Tobacco Documents Online

194 195 Dear Mr. Chairman and Members of the Committee: ..r«« DAN G ucNAMAM, N.D- F~Ma SULW.YE B NNOEBEL. M.0 N~.IN...r F.uN~y ROBERT 0 BRANOENBURG. M D. ........ EBERT MO ~.. wr. JDNN w wALaNAUSEN. MD JMM..N..p.W, .DOLPN M NUnER. JR., M.U JWY. 1....« ANES J EONARO M D CW.vI bw. N Cwxmn GOTTl-EB C FRIESINGER. N. M D. n.r... ALTER N ABELMANN. N D ROBERT 0. 9RANDEMBURG. M.D. DAVID 9 CARMICN.EL.J .. M.D. LAWRENCE S. COHEN. M.O. ROBERT D CONN. M D TNOMAS C 01cNINSON M.D LEONMD S DREIFJS. N D. YAUL J. EBERT. M D. ROBERT S EIIOT, M D. GOTTLJEB C FPIESmGER. U. Y O. B LEONARO NOLMAN. M 0. J. O'NEAL N nRiES M D. ADOLPN Y NtRTER.JR. M 0. PRANCIS J RLOCNE. M.D. BUZANNE B RNOEBEL M D JAMES J LEONARD M D. ROBERT J LUCNL MD DWIGNT C McG00N. M.O OAM G McnA.MARA M D CHARLES B. MULIINS. M 0- WILLIAM W P RMLEY. M D. VICTOR PARSONNET, M.D. JOHN N. PHIILIPS. M D CNAFLES E. RACKLEV M.O. DONALD E 5 UN'DERS JR. M 0. JALR P. SEGAL. u.0. ' BOATS SURAWICZ. ND. JOHN A WALONAUSEN M 0 RNOLD M. WEiSSLER. M0. JONM F. WILL/AMS. JR . N 0 tueMl.. Dlsl« WILLIAM 0 NELLIGAN. CAE awNr E.s.B.. Ur«Nr - WIILIAM D COUGNLA.V. CAE AseIN. Ese1W. BN.cla 00MALD J.JABLONSNI American College of Cardiology HEART HOUSE 9111 OLD GEORGETOWN ROAD BETHESDA. MARYLAND 20814 (301) B97-540D STATEMENT on S. 1929 "Comprehensive Smoking Prevention Education Act of 1981" of Dan G. McNamara, M.D., F.A.C.C. President to Honorable Orrin G. Hatch Chairman Committee on Labor and Human Resources March 16, 1982 I am Dan G. McNamara, M.D., F.A.C Pediatrics and Chief of the Card: Baylor College of Medicine and Te Hospital. I am also President of College of Cardiology, a professi cialty society representing over scientists and educators who spec of the heart and circulatory syst cated to ensuring optimal care fc cardiovascular disease and those for developing cardiovascular di- educational and socioeconomic act bute significantly to the prevent

195 Dear Mr. Chairman and Members of the Committee: I am Dan G. McNamara, M.D., F.A.C.C., Professor of Pediatrics and Chief of the Cardiology Section, Baylor College of Medicine and Texas Children's Hospital. I am also President of the American College of Cardiology, a professional medical spe- cialty society representing over 11,500 physicians, scientists and educators who specialize in diseases of the heart and circulatory system. ACC is dedi- cated to ensuring optimal care for persons with cardiovascular disease and those with the potential for developing cardiovascular disease and, through educational and socioeconomic activities, to contri- bute significantly to the prevention of cardiovas- e

196 Mr. Chairman and Members of the Committee Page Two cular disease. It is in my capacity as President ..:vrH of the College that this statement is made on _.. ~ ; S. 1929, the "Comprehensive Smoking Prevention Education Act of 1981." One main concern of the College is whether consumers;-' receive sufficient and accurate information on the 5o~ demonstrated relationships between cigarette smoking and cardiovascular disease. The College believes _. : that consumers are provided with insufficient infor-. mation on the demonstrated relationships between cigarette smoking and cardiovascular disease and that this lack of information weakens a physician's role in altering a patient's smoking behavior. As the Federal Trade Commission noted in its "Staff Report on the Cigarette Advertising Investigation" (May, 1981), which we commented on (attached), "substantial portion of the public remains unin- formed about the hazards of smoking," and that FTC tests "indicate that the (current) warning is neither noticed nor read by the vast majority of people." Even though the current warning indicates that the Surgeon General has determined that cigarette smoking I is dangerous to one's health, 17% of all s:^okers and 24% of heavy smokers do not know that smoking 197 'hairman and Members of th. 3.-e Three _5 :zazardous to health. Addit: _i-::sumers themselves agree tha- -irning is inadequate. -;hv not provide the public wit: ;•. ality of information sought? -...-es, nearly "two out of ever<. __=_ng the 1978 Roper survey fc r.stitute, believe that the cui - "adequate" and indicated tt :-alth warning that describes t =_sks of smoking." '% 1973 Gallup survey of smoker; :_und that 32% were not aware c ;~iationship between cigarette -ttack; that 37% of smokers dic ---~Iationship; and that among he ==' not know the increased ris} Isscciated with cigarette smok: 3=udy, conducted by the FTC, fc '_neral oopulation and 31% of < `::at smoking greatly increased -'tack despite research that cc -~:=s a person's risk of hea: consumer knowledge of tht -:7arette smoking, birth contrc

