Tobacco Documents Online

416 - STATEMENT OF H. RUSSELL FISHER. M.D. I am H. Russell Fisher, of Glendale, California, a doctor of medicine. I am Emeritus Professor of Pathology at the University of Southern California, and former Director of the Department of Pathology at the Memorial Hospital of Glendale - where I am now on staff as a consultant. Until last year, I was Director of the Department of Pathology at the Santa Fe Hospital in Los Angeles, where I am still on the active staff as a research associate. I am a member and past officer of medical and scientific societies, including the National Research Council Committee on the International Council of Societies of Pathology. My special investigative interest has been in the field of carcinoma in situ. My full Curriculum Vitae is submitted with this statement. As a medical scientist, I am concerned with the legislative proposal now termed the "Comprehensive Smoking Prevention Act of 1982." It would be inappropri- ate to adopt it on several grounds. Its basis is contrary to a significant body of scientific knowledge about the putative role of cigarette smoking in the causation of disease. It misuses the scientific definition of "cause" as that term relates to disease. Its justification rests in part upon statements that have not been found to be ~ .~'_'.. valid. Moreover, the bill creates an unnecessary additional layer of bureaucracy, IF~. .duplicating many functions already in place and available in various agencies in the government; this may well hamper solid scientific research. The National Institutes of Health and the National Cancer Institute are already expert in reviewing grant ~, applications. .A~ 4 In 1969, I submitted a statemF many of my fellow scientists, was puzzled the basis of the evidence then available,r Contrary to the proposed "findings" in tl: causes of lung cancer; nor do we know causation of this disease. Most of the claims made a~ coincidence, or statistical association, frc all the facts of nature are known, which has given rise to an emotional tide, seized hope to fill a void in our efforts to achieve Like most pathologists, I am systems or statistics, but there are a fe example, each population group used in tb and homogeneity. Data must be reliable : reference assumptions must have an existe Most, if not all, of the epid correlation between cigarette smoking a --riteria. For example, they rely primari: 9 cancer even though studies have certificate specification of this disease. -a.^.cers that arise in various parts of the c:_ncer - and cancers that start in the lung

0 417 In 1969, 1 submitted a statement to Congress in which I said that I, like many of my fellow scientists, was puzzled over the cause of lung cancer, and that, on the basis of the evidence then available, no one knew the cause of cancer of the lung. Contrary to the proposed "findings" in the bill, we still do not know the cause or causes of lung cancer; nor do we know what role, if any, smoking plays in the causation of this disease. Most of the claims made against cigarettes are based on statistical coincidence, or statistical association, from which conclusions can be drawn only if all the facts of nature are known, which they are not. This statistical coincidence has given rise to an emotional tide, seized upon by various groups and agencies, in the hope to fill a void in our efforts to achieve a perfect health. Like most pathologists, I am not expert in the use of mathematical systems or statistics, but there are a few basic rules that are easy to apply. For example, each population group used in the statistical analysis must have uniformity and homogeneity. Data must be reliable and comparable and, most importantly, the reference assumptions must have an existence in fact. Most, if not all, of the epidemiological studies reporting a statistical correlation between cigarette smoking and lung cancer do not meet these simple criteria. For example, they rely primarily on death certificates for the diagnosis of lung cancer even though studies have shown great unreliability in the death certificate specification of this disease. This is primarily due to confusion between cancers that arise in various parts of the body and spread to the lungs - metastatic cancer - and cancers that start in the lungs - primary cancer. i

