Tobacco Documents Online

212 STATEMENT OF THE AMERICAN COLLEGE OF PHYSICIANS on S. 1929, the "Comprehensive Smoking Prevention Education Act of 1981" Mr. Chairman and Members of the Committee: The American College of Physicians (ACP) is pleased to have this opportunity to provide its comments on S. 1929, the "Comprehensive Smoking Prevention Education Act of 1981." As you know, the College represents over 54,000 doctors of internal medicine, related non-surgical specialists, and physicians-in-training. The ACP membership includes private practitioners delivering primary health care; medical specialists in such fields as gastroenterology, endocrinology, oncology, and cardiology; medical educators; and researchers. The legislation presently before the Committee seeks to establish a new strategy for educating and providing information to the American public about the hazards of smoking. It would thereby allow members of the public to make more fully informed decisions as to whether they will choose to smoke. The American College of Physicians strongly supports the central purpose of the legislation and believes that 213 -2- such an effort represents an important and ar initiative -- an initiative which we believe health interest of this Nation. - We concur in the scientific finding that ciga important preventable cause of illness and pr In particular, the American College of Physic most recent report of the Surgeon General, "TI Smoking," both warrants and requires the full and policy makers concerned with the protectic We believe the statements that "cigarette smok cause of cancer mortality in the United States single action an individual can take to reduce effectively than quitting smoking" lend strong efforts to more fully infono the public of the smoking. flespite statements of some to the contrary, th dispute with regard to the numerous health haz Cigarette smoking is a major cause of cancers and oral cavity. Smoking is a contributory fac urinary bladder, kidney, and pancreas. It is i bronchitis and emphysema and a major risk factc and arteriosclerotic peripheral vascular diseas to smoking are in excess of 300,000 annually. for one out of four of all cancer deaths and it thirty percent of all cancer deaths are attribu

213 -2- such an effort represents an important and appropriate governmental initiative -- an initiative which we believe is clearly in the public health interest of this Nation. We concur in the scientific finding that cigarette smoking is the single most important preventable cause of illness and premature death in the United States. In particular, the /4nerican College of Physicians believes that the most recent report of the Surgeon General, "The Health Consequences of Snoking," both warrants and requires the full attention of health professionals aod policy makers concerned with the protection of the public health. We believe the statements that "cigarette smoking is the major single cause of cancer mortality in the United States" and that there "is no single action an individual can take to reduce the risk of cancer more effectively than quitting smoking" lend strong suport to this Committee's efforts to more fully inform the public of the health risks attendant to smoking. Despite statements of some to the contrary, there is no scientific dispute with regard to the numerous health hazards presented by smoking. Cigarette smoking is a major cause of cancers of the lung, larynx, esophagus, and oral cavity. Smoking is a contributory factor in cancers of the urinary bladder, kidney, and pancreas. It is a major cause of chronic bronchitis and emphysema and a major risk factor for coronary heart disease and arteriosclerotic peripheral vascular disease. Estimated deaths related to smoking are in excess of 300,000 annually. Lung cancer alone accounts for one out of four of all cancer deaths and it is estimated that at least thirty percent of all cancer deaths are attributable to tobacco use. I ® 4

214 -3- It is important to emphasize that at this time, despite the advances made in the treatment of certain cancers, the five year survival rate for lung cancer is less than ten percent. Despite advances in our ability to perfonn early diagnosis and treatment we have not significantly altered this survival rate. The best preventive measure with regard to cancer of the lung is not to smoke -- this means that those who smoke should stop, and that those who do not smoke should not start. Lastly, important evidence has been accumulated on the effect of maternal smokina on pregnancy outcomes and the well-being of infants, and there is emerging evidence on the adverse impact of smoking on healthy non-smokers. This latter evidence challenges any statement that smoking is solely a matter of individual choice. The fact that new evidence is being developed on the impact of smoking on health must not diminish the fact that there already exists a substantial body of irrefutable scientific evidence with regard to the health hazards and increased premature mortality associated with smoking. It should be emphasized that there is clear scientific consensus as to the veracity and import of this existing evidence. In view of the cost to society -- in both human and economic terms -- which smoking represents and in view of the recognized need to be more diligent as a society in our efforts at health promotion and disease prevention, the American College of Physicians believes that every reasonable effort should be made to alert the public to the range and magnitude of the risks 215 - a- associated with smoking. It is imperative tl to ensure that those who may choose to smoke i risks to their health and the health of other! this action. In addition, we would note that with regard to the addictive properties of tot additional concerns, and that efforts must be to the American public. As physicians, in particular as specialists in its related subspecialties, we are fully aware scientific support for the range of specific w legislation before the Committee. As provider care to adults, we have a strong interest in p and in the mechanisms by which health-related We support the proposed changes in the present cigarette packages. As we have stated, given health risks associated with smoking, we belie effort should be made to accurately convey to this health risk. We believe that the specificity of the warning legislation will help to emphasize the risk wh time they smoke. We also believe that it is v to smokers the fact that quitting smoking will health. We are pleased to see that under the messages would be presented. Some might argue