197 Mr. Chairman and Members of the Committee Page Three is hazardous to health. Additionally, as noted, consumers themselves agree that the current warning is inadequate. Why not provide the public with the type and quality of information sought? As the FTC report notes, nearly "two out of every three questioned during the 1978 Roper survey for the Tobacco Institute, believe that the current warning is not "adequate" and indicated they preferred a health warning that describes the specific health risks of smoking." A 1978 Gallup survey of smokers and nonsmokers found that 32% were not aware of the statistical relationship between cigarette smoking and heart attack; that 37% of smokers did not know this relationship; and that among heavier smokers, 40% did not know the increased risk for heart attack associated with cigarette smoking. The 1979 Chilton Study, conducted by the FTC, found that 25% of the general population and 31% of smokers did not know that smoking greatly increased their risk of heart attack despite research that concluded that it doubles a person's risk of heart attack. In addi- tion, consumer knowledge of the relationshio among cigarette smoking, birth control pills and heart I 9 0 0 I

198 il-tc. Chairman and Members of the Committee Page Four attack is low, despite the fact that women who smoke and take birth control pills have approx- imately ten times the risk of a heart attack of women who do neither. 199 ;•1r. Chairman and Members of th Page Five other health professionals in risks of smoking to their pati The College would recommend th Surgeon General has Determined Therefore, the College agrees that the current cigarette warning is not effective relative to the public's need to know and act on the strong scientifically-validated statistical relationship between cigarette smoking and cardiovascular disease. The College agrees with the need to . improve on the type and content of the required cigarette warning labels. Therefore, in reviewing the FTC report and its conclusions, the College endorses the concept of rotational warnings as being more effective than the current warning. The College believes that the labeling approach and specific warnings contained in S. 1929 (as modi- fied below for scientific acceptability) will assist consumers in making conscious, more informed deci- sions about smoking, because they will have more definitive information on the specific health con- sequences of smoking. This type of information, also,will assist cardiologists, other physicians and Smoking Causes Heart Disease" follows: "Current scientific that Cigarette Smoking is a Ma for Coronary Heart Disease." also recommend that "Current s, indicates that cigarette smoke: to sudden death," and "Current dence indicates that there is lationship between cigarette sr disease, cancer or emphysema" 1 In addition, the College_belie• of the wording of the bill relz nation of research, conduct of authority of the Secretary to c visions of this bill through gi ification to avoid duplication cigarette smoking effects heinc ~ NCI and other Institutes at NIf O :neans the implementation ~ N of a :

199 Mr. Chairman and Members of the Committee Page Five other health professionals in communicating the risks of smoking to their patients. The College would recommend that "WARNING: The Surgeon General has Determined that Cigarette Smoking Causes Heart Disease" be amended as follows: "Current scientific evidence indicates that Cigarette Smoking is a Major Risk Factor for Coronary Heart Disease." The College would also recommend that "Current scientific evidence indicates that cigarette smokers are predisposed to sudden death," and "Current scientific evi- dence indicates that there is a significant re- lationship between cigarette smoking and heart disease, cancer or emphysema" be considered. In addition, the College believes that one aspect of the wording of the bill relating to the coordi- nation of research, conduct of research and the authority of the Secretary to carry out the pro- visions of this bill through grants, may need clar- ification to avoid duplication with research on cigarette smoking effects being conducted by NHLBI, NCI and other Institutes at NIH. If coordination means the implementation of a systematic exchange

200 Mr. Chairman and Members of the Committee Page Six of information on the research being supported .,.;. by different agencies, this would be useful. If, however, the purpose is to provide the Office ~ of Smoking and Health with authority to direct the research of Institutes, the College believes ~ it would be counter-productive and undesirable. However, authority to conduct types of research that do not fall clearly under the authority of the categorical Institutes could be appropriate for the Office of Smoking and Heal th. Examples of such would be in monitoring national trends of cigarette consumption in different age groups, surveillance of the composition of tar, nicotine, carbon monoxide and other potentially harmful constituents of cigarettes and maintaining the periodic reporting of new research findings. In addition, the College also believes that the Congress should review all the current material on the connection between cigarette smoking and the costs to society through increased medical costs and reduced productivity in order to provide a basis for furtaer cigarette smoking prevention efforts. 201 Chairman and Members of the ~ ?age Seven I trust that these comments that ;upport for your efforts in this assistance to you and the Committ te pleased to provide you with ar tance.

support for your efforts in this area will he of assistance to you and the Committee. We would be pleased to provide you with any other assis- tance.