418 Sommers, participating on a committee of the New York Academy of Medicine to evaluate the accuracy of death certificate diagnosis, found them to be correct in less than 50% of the cases. And Rosenblatt, in a series of studies on the diagnosis of patients dying in the Doctors Hospital of New York during the last decade, found that the clinical diagnosis of primary carcinoma of the lung was confirmed by autopsy examination in only 45% of the cases. In 1979 Saxen reported on the difficulty of achieving accurate death certificate diagnoses, working with data from Finland, a small country with a stable population. Reviewing 162 deaths attributed to respiratory cancer in a Z year period, he found,'on microscopic tissue examination, that 35 cases (22%) had to be ruled out as not having primary lung cancer. One thing that has added to the difficulty of this problem is the controversy about the various histological types of lung cancer and their relationship to causation. Some years ago Kreyberg, a famous lung pathologist of Oslo, classified cancer of the lung into two major types or groups. One group was primarily made up of squamous cell carcinoma and the other adenocarcinoma. In squamous cell carcinoma the cells grow as flat plates, like the cells of our skin. In adenocarcioma the cells are cylindrical and grow in rings, like glands. Kreyberg proposed the idea that the reported rise in the incidence of lung cancer was due to a rise in incidence of squamous cell carcinoma and that this kind of lung cancer was caused by smoking and other environmental factors. According to Kreyberg, adenocarcinoma was unrelated to environmental factors. Somehow this idea that smoking caused some types of lung cancers but not others was accepted by many, even though they could not agree with Kreyberg on his standards for classification. -3- 4H Because many investigators assc cell carcinoma, there has been continuing - carcinoma versus adenocarcinoma. The stuc showed that since 1963 squamous cell carcino increased. In contrast, a Mayo Clinic st squamous cell carcinoma. Such differences a in the standards of microscopic criteria, and for homogeniety in elements subjected to stat: The controversy about tumor types lung cancer in women. It is claimed that the i due to their increase in smoking since World the purported rise is primarily due to an incr generally associated with smoking. For exai pathology department at the Lenox Hill Hosp: makes up about half of the cancers in females. That the smoking and lung cancer c strated by the recent study which appeared in the National Cancer Institute. This study cha, major cause of lung cancer. Using data fron cancer, including the American Cancer Socie that there has been a dramatic rise in lung canc have never smoked. In white females who hav cancer in the last 4 decades has paralleled cigarettes. This negates the claim of the Amer- m lung cancer in females over that period h :.nstrom noted that "Many factors other than ;

419 r Because many investigators associate cigarette smoking with squamous C.ll carcinoma, there has been continuing interest in the trends of squamous cell urc:noma versus adenocarcinoma. The study by Vincent et al., from Roswell Park sAosed that since 1963 squamous cell carcinoma has dropped and adenocarcinoma has tacreased. In contrast, a Mayo Clinic study showed a progressive increase in .quamous cell carcinoma. Such differences are probably due to a lack of uniformity ia tne standards of microscopic criteria, and statistical selection emphasize the need for homogeniety in elements subjected to statistical comparison. The controversy about tumor types is particularly pertinent to the issue of lung cancer in women. It is claimed that the incidence of female lung cancer is rising due to their increase in smoking since World War IL However, studies indicate that the purported rise is primarily due to an increase in adenocarcinoma, the type not generally associated with smoking. For example, Dr. Ioachim from Dr. Sommers' pathology department at the Lenox Hill Hospital (N.Y.), finds that adenocarcinoma makes up about half of the cancers in females. That the smoking and lung cancer controversy continues is amply demon- strated by the recent study which appeared in the April 1979 issue of the Journal of the National Cancer Institute. This study challenged the dogma that smoking is the major cause of lung cancer. Using data from a number of broad studies of lung cancer, including the American Cancer Society study population, Enstrom showed that there has been a dramatic rise in lung cancer mortality rate among persons who have never smoked. In white females who have never smoked, the increase in lung cancer in the last 4 decades has paralleled the increase in those who smoke cigarettes. This negates the claim of the American Cancer Society that the increase in lung cancer in females over that period has been due to cigarette smoking. Enstrom noted that "Many factors other than personal cigarette smoking have not -4- 0 I

420 been exmained in great detail in their relationship to lung cancer." We just do not know the cause of lung cancer despite a mountainous accum ulation of research on the subject. Scientists have not produced the kind of lung cancer associated with smoking - squamous cell carcinoma - in animals exposed to cigarette smoke. Experimental work simply does not support the idea that lung cancer is caused by cigarettes and scientists are looking elsewhere for the cause of cancer, into genetic, environmental, and viral possibilities. The federal government, through the National Cancer Institute is now funding research into these possibilities. There is no need to create a new office of smoking and health to collect the results of research on the effects of smoking, or to facilitate such research. This could be done adequately by capacities already in place in the Department of Health and Human Services by assignment to a single qualified individual qualified in bibliographic compilation and by a directive from the Head to those organizations already expert in reviewing grant applications, such as the National Institute of Health and the National Cancer Institute. A new bureau just isn't needed nor is it necessary or appropriate to have a new complex committee on educating the public until there is a firmer foundation of scientific knowledge of what is to be taught, what reliable information is to be disseminated. Knowledge from medical and scientific research must be interpreted with great care and with an understanding of the great variability of the biologicah processes. Any action having the force of the Congress of the U nited States should be based on fact, not conjecture. Experience has shown that social legislation not based on valid information has an unhappy history. 421 CURRICULUM VITAE FOR H. RUSS Address: 1920 Melwood D . Born: May 4 1905 P: , , Education: 1926: Habnema: 1928: Hahnema- Training: 1928-29: Inte: 1930: GradL 1938-39: Fellc Positions: 1933-1941: Anatc Ass 1939-1943: tar. Hos Phy 1943-1946: Phi Co¢ 1941-1946: Uni Pro 1946-1953: Hab Pat 1947-1972: Los Vis 1950-1970: Cou: Pati I 1970- _ . Ear Con: 1956-1981: EEti' HosF Dirc - Patt Host 1953-1956: Dirc - Hunt 1956-1966: Pas~. Patk: Los

