: ::Th( or~ Tun- ~ of~ n tion of canc D I'. 7l-.ID3f l1 r. ~~'_cTs crl ~cienee h the he'A we LSnt ~:on p ticnlar proc, quence vonl `.-.lieni all th( Dr. ZI;ID3I', ATr. «'':rTs you G Iy. 1:0 topsy.~" I ht~, A1L 1: mnv ll 2:,~~ percentL~ First, I tl) I~ just c:un't here.

~ 1044 There is compelling, autopsy evidence that the rise in Iung cancer rates is un- related to the rise in cigarette conswuption. The rise ini lung cancer has ai phe- uomenal correlation with the decline in tuberculosis as is evidenced by reliable records. The rise in lung, cancer rates catne: long, before the rise in cigarette con- sumption. The rise in lung, cancer has been found in areas where there is no cigarette smoking. aind' finally, those who adVocate the theory that lung cancer is caused: by cigarette smoking have made the erroneous assumption that lung cancer was a rare disease in 1930 in the United States. At the present time there are no solid facts to incriminate tobacco as ai factor ini the rise of lung cancer, heart attacks and emphy<semaL ARTICLES PUBLISHED'BF'.BBODA 0. BA8\ESi,PH. DL, II.D' 1., An Investigation of'the Antagonism of'Insulin by Posterior Pituitary Extracts as Indicated byChangesini Gastro-ihtestinaI llotility:, Aii , Jour. Rltly,siol. ~)8': (i~'?.1a3f1~,(',tic ith Quigley)?. Action of Insulini on the Motility of' the Gastro-intestinal Tract. VI. Ant'ago- nistic Action of Postletrior Pituitary LaabePreparations.,Am. Joirn Pltpsiol., 9,5: 7, 1.f;1t). (with QaigleF), 3. Does Insulin Antagonize the Action of Atropine on theCardiac Vagus End- ings?Jottr. Pltarm. Expcrtl. TTter: 41 : 209, 1931L (n-ith Barlow)i 4: The Production ofHemoglbbinemia and Prtl;, cythemi0. in 1V'ormall Animals by 3leans of Inorganic Elements, Jour. Bfol. CJient. 94':,11T, 1031. (with 3I'y-ers andEeard) 5. Studies on Thyroglobulin., I. The Digestibility of' Thyroglobulin. Am. Jottr. P'1i1/cioi: 98: 86,1931. (with A. J. Carlson and Riskin) 6'. Preparation of', Thyroglobulin. Proo. Coa. Exptl. Biol; and Jicd: 29: 605, 1931.. 7. Elimination of Thyroglobulin from the Biood. Proc. Soc. E.rptl. B'iol. and Mcd. 21): 88 ~~7, 1931. (with Lathrop and 'SLulliln): S. The Feather Germ as Indicator for Thyroid Preparations. Am: Joxr:,Ph>Isto1'. 98: 463, 1931. (with Juhn), 9: The Fxcretion of Iodine in ICsperiinental Hypertliyroidistn:. Ant. Joirr. Pliasiol. 101 : -l 1932. 10: ThePhy-sioloricallActik-it'y?ofIodineinThyroglobulin.Ant., Joztr.RlUpsiol;o'rJJ, 101:,583; 1033. 11. The Fate of'f the Thyroid IIormone in Experimental H,rperthy:roidism. Am. Jottr: P1r11sir1: 101: 553,10.',3 (iithieu)'. 12: The I2rfluence of Feed:ing, Proteins. Amino, acids,, and Relatedl Substances upon Creatine-creatinine \Ietabolism. Jotrn. Biol: C7iern. 94:49, 193?. (with Beard) 13. Variations in Blood Shgar Values ofV'ormalJ ancU Vagotomized Do," Follow-ing,Glucose Administratiom Jour. _l'ktrition. a: 77; 1p32: (with Quigley and Hallaran ) i 14. Sex Stimulating,Principle in Extracts ofI Beef Hcpophyses Effective in Female. Dogs. Proc. Soa. Eaptl. Biol6 and Dlcd. 30: 13G9a 1932. (with Btteno), 15. Relation of the Hypophysis to Experimental Diabetes. Science 1933 (with Regan) 10. Further Studies on the Feather Germ Test for Thyroid Hormone. Proc. tiatl: Acad Sci. 1933. 17:, Improrementl ini Etperiment'knl Diabetes Following the Administration, of Amniotin. Am, Jfadl. Assoc. Jorrr. 101:,926;,11933. 13. The Relation of the Anterior Pituitary to: Carbohydrate 'Metabolism. Endo- crin: 17: 52?, 1933, (with Re,an) 19. HypophScectomized and Pancreatectomized dtig: Ant. Jonr. Plipsiol: 105:4',. 1933: `?0:Is Therea, Specifi~c IDiuretic Hormone in the Anterior Pituitary?Ant. Jour. P'lil(siol, 105: 559i 1933. (with Re_an:and Blieno)'31. The Effect of' Culcium GSnconate on Parathyroidi Totany- in the Albino Rat. _int•. Jour.,PTt-psiol< 11051'5 1033. (n-itlh Bneno) °2: Tl'teEtfect o?' C11ciu~mGluconateon P tr,ithyroicT Tetany in theSlbinoRat. .tut.Jonr. Pltflsiol:1105.3~:-1.1'`.1:33. (with 1`o~,elber;andH~~nson)"3:, The Thy~roxineContent, of Thprohlobuflin. _lnn. Jostr. 1']t nsioT. ]Nl;c3~ 1033~. (with Jones) 24. The I:ffect of' Theelin and Theelol i'ni Latent Tetany-. .lu t: .lour. Pk?isiot. 10.; t17°, 1!t33. (withDlathieu)25: The Effect of Previous H;c-pnphcsectomc upon Diabetes resulting from P:rn- createctomy: Am: Jonr: PIiJsiol: 10.,: ir:S; 1033. (wi'th Itegan) ?6i Thc,Ezcretion of 1103 : 693; 1933. ?7:, Studies on Thy-rt stances from (with Bueno) `_'q: The Feather Geri 2JiFurther Studiiesistn. Am.,, Jo ttr. 30! Parathyroid Tet .',1. Sttdies on Thyt G.land. _1ni,. JrJr 32. Influence of' TI the State of' Ca. 32:253. 1932. 33. The Effect of tl I'li,r1st ol: 10S::5, :;1. '1'i.<•I.h y4iolh,_,i'c 1734. ( n'ith But 35. The Effects of betes: Am. Jou 3{;. Further StudieDiabetles. A'm, , 37. Effect of Ad'reand of' Hypoth: 103-4., (iwith Db. 33. Effects of Part tiritv to Insuli: Ferrill and Rol Implantation c~ 1131 1935. (wit', 40. Diure::iyof'IiIF(R-ith Rogoff!) 41. Experimental. _';drenall ReLrior 42. Influence of T 133+5. (Nrith Bv 4.";. Some Observa 3fares Serum.. 44. The Influence A'nl-. .7ottr. Phllr 4 5. Further Studi Diabetes, Am.. -S0. Stucly on Coeci Gl.nndsof Dog:', -17. TlieR'elation, I3locd. Ant. Jbr -iR. Thetiensitliritl Ferrilli and Rn 40. I:itterlin, Ovi S6~: '_'S 7;). nlrti f, On the Oriein iin„(l0.po.ci.to. 51 t?lt~ervarions .Ypril, 1939. 5?. RatlpitU RecoveSerutn of' a P: cortiio~terone:, :,;'. Horntonesanc .i-1. :1ndro„en,, _tj, Experitnental', .Yntitonenio Sti f Nvith T'. Corn :if, Fac•Mrs~ in the i iti-ii h L"eetbn' 57~ I;asal! Temper~~

1031 j' 114. Effectl of' Antihistamine on the Localization of'Trypan, Blue in lclene Treated' Areas of Skin. Rigdon, R. H:, Proc. Soc. Experi. BioL & Med., 711:63:i ,,1949. !'I I 'I I ~ ~ d 115. The Electrocardiogram of Normal and Malarial Infected,Jlonkeys. Ruskin, Arthur and Rigdon, R. H.,, Jl Lab. & Clin. \Iedl 34 : 1105, 1049. 11'6. Lethal Effects andi Eleeta•ocard~ioR ~raIihir Changes Produced by „ Quinine Dihyrh•.ochloride in B2al:ariablYifeetedi.lIonkeys; Rimdbn,R. H. and Ruskin, Arthur, J. Lab..C Cllni _lTed. 3#: 1109',1949: 111;. Effectof' Human Blood on Ylasmaditran Iinozzlesi~ Infectibn in Monke,rs. Rigdon. R. H:and Breslin, Dorothy, J'. Aat'1 Malarial Sbc. 8: `_'9S. ]949: 11C. Sudden Death D'uring, Pregnancy in: SickleCe11 AnemiaL Rigdons R: H., Southern \iedl J. 42: 1032.1940. I ~ i. , ~ I l. 119: Thrombosis of' Cerebral Z"essels with Necrosis of the Basal Nuclei. Rigdon, R. H. anci Lefeber. Edkvard J.. _im, Rev. Thc. 61 :247„1350: ; 120. Sudden Death, duringChildhood ~t ith Xanth~oma Tuberosum., Rigdon, R'. H: and Willefordl George, JA.3I: A. 142: 1268,1950. i 121. Pulmonary Arteritis due to Acquired Srphilis: Hej'tmancik, Jlilt:oni R.. 'Bradfield. James Y., and Rigdon, R: Ii., Am. J. Syph., Gonor. & Veu. Dis:34:236.1930. 1'2°: Chotio-Epit'helioma Following Hcsterect:omy:,Willeford, George and Rigdon, R H., Am. J. Surg. S0: 933 10-50: 123. A Consideration of the Phenomenon of "Sltidged Blbod!' in Disease. Rigdon R. H., Am. JL C1in.,Path. 20: f146;19W 124. S'udden Deat:h During Childhood «-ith, lanthomata. Riadon, R. H. J:, Insurance Med. 5: #'4, 19i0; 1?3: Observations on the Eff'ect of Certain of the:3ntiinalarial Drugs:on Erytliro- ~ H R i d R d B li D th T Re t Bi l & M d S I '~ i. ti cytes. . an : g on, . res n, oro y, exas p s. o . e . : 3 i 1. 19-50: 125. Effect' of Phenydlicdlrazine Hydrachloride oni FLasnzadium Ktito'zalesi'Infec-~ i ti'on in the 'Monkev. Rigdon„ R. H., 3licks, Don: SV., and Breslin, Dorothr, Am. J. Hygiene u" 308; 19.,0 127. , Primary Carcinoma ofl the I nnr in Texas!. Rigdon, R'. H: and Brindles, PauI„Tetas St. Jl Med. 46 85:3, 1950. 125: Observations on the Mechanism of Blackwater Fever. An Experimental Studpii) the3lonkeg. Rigdon, R.H: and Q,uattlebaum, X., E., J. Nat'l .lia.laria Soc. 9:,332, 1950. i ~ ~ ~ ~ e ~ a a 129.: Heinz Body Phenomenon in \Tbnkey Erythrocytes: A Quantitative 3lethod., Rigdon, R. H. and Breslin, DorothS, Prao. Soc. Esperi. BioL & Bledl 7, 6: 242; 1951. ! ~ 130, , N'ecrosigof tlie Basal Nuclei in Cases of Tufiercttlous\Ienmgit'isTreated with Streptomycin. Rigdon. R. H., Tilberculology, Ma:rch, 1951. 131., Frequency of Cancer nf'the Lung in all Jialignancies Studied' at Autapse:. Rigdon,,R'. HL and Iiii<<hoff:, Helen, Sbuthern Med. J. 44: 506, 19M. 132. Accuracy of Death Certificates for Establishing the Frequency of Chncer as Shown by ' Autopsy. R',igrlon, R. II. and Iiirchoit, Helen. Texas Repts, BioL &3ted 9:65?. 19.i1. 133, Some Complreations, OO bsers-edl in Casesof Tulierculous?Vlcnin;;itis Treat'ed with StreptowFcin. J[ed: Rec. &_1nn.45: 525 54 ,1951. ~ ~ i 1a4: An anomalous Coronary Artei;r Arisin,p~ fromi the Ptilmonary _lrterc. Cronk„ E. S., Sinclair, JI. G,,, and Rigduna Id:. IT: Asn. Heart J. 4° : 906, , 17.51.13 1. Srnue 'I'osic Slanifostnt9ons ofI Drug TherapV fromi a Patholbgie Standpoint. R',irdon. R. 11. Piesentecl April 2, 19b1 to the Medical Service Officer P,asic Course. Army Medical Service Graduate School, Army Medical Center: R'asliington.,D.C. 1~16. EFfectof Hypervi'taminosisA and Hi-poci~taminosis A on the Sl.eli•ton of a Duck. Rigdbn.R'. HI amI Rude. J. G.. Arch. Path.,:,2',:299: 1931. 137. . Pathologic Lesionsi:n tlie Nervous Sytitemi oft'he Duck Fed a Ratibni Deticientin Vitalni~ni.A. Rigdon, R; Ili:, An•chi Path. 53': 239, 1952. 13';. A Consitl'eration, of' SonTeof the Theoriez Relative to theI:tiology and Incidence of'Iatng C:)ncet Rigdon„ R. Hl, and Iiirchoff„ Helen,, Texas Repts. Binl C\1ed. 10: 7(31M)i2. 139. Slpcotic Aneuiysmi (Cr~cptococcosia~), of theAbclomihal' :lortaL Reportofl a 0'iicewithAutopse. Riil;on. R: H: and Kirksey„ O. T:,, Am., J. Surg. ir.4,:~ 486, 19:i?. 140. Pancreatic: Fi,brasisin Duekc: on a1y'utritional Basis; Miller, O;, A'ealandi Rli;;don. R'. H., Proc. Soc. Irapori. P,iol..Glled. S0: 1ti.7;495'':. .

1046 5a1 FuruncuIosis-Etiology and Treatment~ Jour. Clin. Endocrin. 3:213, 1943. 59! Headache-Etiology and Treatment', F'ederation Proceedings 6. .\'o. L, 1047. 60: Treatment of Menstrual Disorders in General Practiee. 4iri.wottia .1Tedicine. Jan., 1949: 61. The Early Diagnosis' and Treatment of Pertussis. .4ri'lzona Jfed,icine vol. 7,. #11:34-33, Jan. 1950. 62. Etiology and Treatment of Lowered Resistance t'o Upper Respirat'ors In- fection. Federation Proceedings 12, #1„19a3i 63. PhysiologTand Clinical _l'ianagement of Atherosclerosis and C'oronargHeartDisease. Fcdermtimr.Pro(cedings 16, #1:;, 1.)57. («•ith Rub:rt \V'. Barnes) 64. Role of the Thyroid in Coronary Artery Disease. P'roceedings Iu.Ititerna-tionalCongressB~ioclieini.st7•y; Vienna 1958, 65. A New Approach to Ilypertensioni and Arteriosclerosis. FederationProceed- ings: 1C; rr1, March 1959. 66. Prophylaxis of Ischaemic Heart Disease by Thyroid Therapy. Tlie Lancet, Au,: ?'?:,1i3;i9. pp119-.i2: 67'. Arteriosclerosis in 10,000 Autopsies and the Poz~sible Role of' Dietary Protein. Federation Proceedings 19'=,;5, Pt. 1, JIarch 1'960! (with 1TasRatzenltoferand G. Tscherne): 68. One Factor inIncrease of Fi•ochial Carcinoma. JAlt3 17-I:°?'_'9. Dee. 31, 1960. (with _lI. Rntzenhofer)69. ~'~iy Heart Atitack, Decreased in Europe during the `S'ar : Fat vs. Prot'ein. Fezleratioii.Prooeedi>>qs?0:-11, 3larch 1961. (~withill'. Ratzeuliofer) 70. Prevention ard Treatment of Coronary Heart DiseaNe: Part I. From a Sbien- tificExhibitatl the -1an: 3Ted. 3ssoc. AIeeti~ng, Denver; Colbrado, -Nov.. ?6. 196L. 7L Coronary Heart Disease: al . Preventable _l'IetabolicDisorder. Federation Proceed ings 21,, #r 2; Alarch-Apri1,196°. 7?'. Coronary Heart Disease:, A Sletaboiie Disorder Prevented by the Thyroid Hormone. Ea'~ecrh'ta .17~ed'ica„ International Cbngress : Series ,=15; containing a'bstractsofl Free Communicationsread at the XXII Int'ernationali Congress of Physiolbgical Sciences, Leiden (Hblland),S''ept. 1d-17:19F:": 73. Prevention aud Tf,eatment of C'oronaryHeart Disease, PxrtIiI Fromia Seien-tifleEKhiliit at the XXII International Congcessofnhysi~ologiQal Sciences,. I.eiden. Holland. Sept. 10-17,15)62: 74. Hr_ve AntibioticsI'ndirectlgIncreased! Heart Attaclis?Federati'on Proceed-ings,?2 #2„1963. (withMaaRatzenhofer)75'. DoFem1le 5eaHormones Prevent Fleart Attaclts?Federat'ion, Proceedings 23;. #3, Jier: Apr:.1964. (with A'Iat Ratzenhofer) 76: A Praetical:lDietforSl"eigptReductibn.Federat'ionProceedi4lgs'?4,#?;1Sar:- Apr.,1965. 77. Experimental Thyroid Deficiency in Swine. Pt'esentled:at XXIII International. Cbngressa,of'Phvsiologica'1 Sciences. Tokyo. Japan. Sept~. 1965. 78. Do Unsaturated Fats Lower Cholesterol by Stimulating the Thyroid? Fed- eratFoniProeceding.s 3fi,-t2, 3'Iar.-tlpr:,,1966;. 79: Strsceptibilitwto Iinfect.ion ofC'retinStivine: Federation Procced++igs`?6a, :~,°,. llar.-Apr.. 1967. ((with D. D. Cruea). 80. Whp'FJmphssema,, Lttng,Cancer and l'Tyocardinai Infarction? From a Strien-t'ific Exhibit, American Academy' of Generall Practice. Dallas. Texas, Sept. 1S-21. 1967. 51. Susceptibilit;c' to Tuberculosis and, the Risin„ Incidence of Lung Cancer. Fer7eration Procee(linqs37, -;r° AI'ar.-Apr.,,1968. 82. Thyroid Therapy asProhbylalis againstC'oronary Di ease:, Pres'ented at XXIV International Congress of Physiological Sciences. 1Giishingtoo, D.C. Prareed~ings' of't~hefa2ternationab U'~rionof~ P7e-glsinlopica~l'Sciciices: a~oT:, VII. 83. Eig,ht'een,Fear Fbllowup on Thyroid Therapy in ProphmlaTis and Treatinentt of Cornnary,Dise,ise:,Fedcrat-ion Procecdinds"S, T'_', SLar.--Ypr., 1969. . 1Mr. S.1,a-rERFIELD. Oiir next «-itness is Dr. Ih.vinn 7eFcluI,in. AjrPlr•orrre t,othe columitt~ee. Dr. Geidlnam Do youIhave a prepaled ~zt;ltenient?Dr. GEr'D.L>`N.. ~~~ es; sir. ifln r+.vrrFr.rlnr:n. Is it, venV 1on(y.? Dr. Aol it is one ottfie shrnrt'er ones I tlriltlr~. Ifr.S.~T•rr.nFZULD. Fine.,Tlie,onlyreason Iann mentioilin* !~r it is1lrat I know solneof'tllemelnbersliati-e en~raffenlents tlris evening, and tliebour i's~,ge~tting latle~ receive'.it. STATEMENTi Dr. ZEID3TA University ot inter.nship an Medical' Scho i-ears I have 1 dents about c am Ilow a h' concentrated , ferent partlsc dealS, in part, f'ore, I have n field. The: facc the i=sue. I can sun117 sayinLr that tt is in,;ornplete dents-the fii tilia2r r)resent t,lle feelin(r tl there is little' issuet'ostucle conclusion is it is safest tc c<incer-produc ObServethEceptible:" 1rhE medical studeWitlli thea'bo, olcll not to stal Cer: itiseasN.lrabitn.nl smol «ei_711ing' po5s pos,~ible pwcl. l;urc-d t:o.e•itli+l Iteax-Y cirraret 1)I't! 'CICin 7 1)ll q'11ert!lon :, "T)i7 an7 i`acecl! «itI Tiie ansiver i: sllort of bein.(r 1TI«- all tht'liath heavy ci s]]1o1CS1 cCrttlllli of lunz cance PeolIlesmolcii birriger 1nClde] «Tlloii heavy

ra11e- \ ioa l'. lnlzic and tinnc 1 fl::,0 i ram- 'roc. lcdp . .3r;: der- itedl 'mi- ,l~_a:, 101 :ing 'I ntl i0„ti . N: enr 13: \I: 1H -11, r a. +n- a,. ld Ot ~ 1015 ::. Toxicologc-and safe handling, ofl CBP=55' (Technical 1-chloro•3-brotno-pre~ I,ene-11~ (with H. H'. Andprson„H. D. 3I',oon, J. K. Iiodama. M. Morse, and N. `l'..Iacobsen). A,rch: Indust. 1-Icg: Occup. \Iech 1': 118,135:1 Acute toxicity of'3'methvl-:3-heptanone (with.lT. S. Morse, J. K. Kodama andi -\:', K. Dunlap ). Fed. Proc: 12 (1):, 11/:53 :~. Comparative toxicity of two vinyl-substituted alkyl phosphates (with J. K. I!:odan7aand 3I: S. .\Iorse):, Fed. Proc:,12(11)1, 19.i3' Comparative toiicitt of synthetic and natnral glycerin (with H. H. Ander- son. Id. Il: 3loon, \T. K. Dunlitp: andl M. S. \Iorse). Arch. Indust. Hyg. ()ccup. AIetl. 7: 252:19,53I : i. Toxic•ological appraisal of laboratory cheniicals'and' personnel. Proc. Oi11 IndustirpRegional Saf'etgConference(Berh+eley) JIay, 1953, :, Stndies on the toxicity of two alkcU aryl sulfonates (i«-ith H. II Andetson. '. I!. Finley. and .I. G. Iioore). JL Am: Pharm. A•soc,., Sci'. Ed 42: 4S.`1 1953 l. I,utergency treatment of poisoning. Bull. Am: Soc. Hosp. Pharm July-Au,,::~ _'i(r Vt5.3, J: Choline5terase-inhibiti~ngproperties of two vinyl-suhstitttted phoppllates'( withi\I .5. \Iorse and J. K. Kodania )_ Proc. Soc. Esper. Biol. JDed., 53:. i19 i3 ~~. Thetoxicitl' v of g-chloroallyI alcohoI., and c•otnpari'son n•ith a11y1 al'cohol, a-chloroallcl alcohol, and CBP-55 (with J. K. Kodamai and,H.H.Anderson)- .I: Pharmacol. Esper. Therap. 110 (1). 1954 . 1_'. Toxicity studies on diglt-cidyl ether (with J.,K. Ci'itchlow ,an(1J. K. Iiodaana)'. .I:,Pharmacol. Exper. TheraLr: 11V)(1), 19.54 i;~:: Comparative tioxicitpof two vinyl~substituted phosphates(«-ithJ. K. Kodama. AD. S. J'forse,, H. H. Andersoni M. K. Dunliip),. Arch. Ind'ust., Hyg. Occttp: J'Ied.9; 4F,11)54! 1;-k. Acute toxicity of'four epox5'compottndsin roc3ents(n-it'hJ. K. Kodama ancT. II.Jang.)~Fed. Proc. 13('1).1954Solne effects'of ethanol on the metabolism of' eerebrallcortex in x:it)•o (with V: C.'- Sutherland). Fed. Proc:,1:3 (1). 1954 6+S. Stlfehandlingprocediures for' eomponndHdereloped by tliepetro>clienticale industri- (Avith: N; W. Jacobsen). Am. Industl. Hyg. A. Quart. 15: 141'y 1954 . U67. Toxicolog(cal, studies onp-tertiary-butyitoluene (with II. Ungar. Il. H. anderson, J. K., Iiodama, J. K. Critchlo«-, and N., W. Jacobseni)'. Arc•h.. Indtrst. Ilyg, Ot•cnp. Aied. 8:227.59:,4CN, A rapicU metho& for the estimation of morphine ( n-ith, JL 3f: Fuj,imotoandl h7.. L. Way). J.,Lah. Clin: ~Ile<L F4:G2I.S!)54 IiJ. Studies on the neurotoxic and cholinesterase-inhibiting effects of satne organo-phosphoruscompound:s (with I71 E. Gntlerherr. -li. JI: Conrsey. K.. Seligmtan andR. 3I., Gross). JL Plntrmacol'; Exper. Tberap:11J'(11), 1955~ id. AIetlhod for simultaneous di•terminntlion ofphennhat•bita'1 and diphensll hydantoin in blood (Nvit1iG. L, Plaa). Fed Proa1 -~ :(1), 1955 74. Metabolic studies of' allyl alcohol. I. Effect on, oxy:een nptalce: of tii:stre slices (with J. K:Iiodamat and 1". C. Sntherltwd). Fed! Proc: 7~d1). 1955 72. Toxicity of allyl alcohoi (with11. K. Dttnlap).,Fed. Proc. 1-~(1). 1f)•i•il 73. Effect of acetixtldehpde onetllanel uptake by , cerebral cortex in ritro Ovitli V. C. Sutherland). Fed. 1''toc. 1~4 (1I), 1'.15.,74, Inhibition of ratcholShesterasebesotne tol)•iplloslihntes ('witlhi Jf., s- Conrsey andS..G. Rice), NTed.,Pcoc:1:~(I), 1955 7.i. Central nercoussystemi effects: of' certain aromEltic hrt•drocanbons (withX. 3Lnlamud., 8. Garoutte, audl D. 11': Fnrnus)'. Fecl. I'rctc: 1.y(1' )_, 1fi:,.1~ 7C: A clini~cal evahlati~on of tetraeth~lthiur:uuili~ulh~liidi(:1nta'htt«•) in the treatutent of problem cTriltlcers1 withi K. .lll Btwmau. A. Simon+ E. A. _l'Larklin. (L, H', f'rook. T. N. 13nrbridaesind K. Hansonl. liitnaernleut (i£ 3ddiction5ced. E. Podohl.-}- SL17) Philosoptii~cal Library. New York. ]'11.5:, 77. Neuropatholbt!}*of' rats etperi~mentally poisoned with, p-tet•~ti:iry-liutl-.lr tolktene (Mth H. Ungar, .II. K. Kod~ama, audl IIL H. Anderson /_ Ar.c•11. 76=,f1:lp.i:~. Path: 60: 78. Toxicit;rof or;;anophoUphot•.uscontlrouuds I SPrrteture-actiml reLitionrltipnin amimrrlyand lnanOcithJ. Iti.. Kodvua. 1'd. HL _1'ndersonA and!IL K. Dimlapi. _A,rch. Indlur+t. H',}-„,. Occm17. JLecl. 11: -#Kl~. 7!).i:; id:Theneurotoxii•ity and anticholian-stel•asepropNnties of some sttbstituterl 7rhenyi pluisphates Orith \I. K. IFnulap. E. G. Lliie. AL. 3'I.Coiu•se}-. It: 3L. (,t•.o."; andl Hl II., Anderson). .I.Pharnulcol. I.xpen: Therap. 1Y6:• _'i. 1956 ' Y I 11 i i t !'

987 .L•llu i3ugazlne,. M T 1:.1.-... l;..l 1~ .,~ i- ~, ~;+;;-- .,+~ _etl newspaper . . . _" L-'-"_.°_ __.,. ._.,. ..... . .___.._..~__•,... „.___...,_~....__,., ~ ~ 7J f rs for Hospital 1•leonl1 1J<;.i~ to t1le, present. Iin 1I95was~~named professor o medicinal rIlenli ti1v at Stanford University in the departlnent of pharmocology, It Culne Trlae' },,,in4r theon,ly person to beprorrloted to the rankof full professor on l•fth St¢tistics I l.. 14__ _12!4u_ A'r;.a: ._, c,. :41_..•_441_.. A rr% al.____ r use in most 4,,.. . 4.,u,1.1. :, ~4.~. an papertlacl~; `ilull u1~-,, I haR e for several years been the only' scientist without a t>ditions. gow Inltttical clenree,on the~att!endi~ng stat£ of Mount Zion Hospi'tal,~and am! (-over;_ British :, ntenlber~ of the tumor board' at:that llospitad. In 1966~~ I was,one of ~ ~Ta1Ji)tg. Tests .. l l ~.,1;+;.....~.'_ „+;.,F.. .. ,.~11 +~,.11,,,... „-P +1,,1 n7:.,-... v;,..lr 4 a'.,,.".., W . a,- _ - 4. .. - back editions t, , .t~ Rriti~chi anA /I ~ ) 1: ;`~Clellce~~. _l (leLaLleCl C1lrr1Cll.llL14:I1 V3LiLe~.ls'.aLLQtclleu.~. ("h(l(l (\Iagna! AL Stanford I:.111versIt~,7i c 'lnl C onn• other lecture assllTllments,' I wrote' J.~ , b. uI presente(.l the col.lrse , Y3iochemistry of cancer.. illt 1945; also / r, l lnc* I 1,.++ 1+,, , ,11 r, r a, ar +,. .9 +h adden-Barte11, ., , ~ .. . .~ .,.r ...,,.l l ~LLL.~~ l !s~titiute of Clielnlcil 13iol(rylt t'he >Jnive>sitly of8an Francisco o,.... ~'Cl t I t ll ~t - T16isi' th it f C L lltiI~lo ~ln z idirlsco t e o e~ 6 ~ o e e sil~ cis „ director of ~ :.. , . L: .... .. .,. , .. , , . w . _. _....4.._. . .. , ml... .. .... ....L. .._f.1:.4..4."_ "..__._..",f. • ~l,l 1'l cl ll.all.ll!1~lVt ll C11L.11.C11 U ~ 111C1C1LL 11.1.`1l1LLLL1VILL..~) 1 . 11C 11.1.'ALILULG'~lal.LL1C7 ncisco., il loth teachils 'and researc actiitie iiraiaos fildt ,,,,~~gLv~s vcl scientifices....i ;' th r P t ~ i ti - l t ~~ l l e t f h ~ ~ t >l'u yT1~,1TT~ n~  .~or e~ :uLip e,~ust~~ e ns tu e j conzp etec a proj or c t e _NIll.lona t.-1Pron;lllrl01 flnn~. 111~rP~.~ :Y~rn111n1Srr;lrln111_. retl7Tlylo• tn~ rhe RrIPRr. I _lat;W~~ • " f Il(Y b ~i bi r i' 1'hi h t •ill h h ~ lic i t en oll! ra nI oc el n s ry tie e s a ~e app at on o t .. ~~ inl•tioninir ofl a,tronautls, who~ are~~iil a pure o1yben atmosphere. Z'V'e~ th t ~ 1' i ~ l i b h d ` i ~~a- 11 D xl sanle oI ei-a nb sN nt let c car o y rates~ 1 a~~ that I a'm! /' a~genci,uat f ` i! ~ ~ / s(.f1 thE y e nre suitable for~the ast.ronauts~ diet when on a prolonged il)rllt Lr iti dd' ~ h th i t th ~ i ~ f ' a ~ on we ac-e ano er jo llt projec n on sx es s ~~~.~-' o o spe )n w~itnec.,ses~ , r, 4~,, - -• - /• , • lll/v llllil~~• ~.Y. iVlllull ilLlI,ICLiL 1~.G1il Ca LIU . LIli7 '~ 1J1C L11Vlll VL lll:~l.CL;Llllg~ II don't im~ , r_ _ v r r , n •- l. CL.I;Cllcl., U~~ l.!1LLG. 111C11L11LC2111V11. V1l i111111.1V ill;l(l.7L~ )f who pays 1?0l tlle Air I+.orce we completed al studv attempting to fiald the toba¢co~ i'n- l ~ l i ' l c lan w snr of tox icit of li uid rocket f s ad f th ~~tiI ~ ~ue tnoreona q ~, wrong as~ to ~~~' Iilstrtute~ of llelst ul I~~eallthy~ ~re are conducting ~ research into brain. lecause they 1 I,ulllstx'v~. Ihe~ I'nstitute of~ Chetnic~nl 13iolo~ ~ aIso' doe~s, ~ eonsiderable her doctors' _•..,. _ 1, _ ,- _L , ,I ,!• - tllcu licaU.. V1. Uillll:Cl,1LL11=1!ul.lLL1L_ 1NV1.11.. V11 111C1i11 l;ilill:1.11V~'C11C~1>rfiCPrTlm~n}'. . . • _ _ . _. _ . _ 2^ ~ -C1, .~111JL1.lU • • ' _~N~•Ll1Vll~t1 \ U11 .LC. li` VL l.tllY iJ21~1~1C1ti', \Cil1J~1 tJC1.~Vililll,' ~ L , . ~ ,s w11at anll . Il - b aV e een: engacrccll inn projectshich inol'dli ~ .w'vve~ sluo:ng., 1'ile heaIth bl f th \ ti l l f ~ d pr ems o u e a onare' extrelne y comp esan o rnna t1in+ .rn  '-•~ . a..v.. l,Vtl.~1~c3JlWllcll. iLllCllLiVll... L11 iM17L.1Lallill. 1. Z5L1VlllLL! 111hC~ lU e!value: W 'e~ llis ~ t s ' l ll9y cert ain a peets of someons relatinI t o sllr~olin arld ~ questi~~~cg! lu ,lltll b t i d I h Id e h i h l ~ i ; ~ n n so olng' ou ,~~ s mp lis ze t at t lese qlIest ons! are ~ testimony.~-ll ,t.1L.11 aal~lC. ii1 Vr.1LC1Lla CV1lL~C1.i1111~,. l.1VL. U/1I1 y SC.VCL cl.Ll 1LI1fJL/L.- , I:urt dlseises, bllt also nl¢inv otherfactors, aIso laudel,• study,!as'possibly, ro (Tanar~l"c „ _ _ ~ ~ ..clarrlL LV t1.1U~t, lilJC.2lDCti, hias as, one 1'1S ~ ' ~ e Ireas for reseurch ~~-i tl rerard to th d ~~rese~~setzses~ a~re enolimous-~! i r Illuostll " d l i i li d ld' it i ~ et on o escr pt on na n e( esp c m21ch p1~L lic notoriety, ~ ~~.,~c.~ ILl n fPn fnr ~ 1~~ 1Clle AvLC1L rel„1lrQio (1ILlesLlnn~z ~oT smol:Itl- aI1Ct J1eaLl:n.~~lllelte n11I11v„ ulanv facets~~of these~ question5 that~ have not been inv-esti~- ;,Ithzl o~ m 1! l ~ t h bl~ i h l it l ~ uc > :1 '~oll ese pro t ms allpears n t e press so e of t ~_, Institute of / _, 1!u u1V 7U_1c11LL•u~ 7l[lell.l.tull. 1~uLLdLULC l~LSl~ul~~ a!Ll lJlle~~. ~isco, Calif:, ;~iultlu liv, oulv :1' l/e~inni~nn ht;s been mlde~in tlle~sclent lic rnv•estit;~t-~ e published ~,yilu, rn~ ~ 1k t ~ t 14 h h l i l ~ arv o ( ernulle IV et er t ere itre Mly re at ~lus ~~-~ lips Ile h~l~l•I`IL sI]lOlillll r' ~ d~ tl ' ~ ' 1 '1 l ~ lb b d ~ I I le :11 lolls C .~...'.~..I ~ LSeils1~ AA 111' l a!A~e: eelU 1`?sUCIRte as recel~'ed ~ - at,it~. l.lV2,u. 1l.luL:J111."Il.l~n illu:luhLll,rJ.cll ~ 1L ~ , . 'l:lster s~ de-~ itll/1,111.tt'L4 L1tl"lu. 111~.11111~1.LlALL lt~(IiL.L.lI.I.L.l'll'~~.~iIl.l(lltt-~~lti !•:Ltlalllti~llle' 1111 cheln- j-Vr,hlVlll,, ho.v-~ it is (loirn1(r ~ so.