215 - a- associated with smoking. It is imperative that we make every effort to ensure that those who may choose to smoke are fully cognizant of the risks to their health and the health of others which are being incurred by this action. In addition, we would note that the emerging scientific evidence with regard to the addictive properties of tobacco smoking raises new and additional concerns, and that efforts must be made to convey this information to the American public. As physicians, in particular as specialists in internal medicine and its related subspecialties, we are fully aware of the overwhelming scientific support for the range of specific warnings outlined in the legislation before the Committee. As providers of primary and continuing care to adults, we have a strong interest in preventive health measures and in the mechanisms by which health-related information is conveyed. We support the proposed changes in the present labeling requirements for cigarette packages. As we have stated, given the clear and dramatic health risks associated with smoking, we believe that every reasonable effort should be made to accurately convey to individuals the nature of this health risk. We believe that the specificity of the warnings outlined in the proposed legislation will help to emphasize the risk which individuals take every time they smoke. We also believe that it is vitally important to convey to smokers the fact that quitting smoking will reduce the risks to their health. We are pleased to see that under the proposed legislation both messages would be presented. Some might argue that the information conveyed I a H

-5- by the proposed warnings is too graphic, but we would counter that the scientific evidence underlying these warnings is also quite graphic. We believe that the specificity of the warnings and their prominence on the packaging materials will provide an important adjunct to our efforts as health professionals to counsel patients in maintaining sound health and reducing the risk of preventable disease and illnesss. Some have argued that there is not sufficient evidence of the "effectiveness" of the proposed system of rotational health warnings. However, we believe that such an argument is without merit in the face of such substantial and clearcut evidence of adverse health effects and premature mortality, and in view of the tremendous social costs associated with smoking. It is our belief that this preponderance of evidence carries with it a responsibility and in fact a duty to warn the public regardless of whether statistics are presently available which indicate that the public will in fact heed this warning. We also believe that in the interests of sound international health policy -- and in keeping with a longstanding commitment to being cognizant of the health needs of all people -- warnings should appear on all cigarette packages produced and manufactured in this country, irrespective of where they are ultimately offered for sale. In addition, we support the provisions included in the proposed legislation which would require that nicotine, tar, and carbon monoxide levels be disclosed. We also support efforts to require that information be provided to the Federal Trade Commission and the Department of Health 217 and Human Services with regard to those ct manufacture of cigarettes and the quantit'. At the present time it is extremely diffic risks of cigarette additives because of tt Those listings of additives which presentl specific in terms of the types and quantit being used. The presently unknown health must be explored and such an assessment ca scientific community has access to more ca growing national concern with toxic substa with regard to the possible synergistic ef believe that a national compendium of info should be considered if we expect to be ab health risks. In conclusion, Mr. Chainnan, we support eff of the health hazards, including the incre: associated with smoking. As public policy the importance of individual efforts at dii we believe that it is essential that indivi on the risks associated with smoking. It i this Committee will substantially enhance c to convey vitally important scientific infc The American College of Physicians is pleas efforts and is available to respond to any

-6- and Human Services with regard to those chemical additives used in the manufacture of cigarettes and the quantities of such additives. At the present time it is extremely difficult to fully assess the relative risks of cigarette additives because of this lack of basic information. Those listings of additives which presently exist are not sufficiently specific in terms of the types and quantities of substances actually being used. The presently unknown health effects of cigarette additives must be explored and such an assessment can only be undertaken if the scientific conmunity has access to more complete information. Given our growing national concern with toxic substances and our developing knowledge with regard to the possible synergistic effects of certain substances, we believe that a national compendium of information on cigarette additives should be considered if we expect to be able to assess present and future health risks. In conclusion, Mr. Chairman, we support efforts to better inform the public of the health hazards, including the increased risk of premature mortality, associated with smoking. As public policy turns increasingly towards emphasizing the importance of Individual efforts at disease prevention and health maintenance we believe that it is essential that individuals receive complete information ' on the risks associated with smoking. It is our belief that the measure before this Committee will substantially enhance our efforts as health professionals to convey vitally important scientific information to the public. The American College of Physicians is pleased to lend its support to your efforts and is available to respond to any questions which you might have.