421 CURRICULUM VITAE FOR H. RUSSELL FISHER, M.D. Address: 1920 Melwood Drive, Glendale, Cal. 91207 Born: May 4, 1905, Philadelphia, Pennsylvania Education: 1926: Habnemann Medical College, Phila., B.S. 1928: Hahnemann Medical College, M.D. Training: 1928-29: Intern, Hahnemann Hospital 1930: Graduate Student, Harvard 1938-39: Fellow, Pathological - Anatomical Institute, Vienna Positions: 1933-1941: Assistant Oncologist and Assis- tant Pathologist, Hahnemann Hospital 1939-1943: Physician, Coroner's Office, Philadelphia, Pa. 1943-1946: Commander, Medical Corps., United States Navy . 1941-1946: Professor of Pathology, Hahnemann Medical College 1946-1953: Pathologist, Moore-White Clinic, Los Angeles 1947-1972: Visiting Pathologist, Los Angeles County General Hospital 1950-1970: Pathologist, Los Angeles Eye & Ear Hospital 1970- Consulting'Staff, Department of EENT&D, Hollywood Presbyterian Hospital, Los Angeles 1956-1981: Director of Department of Pathology, Santa Fe Memorial Hospital, Los Angeles, California 1953-1956: Director of Laboratories, Huntington Memorial Hospital, Pasadena, California 1956-1966: Pathologist, Good Hope Clinic, Los Angeles

422 1960-1972: Director of Department of Pathology, Memorial Hospital, Glendale, California 1967-1968: Chief of Staff,.Memorial Hospital, Glendale, California 1946-1970: Professor of Pathology, University of Southern California School of Medicine 1970- . Emeritus Professor of Pathology, University of Southern California School of Medicine Santa Fe Community Hospital American Board of Pathology in Anatomic and Clinical Pathology International Academy of Pathology International Council of Societies of Pathology Representative from North America, Executive Committee American Society of Clinical Pathologists American College pf Physicians, Fellow College of American Pathologists 1964-1965 - Vice President 1960, 1963, 1966, 1969 - Delegate to International Congress of Clinical Pathologists Member, Board of Governors American Medical Association -1978 - Delegate to House of Delegates California Medical Association Los Angeles County Medical Association California Society of Pathologists: Past President Los Angeles Society of Pathologists: Past President -3- 423 PUBLISHED ARTICLES H. Russell Fisher, B.S., 1. Fisher, H.R., Lane, Lowell, L., La Agranulocytosis, Report of a Case - The Hahnemannian Monthly, 68(11), 2. Redman, John L., Agerty, H.A., Bar H.R., Progress in Pediatrics, Adre Amer. J. Dis. Children 56(5), 109 3. Fisher, H.R.-, Monocytic Leukemia, 76(5), 401-413, May 1941 Fisher, H.R., Aleukemic Leukemia, August 1941 5. Fisher, H.R., Synovial Sarcomesoth Am.J.Pathol., 18(3), 529-553, May 6. Sappington, S.W., Fisher, H.R., Ar Arch.Path., 34(6), 989-1008, Decen 7. Fisher, H.R., The Collagen Disease 74(5), 371-3, May 1951 ?Siller, A.H., Fisher, H.R., Carci: Trans.Amer.Laryng.Assoc., 74, 129- 9. Miller, A.H., Fisher, H.R., Carcii Ann Otolaryng, 62: 358-370, 1953 Fisher, H.R., The Basis for Certi Photographic Assn., 21(4), 28-31, Fisher, H.R., Syphilitic Heart Di 544, Clinical Cardiology, Frankli 1953)

