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® 353 STATEMENT OF BARBARA B. BROWN, Ph.D. I am Barbara B. Brown, former Chief of Experiential Physiology, Veterans Administration Hospital, Sepulveda, California. I received my Ph.D. in Pharmacology from the University of Cincinnati College of Medicine in 1950. I have over 30 years research experience, primarily in the fields of pharmacology, psychopharmacology, neurophysiology and psycho- physiology. I began my research activities as a technician in the pharmaceutical firm of The Wm. S. Merrill Co. (subsidiary of Merrill-Richardson) and later became Head of the Department of Pharmacolcgy. After leaving Merrill, I served as Research Neuro- pharmacologist at Riker Laboratories in California and as Consulting Neurophysiologist at Psychopharmacology Research Laboratories. I was also an associate clinical professor of pharmacc'ogy at the University of California Center for Health Sciences in Los Angeles and at the Department of Psychiatry and Human Behavior at the University of California -- Irvine, and also lecturer at the Department of Psychiatry at UCLA. As Chief of Experiential Physiology Research at the VA Hospital in Sepulveda, I was one of the pioneers in the development of the concept of biofeedback. In the past few years, much of my professional activity has centered around attempting to analyze the role of mental activity (brain information processing systems) in health and illness. To date, I have published four books and several theoretical articles on this subject. 11 0

354 Given my extensive background in pharmacology, physi- ology, and behavior, I disagree with the conclusions and the basic generalizations of House bill 5653. This bill misinterprets the meaning of the reported statistical associations between cigarette smoking and certain diseases. It fails to understand the psycho- logy of the multiple influences that determine individual life- , styles and the acceptance of their risks, and it completely ignores a fundamental and unresolved question: why do people smoke? Further, the bill misapprehends the level of public awareness of the widely publicized "health hazards of smoking," and it relies on the incorrect premise that revised warning labels' could substantially affect that public awareness. Smoking Behavior - Most important is the failure of the bill to address the" many unknowns in smoking behavior. A great many perceptive people have observed that smoking behavior is a complex behavior determined by the interaction of several influences, namely, constitutional predispositions, environmental factors, experi- ential (psychosocial) influences, individual psychophysiologic reaction tendencies, and chemical factors. No single factor determines smoking behavior, nor do all interacting factors influence smoking behavior all the time. 3P The most convincing stud of smoking behavior was the decade: oredispositions to smoking by Selt2 psychological and physiological rea able to predict who among pre-teens smokers when adults. His predictio. ' ~ll Page Since a major objective of accurately, and Seltzer's work is ar. achieving this objective, it is unfo ,f his studies have not been activel My own research did not cor •.:ork, but rather from a continuing in '-tivity of the brain. A report of my research stuc activity appeared in the December 1961 an international journal on neurology. .'ariety of EEG measures, along with be among light, moderate, and heavy smoke nonsmokers. Each subject was studied c^ntrol and test conditions, for EEG pz Results of the study were bot discovered striking differences betwe

355 physi- the basic -ets the cigarette .~: psycho= - life-"t! ly ople ic king,• y, The most convincing study ever conducted on the origins of smoking behavior was the decades-long study of'constitutional oredispositions to smoking by Seltzer. Using tests to develop psychological and physiological reaction profiles, Seltzer was able to predict who among pre-teens and young teenagers would be smokers when adults. His predictions were about 85% accurate. fl Since a major objective of science is to predict events accurately, and Seltzer's work is an outstanding example of achieving this objective, it is unfortunate that the implications of his studies have not been actively pursued. My own research did not come from considering Seltzer's work, but rather from a continuing interest in the electrical activity of the brain. A report of my research study on smokers and human EEG activity appeared in the December 1968 issue of Neuropsychologia, an international journal on neurology. The study compared a variety of EEG measures, along with behavioral characteristics, among light, moderate, and heavy smokers, former smokers and nonsmokers. Each subject was studied one full day, under various control and test conditions, for EEG patterns and reactivity. Results of the study were both unexpected and dramati-C. I discovered striking differences between the brain wave patterns ,Page 3

