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( CJTA T -' ~'1 _N T ., OF H. RUSSELL FIS~ =R. ;~;'.D. I am H. Russelil Fisher, of Glendale, California, a doctor of inedicine. I am Emeritus Professor of' Pathology at the University: of Southern Californi'a,, and former Director of the Department of Pathologyy at the Memorial Hospital of' Glendale -- where I am now on staff as a consultant. Until last year, I was Director of the Depart'ment of Pathology a~t 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 aad scientific societies, including the National Research Council Committee on the International Council of' Societies of P'athology: Ivfg 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 198Z." 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 cioa:ette 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. Ivloreoverr the bill creates an unnecessary additional layer of bureaucracy,, ,dupl'icating, 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 Nationai' Cancer Institute are already expert in reviewing, grant OG.7 applications. ~j N . W C11I . ~ ~

C C In 1969, I submitted a statement to Congress in w:.ich L said that I, like ma.-:y os my fellow scilentists, vras puzzled', over the cause o% lung cance_. and that, on the basis of the evidence t:hen av.ailaol'e, no one knew the cause of cancer of the lung; Contrary to the proposed "findings" in t':ne bil:, we still do, not know the cause or causes of lung cancer; nor d'o we know what role, . if an5, smoking plays in the causation of this disease. Most of' the claims made against cigarettes are based on, statistical coincidence,, or statist'i'cal'associlation, from which conclusions can be drawn only if' all the facts of nature are known, which they are not. Tnis 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. Lilaemostpathologists„ I am not expert in theuseoi' mathematicalsystems or statistics,, but there are a few basic rules that are easy to! apply. For example, each population group used in the statistical an.alysis must have uniforffiityr' aad'homogeneity. Data must be reliable and comparable and„ most impor taatly, the reference assumptions must have an existence in fact. Most, if not all, of the: epidemiologicai 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. O . ~. ~. C,~T 611~ ~

r Los Aage_es C.^.+u= _y KEdic4_ As'S.^rci2tioII' Czlilorr,ia Societ~~- of Pathologists: Past P_ es:uent Los Anbeles Societz- of P'4;.hologisus: P2.st Presiaent

c C Sommers,, participating on a committee of the Ne-,w Yor:: .~cadeWy of' Medicine to evaluate the accuracy of dea.i"_ c_rtificate diagnosLLs, fo und taem to bee correct in less than 500,,"a of the cases. Rosenbiatt, in a series, of studies on the diagaosis olf patients dying in the Doctcrs :iospita: of New York du_in o the lastt decade, found that the clinical diag-nosis of priWa_-y ca:cinoma o: the h.mg was confirmed by autopsy examiaation in only 435"0 of the cases. In 197'9' Saxen reported on the difficulty of achieving accurate death certificate diagnoses„ working with data from Finiand, 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 (Z2%)' had to be ruled' out as not having primary lung cancer. One thing that has added to~ the difficulty of this, proble= is the controversy about the various~ histological types of lung cancer and their relationship to causatioa. Some years ago Kreyberg, a famousl1ung pathologist of Oslo, classified - - cancer of the ltuig, into two major types or o oups. One grdup was pri'marily made up of' squamous cell carcinoma and' the other adenocarcinoma» Ia squamous cell carcinoma the cells grow a& flat plates,, like the cells of our skin. In adenocarcioma the cells are cyiindrical 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,i ad'enocarcinoma was unrelated toi envizonmental' factors, Somehow, this idea that smoking, caused some types of lung, cancers but not oth rs was accepted by many, even though they could not agree with Kreyberg on his standards for '-ciassificat'ion. -3-