423 PUBLISHED ARTICLES H. Russell Fisher, B.S., M.D. 1. Fisher, H.R., Lane, Lowell, L., Lafferty, Henry D., Agranulocytosis, Report of a Case During Pregnancy, The Hahnemannian Monthly, 68(11), 828-833, November 1933 2. Redman, John L., Agerty, H.A., Barthmaier, O.F., Fisher, H.R., Progress in Pediatrics, Adrenal Neuroblastoma, Amer. J. Dis. Children 56(5), 1097-1112, November 1938 3. Fisher, H.R.y Monocytic Leukemia, The Rahnemannian Monthly, 76(5), 401-413, May 1941 4. Fisher, H.R., Aleukemic Leukemia, Penn.Med.J., 1432-9, August 1941 5. Fisher, H.R., Synovial Sarcomesothelioma (Sarcoendothelioma), Am.J.Pathol., 18(3), 529-553, May 1942 6. Sappington, S.W., Fisher, H.R., Arteriosclerosis Obliterans, Arcb.Path., 34(6), 989-1008, December 1942 7. Fisher, H.R., The Collagen Diseases, California Medicine, 74(5), 371-3, May 1951 8. Miller, A.H., Fisher, H.R., Carcinoma-In-Situ of the Larynx, Trans.Amer.Laryng.Assoc., 74, 129-143, 1953 9. Miller, A.H., Fisher, H.R., Carcinoma-In-Situ of the Larynx, Ann Otolaryng, 62: 358-370, 1953 10. Fisher, H.R., The Basis for Certification J. Biological Photographic Assn., 21(4), 28-31, November 1953 11. Fisher, H.R., Syphilitic Heart Disease, Chapter 14, pp. 532- 544, Clinical Cardiology, Franklin C. Massey, ed. (Baltimore, 1953)

42 12. Fisher, H.R., Carcinoma in Situ, Western J.Surg., Obst. k Gynec., 64, 630-7, 1956 13. Fisher, H.R., Miller, A.H., Carcinoma in Situ of the Larynx: A Ten Yeat Study of its Histopathological Classification, Prognosis and Treatment, Annals Oto. Rhine. Lar., 67(3), 695-702, September 1958 14. Fisher, H.R., Miller, A.H., Carcinoma In Situ of the Larynx: A Ten Year Study of its Histopathological Classification, Prognosis and Treatment, Tran.Amer.Laryng.Ass., 79, 165-175, 1958 15. Fisher, H.R., Phase Microscopy in the Practice of Pathology, 16. A.M.A. Archives of Path., 65(1), 1-5, January 1958 Miller, A.H., Fisher, H.R., Lejeune, F.E., Carcinoma-in-Situ of the Larynx: A Ten Year Study of Its Histopathological Classification, Prognosis and Treatment. Presented at the 79th Annual Meeting of the Am. Laryngological Assoc., May 19-20, 1958, San Francisco, Cal., Abstr.: Acta Otol. 50(3-4), 371, May-August 1958 17. Fisher, H.R., A Zealot at Work, Bull L.A. County Med. Assoc., 97(21), 7, November 2, 1967 18. Miller, A.H., Fisher, H.R., Clues to the Life History of Carcinoma in Situ of the Larynx, Laryngoscope, LXXXI(9), 1475-80, September 1971 19. Fisher, H.R., Centennial Conference on Laryngeal Cancer, Workshop No. 2, Premalignant Laryngeal Lesions, Carcinoma in situ Superficial Carcinoma - Definition and Management, Canadian J. Otolarnyngology, Suppl., 3(1), 515, 1974, Suppl 3(1), 543-45, 1974, Suppl., 3(1), 567-72, 1974 20. Fisher, H.R., Excerpt: The Delineation of Carcinoma in Situ May 27-31, 1974 • 116-119 2 Workshop No Lar nx f th . y , e o , , 21. Fisher, H.R., Excerpt: Verrucous Carcinoma of the Larynx - A Study of its Pathologic Anatomy, Workshop No. 7, Section 1, May 27-31, 1974 STATEMENT OF J My name is Jean Dickinson Gib' of Statistics and Chairman of the Applit School of the University of Alabama. I American Statistical Association and the and a member of the Committee on Nationc of Sciences. I received the bachelor's and Duke University and the Ph.D. degree in institute and State University. My prev University of Pennsylvania and the Unive Fulbright-Hays scholar at the Indian Sta I was Associate Editor of The currently act as editorial collaborator ing The Journal of the American Statisti Technometrics, and serve as a reviewer f Science Foundation. I am a member of se served two terms on the Board of Directo. Association. My publications include four sc 30 articles in refereed professional and named Outstanding Scholar in 1981 and Boi 1974 at the University of Alabama. My ci this statement.