10?6' 4~ocicties, nietntier of Galveston CountyVIedicallSociet'yState Medical Association of Tex<Is' American Medicali Association Texas Society of Pathologists American Society ofl Experimental Pathology American Association of'Pathologihts and Bacteriologists American Association for Advancement of Science Society for Experimental Biology and Medicine Southern .lledicai Association Law-Science Academy -3rcard's and'recognitionsPresident„Texas Society of Pathologists, 1061 Chancellor, Laac-Science AcademS, Lniversity of'Texas, 1959 CChairman and Secretary, Southwestern Sec•tion,, Society for Experimental: Biology and Medicine, 1951-55 ' Chairmanand Secretarg„ Sectioni of' PatbologF, Southern Medical Associa-tion, 193'8-44I Certificate, Law-Science Institute, in Recogr.ition' of Disting.uislied Serc-ice, 1057 Who'.s'W'ho in American Education, 19-51-a2American \Ien of Science, 1049 Who's Important in, Ji edicine, 1945 V'1'ho's~Who,itz South and Southwest Medicine Certificate of 3lerit, Scientific Exhibit, Amc•r'ioan Medical Association, 19-14! Society of'Sigma Xi. Fr'aternity Phi Beta Pi C•Ii-nrctL' Methodist Con,tribntect to international sy,mpoaia. Capillary Permeahil'ityin Areas' ofI Infltimmationi TlieS'Iechmuismof' Imfl:am- mation, edited by G. Jasmin and A. Roberts, 1cta, Inc., '\Iedical Publishers, Montreal, Canad'a; 1953 Role of Anoxia in the Pathogenesisof' the Lesions in Acute J'[alaria. 1': Congress Internationaux de 'Medecine Tcopioaleet du Paltld,isine,,Lstaubul,. Turkes. 1954 Lymphoidl Hyperplasia Produeedin the Skin ofl C11ich~ensbc MethRlchrtlhn, threne. Second International Symposiumon tlle 1'teticulo-endotheliall Sys- tem, Boston, 1956, SPontaneous' Regression of Tumors'Prochced 11v 1fetllrvlcholthnthrene' ii] the, Skin of Fowls. First Pan Amel•iicanCancer Cytolo;pCongre ss~. ACihlni. 1957Pttlm:onary NieoplasmsProd'uced by 77ethclchohtnthrenein t11e«"hitePekinIDuek:Pan~American'Medical: rYssociation,l,IesicoVity.,19G0. Tumors Produced b9, aiethylhholanthrenoin theRes~l)iratbry Tract of' the\F.hitePel:ih Dttrk. Third Quadrennial Iutornational Confe renceon~Cancer„ Perugiai Italy, 1963. Pal7lications St'e attached sheets PUBLIC.YTI03'S-nR:R. II.. RIGDOV-4\D: AS80CI3TES'. Dnke l;:niversity-Dnrliamt; N:C., 1. .ldenomyoma fAdenom,rosis; of Fi:ankll of the I'teru:s with Tuberculosis Inflecti'on: Rigdon, R'- H:. Am. J. ObHtl. & Gyn., 2:a::110?, 1933. 2. On the Relation betnveen TllromUoplilcsbiti4 oti theInferior'V'ena C"Dvn 7nd' ncelllsion of theHk'patic Veins(Endc3lthlebitis ICe.11alicrOLliteI7tuns). Rl,-don: R'. II., Bull. .IohnsHohh;insHosO. 53': 4. 1G3, 1l1::3: 3', astudy oftheAc.tion of a Filtrable Staliliylocot•ca11 Toxin, on theIi,idneys I. of Normal Rabbits. Rigdon, It: II., .Iop-ner, A. L., ancl Rii•hett ; E. T.. Am. I. Path. 1fl : 3,,1l1:;I:. Ciardiai Infestation of Gallhinclder and Inestinal Tract. Calclt?r. Itoyall \I. and,I3i;cdonl R,. I;I., .Vin. .Il 1ic d. Sci. ]tsui:1, `'• 193.;:, I .5. Early Lesions f. lococcusTonit 6. Renal Lesionsi Acute Glomer i; A Gastro-Intest Rigdon, R: H. S. The Age of Se3 . :>;•lbicus, Wist 1036. i-"nielertiilt Uniti-erait tr, Effect of: StaphArc•h. Path.,?: 10; InlliUitor}- 3cti, loroccns Toti. 11. Inhiliitory ' Effe coccus Helnol 12. Production of ( Arch. Path. 2 I ;: Iiffcet of'titalph Arch. Path. 2 14. A Study of hnR. H',..,J. Lab 15. St,iphclococci R,igclon, R. H 16. Effevt of Var StaOhclbcoc( Proc. Soc: I•:: 117. The Effect of Sta01iylbcoo 159. 19.37. 1a!, Observations i cocral Enter1!l:',8. 1!): Deterioration Ilenrc.. Pi'o, 20. Effeet of H:ea;coccus ToM '. _'1. Capillary Per h:SPori. Biol Failure of an. Injectodl ivi Experi. I3io" 2_'3'. Esiieriauental Rigdon. I{. 1. 2`ll. LOcill Leslons V'on-tosin _':;. Smne of the don R: H.. ' -''0: Hemulksisllr contaaninE: :°-t : 12. 1:'li-1 ^_7. C0pillnrt-Pel . I.a1~i1tD: a 'S'. EffEctSof It. Cutlant'Oll' Med. 23 :t;. 29. Staph}-lococc, 1940. ::0. D'emonstt•at'i \ornsal Rt 31. Cahilla2' v I" Ripdou, I2: a?. Tlto Detoxii Liituiiis:, J

1018 1,',-1. Pulmonary changes in animals exposed to nitrogen dioxide (with F: H., V'Ieyers, R: «. Wriglit,, andl 3f. L. Dewey), Western Pha~rmacol: S'oc: Proceedings. s. 7:'19; 1C)6:6 13.;., Clilorinated Hydrocarbon Insecticides in Human Body Fat in the United States (with M. R. Zavon and K. D'. Parker), JAMA 193: 837-8 (SeptL 6'),, 1965. 136. Evaluation of' Methods for the Tfreatment of' \itroren-Dioxide-Induced Pulmonary Edema (R-ithD~, Cavalli, J.Detling, and J.Irish), Abstract, J. Toticol: Appl. Pharmacol. 8 t336a, 1966: 137. Effects of! Alcohol, Drugs, and Lowered Environmental Temperatunes on Conditioned, Avoidance Response in Rats(«-ith G. S,, Stone and K. Cl T.eung), :1bstra,t. J. Tosii?ol.,Anpl. Pharmacol. 8:355. 1966. 11,14. L'rine Screening Techniques Employed in the Detection of' Users of \ars cotScsandl Their Correlation with the Nalorphine Test (with K. 1). Parker. N. \omof andl II: Il'. Elliottl, J. Forensic Sci f?:152-167j, 1966. 1.",9: Ti'ichloroethane Intoxieation:A Report of' Two C'ases! (with F. B: Hall)!, J. Forensic Sci. 3:404-41.',l, 1J66: 14'0;, Manual for the Determination of Narcotics and Dan:;erou:s Drugs in the Urine, Aationat Clearii: ;housefor Ment,al HealthInfortnation, USPHS, J:1S' (1966) (with K. D; Parker)., 141. Jfethodes de determination des, stu:pefiants etl drogues nui~4ables dans lturine with: K. D. Parker), Extrait du Bulletin des Stupefiantls; 1IX':-12 (1967). 1-k?. Convnlsions in Thiodan Workers (with T: S: Ely, J: «': JIaef'arlhne and IV: P. Gh1hn), J. Dcc:, Med. 9:3:r37('196i). 143; Effects of Solvent I'aihalation on Conditioned Avoid'ance Response in Rats (withi G. S. Stlone and K. C. Leung),, Abstract, J'. Toxicol. Appli Phar- macol! 1~0':'386(19(37). 1I-ll: Effect of Chlorpromazine, Phenobarbital, and Iproniazi'rI on, the Polyphasic Mbrtality Curve of -A~rgregateAmphetamine (~with D~ E. Smith: and C. JI: Fisher), Abstractl. J. Toticoll Appl. Pharmacol. 1a:40'?' (1967):. 14.:~. Factors Lhtfluencinr, 3Leasurement of Ethyl Alcohol in the Expired Air («-ith~ J. P. Aitchison and K., D; Parker), Abstract,, J. Taticol. Appl. Pharmacol. 10 : 403' (1967). 1461 A Sy3tem, for ldentiCication ofCbmponndsiPresent in~ tfie\Lscrogram Range irtiilizin.e, Gas Liquid Chromatography inCombination, with, Simultaneous Fraction Collection and' Separation by Thin-Layer Chromatography (with K. D'. Parker and .T,, A. Wright). J. Forensic. Sc.i. 7':,162-1Z0: (1t16i ). 147: IPuman Tolerance to, the Acute and Subacute(lral EYdmini§tratibn of'Poly-vinyichloriti'eFormnlation oC' Diclilorcosa(Z"-3' and 1'-13)~ ('with 11: B. Plomk.1),. Abstract, ThePharmacolorist 10::„?2 (iA;nmber2) (Ta11.,1tI6S)'_. 14.@ The Teratonenici~ty of Some Industrial Chcmicals(with S. .1f. Roche)'„, Abstract. J. Toxicol. Appl. Phermacoll 2:111 (1'S1fiq). 1-19: F.ffectc:of Trace Amounts of Toxic Jieralsion; Hepatic S'ficrocomal Enzymes (witlh, Hl A. Ribeiro). Abstract„J.Tnnicol. ApPll PharmacoL 2':111 (1f168)'. 1•~0: Predicted and 'Yeasnred Uptalce of' Three Solvents: ;n Human Subjects (wit9iJ. P. Aitcliition),, Abstract, J. Toxicol. appi. Pharmacoll 2:11 (1I968). 1.;1. Forensic Tbxieologs an l the Praetibins; Physician (with, F. B. Hall and IIl W. Turkel), Clin: Toticol.,1: i1 (1968). lIr. SAT•nFr.FIF1,n: nlrnI7ext witness isTDr.II: TI. Ri(rdhtL Dr. Ri-- (lon.we «-elrornevott to, ollrccrmmsttlee. Do, . vouhave aprepared~ statement,, sir? STATEMENT OF R'. H. RIGDON, PROFESS'OR' OF PATHOLOGY AT THE MEDICA~L~ BR'ANOH„ UNIRERSITYOF TEXASDr: T:Ir.t)oN.I:esi I ltan-e a briefstantniary 11ere of'rnycornment's,, if TI may. Mr. ~,AYnrPFita,n. Would i-rnn rea(lit?' I)r. Tii+;noN. T am Tt'.. TT. Tl'iffden. Profe.ssnr of Patliology at theAfcdii'a1 T3rvIC1I of the T-iliver5ity of Texas at (x:tlvest~on.~'rexas.I[ ~ obtaiiied ney derree iurI'Lediicinefrollt Emory i`nivetr4}•ili 1'!):3~1'. _l'I.N postgrad'uat.e I oiz the medical llessee~, the ~ U1 hranch at Gal, of PRtholory: reported on tl- T[onse of R!ep ~ luta v I sav ~ tha ilii 1a4i1, I 1 7..-1f)(l tliltopstiy iinrlhtrilinza~di~~ anlll ai discuss lV Niewed the 1 lhmL,catilcer f'i~ 1~~1:;i~/ to 1960' (' "hlde, first cn~. '-rorer (23~)~ r;~ ~. to IN~'( i~1'olll LISJG' to' tlle fueqtlency~~ 1')2i. King ari tlds increase i I o~, 111T17rove[ll 1 ~ iea~tll~ [lile diagno. 1 iefore~ 1900. ~ , ,lli tl"erentiall di' eVer.~ con1n-left at'e not alwaI,r1•ot~tp ~ of 89 t nrarleo itr onh, ~ 'lON%: ;in7ati1iiblk~ i ucreased.'" 111 C'ellti, lll a! ~~'.,1.'ol C\S (i ( l~L'~' lIl :. il,'el lt. 1>i'1"'rlha ,';ulrei' (Ila:.rn( ];,u'<'1<n- and . tli,u--rno~4es~ arE~ ia(lic,ition of 'l~'Ile est.ibli S~tttistics~ 1Ia~ h ~- u(1'it~ial~~ 0 1)rortanti to hIl st;ttiyt~ic-:Jes :t --rcmp of ct (:)1` the~ I3~~nt'.e< Ilealth (,:;:3) iw tile'l3iire,t a~nd (`'~ritnsti ~ found th:Yt tl~ percent, andl

. 1064 I[ am very much aware'that voui have heard or read untold hours of' testim:onvan:d debate ontherel'ationsh2pof'smoking, to cancer of't'h:e, lun; andl other diseases, including tihe presentation of reams of statis- tical data and analyses, as well as a variety of strong opinions.. I do not iiltend to produce acddit'ionall evidence, but I do hope to review sonz:e: of the conflicting claims and argtirnents with emotional detachment. II certainly present no brief for smoking,, but I do present a brief for objective reasoning in an important public issue that has become so beclouded in emotion; superstition, religion, morals, and conviction as to be almost unrecognizable as a scientific problem. The issue of the re.lationship of'cancer of the lung to cigarette smk- ing resolves about two conflicting sets of arguments. That of the' pro- ponents of the causal relationship h~-pothesisinvohTes essentiallyfour cont'entions: 1. That there has been a striking increase in the incidence of' lung cancer over the past 40 to 50 vears coincident wit4 a, siinilitir idicreasein the per capita consumption of cigarettes.?. That cancer of the lung is approximatelv 10 times as frequent in cimlrettle'sm:okers as it isin, nonsmokers. ~ 3. That t'obacco smoke condensates contain materials that have car- cinogeniic properties when applied to the skin of'esperimental animals. -1. That mzscroscopic changes which are regarded by some pathol- ogists as "precancerous?" ' are much more frequent in smokers than in nonsmokers. Theopponent's of theliypothesispresent,the following, set of'argu, ments : 1. That there' is serious doubt that the great increase' in reported lung cancer representis in: fact a true increase' in incidence of the dis- ease. 2.That if' there is some de(rree o'f' increase in true incidience there are other equally, or even more, likel_v causes for it than smoking: 3 . That cancer of tihe' bronchi' and lungs has not been producedl in experimental animals by the applicationi of tobacco smoke or its con~- densates. 4. That the microscopic changes seen in the bronchial lining off smokers, and to lesser extent in nonsmokers; have not been proved to beprecancerous, nor are they sperific to stnokiilgn and they do not have the same~di'stribntion in tlhebronchial systemth€ut cancersdb: ,i.Thatani uncontrolled st'~ztisticall cori•elation ca.~mnot prove:a canse~ a'nrl-ettectrelntionslrip.-)L tremendous bodyoflfiteratute tel',ltivetothis problem has grown in the past decacle orr two;, anrli mas-sk-e accuanuliitiot7s andl analvses ot~;t~itistlical dnt~ti ha~°.e14eeii cle.%-elopecl in etlortstos substantiatc ordislproveths Itypotliesis. Vy irtually ,ill of these studiesind reports have:been in reference totl.ie:-e pon~ts. T'r'.acli side presentssoi»ehighlv per~iinsive;confiict~incr ai,-iluients., bkitneithercanr oiter unerluivor;il scieiitifia l,roof'tiiEit ~ulokiii~, does oudoes not c.nisecaaicerottl,ie: lwl(,'. The crucial point iu the wholedieblte centers! . ots n•lietlier orr)ot there hEZa, indeed been a trueiout.easeihr incidence i'nu cancer oftlie hul' -; for5„ ifin f;1ctther.ehE1s, notl, it is hardly lo„ ical toattriilntte cancer of t16ellunlt„r to the iuoreasetl consutuption ofcig<nrettesover these decades. Front in cancer of't 1930, ~ or ei.', tires of cot of lung,car ti~tu•es are (dagnosis) ua11 pra:ctiii~l no-,ticians~~. 1)irti ; and cit e5 with _1A large pr relati;.-el'v patholo`ic The clin centurv -N1° sion~ (~Eve ciial infarc Other disE were far~ ii both of tl~. ?:N-en now tinns are ~ hneutnoni fected by biotics en; susl>ected. _1.G.G -N'ational t' de~at~hs~ in sl-tem htt iilcidence b1rt~ fonrf, relati've t( in ehest d 1914 entii lapl;~of~ ac pol;,nlaYtio~~ pro~fr~siot on ror, in 1 nlu liii~tt mrer the (Ii t,,tlr>,tli( lnAt' a~~ tn-o; iiiff, «lrat tl1io ~ ei•tror~~ "< wi(x- ,i~ tii6~ 9e a~rt,~ o~f~~tlie~im r aurin R,i iIir.'ets of F 11) 5 5:

is getting late. If'you care to present your statement we will be glad to receive it. eart, les)i rna- ecd~- ~cet, -c!in. ofer 960. ein. ien- ~ov. 'ion roid iing :ess ien- ces, ,ed- ?3, nal ed- 12~ en} 'pt. ,er: at ).C1 _rr: ent ~ne STATEMENT OF'DR'. IRVING ZEIDIIIAN, PROFESSOR OF PATHC1hOGY,. ITNIVERSITY OF PENNSYLUANIA. Dr. Z>siDaiAx. lIy name is Irving Zeidman. I br:acluated' from the ITniversityofP'enn.y1'x-ania School of '.N'Ied'hcinein 1341'.Af'terani internship and 41 vearsof servicee in~ theArmv. I returned to the .l'Iedical' SchooI anel joined!t'heDepartmentof Pathology. Forover ?0~ years I liave been here in an academic position, teaehin~ ~medical stu, dentis about cause and effects in disease,, and dbing cancer researcllL II am~, now a Professor of P~atholo~y.~ l~'Iy chief research eiforts~~ have~~ ~~ concentrated on the way cancer spreads from its site of' origin to dif- ferent parts of' the body. Every year one of my lectures to student's deals;~ in part,~ w~ith~ the relfttionehsp~ of'tobacco to~ lung ~~ cancer. There- fore, I have made extra efforts to keep abreast of developments in this field. The fact that I am ar smol.er has also sharpened' m~.• interest in the issue. I can sum~marize~ my~ opinion~ in~ the tobacco~-cancer~ cont'roversy by~ savTng that:the~~evidence'poTntlng ~ to~ snloklna~~ as~~ a eause~ of1~lUIl,(r ~ca11¢er~ isuincomplete. However, in eipressing , this opinion to: medical stn- dent'.a-the future: doctors of the "Nation-I feel oblibated to do more: than present the purely scientific facts. I cannot leave students with the~~ feelin„, that tobacco~ isdefinitely ~ not al cause, of~ luni~ , cancer, as there is little evidence for this stand. Therefore,, in presenting the issue to~ students, t~he~ pros~ and cons are reviewedy~ and the follow~inb conclusion is then offered. Considerin2~ all t'he available : informat'ion,, it is safest to~~ assu~m~ that heavy cl6,i~rette smoking, may~ be~ a weak cancer-prodticing agent in a susceptible person.. dbserve~ the use~of tlle: words ' "safest," "assuInei•• "R"eali'~,"and '~-slTsr~ ceptible." These are hedginb words and they are used purposely. The: medi;caI students will be~ adrising,patients~ and farnil&es~~ in the fiiture~. With the above~ conclusioni in miiad,, the~ doctor c<lniadvise the~ 15-year- old not to start smoking; there may be the future danger of 1ung can- eer~;~~, it is easy enough t'o~ avoid the start, hard tio~ stop. Andl the~ older, habitual smoker mayv be advised to stop or continue smoking after weighing ~~ possibl~e~tob~acco hazards~on the one~ side, and--on the other-- possible~ psychological disturbances, weight gain, and' other~efl'ects~~re-~~ re- lated to «-ithdran-al from~ tobacco. In sliort, if~asked tlie~question: "~Afay heavy cigrarette smokin- cause lung caneer?" I am like the cautious~ practicing physician and I answer :~~ "'Itt may."' HoR•e~ver, if~ asked the~ duestion:~ "Does heavy.~ci-arette smolcin(r cause Iun- cai7cer?'.~ then I~ anI faced with a more specific questiond and must answer as a scientist.~ Tlie<lnswer is, "I cannot tell. The evidence is suggestive, but falls~ hiLher incidence of~ luno, ~ cancer. Tlie~n correl~atien i',~undeniablo. (1I), When heavy cigarette~ smokers stop smokilib; then their~ cha~nces~ of : , Per,ple smolcin, two~~or morep,lcks of ~ cizarette5~a~datrhare~a decid~edl~y i shortl of'being incontrovertible and conclusive."' j1-1n-all this h~ed~in~when, . thereis~ so much sunnesti~-ee~•idencetliat lieavyci;arette smokin, , causes, lting , cancer? (1) E'xtractsof, smolcecertainl~ prodtacecancer of tliesltiini ofmice: (2)' Theincidence, . of Iun-cancer Isilacreasin(y aiad soistlieci ~,irettecniusttuiption,

1066 ' Certainly ast'he quantity and qualit~~-of medical care~ in any popu-l.ition inereises; tJheincidenceof recognition and reporting of anyparticul'ardisease,especially those difficllTt, to dfiagiose, is~ bound toincrease: Thiscircumst'~aarceobviouslydoes not mean that'tiheparticulard7sease is necessarily increasing. Despite statistical analyses, there is no earthlv wav of determining with any sort of accuracy or certainty in a rapidly chan~-~ing and improvillg~TYealth earesystem whether a dfiseaseIs,indeed ilicreasing in Incidenceorn-'hetherit~s recogni~tli'on is. Hence, we really donot know whether t.hetrneincidenceof cancer of the lung is in fact increasing as ci;arettesare iaicreasin1gdk- constuned.There is~some sueovestion from the older, pre-cigarette era, based on , lar-eseries of'autopsies,largely fioln~Europe,~ that cancer ofthe lung then constituted about thesatnepropol:tion of cancer of' all sites~ as it does, no.r. This would sugQ~est that there has been no selective in~ crease in cancer of'thelunz relhtive to cancer in general. The report of'the Advisory Committee to: the Surgeon General of thelT-SPHSentiltled'; "SmokinzandHealth"(196I), statesonpage435~, "Lu'ng,cancermortalityhasrisenat afaarlyconstant rate:since 1'930."' The authors of this~sectionevidentlv: were not a-ware of another publi- cation of' Gillia,m'sini 1951.2 In this reportl, entitled "Trendsin l1Jor- tzlityAttribu'ted to, Ch.rcinoma of the Dung"he statesi`°It is cl'earthat" thouO the, totall death rate recorded for, the white male popul~ion h€ls increasedl throughout the period (1930-11958), there has been a, rea-ular' decline in the rate at which thlshas occurred"and,"'It must , hevemphasized therefore thatwhen considerin.g'trends in lnort.ality the rate at which a disease is rising orfall2na , Is,of equal importance to the increase or, decrease in actual rates. It is common practice to make clite predictions of the future position of cancer of'the lung as a~ canse; of death 'if present trends continue:'' An important aspect of present trend's in this~ country, -wh2cliis genera'ldyib ~ored, isthede- clfinin` rate of' increase. If'tllis feature of the trend cont'i2iues, the dis- easeR=ill reach ifs,peakamong the whitem~ale population in t'hefore- seeablefilture(1983)andthenstarttodecline."' The fact that the : rate of increase of cancer of the lung was greatest hetween 1930: and 1935, and has diminished in almost eti~el5 period since1935,,despitei the rising,per capita consumption of cigarettes,overr these manyy'ears; ishard7yconsistent'wit~h thesmokin--caincertheor,y. Certaanlv as smoking ' years and increasing , consumption of' c.igarettegoes on year after year, lonical consideration would dictate that with each passing year there would be a; greater increase in lhlng cancer in any year than in the year hefore, if indeed smohi.n_- were a sijniheant ca.tlse: The observed decline ini the rate of' increase of luncr cancer is exactly what onewoul'd expect, however, if the reported increase~weredne to constantly improwina, detection of this dii;e2se-or of any other for that rnatter:.That medicalcare,has~ become inrreasin.grli~aVZ.ilabTe toourpopuTation o~-erthisspan, isundeniallle. Likewise,~dia,-nostietechniqueshaveinaprovedtremendouslv. Aslon- 'as-oodrnedicalcarebecomes increasin,-(rlv available to our populfttioni and dia-nostic tech- niques improve, tlie reported incidence of cancer of the lung 'R-ill in- evirRlilh-increase„ but as t14 dia,-nosed and' reported iizeidence ap. " Gi111am. A. G, :"Trends of Mortality Attribut'ed to Carcinoma of' the IIung."' Cancer, 14I: 622, 1961.. proaclies the t; increase~ in rer, Dr. Gilliam ulation. Ti he : smoking and hypothesis thc concomitantly ~ of~cigare~ttes~~( and by~ the,pr years, of snob' If ihis:..rere~~ low hv ~ •-)0 ,to I( that t1ie~~ ~reat curred het«ec sumption, anr :~*re:Ib increasee i?:deed a signi b~e~ -eeinq an obPerved decl6 One~~ other 11 t'lie~ ltin- begi tion con~zpicu neousl~.~~.~ It d( ~ of 'c_Yncer by ; increase wouli unc_'_,lil~~~d. I would of _lledicare anc 1'ions of pre~--i Vinu'_Ziv~, «•iIll cretl.-e for~ sex ~ rar- of~increa EVeni if'a 1, :7nd~ not s~imi) thiil;rs as then ii~:iti~on of'onr: le~ 'n the 1110 stnod. Duriii diua~lu:rt~,ic 1j1~V mc;=t~ ecluallv ~. rel:ltivel y ~ lii; (•nn-~ ictiinn tl- 1'~e~ He cl)arred fat o t'o~ the chin c decline in st, thi, oonlrtrc. rise- nl~~l fal ('C~rlilj~ill~iflnl. to~1~r ~1'-nri if~ The n7f,st 11yprnth(91S h~

ers much more frequently than~ in nonsmokers, and that the inci'dlence i's~ relatecll to~ the: amount smoked., (In oth~er~ diseases attributedi tn ~ smok- ing, the difference is mntch less.) This ratio is cited over and over in the protagonists' ' debate. Although it is admitted that other differences in constitutlon„temperament,,personality,living habit's;economir level„ and psychological attributes exist between smokers and nonsmokers, these d'ifferences are considered as being of minor consequence~~,,re~lativ~e to tlie difference in smoking patterns. Tliis is, of'course: a~ jnclnnientd based on~ statistical rel~ationshi'ps in which onl~~-~ one~of man~- variahles~ is ~ controlled. O'pponents~ point out~that~ despite ~ this hi_h ratio., ol,~h, ~ a: very small prol~ortion~ (probabli~- less than ? percent) of heaj-.~-v smokers orer~ many.~ years dt?velops cancer of~ the ltmg. The incidenre~ is~ even n7n;lch l'ower~for smohing~wonxen. If snbokinn nere~indeed an important eause~of lung ealicer, it is diffieul~t~to~expla~in~ how 98'pereent~ of siu7okers~ of long duration escape: tIle disease: _1-ain,~ lo(ric dictates that there must be something verv ~ different about these~ 3 per.eent, other t~han their smoking habits. This difference has, of conrseY not been identifiecld as to~~ its, nature. If'the "reat "~increase""~iii, the~~ incidence of cancer oh er the~ past four~ to~~ five~ decades is~ indeed spurious, for~ which tllere~ is sub.st'anztial~ evi- dence, smoking can hardly~~ be~ blamed, and other causes must be~ seri~- oUsly considered for the differences in rates' betweeni smokers [lnd~ nonsmokzrs.~ There~ are~ a number~~ of' otlier~ points~ of' debate~ between the beliei-ers~~ and the nonbelievers,, each~ with v~ary ing d'egrees~ of~ merit. The~ inevi- table conelusi~on~that an unbiased person of reason would~ reach isthat ~ neither, sid,e~has conclusive evidence~fnr~~its~ position. 1Ty own opini'nn is~ that the~ evidence~ in favor of the hypothesis~ possesses~ weaknesses, and the proponents have fililecTd to ansN•er satisfactorily ai number of' sharply confiicting, observations,, the~ most signifihant one being~ thel perslstentlryy declining rate of'increase of reported cases of lung cancer in the face of increasing per capita consumption of cigarettes. Aledilcall hist~ory is~ replete~ with~~ cherished beliefs~ based on uncon-~ t',rolQed observations and clinical impressions, whichi have~~ subsecluently~ been completeiy~ demoli'shed -when subjected to properlv ~ controllealI cliaiu:cal investigation. Only ~ recentl~-., for~~esample„medical goslpel~ llelkl that the rupture of' a peptiC ulcer~ constittrted the most ur,•ent indicaition for immedfiate emergeney~siu~ger~-. ~'e~«ere tauglst, ancT'virtuliliv every physician fiil~l~~r be~lievecl,~ that the greatler~ the nnmber~ of hours that~elapseel between perforation and the operation the~ less the cllancea! of survIva~l of the patient.~ Approximatiely ~ 2© ~-ears a,•o a Briti~ h~~ ~urn geon treated a large~ grouq~~~~ of' such~ patients R-ith coi7servnt~ive, nono ~ surgical means with resultin- low~er~ mortallt~>~ rntes than ilI colnpa-~ rnble~ grou~ps~~ treatedl surgiicaTly. This observation Ilas~~ led to a tot~allv ~ different approach to the Ina,nagement of~ perforated peptlic~ulcer: ~~ r1~ few yearsago: a R-~a~~re~of enthusiasm for a surgical procezlh~lre for angina pectoris~~dne to coronal-y heal•tl~diseRses s«-eptthe countrY. This ~-as, a relati~v~ely~ simple opei2tion In~~ol~-in~~ the lig2tion of~ thc, leftf i~nternal~~ ma:mmar.- artel~•~~~. The~ res 1`,~s ~~ i;l the relief~ of' an~''.inal ]~ain ~-ere~, so~ impressi~-e, that the operation gxained'wide~popularity ~ until a, Boston hea~rt~ stn•-con performed ti'Ie~ crucia~l controlled experiment in  which approsin ligated and the 4 ina:lysis of the cant difference the operation q today. There are in~ : lieliefs based or presumptive or objective scienti The Report ~ of'the TJnlted cproperly states, is •-relatlvely la Inent, and so f, years of smoki in7possiUle. Theeiseiv the kind sions in the paunder any: com~ dloes not warra make a final jV pe•esent,edL What is rea ~tatistieal suri k1:.IJaCledgeInto isincreasialg rr that some of t :Ahead.Untill t. in abeva.nce. ThnilkYou v~ T7leattachl 1337 32-1933 35--._., 933 5-193& 38 ---._., i 9'39~ 1'-194Y-43-.--.-.. 9LZ-44-1945-47 ~-------. 95-47-1948 50_.._..., ,9,5-57-1954-56....... . 19b4-56-1957-58-------. ~ Gilliam A. G., Cancer, = "Smokingand!HO lth p. 45.

