Tobacco Documents Online

ACTION ON SMOKING AND NLAL TH 2000'H Street, N. W. Washington, D:C. 20006 (202) 659-4310 TESTIMONY OF ACTION',ON SMOKING AND HEALTH BY ITS EXECUTIVE DIRECTOR JOHN F. BANZHAF III, ESQ., BEFORE THE HOUSE SUBCOMMITTEE ON HEALTH AND THE ENVIROnMENT RELATING TO SECRETARY CALIFANO'S ANNOUNCEMENTS CONCERNING SMOKING, WEDNESDAY, FEBRUARY 15, 1978 I would like to thank you for inviting Action on Smoking and'. Health to appear before you today to express our views -- and'the views of many individuals and organizations sincerely concerned with the problems of smoking -- concerning the anti-smoking program recently announced by Secre- tary Joseph1E'. Califano, Secretary of Health, Education, and WElfare. In two words, our reaction is that we are delighted but disappointed. As many members of the Committee know, Action on Smoking and Health is a national non-profit charitable health organization, the only such national organization eoncerned solely with the problems of smoking and the rights of nonsmokers. ASH serves as the legal-action arm of the anti-smoking community, representing the anti-smoking point of view imadministrative, j~ud3'- cial, and legislative proceedings. We are happy that our efforts have been successful in bringing about anti-smoking messages on radio and television followed by a ban on cigarette commercials; "no-smoking" sections on trains, planes, buses, and'many public buildings; a major investigation of the tobacco industry by the FTC, as well as a multi-mill,ion dollar law suit by the same agency over cigarette billboard advertising; and'other major steps forward in the war against smoking. Action on Smoking and Health, like many others concerned with the problems of smoking, was both delighted and disappointed by Secretary Califano's proposals. We were delighted because, for the first time, an HEW Secretary has recognized the importance of the problems of smoking, and'made a strong personal and departmental commitment towards solving the problems. We were disappointe&, however, that his proposalis did not go far enough, that the remedies he has proposed fall so far short when compared to the magnitude and realities of the problem of smoking that it is like trying to contain a raging forest f'.re within an ashtray. Secretary Califano's speech cannot be dignified as a "war against smoking." At most, Secretary Califano has issued a challenge to the tobacco industry -- it remains to be seen whether he, the other regulatory agencies, and the United States Congress are willing to go where common sense and the public interest logically would lead them. In our judgment, Secretary Califano's decision to use HEW resources to take reasonable and limited steps concerning the problem of smoking is more than justified. Mr. Califano sees, as many of us in the field have long since recognized, that the nature of the problem is different than it was generally preceived to be in 1969 when Congress last addressed itself to the issue. In earlier times smoking was seen to be a mere habit, freely engaged in by adults who had'voliuntarily chosen to do so, and harmful at most to the smoker himself. From that standpoint, a simple factual warning about the health dangers.might seem to be all that would'be called for; anything further might be,viewe&as an infringement on the freedom of choice of indi- vidual adults. However, we know differently today. For at least three major reasons it is now not only appropriate but necessary that the Department of Health, Education, and Welfare address itself at long last to smoking, des- pite the self-serving and h pocritieal cries of the tobacco industry that it infringes on their rights, ~S "big brotherism," or smacks of prohibition. Indeed, it is none of these things, for at least these reasons: r A. Far from being a voluntary preoccupation, smoking is aniaddictive and/or habituating enslaver of the majority of adult smokers. Most Smokers take up the habit as children far too young to appreciate the addictive nature of nicotine or the deadly consequences of smoking.-