356 and brain electrical responses to sensory stimulation of heavy smokers as compared to those of nonsmokers. Results for the average smokers and for the former smokers were between the other two groups. intermediate The outstanding characteristics of smokers' EEG patterns are a high frequency, rhythmic, high amplitude, sustained activity. It looks like alpha activity but is twice as fast Alpha is commonly referred to as the brain wave correlate of relaxed wakefulness and is always contrasted with the nonrhythmic; low amplitude, very fast EEG activity that is commonly correlated with alert behavior. After comparing smokers' patterns with those of former smokers, with those of individuals in various emotional or physical states such as fatigue, etc., I decided that the best explanation for this distinctive EEG frequency is that it represents an inherent tendency for people who smoke to have a level of "alertness" higher than the average and also apparently excess brain electrical activity. These absolute physiological findings can be interpreted in either of two ways: one, that the high frequency, rhythmic activity is associated with information processing that is concerned with specific elements or thoughts, or that it is helter-skelter, poorly productive, non-linear mental activity. either case, the smoker consistently shows an excess of (for lack of a better term) "cerebral" energy. "Cerebral" energy can be :-~ier productive or nonproduct I studied a small gro .r ther their brain waves would ::ods of abstinence or any ef i;^er abstinence. The heavy sm. ?acks of cigarettes per day w< '_east 12 hours prior to begii 3s=on. we then intentionally ..-. attemot to increase the "neec recording experience more st _r subjects were allowed to ..:c•.,ed to smoke ad lib. through ~.-,ut 2 more hours). The results of this su __ -zsing. First, no differenc --:nd after the subjects had smo ~-terns found after 12 hours of - -nanqes in brain wave pattern. e subjects were actually smokii ":e subjects were finally told t: 1:-s'lnence period, only 1 of the - r.eed to smoke. One interprete

7 r 357 either productive or nonproductive, i.e., satisfl a predetermined objective or not. I studied a small group of heavy smokers to learn whether their brain waves would show any effects from short periods of abstinence or any effects when they resumed smoking after abstinence. The heavy smokers who habitually smoked 2.5 to 5 packs of cigarettes per day were asked to refrain from smoking at least 12 hours prior to beginning the experimental recnrding session. We then intentionally prolonged the recording period in an attempt to increase the "need" to smoke, presumably making the EEG recording experience more stressful. After this, these heavy sm..oker subjects were allowed to smoke to satiation, and were allowed to smoke ad lib. throughout the remainder of the recording (about 2 more hours). The results of this sub-experiment were quite surprising. First, no differences in brain wave patterns were found after the subjects had smoked to satiation as compared to patterns found after 12 hours of abstinence from smoking. Second, no changes in brain wave patterns were found at those times when the subjects were actually smoking cigarettes. And third, when the subjects were finally told that they could smoke after the abstinence period, only 1 of the 9 expressed any particular desire or need to smoke. One interpretation of this is that the novelty Page 5

of the experimental situation acted as an effective substitute for smoking for this brief period of time. The sustained and marked differences in brain wave activity between smokers and nonsmokers are very probably unrelated to the pharmacologic aspects of smoking. When nicotine is administered to animals, or when the effect of smoking is measured, a stimulant effect is only briefly noted. If the continuing action of nicotine and smoking, especially in "smoking" doses is a tranquillizing one, then the fast EEG patterns of the : habitual smokers cannot very well be a result of their smoking activity. The remaining conclusion, then, is that there is a constitutional difference between people who tend to smoke and those who do not. My studies, and those of Seltzer, comprise powerful evidence that constitutional factors can predispose to smoking behavior or some equivalent behavior that effectively diffuses the excess "cerebral" energy (such as the "high" that runners or joggers enjoy). -This does not mean that shaping factors such as genes, home environment, individual experiences, etc., predispose specifically to smoking behavior, but that these factors predispose to a behavior that can discharge excess "cerebral" energy and at the same time be socially acceptable. In other words, people likely to smoke are people who have this particular 359 {ind of excess energy -- and smoking prc by which that energy can be discharged. Smoking and Health Studies The bill's "findings" on smok: government position which is promulgatec Reports. These Reports are based on hic that literature. The behavioral sectior example, admitted this very scientifica: approach. Many excellent "dissenting" x Frequently, when differing reports are c inadequately or inaccurately reported. sionally the Reports' authors might not cf the government's policy on smoking. unbiased research -- cannot be fostered Many research studies cited i: serious errors, such as questionable cr. subJects, poor experimental design, wea: of results, conclusions not warranted b• ridden or inconsistent public records f disease, and the abuse of statistics. One of the weaknesses of thes concerns me is the failure of the epide

a 359 kind of excess energy -- and smoking provides on acceptable outle7: by which that energy can be discharged. Smokinq and Health Studies The bill's "findings" on smoking and health reflect the government position which is promulgated in the Surgeon Generals' Reports. These Reports are based on highly selective reviews of that literature. The behavioral section of the 1979 Report, for example, admitted this very scientifically uncharacteristic approach. Many excellent "dissenting" reports are ignored. Frequently, when differing reports are cited, they are either inadequately or inaccurately reported. One wonders if occa- sionally the Reports' authors might not have been biased because of the government's policy on smoking. Unbiased reviews -- and unbiased research -- cannot be fostered in such an atmosphere. Many research studies cited in the Reports contain serious errors, such as questionable criteria for selecting subjects, poor experimental design, weak criteria for evaluation of results, conclusions not warranted by the data, use of error- ridden or inconsistent public records for information on death and disease, and the abuse of statistics. One of the weaknesses of these studies that most concerns me is the failure of the epidemiological studies to Page 7 u