10.75' kal- '( ot' out iose lne, .i ry ,sis~ one to- uch sr- ,*1-it un- res nie ichi ich uid .lly i lrs, ' ~al.~ ~~ rt'i1 ) a, an, in in ,er. Do you notice any increase in heart disease from, smoking?, Dr. BRE_s~. The reasony really,, that Ti have chosen eancertol talk about is that this i's srhere the most sharp correlation occurs. In regard to heart disease, the correlation is really so low that the P'ublic Health Service doesn*t assign any causal relationship there. So cancer is the tonghione. The CxL~rr--Nr_w. Mr. S pringer ? Mr. SPRINGER. Doctor,,this is just one question Iwou1d like to putt to: you which is not covered by your statement, but I would like your observation. jj"hy is there such awide variance in the testiinony as to whetlier or not smokin, of t bacco causes lunff cancer ? Dr. Brr--Nr. _lmong doctlors? Mr. SrxzNcEx. Among reallk- eminent people. I take it you are an eininent rnan in ~~~our field. ~`'~`e have had tjvo or three others this week n-holiavetestified similar toYou, andl we have had some whoare equally as eminent who have testifiedl to the opposite.. 11"hv this great variance?. Dr. BnE.r: I think the fact t~hat there is this disagreement indicates that the case is not closed yet. There is one other very important thing„ I am perf'ectly sure that if' y ou poIlthe~ doctorsof this country you R-ould get a verystrong, majorit,rwho~ belier-es R-hatthePnblicHeaIth ServrceIi'eportsa3,s!: that th:ereissubstantiallproofl oftlrecausaltyrelationship:, But I think there is,onlv one in 10,000doctor°sin this country who real'lyliasread t'li;epapers and'evid'enceon tlieoth:er side. That little book, "Smoking andHlealth,"that they put out isas splendid docunlent for one side of the question, but they have not consid'eied,seriousl~- enonghiin my jud_n~ent sonze:ofthevery; sharply condicting and irreconcilable observatinns.Y~~ onjustcan't make sense out of'these t'woconfifictingthings. The higli incidence of cancer of the lung in smokers versus non- smokersaaid the filc't, that it appears th.attlherelias been little! if anyincrease in cancer of the lung over all of these years that smokiiib has.increased so much-the two just don't fit. Isaytha.twec.lnnotconie: toanansR-er on: this.We cannohsa3;: that it does not. We c<unnot savy that ik does.. Mr. Srizr-\crai: There is just one other question I would like to ask. From t1ierilortalitv tia~blesitihas been estimated that t'~heincidencee of cancer of tlhehui,~~in white m~alesincreased ?G-fold betweem 11914, alid 1950,andleiglrtfold between 1J3t1~aurd 19601 ~S'hatcaused that ;ieat variation ii1irate of idicrease? Dr.B'r.F-ir.These arei'ncre:nses Mr. Si•r,rsr,r.x: Tihatistheincidence,of'cancer:. Dr: Bldrsr. '-\7o„ itisn'tltheincideirce. htlis~ theincreas~e;tlre y~earl~-y irrcrease~.iu incid'mrce,the percentageincrease. If one star.tsabtTrestart-ing point of 191-1; there really were very few cases of' cnncer of the l~un~t1Lat were rehorted at' tl7at', time,v ersfew. 1'f i•. SPRrNcnr,. Wien ? Di•. BtLM. In 1914. Tliere «-ere veri fe5v. So if You c:r.Tcnlate the number reported then as contrasted t'othe number riepor•ted in tlhei'ncrense hasreallv beenienormoud, ?G-fold.

1056 65 weeks (as reported by Dickens, Jones, and Wynforth), orr whether asinglee massive application has been made (as reported by GreenberaandHallmanu).In sharp contrast to the lack of success in producing cancer of the lung in experimental animals with cigarette smoke tars and residues is the definitivee squamous cell cancer that has been produced im experimental animals by the . injection of betapropiolactone, employing the same technique. A1so; numerous carcii:omata,,inclttding those of the traohea, liver;,kidney;,and intestine, have ap-peared in rat's following the illGratracheal insutHation of afiatosin. Thus, the experimental techniques t1lat:hame beenienlployed appear to'be satiafactory, since the above tzvosubstances did produee:cancer when applied by the same method~ as those «-hich failed to produce cancer from cigarette suioke tars and recidue. .. Furthermore, cancer can be produced in1lle trachea of dogs using,9,10-dimethcl. 1.2-benzanthracene iii a colloidal gelatin suspension, instilling i't' weekly into tlien righx-stem bronchus. However, it was', necessary to reverse the seqlnent, of cervi; cal t'rachea, treated for treacheal cancer to be prodh:cedl with thi's cliemicali Thi~n-ork of Stlaub~, Eisenst'ein, I3I-•s, and Beattieismentionecd to show that certain, substances can be made toproducetraclleal cancer under specificcondlitions.wimilarl~y,, Dellaporta, Iioib, andl Shubik have produced mali'gnant el.ans;c7, in: thetracheobronchial tree of Sl-rinn, golden hanistersbFtheperiodic tracheal admiuistratlion of this, same substasice:. Thus, iti,s clear that' it, isposcibletlo, produce eancer of the tracheobronciiial tree experimentally with certain ~ul)- stances; it is equally evident thatl it, has been impossible to produce a similar canceresperiment'alfly witlithet:u:sand residues of cigarette amoke: The proponents of certain restrictive legislation apparently believe that it has heen incontrovertibly proved experimentally tliat'tars and residues fronl cigarette smoke produce:cancer of the Iower respiratory tract. As noted, suchicancers have not been produced and therefore; this billi is based on a false premise. Present scientific knowledge provides no valid reason for printing the nuantit$ of tars and nicotine or other: "incriminating agent" on each pack of'cigarettes. Further- more, such 1.lbeliilg, might set off competition between various tobacco companies,, encouraging, claims and counterclaims which. in: our present state of kalo«-ledge; would, be nieanin_lkssand confusing to the public. Thus currently submitted legislation although purportedl to bebased' on, scien• tific fact, has gone beyond established' scientific knoR led,4e in its conelusions:. Legislation concerning health should have a firm scientific basis if it is to be valid and, meaningful. When a bill goes beyond proved scientific, knosvled,ge; it sets a precedent', for the introduction and passage of further bills without: valfld scientific reasons; In summary, the facts are these : 1. Cancer of the tracheobronchial tree has been produced in experimen- tal, animals by ' theintroduetion of eertaincarciilogens (hethpropiolactone;, a$atotin, J;10-di~methsl, 1',2-banzant'braceneiiI a colloidal gelatin suspen-sion). 2. ti sinn the same techniques in experimental anima]t; introduction of'tars and residires from cigaret'tesmoke hasfailecl to produce cancer of the lower respiratory tract., 3'.. Since itl has not been proved: experimentally that tars and reyidues from cigarette smoke produce cancer of' tiiereslliratory tract, there i's, no: valid'reason to li'st,the~percenta,,e of'suelr tars and residues on pack.agesof the cigarett'es or in the advertising of the cigarettes, as recommended in smne of the legislEltion currently being,considered., nIOQRAPItICkL D.1T-1. The writer's interest in carcinoma of the:lungis the: result of practicingmedi- cine as a specialistilu4horacicsur„ery for more than_'7years:,This spc,~eialization, followed eight yeztrs of lost-traduatetr.aindngini thorac.icdiseasesc andgeneral] anrl, thorucicsurgery, folloccinggraduation £i:om theUniversityof\Iiichi;;ani Medical School in 1932: Advanced degreeihlclirde: Ai.ti. i'n, surger,r(L'niversit~y of' 31ichigan) : f'ellowsliipsi'n theA,meric:Tn Collegeof' Surgeons (F.A,C:S.),,f'orznergovernor the \merican College of C11est Physicians 1 b t.C.C.P1, and t1w Amer- il•:In College of Cardiolofi}:(F.a,.C.C.). I.itrenses are held in the states of Michigan andl California,;and certification asFouader \lemherof'~ theAmerican Board ofTlioracic stlrp;£rF. Past President of the Socii•tyof TboracirN1tr,ccons, Paci]9h (PnaKt sur,gical lstiociation„C'aliforniaChapt'erof't1ie _lmeriran~Collegeof Chest' I'liysicians, Trudeau Societt',aml the I:k:celsior :iurbical Society. Presi<lent of tlie- John, AlesandlerSociet'y: During World `' in the United Staa to, studies ~ to ~ imp ordedl in j"olumes, Department. G:xitSince Worldi W research in, tlior,, elude: 1'rofecsor , Professor of' Surg 1:niver~sitl}* of C.al are: civiliiui con Corps; consultaa7. 7]horac•ic ',urgerS years, as an eme] societies devoted service as, presid(I addition to thetR: 70 scientific art!icl' Ct-aRZ4 Prcnredical educa -1Lcd~ical cd'awatiot University of University of! In'ternslripa':, Mercy Hospi Boston CitySchoo1-4/ Bcllerue Ho; Bnrues FIosl tw6/1937. Rc:sic7encies :U" ni vers i'ty o'. 1;e19evire IIo~ ' -1-'1986. Barnes Hosl, ( /1J38:, L niversity, o; Board ccrt ificati( I:"onniler 3Iei Representatli 1960- TcacUaidappoin; Assistant in vorsity, 1/ .1ssist4nnt in. Teaching RI Instructor iI Instrnct.ori Professor _ingeles. Clinical Prc of Tledirt 1 1'JLer1')G4 Visiting I'ro •Cdnsultant for _!1-^_3fi-6J.

224. A long-term feeding study of icradiatied' foods: using rats as esperimental, animals. Richard,son; L. R.. S. J. Ritchey and R., H. Rigdon. Federation Proceeding?. Vol. 19 : 1023-1027. 1360. 225. Muscular dystrophy: Spontaneous occurrence in daiclts. Tex. Repts. Bioll and Med, 19: 167-177,,1961. Rigdbn, R. H. '_'•_'6. Pulmonary neoplasms produced by meth_r]cholanthrene in the n•]iite Pekin duck. Rigdon, R. H. Cancer Res:211: 571-574. 1961. 227. Tumors after implants of' methpl;cholanthrene in ducks. Rigdon, R. H. and Syed Omer. Arch of Path. 71 :,641-635, 1961. '?_'8., Spontaneous muscular dystrophy in the white Pekin duck. RigrIon, R: H. Anrerican J: of Path. 39 : 27-10, 19611. '?9:, Spontaneous occurring muscular necroses and encephalomalacia in tiie turkey. Rigdonl, R. H., T. 31. Ferguson and J. R: Couch. Poultry Std. 40: 766-771, 1961. 230. Pendulous crop in the chicken-a pathologic study. Rigdon, RL H., American. Journaliof Ceterinary Research, 2? : 379-3fi1„11961.. 231. _imyloit3osis, spontaneous~ occurrence in white Pekin ducks: R. Hi Rigdon, 3I.D., American Journal of Pathology. 39: 369-378; 1961. '232. Cancer of the lnng-1.)30-1960: A Review. Rigdon, R. H., andl Kirchoff, Heleni Texas Rept:,BioL &Med:. 19: -16r513: 1961. '_'Q3l Lesions in DucksGisen Jlet'hsleholantihcene: Rigdon;, R. H: andl MieAnellv, S. 3I: A rch. of Path.. 72: 45r46-k. 19(31. ^_34. Trinu~ma and Cuncer: A Relationship Based upon Coll lfutation. Rigdon, R. H. South. 11. J., 55: 3.-I'1-344• 1962. '235. Spontaneous Occurring, Muscular -Necr:oQi's intbeChicken. Rigdon, R: HI, Fergzrson. T: _ll:, and Couch, J. R: Poul. Sei_„ 41: 398-4()9; 1:T6?. 236. Fatal Chickenpos :A Review ofl the Lit'erature and a Report of' a Case. Rigdon„ R. H., Shojaii; S: H. and Garber„ E. P. Am. Prac:, 13: 29?-302, 1962'. 237. Jiuscular Dystrophy in the Chicken. a Pathologic Study. Rigdon. R. H.. Ferguson, T. M:, and! Couch„ J. R. Texas Rept. BioL &IIed., `?0':446-- -1,;3: 1962 ' _'3S. S'pontlaneuosly Occurri~ng3ltiscle~ \ecrosisandi Amyloitlosic in the White Pekin Duck. Rigdon. R. H. Am. J. Vet. R,es., 23: 10:,7-1064: 1962. '239. Effect of irethane oniPulmonary Tumors Produced by 3fethyicholanthrene. Rigdon. R. H. Texas Repts. Biol. &\Ied., ?L: 6~~-7:;. 1963: 240. Pulmonary LeAons in Dogs from 3leth;clcholanthrene:, Rigdon, R: H. and Corsszen. Gunter. Arch. of Path.. 7:, : 323'-3 31. 1963, °47L CareinoGarcoma of the Stomach. Arganaras:, Edivardo ancU Rigdbn, R. 11. Gact'roent.. 44 :, 3'?_' -3''9: 19631. 242. Vital Statistics and theFre[Iuency ofIDiseasF. Rig-don, R. H'. and b:irchoff'; I3elen.,TexasState,J, .NSed!. 39: 317-32=1L 11963:243'. AiisorbingandErcretion of Benzp,rrene:Observationsin the Dttrl:; CliinltYn•, ~IouSe and Dor., Ri,--don, R: H. and Neal, Jac., Texas Repts. Biol. & 3IetI.• 21 : 247 `-ti1. 1!103: '-1-t: Clinicopatholo„ io Conference: Rigdon. R. H: ; Harrioon. «'il~zon: 1F"ilson; 3lcClure: Chen. .Julian:Green< «''m: 0:,;and3laeuelos, D. _lIl Texas State J.,3iedl.• 39: 70:;-711, I963. ?4.;. GalactoseIntosication. Pnthologic Studr, in theChick. RIiErrlon. R. 11. C'otuh. J. RL, Cre:ger,C. R. andFer,guson., T. M. Exheeientin. 1A:3:1:Y:1-57: 1tlG3:. °4GJ _Absorption, andEccretion of Benzpyrene, in t11eCock'ronch, (Periplanetia AmericanaJ', R,iedon, R. H: andl \ea1, Jack: Experientia. 19:47-1--1D1. 1963. °247. ParosisS'econdaac to-N.nturallpOrcurrint3lusc•le Aec•rosi. in the I)ark. Rigdon. R- H. .am. J. Vet'. E{Ps.. _'-t :1030-10n7. 1063. ^_4Si Effect of VitZmin E on Si?ontaneous-Occurring Necroses in Striated' 3luscle of Ducks. R,igdon. R: H. J. Comp: Path. & Ther<op.. 7-t :,S:~~511 1!t64:. ?4tll Flourescenre of Chic]:ens and Eggs Ft,llowina the Feedliii_ of B'enzhyrene Crystals. Rigdbn,R: H. and\eal,, Jac•h, TeTas Rept. BioL &, I'Led'.., 1cJ6:3': •'Sfl: PSffrc•t nfC':arcinngenicHydrocarbonconGrow,tlinf Sli~ce. R',i;rdon. R. H: aairi f:iannnkos, A'iekJ. Archi ofPath.• 77r.173! _04: 1964„ '_'.;1. .ah4orntion and Excretion of BenzncrE'ne Nchen flcrl to 7Tice. Ri'_,Iton. 13. IiI: and N'enl. Jack. TevasRept. Bibl. &l(ed.. •?_':1'.;C-16,t. Sprimr. I!1G4. •?.-,2: Muscular IDcstrophY in \Inn~and Duck. A Chnrparatii-e S'tud.y: RiLrrlon. R'. Pi: and Drager; Glenn. .1rch. of'Int 1t1C.i.

of' -he is- do~ lue Ilt: -or so on ur in nt .r- ls. )i- in u- s- re. in n- ro e- 1065 Froni, niort~alitv t-a~bles~ it h~as~ been estiitlated that the incidence of cancer of~ tbe~ hulg-, in white~ males~ in!creased 26-fold between 1914 and. 1tJ50i, or einwhtfbld between 1930, and 1z16~0. Tlie~ validity ~ of'these fig- ures of course~~ depends~ on the con7pleteness, and accuracy ~ of diagnosis of~ lturg~~ cancer over~ this~~ period. The mortality tables~ from~ whicls these~~. figures~ are developed consist~ of tbe~ acctmn>'I,ation of causes of detttlr (dagnosis): listed on death~ certi~ficates~ by ~ many ~ thousands~ of individ-~ tti-t1 practitlianers of' mttny vilrietiies. froni well-trained, capable diag- nost~tcians~ throttgTli country ~ wenerai practiti~oners, o.steopathsi~ bomeo~- ljatllsy and others.. TTle~.~ come ini from all parts of t']te countm--laraee cities wi~tli excellent diaanosti~c~ facili'ties~ to~~ sm:211~ hnmlets~ witbi none. A larce~proportibn of~ the dfiagsiosis, rests~ on clinical in2lressiolLs, and . relhtivel~~~ few, espeeiall~.~~~ in t'~1ie~ ~~ast~. will have been substantiated by: pat'liolon~ic e~.a~min;ttion-biopsvor ~au,topsy. Tlie~~ cliniral entitv ~ of'carcinolun ofl the 1innal in the~ early ~ part of this~ ceiiturv ~ «-as~ not , widelv ~ known auirolrg, the prac tiicialg- medicitil profesr~ sionL ~ (,Even such~ it,~, common disorder~ as~ corona.rv occlusion or mvocar- dial illfilrction «a~axirtiu~nllv ~ unkno«Irto~clknicians~pr.ior to t.he~ 1920's.) Other diseases of~t''1ie~lung-s,~particnlary ~ tiubercnl'osi's~~ andl pnetuuonin,~ w~ere~ far more~ prevalent as causes~ of death than they ~ are now, and~ I both of~ them ea,n.~ and~ often do;~ resen7ble~ lung cancer~ .-erv clbselv. EVen no.V sophisticited diagnostic techniques or postmortem esainina~-tions are~ often required'. to~ differel7tiate between them. E>:irtlierni:ore, pneumonia, is frequently present in th„se~mentof theh7ai~ that isaf- fected bv cancer and onl~~ the ettectire tlierap;. «-itlt mode>:•n ant.i- biotics enables the patientto survive until the nndierlyiilgcancer issuspected andl special dial-nosticln•oceduresprove its presence., A.G. Gildiam'- of'theBiomet-rv and Epid'emiblo~~~ Brat~7c~h of'tfie i National C~ancerInstitute.has calcltlated th1tifonly2' percent ofthe~ deaths in 191-1 ascribed'i tonon-cattcerous diseases of the respiratory ~ svstemi liadindeed beeni clue to: cancer of tli:eludig, the increasein ~ ineidence of cancer of theImt(y between 11914 and 1955Iwoudd ltavebeen but fourfold instead of the clainteol 2G-£olal.Eridence that 1Secites, relatireto, the confusion or misilia-mnosis of ttrbel.•culbsis for cancer bnt iti twofold increase in incidence. T here 2s. of c_nnrse. no iva~l ~ ef ]c~no.~-~- in~ u-I>.tlt tlie error has lbeen over tbe~~ ~~elrs, bnt thee content~ion th1t~ t1le~error in oba ~_•~nnsis, and licnce r.e:~lorti'n~r., was lar~e a~, at~el eretr tieclades~nL~r is hardlv assailable. Gilliam's conclusion i,~~th:1t ";iltlmttffh ~' there~ nphears to~llnre~~been a trne iu7c re.lse~ in the iilcidence~~ o~ll carciilon7tt !' of tlie~~ ittn' (Z, and~ that it iF, stilll increasial~.~ tlrnt~ the rntaa~luitnde~ of tlle! ~ Illcreffse~i~s~llowhere nelr 415' -Teat il~z recorOled'i nlortZldtj"~rtl~r'r~'e~~C'.~.~~~~ I in cheFt disease IioSpitali in rel'ent tinle3,, nltilveS ;1 ?--perce.nt erlrori11 11911 entiaely ltliinsible. _l'1IY jndt•1»entwouldbe~ thtt;considerin,~ the ~i laclzof access toconlpetent medic,il' cnre of s 1.2rtre prohortion of' onr~'population, the lack ofan-areness oftbe disea~e b~-tlb_ehracticii>;,~profession, vnil the inlperfectibn oi9'di,l~no~,tic tocb~iiirlnes. a?-percent; err.orior D14 ie~ a distincttondere-tin)ztte. II'e (Yoes, en tostateo tliat, if thediaanostic errorwerel(1 percent in191-t and ffr.1du<112.v din.ni'nlaslier_I overtllievears asmedi;?al czre1>ecnnieincrelsinglY avail'alille and ~~ di'ttmiostie cap2bi1ities intproved„to ?peUcent in 19.-(); therewonltl be ' rilli;tm A., fC.. : "TrrndF of \[orhhlity-. Attrihutrrl ro Careinnml of tlle Tnin~: : Possilrle, rfPPet'eof IPaultpCertitie;rtion oCIDi.rtli:Uo OthirII-hir,tt'on Dt~eases' t'ancor, S: lill,o, 1955.

1072 Dr. BxEaI. This I believe is true. One of the real problems is that it is going ~~tlo~ be utterly~ impossible, I think,, to determine: this because~ the~ calculht'i'ons are based on death certificates, as I mentioned'. Death cer- tificates are notoriously inaccurate. Probably less than 10 percent,, andl I~ tTlink~considerablv ~ less than that, of all deatlls~ hav.e~ a~ cause :proven by, post mortem~ ex~~ami,inatiom . Without post mortem exaRnination4 or patholobic study, cancer of the htno, is~ an estraordinarily~ difficult diaanosis~ to~make: Even now~ with: nI1 of ~ the sophisticated techniqnes~~ that~ we~ have~ there stilll is a large~ error~ in clinical diagnosis versus what is found at autopsy.. llr.:~ PRErER: Doctor, one~ thing ~ that ishard for ~ me tio understand is~ that we hear testimony from our respected scientists like Z-ou, and we Tlivs~heard aLrreat deal earlier this week along th~e~same~line~ v.ou were~. m~entionin~, auout the~unreliitibilitw~ of'mortality~ fi~ures-we~hear that,, and then on t'he~ other~ hand'4 the~ IPi.iblic~. Health Service; t.he~ American Cancer Society, the American Heart Association, come in and say flat1v that the case has been proven abainst cigarette smokin;? How do you account for that ? Dr. BnE:r.,I can simply~saythattlheir threshold fon~proof is very~Iow~ and tolerant. I[ can assure you~ that they~ would not accept this kind of' d~at'~a, as proving, anything in one~ of our~ experimental laboratories~~ or i~nn pursuo_n, one of'the research projects tha.t tlley finance for us: They n-ot.ildh7r't anymore~~accept~a protocol like tliis~~and finanee,itfor~ a dru(r trial. say~. They use an entlii<•elv~ different set of standards. They reall'y ~ have:departed from strictl scientific discipline. Mr. PRE),ER~. Y ott wouldl a~-ree~~, tTlen,, Ti take it. with~ tlie~ recent state-~ Iment~of Secretary Finch that there are~ (raps ini knowledge~ about~ to- bacco, and that ai cooperative research effort between Government andd industry i's in the public interest, to find an answer to these baps'? Dr. BRESI. I do. Mr. Pr.tl~.-ER, You speak of the wave of'entltusiasm agrainstsmokin7Y and I think we all sense that. We had one witness, for es,2mple, Mr. Banzhaf, that testified that to slnoke a ci`arette was,, as I recalli it, like play-ing, Russian roulette. Then lie went on to even stronger tlestinlony, , leavi'ng the impression that to~ smoke.~ was~ almost certainly to~ contract a, disease:~ I{.tissian roulette would be one chance in six. Ot.i, page~7~~.: v~ou pointed out something wIlich~ is the first time I llave~ heard it,"tiha~t only 2 ' percent,, or probably ~ lless than 2 ' percent, of' heavy ~ smok~ers~ over~~ many~y'eans actuall'y~ develop~ caneer~ of'the~ lung. Is that accnr.2te?' Dr: ~ BfiE-M. ~ I t'liiinl'c~ it is ~ a good deal less ~,tllan that. Mr. Preyer; ~ actu- ally. If one~ simply~ calculates~ on tlhe~ basis~ of there~ beino70 ~~ million smokers in this conntry, which I tllink is the finttre that the Public Health Servi~ce~ and everyone~ else~ quotes and aecepts,~ and' each year there are somewhere near~40.000 deatl'is from cancer~of the ~lung; this makes the vearlv death rate in smokers exceedin"lr low. It isa tiny fr2ction of 11 percent per~ year. If~~}-ou mul~tli'plv tbat bv~ 20 or ,0 ye.lr.s; it still is a small fractlioit of 1 percent.~ If you get to 20 oL•-10~~y~ezrs; it comes somew16ere perhaps~ nearer 1 percent w~h~o~ willi die in a 40-year period. l'Fr. PREYER; TI say. Of'course, Nv help it. I1'r:, BRESI. RIf Mr. PREYER. 1: callously~~ disrega understand it!, y'c a.tFected by sm.ol~c then that shou1k11 asti,e cause. Dr. BRER. I th pr.o:b;em. AVh= is it tlha~ of the lung andl thet-e are heavy : What~ is, it th;~ verv ~ conn-incinff ~ on1~'.~two~out of ~ ilti'lou~h~, of co~ \Ir. 1'RFyER.~ ~ think it %vas in ,inci -onle statist AVe~ sav&hear ti,t~• Lelitale~ snto- til<<t it apparent! it;~1 tlle~ ftic~ il>.(lication that t li,,- wbite~ lnale Dr. BREM. _Na Ui~~rl'rv.1tlQlls to :'-11, ,,ucl 40 vear ~•, lrite~. The~ faci repr,rted inciale~ iriuc•lu _rea~ter t: in 1'~:;i~i. Iihe~ reason ~ 1ti121r ~Ctls ClJaff ~rnlll cl~earl~.- it~ ~ as soon as t uinltihliedl extr wiiites~is~~jiist al Mr. Pr.Ell-:R. The Ctt:cirM 1'jr. C_,AI:TER. I certainly v e1c,ellent prese~ the~~ clehartnler Meclicine?' I)r. 13rtE.r. S llr: C':cRTER. your explan2tt cancer of ~~ the ~ 11 29-2:,F-r9

1083 tion and that, Ccu- -ests ialf:arv ~,ase ion, -son aIS* are on ltal :on, niM n de- aev )ses =ci- rch: too no: !rt- th" - ny the vet %le. 'lie on. clt. , en n- k- 3i- ,11. or as 1ni r- ,r >r ie n Asto coronary heart d'i'sease,a spokesman qu,otedltliedean of'Mount. Sinai 1Tedical School tothe, effect thut therelation of ci ;arette sm~ok-ing, is as firmlv established as the therapeutic use of'anticoalrulants for treating myocardial iaifarction. A recent publication fromi Yale \Tedi- cal School analyzes the use of anticoag-tlants and concludes that. tlree studies are not well enough designed to draw any useful conclusions. These are: cited as overstatements or misstatem'ent's of inedicallkiowl- ed'ge made by some v-itnesses., , The 3,4!-Uenzpyreneisnotprovedto be responsihlef'or human Iung cancer,, and consequently its amount or the removal of it can scarcelyy be considered at present crucial scientificmatters. Cigarette smoking is not a unique health hazard, as claimed by ChairmanHydeofFCC. AsDr.Kotinpointedout,nomysticalprop-erties are attributable to cigaret'tes: Scientifi'callly,cigaretltesnaoking, hasnot been proved tobea health hazard at all. 21'Tany figures weL•eci'ted concerninb30;0©0or50,00©,,or 260,000 per-sons per year having or dying from.lung cancer or the other diseases, beinff considered. Since it is not known what the causes of lung cancer,, eoronarv heart disease,or bronchopulmonary disease are„the multipli- c~ition of' numbers dbe-s not contribute to und'erstlanding them any better. One recent article on the millions of persons, reported to have one of a long list of diseases~concliid'es tha:t; there must be scarcely any healthy people left•: -No;v to review briefly the specific areas of deficient knoavledae :ind the research neededl for better understanding of' the major diseases claimed to beassociated: with cigarette smoking. As concerns luna cancer,, multifactorial statistical techniques are now in use epidemioliogically; and they may be expected to provide quantitative estimates of the relative statistical' importance of urban residence, occupation„ lunhinfection, and inherited tendencies, . among other possible factors, including cibarettes, We strive for a better ao,reement on the~ classification of so-called precancerous Iunr condi tions and cancers, and this is slowlvy beingachieved„ partly. by inter- national c.ooperat.ion through NHO. Techniques to study viruses. iir- cludting chronie v.irus~~ infections, are now becoming more widely applicable. Thepredoxni'na.nee of malps wiLhi lung cancer and' tlieevirlence that men who have lung, cancer are e.ndociunolobicaIly ab- normal also deserves more study: In animal e~eriments„asuitnlilelungbioassay model for inhalation studies is earnestly sou-ht and technical advances may be achieved withint.he nextyear: Nev-techninues of histologie,hi'stochemi~cali and biochemical study need wider application,, and pathologistswills need help to appiyy these special methods more widely both to: human and . animal matlerial. IJxpasures, to both thegas~ ~ltaseandi particulate, phase of cigarett;e smoke must be designed so that the chemical reac- tions at particular sites in the lung rnavy be understood. Doses and re- lated responses must be evRluated. Although hitherto not found, an animal model system for prodhlcing lung cancers like the common hu- mantypes still'needs to be sought.. In reference to: cardiovascular diseases, additional multifactorial statisticalianalyses and patholo~icstudies are needed. We ivill'endea~-or todet'ermineacc~~iratelvwhetherarteriosclerosisof' thecoronarwar- teries and aort;a differs in~ its development or quality or ini qtiantiity

1071. D. Society memberships 1. Local : Los Angeles County Medical Association California Jiediual Association. Los, Angeles Societ5of: Internall 3Tedici¢~e-Secretar,r,~ Fice President-1952: President-19:i2 Los3ngelesAc~ademy ofMedicine~B'oard of: Governors-l954;President-19G1 Los Angeles Heart Association-Board of' DirectorsT]JYI-1Fl:io LonhBeacii H,eart Associhti~on-L'oard of! Directors-r-1J31-1:,i-51 P;lcificInterurban Clinicall Club_. National: American \Iedical Association American College of'Physiciana( Felo%T ) American BoarcI of Internal \Iedficine-Aiember1955-present; Chairman 1963-10G5' Ilesidency Itcvie\v Cn_nmittee in InternAtl Jledicine-la5i -15G.1_: Vice Chairman-lJG2-iNJ63'1ssociiztion ofYrofessorsof MedicineA:ssociotion of' American Physicians Western~ Association of Physicians-Vice Presi:dent-19G5 Advisory Board for the Medical Speciait5esT1'9C3;, Vice Presi- dent-1966-19G5 ; President-l9GS-present, E., Consiiltant'SAips 1. Local :Area medicall consultant to Veterans Administration, Editor- in-Chief;,3udiodigest.1959-present. 2lAational: 3Iember of special lled:iQal Adtisorg, G'roup toV"et'erans Administration-111G4-19135; Vice Chairman-1pG1:-19G4;, Chsii-man-19G~19G5~ Califom•nia : Ji'ember of State Advisory Hospital Council, 19G1-1'JG3 Tlie Cirel>;.r_~s.Thank S-ozuDr. -Prem. You have2, n: ell'-preparerll paperr which certasnl'yshould be of ~re~it helptlothis committee in reaching some clecision. Dr. BizFtif. Thank vousomuch. TheCiaAzr,-MaN. jj'e have learned throtr~Jh tlie vears that usuallv there: are two sides to every question ancll we are tryin.- to bet both si des: 1Tr.Preyer,,have you any cluestions ? llr.P.n~yrr: Thn,nll you;'i1~r. Chairman. I have just.t a few. Doc,tor;i:fI understand yourstateinent correctly„~ou are saying thatiwedonot i:no~cR-hethertLere reall~~linsbeen this -reat increabe i n htno, cancer incidence that we liav.eUeen, hearing so much about.Is that correct ? Dr. BP.r1t. Yes, sill'.. \Sr.PZua~i:r, :~i:r,: This really gets at the corner.st'on eone of the Piiblic I+Iea lth. Service''s case. Dr. B~ri:M. It certainlv does: ves. llr. PrEYrr.: U nti~l that is established, that iQ,untill iit hnsbeen estab- lished that there is a ;rent increase in lnna cancer, then vou can't sa~-th~ltincreasin- consn~lnE~tiott oEci-~arett~es'is the cause of lusiq~ cancer,can3.~on ?

