Tobacco Documents Online

218 Testimony of THE AMERICAN COLLEGE OF CHEST PHYSICIANS Submitted by Thomas L. Petty, M.D., F.C.C.P. President regarding S. 1929: "The Comprehensive Smoking Prevention Education Act of 1982" Senate Labor and Human Resources Committee Senator Orrin G. Hatch, Chairman March 16, 1982 219 cator Hatch and Members of the Committee: I am Dr. Thomas Petty, Professor :d of Division of Pulmonary Sciences, Un: alth Sciences Center. I am also the Pree ,.;ilege of Chest Physicians, a professiona= :iety of more than 11,000 physicians, sc' ...o specialize in diseases of the heart, 1L .~em. It is .in this latter capacity that r S.1929, "The Comprehensive Smoking Pre•. As pulmonary and cardiology speci . ::t-hand the significant health problems : recognize that we are in a unique posit --:ents to forego smoking in the first plz .~._n health conditions so require. Accordi ._.^,itted to post-graduate medical educatic education of physicians (who in turn ec c: the smoking problem as one of our highes -- In 1968, the College supportec :7ational Clearing House for Smoking anc `,,rum on office management of smoking. Thc .erence were published in CHEST, the of1 -- ACCP joined the National Cancc -'~ the preparation of a correspondence cou: r-,lationship to chronic obstructive lung d :',is course was mailed to tens of thousandi 95-077 0-82--15

I 219 Senator Hatch and Members of the Committee: I am Dr. Thomas Petty, Professor of Medicine and Anesthesiology, Head of Division of Pulmonary Sciences, University of Colorado Health Sciences Center. I am also the President of the American College of Chest Physicians, a professional medical specialty society of more than 11,000 physicians, scientists, and educators who specialize in diseases of the heart, lungs, and circulatory system. It is in this latter capacity that I express our support for S.1929, "The Comprehensive Smoking Prevention Education Act of 1982." As pulmonary and cardiology specialists, we have seen first-hand the significant health problems associated with smoking and recognize that we are in a unique position to influence our patients to forego smoking in the first place and to stop smoking when health conditions so require. Accordingly, as a society committed to post-graduate medical education, we have viewed the education of physicians (who in turn educate their patients) on the smoking problem as one of our highest priorities. -- In 1968, the College supported in conjunction with the National Clearing House for Smoking and Health,a national forum on office management of smoking. The procedures of this conference were published in CHEST, the official journal of ACCP. -- ACCP joined the National Cancer Institute in the preparation of a correspondence course on smoking and its relationship to chronic obstructive lung diseases and asbestosis. This course was mailed to tens of thousands of primary care I I 0 95-077 0-82--15

220 -2- physicians. -- The national media focused on our 1972 Annual Scientific Assembly, when the College established a policy requiring smoking physician-registrants to sit in a special smoking section in the assembly room. This section is no longer utilized because so few of our national convention participants now smoke. Since 1980, new Fellows of the College have been asked to take a pledge that they will use their offices, clinics, and hospital environ- ments as health centers to discourage smoking. -- The College is preparing for publication in CHEST a document describing procedures that the physician should utilize in the office, clinic, and hospital to discourage smoking and to identify the pulmonary specialist's role in smoking cessation.- -- The College is preparing a monograph for distri- bution in October 1982 identifying the responsibility of chest physicians to inquire of all their patients about their smoking habits and to assist patients in smoking cessation. The impact of cigarette-smoking is well documented. It causes approximately 300, 000 deaths annually; this is one out of seven of all deaths in the United States. In 1980 over 80,000 individuals died from smoking-related emphysema and chronic bronchitis; and approximately 200,000 heart attack deaths were attributed to smoking. The Surgeon General's latest report concludes that "cigarette smokers have overall mortality rates substantially greater than those of the non-smokers." The statistics on the impact of cigarette-smoking are staggering and clearly call for relief in the form of the proposed 221 -3- legislation. Regarding lung cancer, t states that: 1. Cigarette smoking is the in the United States. 2. Smokers who consume two lung cancer mortality rates 15-25 time 3. Cessation of smoking red mortality compared to that of the cont 4. The economic impact of 1 approximately $4.25 billion per year i costs, and physician fees. 5. Lung cancer is a prevent estimated that 85% of lung cancer mort if individuals had never taken up smok Over one-third of our member they see in their offices and clinics of smoking vis-a-vis cardiovascular di 1. Smoking is a major contr of heart attacks, sudden death and per 2. Smoking doubles a persor and heavy smokers are three times as 1 attacks and sudden death. 3. Cessation from smoking c cardiovascular disease. 4. The economic costs of ce U.S. is approximately $41.8 billion pc