2. B. Smoking is an activity which unfairly costs the great majority of taxpayers who are nonsmokers over ten billion dollars annually, a cost which in fairness should'be borne by those who engage in and "benefit" from the activity. C. Smoking,is a Serious Health Hazard and Irritant to the great majority of Americans who are nonsmokers, and constitutes the major cause of indoor air pollution. For the great majprity of Americans -- adults or children -- smoking is hardly a voluntary act. The most recent HEW survey indicate&that fully six out of every ten adult smokers has made one or more serious attempts to quit smoking, and that an additional three out of ten would like to quit if only it weren't so difficult. Evidence of this is alil around us: the pro- fusion of smoking withdrawal clinics, programs, books and devices; the dramatic switch of those smokers who are too hooked to quit : to "less hazardous" cigarettes; the considerable attention given the problem on radio and television; and even casual conversations at parties, etc. Moreover, medical and scientific evidence, much of it recent, demon- strates that many smokers are addicted to nicotine. This addiction can be every bit as serious and compelling,as those related to heroin or other hard drugs, and in extreme cases people have been unable to quit even when smoking was causing their death, 1'oss of limbs, and other extreme consequences. Thus many smokers smoke not because they choose to do so, but rather as a convenient means of administering a nicotine "fix." In the words of one researcher who is also a smoker: "a smoker's mind is in his bladder." For fully nine-tenths of aLl adult smokers,the issue is not whether HEW is planning to curtail a voluntary activity. These are adults who have believed and tried to heed the Surgeon General's warningiand who are trying to quit. It could not be more clearly in America's interests -- from the standpoint of health, humanitarianism, or economics -- to help them do so. Secretary Califano's program will provide them with some assistance, and other more effective programs could do far more to help adult Americans help them- selves and cure America of its number one preventable health problem. With regard to children the problem is far more serious and far more tragic. Recent evidence now indicates that at least one out of everyy five twelve-year-old children is a smoker. What the tobacco industry calls an adult habit, and which has long been recognized as a teenage problem, has now been recognized in pre-teens. Despite the health warnings, children are taking up smoking in record numbers for two reasons. The first is that they view smoking as a symbol of maturity, sophistication, sociability, and success with the opposite sex. Children can hardly be blamed for this view, since it is reinforced in the most effective and insidious ways day after day by hundreds of miLlions of dollars' worth of cigarette advertising. Ironically, cigarette advertising is still featuring today the very same unfair and deceptive images of smoking so roundly condemned by Congress in 1901. Although they no longer appear on television, the same healthy, robust, sensual, and sociable figures of people smoking assail children from giant billboards, from the back covers of magazines, in point-of-sale and display advertising, and in anlincreasing number of promotions, giveaways, free samples, etc. Moreover, the tobacco companies have exploited, abused, and debased the women's movements with themes such as "you've come a long way, baby" to induce young girls to substantially increase their smoking. The result of all of this advertising is to engender and to constantly reinforce the belief among those too young to understand otherwise that smoking is a symbol of having reached maturity.

3. s The second reason why children continue to take up smoking is that most do not believe that they will become hooked. Surveys show that most chil- dren taking up smoking do not see themselves becoming life-long smokers. Rather, they believe that they will smoke as a symbol of having grown up but will quit when they reach adulthood. Unfortunately, far too many of them thenifind that a decision made in early childhood is irrevocable -- irrevocable because of the addictive nature of smoking to many, and the habituating nature to others. Thus, not only do we adults permit the message about the harmful effects of smoking to be drowned out by hundreds of millions of dollars' worth of care- fully orchestrated inducements to smoke; we fail to provide notice to chil- dren that their decision to begin smoking may have life-time consequences. even in schools. Ironically we recognize in most other areas that children are not equipped to make such decisions. We do not let them get married, enter into simple.contracts, or even agree to have sexual relations, because they are incapable of appreciating the consequences. Yet we have no reluctance about permitting children to purchase cigarettes as soon as they are tall enough to reach the coin slot of a vending machine. We have no apparent qualms about permitting them to smoke, not only in most public places, but increasingly Recognizing that children may not understand the risks associated withivarious products, we take reasonable steps to keep them out of the hands of children. Hard drugs, alcoholic beverages, pornography, and fireworks are some common examples. While the measures are far from 100% effective, they do tend to make it more difficult and expensive for older children to obtain these items, and'to a very large extent we keep them out of pre-teen hands. Yet many nine- and ten-year-olds are already confirmed'smokers; more than 207.` of pre-teen twelve-year-olds are smokers; and both smoking rocros and'even smoking,withdrawal programs are now being established at schools. Iif children could buy alcoholic beverages or pornography out of vending machines, and use it in special areas at schools, there would be a major public outcry. Yet when the same thing occurs with regard to a more dangerous product, we blighely accept it and any attempts to correct the imbalance in any way are met by disingenuous cries of "unAmerican"' and "freedom!' by tobacco industry representatives. Viewed'iin this perspective, it is clear why Secretary Califano's plan does not go far enough. According to his own figures, cigarette smoking costs the American public over 20 billion dollars a year, and costs the Federal Government over 7 billion dollars. By his own admissiony it is a practice every year. So, in an effort to reduce a cost of 7 billion doDlars, he is going to throw 5-6 million dolliars of anti-smoking education against hundreds of mil- lions of dollars of pro-smoking advertising. The commitment is cliearly too smaLl in view of the magnitude of the problem an&the power of the opposition. By way of contrast, we might note that it was reported that HEW would spend over 150 million dollars on the problem of teen-age pregnancy. Although teenage pregnancy is, of course, an important problem, it does not approach the problem of smoking in terms of the number of people affected, the amount of death and disability caused, or the potential cost to the nation. Moreover, it is almost certainly true that youngsters need at least as much education about the hazards of smoking than they do about the hazards of sexual intercourse. Why then, other than the power of the people who profit from this death~and disability, do we spend over 25 times more on teenage pregnancy education than on the far more serious hazard posed by teenage smoking? Although ASH supports anti-smoking educational programs, it is now apparent that education albne is not a sufficient response, particularly when every dollar going for anti-smoking education will be opposed by tens of dollars of cigarette advertising or tobacco industry counter-propaganda encour- Q P aging people to smoke. It is also ironic that it is only with regard to this one product binw~we urged to believe that education alone will be sufficient. ~ We do not launchimajor educational campaigns to deal with other public health and safety hazards. We did not simply put up posters warning ~ peoplie about the dangers of certain consumer products. We did not just warn ~ W