1059 ~ 1933- Fern- >pital, rgean ;eryY aunty 25/41 aatiers harge chest so in head thern frica, ntraD aus- rvice, Ann 1942. de at 5. Do11es, F. S. and Brewer,, L. A., III : The diagnosis and treatment of' primary intrathoracic tlumors, J. A.\: A:. 121: 1130',,1943!, 6. Brescer; L. A., III :! Portable hand driFen, suction machines. Bull. Med. Dept., U.S. Army,,75 : 119, 1944'. 7. Samson, P. C:, Brewer, L. A.. III, and Burbank, B'. : Immediate care of' the wounded thorax. J. AM:A. 129 : 607, 1945: i 8. Burford~, T. H., Samson, P. C.,, and Brewer, L. A.,, III: Recovery from hemolyticus staphylococcus aureus bacteremia~ attributed to penicillini therapy. Jour: Thorac. Surg. 15: 1-30; 1946. 9. Camsons P. C., Burford, T. H., BreR-er, L. A., III, and Burbank B.: The i management of war wounds of the chest in a Base Center. Jour. Thorac, Surg. 15: 1-30, 1946'. ~ 10. Brewer, L: A., III, Samson, P. C., Burbank, B., and Schiff, C'.,: The wet lung i in XN-ar casualties. Ann. Surg. 123 :, 343,,1946. 11L Samson, P. C. and Brewer, L. A., IiIiI : Tracheobronchial catheter aspiration Ind'.cations and technique Med. Bull. U.S. Army 52: 228, 1948; i 12. Sams ony P:. C. and Brewer, L. A., III : Principles of improving inadequate tracheobronchial drainage following trauma to the chesG. Jour. Thorac: Surg. 15: 162-172',, 1946. ~ 13. Brewer, L. A. III: Plombage in the treatment of pulmonary tuberculosis. A preliminary report of use fbllowing unsuccessful thoracoplasty. Calif: Med. 65: 28; 1946: ~ 14. BreR-en L. A., III, Doiley, F. S:, and Jones,, W. a3., G.,:, Non-malignant int'ra- ~- thoraeic lesions simulating bronchogenic carcinoma. Report of 30 operated ~ cases. Jour. Thora,. Surg. 17 : 439-463, 19=18. 15, Brewer, L. A., III,, and Bogan; E:: Strept'omycin ini tuberculous tracheo- j bronchitis. Amer., Rev. Tuber. 56: #5;1947. ~ 16. Brewer L., A., I'IiI, Dolley, F. S., and Jones, W. Ji. G'::! Indications for pul- I~ monars resection for tuberculosis both by lobeetomvl and pneumonectomy. Dis: of Chest 14 : 491, 1b48: , ~ 17. Dolley, F. S. and Brewer, L, A., III : ~ Chapter oni Pulmonary Resection, C1in- ~ ical Tuberculosis by Benjamin Gol:dberg, Sisth Edition, F. A. Davis Co., ,1 Philadelphia, 1948. j 18. Dolley, F. S: and Brewer, L. A., III: Diagnosis and surgical treatment of ,~ patent ductus arteriosus. Revista Panamericana, de /1ledicinal y Cirurgial del toros,,1: 1, 1948: ~ 19'., Brewer, L A.,, III and DalIey, F. S.,:~ The surgical treatment of carcinoma ;: of the thoracic esophagus. The technique of t'ransthoracic thoracolapar- ~~ otomy with esophageal resection and high esophagogastrostomy. West. j~ Jour. S. G. and O. 56 517-528,194b. j 20: Brewer, L, A., III andi Bogen, E.: Streptomycin treatment of t'uberculous !' tracheobronohitis. Calif: 11Ied1 58 : 1,,1948: 21. Brewer,, L. A., III: Surgical treatment of carcinoma of the eervicali andi ui~per thoracic esophagus. West. Jourr. S. G. and O',, 60:, 1~42, 195h. 202: Dolley, F: S.,, and Brewer, L, A., III: Concepcion Moderna del Trataminto. Medico y Gluirttr.aico de la Tuberculosis Pulmonar. Contribucion Extra- ordinaria. Segundo Congrilso~ Argentino de Tisiologia, pp 1005-1024, Nov. i 23. B'rewer, L. A., IQI, andi Dollev; F. S.: Plombaje con Lucite, VIII Congreso Panamericano ,13emorias de Tuberculosis ULAST, pp 517-524, Mexico,: E; 1J-19: p l. 2-1. Brewer, L, A., III: One, stage resection of carcinoma of the cervical eso `- phat,-us was subpharyngeal esophagogastrostomy., Ann. Surg. 1k30!:1, 1N9. ~~ 25. BreR•er, L. A.,, III and Dolley, F. S.: Careinoma of the thoracic esoPha,:u:s. A discussion of earlyy diagnosis and surgicali treat'mentl Ca1if. 13ed. 71: ~~,' 2, 1949. 26. B'r:-wer, L. A„ III and Dolley, F: S.: Tnmars of the mediastinum, A discus- sion of diagnostic procedure andl sur,aical treatment based on esperiencen•itli 44 operated cases, Amer. Rev. Tu;ber.60' #4;19491 27. Brewer, L, A., III, Dolley,, F. S. and Evans, B. H. : The surgical management't of chronie "s~pontaneous" pneumothorax-Repor~t on etiological fact'ors and sur;ical, treatment employed in~ 15 cases. Jour. Tliorac. Strrg, 19: Ui7-194;,1950. 2S. Dolley, F. S. and B'retrer. L~ A,.. IiII : The diacnosisand treatment of'chroniYtf spontaneouspneumothorax. West. Jour. 8.0. and G. 58: 46:"71„ 19.50;, `_'9. Brewer, Il. A., III: Thesurgieal treataient! of lmlmonarvtnberculosis, L. A. County TuberculosisAssn~: lLonogranh #J, (ict'ol<er, 19;,0:

1079 -he find- hologist " in the ' toseeo divided -ug car- or not )f three: in thee areas. versits, ' LAU'- -ia and 1, both ly andd racter- labels. -SC.%IC able 1. rancis ~rmoi~d~ resultss at the. HoR'- ,tdular' ,rs for ~rmoid LAC- •d, the time. which ), but les of' 'roup: n:eles hough squa- rmoid areas i : Los raph- road' f Loss stand , 17). may rth er lting, TABLE 1-COMPA'RISON OFl'HISTDLOGiC TYPES OF LUNG CARCINOMAS OBSERVED ATiNECRaPSY Tppetumor Squamous!------------'--------------- Adenocarcinoma---_,__________________, M'ixed------------------------------- A'napVastic~---------------------------- Btonchiokar'---------,---------,--------- Uhdifferentiated large--,-______---__,_-_ Adenoma----------------°----------- Other-_------------------------------ Male-femaie ratio__--__-___.,______-___ r Incomplete. LAC-USC Me;dical I Men, Yale Francis Delafield Center, 1958-62' University, 1955-59 Hospital, 1951-65I New. (281 cases): (82'cases) (274 cases)I Orleans,. 1957,62 Number Percent Number Percent Number Percent (268lcases) 81, 28!8 37, 45.1 1o0 36:5: (r) 100 35:6'~ 1'T 20.7 87 31.7 _._-__,_-,-_ 5 1'.8'-------------------- 3 1.1', ---------- 62, 22;1 211 25.6 54 19.7 ______,_--_ 5 1.8' 2 2.5 6 2.2 _,_____-_-_ 20 7.1 5 6L1, 18 6.6 ---------- 4 1.4 --------------------------------°----------------- 4 1.4 -------------------- 6 2.2 ---------- 4:1:1 5.1:1i 4.6:1 REFFRE~'-CCEB'. 1. Adler, I. : Primary \Talignant Growths of the Lung and Bronchi ; ai Pathologic', andi Clinicall Study. \ew York, Longmans, Green and Co., 1912. 2. Willis, R. A.: Pathology of Tumours. London, Butterwortlhi and Co., Ltd. 1948. 3. Kreyberg, I1,. : The significance of histologic typing in the study of the epidemi- ology of primary epithelial lung tumours. Brit. J. Cancer,, 8!:~ 199-208,,19.34. 4. Kreyberg, L.: One hundred consecutive primary epithelial; lung tumours.Brit:,.7. Cancer 6'.: 112-119,1952'. 5:Kresberg,,L.:Lung,cancerand,tobaccosmoh;inginNorwa9:Brit. J. C'ancer9: 495--509, 1955. 6. Kreyberg; L.: Occurence and' aetiology of lung cancer in Norway. Brit. Jl, Prev. & Sociitl sted. 10 : 1'4:r-15S, 1936. 7. Doll, R., Hilll A. B'. and KreSUerg; L.: The significance of'ceIli type in relation to the etiology of lung cancer., Brit. J. Cancer 11 : 43r48,1937. 8. I'errari„ E: and Kreyberg, L~ : ~ Histologic types in a lung cancer material~ ini Z"enice: Brit. J. Cancer; 14i: 409-619; T960: 9. Kreyberg, L. and Saxen, E.: A: comparison ofl lung tumor tppes in Finland and \orwav: Brit.,J: Cancer, 15: 211-21J. 1961. 10: Spain, D. JI. : Recent changes in relative frequency of' various histologic types of bronchogenic carcinoma. J:, Nat. Cancer Ihst., 23 : 427-434, 1959. 11. O'Neal, R., \T., Lee, Ii. T. and! Edwards, D. L. r Bronchogenic carcinoma. Cancer, 10 : 1031-1036. 1067. 12;, Wynder, E. L.: Tobacco as a cause of lung cancer. Penn. M. J.: 57: 1073-1083, 1954. 13. Herman„ D. L. andl Crittenden, 3i': : Distribution of primary lung carcinomas in relation to time as determine by histiochemical techniques. J. Nat'l Cancer Ihst., 27: 122 7-1271. 14. U.S! Public Health Service:, Smoking and Hea1t'h Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washing- ton, D.C., Dept. of Health, Education andi Welfare, 1964. 115. Kreyberg, L. in collaboration, with Liebow. A. A. and Uehlinger, E. A.: His, tiological Typing of' Lung, Tumours. Ixtcrnatioraal' Iiistological' Classihca- t'iion of'Tunxoacrs, No. 1. Geneva, World Health Organization. 1967. 16. 3IhcdonalcL IL : Biological predetermi~nism, in human cancer: Sbrg. G':ynec: S;OUst.,,92 : 443'--4:i2,19ci1., 17. Sommers, S. C.:, Hbst factors in fatal human lung cancer. Arch. Path., 65: 10+1--1111, ,19a8; 18. Krant, 3L J., Jlansl:opf, G., Brandrup, C. S: and Madoff„3f. A.: Iimmunologic alterations in bronchogenic cancer, sequential sthtdy.Caiver, 21:, 623-631', 106.3: 19: Hoslt:v,, H: E'.: 'M'-Proteins; plasmacytosis and cancer:. Cilncer,, 20: 295-30T„ 1969. 20. Ed'itoriall Review : The endocrine and genetic factors i'n cancer of the lung. Growth, 28':'1-15i 19fi4. II

1048 ' get'tiilg lnng cancer are said to be decreased: so there seems to. be a dependence on d'ose, and we know experimentally that the hroductiolt of cancer depends, in part,,on the dose of'the careinogellic:agent. These observ ations seem to incriminate eigRrette smoke as ai causative agent in lnng~ cancer. Tj'hti deny~it? The denial is based on the~f<2ct that eaclli obserNation: only suggEsts~ that smohing, causes~~ cancer. And each ob- servation can be~ interpreted' in a~~ nonincriininating~ wa~y~. Let us~ con- sider~ some ~ alternative ~ interlpretations~ of~ tlles~e~ observations-iaii the~ sxnne~order~as~,list~ed.~ (1)~ Tlie~ least~ uaefull ol5servatiion concerns~ the czncer-producin,~ ef- fect of tobacco tar on mouse skin. Indeed, this work shouldl never havee been done recently, ns!,similar ~R-orl.~was done~mantir~deca~cles~ago~ and t,'he~ results were hlown alread-v . Years ago it ~t-as shown that coal tars pro- chice~~ skin cancer.~ The~ responsible~ chemicals in the tars~ were isol'titedl andlide~ntlified. It n-~as also known that tloliacco~contained some of these~ chemicals ini small amounts. So. oiice~ a~_r~ain, in tlhe~ recent tobaeco~ e1~- tract esperini~ents~,known earcinogenic~ chemicals~ R~ere~ applied~to~mouse~ shin, and once agaidi cancer developed. \othing,new here: 3lore impor- tzYnt,~ however, is the difficulty in interpreting the result. (a) Thi's~ same~~monse~experiiirentTlas,~been repeated again and agYin, iiladrertentIv; in~~ man-ab cigarette~ smoke tiars~~ the~ fingers~ tlsat, holdi the cigarette~during vcars of heati Sr~ smohing~~.~ No callcer, , d,evelops~ in~ the~ fingers. Co the~mou~se~experiinent, for this, and other~reasons,~ lias~~ no~ application to man. (b~~)~ Many chemical carcinogens~~ will produce~ cancer only~~ in cer- tain or' aans.. This~ finding~probably depends on tlie~difFerent cTleniirall constitution of' different organs. ~~ome~ org ans will cllemicalQo~ bind ai carcinoo•en and theni cancer beg>'_ns!, ~ other orgnns~~ do~ not respondi to~ the~~ same ~ carci'nogen,, probably because~ such organs lack the ~ chemicals needed to liind t~he~ carcinogen. AnclS for~ similar~ reasolls, chemical carcinogens produce cancers in some animal species asld not in others. The motise~sl.in is~chemically ~ different from the m,ouse liing or the~ l'ung of me.n.~ ITence,~ the production of cancer~ ini luonse~ slcin~ lby tobacc_o~ extract' is nlo~ indication~ whatsoever tliat~ tobacco~ extract wiIl produce cancer~in t11e~Iunrr ~~of'mouse~or man. (4 Aiid when~ the~ mouse lking is exposed to cigarette smoke, t'16e~ so- called c;lll~ed smoking-type cancer cl'oes~ not~ develop. So the observation tlh;it . tobacco tar produces cancer of the~ mouse skiiu then lias~ little: si~gni~ti- cance. (2) \~t~first~glance, a bit niore respect~seemsAue, t~o~the~~ ollservatioii, tllat~the ~incidence~of lu~ng c,incer isihcreasing, as i~s~ the~ cil(rarette colt- sulnption. niie~could, d'npm~iss this correlation hv savin(, that the~inci~- dence of u~sinr~~ elhctric~~ shaver5 i~s~,also~ihcreasing. B'ut tllere~ is~ a more~ serious objectlion. Is tlie,incidence of~ lun- ~~ cancer reallv ~ increasinm~? It is reo•rettahle~ that' mnny ~ people~consicler~the practicing ~ llhv ' z~ici~;ur iilfailiMe~ in slpecifying~ the di;case~ on h~and. IIe~ may ~ hai•e tbe i)est. brain. the~ lbest eclucat~ion.~ the bost~ l~abmrat~or}• and llospital' tlests~ ar~,li~l- ahle-vct, his~ }batting a~-er.~„~ °cc is ~ far from T,(?C10. Tt is not the db^tor's~~ fault. ~Simpl~y~, the available Ihno«ledLra and tests~ are inadeq~uate~ for. 100~ percent accurac~r~ ii'u diil~nosis~. It so happens~ that cancer~ of tl.ie~ lhialg~~is~one~of the-more~diflihnlt~~conditions tol.diaglose~, as it is~niimickecl~ 1~~v ~ na;lni~~-~~ orher~~ con<<,it~irnls. Evell inlder the best hoshi'tal contlitionr~, the error i'1ii diagnos~ing prin»;ur}- cancer of t'lie~ lmig~~ is duite~ lnarhecl. ` The n-itllou that th. cert 1 fic Illg,plll contirn crease stead c hotillita is~ dkie proved' ago, tl lnisl,- a] tient a cancerr is atltri disease inilungtable tlc. We t the onl onl y al i nciden a,hoa-eincreas ) rette,s] correla cancer.c1use. 7 (a). (b) .1Ssoc1.`l (e) : 1 sclowing occur t partiaI ceer. tie expeeir linh in expose( tlie tY11develol 'In.-elol fot 1'«red. .~inr,ke 1'oii dirc S(). t tlu• ;ibc eare then rb

1!070~ CURRSCUIlUNCVITAE AL Persanal, tinformatian 1. -N1me: Thomas,Hanailton Brem 2. Business address': 2025 7.onall Avenue. Los Angeles, California 9(0;3'3. Business phone : C A. 5-1511. Ext. 230,231 4. Home address : 1310 Milan, South Pasadena, California 91030 5. Home phone : SY. 9-5694 6. Date of lairth : O'ctober.3,,1910! 7L Place nfbirth :Canal Zone, Panama S. Citieer:-dlip : T';'.S:A. 9. Sez :,Jiale. 10. Marital status r liarried. 11. Wife's maiden name: Elizabet!hi Bloss. 12. \umber of' children : Three B'. Education 1. HiMh, SchooI : Fairfax High Sehool, Los Angeles,, graduated-1J2S ?: Colleae : Stanford University, A.I3.-1933'3. Eledical SchooI:1ohns Hopkins',i:niversity, School of JI'edicine, M.D.- 1937 4. Internship:: Johns Hopkins:Hospital-1937-1938 5. P.esidencies: Resiilentin Pathology, Stanflordi Universitc-1'935-1'939 Resident in -lIedicine-L'SC service. Los Angeles County Ho:spi- t'a 1J-1939-194?~ 6. Fellowships : None 7. Honors and awards: AlphaOmeba Alpha (A1phaChahter ofAO-k), Johns Hopkins University 8. Licensure :, Californias, Jiai;cland 9. Board certification : American Board of Internal :iledicine-1946 6': Professianab baciv'ground' 1. Academic appointments : Assistant in Patho?ogT-Stanford rniversity-193sr1939Instructor in JIedicine-Univ. of Southern Californi€t 1939-1J-19 Assistant Clinical Professor of -.NIedicine-ti CL A-194.>•-1t351 Associate Clinieall Professor of \Iedicine-UCLA-1951-1Jii3 Clinical Professor of' Medicine-UCLA-1cJa3'-11034 Professor of' 3ledicine and Director of Clinical Teactiin,;-USC- 1954-195.i Professor of Medicine and Co-Head of' Dept. of Jlediciue-U SC- 1951r19~.~5 Chairman. Interim Administrative Committee (Acting, Dean) U SC-19-56-195S Head. Department of! 3ledicine, Univ: of Southern Cnlifernia- 10a58--present' 2. Specific teaching responsibilities : Daily rounds witlt undergraduate students and house shitf ' Fourr regular clinicall conferencesperr.-eek 3. Specific administrative responsibilities: Chnirman of Interim Adininist'rativeC'ommittee-U4C. 111:r6- 19154~ .1diniEsions Cbmmittee-i'SC-19:~ri PltbiieRelatibns C'ommittec: i'SC. 195S-11762 ' Board of Dicectorsof' L.A. County Attending Staff Association- 1061-present Medical Education andi C'urriculum Cammittee-USC-1963-present 4. Military service : Medical Officer, A.U.S.,, in C.B.I. Theater-Feb: 1912-Dec. 1945 D. SoeietY meniD+1. Local : Ls C: Lc Di R E, Consulta9it8k L Local in4 2. Natic Ad ma Ca1if' The ChAIilt' pape1' «Iiiw?Irh ~ reacTlano, som( Di% Ilrrit. 7 The CHAi'IrR there are t'%vc sides. ~ _l' I r. Prover 1S t•. I'r >> r•.r D'octoh,if71'~, we~ cin~ not ikn~ 111111-T ~('illlcel' 1~. I:IIt)]tlti cC1L'1: D~1r: 1 1'T:r 1a. >Ii•..,PRatl.'I:I 1ervICe"S c1151'. I)t?: lirl: ~r. IIIL•.. h1.1;1"I:~ IiAle(I tla,lt ti t]lat ilwtteabit cilII~ 1'Oll ?~

1073 '. titis~e the i cer- , and en by ,f the «-ith larae nd is d R-e «ere t'hat, ican say' low dl of )r in t for :hey -ate- n to- and 1 Ing„ l'Ir. iion .,ian Ltive av.y. '_tll- !ion b1ic earr his by to ri12 1Ir: PREYEtz: That is a~ gooddeaT less~ than Russian roulette, I would sav. Of course, we do not want anyone to die from smoking If' we can help it.~ Dr. B'REM R'lght. Mr. PnEFEFt. Iiut the point you are rnaking is not' that we sliould. callously disregard the 2~ percent or ~~ 1 percent,that are ~ dyingT but, as~~ I understand it, your point is that if it is that small a percentage beina alfected by smoking, and there areJ8 percent who are not beingattecteT then~that should Iaise~ very~serious~ dou'bts~ in our~mind~s,about smoking as tlie c ruse: Dr.~BxE~-M. I~tliink~~it,sliould foctis~ attention for research on this~~ very proble~n. V What is~~ it that; differs between the ~~3~~ percent who do not get ca2icerr of the lung and the 2 percent that do; who are heavy smokers. and, these are~heavy~~ smokers, one to~~ tw~o packs! a d<ay over 0-0 1 to~ 401 years.~ Wliat~ i~s, ~ it, that makes~ only 2 ~~ percent get cancer?It doesla't~ see~In very convincing that smokii:Ig can have verv much to do with it if only two out of'a hundred over a long, long period like this develop it, alt!iough„ of' course;, possible.~ Mr. Pn.EYEP., One other question along~ that line, Doctor. ]C do~, not~t think it was~ in your te~stimolay, ibut as: an aside, ti'oui¢itetl' Dr:~ Gilliam and son1e statistics relating~ t~o~ tlh.e~ wllite~ male population and smokin~. I~e save heard t~estimo~iy.~to the eilec:t~tlhat sm~okinn~does,not aifect~i . the teni~a~~te smoke~r., I recall one doctor.~ vesterday; Ilelieve,, testified tliat~ itt apparent'1y~~ did not~ affect B+ skiuros. ij~"itlr the fact that you said wh,itie~ n,ale population,~ i's ti'nere any indication that races~ of otl:Ier, colors are not as~ seriously ~ affected as the white male~ population?~~ Dr. BIE.Nr. \ o, sir: One of the reasons they confine a good bit of tbeirr ol,ser.v~ations to whi~tle~ is~ that stintistics: for~ the~ nonni-lii'te~ population :znd 40 y.ear5~ ago were even more: unre~liilbl'e than they were for white. The fact is that there has been an enormous increase in the rehortedl incidence~ of cancer of the~ humg, in th:e~ nomvh~ite~ population, niuclli rreater than in t1ie~ white; in the ~ last 3~5 ~~ or~ 40~ yenrs, begirliiing, in 1S)11;C). Tl,e reason, was that at that date the incidence of cancer of t11e, lung~ was diagtlosedl v~ery,~ very rarelv~ in the~ nonwhi'te~~ pol~uls.tion,~ and clearly it~ was becattse~ tliei~-~ did not hav~e~ access~~ to medical care. ,-~o~ as~~ soon as~ they began to~ get access to~~ medical care~, the~ incidence multiplied extremeliy ra-pidly~~so4li:nt tod:ly the~ incidence~~ aanong non- white~s~is~just about th,e~same as it is~~ among n-~hites~. Mr. Pr,EYEIZ. Thank you, Doctor. The CtiAilt-_Nr:w: Dr. Carter? l'Ir. CAr.TF:R. Thank you, A'Ir. Chairlnan.. I'~ certainly~~ want to~ compliment the distinguished rentlem,in on liis ~ excellent presentation:~ I~~ notice you are, professor~ and chairman of~ the-~ depa.rtlnent o' medicine, L`iriR-ersity~~ of' Calsfornia~, School of~ .l'Ie<licidie ? Dr. It3tm-_\~r~. Southern C~alifbrnia., llr: CAItxER. I was very' much impressed by your kno«-lpdge and your explanation of ]io~i~ we have come,, over tlie years, to dia.gnose. cancer of'thelun g, ~ . 21) -236-69-pr. 3 -13

T0S2' including smoking i's not a cause. A number of studies show no relation of smoltangtoheart diseaseandl ought not be ia ored.Aging and coronaryarteriosclerosis; of' course, overshadow other processes that contribute to the most commonty,pe of heartdisease:Another difficulty with coronary heart. disease concerns how accu, rately the diagnosis is made. When the most advanced clinical tests are employed, evidence for coronary disease is found in alhnost half of' all men over 4Gyears. $othis age practicallyald the coronaryartleries show some. patholopic lesions.. Since both coronary disease and cigarette smoking are:socommon in the U.S. malepopuTation, it is~ quatedi~fficultto: find adeqtzatlenumbersofpeople, forcompari son who have neither;,or, onlyoneoft!heseconditions. A tve11-known statis- tical fallacy is likely to esist n•hen groups of such unequal size are comparedL Emphysema has now been added to the list of diseases blamed on cigarette srnoking. The newest medical publications and governmental reports emphasize how difficult are the diagnosis, the classification, and the grading, of severity of puhnonary emphysemay even among eaperts, The cause admittedly is unknov-n. One common, form de- velops in every person R ith age, and lumping sei-eral types as if they comprised an entitwisunwarrantled. Thus; death certificatediagno.sesor a routine pathologicdiagnosis, of emphysema atpresent aresci- entifically practically: useless; except in afew specializedl research centers.. In the current', era of relative ignorance concerning how to define andl recognize emphy.sema and' other chronic lhzng diseases, no sweeping, generalieations as to causation can be justified. In reviewing above a, few selected discr.epancies,, difliculties, sliort- comtngs; and unsolved problems in tlie field of' smoking and, health,, there is no wish, to ~ dentgratietheconeent~rated efforts made, by many workers to find' answers.It is simply that the field is too, new;the techniques still being developed, and the conclusive proofs not yet in., It is less than 4'Q0 years since lung, surgery began, for example:. A few items in the testimony of others may anstify comment. The Surgeon General comparedl inability to demonstrate the formation of' lung cancers in e~periinental animals exposed to smoke with lack of' experimental production of leprosy., However, Ieprosyy has been produced in animals. Some confusion arose through use of the woi:d' "'adidiction" in con- nection with tobacco use:Iiy generallv accepted WHO: criteria, smok- ing tobacco is not considered an addiction. Dr: Williams of the American Cancer Soeietv stated tihat a phy.si- cian looking at a slide of', lung cancer without information could tell in some detail aboutthe patient's social liifle; cigarette smoking for some 30 vears,and' so forth. On the basis of' my daily experience as a pathologist, when one looks at a, slide of lung cancer neither a pathologist nor other physicians can tell whether it is from a man or woman, andi thuscannot accurately describe the social life. Fur= tlier, it is not possible grossly or microscopieally, or in any other waykno~vn tome,todi~st'ingursh~ between, thelungof a smoker or anonsmoker: Blackening of'lungs is from carbon particles; and smok- ing tobacco~ does not introduce carbon particles into the lung. The educational value: of the various specimens shown the committee in this situation escapes me. As to coronar_ ~~ Sinaii Medical ingisasfirmly~ treating myocir cal School' anal! studies are not These are citedd edge made by so The 3,4 benzl cnncer., and con be considered atl Ci_arette sm Chairman Hvd, ertiesare attri1 has not been prc. H~:lnv ~ figures sons per year~ be~iar, ~~ considere~ coi,onary heart cation of nunzi better. One rece one of a~, long~~ lil ~ lreaz~lth~~ ~ people -Now to reriE t~he~rec~earch n clainied to be a;. As concerns, now in use ep clu<lntitative eE residence, occu oth:er.•~ possible ,i(yveeuient on tions and': canc natiional coope~ cluding ' chron ahpli~cubl'e~~.. TI ev~idence, that. normal also~ de ~ In animal e3 studies is~ ear.t within the ne3: biochemical st help to~ applh- animall mater ph~ase~~ of cigat~ tions at part~i( lat'ed responsE( animal model mamtypes stiil' In: referenc stati'stical ana: to, determine teries and aoi

1077 :m- iedl the =av In ids , me ', Lia, I lve ice ITo ~m ts- ~ lie~~ of or le., ~ls'. 'r- Cto is'- tTt a, er os' My medical educatiion was at Georgetown University and University of: South- ern California. Since 19,56 I'' have practiced and taught pathology at the Los 2in« geles CbuntT-U'niversitp of SottthernCltTifornia aTedicalGenter (LAC-TJSC:TIC),, where I am presently Assistant Professor. During the:last decade of the 19th century,,when Itrng cancer was a rarely reported human neoplasm, pathologists (1) were occupied with a detailed study of'" tumor types. Lung carcinomas were frequently associated with tuberculosis, chronic' bronchitis, chronic interstitial pneumonia~ and atelectasis. Eitrly reports (2) during, the first and second decades of the 20th century, although based onw few cases, showed an increasing incidence that seemed to be reflected almost esolnsivelrinepidermoid (squamous): andlundifferent.iatedtypes. In 1954 Dr. Kreyberg, who had been studying lung tumors since 1930, devisedd a comprehensive,andl reprodtr:ciblemethod for histlolbgicclassifications (3) that was later adoptecLby the World Health Organization (WHO) (4). Since approsi- mately 30 to -10&c of lung tumors are difficult to classifs by routine methods. Dr. Kreyberg also developed a more refined technique, by which a large portion of' these tumors could he classified. In otlier work. Kreyberg divided lung tumors int'o two groups': Group I in- oluded epidermoirl tumors; Grottp IIinclude'd glandular tumors. In 1Ja•"' (5p and' 19:;6j6)he reported!findings: from hisNorwegian mat'eriad which indicated: arela-tionsliip between cigarette smoking and a higher incidence of Group I tumors tibmi of'Group I!I tumors. In order to test his theory further,, Kreyberg reviewed lnng tumors in other geographical!sites. In 1957 (7J, with Doll and!Hill, he found similar results in the British stiudies. He concluded from these two studies that cigarette smoking was the main causative factor in the develbpment of Group I lung tumors, but, was not: related to Group II tumors. The 78 cases collected in Cenice. Italy. from 1936 to 1960' by Ferrari were reclassified by Kreyberg (8). The ratio of Group I:Group II in men was 3.2 :1. In 1961, hreyberg, and Saxen (9) reviewed 624 tumors collected in Finlandl for tliere.Zrs:1957to14a9. Finland was~ selected because of the high f'reqtie'ncpof'l~ung, c,:ncer desnite lack of indust'riatization. The ratio of Group I to Group IT t'umors, in meu wa . 12.1 :1. However, there was:no information on smoking habits. Sbveral retro?pectit•estatisticalstudies(10, 11) in the United .r+tatesindi-cated that the frequency of'epidermoid t'umors was increasing, while glandular tumors remained constant. Some investigators (,11„ 12) therefore suggested that't eaogenousfactorss such as ciaaretltesmolting„ wereeausal'1y related toepider-moicT bu:t not to Qlandular tRimors:,Dlethodsof stud;vand'tliecrit'eria: for histolog- ical classification, varied'considerablv among these studies. In 1958, Dr. \iichael Shimkini then of'tbe National Institutes of Health. sng- gested that t'heI:AC-L?SC'NIC neocropsp,(autopsv) series wouldl he, an excellent sourca of material tio determine,the differential! trend's'of Inng cancer by histologic type. This material hadibeenkept over the years',si.nce:1927:, I was the pathologist selhcted to mnl.e this study. All lung t'nmor:s obscrved at necropscat LfiG-USCMCfrom1927to 1957wererevieR-edi All neopinsans wererecl'assified according totlmocriteria: a) a modification ofLiohow's methadi and b)I{recber,Q'smethod' (rVHO)bvthe useofi special sthin,~~. St'a- tistieal analysesn•eredoneby the 'National Canc'erInstntute (1S).,Ninebu~n(lr~edi fifty-si's tumorsmetl tliecriteria for inclrtlsibn in tihe study. Dr.Is;nociierg, kindly consentedtloclas:~ifF]I00ttmioi7s. Therewasescellentagreement lietween, mpdiagnoses and his, according to the1THO method. Results of this study differed significantly from other publi',shed' d'ata. o4m resu:lts indicatiedi that' the proportion ofI gIZndnlarftunorsin man was inornas_ ing; while the proportion of epidermoid'carcinoma was d'ecreasing. Oirr'ratios of' Gronp I'' to Group II tumors in men were decreasing, while the ratios reported bs Kreybergand others,~vere i'nereasing. Amon., possible explanations for our unanticiPated find'ing.~; v-ere ]) errors bvthepntholo_iFt in liir•tolneic cLassification: 2)va2•iations: (lnet'o autnpappopulation and/or geozraphicnblocntion: In lpril' 1116, I inas invitecT to attend' the workshop for the clascifcin,r of'1'rnn,tumors that' R-as'sponsnred by the Cubcommittee on Cancer of the Surgeon Gen- eral's _Ydvisor,r Committee am Smohin,g and' Henlth. Tissues from 400 recent or currentl D_1C-T?SC3L('' patihnfs Ncithi pttlnionar,vcarcinoma, n-er- snhn:irtedd to the Cbmmitteef'or classification bsDr. Kresberg, (14)_ 'Pher~ewas remarlti-

1076' But that is because the initial number reported in 1914 was so im- possibly and u~nrealisticall~ low. What thi~s ha3~ to mean, is that the vast majprity~of people~ who~ died from cancer of the luno, around tlie country were signeeld out on the death certificates as tuberculosis or pneumonia. T think one can say that with, considerable assurance.~ Thi's~ is, a difficult diagnostic~~ proliliem. Ca~ncer~~ of~ the~ hmz stilll is. In almost every ~ patiient you see, pneumonia,, tuberculosis and other kinds of infection o#~ the~luiig~ has-e: to~be~differentia,ted. It isn't easy ~nosv., In some studies, as many.~ as~,?~7~ percent, of the patients ~-.ho come tio~ postmorten exami'nation~~«ith the~ elinical diagnosis of pneumonia, of'lun~ abscess, of tubercuio..i5-turn out at the autopsy table tolhave cancer of the~lu~n-,,eventod iy. D~~Tr.,SrRi~~oEP.~~. S'ome of'that i's~ dne; then, to the~ fa:ct'~thRt R-e~ are~doinge more~~ autopsies ~~on deaths„1' presume ? Dr. BRE.f. ~ This~~ is oi><e~ th at has ~ made the ~ reco:nizedl incidence L01o n~p,, yes. «~r~e~ do more., But still,~ I~ suppose of~ a111 the~ peoplb who die in this country, less than 10 percent of them have a postmortem ,exalnination. Mr. CARTEr,. ~ti'~, Ould the~ dtstl~Ilgulshed gentleman y.leld ?~~ lfr. SPRI_\'GERL~ Yes. Mr. CARTER. The main reason -,rhy lung cancer has become increas, inaiy.~evid'ent is~because:of our increased dia~po=t'ic~ca~pabilities~ at the~ pre-ent time. Is~that not true, sia• ? Dr. I3RF-Nr. Yes, indeed. I migh't~ e•ite~altinstance in our own hospital. not rel :tive~to~cance:r of t'he~lhznxg but of hyperparathyroi~dism, which is ttiie~ to a beni-n tumor in the pararhyroid glands. As of 10 years ago. we virtually sa-,u none. Tihe~increase~in incidence~of~this dise~se in our~hospit.ll population has, increased probably 100 times in these last 10 years. Why ? Because we have a group that is interesterll in this! p.irticnlar disease and liecause almost every patient now has a serum calcium level r;er- formed'ion him. We now have these automatic machines and they can do a lot of chemical tests; In hyperparatliyroidism the calcium, level is high. We have di's- co.rered them andl the~ incidence~ has increased alino~.q 100: times~. That doesn't~mean that the disease~~ has~, increased over these 10 yea.ry, not a~ bit; but our ability to recognize it has. Mir. SPRINGER. Thank you. Tlie CIi:URAzAiv-Thank y~ou~ very~~ kindll~~, Dr: Breui.~ for comin~;~and. ~iR-1n,~~us~the benefi~tof your vi'e~i-s. ~ ~ Dr. Br.Eat. Thank you, sir. The CHAiRM<',N. At this time, I would like to present forthe rerordd a statement of Dr. Doris IL. Herman. It will be presented for the record. Wi'thout~ objectiony, it will be~ included in the~~ recordi ~ directl~y.~ after tliete,timonve of Dr. Brem. (',The~statement of Dr. Herman~ £ollow~s :) , STATEMENT OF'DR. DORIS~. L. IIER\LA\L~ r'y:SSISTLINT PROFESSOR~.OF PATHOLOGY, LoB~~ ASGELES~~. COU~:TTY'-L.MVERSITY~ OF SbUTIIERN ~ CALIFORNIA ~ AIEDICAL~. LENTER I anI Doris L. Herman, physician., a pathologist interested; in tissue diafinosis of' tumors. I aul, particularly interested in the biol.ogical behaTior of the specific cellular t!ypes of'. lung tumors. My medl erni Califoi geles Courr where I an During reported h of tumor t chronic br (2): dil,rinJ few cases, elelusivel~. In 1954 a compreh was later ; mately 30 Kreybery, these WIn( . In othoi clnried: epi. 1956 ' ('fi ) h i tinnship b~ ll:ruofGi 1, _urg tumo Sillliiar reci;arettes lluI~, tumG VFnice. It Theratio i 111 1961, the years . (•;c3lner deFI II:1 nIPIL \G.f Sevc-ral' crrted thal tnmors re eso,,enous moid!hut r i~~:,~ ~flnsNiiI L 19:;Q: mstei tha sollrno of I tyrn+: This I W:1 y t at necrop n-ere reel metho(la tisti'ral ar fifti~-~ir t kindly caI mr cli-t;:7•.Ir Re~zII I tarrsults in inL% n•liiln (;rnup) I t by Iireybe _\rnon,, I,r the 1,, ITOIrulation In APri thlmor5: th r-r:11'. Ad~ orrurrnn to tlhL•Cr

