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Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 2 of 3
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- Cottini
- Cutler, S.J.
- Doll
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- Dunn
- Eisenberg, H.
- Falk
- Farber, E.
- Ferber, B.
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- Furth, J.
- Gellhorn
- Gilliam
- Gordon, T.
- Grossman
- Guthrie, E.H.
- Haag
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- Hammond
- Hartwell, J.L.
- Hauser
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- Schairer
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- Schneiderman, M.A.
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- Schuman, L.M.
- Schwartz, J.T.
- Scott, O.
- Seevers, M.H.
- Segi, M.
- Seligman, A.M.
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- Serra
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- Stocks, P.
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- Stowell, R.
- Syme, S.L.
- Taeber, K.E.
- Terry, L.L.
- Tokuhata, G.
- Tompsett, R.
- Totten, R.S.
- Turner, C.G.
- Vanduuren
- Vincent, W.J.
- Vonsallmann, L.
- Vorwald, A.
- Walker, C.B.
- Wallenstein, M.
- Webb, B.M.
- Weinstein, H.I.
- Woolsey, T.D.
- Wyatt, J.P.
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- Baynejones, S.
- Litigation
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Document Images
1. New studies indicating that smoking has maior adverse health effects.
2. Representations from national voluntary health agencies for action on
the part of the Service.
3. The recent study and report of the Royal College of Physicians of
London.
4. Action of the Italian Government to forbid cigarette and tobacco ad-
vertising; curtailed advertising of cigarettes by Britain's major tobacco
companies on TV; and a similar decision on the part of the Danish tobacco
industry.
5: A proposal by Senator Maurine Neuberger that Congress create a com-
mission to investigate the health effects of smoking:
6. A request for technicall guidance by the Service from the FederalTrad'e
Commission on labeling and advertising of tobacco products.
7~. Evidence that medical opinion has shiftedsianificantly against smoking~
The recent study and report cited by Surgeon General Terry was the highlay
important volume: "Smoking and Healt'h+-Summary and Report of the Royal
College of Physicians of London on Smoking in Relation to Cancer of the
LunT and Other Diseases." The Committee of the Royal College ofiPhysicians
dealing with these matters had beem at its work of appraisal of data since
April 1959. Its main conclusions, issuedi: early in 11962, were: "Cigarette
smoking,is a cause of lung cancer and, bronchitis, and probably contributes to
the development of coronary heart disease and various other less common
diseases. It delays healing of gastric and duodenal ulcers."
On June 7, 1962, the Surgeon General announced that he was establishing
an expert committee to undertake a comprehensive review of all data; on smok-
ina and health. The President, later in the same day at his press conference
acknowledged the Surgeon General's action andl approved it.
On July 2-1, 1962; the Surgeon General met' with, representatives of the
American Cancer Society, the Americani College of Chest Physicians, the
American Heart Association, the American Medical Associationthe.Tobacco
Institute, Inc:. the Food' and Drug Adtninistration, the National Tuberculosis
Association, the Federal Trade Commission, and the President's Office of
Science and Technology. At this meeting, it was agreed that the proposed
work should be undertaken in two consecutive phases, as follbws:
Phase I-An objective assessment of the nature and magnitude of the health
hazard, t'o, be made by an expert scientific advisory committee which would
review critically all available data but would'not conduct new research. This
committee would produce and submit to the Surgeon General a technical
report containing evaluations and conclusions.
Phase II--Recommendations for actions were not to be a part of the
Phase I committee's responsibility. No decisions on how Phase II would
be conducted were to be made until the Phase I report was available. It
was recognize'that different competencies would be need'ed& in the second
phase and that many possible recommendations for action would extend
beyond the health field and into the purview and competence: of other
Federal agencies.
The participants in the meeting of July 27 compiled a list of more than
150 scientists and physicians working in the fields of biology and medicine,
8
~,.
with interests and competence im the broad range of medical sciences and
with capacit'yy to evaluate t'he elements and factors in the complex relation-
shi'p between~ tobacco smoking and health. During, thenext' month, these
lists were screened' by the representatives of' organizations present at t'he
July 27meetiiig. Any organization coul& veto any of the names on the
list, no reasons being required. Particular care was taken to eliminate
the names of any persons who had1'aken a public position on the questions
at issue. From the final list~ of! names the Surgeon General selected ten men
who agreed to serve om the Phase I commit'tee. which was named The
Surgeon General's Advisory Committee on; Smoking, and Health. The com-
mititee members, their positions, and their fields of competence are:
Stanhope Bavne-Jlones, M.D., LL.d., (Retired ), Former Dean, Yale School
(4 Medicine (19351-40), former President. Joint Administrative Board. Cor-
nell University.., New York Hospital Medical Center (1947-52) ; former
President. S'ociety of American Bacteriologists (19291. and American Society
of'~ Pathology-andl Bact'eriolog,v(11940). Field: Nature and Causation of
Di-~ea<e in Human Populations.
Dr. Bavne-Jones served also as a special consultant to the Committee
~ta fl'.