4. people about the hazards of air pollution and the particular hazard of lead. We do not simply inform people about the hazards of thalidomide, or of valium, or even of birth control pills. In each of these cases, as in the case of virtually every other product which comes:in contact with human beings and'may affect their safety and health, the most effective and appropriate remedy has been to adopt reasonable regulations on the product itself. Even with~ regard to alcohol, which for historical reasons has some of the immunity from regulation that tobacco enjoys, distribution is limited to certain outlets, sales to minors are enforced withisome strictness, potentially harmful addi- tives are limited, andithe product is not consumed in offices, in most pliaees of public assembly, imschools, etc. For these reasons, Action on Smoking and Health feels that the government's anti-smoking campaign cannot be limited to requests for voluntary action and a mini-educational campaign. As with any other potentially danger- ous ous substance, there can and should be reasonable regulations relating to its composition, distribution, and use by minors. This does not mean prohibition or restriction on the privilege of adults to commit slow suicide; it does mean that cigarettes should no longer be immune from the same reasonable restrictions now adopted for other potentially hazardous products. Another reason why Secretary Califano is more than justified in launching an effective anti-smoking program is the tremendous costs cigarette smoking imposes on both~his department and the general public. At a time of rising concern about the rapidly escalating costs of health care, studies show that the major preventable factor -- responsible for approximately 110% of health care costs in the United States today -- is cigarette Fmoking. It has also been determined'that the totali cost to the United States of smoking is over twenty billiion dollars. Today the greater part of those costs fall upon the majority of the population who have chosen not to smoke and who derive no direct benefit from smoking. Nonsmokers pay higher taxes to pay for the medical and related expenses of those on medicare, medicaid, social'' security, veterans' programs, welfare, etc. Nonsmokers pay increased health insurance premiums because of the increased'illness and disabilities smokers inflict upon themselves. And' nonsmokers share with smokers the noi-insignificant costs of forest, home, and industrial fires caused by smoking; damage to clothing and furniture caused' by smoking; and the additional cleanup costs associated with this practice. Secretary Califano, as the head of the department which bears most of the cigarette-related'costs of the Federal Government, has the duty an& obligation to take reasonable steps to reduce those costs. We on,ly regret that, at least for.a start, he has adopted a program which does not measure up to the problem. The Secretary has written to the major providers of health, fire, life, and disability insurance to ask them to voluntarily offer special dis- counts to nonsmokers. Although ASH feels that this is a step in the right direc- tion, again it does not go far enough. The costs of smoking, insofar as it is possible, should be borne by those who voluntarily choose to engage in the practice and assume the risks. A mere discount -- an economic incentive to help smokers quit -- is clearly inadequate. Furthermore, if insurance companies do not recognize their legal as well as moral obligations to set rates which rea- sonably reflect and take into account all of the relevant risk factors, it may be necessary to take the appropriate legal action, not only to correct these rates for the future, but also to recoup on behalf of nonsmokers the unnecessarily high payments they have been making since the hazards of cigarette smoking,became well known. I It is our understanding that the insurance industry has or will claim at this hearing that it is not possible to charge different rates for smokers and nonsmokers. This is a smoke screen, and they know it. First, there are many companies which already offer such discounts to nonsmokers, so clearly such discounts are possible. Secondly, anyone who has ever applied'for life, automobile, fire, and other insurance knows that applicants are required to