1037 2N1. Spontaneously occurring~ scolios~is~ in tlhe~ white~ Pekin duck~ (_1nas~~ )l(,ItY-~ iVqiiiclros), Rigdon„R.,H., and John _licick. Am. J. Vet. Res., 23; 1051-1US.7,. 1965. '?S?: 1'falformationsW vertebrae in s~te•ile~ hy~brid ducklings~~, Rlgdon, R. H.,Avian Dis:. 12':',303'-207~s 1965'. =''S3: Aggravation off eancer~ by traumaL Rigdonl R: H. Trial Lawyers~ Forum. "r~,:~14, 1968. ~?54.~ Amyloidlin the wliite~ Pekin, dhck~:~ a fluoreseence~microscopic study. Rigdon, R. H. and Philip Schwartz. Jl -km. Geriat. Soc., 16: ?S3; Spont'~zineous~ occurrence of~ scoliosirs in the~chicken. Rigdon, R:. H. and John Jiiick. Avian Dis~.,12':'330r.r13. 1'965~. ?S6; Necrosis in the "pipping"muscle of the chick. Rigclon; R., H., T. M. Fergu- son, JL L. Trammel; Jl R. Couch and H. L. Berman; Poultry Scii, 47: 873! S77;,1965: °_S7. Chromosomes of'the sterile hybrid cluck. Mott. C. L., Lillian L. Lockhartl and and R: H. Rigdon. C$-togeneties 7: 403~~-412;,1965: `?SS: R'elationship of leukemia to ltrng and stomach ttrmors in Mice fed Benzo (a) psrene:,Rigdon, R. H. and Jack \eal. Pnoc. Soc. Exper. Bio1i -AIed., 130 : 146,, 1969. ?2S9. Effect of hormones on gonads of sterile hybrid ducks. Texas Rept. BioI ]Ted_`_'6~ :~ 581, 1968. ~~. Rigdon. R'. H~. 290.: Cigarette smoking and lung cancer: a consideratiom of this relationship. Rigdbn„R. HL Southern _ll'ed. J., 62,232,19M Aft: S'ATTrxFrr•.Ln.~ Thank you, Doctor. Mr: Echharci't'7 _l'Ir.~ I:cvrIAr.nT:~ On pa~e >, Dectlor: ~-ou refeit~~ to the~D'olI and Hill ,tucly~~. CbulklWt it be~ sa2c1 a littl~e~ bit ens~ier that both those linvinz ~~ lung cancer and those~ not ha~a-in~b~~ lung ~ cancer~ i1iliale~ at just about the~ same r.ate'?~~ 1~bolit~ a third of' them with l~un,' c~ance~r~~ did.~ about two~s thircl5~ of~ them without do not? Dr. R'iGno-N,~ Well,~ I gliess soAbut that~ is jpst «-hat~ theti-~ sa~irU ancl I am just goin-_- by that. Mr. )i c.Ti_rr.DT. Whatl it really ~ me2~ns~, is that t11eS-~ fotincl tli,lt percent of tllo. e~~ »,•ho~ did hz1ve~ hrn~r ' cancer inhlled znd of~ tlltose wi'th~ no~hmg cancer G6:6; so~there~ is so~ little difference there~ that , cwisiclcr- in- «~liat is inhalin-Ir ~~and th~e~inclefinuteliess of~thntou «•~oitIdn't reall'v ~ ,rire~ anv ~ sin•ni&cance one~ way ~ or~otller~ t'o~ that proposition, wou~ld i-ou !~ ~~ Dr. Iaono-N~, AVell, I~ think there~ is~ a ~ lut~ of~ ditlerenee betweeiil and 66~.6~ myself. I am no statistician. Iwou'ldl.~'t, know ~ a~bont th~at. Mr. EcFrrAa;m•r. One~th~iiig ~ that bothers we~~ heiie is~~ if~ in a ;rronh~ of~ smokers foinlid «-ho~ hadl Iung caibcer~there~ were 3I'.~ percent~~„f tiiose~ whoA'hd not~inliale,~that~zrneans that',there~wereNv1io di<iiinhnl~e~aulul ii in yonr fi~ire~i't say~s~of tliose~.r~ith~ no,lhin~ c~uicer 66~.6 did i~nlr.ile. 1~Tow, R-liv~ not nse~ comps:rable statistics ?~ There~ is~ only ~~ a li-percentt difierence~ actuallv betlween those~two~ fi~cai~eS; is~ th~~t not correc_t?~~ Dr. R'~iaoox. OK. The thing ~~ is tliat if' we~~ are gonig ~ to, conelnde that inlialation of~ cigarettes' is tlie:canse~ of' cancer then~ we are -0inW to find a, lot of peol>lr; that iisha~lee and clon't~h~.nR-e lung cancer~itncl~~ to ine~ it is just >is important to~ es~tablish why people~ srn~olce and don'ta h<ive lun,.,•~ c1ncei• as~ it is~ the reverse~ so~ that~ we Tiave~ to think ~ aboutt it from~both sides. There is no use to take one aiile :lndl not', take the other sicle. Mr. I:Cr r~tAr.nT:_ Doctoz; I;i_'l'ee~ with bjjt I' don'ttlii7iktlie;ze~fii,r,iresshow an~-thi~n(v:~ ~ Dr. P-.iGno.r, Okay, okay.

1081 the r„ in Ne 1c ~:'ol. q, mf Los :1nd. .\d- ; of a ~•s nlC,o r of :ure ~lcil tree Wco rhe '<t m, re- tblg 'nts Dr: aclll rec~~- lKr- ideaU eld ice. =ta~= 1.lis ~-n in, rnd re- are LnnL,• cancer has aroused the greatest public and governmental in- tere-t. The most common types affect males five or six times more often than females. No theori- of catt5ation knowii has adequately explained this strikinasex diff'erence: 11'"onieny whether thev smoke or not, are less susceptible. It is doubt- fitl that notable benefit~could be anticipated in prel-entiaig lung canceraazoaz women by anti.present public health pro~ram., _Iationg men, who are relatively more likely to develop lung cancer, only ai smaill number of even heavz.cigttrette smokers are found tohav-ecancer. This association doesnot,conatitute causation. Of the total popi_;lationmost heavily exposed on1Fasmalll minority subgroup is affected, and why i's unknown. Lung cancer dbes not occur in the (Treat majorit3rof eitherlnoderateor henry smokers. Statistical coln-haniz~onsbetl«eenisnlol:ers and nonsmo,-ers ar edifCieult to maken-ithout introduciIllg, . two serious tN•pesof~ scientific bias: (1) people self-select wlietherto slrn.olteornot, and the populations stndiedl tiliusarenot random: (2) no mathematics exists for statistical comparisons of', nonranclbini or selected populations. _liedlcall-v trained pathologists«ouldl notelnploydeath cel-tifi'catednano es; unconfirmed by a, study of tissuesgrossly and microscopi- cafl~ tt sna-qer~~ or autops~•, inisuch investigations. The overall autopsy rate~in theUnitecl'titat'es is below 10 percent, and «-'ithoutsupporting data there aretlooe manv death certificateerlrors in distin(rulshii~_ :betl.een primary lun.- cancer and secondarvsprea:d to the lulsb of other cancers,among a number of' difficulties in~ tlhescieiitifib use, of cle,ul, (ertificates. Lvn_- cancer is of various types, and several IiEtve~ no iu-1ilyliedrela- tioll~4iipto anoenvironmental~lgent. Itisai gross oversimplification toiiimp to~ether~~tleast nine different tumort'~ypesas~cl ascribetheln all to anr: a~g'enta, inclttding, cigarettes. After at leabt 30 yearsof esper.imenta1irorh,, and manysmokei,nh•:l.itfion esperi¢raentsin anizna'ls. Iun ;, cancers of the most common, sqh;rnrous cell liunnan t~•pealave not~been produced. It is usually difficult to j)i•oCe'a: ne(ratlve, bttt lf QlgIIl!ette Glllolie «'as il' cause of lull" canc:er, Itt isMrieed~ surprisiil- that no ani2na~l experitnents'hai-esucceeded inttls'n proc~tuction. Skin painting stltdiesare scarceltirrelevantito the lun~. MoreAudy ist'ir-ent1v needed of«-h.rt other factors, such a,sviruses, urban air polhutantsa'na de(renerati~-,echan~-escontributetolun- cancer developinent in aulimalsalld lnan. Medical fashi~onsch;tnp-e : for example, 30y-ears a-o authoritiescon-siderecls tuberculbsis~ the: nzostl conlnlon cause~ of lh'iatj~ cancer:I'tis also we111 to! mention that unclerstaalzling tTleformati;on oflun- cancers is oneof themost complesand~ eli{iicultnrobllelnsiQZ: cancerresexlrch, not pire-entiy,kvelI ttndei-stood alad not ' rielcling sinipleansWers. A ~ccond' even moreserious~ medical problein is cardiov.asculardis- e>lre, ~;uce it causesalioiit half the total deaths in the United S't<ttesanrls o~~e1_til ritl'ectslotlge~~ity niorethan lttn~cancer. ~Y~ain,~ it attacks middile-acresll llriles nlore ofteni than f!en.ialesi forunik,'non•ni reasons. In 1esnect to sluoltintrasa possible cause orcontriilmting factor,,newer mu'.tifactorialstatistlcal stmdieaal~o point toa fannilv hii?tory of heart d'isease, cliet, bloocll cholesterol, bocl~twei~lit,tnrl l~lklo~l pr.essure as independent pre<lictil e factors, ~~°liiiclt in~ v,urirnls conihinatiolls arets:=<1wiatecl with increased rates of heart disease. Lach, factoralone;

1067 I- L E hroaches~the:tr~ue~incidence, there~~.v~il be~ a~~ steadv~decline in the~ yearly~ increase in reported incidence until a level state is reached. DD r:, Gililiam estimates this would be in 1983 for the whitle malle pop- ulatian. The advocates of the causal relationship between cigarette: smoking and lung, cancer cite as a major argument in favor of their, hhypothesis the great increase in cancer of the lung which has occurred concomitantly with the great increase in the per capita consumptionn of' cigarettesov.er the past 40 years. It is generally conceded, however, anci by the proponents as weIl„ that it takes many yearsi 20, 30 or 40 3~-ears, of smoking, to produce cancer of the lung. If this were the case, increases in the incidence of cancer should fo1- lowby 20 to~40 yea~~rs therise~in consumption of~ cigarettes.. Th~e~flacts are that the great'est increase~ in tlre~reported incidence~i'n~ lung cancer oe~- enrredi between 1930 and 1935, before the rapid rise in cigarette con- sumption, and the yearly increase has been falling ever since:~ If the great~ ilzerease~ iniconstunptionof cigarettes~~ over ~ the past 40 ~years ~were~ indeed~ a significant factor~in the prodnc'tion of~ lung~~ cancer, w~e~ should lie~ _eein,~~ an~ increasing rise~ in yearly rates todh,y~ rather than the~~ observed decline. One other point, the observed yearly~, increases in reported cancer of' th~e~lung beginnii7g,40: ye~ars~ago,, at about the time cigarette~cons~umpr~ consump- tion conspicuously be,~an its increase; affected all age groups siinulta- neousl~-: It does not pa•ovi~de:for,the~necesRary~ti~ine~l~ar~ for production of' cancer by smoking either: If'smokiiig were a significant factor, the increase~ woulil' have~ affected the older ages~ and left~the younger~ones unchanged. I wouldl offer~ the speculation that in the~ next fe.w~ years,~ now ~ tihat JTed~ir;are~and AIedicaid -w~il'l'' m~alie~~ medical care~ moPe accessihi'e~ t!o~ mil- lions of'previously~medicallv deprived citizens~~, and mrstt of these,~ ob- z-iousi~-., will be~initlhe~ older ~agE~~ nroups, that t.here~~ may~ 'weIl be an in-~ crease~for several years, rather than the current decline~,~ in~~ the~ yearly rate of increase in reported cancer of the Tnng. Even if' a pa~rb, of tlhe~ increase~ in reported! cancer of the~ luncr is real, and not siunply apparenti, to attribute it to smokiulg is specnlat,'ive. Such thiiras as~the~urbaniz~aticn of'ourpopulntiony an& increasi:ng~indtt~strial'-~ iz~atiori of'our~societ~-., socio-econornic levels and other factors ha,ve~been statisticaillv~relhtecl~~to~~an increased'~ risk~of lunm~cancer. _Llso~~, thevanar~- ies~ in the incidence of cancer of anw organ~ on~s~i'te are~ notl at all~ und'er- stcsod!. During the~~ period that larng~~ cancer~~has~ appeared to~incre:ise~ so drnniaticallw, the incidence~of cance~r~of~tlie~~ ston7ach~~has~de~creased aL most, equally. Thirty years ago; when ea;ncer~~ of~ the stomac}r~ wss~ of~ relatively ~bi~gh incidence-an eminent inedicall scientist attriliuted' n ith conviction the~ rising~~ incidence~~ at the tiinre~ to~ t~he~ increase~ iin~ home har- becning. He supported' the hvnothesis by d'emnnstr:ating~ thatl~ the~ charred fat of the meat~containedcareinogei-1ic~prope:rties when appl'ned~~ to the~ skin of mice. One would hardly conclude that the snhserluent~ decline~ in stomach cancer is due to~ a diecrense~~ in Iiome~ harhectrinr~~ in this c,ozlntrv: The fact is ~ tha~ti we simply don't~ know ~ what ca.uses~ these, . rises~ and f~lls ~ in freqnency, hut there~ iQ~ a~lways tlie~ temptation, even~ compa1l~sion~,~ to: a~scrihe~ them to ~ some~ sort, of~ e~-ent:~tfiztt soen-i;~ at least~t tn~lie~a sociatedwithtlie~clianze. The most persuasive evidence in favor rnf~ the snYnkrm,'-cancer~ h.ypothe,is~ is the~~ repeated ol'sservat i'nil that Ti?.~ir.n cancer,occurs in smok-~

1097 lneta~- ;trate, iimals na2 nodell ave f TPo - verr f' the •,pect e ap- it thee lretltee ands, I am a~ little surprisedl that you, representidig, the~~ Tobacco~ Council„ would not recommend a~stronger~~statement if, in fact, it can be shown tliat,that is aitruthful st'~atement.~ You question the statement, that if' we strenbthen it, it would not be~ a truthful statementl. Dr. SOMMERS. Sir.; I am an individual. I am not reallv a spokesman for anyone~ but myself. I'~ am a practicing pathologist. I~ am an inves-~ ti;;ator ill medical science. I do~ not believe~ i't would be; j;ustifiable~ to go~ furtller:~ I, myself;, could not. «~ith intellectual honest~~~,~ mnke~ a statement'~ that ci~ar~ette~~s smohin~,is~ dan~erous~ to yoiir~liealtlh, and that it may cause cancer,and other~ disea~ses. I think that is, mislendi'n«; sir; andl I~ do not believe~ i~t'~ has~ been clenaonstrated. Mr. Prc:Kr,E. Than1k you~„Mr~.~ Cha.irm~an.~ The CiiArir-MA.r. Mr. S'auterfield'?' _llr: SA=rrzEr.D: Thank you„lllr. Cli:zirmam Doctor, II notice on page 4 of y-our statement you made reference to~fiolires that have~ been cited concernin,g 2?60,000 people having died of hrng,cancer and other diseases. -A re You faanili<irr withi the 300;0M excess deaths figure that the Surgeon General has used on occasion? Dr. So.r-,NtEizs. Yes;sir;:Ihaveheard~that. _llr: SArTr:r,rrEr.n. Do you hnow, or can you telllus,,have you an3y idea how they arrived at that figure? Dr. So~raEx~s. Sir. thatt is outsi'de~ mv field of' competence I believe ~ iuok~- j-.ondd u law that your?very your >aint ~ . it~is derivedloriginally~~ from~ death certificates~~. This !kin cl' of information doesn't lend itself to~ very ~ accurate ~ repor.t-~ inb of such diseases, as other witnesses have rnent,ionedl, That R•ouid' be my imderstandhn,-, sir. Mr. S'A=r.FiEr.n. I ask the question because I am quite interested ih~ trti~in(y ~~ to getl an ansR-~er.~ Over 2 weeks a-o I asked the~ S~ur,eoni GenerZf to: supply t1rR.t information to us. It hasn't~ come in vet. h assnine ~~ he is~ eith~er~ having t~or~uble reconstructli2rr it or~ li~e~~does~ not want it subjected tlo~ the~ scrutiny of the~ wit'nesses~ «•e~ e re hearing th~is~ «eeh.~ ~ As ai patliololg~~ist, Doctor,, yan~ haR-e~ occasion to examine lungs on autopsy, cio Yolr? Dr. So_Ni_NiEris.~ Y es, siir;~, slrgical and autopsy ~ specimens al'most~ e3-ery ~ da~~-.~ .~~~Ir. S_=rr.rrr•.r.o.~ Can vozu tell the~ di'dl'e~rence~ between the lung of' a, . ider- hom have our smoker andl a nonEmoker'? Dr~., Saxart:2;s~~. -No,~ eiir. Neither oioc-sly'~ or~ lnicroscohiically~~,, or~ aury-~ ot~het•~«-a~v ~ tlrat~ I know ~ can I tell tha~ ditTerc*nce: _N'lr. S'_i=.r.r• rrtiu. Do Yon know ~ of anv ~ new ~ factual ev~idence~ t.hat llas~ been developed since 1I0'C4 ~, relating ~ to~ the~ hazayd, of smokinz andl ~ 'Ihen~ e no headtlii? Dr. So.raFr,s. I do not lcnow of any t.rulyy new or convincing evidence bevond wh;tt was~awailable:5 y-ears~~a~o. O W ~ i - to I]ta~-e read .irti~cl~es~ ~chich~ state tllat~ tliere~ is notl6inl- new ~ in car~-~ cinoffenises of tob:icco-and t.hat.-ery few people~ lrave~ applied theisY-~ ~ that l. selves receirtly~~ in the~ fielkll of t1i~e~ stRtisticall proof' or disproof. .

The CxArxMANT. Our nefit; witness is Dr. Sheldon C: Sonj;ner_s, patholbgist,,'New York, N.Y: STATEME NT OF DR SHELDON C. SOMMERS, PATHUhOGIST. NEW YURK,. N.Y. The CIrAartirar. 11relcome to the committiee, Dr: Sommers. Yon ,nEry proceed as3-ou~: see~fit:~ Dr. Somuims; Thank vou, llr., Chairman. I am appearing ~ at~ the~ reqnest of'representat~ives~of~the~tobacco~iiidhustrZ~~. -Afv name~ is SheTdon~ C: Sommers~~. I ann a, plivsici~an speci~adiain_; inn pathologv and director of' laboratories; Lennox Hill Hlospital.A ew ~ York, -NY. ; clnnical professor of pathlogr, Columbia 1vTiiiver ity Co1- lege~ot Phrci~ci;ins and Sttrgeons; New ior1;~„ and ciinical profesror~Of pa,t'h~ology,Uni~versi'tv~ of~ Soutihern California School~ of lTedicine~.~ Los Angeles. I a,~~lso~t'~ea~ch~at Cornell llediea,l~ School~ ZPuflts-Newe~Enaland; ~ )'Ie.di:cal Centier, and -Ne.w Yorh l'iedicaI Coi'lege.I am aVetetan,' Ad- ministration hospitall consult'ant in patholo-m-~. I am the editnr of P~atliologF .lnnnall~ a,vear1v ~ schol;trl~s~-~ pu'i>lication composed of e-,=av~s~ written bv and for.~patholbmists; I serv,e~~on tlie~edit'ori~al boards of tv,-o~ j~~ournals,~laave abont~ 220 medical publ~ications, and~im am the coaut~hni~of~ a~ dvnecology ~~ textbaoli^~. _l'h- curriculum vitiae Rnd~ publicatibl.~s~~ ,rre~ attached, For 21/~ years~ I li~ave~ been~on~ the~S~cientific~ Advisor.-~ B~oard~ Cottncill for Tobacco: Research, and am currently serving, on its subcommittee to~ reevaluate~ researclr promrams and planni~ng ~~ in thP~ field nf'toh,leco~ and~ health. ReecnGlv, I ha,v.e~ been~~ appointed research director~ of'the Council of~Tobacco': Resea~~rch,, as~ part of' a~ ne«•li-~ initiatecl prozi•am~ to~ broaden th~eiscope~ and sharpen the~ objectives~ of'tQie~ supported re- search. The~fun.ds,~bndgEted for these purposes have~been conside~r.lblv~ au~mented. A~tI~thispoint, iY1!r. Cha~irman.~mav~I~present~~for the: record sta tetuent~s~~s bu~ D~r. Cl~a~rence~ Cook~ Lit'tle,, v-ho~ is~ the scienti~fic~~ director,~ and Dr.. Roberh~~ C. IIocl:ett, the associate scieutific~ di'rector, of the~ Council f!or Tobacco Rese~arch ? The CrsAix.r AN. Without obj'ection, they will be inciuded! in the rec~- o rd' floll o1i,in n y our testimony. ~ D~r.: So-.Aesrrr.s~. Consideratton lias~been given extensively ~ in ti;1e~ c>lr-~ reia hearings to~ the~ question~ of smokiat.L- and heal~th., Fhue-t iride~ dsfi'erences of opinion as~~ tolhe~ ilnportance~ of reported statistical as-~ sociat~ions~ between ci(rarette~ sinoki'n- ana variotts~~ dfi~seases~~ a~ne~ held by presentlY active~~ R-~orkersin tlhe~ pertinent fiolds of~ tsredic~il~ ~ei-nce~. It~ won~ld be~ nnf'ni~r to~ deny the~ esi6tence~ of evidence~ botla fa~vot.•ina and opposin„ the belhefl~that ci'z2rettes may~ be or, are~ associ.ited~ aa ~ tistically v-ith~ various~ human diseases. I zcir indi~vidil2l worki~nfr ~i'ni this field is, n7.tnnfl1.v ~ inffnence(l 1)v ~ hi~s~ particular scientific discipline.~ es~perience,~ and th~e~ resltlits~ of his~ own experimental projects. I~ am a~ physician particularly intere~tedl in human d~i~eases; their~ crau7es,~ the stazes rnf~~ their development. and tlYe~ consequent ohportanniiies 2nd~ stra~~tenies~foi•~their~control andl preL vention. Diagnosis of disease; patient eare, andl disease prevention are the inedieally~ crncial issues. Ltat t:iei•r-11 oiteti eSl)lili 11`c fnl th. .ai~r>n A?t "~- i s att'1 `rrc.U i rll2 .. ii.zi•.o, «-he-; z.• a n i1 (i .•. dia`t ciata liet vv, o>t 1l(r.i l.u iio :u: _L - ittl,,:l ru t,. i_~ Iprc'' i ~N D, ,>, tarl ,; \~. Nve~ill ~~Ilt' t

. 1060 30! Brewer, L.. A., III, King, E., Killy, L. and Bai, A.: ~ Bronchial closure in pul- monary resection-A clinical and experimental study using a predicled pericardial fat graft reinforcement'., Jour: Thorac. Surg. 26: 507-532, 1953'., M. BreR-f. Cba 1 52. Brew, 31. Brewer,, L. A., III, Harrison,, H! W.,, Smith, R: P., Bai, A, F.: Indications for segmental resection in~ pultnonary tuberculosis. Amer. Rev. Tuber. 89 :. 55-f-565,1954. Dai ary, (Sc 32. Brewer, L. A., III and' Bai.,, A. : Surgery of the bronchi and trachea-Esperi- 53. Hinsi ence with the pedicled pericardial fat graft reinforcement. Amer. Jour.. Surg.,St,: `:,1-3-I6,1L955. 33. BreR-er, L. A., III : The surgicall ma nagement of' lesions of' the thoracicc Itivi~ Squ tiot duct. The techniqtte and indications fbr retroperitoneal anastomosis, of'the thoracic duct to the hemiazsgos vein: Amer. Jour. Surg, 90: 210-227, 1955. 34 - .i4:. Carte ~ P, rc 104' . Bren er, L. >•, IiII, Bai„ a., and Jones, R'. JI! G. : The development of the pleural partitioni to prevent over-expansion of the: lung following partial lung resection: _1ni eiperimentall st'udy with clinical application. Jour. Thorac: Shrg. 311: 165:--11,2, 1956: . . . . Ii re«•. sut 35. Hon-san, C: H:,, Brewer, L. A.,, III, Oatway, William Jr., Rouff, E. A. : Pro- Am. i gressiti-e pulmonary histoplasmosis with bilateral resection and ehemo- . i,rew., '5 therapr., Ann. Int. 'Med. 44 :, 985, 1956. 38: Brewer, L. A., III and' Bai, h. F.: Tratamiento Quirurgico do 14 Tuber- folll nat cluosts Pulmonar: La Importancia de la Reseecion~ Pulmonar. Contribucion Brew Eitr.lordinarial al Quinto Congreso Argentino de Tisiolbaia. \oR: 2S-.;0, 19 -55. F i s In 37. Brewer. Lyman:A.. III : Operations an the pericardium : A review of current sur~rieal procedures. Calif: 3led. S5:3S4-3SS.1956: 3S. Hamel, N. C. and Brewer. L. 3., III: Cardinc:arrestl one hour following nneu- :?i. Br.e«- IT., T~le 41 monectomy. Successful resuscitation and religation of right pulinon .r.v artery. Arch: Strrg• i5:2~~77,,19~,.i. 39. Brewer. Lyman A., III and Bai• A., F: :! Chapter on : Surgery of the Brmtclii and Trachea. B>•oncliopvrl»iorwry Dikcases. Emil A. Naclcrio; Editor. iloc+ herHarpen New York. 1957. 1 I i tie ~ to ~. ~ but 16 adi otlrlt ``o' t -40. Brewer. Lyman A., IHi and Bai. A.: F:. Little:,.7. \. artd Rsharo y Par(io: G. : ' . . 9:a0: Carcinoma of the lung: A Practical cla.,sification for early diagnosis and surgical treathtentl .7: A,\h A. 106: 114'J, 1954. 41. BreR-er: LymanA.,,III::Pleural partition procedArre: A technique for the im- (Ij'hE. 1~~'ednes mediate management of' large intra pleural dead space. following lohee- tomy: Bulleti'm de la, Societe Internationale dP Chirur,,ie. 30.;. 1`.ir . 42. Brewer, Lcman, A., III : Cn¢•cinoma oft1teesophagus : Surgical resection nn-den cyltothermia. Preliminary report. Bulletin de Ia SocieteInternation;ilc de Cltirnrgie; ;r-6': 1„1958;. 43! Bre«•er., Lcmani a., III and Edward L: King: Hypothermia in Thoracic and Thoraceabdominall Surgery. American Journal af' Surgery,, 96 : 1,37c. 19:j;q. 441 Brewer. Lyman A.. III. Bai, A., Iiing: P:. L.. Wareham, E;, E., and Fin7ris, J, JI.: Thepathologiceffects oflmet4211icforeign bodies: in Ghepuhnonary cicculhtion. Jour: of Thnr: and C:nrdiovase. Surg.. 38: 670: 19.559. 45. Brewer. Iliyman A., IIiI: Craft, and plastlicoperationsatl t~hetracliea and llronchi., Comptes Rondus XVIII e Congres de la Societe Internationalr de Chirurzie1 :7t19;,1959: 46: Coggin;, C. J.,, Warehnm, El E.. Brewer, Lyman A.. III : Serum ,:lntaminic- oxalacetfictransaminaseact'irity as ai prognostic aid fbllowing open heart't surgery with cardiopulmonary by pass. Bulletin de Iai Societe! Internat:on- ale de Chirurgie,19: 440;,1960: 47. Bre«'er; Lyman A., III:, Frank Stehhen Delle' v 1S 84-1961r Jour. Thnr;tv. anrll CardiovascularS'urzerr., 42:421, 1961. 'flctolier: 48; Brewer. Lyman a,.., IIL Cotautlinr: .1ZerL Dept. I?.S! Arm,r. ST'RGER1` I\" W(1RLD At'A,R lI. Thoracic: Surgery, Vo[. I. page 33#. 1.'.S'. Goc. Pi•intingOfnce. 1afi3. 49: BreR-er, Lyman A., III: TRAL'3I:1TIC' 3IPIDICI\E k\D CiIRGrRL' F'llR'. THE .1:TTOO ItNEY. Pages 271 287. Clialiternn Trar•Lial! Injurie.; audl Diseases. Butt'erworth, Inc.. 19631 London. England. O tiI ~ 50: Bren•er: Lyman A., III : Selective deep hypothermir cardioplpgia R itlt extra- corporeal circ•ulatlion in the treatmenta of' conreni't,il heartdiswtse. :wni- posinm,surL'HFpotherm Profbnd'een Chirur,ie Cardiarytteet F.~tr.1 Cardi,ic„ ~. Paris, France, AnnaIes de Chiirurgie Thoracique eti Cnrdio-vasmrlitire: 11:30 (Apri11) 11962. ~ ~',

1094' major ones in the United States, got together and provided funds t'o, be used for medical and hiolobical research in the field relating to smoking and health.Tliere R-as developed a sciientifir; adv iEoryboard~ Theboarcl is, Listed! in one of the attachments that I have inserted'i into the record. These are individual scientists and physicians -who act as arevieaz- board for any project rerluest'for money to help research in thesefields.. There is a report of the 15 years activityy by Dr. C: C. Little which liasbeen published andl isavaihbles Mr. `':'Ax DErRLiN. What is the A1T A-ETi.h' ? Dr. SomlrEits. TheAlnerioanlledieal Association hasaneducatlional and research foundation -which was funded bvthe tobaccoindzzstry. NIv memorvisnotl exact, but I believe,at firstlthev wereffiven '-10msllion and tlien somevears lat'er ~,' -8inillion moreitl order tounder- tal.e inR-estiffatlionsin thefi'eld'of smohinir and liealthL . This money is administered and dispensed hvthe _t--X~I'_1; tlirou~,h a, scientific board to~ investi.(rators interested in the.projects in thisfield. Mr. VA-x DEEnLax.There was criticisn at the tlme: asI' rec_all. oftdteAliAf for accepting moneyfi:om thiispartic-ula~r, source for tLis particular stn,dy., HoR-- long abo «-a st,h,is thisSo--%t-itFxs. I believeit g©es.bacli 7 or S'vears now. r I EERr.i.N-. Thank votu, ,l'Ir. Chainnan. ltr.VA N The Cx_ranMAr. Mr. Z1'atson?' Mr. 1VnTsoX-Jlr: Chaii:ma,n,I apolo,~ize for being latein arrii-iil~. but I~~astmavoidablydetaine~dI llayI deferanyduestion~ing until I have occasion to glhnce over tilie witness' statement? The CtiAiu;-aN. Dr. Carter? Mr. CAr,rEr,. Thanh vou.lTr. Chairman.. Doctor,, it seems that vou are quite a busy man. Pirector of lnl>ora- toriesi Lenox HIil1llIospital; clinical professor of patholo--v, Colilm>>ia Universi't.vColle(,~e: of Physicians anrd Sair1reons, -Ne.cI:orlc merlwalprofessor of pathology, and University of Southern California School ofD1[edicine;LosAn-creles; voui teach. at, tiheCornell1'11ecUical Soliool IIedical Center and New Yorlt _lledical Colle_e. Also, the Veterans' Administration hospital consultant in patholomY and editor of the Pathology Annual. I think from these connections you nutst: be.rorthn-and well quali- fied. I further think you, have, miven a vervgoodl presentatinm I readl in the paper last Saturdav that Secretary Finch of the De- partment of Health, Education, and WeIf.nre li<Rd :uusounced that i11~dustry andi Government were engaging in cooperative efforts to ex- plore the gaps in knowledbe on the question of srnoltingand health. Did you read that? Dr. SoM-MnRS, Yes; sir; I saw tlia~t'news release. ~'hathas~h<a.ppened is at the tiane of the ~'~merican Medical Association Convention in San, F'ranciseo in June last year, a committee was formed comprising representatives of' the National Institutes of I$ealth,, Dr. Endicott bein(r tlieehai~rman of that: meeting; and al'so1 representatives from the American 1'Tedical lssociation-ERF' and the Coiincil for Tobacco. Research Sciientifie _Ldivsorv BoardL The .vishi was to outline for all three groups the lack of knowledge or the places where knowledge was deficient in regard to smokinLr and health, and then to: set up priorities for research in this field. Ti ) met , meni of B datic Boaii prio: I help _lI that true~. Di JIl ciatli. mitt, Di me c D, a scil I Hos, Di path, ferei, I- port to, re feeli `*oou S( baP1 The• the E _l I a=f~e n1 :inc1 I7 alko hrirr. al~mii .,, froir to 1'> ,rar(',