360 account for biological variation. In the behavioral area, this translates to the fact that the reasons for smoking differ in different kinds of oeople. The sum of psychological, consti- tutional, experiential, motivational factors is never the same for all smokers. There simply is no one, single condition of smoking behavior (incidentally, no single factor accounts for the high rate of recidivism in most stop-smoking programs). Moreover, studies that classify the one pack a day dilettante smoker (one who doesn't care whether he smokes or not, but does so for social reasons) along with the pack a day smoker who sincerely enjoys his smoking but limits it to a pack a day are extremely bad studies from the standpoint of subject selection. Congress must remember that science is not infallible. Both scientists and scientific reports have normal distribution curves of quality. Very few are excellent; most are just average. Awareness In regard to awareness, I strongly disagree with the implication in House bill #5653 that the American public is still too ignorant of the hazards that have been associated with cigarette smoking. I can think of no health claims in the past 20 years that have received more intensive and pervasive media coverage and governmental attention. The media regularly cover Page 361 all research on smoking and health, suggest hazardous effects. This of Further, official warning anti-smoking commercials and advert and TV. Advertising by stop-smokin etc., constitutes additional media campaigning. Finally "educatior.al" nent part of many school programs. `irst graders signing oaths that th repeating the oath virtually every wnich is probably representative of goes beyond merely an education our --hought control. ;Jarning Labels Even if i agreed with the tne belief that public awareness of I would still disagree with the prc 'arnings. As a society, we are ext --asis for behavior that we have ter -~bvious that the extraordinary sums research, its almost complete failu ='•:ese behaviors, and its near failu carry a message. One of the outsta

361 all research on smoking and health, particularly reports that suggest hazardous effects. This often amounts to a media blitz. Further, official warnings are constantly reinforced by anti-smoking commercials and advertisements on radio, magazines, and TV. Advertising by stop-smoking institutes, courses, clinics, e*_c., constitutes additional media coverage and anti-smoking campaigning. Finally "educational" programs are a fairly perma- nent part of many school programs. A recent TV news report showed first graders signing oaths that they would never smoke and orally repeating the oath virtually every day. Such a strong effort, which is probably representative of many educational orograms, goes beyond merely an education purpose and approaches behavior thought control. Warning Labels or Even if i agreed with the bill's findings and supported the belief that public awareness of health hazards was inadeauate, I would still disagree with the proposed change in health warnings. As a society, we are extremely uninformed abcut the basis for behavior that we have termed risk-taking. It should be obvious that the extraordinary sums of money spent on behavioral research, its almost complete failure to discover the causes of these behaviors, and its near failure to prevent such behaviors carry a message. One of the outstanding flaws is the failure of Page 9

362 scientists or interested people to encourage studies of personality factors (not neuroticism scores which relate more to e neuroses than normal behavior), studies on the role of the environment, studies on the role of psychosocial influences (again~ the normal rather than the abnormal ones), studies on the role of the human intellect on behavior, and the role of everyday stress on smoking behavior. te Congress must understand that even the so-called experts• just don't know enough about why people behave the way they do in:`. a variety of areas, and how that behavior relates to the individuals' health. We need for example tests built on the characteristics of normal people; we must study the normal range .. of behavior, rather than the abnormal. The majority of smoking . behavior studies have used conditioned learning theory. Condi- tioned learning is an automated, primitive kind of behavior (obviously, since most of the studies are done in rats and pigeons). This theory is unable to explain a behavior as complex as smoking. . Smoking habits have changed, but only a minute part of that change is due to anti-smoking campaigns. People likely to smoke may be people who have excess "cerebral" energy, and our society in recent years has provided them with a variety of other acceptable outlets for that energy. Before any governmental program to reduce cigarette smoking should be considered, a total Page 10 363 _aevaluation and restructuring of res, ~ behavior should be commenced. Be- ,-ronaly that the reasons people choo -astitutional origins and this must I a advisability of a government cess~ ^Clusion House bill 5653 should not b =:entific underpinnings are weak and