~ C been e3:=a1:Se'd in great Qe tail 1n tIIel_' re'iatTo_ s:5p to: lung cancer." We just do not know the cause of lung czn cer despite a mountainous acc::mulation of research on the subject. Scientist's have not produced the kind o: 1Lno ca_:cer associated with smoking - sq°,:amous celi carcinoma animals exposed to cigarette smoke. Experimental work simply does not support the idea that lung cancer is caused bS~~- cigarettes and scientists are looking elsewhere for the cause of cancer, into genetic, environmental; and viral possibilities. Tne federal government, through the National Cancer Institute is now funding research into these possibilities. There is no~ need to create a new office of smol.ing, and' heal'tn to collect the results of research on the effects of smokiing, or to facilitate su'ch resez~ch. This could be d'one adequately by capacities already i:n~ place in t:ae Department of Health, and' Human Services by assignment to a single qualified individual' qualified in bibliographic compilation and by a directiae:*from the Head to those organizations alreadw expert in reviewing grant appl.ncations, such as the National lhstitute of Health and theNa~tional C'ancerInsti'tute., A new bureau just isn'tn'eede'd 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 researchmust be interpreted with great care' and with an understanding of the great va.*.iability of the biological processes. Any action having the force of the Congress of the~United' States should be based on fact, not conjecture. Experience has shown that social legislation not based on valid' iilformation has an~ unhappy history. O N ?V -~- h+ ~

1960-1972: L`_rector o= Deo4rtn:eT -- of Pa whologt-,, Memorial i:'os:~_.tal „ Giend'iale,, Calif.orni a. Chief of Staff,, Memorial fiospi;.al, Glendale, CG1i 2orni4 Professor or Patholog~~~-, Universitr of S'outher^ California School o.f' Medicine Emeritus Professor of P2tho7:ogy, tiniver sity of Southern California School of Medicine C'onsultant in Pathology, Memorial Hospital, Glendale, California Research Associate,, Medical Staff, San~t~a~ Fe!C~o~mmunity~ Hospital Certification:. Boardof Pathology in Anatomic and'P'atho]:ogy Past & Present Organizations: International Academy of Pathology. International C'ouncil'of Societies of P'athology Representa~tivefromNorth America,. Executive Committee American Society of Clinical Pathologists American College pf Phcsicians,, Fellow College of American Pathologists. 1964-1965 - Vice President 1960, 1963, y 1966',, 1969 - Delegate to International Congress of Clinical Patholo€ists Member, B'oard'iof Governors American Med'ical A'ssociat ion. -1978 - Delegate to Iiouse of Delegates California Medical Association W' . ~ U1 OA 0 -2-

PL:BLIS :=D =R~:CLFS H. RussEll Fisher, B~.,S. ,, '1:.D. H.ER. „ Lane,, Loweli~, L~. „ Laffertz-„ ~ienr~~ D~. - - , _":'-r'2_^.lllo'c-utos'is, Report of a Case D'u!ring Pregnanc'y , The Hahnemannis.n kiontxl;-, 68(1_), 82'8-8'3, 'Nooemoer 1933 2. Recman, John L;.,, Agerty, H.A., Barthmaier, O.F'.„ Fisher,, H. R. ,, Progress in Pediatrics, Adrenal hTeuroblastoma, Amer. J. Dis. Children 56(5), 1097-1112,, November 1938 3. Fisher, H.R., Monocytic Leu!kemia,, The Hahnemannian Monthlp, 76(5), 401-413', Has 1941 4. Fisher, H.R. „ Aleukemic Leukemia, Penn.Med.J., 143'2-91,, Auguist 1941 5. Fisher, H.R., St-novial Sarcomesothelioma (Sarcoendothelioma),, Am.J.Pathol., 18(3), 529-553, May 1942 Sappington, S.W., Fisher, R.R., Arteriosclerosis Obliterans, Arch.Path., 34(6)„ 98'9-1008', December 1942 Fisher, H.R., The Collagen Diseases, California hSledicine,. 74(5), 3'71-3',, May 1951 8. Milier, A.H., Fisher, H.R.„ Carcinoma-In-Situ of the L2rvnx, T'rans.Amer.LarFng.Assoc., 74, 129-14'3„ 19153 .'+'.'iller, A.H., Fisher,.H.Ri., Carcinoma-In-Situ of the Larynx, Ann Otolaryng,, 62 : 358-370, 1953 O. W. ~ N 10. Fisher, H.R., The Basis for Certification J. Biological W' Phozographic Assn., 21(4), 28-31, November 19'5'3' ul . ~ . GiD. 11. Fishe ,, R.R. , Syphilitic He4rt Disease, Cha;pter 14, pp. 5'32- 544, C'linical Cardiology, Franklin C. Massey, ed. (Baltimore, 195I3')'