1074 For instance,, X-rays were dea-eloped prior to the turn of the cen- tury but were not in common use, really, until perhaps the 1020's„ or even then, But there has been a great proliferation in the use of' X-rays in the past few years,, in the past 20 or 30 years, throu(Tllout alli of our country. Prior to this, lunb cancer would have been very difficult to diagilose or to differentiate from tuberculosis or other pulmonary conditions,, is that not true? Dr. BRE-31. Yes, indeed, it is.D1r. CARTER. Even bronchoscopic esaminntions, which is necessary today even when we have films, to actually make the final diagnosis, bronclioscopy was not developed until, I believe, until Dr. Jackson, one of the pioneers in that field. Dr. BxE-M. Yes, sir, in the 1~:93Ws.1'Ir. CARTER. IV, ell, the rea:son we know there is more lung cancer to- dayisbecauseourdiagnosticprocedh.lres,haveirnpi:oved somuch over the years. Isthat not true, sir ?' Dr. BRE3L. YCs. l'Ir. CARTER. I certainly appreciate your statements on tliis par- tiicular fact. I ama also impressed by thefact that vou havebrought out, that less than 2 percent ofl the 70 million smokers in ouncoun-try. aetuallk develop this condition. Feall~-;,if we base it on the figures which areyin our mortality tables-andV I keep them here with me constantly-it would be l'esstlian 2 percent. Dr. BxE,r. Yes. Mr. CAR`rER,Tliat is, of theSquamcious cell type, which isusuallyassoeiated with smoking,, much Iess even than that. I ami happythat' youi brounhtout the statistical association which sometimes is used for the basis of disease causation, particulra,rly such as the operation, that was performed~ on tlheheart to relieve anginaand coronary disease, -which was proved fallacious, althouh statistically it seemed right for a~ time., ~ Of course, as has been brought out so nlany times for many years,, pellagra in the South was associated n-ithnbgestion, of corn meal. Malaria was'associatedl with breathinbmiasminair in marshes, until scientists set to-«ork out and found out that pella~ra wasduetoa, diet,ary deficiency and malaria, due totli~ebite ofthemosqtuto.I am happy toreceive such an excellent pr.esentation, from a nlan of great standing in the medical profession. Thanhyou,, llr: Chairmam The CFrAiRINIAx. Mr. Van Deerlin? Mr. VAx DEERniN. No questions. The CIiAiR-.%I Av. Mr. Brotzman? Mr. BttoTZIUArr. No questions. The CxArR__NtAv: b'Ir. Dclchardt?' Mr. EcKuARDT.Nloquestions.The CHAiR.1IAx. i1Tir. Springer? Mr. SPRINGER. No questions. The CII1rR-MAx. You say on the first'. pa(re, "I have been enncred in clinical medicine, research, m~eolicall education, and administration ini these fields for myR-holeprofessibnal life:" And neoplasiay or cancer in general, Do: you not, Dr: BREM about is that Iii regard t Public Healt So:cancer is tl! The Cir b~IR; _llr.~ Srxitic to you which ohserv.ation. «`hy is th( or not smoltir. IDi: Bi:E-Nt. Mr., SrRI\ ( eininent nz:ir week who ho are equally a, A1"hV this g Dr. Br,Ex. that the case There is o: i f you poll t 117iijority „-1i" that there is < lhere is, only the pnpersur That 1ittIE splendid doc consideredL s confiirring a out of these t The hi(rli Z111okers and inclease in. IhasincreaSec I ~~Iv that it (lhes ilot. 11 M1r. T'roni the in, ~'a~~in er ofth( 1'.).-il: and ci~2 cauc hr. I3r,E'Nc. _lCr: Snt;ix I>r. liiu.'r incr~e,l~e~in iilar prnioit of ltur•,~ that Ic fr. Spi:t-, 1;)r: li[;I \II niimber repc tlieincre.rse

1098 So I think the information is about the same; as where we stood' 5 years ago. Mr., S'ATTEPFiEi.n. Thank yot.i; Doctor. The CHAuttirAnr. Mr. Eckhardt ?. Mr:, ECKH ArtnT. Thank you, llr. Chairman. Doctor,, I not.ice on page 4 of your statlement you state that a number of studies showedi no relation of smoking to heart disease,, and that these ought not be ignored., Can ~-ou give me any of those studies? Dr. So~t:srExs. Yes, sir. Aside from the general understanding that anaina pectoris has no relation to cigarette smokialg, there have been rFportsoni twins inScaazdanavia (Lttnclkn:an, Actlai Medy S~candi,, 19661 . Supp. 455). He used twins i'n«hich one member smoked and the oth:erdidn't, and hecouldl find no, did''eerence~ attributabletosmok~ing, and' believed that constitutional factlors were moreimportlant. Mr. ECKriAxnT. With respect to coronary heart disease? Dr. So.r-1rEi;s. Yes, sir. A study~ byJohnson,, et al., American Journal of Public Health, 1968, found in survivors of the Hiroshima at-ombomb explosion thattlie proportion of men who smoked R-as sma11'er in peoplle n-ilh coro- nai v, heart disease than: the nonsmokers. There were more nonsmokers in Hiroshima that had coronary heart disease: 1Ti".EC$HA1aoT. These «-.erepersonssttbjectecl t'othe bombegpl'osibn?' Dr:, So-irsruxs: Yes, sir: Theyarebeiiia studied in ai variety of «avs. Ait articlebyBi•ultny et al., Social Science and IIedicine; 19'68~. Hestudied thepopttl'ation, of'__N-azaretlt,,Pa. In the men hecould'detlerminee no effect of smoking on the pr.eseitce of coronary disease. Then there, is an article by Brown, etah„ Journal An7ericanGeri-atriesSocietv; 119'67, volume 15. Tlieystudiedl individl.tals at theUet- eransAdrnirststratlion Hospitall in Portland, Oreg., and theyi~nclud'ed both smokersaiid nonsmokers. These peoplewere chosen because they had absence of coronaryy disease. There were cluite a number of smokers, with many years of smokinb, and they sho~~ ed no evidence of coronarv disease. T hese are some of'the studies in which there lias been no correlation. Mr. EcKHArnz. And there are a number of studies that db: show a correlation; is that not correct? Dr: SaM:.rErs. Yes„ sir. Mr. Ecr.HAr,nT. Do you have them, con5-enient?' Dr. So1r.TErs., Yes. The important ones are Hnmmond, t«•o studies, fortlie American Cancer Society; Doll and Hill, and their~ publica-t'ions.Mr. ECaHAnns. That was tli:eBritiuh 7ledical' Journal ?: Dr. SoJIMEr,s. Yesy sir. Then there is a C.lnadianstud!y on pension recipients. That is Bestas~ the senior author.. That is iti! t'1'teCanadiani -M'edical .1:ssoci~ation. Journal in, 1967, volume 96: Then therei'sa study by Aubry, and others,, in the Canadian Journal of Public Healtli,,1!966'. Then tlierearestttdiesofcolle„ estud'entswTtich have lieen referredd to previously in theltearings;, Thorne et al., Am. J. EpidemiolL„ 1968, volume S7. Mr. ECKH_-' trodktced herc And that; i dosvnvariou. ~ to heart disea It used ch(! activity, amo and then m, patterns.. In all of tl] eluvion, part_~ ers lind abou nonsmokers.. Do youi kr tions-I rat, you know -~ o: to~ correct fc statistic,; onit Dr. Sonz:ru the Britain reports is Tr They foun Mr. Ecrtr cou not ]belit iiea.vv~ s~mol:~i'~ Dr. Sww-+r several popu noit zzeem to I lz:'o the e\] ~faotor in the~ ?. bot] and. _\'~o. 3" t nf'those tt likel'v. Tli€ut~is, tl certa~~iart<<pe T~-,ne _~A is 01 cl~~,nrihtionL Here~v-elt _llr. ECtCttI t'hose'v:~ho' s/~ 1,~reoau-:e~ of t1l . «'hn~ rl id~ not «~itli res~pect I think in the i-:(,irieiie. Dr. So-_%r.N ti' tical rel,t I .Vnfl: rn ~ 1"I ~ }'.I tir2rII.1 R~~11~'~ ;u t• • „ 1~9'~C0 N

1042 the United States at that time. Incontrast, Iungcaneer in 1930 was quite low, being only eight out of eacln 1.000 deaths. This is about one-half' the incidence of lung cancer in the autopsies perf'ormed during the same period in either England or the United States. It appearsthatl «hentu:berculosisdeaths are numerous, dhaths from lung cancer are scarce. Between, 1930 and'.1940: deaths from tuberculosis ini Graz dropped dramatically f'ronr 167 per 1.000 in 1930 to 66'in 194:0; or less thanihalf the previous level. During the same interval, lung, cancer was rising steadily from eight per 1,000 in 1930 to?0 in1'941. more than tivice as many. By this time the war had started. and tuberculosis jumped again, from 66 ini 1940 to 130 in I944, or almost double,. Simultaneouslg;, deaths from lung cancer f'ell from~20 in 1940 to 12'in49-1-1, or almost half. Here it', is seen that if'deaths from; tuberculosis rise, those from lung cancer f'alI at once. Exactly the same observa- tions were made in Germany durinig, World War I. One gets the impression that both diseases are competing for the life oflthe same individual. Patients~ surriving tuberculbsis areunusually?susceptibieto~lungcancer: In 1945 antibiotics became available and specific drugs against the tubercle bacillustx-ere empl,oyed.. Immediately deaths f'romtubercuioyi'sdeclined pre- cipitously, falling from 130 per 1.000' ini 1944 to 4?' ini 1952. In contrast;, lung cancerjirmpedifrmn 12 per 1,000in 1944, to an all:-timehigh, of 44 in 1953; The reduction in, tiuberculosi'sleeelpd off in 1'9;;0atabout:30deatlhsper, 11000autopsies. Lung cancer showed no further rise during the next 11 years. This leveling-off of' lune cancer is the most significant fact in our discussion todny:This disease at present is, a littlehi~gher at Graz thani any placereportiitnstatisticson a community basis. This is~probablydue t,othe fact that all hospitali deaths are autopsied. and all lung cancer cases are reported as sucli.. In 19(i0 at Graz lung cancer represented 17.1 percent of'the totali cancers. The Public Health Service estiinated that for 1967 lung cancer would represent 10.4 percent of all' cancers in the United' States. W'itliimproredh di'agnoses iIi believe that the number will soon level, off in the L?iiited States just as it has inGr.av.wher.enodiag~nosesaremissed. Present evidencefi•omEhglltnd', Canad'a: and the United Statesinidi- catesthat, the rise in lung cancer is, slowing down astuberculbsis is being conquered. The probability seems good thatl lung cancer is nearing its peah: andi will take its place with, the other cancers, depending, upon patient susceptibilitv!:Duringthepast 100 yearsi theincidenceof' lung cancer has depended upon: fluctuations in, deaths from tuberculosis. As sooni as tuberculosis is eliminatedl lungcancershoultl riseparallel' to other cancers, only as the poliulationi becomes older. At the present time irradiation among the uranium mimers seems to be the only factor increasing the incidence of lung cancer:. Thi'sphenomena of' a rise in lung' cancer simultaneously with adt:clihe i'ntuberculosis is too exact to be mere coincidence. There: was a marked rise ilt the tuberculbsis rate during botlh, World Wars; and a: simultaneous drop in, t!herateof lung cancer: The:adsent of new treatment,for tuberculbsis after Worldi War II caused a dramatic decline in the rate of this disease;, aniequallS dtamatic rise in the lung cancer rate occurred at the same time. And finallc, wheni tubenculosii~deathsbecamerelativelyneg3'ibible, lung cancer rates ceased to rise. Tl'ii'scompelling evidence indicates that there is a certain susceptible group of': people who either contract tuberculosisearlvi~n, life or l'ung cancer later ini life. When tuberculosis is under control, more of these people live to develop lung cancer, andl wheni tuberculbsisisnot undlercontrol~ very feR-licetn dep elop 1t1ng cancer. Thepllenotnena observed in Austria has also: been found in autopsvreports in other countries. In each, country ih whi~chi autopsieshaveb,een dbne: 1luig- cancer beganto~appearatlai timetuberculosisdeathsfeilbelocra crit:icallereL Englan(I and', thetinited States led theu°orTdl in reducinc: tuberculosis: the,vhaveledl the«'orld irct the rise in lung cancer. Tuherculo5isberan to falllih Germany 20 yearslkiter than,in L•'itqlhnd; lnng cancer began to: risein(';~ermany 20-,-cars later than in England. Budapest had the highest death rat'e from tuberculosis in the last century, and was the latest of our major cities to conquer thedisease;lun.gcancer roselater, in Butlapest'than elsewhere. ;r~~memiglit cclaim, that the risein lung, cancer has been due tm ci,: arettes~tnol tn:_% ancl thedrop in deaths fromttrbereulowts ha., only ' heen coincidental. Such au argument is refuted by the tiYneofl occurrence. A,ni opirlemicof itmgciuncer was, prrsenti'n the a2lfOhsics at V'IIAnrhrvter ITospitlal in P:ngland dnri6ig tl'iRlast century. _l sitnilnrepidemie waspresent; in the autolisip.at lIoovbturr, Germany, before World R'ar I. Lung cancer n'as rising , rapidlc in the antop.Aes at the Boston City Hospitall in the United StatesIieforethe cig;lretteera. Iti's cibcions th<1ti a, hl cig;tretre. In fact,, times in the tota From East P£ environmental fohighincidenceogasoline fumes, r firmed ltr:ng canc never smol.ed.an through water be and' t'ar., the environment; rate as liir_hast] Fitrther proof ci,;tiretteconsum, laln, cancerandThe tremendou La~tria~ Austria, ..tla. .Thpan andll ca2tceroccurre& i of' the4er_ountrie: fell below a critii ~r.t'op:;ie=< fromi an;it'.!riums in t cauarer iui tdielas~ ivith tnl>erculosi~ltu:~: -:incer, it sl ~Vonld have~ ni 1'iip~ r.rvcr had tuberc canoer in tiibercu poplllatiOni. \',.rp ,rron~r 'ev people get both la his col?e;t:;uey at vestigatorsstudietion. A high perct tive ak;in tests t'o sctrson s-rays of Iuw::; cancer had hi The theory tha- a.•:umptioni that It i'strue that in tilne: ffibwecer, at cases of lung can it ik found that 3t ineitlenr-c• in 11V0;, dkonse inithe Uni It i, apparent I h •tter di,il;no,tic tuis.rA, itn ntuny < odllitional new c: c,nu•er age. Proof dikea~;os in our ttt c•or vonad arconnt tbe pr<Y.~cznt. Thcr mental fl:t,•torhas: Wlintl would ha llrt^dik•t tlt;it thec( on ona, dimtlhi ratedkvascsa]]rLledly riea he•e tn~e pre e Irlc* ;1;tc have he mitn}• ot' the c•aser .,intr botlhi dise;tsc somo of t9ieotlle, att,tcli~nndicmph~) ,

1099 llr. EcXgAxnT.~ Then there is a study by Jenkins; et aL, that was in- trodktced here. And that,, incidentally, rather inapresses me iai~ that that study broke down various factors that you referredi to as being contributory fact!ors tolieart disease. It used cholest'erol,, beta alpha, cystolic BP, diastolic BP, physical activi~tv ;,amount of exercise, i'ncome~lea el~,~alli of the~abowe~ triglycerides, and then made a separate study with respect to some behavioral pntterns: In a11! of~these~ cases, the study ~ came to~~t~he~remarkably~simil'ar~ con-~ clusion, parti~cularliv ~ in the age~ groups of 3cJ nnd 49. tlia:ta',hea~vy~ smok-~ ers~ had about three~ times the incidence~ of coronary~ heart disease: m nonsmokers. Do you know of' any studies that similarly usedl clinical observa- tions-I~ Uather this w-as, from 1.000~~ persons~actnally~ examined-do y ou know of' anv study that similarly attempted to4 break down or to correct for the various contributory factors, and established the stati,tic_s on the basis of th,ltcorrection ?V Dr. So.rINtEas. I know of some in progress. I doni't know if you cited the Britain stttdy which has been (roiiacr on for vears. One of their reports is Trnett et al., Journal of'Clironic Disenae; 1967, volume 20. Tiiev found seven risk factors, for example~. llr.~E'cKriA'RnT. From a;lliof~ your conside~rntihns~of~ these studies,,do~ you not'~bel&ece~~ tbatl~there~ i:s~atl'easts a statistical relations~hip~ between~ heavy smoking and' coronary heart disease 7 Dn.~ So-_Nn.rII.tis: Yes,~ I believe thei•e~ is ~ a statistical relationship~ in, several ' populations. There are other~ populations in which there~~ does~ not seem, to be a stati'stical relationship, some of «-hich I cited. So the explanation would be~ that. 'No., 1, cigarettes are the~ causal factor in the relationship. No. ?„ both tlie hear.t disease ~ and~ tlhe~ smoking ~~ reflect a~ third fnctor; and'.~ -No. 3,~ that the~ statistical correlation i's~ actually a chance~~ finding. Of'those three, from my own work I belieae, that the second is most likelk-.~ That is, that smoking and coronary disease are two reflections of' a, certain type~of'individuall, A person has been described in various wavs: Type A is one description. A person who lives in overdrive is anotller description. Here we have~, youisee: a susceptible subpopulation. \Ir:~Fcr1iAuDT. But do voninot recalllthat in t~he~ Jenkins,studh. both those who seem susceptible~ t~o~ smol:in~ and to~ coi.•onary~ heart dfisease~ because of'their inclhnationsi both those~who~~seem, susceptible~and those~ wholdid not seem~to~~besusceptible,~seemed to have~had an eqtial increase~ with respect~tolhe incidence of heart~ disease if~ they ~ were smolters. I think in both csses~ smohing ~heitiR-ily~ resulted in~ about three~ times the incidence of heart disease inboth,roups. Dr. ";o-_Ncicla:s~. You s'ee~, what is bnthersrnne~ to me about the~ sta- tisticail relationshi~ps~~ is that,, in a sense, if they.~ convergee t~heu~~ infer a eausntive~ relationship. But statistics can neR-er demonst'ratle~ the~ causative relationship. I work on kidney disease and R-e have a statistical' study. 1'[v sta- ti' qica.l consulla~nt senrlr~me this~paper1rom Scientific R'~esearch„Fe~bru- ary~ ')',~ 1969, ~~by ~ Prof~. I't"illianr Fpller,, Hi~g(yins~~ Professor of~~ Ilatlie-

I 1044! There is compelling autopsy evidence that the rise in lung cancer rates is un- related' to the rise in cigarette consumption. The rise in lung cancer has a phe nomenal correlation with the: decline in tuberculosis as is evidencedi by reliable records. The rise inilung cancer rates came long before the rise in cigarette con- sumpto:on. The rise in Uing cancer has ~ been found in areas where there is no rigarette smoking. And finally,, those who advocate the theory that, lung, cancer is caused byy cigarette smoking have made the erroneous assumption that lung cancer was a,rare disease in 1930 in the tinited States, At the present time there are no solid facts to incriminate tobacco as a factor in the rise of lung, cancer, heart attacks andemphSsema. ARTICLESIPtiBLISIIEDBYBI'.QDA 0. .B'ARVES, PH. D., 'M.Dl 1. An Investigation of the Antagonism of! Insulin~by Posterior Pituitary Extracts as Indicated by Changes in Gastro-intestinal Motility. Am. Jour. P9tysiol: )3:t;52.1330: (with Qui~ley)2. Action of Insulini on the Motility of the G'astro-intestina!1 Traet: 1'I. Antago- ni5tic Action of Posterior Pituitary ILobePreparations. Am. Jour. Php,siol. 95: 7.19.i0~ (a•ith Quinley). 3. Does Insulin Antagonize the: Action of Atropine on the Cardiac Vagus End- ings?Jow'. Pharm.,Expcrtl. Ther:41:,_°09, 19311 («°ithiBarlow), 4. The I"roductinn of Hemoglobinemaai and Polycyt'hemih in V'ormall Animalsby \leans ofl Inorganic Elements. Joiu•. Biol: Chem. cJ4:117, 1931. (R-ith, ll,cers and Beard). 1 Studies on Thyroglobulin. T:, The Digestibilith of Thyroglbbulin. Aan. Jour. Php.ciol. 98: S6, 1931!. (with A. J. Carlsoniand Riskin) 6; Preparation of':^lhyroalobulin. Proc. Soc. Expt1: BEol: and 3Led: °9: 605, 1931. 7. Elimination of' Thyroglobulin fi:om the Blood. Pxoe., koc. E:rptl: B:iol. and J.6cd: `?fl : 357, 19311 (w,ith:ILat!hropiandi tlullin)S: The Feather Germ as Indicator for Thyroid Preparations: d'm, Jottr. Phpsiol. 98: 463, 1931. (with Juhn) 9. The Eicretion of Iodine in Esperimentlal H~pertllyroidi?m.,1ni. .Jbur. P1ips,iol: 101: 1 1932. 10. The Physiological Activity of Iodine in Thyroglobulin. Ant. Jour. PhpsioloJy: 101: aS3; 1D32:, 1r1. The Fate of the Thyroid Hormone in Experimental Hyperthyroidism. Am: 26. The Etcretion: ~ 103: 699, 1'J3: 27!. Studies onTh,y st'ances frotr (with Bueno 28. The Feather Gn 29., Further Studii ism. 3an.,Joit 30: Parathyroi'd' TI 31. Studies on Th Glhnd. 3nn. J~ 32. Influence of, ! the!State of (' 33 :?531 1932. 33. The Effect of I'h psiol. 1CS:~i34. The I.jjpsiOlo;;1i93a, (with B 35. The Effect'so betes: dlm: Je 3i;. Further Studi Diabetes. Am. 37. Effect of' A.dt andi of Hypot: 1P33-1. (withD3S: Effects of' Pa, tivity to Insu' Ferri:ll, and R. 39. Implantation 1,1:i 1935. (nt•i-?0. DiureAy:of 11 (R-itlt Rogoff') 41. Etiperimentali Adrenal Regic 42. Influence of'' Jizur. PIi1lsiol. 101: 583,1933: (n•ith3Ittthieu), 12. The Influence of Feeding I'roteinr-: Amino Acidb, and Relhted Substances 1935. ( n•ith B 43iSome Observ: upon Cteatine-creatlinine Jletabolis.m. Jom^. Bial. Clicm. J-1:49, 1932: (with Bea rrl ) 13. Variations in Blood Sugar Values of Normal ancl, A"a,otbmizedDogs:rl"ollow-ing, Glttco4e Adtninietratiom Joiu:., l ttti i,tian. 5: 77, 1932;, (with Q,uigley and Hall'aran ) Mares Serum. -Il. The IntTuenee .-1bn: Jour. Ph!; -15 ).Fitrther Studl Diabetes. dm; 14. Sex Stiinulating Principle in Extracts of!Beef'Hypophyses Effective in Female (with Bueno) 30:131i9; 1932 h and Med tl Bi E 46. St'udy oni Spec Glh dl . . , . : o xla Dogs. Proc. Soc. 15. Relation of' the H!Spophysis to Experimental Diabetes. Science 1933 (with 47: n 5 ofDog The Relation Regan ) 16: Further Studies on the Feather Germ Test for Thyroid Hormone. Proc. -1'atl: 4S. Blordl 3m. Jb Tha- Sensitivi .4!cad S'ci: 1933, Ferrill! and Ri 17. Improvement in Experimental Diabetes Following the Administration of 1933 9"?6 Joa 101i A 40: P>itterlfitigOv 8-1' '1 ' , . tr. : ssoc. Anmiotin. 3nn. DTed: : _ ;9. O, -t . 1S., The Relation of the Anterior Pituitary to Carbohydrate 3letabolism, Endo- On the Ori*in erin. 17: 522, 10331 (with Re,an)1 19. IIypoph3sectomized and Panereateetomized dog. A»r. Jour. Phpsiol: 1!0`a:4, ;1. ah: ' (1vinosita Olrerv,itions 1933. ' .Ahri1. 1039. "0. Alm, Jour. Is There a Specific Diuretic IIormone in the _Uiterior Pituitary? ICnpill RlecoAf 21. Pli1tsio1:10-5: 553,1933. (with Regan and Bueno) The Effect of Calcinut G'hicanate on Parathyroid Tetany iu the _1]binoR'at. Serutn of a P cOrtico,terone 105: 1:i'1D:3•',l, (n'ith Pneno) Phy.Ool tau: Jorrr 52. IIormones an, ^°: -~ . . _ The EPfect of! Cnlhiu~m Gluvon^teon Piirathiroid TeYs:n7.: in the -ilbino R:7 t.. ,elber;and Ilinsan) 1$ ; Iwith 1'o 11 1` 3 05 54 .1aul ro,, en~4. .1: I' : . : - _Uni. Joatr: Physiai;1 . ): bS; 1933:, :''3J The Thyroxine Content! of Tli. roblobulin. .t!m. Jour: 1'h;tsiol: 10, - tilueriinental -Cnii'rozenie S (Ivith Jones) °4. 'LheIaTert of Theelin, andl Theelol in I6at'ent Tetan}:. .1 w. .Lo'ar: Ph 1l.qtol~ 50. (with T. Corr Fac•tors in th,e 1115:1T'; 1933. (withMtithieu) 25. The Effect of! Previous Hypophysectnmy upon Di:nbetes resulting from Pan- oreatectomy.,Apn: Jottrs Ploysial. 10.; :S3: 1!);33: (with Rehan ) iI. f cvitli Ii~eetbn, Basal Tempet

1103 iV tlii'dig5 he areas nsed ban 1t-itil the ..iaig is a iz cigars ea:ses, in ionship. what he it in hi:s -timony,, iflicting : e couldd al prac- )uld t'ell z at his -o1'utely iow one ) to test ~vhether ')9S' out id' some worher; he field nst the -~rel~atedd nericann re. You of' this You conclude that the blackening of hings,, or black lungs,, as they call it, is the result of the inhalation of carbon particles, and you say that smoking tobacco d'oes not introduce such carbou particles. j I believe it `vas the doctor who gav.e us the visual demonstration here, who happened to practice in a coal region of Illinois, so perhaps I! that might have something to do -with it.~I ~~ I believe there is one: thing that all' doctors and everybody e16eagreed on medically, that you have: never produced lung cancer ~ through tlheinhalatlion of sm:okein the liungs. IVea111 agiee; the S4.irgeon GeneraT and everybody else:~! Dr: Sosamms. Yes. Mr. IVAxso-N. Of'course;the: publ'ichas a different idea because of all of the reports that have gone out. But you have never produced it. Dr:Soas3irRs. That is correct: Mr. IVa:rso-N. You ha`-e spent hotiv many millions of'dollars, do you estimate, in trying to prodluce lung cancer througli~ the inhalation of smoke ?~Dr: So.nraits; I personally could not answer that question. I would buess it is somewhere in excess of $S milli'on or $10 million., Mr. WATSO.N. IV, hen the --~-meriean Tobacco Council gave this $10 million to the AaI A. for research in this particular field, were there any strings attached to it,,so far as you know? Dr. SoM3rEas. Not to my lniowledge. They were f'ree to use the money as they saw fit. lllr.vW_,.TSO-N. As I stated 3-esterday;,Z observed that apparently some had concllud'ed on a very shaky statistical basis that we have~ found! . the panacea, .i-e have found the cure-alll now. IVe have this dragon and weare going to stop it. There is going to be a decrease in the research in tliis field. I know oiie of the laboratory scientists yesterday was apprehensive about t'hat. I know, tthe American Tobacco Institute has committed $10 million to tilleAltZA. Theyhavepledged another $8 million. Do y,ou happen tokno~r Ii~osvmuch theCancer Soeietyis~ spendiilg , in this field, in this particular field of research?Dii: So-NuaEr,s. No; sir, I[ do not know. Mr. WATSON. I think it might be interesting to find out., Certainly, I am not fa2tItin,,, them. I have served as a couaityv ehairman, for tlie Chncer Soc.ietfy andi I amivitnllv concerned in this., I3ttt 1[ am afraid now that perhaps they are backin g up and trying to look for an answer.. You point out a~gain,as I believe Dr. R'i~gdonof tlieUnhersity of Texas.1fedicall School didLthEit there has been quite ai ddscrepancyin themedical profession, so far as~ tutediagnosise of the causes of &at'1i and such as tliat.. You contirznithatstatement. . Dr. So~s.Ncri,s. Yes, sir: Mr., «' ATsox. Do you recall that hepointed' outyesterdav that in. 1~oi;~ Ibelie~~e in the State of ~ew Yorh, they fou~iid aut;~ n-~hen per- foiminn autopsies, that the causes of death lfistedl on the dleath eentifi- ~ cates«-ere wrong in more than 50 percent of the cases so far as: . tiiediii,mnosis of pneumonia? ' Dr. So.Nc-itrr,s. Yes, sir. Mr. W.rTSON. It hasbeen indicated earlier here that in the state of' the art of't.he medical' profession perhaps, now thatt we have a greatier

1096 Mr. CAR-rFr.. S'o many of these reported cases actually are ir_eta- ctlatie~~ aind come~ from lesi'ons~~ in other places~ in the~ body~, prostrlte~, perli,aps,,or~bone; or stlomacli? Dr. So-3i.TExs. That is correct; yes, sir.~ Mr. CARTER. Inhalation of smoke. again,, in esperianentall animals has never prod'uced lung, ca.~,, is~~ that true'?~ ~ Dr. SommERs. That is my und'erst'anding.. Mr. C.RTFx:~ By the~~ tvary~, do vonknow~if horses~hace emphysema~~?~~ Dr. So-_Nr-.NtERs. Yes, sir.VHorses are a`-ery good experimental modell for one form of emphysema. _llr. CAxTEx. Do horses smoke? Dr. Sox-Mrxs. No, sir.. Mr., CAxTEx: Thank you; sir. The CHAIRMAN. 1Tr. Pickle ? -ITr: Prear E. Thank you, Mr. Chairman. Dr. Sommers; I have been impressed with your testimony. You have qnite~ a background.~ You are~ researeh~ director for~th:e~Cotuzcil of'~ To- bacco Research, but I still must say that you have made some very stronz statements that are in contradiction tol the majority of the people~ who have~ testified here~ before~ tbi~si committee. Do you fiave anv recommendations for this committee with respect' tio~ the~ problem~ fa;cina, us~ so~ far ~ as the coitrse~ of~ our le,~isl~.ti~~~~e~ap-~ proach is concerned? Dr. SoMMInnsa I~ would answer you as~~a physician. I~bel&eve~ that~the present'~ labeli~ng ~ on tlhe~ ci; arette packn~ge to the efteet that~ cigarette~ smr,ltinQ~~ ma-v be~ hazardous to your~heal~rh,~ as~ theisituatinn non-~ stands~~, is sufficient. ttl is~~about asimu~ch as I feel we know iiit'he~field of smok~-~ ingand health. I don't beli~eve~~that~ indiviiduals~or the Government should zo beyond what is ~ proved in~ campaigns of any~ kind in the ~ healtli~~ field . I aomewhat regret,~ as a citizen,~ that that la~beling becan7e~~ a law~ becanse it seemed to me somewhat discriminatorv:. Fromi my own experience in reading, Iwolild have thouglitthatpriv~ate~ airpla~nes, would~ need to~~ be called, possibl~y~ liazarclous~~ to, y~onr~ health. I read of young businessmen and their families almost every weel:~killed in smalllplianecrashes. -Motorcycl'es Mr~. PicKLr. Doctor„with~ alU due~ respect„I want'~to~ challenne yonr~ statement. Of conrseithey~ can be~d'an.-erous.l3ut that is not to~the~point of onr,liearin~s,, really, in mu~ op~inion~. ~ Dr. So.1ai:r;c. Pardon me: sir. _l~Ir. Pic1:LF. Your~~ testimony is~ that yoct think tlie~ present labeling is~ suflicient. This~is- in strong opposition~ to the very ~ heavy.~preponder-~ ance of ev~id'ence,submittadto~,tiii5~committee~~. Sometimes II n•.onder~ if v-e~ on the cotninitt!ee are~ confused. Whom do «-e~~ beliesre~?~ Which «-~av~ do Re go~?~~ I~.1-onder~i'f we should not have an i:n-.esti`ation of the investigators to try to find sonle facts of our o1i-n6 Mean.v~hile~, we aiie~ facedl NvitTr the~ prohosition, that «-e~ are e~ither~ ,noin, to renew the law that we have cni the books now, and take no acti'rin, let the FCC probably ban all .Zdvertisement, oi°we are goin- to incr.ease~ t'hc~ warning. It seems to me that we have such a heavy amount of evidence that tlie~ warning should be~ increasedl tliat,' thnt is t'he~ proper approach~~ I amia litt -would not re( that that is a You quest:' be a truthful Dr. So-Ni-N.rn for~ anyone L tl:,rator.' in mC~. I c1o not could not., w smol-inb ~is ~id other~ diseasc I think tl~~ denionstrate, _llr. PtcKi The CI3At: Mr. ~ SATrr Doctor;, I to thaures tli of lllng canC lre~ yoit SurcTeon Cxe Dr. So.[a1 Mr. S!.rr how they ar Dr. S0.r1- it is cleri\,ed 'i'lii'b kinc~ ing. of such my miderst. 1111% S_~TT in trvin(y , t( Gener.al to I asplniie . want it sub Weeh. .Y~s~ a ~ pa~t~ ~-'ntohsy ; d~cl 14. datir~. NIl Sn.r sul0her anr. 1).:. SoNr other way t JLr. been cleN~-el he;il t.h ? I)r. So-mi bevrn>ndWh I have I cino renise~' selves rece.

1095 nds ~ to -tecld are uiy. Tn_rrv iali- Di e- t in- ~ es~~- dth.. med n inn sing icott i the :1CC0 ec1Re ~. kiiig !dL . The subcommittee was appoiinted, of which I am ai member. It has met on several occasions since then. We are hopeful that in a month or so we will have a single docu- ment that -wiil refiect the combined feelings of'the : National Institutes of Health, the National Cancer Institute, the AMA Research Foun, dation and the Council of Tobacco Research Scientific Advisory Board as to the deficiencies in knowledge in this field and the order of' priorities that one or more of these groups will give.. I very much hope we will get such a dlocument. I think it will be heloful~toall of'us~in the next 5 years,orso. Mr. CARTER. Realization lias dawned upon many of these people that there are many gaps in the causation of lung cancer, is that true ?' Dr. So.r.rrxs: Yes„ sir. Mr. CAaTEx., Areyoui acquaantedl with, and have you liadi any asso- ciation with,, any members of the Surgeon: General's Advisory Com- mittee which issued its report in 1964? Dr. SoamiExs.Yes, sir. Professor Fieser, organic chemistry, taughtt me chemistry in college: I have known him for over 30 years., Dr. Emanuel Farber and I are friends and belong to a club together, a scientific club. I rcorked for Dr. Jabob Furth as his executive officer at Delafield Hospital for five years, so I saw him every day. Dr:, Furtih is a wonderful man. He and Dr. Farber are experimental pathologists. Their interest is in animal experimental models of dif- ferent diseases.I'. was very inYpressed with the committee andi with the scientific re- port of the committee in 1964.,As~a matter of fact, I helped Dr., Furth to rewrite part of it because being originally Hungariani lie had some feeling liisEnglishwa6n'tas~ goodi as it might'be, but,,in fact, it isvery good. So I was impressed. Then I read, the report and I realized'svhat hadd happened. They had'simply-' done: a selective review of the l'iteratiure.They liad, not investigated all aspects. Tlie report simply did'n''t cover the entire fieldl in my opinion. I[t was a disappointment.llr. CARTER. It was a disappointment? Dr. SoararERs, It R-as a disappointment; yes.. Mr. CAxaEs:. It was not accurate as you see it,, and did not cover all aspects?' Dr. SoarMExs: It is not, sir, that it was inaccurate. It was selective and' it, so to speak, wasn't quite equally weighted on both sides. Mr. CnrtzEx. It contained many gaps,,then? Dr. Sonrirrxs. Yes, sir; many deficiencies., Mr. CAxTER.Inoticed you ~-Ientioned primary ca.,of' the lung and also the secondary ca. of'tlle lnng. According to thernortality tables whiieh][ have; 21,000 people hadl primary ca. of the lung last year,, and secondary ca. of't'li;e lung was about the same: Second'aryca, of the lung may bed'ue and often is due: t'oproblemsfrom other parts of the body, is tlrat not true? Dr., Soar:Nrsas, Yes, sir. In one study, ?5 percent of the cases thought to be primary lung cancer at autopsyy turned out to be secondiity carcinoma.