5. answer a large number of questions about their habits. Furthermore, in accor- dance with well-established principles of insurance law, amapplieant who con- 'ceals or lies about a material fact does so at the risk that his protection will be invalidated,. Being a smoker is not a one-time or secret event which can be effectively shielded from friends, neighbors, and business associates. In~ situations where any siginificant amount of claim is at issue, insurance companies will have little trouble in determining whether the insured lied and/or deviated from the terms of the policy, as they now have liittle trouble determining if other violations occurred. There is one final, an&very compelling reason why Secretary Cali- fano's program is both reasonable and necessary. Smoking today is recognized as the major cause of indoor air pollution which,creates a serious health hazard for those with a variety of particular conditions, and a health hazard for those with a variety of particular conditions, and a health problem causing physical irritation for many additional' nonsmokers. Like any other form of air pollution, and like any other health hazard'ioccurring in a public premises, it can and should be regulated to protect the health and comfort of others. The tobacco industry argues that all smokers have a right to smoke, an&that any restrictions os• limitations on these rights is an infringement upon personal freedom and an impermissible governmental activity. Such an argument is ludicrous on its face. The chewing of tobacco provides the same reLief and satisfaction for chewers as smoking does for smokers. However, no sane person today would argue that restricting the chewing of tobaeco:and the accompanying spitting in public places is amunreasonable restriction on personal freedom. No one would'argue that ~there must be a chewing and spitting sections on airplanes, or at the theatre, or even in an office or other place of business. By exactly the same token, and for virtually the same reasons, it is appropriate an&necessary for Secretary CAlifano to restrict smoking in publiic areas under HEW jurisdiction. But agaimthe weakness of his plan is evident on its face. Although employees of HEW will be protected from the hazards of ambient tobaeco~smoke while in HEW buildings, what happens when they gca to meetings and other pro- grams sponsored by HEW funds, or visit health, educationy or other facilities supported in large part by HEW programs? A1L such facilities must, under the Rehabilitation Act of 1973, provide reasonabLe accommodation to those who are blind, deaf, or in wheelchairs, and even to those who are alcoholics or drug addicts. Yet even persons who suffer a severe physical reaction to tobacco smoke are apparently not to be extendedthe same protection. At the stroke of a pen, Secretary Califano could have provided clean indoor air for millions of Americans; instead, he chose to protect only those at HEW builidings. Wh11e we believe that his efforts are a step in the right direction, we only wish that he had not been~ so timid in taking his first step. - The Tobacco industry has tried to convince the publ~ie that Secretary Califano's program, and the requests of various anti-smoking organizations, are an attack upon smokers, and that the battle i8 one between smokers an&nonsmokers. Agaim, nothing could be further from the truth. H.E.W1f anUother surveys indi- cate that.the majority of smokers are in~favor of additional restrictions on smoking in publiic places, and believe that employers have the right to restrict smoking in the workplace. Indeed, at least one-third of all smokers admit that they themselves find it annoying to be near a smoker. , . • It seems clear that the majority of smokers are concerned about the health risks of smoking, and would not want their children to take up the same practice which they are a1'1 trying desperately to~break. At the very least, O most smokers would want their owmchildren to make a decision concerning smoking ~ only after they are mature enough~to do so, and'not to be lured'.into,it before ~ they can fully appreciate the consequences. Many smokers have indicated~that they would not oppose reasonable restrictions on smoking; in fact, many have Oh N indicate&that such restrictions might make it easier for them to carry out ~ - their decision to quit. ~ $ W1

For all of these reasons it should be clear that neither Secre- tary Califano nor organizati'onisuch as ASH are out to punish the smokers. Indeed, among the many suggestions that ASH made to Secretary Califano's task force on smoking were that HEW should'assist those of its employees who wi'sh to quit to do so; that additional studies should be made as to the most effective ways to help people quit smoking; that health and life insurance companies should pay the reasonable costs of smoking withdrawal' programs for smokers who wish to quit, etc. Secretary Califano!s program is a major step forward, but it is clearly deficient in terms of the magnitude of the problem and forces on the other side. 'To more fully indicate ASH's concerns to the Committee and to permit a comparison to be made between what was proposed and what was done, I would like to attach to my written testimony a copy of a letter of concrete proposals that ASH submitted to the Secretary. We thank the Committee for this opportunity to present our view, and hope that the members will have responsi N.e questions or comments.

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