Walter J. Burdette, M.D:, Ph. D., Head of Department'of Surgery; Uiti-
versitv of Utah Schooli ofl Medicine. Salt Lake City. Fields: Clinical &
Trxperimental Surgery; Genetics.
William G. Cochran. NI.A., Professor of Statisttics., Harvard University.
Field: Mathematical Statistics, with Special Application to Biological
Prohl lerns.
Enunanuel Farber. M.D., Ph. D., Chairman, Department of Pathology;
1 niversitw of Pittsburgh. Field: Experimental and Clinical Pathology.
Louia F. Fieser, Ph. D.. Sheldon Emory, Professor of Oiganic ChemiEtry;
i{arvard University. Field: Chemistry of Carcinogenic Hydrocarbons.
Jacob~ Farth. MLD., Professor of Pathology. Columbia University. and
I)iiector of Pathology Laboratories, Francis Delafield Hospital, New York.
N.Y. Field: Cancer Biology.
John B. Hickarn, M.D., Chairrnan, Department of Internal Medicine; Uni-
versity of Indiana, Indianapolis. Fields: Internal Medicine, Physiology of
Cardiopulmonary Disease.
Charles LeMaistre, M.D., Professor of Internal' Medicine, 'I1heUniversity
of Texas Southwestern Medical'School, and Medical Director, a'oodlaNN n Hos-
pital, Dallas, Texas. Fields: Internal Medicine, Pulsnonary Diseases,.
Preventive Medicine..
Leonard M.. Schuman, M.D.. Professor of Epidemiology, L niversity of
1linnesota School of Public Health, Minneapolis. Field'i:~ Health and Its.
Belationshipto the Total Environment.
Maurice H. Seevers, :11.D.,,Ph. D.. Chairmam Department of Pharmacology.
Fniversity of Michigan, Anni Arbor. Field': Pharmacology of Anesthesia
and Habit-Forming Drugs.
Chairman: Luther L. Terry,, MI.D., Surgeon General of the United! States
Public Health Service.
Vice-Chairman: James M. Hundley, M.D., Assistant Surgeon General for
Operations, United States Public Health Service.
Staff 1)irector Medical'Coordinator
Eugene H. Guthrie, M.D., M.P.H. Peter V. V. Hamill, M.D., M.P.H.
Public Health Service Public Health Service
10.
.:;.~<. _ ..~:,,:. ~, ..
i
4
Chapter 2
CONDUCT OF THE STUDY
The work of the Surgeon General°s Advisory Committee on Sinoking and
llealth was undertaken, organieeds and pursued with independence, a deep
sense of responsibility, and with full appreciation of the national' importance
4 the task. The Committee's constanfl desire was to carry out in its own
way. with the best obtainable advice and cooperation from experts outside
it; membership, a thorough and objective review and evaluation of available
information about the effectsof the use of various forms ofl tbbaccoupon the
hvalth ofl human beings. It desired that the Report of its studies andijud'g-
nwnts should! be unquestionably the product of its lhbors and its authorship.
With an,enormous amount of' assistance from 155 consultants, from members
and associates of the supporting staff, and' from several organizations and
institutions. the Committee feelsthat, adocument of adequate scope, integrity,
and individualitv has been produced. It is emphasized, however, that the
;,untent and judgments of the: Report are the sole responsibility of the
Committee.
at the outset, the Surgeon General emphasized his respect f'or the freedom
4 the Committee to proceed with the study and! to report as it saw fit, and he
i4ecl,t*ed all support'; possible from the Unit'ed! S'tatesPublic Health~ Service,.
['he Service; represented~ chiefly by his office, the National Institutes oflH'ealth,
the National Library of Medicine, the Bureau of State Services, and the Na-
tionall Center for Health~ Statistics, furnished the able and devoted personnel
:hat constituted the st~aff at the Committee's headqparters iniWashington, and
provided an extraordinary variety and volume of supplies, facilities an& re-
~:ources. In addition, the necessary financial support! was made available by
the Service.
It is the purpose of this sectioni to present an outline of the important
features of the manner in which the Committee conducted its study and com-
posed this Report. A retrospective outline of procedures and events tends to
convey an appearance of orderliness that did not pertain at all times. A plan,
was adopted at the first meeting of the Committee on November 9-10, 1962,,
but this had to be modified from time to time as new lines of inquiry led
into unanticipated explorations. At first an encyclopedic approach was con-
sidered to deal with all aspects of the use of tobacco and the resulting effects,
with all relevant aspects of air pollution, and all pertinent characteristics of
the external and internali environments and make-up of humani beings. It
1Nas soon found to be impracticable to attemptito d'o all of this in any reason.
able length of time, and certainly not under the urgencies of the existing
sit~uation., The finallplan was to give partieularattention to the cores of prob-
lems of the relationshipof uses of tobacco, especially the smoking of ciga-
rettes, to the health of men and women, primarilyy in the United States, and
13
I
to deal with' the material from both a general viewpoint and on the basis of so
dlsease categories. u~.