1086 3. LeCompte; P: M., Sbmmers, S, C: and Lathrop, F. D. : Tumor of carotid body type arising,in the middleear: Arch. PathL„44: 78~-51, 1947. 4. Warren S. and; Sommers, S. C.: Cicatrizing enteritis (regional,ileitis) as a pathologic entity. Am. J. Path,, 2-1 :475-501, 19-1S. 5. Warren, S. and Sommers, S. C.,: Giant-cell inclusions in cicatrizing enteritis. Proc. Soc.Esper. Bioli 01, Jled., S: 461-163,1943. 6. Warren S: and Sommers, S: C.:: Pathogenesis of ulcerative colitis, Am. J. Path., 25 :, 657-659,~,1949. 7~ Hertig, A. T. and Sommer. S. C:: Genesis of endometrial carcinnoma. I. Study of prior biopsies. Cancer, 2: 946-956; 1949. S. Sommers, S. C., Hertig, A. T. and Ben'loff, H. r Genesis of'endometrial car- cinoma. II. Cases 19 to 35 years old, Cancer, 2: 957-963, 1949j . 9. Hertig, A. T., Sommers, S. C. and Bengloff, H.: Genesis of'endometrial car- cinoma. III. Carcinoma in,situ. Cancer;? : 964-971, 1949. 10. Sommers, S. C., Lawley, T. B. andl Hertig, A. T. : A study of the placenta in pregnancy treated by stilbestrol. Am. Jl Obst., & Gynec.,,58: 1010; 1949. 11. Warren, S: andi Sommers, S. C.: Proteolysis in intestinal disease. Gastro- enterology, 14: 522-526, 1950:. 12:, 1'i'catt,, J. P. and Sommers, S. C.: Chronic marrow failure, mSelosclerosis and extramedullary hematopoiesis. Blood, 5: 329-347, 1950'. 11 Meissner, W '. 3:., and Sommers. S! C. : Postpartum endometrial hyperplasiaa in diabetics treated with stilbestrol and progesterone. J. Clin. Endocrinol., 10 :: ~ 603r6,09, 1950. 14. Sommers, S: C. and Johnson, J. 3i. :, Congenital, tricuspid atresia. Am. Heart J.,, 41: 130-143', 1951. 15. Sommers, S. Cj, Wilson, J. C. and Hartman, F:, `V'.: LSmphoidi lesions in poliomselitis, J. Exper. _lTed., 93: 505-512, 1951. 16. Warren,, S., Holt, M. W. and Sommers, S! C~ : Some early nuclear effect's of ionizing radiation. Proc. Soe. Exper. Bioll &'Medl, 771: "SS~-291, 1951. 17. Holt, 11. W., Sommers, S, C. and Warren, Sl : Preparation of tissue sections for quantitative histoehemical studies, Anat. Rec., 112: 177-186; 1952. 18. Sommers, S,,C. and Teloh„H:: Ovarian st!romalihyperplasia inbreast cancer, Arch. Path., 53':,160-166, 1952. 19., Warren, S., Holt, M. W. and Sommers, S. C. : Some cytologic and histochems ical' stludies of radiation reaction, Am, J. Clin. Path.,, 22 : 411-417, 1952'., 20:, 3icManus„ R: G. and Sommers; S. C.: Breast cancer prognosis and ovarian corticali stromal, hyperplasia. New Eng. J.,Med., 246:, S110-892; 1952. 21.Sommers, S. C: and Young, T. L.: OxSphi1 parathyroid adenomas., Am. J. Path., 28: 673-FiS9;1952. 22. Edwards, J. L. and! Sommers. S. C; : Radiation reactions in parabiotic rat's. J. Lab. and Clin. Med.,,40':, 342-35-1, 1952:, 23. Chute, R: N: and Sommers,, S. C.: Hemolytic disease and pol~cSthemia in parabiosis intoxication, Blood, 7:,1005-1016; 1952. 24. Hollandpr, A. and Sommers, S. C.,: Lepromatous leprosy. New Eng. J:, Med., 247: 634, 1952. 25. Christensen, W. R:, Sommers. S., C. and Spaulding, C. I+"..: Effect of soft: roentgen rays on the rabbit skin: :1m. J. Roentgeuol.,, G3': 801-SOS, 1952. i'6. Sommers, S. C.,, Chuti, R. N. and Warren„ S: : Heterotransplaantatfion of! hu- man~ cancer. I. Irracli'at'ed rats. Cancer ICes., 12: 90:)-9i1, 1952„ 226A. Chute; R; N',, S'ommers, S., C. aild Warren, 5.,: Elhterotran4plantation of hu- man~ cancer. ISi H[im~rter cheek pouch.. CancerRes:, 12: 91°_ Jll: 19i"~2. _GB, Sommers, S. C., Sullivan. B. A. an& Warren, S'.:, Heterotranspl,[utation of human cancer. 111. Chorioaldantoic membranes off embryonated eggs. Cancer Res.,,12 : 915-917, 1952. 27. Brown. W. J,Winston, R. and Summers, S. C.: 3lembranous staphgilococcali enteritisafiter antlibiotietheralro. Report of two cases _Tm.,J: 1Ji;;e.-tDis., 20 : 73-' 7.i,,19,53'. 28. Sommers,, S. C: andi JIcJianny; R., G. :\tultiplle arsenical cancers of skin andd int:'r.nal om~,:[ns. Cancer; t;:3-I7-:1:,9. 111:,3. °_h. Sommers, S. C'., An[]er~zon. L. _3'L and Warren. S.: Basenlent membranesin, ef:rouiciiit'e»tinaLdiscases. I6ab: I2:rest..'.'.: ?°'.3: '_1°_Gl 1'')-53.30. Waculiel'd. M IY. and Sommers;, S. C.: Fatal membr:[uous staphylococcaSl enteritis in surgicalpatients-knn. Sur•,:,,13,04: :'_-419--2521 1il :13'. 31. JIe\Ianuh. Il. G: and Sbinmers. S. C. tiigui'ftc;rnve nf ~;lstric polyps accom- panyin:; cancer _Au[! .T.,Cliu:, P3Uh:,, 23 : 7-16-7.:,.i. 19:;3. 32: Sommers, S: l). : Ovarian Itete CSsts Jm. J. Path.,,29 : S: 3-cu9,,1953, 33. Sommers,, S. irradiatior 34: Holt. M. W: ., from espo tiions. Lab. u5. Sommers, S localizatio Proc. Soc. 36: Sommers, S vival in bl 37. Sommers, S hg-porplas S. colitis. J. :iJ. _~ i: n[son; : Obst., and -10. Chute, R. I human-t3, 119541 41. Marcial-Rc t'[uuors o. 42. ITollhnder„ ultraviol membra 43: St'rwlnde, ~. . spaniel ,, 44. So[nmers, tbcroidi -i5. Wood. .L ren, S.:, number: 46. Goddard, Invest., 47. Colcoci: breast. _S. Burt, A. hypop1 4J. Sommers Arch I 50. Soinlner:: sensiti, Lab. a ~l. Sommeri; glome Turner, Plrttecs( t uiuol 54. C;odilar- _ litus. JJ. RUlllnle7 ,uid c nl'ill:. IL [u:,n ~i,i.

1089. ucer. Lah: 92: Sommers, S, C.: Host factors in, fatal human ltrne cancer. Arch. P'at'h:,, 65: 104-111 1958. -mparison 'a th.. 59 : , 931, Merriam, J. C., Sbmmers, S. C., and Smi;thwick, R. H.: Clinicopathologieal correlations of renal biopsies in hypertension with pyelonephritis. Circu. lation; 117: 213-2-18' 1958 ' ,. Am. J. :ranulosaa ., . 9-1: Koefer;, E. D'., Swinton„ N. W:,, Atki,nson., R: P. and Sbmmers, S. C. : Panel discussion on chronic ulCerative colitis. Am. J. Gastroenterol, 29: 3•~9- 3?3, 1958. ri;tii Hos- 95. Azar, H. A. and Sommers, S. C.: Retroperitoneal ectopic seminal vesicle communicatine with a, contralateral solitary kidney-: Report', of a case. J. t ro1. 19 : 91-9J8i 1958. 1i esperi- Onpany- , 996. Sommers, S. C.,, Relman, A. S. and Smithm>ick. R. H.: Histologic studies of kidney biopsy specimens from pati,ents, with hypertension., Am. J. Path., 31irG8r715;, 1938: pa~ric~ing~~ 97. Sommers; S, C.: Constitutional aspects~ of gastric carcinoma. Arch. Path. 66 : 487-493; 1958. raa•,ioletl 98. U1lriok, W. C., Lentiniy E. A., and Sommers, S. C: : Oygen consumptioni of postmortem human heartmuscle: Proc. Sbc. E.per. Biol. & AIed., 95i: 2-I6- 247,,19u8. •actions. :-~{udknt I. Obst. h~~c~ti!c B!ull.,, 99. Shamma,,A. H., Goddard, J. W. and Sommers, S. C.: A study of the adrenali status in hvnertension. J. Chron; Dis:. 8: 5S7-59d, 1958. 1VQ7.. .~.11Va, '1.. h. a'nLL z'om111eTs., z, k,. : 1tClla.1 Un1115f" l'Lau'p'C`J': \t'1lll 1JlleVellrVmU('J:- toma, Am. JL \Ied! Soi., 236: i00-i!O-1, 1958:101. Ketiler, R., Lenson, N. and Sommers, S.C.:, Carcinoma arising in minorr saliPar1 gland ducts of' the lower lip. Am: J. Surg., 97 : 79=82', 19a9.102. Strong, S: -lI. and 5ommers,, S. C.: Bronchiogenic carcinoma Arch. Oto- larsna: 6Ss!:71i4-i69, 1J5S.. 103. Wilkins, R. W. and' Sommers, S. C.: Clinicopathologic Conference. Ehiarge- ment of the heart, cardiac failure and loose, drs scaly shini Am., J: Clin. 31: 66-72. 1959. Path . Am. ii n`ith. lrlli,rc .,, 104. Sommers, S. C.: Pituitary cell relatibnstobocl3' states. Lab. Pnvest.,8:358--621, 1Ju9. 105. Coffman, J'. D: and, Smmners, S. C.,:! Familial pseud~osanthoma, elastieum, and vali<-ular~ heartd'i'sease. Cir:ulation, 19: 242-2a0, 1959: 106'., Sommers,, S., C.: Pat'hology of tlle Iiidhetir and adrenal gland in relation~ ship mhypertenhion. In: "H!rpertension" \V:,B. SaundersCo:, 23. 195s; ~idevr 107. Andritsalti:s„G.D: and Sommers, S. C.':Criteria!of thymic cancerand clinical correlations of, thmmic tumors. J. Thoracic Surg., 37: 273-290, 1959. r. 10: 108. Androutsopoulos, -N. a.,and Sommers, S. C.: Postmenopausal endometriosis. Con- Obstet. &',GSnec., 1'd: 24.-218, 1959: 109: Ullrick, W. C., Lentini, E. A. and Sommers, S. C.: Summationi and tetanus tt:uur.. in postmortem human heart muscle. J., -1'plai',, Ph1-5io11, 14: ,,67-GU8, Ll.-'9;, atho- _ rati, rela- . 1110. , Hollander„ A. and Sommers, S. C.:~ Current case, of lepromatpus leprosy, acid-fast bacilli in epidermis. Conn, _l'Ied., 23:6u0-G51,1959:, 111. Thayer, C. L, and Sommers, S. C.: Host factors in carcinoma of the uterine cervix. Am, J. Obstet. & Gynec., 78: 3S6-392. 1959:, 112. Bloodworth, J. M. B'. andl Sommers, S. C.: "(,irrhotic glomerulosclerosis". A nerali lesion assoeiated' with helatic cirrhosis. Lab. Incest.,, 8:962-97$ 1059. :: in tAa. - by 113. Fttllt,r, C. H: and Sommers. S. C.: The thyroid status in relation to ar- teriosclerotie disease. B. 31Q. 10: 1-2; 19-59 114. Sanchez. G~. C. and Sommers, S. C.: Peptic ulcer diathes:is with a mised adenocarcinonla of the pancreas: Case repol't., GaatroenterologS, 38: 1Gi- 470; 1900., -!ta1 115., Sommers;, S. C. : Renal and' adrenal pathology in hrpertensiom Conn. Med., 2=1:, .'40-241, 1tJG0. 116. Kelly. .J. W.JT.,,Parsons:, L,, Fi•iedeili G. H: and' Sommers. S. C.: A path„lo;ic study in ~55 autopsies after radicall surgery for cancer of the cervix. Surg, Gcnec. and Obst., 110: 4'?3-43',1960: 117. Hollander; A. and, Sonuners. S; C.: A liistovbemical study ofmucopolc-sacchariciesof leprosyoftheskin: _1cta. De.rmat'. Venereol. Proc. 11tbInternat Congr. Dermatl. 3: 407-4111. 19J7-1;Hi0. 118: Bvckin-liam, S. and Sommers, S;C.: Pulmonary hyalihe niemhranes;,J: DiR: Child., 99: 21fr-'_'_°i,: 1b60:, 119:Patton, It. B, and Smnmers;,ti;,C.: The hisopatliologr of infarction and other ulceratire diseaEesofthe esophaaus: Am. J. Clia. Patb.,,33: 31ti'-G24, 111GO., _9-2:ki'-6n-pt :f---1 4 V ~ ~ ; i ~~ ~ ,

1091 in. :0: a. J. id in of' le ve a- n a. o, d- r- es', a- id a 2 is a- if f al n is n. 1. 148. Harh; B: and Sommers, S. C. : Endometrial'l curettage in diagnosis and therapy. Ost. & Gynec., 21: 636--63$; 1963., 149. Sbmmers, S. C., Weber. C. E. and Reeves. E.: A hemagglutination reaction of' mothers and infants of different ABO' andl R',h groups:, Am. J. Clin. Path., 39: 462-454', 1963. 150. Russfield. A. BL and Sommers,, S! C. : The effect of' malnutrition on, tropic hormonestorag!e in the humani hypophysis. Arch., Path, 7a':b6=1, 1963. 151. Beaser„ S. B.,, Sah, _l1. and Sommers, S. C.: Influence of insulin therapy and pyeionephritis upon diabetic glomerulosclerosis in hamsters. Metab. 12 : 704-5W,1963' 152. Sommezs, S. C.: Some end~ocrimeandl immunologic aspects of protrnnsis, inn breaet' carcinoma„ ActaUnion Int. ContreChncer16: 959-60: 196?':. 153. Reeves, G., Figuerclo,: A. and Sommers: S. C~:~ A case of breast carcinoma with hypothalamic malformatibn. West. Jl Surg. Obs: & Gyn. 71: 134- 19Fiia: 1:x1: Hutt, li: S. R: and Sbmmers', S. C.,:A- clinicopathologic analysis ofbiops9 specimens in persistent glbmerulonephritis, Am. J. Path. 43: 4.59--4:7d, 1963 155: Bowden. D! I3!. Danis. P: G. andi Sommers. S. C.: Ataxia~Telhngiectasia. J. Neuropath & Esp: Neur. 22 : 549-553, 1963: 156. Reaser, S,B'., Sak, ]L, B'., Donaldson, G', AV., McLaughlin, R. Jl and Som- mers. S. C: ::lllosan diabetes in the golden hanister, Mesocricetus wratius. II. Glomerulosclerosis! and its reiatibn to diabetic regulation. Diabetes,, 13: 49--53', 1064. 157. Williams, M., Barnes, .ll. D., and Sommers, S. C.: Hyponatremia, anti- diuretic hormone secretion and oat cell carcinoma of' the lung. Dis. of' Chest, 44!: 4Ja+99, 1961 15.5:, 3Tonroe, L. S.. Boughton, G. A.. and' Sommers:, S. Cl: The association off gastric epithelial hyperplasia and cancer. Gastroenterology 4G:~ 267-272,. 19464. 1591 Teel, P. and Sommers, S! C.: Vascular invasion as a prognostic factor in breast carcinoma. S1irg. Gynec., andi Obstet. 11S!:,1006-7008, 1964. 16q. Reeves. G.. Lowenstein, L. and Sommers,, S, C.: The renal macula dbnsa and' juataglbmerulhr body and', cirrhosis. Archi Intl. 'Med. 112 : 70S-715, 1963. 161., William, SI. J. and Summers, S. C: : Emphysema, peptic ulcer and lung carcinoma with pituitarrCt:ool:e°s eells, Am. J. Med. Sci. 247:~ 422-426;1964: 162'. Sommers,S. C. and Dixon. F. J.:Seminaronuntomard reactionstotreat- ment., Am.. Society of Clinical' Pathologists, Chicago. 1964, 67 pp: 163. Breulhul A. M., Gonick, II. C'. Sommers. S. C. and Guze, L. B.: Patho- genesioofs chronic pyelonephriti's: Aim J. Path.,, 44: 659~705; 1964'. 164. 1Vright, C. F., JIedenilla, G. 3. and Sommers: S. C. : Pt•rinutaL death :A clinicopathologicalanalysi'sof' 99, cases. Calif. Med. 100:331i 339; 1964. 165: Sommers„ S. C.: :lbnormalitflesaccompancingcarcimomasof the larhein- testline. Dis. Colon and Rectum 7:`_'6? 269, 1964. 166:, I'iennedy, J. H., Williams. \D. J. and Sommers, S. CJ : Cushing's syndrome and cancer ofl the lun.g:P~itluitary Ccoove.Ce.ll hyporplasiaa in, pulmonary oat cell carcinoma, Ann. Surg. 1160::J1)-04: 1t164:, 167.. Somnaers~, S'. C.: Pathologs of essentiali hFpertension,, CSclo. 3led. 4:9-15; 1964. 168: Bucl uighatn, S. .llc\iu•y: W. T.. Tr., and Sommers, S. C.: Pulhionary alveolar cell incluFions : Their (levelnpmentin rat. Science„ 140 :1119'? 93. 19611 1KA`J: R~ttssfield, Arnes, B., Fisher, Edwiai. l.'. andl Sinmmers, S. C.:I)issociation of'hspophpseal contentand urinarc excretion of'gonailtitrohin inici>•rhosiaPrbc: Soc. Exp. S'MCd., llM:-14l 1022-1024, An., tiP.pt. 1fNi'1l 170. Sommers. S, , C.: Pullnonar.se.upHcsemsy healed mmoc<lrdial infarets audl other di~ease co rrielstiunswith mnle,breast structure:, A3I. J., Med. `+ci., •'4,S: Sept. 1:;6#, 3-1 S-:! k4: 171. `a'ionnuers. S. C.. Goniclt, H. C:, Ttiailmanaon. G.AC. and (,u•r.e. I:. P,'.: Pntho- ;enesisofchronir pcrlonephritiir AM. J Path., -1.5#5 i!1 731. No. 11911-k. 172. Friedell, G.. Bett's, l and, Slommets S. C: The prognostic valne ofbi6od'Rsesel invasionandl lympocctic intiltrates in breast c:ircinomu. Ciuncer„ 1S:#2, 164--C6, )!,l,b. 1F)G~i. 1Z3i henned* V. J. IS., R"illianms, M. J~ auQl Sommers, S. C.,:Pituitary , Chooi:eG'c,l& hyperplhsi.a in pulmonary carcinoma, Acto I;iiio Contra Chuicrum, 20:11,23; 1964.

11'00 matics at Princeton,, in which he agrees life seientists are overawed bFy statistics. ~ I fear we~ have all been~ znfl'ueneed~~ bu~ statistical relationships~~ where~ if we had observational data we would discard them as not really cogent. I fear tihat.. '_1Ir: EcKxAftnT. Let me ask you this question: Do you think it -would be an accurate statement to say that im~ men under 60; heavv ciKyarette smokers have a higher incidence of heart disease than nonsmokers? Dr. So-mmExs. I would have to~ ask which meny because~ in a group of farmers reported by Morris (Canad.~ _lfied. Assoe: J., 136.7, volume 96) it appeared!, that~ their farming protected them from anr.~ efrects that might have been due to~~ciaarettes: ~ In the~American Indian population it «as~~not proved. So~I would have to know ~ which popul'ation.~ Mr. EcKtrARnT.~ 1fi~7'e~ m~i-111ht say ~ .Iapanese-Americans would be less~ lihely~ because~ of the st~udy ~ of ~ Iiiroshima. Dr. So}rMrxs. No, sir. That doesn't, applyy to Japanese in H<< aii' andl on the~ rnaiirl<and of the L`nitecl~ Statlesa ~ The~Japanese~coronary disease study by~Kiinura (Acta 1Ted. S~.- aird~.,~ 1967, S~u~ppl. 460)~ simply showedl that smokers had lower~ blood& pressure. Mr., EcxFi:~nnT. But because we find' specific areas where a con- trarv result is discovered,,does this mean that we cannot make a statie~- ment~ with respect~ to~~ t!he~ general' ma1e~ population under~ Z-i() ' if our~~ association statlistieally~ is~ as~sharp as~~ it aphears to be i'n~ the Jenkilr7, Report? Dr: Sommrris. Xo,isir; I~w~ould not~<<•-ant to m~al.e~one~because~~I fear ~ it woulkll give~ an impression~ of centaintv where statistics~~ can never bive that impression. I seiiiouslv ~inean this., sir. Tbe~ Cir AixMAN-. Mr. Pretter.~ Mr. PitEir~i3. Thank you,~Mr. Chairrv7a~n. Dr.~ Sommer,s~., you have chrtllenzed several stateu7ents~ macTe~~ by ~~°~'ther~ witnesses here in: a direct way. 6ne of' mv ~ collcal~nes j~~u~;t n]er.tioned that the~~heavy preponderance of~tlie.~et-iderce~«,e had heard shor;ed that smoking causes disease. A f~~ew.~ davs~ a~o:~ another colleanue~ cominented th,it' r?~h~~msr e~-err~ witlness,~ ~rith the exception of~ perhal~~,, onr~ patholo,•ii?t. te-4tifi~ed that ~ a phy~siciani could ezarnine~ a~hinn~~ and tell whether the person -was a smoker or not. It seems t'o~ me that id~ea~ has been tot,ill~, ~~ destroved! here. It seenl-~ to me~~ t11~:1t tnan~v ~ of the~ tlii'n' Lr:, which h the ~ener;tl pu131 i~c~ feels~~ a~~re~ t~rT.~e andi which I~think~memhers~of this committee,thougJit.rere~ true.,mav rtnt; ini fact. be~~true~. ~ What~we are~in-volved in is:.we~iffliinz ~the~ evidence; to ascribe a vslu~e~ to~ it. Your qualiifrcations peern to be absolnt~~ely ~ i~mpecc^ble. w~o~ som~e~ of~tliese~rnatteiis,~on nhiieh!ron cha~llenge otlier~~witnesses are~ important. First, ontihe~black Itn1g contrnversv, yrnr stat6fliitl~y tbat'~yon cannot~ tell from ai lirnz ~«-1.ieYliPr~ :;-~ per-oir i~z ~ :, ~ srno'~-r,rr or~ noli,runl.e:•. rtnl V0n1 ehallenge, Dr. Willi'rtuns of the 1mericln Clrncer Society on th~a*. Iie~ 'went so~far as~ to sav v~vcou~ld de:termine~ a personrs~ social life~ from~n esamininz ~~ al . hirlg.~ You say ~ you c:an't tell whether it isa man or a~~ woman, which is~ a~drawback.in determining~their social~~, life. l ou sa ~woixer an Dr. So3 Mr. PR Dr.. 5or l,iack pig, ;to is.~not hos~ 1>roaizicts,~ Li~ Sin oi~ ~-)ill~ nni~ Mr. I'rr c <<~ir Umce ir. So: aa l, li ~-±Oiv~i l)<<r~~ie~lar. ~ ! I,;e cal Lei:c ,,-e N-c cnuikli ~_~o: I'nn t li:tt ne ga u ~!Xl;eriii 1 e :i_-.odt i~- ou saY :JD. ";u.. pr:ue fror su _ Lir. Pr,. :nrn: 1)1.. 103 :~,e clh ure~a 1'i: ~l'..lUl'l',: .I ~ ~ i' ;tnn,l~x xr,1n0 u W' .\i>~r\ il (J1i ;1kTt. nlw I .14 W1 ~ ,\P -)I! (l I hG -4

1040' di~sease?Are «e~ talking ~~ about syphilis of the heart? ,1re~~ we talking abr,ut~rheulnatic~heart cdisease~or arthrosclerosis? So;, it is one~ thin~, to use a: bia~~m term like heart~ disease without sp~eci- fying~ what youi are~ talking about but~ I have to~~ elo~that, I[ ami sorry~ to say. Mr. ~'t~'A~xsoN~. I agree~ with you~ anaLyou just looh;~at the~f-tgtues~that I mentioned a moment ago~ «-here~~ the~ consumption of cigai.•ettes, for~r a~diilt males is~ higher in the L: nited States than i't is in Fii2la2id, but yet~the~ incidence~ofi~hlng ~ cancer~is better~thair almost t-n•o~~and a.half there~ th~anit is ~in th~e :U~nited St ates ~. Somebody ought to be concerned about finding out «hyl:and it ought to ~~wave :a red flag in the: mind''! of any ~~ unbiased indiviclual: ~as,to ~whether~ or~ not~ there~ is a causal'~: rel~.tionship~ between or~ even in my..~ j~ud~tnent I am beginning ~ to~ qtiestion the statistical relat~i~onship~ atl~ this point as we~~ found out the~~;:nconsist'~encies~ in the ~~Far.•ious reports~ and studies that have been made.~ CertainIy I alu~ eoncerned' and I appreciate: your testimony as a, p7thologist. One~ fitra:i question:~ What would be~ the: l;,ercentage ~ of~ deaths~ in which the-re~ would be~~ an airtopsy performed ?~ Dr.~Puc»a-N, That~wouhl vary in d'iiferentl~hospitals~.~Atone~tiinein: Galveston we were doing over i a percent. of cases that died in the lrospita~l'.. There~~ are~ some hospitals thtit,'~will do thatt now. I believe~ the~ _YJIA requires for accreditation ?5 percent. Ti could be wrong about tlrat;, but you have to do that nlany to meet the requirements of 'an acceptable hospital. Mr. WATSON. That is elt'her with or without the consent of' t'hee survivor. Dr. Pzcnos; Oh,, no. You have to have the perlnission from the sur- t-ivincr onee who~ is legally responsible. for the burial of the herson. Mr. ~~~:~ATSON., Thank von verv~m.uch. Mr. SATTnaFrnLn. Any other questiions? If not, then I have one,. Doctor. Do~ you~~u knotir~ of anv nen-~ evidence reliltin(r to srnohin~ ~or,the hazard of'smohing that has developed since 196t1~ ?~~ ~ Dr: Ii>c;vo~. ''1'her.e~ is this study of~ twins whichi is~ sonletllilYg that ha~s, been clevelopi~ng ~ since~~ tlaatl~ time~ and tliat~ is~ alll I recaIl that is sianificantin this~~oti-~eralllproblem.~ Mr. ,A.rTrra~rELn. Thank you very mnch.. Mr. EcvraAr,nT: Doctor.; do you recall the ci'tation, of~ that study of twins ~ Dr. Etc:r©-N. Oi~l;~ there~ have~ been two or three. Mr. I;CKtiArtn•r. I mean the one von are tltll.in- abont. Di•. I.~TC;rnox, Oh,,we11, I heard the man vestet•eIav ~f rom Sweden ta1hk about it andl then~ there.iire some others. I~believe tllat~ Fislier referredd to~tllis mzuv ~vettrs~a_(rol in 19.50 orhltei•.~ Mr. I:cii:rt Ar,ni. We.~are~talk~iira~about after~19G-t. Dr. Rrcn+;)N., 011, ~ no, Ilt~ is what is~ !roill-- on l:ow. I~ don't~ know whether itilias been published~ or~not but tllis,stucly ~ oir ~mr~hin~~r~ lia}bia=s~ of twins is~ a piece~ of wor1k that is~ unclh~r«•:ty~. Whether it has been p1iblis1Eeo1 I~dh~.notl know. Air: F.rsrrAaa)r. 'I'hamrlc vou„sir. _lfi: ,-;x1 ~-:1 n:l.n: 1,uY other quertiolt5~~~ iw1t-I1, to, tlk:unl: voli. Doc- toC, f"ol l'11.,1,~12n~i)('f{)le. ~Che~co111ll.1ttQe an(1 1--'I'.'111-o. 'liti'till I)f'I]ketlCotZ"UIiL' tCStlll]O11~?. Dr. 1u~i(:no~N-~. Thanl:~ you. Mr. S'AvrEltr time, that'Dr. of Ft. Collins. and without ol It will be incll; (The stateme STAaEMn \Iy name is Br.: Isntl dprote over 1I was done at the 1'.r2ti, 43 years-ag' Western Reserve in 1930. Itaught of' Chioago«hert«•as completed at ticed medicine fo included the tiniv, and Colorado at: Loth: research an, inboth, fields and For many yeai vince us tliatl cia;i a numerically smi 4tronhlsthatth( ticnlarisinconcll tists. it', usua7ly or i2)tliatthee This statemen involvedin tlie : tell my patie.nts: were going to let, about the naturacenters ofEuron( an autbpsy on c, JIi- studies we n•itihi 01113' one m, one can get a e since about 75~,b the largest I'athi ltereent'age of' de: I can not:overe) true regarding lu onset; symirtoms; shotivtlrat becau: physicians oftentautops5., For e1a \Iichigffant collect they had , been, rrr correctly diannos (lhservations c 11an-e,led to the c+ caneer, hearC attz diet orotherenF sonicdiseaseswlc contract those d theory that' ci; a: t ainst the tlheorr tolnnecancer:_tt Graz comns incidence of lung (lnring, this intori first iy1tl;t1wher. very high, figure, 119 -2:116-c:~-

1122. 11Ir: VA:vDnEiu,zlw (presiding). Mr. Pickle?' Mr. Prc$r,E. Mr. Chairman,, thank you.. On page 2, Doctor, you make the statement that one also is struekk by the almost universal bias andl perhaps need t'o find' a positive rela' tionship between cigarette smoking and lung cancer. Are you saying, that some of'these people who have testified,,who hav e made investigations on the cause of lung cancer related to ciga- ret'te smoking, have started out to prove the need and their resultis were concluded before the research actually started?. Dr. Ozcu-.N-., II think in a sense that is correct. I feel that there is such an emotion-laden question here, there is so much bias, that one is inn danger of' being ostracizedl by his collearues in the scientific commu- nity if his data doesn't fall in~ step with preconceivedl opinions,. Mr. Picsr. r. You make the further statement on page 7, "1 find~ no persuasive evidence that cigarette smoking causes lung cancer."' That is a direct contradiction again to ~ a heavy number ofl wit.nesses who have come liefore our committee. I wonder if' your word "per= suasive" is a proper choice of words,Would "positive evidence" be more clearly descriptive, or are youu staying with your use of the word "persuasive''? Dr.O'Ku_N. I am alwayswi'llingto~ reconsider the use of theword, sir. What I merely meant to sayy was that I found' no evidence which persuades me that cigarette smoking causes disease. Mr. PtcuLE. That is a1l,1lr. Chairrnam Mr. VA:vi DEExraIN~ Dr. Carter. Mr. CAnTER. Thank you,,_.NIr.Chairman:, Doctor, as I statedl previously=,; of course the people who want to egtendi the present label on cigarettes;, and the Federal Cornmunica- tions Commission testifiedl first. People: who desire labeling, cigarettes in a much harsher way have only this week beguni to testify. But I assure you, that they are nu- merous and!come worthy and well qualified. You say oni page 2 of' your prepared statement that "some persons have takeni a crusading point of view and' ha1eoverextendeel the conclusions from limited data."' Is that not true? ' Dr:OKrti. Yes„sir:, Mr. CARTER. Could you explain what you mean by this statement? Dr. Ogu-N, Yes. I t~lisnk perhaps based on the:neecl to find' an, answer, someone at sometime felt that perhaps cigarette smoking may be related, to illiiess many years ago, and attempted to prove his IIy- potlhesis and I think failed miserably.. Yet,, I f'eel that because a stone was started rolling dow.n a hill, people have continued to take up this crusade-the word I chose to use-with really no eviidence; but just the momentum of! a stone roll- ing down a llill, with, no one pushing it, with, no more evidence to pushh it. It is just it~s inertia. That is because of the lack of ideas, perhaps, as to what else might be responsible for what:I believe to be a fibrnent of stati'stical arithmetic and other matters. I think when one lool:s at the daata: in a coldy hard light, there is insufficient data to dkawany conclllsions. Iffonewant.s to be a crusader and remove a social' habit from our environmentt which some people find di:: to, Inaks _l' Ir. ( people cool, ca Do y, witch-li Dr: ( which The _llr: tion Nv ialcrea:. 1Vhz tests ~~!~ I)r. (DLT' (toIl la~bori~4 eral ii Iti ir. tliat o-t (llrum. fashio Th( I+'oe e: colnm~ se~~~era~ I-IuI menti A~Ir ~ somet Dr. .llr do yo I)r outt tl _1t this i T (1 ci 1Pc1esc I )i. PO1Pt' I lI4L' . tliat 41 'L'l A f CD' ~ \L ~. CD.