a 221 -3- legislation. Regarding lung cancer, the Surgeon General's report states that: 1. Cigarette smoking is the major cause of lung cancer in the United States. 2. Smokers who consume two or more packs per day have lung cancer mortality rates 15-25 times greater than non-smokers. 3. Cessation of smoking reduces the risk of lung cancer mortality compared to that of the continuant smoker. 4. The economic impact of lung cancer to the U.S. is approximately $4.25 billion per year in lost earnings, hospital costs, and physician fees. 5. Lung cancer is a preventable disease. It is estimated that 85% of lung cancer mortalities could be avoided if individuals had never taken up smoking. Over one-third of our membership are cardiologists; they see in their offices and clinics the devastating implications of smoking vis-a-vis cardiovascular diseases. 1. Smoking is a major contributor to the occurrence of heart attacks, sudden death and peripheral vascular disease. 2. Smoking doubles a persons' risk of heart attack and heavy smokers are three times as likely to suffer heart attacks and sudden death. 3. Cessation from smoking greatly reduces the risk of cardiovascular disease. 4. The economic costs of cardiovascular disease to the U.S. is approximately $41.8 billion per year in lost earnings fl ® 1i

222 -4- and health costs, both Federal and private. Other chronic respiratory diseases are also caused or aggravated by the direct inhalation of cigarette smoke, including chronic bronchitis, asthma, emphysema, pleurisy, pneumoconiosis, bronchiectasis and other disorders. Over 16 million Americans suffer from these diseases. The most salient characteristic of the smoking problem is that not smoking or ceasing smoking is a means of preventing or delaying the onset of the above-mentioned lung and cardio- vascular disorders. This Committee has been apprised of numerous studies that demonstrate increased life expectancy in individuals who stop smoking as compared to those who continued to do so. A twenty-year study(British Medical Journal, 2: 1525-1536, 1976) of over 34,000 physicians in Great Britain showed that deaths from chronic obstructive lung diseases decreased by 24% for those who stopped smoking. The death rate from lung cancer for those who continued to smoke was 16 times higher than non-smokers; after 15 years of abstinence by smokers their death rate from lung cancer fell to only twice the rate of non-smokers. Most recently, an American Study (American Review of Respiratory Diseases, 125:144-51, 1982) documents that cigarette smoking in adults is the most important predictor of obstructive airways disease and its cessation significantly reduces the future de- velopment of the diseases. The use of a simple spirogram (pul- monary function test) markedly enhances the ability to predict obstructive airways diseases. Another study (New England Journal of Medicine, 300: 213-217, 1979), showed that individuals with coronary artery -s- =::e claims of the tobacco industry that tt exist a scientific causal link between cic and major cardio-pulmonary health problem: cuite clear. Government intervention in t 'asirable when the problem is one of natic costs of regulation are clearly outweighe, . and when the government can perform a func by the private sector. A visible governm, recommitment -- to the eradication of smo; .a believe that the passage of S. 1929 wi: ..e practitioners in educating the public - _nvolved with smoking cigarettes. We wou _` the major provisions contained in this 1. We'support the establishmen the public of the dangers to health from :'oluntary sector cannot bear the entire r ~_ducating the public on the risks of smok _`_ advertising and the volume and influen ivertising are major deterrents to volun establishment of an Interagency Committee to coordinate research and educational ef ~overn:nent and private sectors will help research already being conducted by NIH c It is important that the NHLBI and NCI, a a7encies you have mentioned, be represent Z:om.^iittee.

[F 223 -s- the claims of the tobacco industry that there does not yet exist a scientific causal link between cigarette smoking and major cardio-pulmonary health problems, the evidence is quite clear. Government intervention in the marketplace is desirable when the problem is one of national scope, when the costs of regulation are clearly outweighed by benefit to society, and when the government can perform a function not assumable by the private sector. A visible governmental commitment -- or recommitment -- to the eradication of smoking is clearly required. ne believe that the passage of S. 1929 will do much to assist we practitioners in educating the public regarding health risks involved with smoking cigarettes. We would like to focus on each of the major provisions contained in this legislation. 1. We'support the establishment of a program to inform the public of the dangers to health from cigarette smoking. The voluntary sector cannot bear the entire responsibility for educating the public on the risks of smoking. The high cost of advertising and the volume and influence of cigarette advertising are major deterrents to voluntary efforts. The establishment of an Interagency Committee on Smoking and Health to coordinate research and educational efforts of the Federal Government and private sectors will help to avoid duplication of research already being conducted by NIH or other Federal agencies. It is important that the NHLBI and NCI, as well as the other Federal agencies you have mentioned, be represented on the Interagency Committee. I