As may be seen in a glance at the Table of Contents of this Report, the main
topical divisions of the study were: ~
Tobacco and tobacco smoke, chemical and physical characteristics ~
(Chapter 6). f
Nicotine, pharmacology and toxicology (Chapter 7).
Mortality, general and specific, according to age, sexdisease, and smok- n
ing habits, and other faators (Chapter 8). n:
Cancer of the lungs and' other organs; carcinogenesis; pathology; artd ti
epid'emiology (Chapter 9). n Non-neoplastic diseases of the respiratory tract, parrticularly
chronic r
bronahitis and emphysema. with some consideration of the eff'ects of '1
air pollution (Chapter 1O). i
Cardiovascular diseases; particularly coronary artery diGeases (Chapter v
111.
Other conditions, a miscellanv including gastric and duodenal ulcer,
peri'natal disorders, tobacco amblvopia, accidents (Chapter 12)'.
Characterization: of' the tobacco habit and'beneficial effects of~ tobacco
(Chapter 13). 1
Psycho-social aspects of smoking(Chapter 14)'_ ~
llorpholbgical cons6itution of smoker~s (IChapterl5).
As the primary d'uti of the Committee was to assess information about
th
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i
h
l
h
f'
ng an
ma
ng
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smo
ea
t
rement was t
at o
, a major genera
requ
information available. That requirement was met in three ways. The first
and most im>>ortant was the bibliographic service provided by the National
Library ofl Medicine. _1s the annotated monograph by Larson; Haag; and ~ ~
Silkettte-compiled from more than 6,000 articles published in some 1,200
journals up to and largely into 1959-was available as a basic reference
souree_ the National Library of Medicine wasreqpested tocompile a bibllog-
raph} (by author and by subject): covering the world literature from 1958
to the present. In compliance with this request, the National Libr:ary of
Medicine furnished the Committee bibliographies containing, approximately
1100 titles. Fortunately; the Committee staff was housed in the National
Library of Medicine on the grounds of the National Institutes of Health,
and through this locat2on: had ready access to books and periodicals, as
well as to scientists working in its field of interests. 1Vlodern apparatus for
photo-reproduction of articles was used constantly to provide copies need'ed
for study by members of the Committ'ee. In addition, the members drew
upon the libraries and bibliographic services of those institutions in: which
they held academic positions. A considerable volume of copies of reports
and a number of special articles were received from a variety of additional
sources.
Alll of the major companiesmanufacturing cigarettes and other tobacco
products were invited to submit statements and any information pertinent to
the inquiry.. The replies which were received were taken into consideration
by the Committee.
Through a system of contracts with individuals competent in certain fields,
special reports were prepared for the use of the Committee. Through these
14
sourc.e-, much valuahle information was obtained; son-ie of it new and hithertoo
unpublished.
In addition to the special reports prepared under contracts. manv,con-
flerencesv seminar-like meetings. consultations. visits and correspondence
madeavailablp to the Committeeal lar,e amount of material and ai consider-
able amount ofwell-inform4and well-reasoned opinion and' advice.
To deal in depth and! discrimination with thetopics listedlabove. the Com-
mittee at it's first meeting formed subcommittees with much overlapping in~
ineneber=hip. Tihesesubcommitteesw-eretihe main forces engaged in collec-
tion. analn-.sir. and evaluation ofl data from published reports. contractual'
r,,ports. discussions at confierences: and from sorne new prospective studies"'Programmecl and
carried out generously at' the request of theCommittiee.'Iiir~e will' heacknowledged more fully
el~esclier~einthisReport. The first
i1,rmulations of conelusionswere made by these subcommittees. andl these~
MT(' submittled tot'he fulll Committee for revision and adoption after debate.
1t the beginnin,, and until the Committ'eebegan to meet routinely in
I vo4uti~e session, it had the adkantage of attendance at its meetings of oh-
-tr%,0rsfrom otlier Federalagencies: There were representatives fromthet,~)llhm,inr a=encies:
EsecutiveOffice of t'hePresident ofl the United States.
Fr~_lural Trad!* Commission. Department of Commerce. Department ofA-ri-
~ulturc. and theFood and Drug~ Admiilistration., Serving as moret'hani ob-
~~r~f n, and reporters to their agencies. when thev were present or by
«,rittrn communication, they supplied the Committee with much useful
infii,rmatlion.
Thcre were an uncountednuunber of inectiii_s of subcommittees and other
i0 ~=er gatherings. Petweeni Aovemlier 119f>2 and December 1963, the full
t:ommi'ttee heldlnine sessions each lasting from two tof'ourd'aysin Washing-
h,u or Bethesda. The main matters consi'deredl at the meet6n_sin October.
\on-ember, and December196.3' were the review and revision of chauters.
l
is
f
l
i
'
ca
scrut
!IN o
cone
us
ons; andlt
he innumerabldtilf thi
eeas oecompos-
t:iun and editin~ of this comprehensive Report.
714-422 0-64-3' 15
- ~.._._.~_.,~:.~....
U37sss93
Chapter 3
Criter ia f or Judgment