1092 174. Gonick, H. C., Rubini, -.NIi D., Gleason„ I. 0;, and Sommers, S. C. : The rena2' lesion in gout. Ann. Int. l2'ed., 02 :6G7-674,1965. 175: Sommers, S. C.: Hypertension and Kidney Disease. Prog. in Cardiox•ascuiar Disease,,8':210-34. Nov., 1965. 176J Kalmanson, G. M., Sommers, S. C. andl Guze, L. B. :, Pyelonephritis T'Ii. Ei- perimental' ascending infection with progression of lesions in, the absence of' bacteria. Arch. Path., 80 :ii09-516; 1965. 17~7: Reeves;, G., and Sommers. S! C.: Sensitivity ofl the renal macula densa to urinary sodium. Proc. Soc. Exp. Bioli 3led., 120:334-326; 1065. 178. Sommers, S! C.: Endocrine pathoIogr of prostatic hgpertrophv and carci- noma: Bull. N.Y. Acad. 3ied., 42:p24S. _llarch, 1966. (Abstract). .'.e0n1 N pa,tier.19G7. "O'1. G'cnick, in ex abilit; cliemi. 'u_: t;'oldenb 1a2 le: _ ~--mmer Ipeutic .~,:clcin, raa21 -1S :2G' ~omme: Mier( ~~ra,nss. nile : survi~ --~22, 1 Leltnin. Nvith~ ~c;th in- f .T. Ii. i:m cine. 179. Bercovitz, Z. T. and Sommers, S C. : Alteredl inflammatory reaction, in non- specific ulcerative colitis. Arch: Int. Med., 117 :504; April; 1966. 150. Friedell„GL Hl, Sommers;,S.,C., Chute. R. \.,and Warren, S.:,Ovarian tumori- genesi~s in irradiated parabiotic rats.Cancer. Res. 26,:42T-434. 66. 181. Meissner; W. A. and Sommers, S+ C.: Endometrial changes after prolonged = i _U5. progesterane and testosterone administration to rabbits. Cancer Res. 26: 474-478, \Iarch, 1966. _.:)+;. 182. More, B. M.,,.lierdinter, W. F. and, Sommers, S. C: : Chol:eccsitis and srenotic arteriosclerosis;Am.J. Cli~ni Path.45:465-467;,19G6i. ;. 1831 Sommers; S. C., Friedell, G. H. and Robinson, C. R. : Chemotherapy of Human Cancer Transplants wit'hi Methotrexate (Amethopterin) and Horse Serum. Cancer,19c674-6Z6: 1966. ~: 184: Schindler, A. M and Sommers, S' C: Diabetic Sclerosis of the Justaglameru- lar Apparat'us: Labi Invest., 13:877-SS4. _llay, 1J66. 185. Sommers, S. C.: Renali Fact'ors in Hypertension. Henry Ford Hosp. 3ied. Bul1.,14':47-54; Vlarcli;,1966. 1S6~: Buckingham, S., Hiinemann~ H. 0., S'ommers, S. C. and \IcNary: W. F.: Phosphollpid Synthesis in the Large Pulmonary ali eolar Cell r Its R.la- tion to Lung, Surfactants:, 3m. J: Pattlh:, 48:1027-1041, June, 19U6;. 187. SoIoway,, H. B. and Sommers. S. CJ : Endocriu pathr Associated Nv,itii Pan- creatic Carcinomas-Review of Host Factors Ihtclnding I3ylterpl.usict cuid Gonadotropie Activity,, Annals of Surgery, 1I64:300-304, 1066. . 188. Laragh, J. H., SeaIeg,, J. E. and Sommers. :+., C.: Patterns of'_ldtenal ~Zecre- tiion and tirinarv Excretion of _1ldosterone and Plasma Rlenin Activity in Normal and Hypertensive Subjects. Supplement 1 to Circulation Research. Vols. XVIIIi and!Z:IX. 1-15S-I-17-i,,June:1966. 189. Cannon, P: J.. Stason. W. B., Demartini. F. E., Sommers. S. C. and Larazh;. J. HL: Hyperuricemia in Primary andi Renal Hy~pertension. New Eng. J. ATed.,,275: 4u'"-4ti4, Sr3ptember, 1966. ~ 190: Sommers. S. C'. and Friedell„ G, H. I Studies of Carcinogenecis in Parabiotic Rats. Annals of New Yort: Acadetuy of Sciences, 1'?5al28-9:3_;, January,, 1966. 191.Kister;,S.,J:_Sommers. S. C_Haagen_.eu, C. D!, andC'ooley, E.: Re-ec-orlu:Itionn of Blood Vessel Inv,asiun as a Prognostic Factor iht Carcinoma of' theBreaHt. Cancer: 19 :1'?1:;-1'?16. 4t•utetn ber. 1!)(1G. 1192:Hcman„G., :1'.,and!Sautmers. S. C-: TheI)ecelnTtmentnf'Mtnlgkin'., Di.-ave and Lyntphoma llurin~, ; Anticonxulk:rnt Therapy. Blood, 28,:-41t4--1^_I. l::r,tt:, 193. Sommers, S. C:,: AIast! Cells ~ and Paueth l'ellsin Cleerative Cblitts. ts:lstrt+en- ternlogy, 51 :R41-14,S,,1!Hili: 194. Sommers. S. C',.:Patltoho_y of' Cervical C.rcinotna. In "\ew t°uncel+t:in: Gyttecolbgical ourolu,y "ll:tlinotn.nun S ;vmltosinnt., N---yU. 1066. 1'.)+. Sommers. S! C.: The :+i;nitic,ture+tf hud'r+metrial 111j-perltltrsias. lit A+•t~ Concepts in Gy~necoloLical uncoli+ny.'H,ahnetnao:ur .'.ympnsiunt., 1906. 196. Sommers, S. C.and!Pereovitz. Z. T.: Iutiammator}•Rc..ponsc•s inl:crrati~eCulitis. N.Y. StateJ. -lletii.,tiu:atD4il-:3u-12• 1966. 197. Svobotla: A. C., Jr.. Itincttter. Q`. 11.. faunble. t1_'. A.. Sommers. 'S: C. an+l L. 5. Problems in the 1'at•~ly-l!tia,:;itusis~ofPelrtic i]yuphae;itliv: f,u;tr+yiuti,st. Endoscopy. Fob.1431t7. 198., Caravaca, J., Dimond, E. G., Sommers, S! C. and Whuk• It, : I'na•~ u i• c: r' IntiucedAtherosclerosis by , I'F•rotiiL•tRe. :*rience. ,1:,5:12S4-1 'S7: ll:t,:ch. 1967.: 199. Rippey,J. 13: ,tndSoutm rv. S. C: Il,rltertrr;phihd plaauta cellsin rr;i~~nalenteritis:,lm, J. Dig.DIs, 12':-;; L167. _ L:,I•ogt. rniNt .~m., 212. `,Iarke• :iir I 100 : `+?I[1IllFP:,tr mnic 1 o rt'. iatn :1:,. o„t, "t+. =:ttrlat ;itry ::act rdie l!:: _17. ,a rc. _1,: G++lilct 'at,i(_

1123 is struck tive rela- fled, who 1 to ciga <ults were re i's such one is in comml ons. I find no cer:" witnesses )rd "per- • are you he word" ce which want to imuniica- vay have are nu- persons :ided the ment? L answer, may be his hy- n, al hill, chose to one ro11- ~ to pusli! herhaps, figrnent~t there i's. ,rus:aclor e people fi¢idl distasteful, they choose a very emotion-laden illness to: pin on it to make it easier to get their job done. Mr. CARTER. Certainly, I agree with youL I feel tliat many of these people have acted unnecessarily from a scientific basis and' without cool, calm, well-reasoned experimentiation. Do vou, feel that cigarettes may be the unfortunate victim, of the witch,hunting for the cause ofl lung cancer ?' Dr., O=x. I very definitely do.I~ don't know of another sociall habit which has come under such vigorous attack with so little justification. The best terminology I can use for this i's witch-hunting. Mr. CARTER. You mentioned that you have done animallesperimenta- Yion work and you say on page 4' that the toxicity of anl agent may be idicreasedl by the crowded environment of the animal during the test. What is tjae significance ofi this crowding of the animals during the test!s ? Dr. Ogt-N. Many experiment's have been done using cigarette smoke or condensate; or various material r.emovedl from cigarette smoke viaa laborious laboratory techniques and applied to animals who live sev- eral in a cage, for example, mice.It is now well-known andl n-ell accepted in the scientific communityy that anzan:als th.it are stabled with more thanl one per cage had a11 these drug3, medications; chemicals, what will you, in a much different fashiorr than aniinals thatlive crowded. The crowded animals tend to: respond more adv.ersely: to chemicals: For example, v,-e shoaTed'some years ago that the lethall effects of some common drugs were increased four or fivefold by having aninials live several in a cace rather than by themselves. I-Iumans don't liv.e crowded in ai cal-e. I think the way the esperi- mentationi was carrie.d out and designed was very faulty. Mr: C_LRTEr. Your answer indicates, then, that stress would have something to do -with the results. Dr. OKu-_Nr. Yes, very definitely. Mr. CARTER. 1j7hat youi find in animals may be true for humans al'so, do you think?' vr. OnU-N. I see, no reason why it shouldn't be, but I have not carrie& out the experimentation on hiunEtins. At the moment, I[ can't put my finger, on any data to indicatlel that ~A this is correct. I don't know ev.idence thatit is not correct either. I don't believe it has beenl Tmoked into. 1°Lr. CAnTEa. I)o y ou feel that the present .i arning contained onn cigarette pa:cka~xes,trulvandlaccurately tellst'hepubli~ctl'le stat!eof our present scientifie knowTedge about cigarettes? Dr. 0,Ku-N., ~ti~~~ell, I am afraid I am going to take a somewhat un- popular view. I think itis a littlle strong. Based on the evidence «-hich. II have evahiated, the scientific literatnre, I dbn't think that statement is accurate. It;hink it tends to ~ imply that there may: be a healthhazardl I feel that this is distinctly untrue. Mr. CARTER. 'l:.hank:y,ou,,sir. Thank you, _l'Ir. Chairman.. M r ~~"_„ Dr:rr,Lix.1Sr. Satterfieldl? D'Ir., SAYrFRFrEr.n. Thankyou, Mr. Chairman.

1114 ments on the induction of' cancer by chemical agents will be profoundly al- teredl This reinterpretation and reevaluation will have to be extended also to all the animal work that has been done involving, either the painting of tobacco smoke condensates or the inhalation of smoke. The new virus studies have strongly raised the questioni whether similarr virus mechanisms wiil be found operative in humans. The: human i:nvestigations are slowedl by the impossibility of carrying out certain kinds of experiments with human beings. Hence indirect methods must be worked outl by more la- borious processes butlthere is good reason to hope that they will be develbped successfuIly.. CHRONIC. PIILbfONARY' DISEASES, Siu'chdiseases, inclu~ding, particularly those called chronicbronchit'is, pul- monary emphysema and bronchial' asthma, are more prevalent tlodlty largely because of the lhrge number of' oider persons who have survived the acute fatal, i,nfeetionsofearliertimes~by the aid of the new druris. Whethertliereis an absolute or age-corrected increase is much less c.lear. They are ill-definedd conditions andl it is likely that the t'erms "emphysema"' and "chronic bronchitis'' will be replaced by a«'hole series of'new namesithat applr more specifically to particular conditions as they come to be reco.gnized. Thns epid'emiologicaU studies will mean littdeunt'il standaridizedl techniqnes, of' recognition. definition and classification as well as uniform nomenclature can be widely applied in, various countries and localities. The Council is sponsoring long term clinicai studiec designed to observe manp patientlsover longperiodsoftime; collect a vast amount of descriptive diita about them and follow the progress of their conditions; with post mortem evant- ina~tion in many cases. The use of multivariateanalssisisetpectedtohelp group the various conditions into definite cliitical: enti'ties:and' to help develop clinical diagnostic criteria that will correlate with morphological findings.. As to etiology, it has been indicated that there are hereditary aspects in some of' these diseases, thatl enzyme dcfeets sometimes plhy a part, and that reeurrentt infections may have a role:. Animal models are in use for describinnthe possible causal orag'gravating, effects of chronic inhalation of, such irritant gases as oxides of nitro,,en, sulfur dioiide, ozone;concent'ratedl oxygen and otlhers. The eff'ectsof such etposureon the immunity systems of' the animals and on the Iung macrophai;es are being observed.. Pilot studies of chronic cigarette smoke inhalation by animals have beeni carried out and are to be extended as improved equipmentl becomes availabie: NICOTiINE: AND. TiHE CENTRAL NERS"OIIS. SYSTE.\r. Smokers have often reported thati smol.ing ' "helps pickt'liem tip and ;etl t11emgoing in the morning", ; and, also that' "'it helps thenr relax when tense". Though thesestatementsappearcontradictors; there is now a scientific basis for both, in tlhe: findings af' psycho-pharmacological studies. Studiesof' braiit w.nves, both in animals and', man, have shown that nicotine has an "arousal': effect" on the brain when it is in astate of' repose. When thc animal or man is in a state of agitationl nicotineliasan effect'on the braintcavesresembling'tliatof some of'tlie tranqpilizers.. One Council sponsoredl investigatbr has reported that persons who like to smoke show a predominance of'the brain wave tylr;s that border on a,'itation„ and posthrlatesthat this type of person srnolces4or the tranrlttili'sing effect It isnotl yetl known whether this type of prevnilin;encephalo::raphicpattern ishereditarmor nltetlierit si'gnalspredi'sposition to psychosumatiodisensessuchc as ulcer or certain heart conditions,, but these areimportantl preblemsfor further research, some of which is undermas•.: ' Several studieshave alsoetplored theeffectsof' nicotine on the Iearning processin rats and other animals. A dcfinite nositi~veeffect lia~been reported. STtiDIES. OFPEPTiIC ULCER :1; statistical association between cigarette smohi:nz andl mortality from tlli:s disease has been reported.' The Council sponsored a series of' studies to deter- mine whether sri believed by man oc-ersecretion of' of ten measurec smoking just' be significant chan>; OO n the other temperament, tYl reasonable to stt fromtensiom bgcnl association tt to an increasec cigarettes. T1ieC'ouncil, fI sored much res been st'atistical romplet questi( Gontinuiog,Cbu' 1cennetlt 'MerrII. l:ineritns of'~ ~ I'tlrulina "'Tlns;-ard B, A t_':tnoor Instit Pichan'd .T. I;int NiulteL'nicer Mclceeu Cattel* \-t•nsity AIedit I;whcrt .I. I3ttel, lhstitttte;, BeI.cnn G/. Jacobs I'rofessor ofl Cho.ton G. L;ot ,;iversity o: ('L•ir4-nce Cool#Ti~ilacco l.tls T::ilioratory. 11"illii nr IP. Iii Univer.itv. S liwfilolt, C. Sor -f I'11, vsl,(lan l-'rk,'New Y' hl:e C`n.\l 1`t olucsllle i ST11TET -5h2tistical stud.les:of'ulcer incidence r:ither than mortality would 11are been more menn- in,zfnl sii cr mostl nersons n•ho develop the disease are kept under medieal! control andl eventually dlefrom.some.other cause;.

1119 aims lung ~, the view nent, com- reffi.tl. :) de- :tar'', ;itorv otinee to be i, the • this and'' ip of )king luali- pool"' a the may ay be bacco be ar~- -ed inn ve no s~~ not~ iallyze, res as. thesee scien- Nrhich ciga~ ntists open: liemi- ,f sev- otmds Agnin; some i{cient lation ~ bear- these 1. same lation versus oral), but also there are great differences in, the way the body reacts to a material i'n fixed quantities but adininsstered over different amounts of time. For example, a certain amount of cigarette smoke could conceivably have a different effect if'it is slowly inhaled rather thanrapidly?inhaled. The rate and amount of' absorption of cigarette smoke constituents probably depends upon the following factors : 1. The length of time the smoke remains in contact `vith the mucous membranes. 2. The acidity of tlhebody fluids -with which the srnokecomesin contact. 3. The depth and' degree of'inhalation. 4. How accustomedtheperson is to smok~ing, :. The chemical content of the tobacco smoked., 6. The moisture content of the tobacco smoked. i.'11'he form in which the tobacco is smoked, for example, finely cut tobacco, coarsely cut tlobacco; amdl so forth. 8. The amount of cigarette remaining when the smoking is stopped.. 9. The use of aa filter. 10. The a~ciditvof'thetobacco smoke. 11. The agglomeration of smoke particles. 12. Theamount of'moistureover wliichi tiliesmoketravels. All these variables must be carefull'vstudied and held constant before a scientist can accurately predict absorption. There is great variance in susceptibility among laboratory animals. There are manypotent-i'al factors which mavaffect their health. It is important that other environmental factors be studied to see if'they produce similar results in identical situations as are used in the study of cigarette smoke or condensate. The problem of our total environ- ment's effect on disease must be ptrti in proper perspectiv.e M'any every- davmaterials mclv be d'angerousi lieaningful research leading,to facts, tlien public dissenninationi of the facts is appropriate in a society based oni an educated freedom ofchoilce: As a scientist, I find no persuasive evidence that cigarette smokingg causes, lun(r cancer: Further, if' eigarettesmokingwere mad'eil'legal or i'f' warnrngs about smoking go%eyond the true state of scientific knozvledge or if eertain cigarettes are eliminated from the marketplace on the basis of "tar"' and nicotine contenti-might the public turn else- where for, satisfaction? Certainly there is reason to believe the con, sumption of alcoholic beverages and the illicit use of drugs; and so forth„ would increase. These self-indulgences may be dangerousto the person and alao to anyone with whom he comes in contact. I[n~ summary, there is insuflicient eviidence to determine the etiolog y. of lungcancer: There hasbeen,~ abovea~ll, a consistent f'a,iluretodem-onstratea causativerel'atiienship between ci-arettesmokingand lung cancer. Legislation which is directed at causing people to stop smoking may simply encourage some personsto turn to practices which constitut'ea real dangertoinnocentthard parties.

11078 ~~ able agreementl between Dr. Kreyberg's diagnoses and mine, confirming the find- ing ofl a low ratio of Group I:, Group:II tumors. Thus, errors by the pathologistl in classification did not seem to be the explanation for our findings. Since the: L AC-US'C3iC material appeared to: be different fromi that in the countries reported by Kreyberg and others, I undertook a further studg t'o see if a geographical explanation for these:differences eaistedl The study was dividedd into two phases: Phase one: was an analysis of the cases of primary lung car.- einoma observed at necropsy from 1958' to 1963': to determine whether or not trends noted in the previous study still existed. Phase tR o n as a survey of three different locations in the United States to determineif'~ a true variation in thee distribution, of Group II and Group II lung cancer occurred among these areas. Sites selected were the Francis Delafield Hospitlal,, New York;~Yale University, \ew Haven, Connecticut; Charity Hospital, New Orleans. The study was designed on the same basis as:tbat previously used at the LAC- USCJIC. ATli neoplasms were designated on the basis of I:reyberg's criteria and methods.. A recent revision of the WHO: classification (15) was not used, both because of' the need to maintain comparability with the Los Angeles study and because I am not convinced, that the revision is helpful. Of course, the character- istics of the lung tumors remain unchanged', regardless of'the classification labels. Distribution of the hilstologictcpesofltmgc tumorsfrom~ the LAC-USCJIC and those from Francis Delafield andl Yale-New Haven are compared in Table:1. Tumor distribution of all major types for LAC-USCIIC data andi for Francis. Deiafieldi are similar, except for the slightly higher proportion of epidermoid (squamous) carcinomas in, the Francis Delafield material. Althoughi the results, from; New Orleans are incomplete, preliminary tabulations indicate: that the tumor distribution is similar to that of Los Angeles and', Francis Delafield. How ever. differences «ere notedin the proportions for both epidermoid andiglandular groups in the Yale-New Haven figures. The proportion of glandular tumors for Yale was 10 to:15FJd lower than for the:other two locations, while the epidermoid group~ was 10 to 15% higher. The ratio of Group I to Group III tumors for Francis Delafield and' LaC= USC\IC' are similar;, iie., 1L7: 1 and 1.3 : 1, respectively. As previously noted: the data fromi LAC-USC\IC show ai decrease in the ratio with the passage of time. On the other hand, the datia from,Yale-\ew Haven revealed a 3.0:4 ratio, which issimillar to those reported' bgRreslierg for N'ornvay (3) and' VeniQe(,8), but different from Great Brit'ain (7) and Finland (9). Although smoking habits were unknown in many indiridtials, histories of' heavy cigarette use were obtained for numerous patients in each histologic group. :'< history of nonsmoking was verified in some patient'6. Data from Los! Angeles andi Yale-New Haven indicate that, ini nonsmoking women and men, although glandular tumors predominated~ other cell types-inelnding epidermoidl (squa- mous)-were also present. co. CI:Li~SION ' The theory that cigarette smoking lias caused ai rise in incidence of'epidermoiilf tumors of'the lung, (Group I) is not' supported by our studies. Since other areas of the United States show the ~ame distrit>ution~ of types of tlumors as Los An,geles, the Los Angeles data cannot be dismiirsed as merely an unusual geograph- ical result. On the other liand, there are areas in the United States and abroadd which show a distribution of t'ypes of tumors very different from that of Losl Angeies. Therefore, much more work is necessary before we can understand any possible relationships between types of tumorsi and, possible causes. Fiihue workshould' include research in relation to host factors: f16. 17).I2nmunological' (18), hereditary (19) and endocrine (^0) chnractieri's•tiesmay ' beimportantl ini determining why individuals;et lung cancer.Fi;tensive further investigation i~ni these and other areas is needed to~ establish the causesoflnng, cancer, and to determine whether or not cigarette sniol:ing is one of them. TABLE' 1.-COM Type tumor SQuamous____--_-_-_, Adenoca,rcinoma--,--- Blixed--~-----~--~-----A naplastic-_-...----.--, Bronchliolar_____,___ _ _. Un~ifferentiated Iarge: AdAnoma-----_---,-_, Other Ma1e-te^ ale ratioi--_ "Incomplete:. 1. Adltr,I.:i and Clini 2. Wiilis, R. a 3. Iireyberd, I ology of 4. Kreyberg, 5. 6. I"irzyberg, Pi:ec, & , Q T. D~ll, Rl, Hil tot'he eti S. Ferrari, E. Venice. I 9. Kreyberg, andi\orv 10. Spain, D. types of 11. O'Neal, R.. Cancer, 7 12. W}-uder, E iairl'. 13: Heriuan,, D in relatil t'ancer I L'.1S. Pttblil Committ ton„ D:C UritL J. C I"ii-eyberg, 1 -IC15-109, 15. Kreyb erg, , toio,gical. tiow of 7 16. Arardon.rid(Hbst., 9Y-17. Suutniers:. 10-4-111, IS. Iir;tnt -lIl 19. aiteratib 1968. Ilosle,v, HI 1969. ' 0 W ^0, Lciitr>rial l. ~ Growth, ~ ~ ~. ~'

I087 ly ' a. S. J. L r- a r s t i i 33. Sommers, S. C.: Endocrine changes after hemiadrenalectomy and total body irradiation in parabiotic rats. J. Lab. & Clin. \Iedl, 24!:, 396-407, 1953. 34. Holt, lI. W., Sommers, S. C. and Warren, S:: Intranuclear changes resulting, from exposure to ionizing radiation as detected in,frozen-dtied prepara- tions. Lab. Invest.,,2: 40S-4,18: 1953:35; , Sommers, S. C., Geyer, B, , S. and Chute,, R. 1V. : Autoradiographie arsenic localization in adult and embryonic epithelium and' connective tissue,, Proc. Soc. E per. Biol. & Jled., 84 : 234r239;,19531 36. Sommers, S: C.,, Telbh, H. A, and Goldman, G. : Ovarian influence upon sur- viva1 in breast cancer. Arch. S1irg,, 67: 916'-919; 1953: 37. Sommers, S. C. and Lombard, O: IT. : Cancer associated with ovarian stromal' hyperplasia. Archi Path., 56 : 462--165,1953:. 8:Warren. S: and Sommers, S. C.: Patholo;vof regional ileitisandulcerativecolitis: J. Am.,1Ted. Assoc., 1'5-1:,183-193, 19541 39. Acl<<mson, N. E., Jr. and Sommers, S. C.: Endometrial ossification. Am. J. Obsti. and Gynec., 67 : 187-190; 1954. -i0: C1nrte, R. \.,, Iienton, H. B. and wommers, S. C:,: A laboratory epidemic of: human-type: tuberculosis in' hamsters. Am. J. Clin. Path., 24:: 223-226, 1954. 41. 3iarcial; Rojas, R. A. and Sommers, S! C.: Differentiat'ed mucoepidermoid tumors of salivary glands. Archi Otolarying:,,59: 1.;5-14,0, 1954., 42. Hallander, A., Sommers; S. C. and Grimn-ade, A. E.: Histochemical and, ultravioletl microscopic studies of chronic dermatoses and the coriumm membrane. J. Invest. Dermat., 22: 335'-34S,1954. 43. Strande, A., Sommers; S! C. and Petrak, M.: Regional enterocolitis in cocker spaniel dogs.A,rch: Path,, 57: 357-362, 1954. -I4:, Sommers. S. C. and \Ieissner, W. A.: Basement membrane changes inichronicc thyroiditis and other thyroid diseases. Am. J. Clin. Path., 24: 43-1-44'0;, 195I'. 43. Wood„ J. S., Jr., Holyoke, E. D., Clason, W : P. C., Sommers, S. C. andWar- ren, S.: An experimental study of the relationship between tumor size and' number of lung metastases Cancer,, 7: 437-443,1954. 46. Goddard, J. W. and Sommers, S. C. Method for thyroid cell mapping: Lab.. Invest., 3 : 197r210,,19541 47. Colcock, B. P. and Sommers, S! C.: Prognosis in Paget's disease of the: breast. Surg. Clin. -N. Am., 34: 773-783, 1954: 45., Burt, A. S.,, Landing, B. IL and Sommers, S. C. :Amphopliill tumors of the, hypophysis'induced in1 mice by I": Cancer Res., 14: 497-502, 1954. 4'9: Sommers, S. C; and 3Teissner,, W. A. : Unusual carcinomas of the pancreas. Arch. Patih,, 58't 101-1111 1954. 50:, Sommers, S! C., Edwards, J: L. and Chute; R: \.:, Increase ini hyper- sensitivity lesions and parabiosis intoxication after adrenalectomy. J. Lab. a nd Clim JIed., 44 :~ 531-543; 1954.. 51. Sommers, S. C., Crozier, R'. and Warren, S:: Ultraviolet microscopy of' glomerulhr diseases. Am. J. Path., 30 : 919-939, 1954. 52. Turner, D. D: and Sommers, S. C.: lledical intelligence. New. Eng. J; Med., 251: : 744-745;,1954. 53. Patterson, W. B'., Cliute, Rl N. and Sommers. S! C.: Teanplar.tatian of'humnn tumor;5intocortis~one-treat'ed hamsters: Chancer Res:,, 11.:, Gi",C>-659;,1954. 54. Gk,ddard, J. W. and Sommers, S! C. : Thyroid stimulationi in diabetes me1- litus. Diabetes,,3 : 383-3yS. 1R.)-1:, 55: Sommers, S'. C., SIiirphy;, S: A. and'1S'arren, S. :, Piincreatic duct h,rperplasia and cancer. Getstroenterologc-, 27 : 629-F10, 1954. 54. Roliman„ lI. and Siimmors. S. C.: A double primary carcinoma of the urinary liLldiler. J. Ui•o1.,,72: 117:1-117,7, 1954. 57. Somniet s, 5 C.: Some applficat'ions of ultraviolet mac_roscopy to~ pntfioing;v. 105-10v.1954: 59:, Lemt,n, IJ. M. and Sommers; S. C.: Clinicopatliologic conferenae: _Ym. J, Clin. Path., _'4': 1i-S0:.'-1407.. 1fY.;-1..i9. Suinmers, S. C:. Croziirr, R.and Warren. 8:: A stady of t;jeultraviolet' muiu scopc of'renali v,asuular ili etyes. C,rculat'~on. 1'1: ti13. 60. Wuod i. S: 7r... H;,lyo>>e. I7, D., Coinmrrs. SCl anclWaricn `r:: liiflnunce of pituitary ;;i•ou-th]iorinone on;rowth and metitasi:form;itionofa tr in pL•intahle mousesaiicoma. 1131111. Johns IIS,pltinsIIop:, QG !i ;-1'00, 1r>> 5. 61. Sinnuiei.s, SC.and R'itrren,a:: Ulceratih-e colitis lesi~onsin irradiated rats. „\uu J. Dietst,D'l9', 22: 111, 1195i,.

1093 The renal ,)t•,ascuiar , I'Ii. FT- a absence densa to .nd carci- n in nou- n tumori- )rolon;ed, Res. 26: i~ <tenotic f Human e Serum. glomeru- ,p. Med. . W. F.: , .._Rpla- II ith Pan- I i,i;r and il Secre- tivity in ez~earcb. Laragb, ,w 1Png,., rablot1C anuaryi tlttntioni of the Disease 7. 1 Cti6: ~ ~troen- epts in. "\ etv c•rative Ii~ ~ n s „e. ~~ Ltlte~st. .i:, fif xii-na1 _'00. Leon. \, and' Sommers, S. C. : Cells of' masculinizing type in ovary of a patient with feminine phenotgpe. Acta Genetica et Stat. Med., 17:345, 1967. ?201. tsonick, H. C., Paul. SV.,, Sommers. S. C: and Guze. L. 131 : Ftmetional studies in experimental pgelonephritib. II. Correlhtion between acidl excreting ability and~ enzyme histochemistlry; Acid' eicretion and enzyme histo- chemistry in experimental pyelonephritis. \ephron4 4:75, 1967. 202. (_"'i,idenberg, V. E., Buckingham, S' and: Summers, S. C.' : Pulmonary alveo+ iar lesions in vagotomized' rats. Lab: iuvest: : 16, 963, 1967. , _(13. :ommers. S: C.. Reeves, G; and Reeves; F.,: Immunologic and chemothera- peutie' effects on human, melanoma lieterotranspiants. P>•oe. Soc. Exp. IaoL and Jled:. 1_'3:740: 1967:. _'04: B„ckinrham. S!. Sommers. S! f" and Sherwin, R. P:: Lesions of the dorsal' vagal nucleus in the respiratory distlress syndrome: Am., J. Clin., Path. 48 :269. 1067. `0:5. `ommers. S. C.: Systematized nomenclature of pathology. Pathologia et II7crobioLogia, 30 :8'26. 1967. 20t;. S ira uss: 3I': D!, Sommers, S. C. : Siedulla¢•r cystic disease and familiall juse- niie nephronophthisis. New Eng ;, J. llied. 277:SG3, 1367'. `_'07'. E;alii. L•'; H.. Long, :lS. III., Fi•ick, H. C.. I!I and Sommers; S. C.: Long-term surviv,ad in disseminated ovarian carciuoma. Am. J. Obst. and GWnec., 99:~ ;,22, 196Z 208:Denning, C. R., Sommers, S. C. andiQiiigley, H. J.: Infertilitsin malepatientlswitlhi cystic fibrosis. Pediatrics, 47 :7-17., 19uS. "_09! Harrinbton, J. T.. Sommers; S. C:,and liassirer, J: P.: Atheromatous emboli with proeressive renal failure. Renal arteriography as the probable incit- iii- , , factor. Annals ofIizt. .lled., 68: 152-1604 1965'. ^_10: C. nnon, P. J.,, Leeming: .I: Somtue:rs, S. C:. Winters; R: W. and Laragh, .T. H.: Juxtaglomerular cell hyperpl.2sia and secondary hyperaldosteron- ism (Biirtter's Syndrome) : A reevalttation, of'the pathophysiology. lledi- cine, 47:1:07-131, 1965. 211. L: a•a;eli. J. H., Ledinrham. J. G. G. and Sonuners: S. C.: Secondary altloster- onism~ and redneedlila~ma renin iii hypertensive disease., Trans. Assoc. Am. Physicians. IRFX:1hS 151, 1cJ6S: 212. Markewitz, lT., Sonnnei ~. S. C:. VeenenTa: RI. J: and Butler, DiL D.: Testicu- lar biopsy artifact's resulting frotn improper tissne processing. J. Urol., 100 ~: 4'4-k9, 1965; 213. Sommers, S: C.: Iir (J.M.B: Blondwom•th, editor) "Tettbool:: of' Endocrine Pathology" Thrlroid, Glanrl. Williams and Wilkins Co., pp 133-180. 1968. 214~ tiommers;_, S. C.: In"Textbook of EndocrinePathology":.T.-IP.B. Blood4 worth„edit'or., Endocrine_tc•tiri'tdtraofNoncndacrineTissue Tumors: Wil~?iRms~and,W'ilkius Co:. Baltimore, .lld.,1fl6~a;215: Altchek. A.. Albright, \. L~ and Sommers, `; C. :'1',he renall pathologyy of' toxemiit of'preg~nancg. (1)i: and G,cn,$11:5515'-ti0'u., 19i,s;, 216:BnclcinYham, S.. ;lonimers; 14. C_;,and Sh°Nar.y. W:,F:: PxperiYuental respira- tory distress syndrome: I Central' autnnomic and humoral pathogenetic factors in pulmonarv in,iurv ofr.its induced with hc,perbaric osygeniand' the proteirtii-e effeots ofbanbitu'r.ntesand Tra~ydol ~,Q ` Biol'. Nconat., 12':261 '2ti1. 1068. 2117. Paley, W. B.. Phaneufl. G', J. and Sommers, S. C.:Cuinciclentall primary sarcoma and carcinoma of the cervix. Qb. and! Gyn. 3.','c4'~i~4Z, 1969: 2218. Goldenberg, V'., E., Buekikt.;liam. S. andSommers. S. C.: Pilocarpinestimu- l;ation of grannLarpneuniocytesecn:etion, Lab. Invest, 20::1-47-1:iS. 1969. 279. F"iister. S: J~. Sbmmers. S; C'. BI,nazensen,,D: C.. Fi•iecl'ell', G. H~ and Cooley, E.: _\'iicl(,ar l:rade and sinus hi~4tibcytosis in cancer of'the breast. Cancer, 23' :57D: : 7u: 1969. 220. Sommers„ S. C1 :His#ologic changes in incipient carcinomn of the breast. Citncer„ 23':S'