224 - 6 - We believe that the bill should be amended to establish. by statute the Office of Smoking and Health within HHS so that there may be a permanent focus for Federal activities in this area. Smoking and its health problems are too significant to -.- # be subject to the economic or political climate. The Office of _ Management and Budget, in its effort to reduce domestic spending, has tried to zero-fund the Office twice. Thanks to the efforts of Secretary Schweiker, the Office has retained its strength and integrity. A Congressional mandate for the Office will assure continuing public education on the hazards of smoking, and will demonstrate Congress' commitment to a healthier America. 2. We also support the provision that would require the rotation of five new warning labels to appear on cigarette :_ packages and in advertising. The Federal Trade Commission recently determined that "current cigarette advertising practices '.. ~ may mislead consumers by omitting material facts about the health risks of smoking". The report indicated that consumers do not know enough about the harmful effects of smoking and often underestimate the risks of suffering from health problems related to smoking. The current warning label is overexposed and too non- specific as to the health hazards of smoking. We feel that disease- specific warning labels tailored to varying populations (such as pregnant women) will more effectively inform consumers about the health problems associated with smoking. Rotating the labels so that the label statements will appear an equal number of times on each brand of cigarettes and advertising during a fifteen month 225 - 7 - =:od will aid in efforts to get more the public in the future. Varied wa ,:_ater dialogue between physicians and 3. We strongly concur that a 3 cigarette packages should be requir :..onoxide yield of cigarette smoke as we :-td nicotine. Carbon monoxide is one o _r:gredients of cigarette smoke, in that ,_lity to carry oxygen to the cells. .irticularly harmful to pregnant women ._,ctor in coronary heart disease, sudde :d chronic respiratory diseases. 4. S. 1929 should be amended :n the companion House legislation (H.R t:c civil penalties for violation of th outlined in the bill. In conclusion, we feel that t `_or a national education effort on the •:?elming. Study after study has establ and lung cancer, cardiovascular disease Consumers do not have all of the facts between not smoking and smoking. Cigar $1.0 billion on advertising their produ times the amount expended on public edu establishment of an Office on Smoking a

225 -7 - veriod will aid in efforts to get more up-to-date information to the public in the future. Varied warnings will also promote greater dialogue between physicians and their patients regarding smoking. 3. We strongly concur that advertising information and cigarette packages should be required to identify the carbon monoxide yield of cigarette smoke as well as the content of tar and nicotine. Carbon monoxide is one of the most harmful ingredients of cigarette smoke, in that it reduces the blood's ability to carry oxygen to the cells. Carbon monoxide is particul3rly harmful to pregnant women and may also be a critical factor in coronary heart disease, sudden death, atherosclerosis, and chronic respiratory diseases. 4. S. 1929 should be amended to conform to provisions in the companion House legislation (H.R. 5653) which increase the civil penalties for violation of the new labelling requirements outlined in the bill. In conclusion, we feel that the evidence of the need for a national education effort on the hazards of smoking is over- whelming. Study after study has established the link between smoking and lung cancer, cardiovascular diseases and many other disorders. Consumers do not have all of the facts to make an educated choice between not smoking and smoking. Cigarette manufacturers spend $1.0 billion on advertising their products each year, or 50 times the amount expended on public education The statutory establishment of an Office on Smoking and Health will insure a I 0 0 I 0

226 -a- continuing national education effort on the dangers of smoking and rotational labelling will maximize exposure of millions of Americans to at least a minimum level of information on smoking's health hazards. We heartily welcome the exp~.nded Federal role in addressing the smoking menace to this Nation's health. Mr. Chairman, you and your colleagues are to be commended for recognizing that this problem is one of national scope and deserving of a national legislative and administrative focus. We, as practitioners, educators, and researchers, are pleased to have the opportunity to join hands with the Federal Government to help eradicate the human, social, and economic waste resulting from smoking. 227 TESTIMONY OF ACTION ON SMOKING AND HEF DIRECTOR AND CHIEF COUNSEL, JOHN F. SENATE COMMITTEE ON LABOR AND HUMAl, THE HONORABLE ORRIN G. HA1CH, C SMOKING PREVENTION EDUCATIC Submitted April F i I am happy to appear before you and F@alth (ASH) to strongly suppor Prevention Fducation Act. As you may kno4 is a national nonprofit organization wt arm of the antismoking community. In this involved in virtually all major actions cc advertising. For example, in my individual at the Federal Communicatiorts Commissic that stations make free time available the Fairness Doctrine. Shortly thereaf* major role in upholding the Congressional: advertising. ASH was also instrumenta: off the air and in persuading the Fe complaints against the tobacco industL advertisements. In my individual capacity a, National Law Center of the George Nashh persuade the Federal Trade Commission to a-pon against deceptive ads. Since t numerous proceedings concerning deceptive including a major fact-finding procee effects of advertising. On the basis of this experirequirement of stronger, clearer, mor necessary and long-overdue step. Thi changing, or 'rotating,' warnings wil effective and to bring them forcefully to Because the need for th demonstrated in other testimony and in ma Commission and other agencies, I wil However, I think it is important for depths to which the tobacco industry wi people into smoking and to negate or oth from the serious health problems it pre attaching, as part of my testimony, a p prepared by the Staff of the Federal 'lYad one may rell conjecture -- not made avail The report demonstrates many apparently has nothing but contempt fo people who might be persuaded to do so. report at page 2-16 of the Federal document says,