c CURRICrIL'' VITAE FOR H. HUSc'"T L FISHER, 1..D Address: Born: Education: Training: Positions• 1920 Melwood Drive, Glendale, Cal. 91207 May 4', 1905, Philadelphia, Pennsylvania 1926: Hahneyann Medical College, Phila., I.S. 1928:HahnemannMedical CoITege, M.D. 192'8'- 291 1930 1938-39: 1933-1941: Intern, Hahnernann Hospital Graduate Stuident, Harvard Felloa,, Pathological - Anatomical Institute„ Vienna Assistant Oncologist and Assis- tant Pathologist, Hahnemann Hospi tal 1939-1943'r. 1943-1946: 1941-1946:. 1916-1953 : 1947-1972':. 1950-19701 197'0- 1956-19s1: 1953'-1956: 1956-1966: Physician, Coroner's Office, Philadelphia, Pa. Commander„ Medical Corps., United States Navy Professor__of Pathology, Hahnemann Medical College Pathologist, Moore-White Clinic, Los Angeles ~ Visiting-Pathologist, Los Angeles County General Hospital Pathologist, Los Angeles Eye & Ear Hospital Consulting'Staff, Department of EENT&D, Hollywood Presbyterian Hospital,, Los Angeles Director ofDepartment of Pathology., Santa Fe Memorial Hospi tal, Los Angeles, California Direczor of Laboratories, fiuat ington Memor i a1 Hosp it al , P'asadena,, California ~ G.y Pathologist,, Good Hope Clinic, Cul Los Angeles Mn CIA

12. Fish'er", H.F:«, Carcinoma in Cl'T' y;:cs-'err: J.Sl2rs., 0bs'-c. ~ Gyn'ec., 6^ , 630-7, 1956' 13. Fi sher ,H. P.. , Miller, A. F~. , Carcinoma in S'i zui of the Larynx: A Ten I'ea`.. t3ZL1C..~~.~~ of 1 Ls ri1iJ''topai.hv`~-oEi'Ca_ ~:._2.ssiflc2.tlony Prognosis and Trea-,L*ient, An n2:ls 0'4.G. Rhine. Lar. , 67(3)',, 695-702, September 1958 14. Fisher, H.R., hiiller,, A.H. ,, Carcinoma In S'itu of the Larynx: A Ten Year Study of its Histopazho'logical! C'lassif'ication', Prognosis and Treatment, Tran.Amer.Larsn'g.A'ss., 79', 165-1751,. 1958 15. Fisher., H.R'., Phase Microscopy in' .the Practice of Pathology, A. M. A. Archives of Pathi., 65(l), 1-5 „ January 1958 16. Miller, A.H., Fish'er, H.R.„ Lejeune, F.E., Carcinoma-in-Situ of ' the Larynx: A Ten Year Study of Its Histopatholiogical. Classification, Prognosis a'nd Treatment. Presented at the 79th Annual Meet ing of the Am. Laryngological Assoc.„ May 19-20, 1958, San Francisco, Cal.,, Abstr. : Acta Otol. 5'0(3-4),, 371, May-Auguist 1958' 17. Fisher,, H.R.,, A Zealot at Work, Bull L.A. County Med. Assoc., 97(2'1),, 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(91), 1475-8'0,1 September 1971 19. Fisher, H.R., Centennial Conference on Laryngea'1 Cancer, Workshop ho. 2, Premalignant Laryngeal Lesions, Carcinoma in situ' Supe.rficial Carcinoma - Definition and Management, Canadian J''. Otolarnyngology, Suppl., 3(1), 515, 1974„ Suppl. 3(1), 543-45, 1974, S!upP1•, 3(1), 56'7'-72',, 1974 20. F isher, H.R.,, Excerpt: The Delineation of Carcinoma' in Situ of the Larynx, Workshop No. 2, 116-11'9'„ t±:ay 27-31, 1974 21. Fisher, H'.R.„ Excerpt: Verrucous Carcinoma of the Larynx -0 A' S Gud!~r~~ of its P~atholiog,ic~ Anatomy, Workshop No. 7, Section 1, May 2'7'-31, 1974 W C1'1 . ~ Ca