Tobacco Documents Online

Inside: ~ Suit against tobacco companies could be landmark case PAGE 3 The threat of scientific illiteracy PAGE 4 Raw milk is for sale but with a warning PAGE 5 How accurate are textbooks on health? PAGE 8 Scare tactics are airned at PVC conduits. VOLUME 5,, NUMBER 5 NOVI'DEC 1984 NEWS & VIEWS PRICE: $2.00 PUBLICATION OF THE AMERICAN-COUNCILON SCIENCE AND HEALTH • 1995 BROADWAY • NEWYORK, NY10023 (212) 362-7044 Product Liability: Laws Promulgate Chaos Congressional bill that, if enacted, could bring order to state Under the present state laws, if the driver of this crane were injured, who is liable for what depends on where the accident occurred. (Photo by J. Jones) Wisconsin Senator Robert W. Kasten, Jr., has spearheaded a -~ =- ~ PVC: H ow Toxic Is . the Smoke? by Sharon Lynn Campbell THE SMOKE FROM _BURNING POLYVINYL CHLORIDE (PVC) CONDUIT IS LITTLE, if any, more toxic than ordinary wood smoke. Yet a manufacturer of metal conduit has launched a campaign to scare consumers into buying its more expensive product by raising exag- gerated concerns about the safety of PVC. Metal vs. PVC PVC conduit is a superior product for CONTINUED ON PAGE 2 liability laws. By Sidney Shindell PRESUMABLY, IF YOU~BUY A PRODUCT YOU SHOULD BE ABLE TO RELY on the fact that it will serve the purpose for which it is intended and that it is either safe to use or you~have been warned of the hazards that may result from its use. If you get injured because the product wasn't suitable or wasn't safe or you weren't warned, you should have the right to seek redress fromithe manufacturer through our legal system. Presumably this should all be true. But in practice, the question of who is liable for what and why depends very much on the question of where the injury occurs. The idiosyncracies of state laws, rather than a uniform standard of justice, may determine whether you win your lawsuit. There is little agreement among states on these issues. Roll Call of the States . • Your employer buys a crane which you are operating and, during the opera- tion, the boom of the crane touches a power line and you get hurt or killed. In Minnesota and New Mexico, the courts have said this hazard is obvious and you (or your survivors) cannot recover. You could collect Workers' Compen- sation if this occurred in the course of your employment, but the company that made the crane would not' be liable. If, on the other hand, the same situa- tion happened imIllinois, damages could be collected from the manufacturer of the crane and your employer could recover what might have been pai&out in Workers' Compensation. • You buy a backyard swimming pool made out of vinyl and, in spite of a warn- ing sign: "Do not dive," you chose to dive into this 31/z-foot high pool and when your hand slipped on the bottom you hit your head and were injured. In a case in New Jersey, the jury was to decide whether a person injure& in this way was entitled to collect damages by deciding whether constructing an above-ground swimming pool out of vinyl was a design defect. 81210239 CONTINUED ON PAGE 10

by themselves carry the force of law, but ' : That hasn't stopped the regulators. In 'which are almost always adopted by local Oklahoma, the city of Tulsa has denied . governments by reference. This then gives 'approval of PVC conduit, stating that the them the force of law, and they become part dangers of PVC' "particularly under fire ='"°~K ~` of local building codes. Products not ner- '` rnnrlitinnc arr wPll knnwn hecause of Yhe ~~~~ rmany uses. tvtetat conauit ana piping cor- .: 'mitted'by the NEC thus suffer a serious mar- "'hazardous, disastrous; death dealing prod-' li; it does so only so' long as a flame is held I p ofFortune, in 1980A11iedTubeandConduit Transit Authority (MTA) was censured by directly to it. >` k took advantage of this system by buying public interest groups for installing it in sub- PVC's virtues are reflected in the growth _ memberships for its salespeople and other ' way stations. As a resultof the highly publi, of its market share, from a mere 9 percent in employees, and using that voting power to cized allegations that the use of this conduit the late 1960s to 31 percent in 1980, with prevent the Carlon product from being would increase the risk of toxic smoke inha- projections of 49 percent by 1995. Steel, approved. Carlbn nromntlv brought suit .:-lation during a fire the installation of PVC cannot start ftres„and although it can burn, ;':•As renorted in the February 7 1983 issue headlines in 1982 when the Metro olitan and easily even by do-it-yourselfers. PVC :.;you, for$50 ~,;":In New York City, PVC conduit made~ ~' duit to produce, and can be installed cheaply ' .47 ship can be nurchased by anyone including 'tations on the use of PVC conduit cannot burn. In contrast, PVC does not corsince NFPA membership is not limited to Director of the state's Construction Indus- rode, costs one-third as much as metal eon=, r''ezperts in fire nrotection A voting member- tries Division has recommended severe limi- some other way, and they can somettmes having the NFPA membership vote on pro- • does not seem to have deterred city officials. cause fires via short circuits; although they „-_posed changes. This method invites abuse In New Mexico a nanel headed by the painted or protected from the elements m Unfortunately; the way this is done is by bustion products are unusually hazardous .~~;. ,A costly trained labor to install. They must be `.The NFPA periodically updates the NEC. ' method of determining,whether these com- t ~:. rode, are expensive to produce, and require keting setback •~ `ucts of combustion" The fack of a valid which accounted for 68' percent of the con- . against both Allied and the NFPA. The tubing in the subways was discontinued, ata ° duit market in the 1960s, is expected to drop NFPA has since beem dismissed from the high cost to taxpayers. Existing PVC con- 43 b in which burning plastics are involved. of circumstances, which makes the develop- have taken much account of the dangerous` ening symptoms suffered by victims of fires real fire situation. Each fire is a unique set building codes nor fire regulations seem to sing Why you might not escape from a method of rating the relative toxicity of vari- toxicity test for the state'svse that such tests high-rise fire" and describing the so-called ous burning materials has yet been devel- should'not be used for regulatory purposes. Intoxication Syndrome, supposedly caused oped. There are at least six different' tests New York Secretary of State Gail S. Schaf- by the presence of burning plastics. The used for this purpose, but each has short- , fer has called the current codes and regula- advertisements describe in detail the fright- comings and none of them approximates a tions inadequate stating that "neither Tube and Conduit has placed a series of No Good Tests Available The state of New York has also taken steps advertisements in trade journals, the Wash- What makes this whole situation almost toward limiting the use of PVC, despite ington Post, and other publications, discus- ludicrous is that no validated, well-accepted warnings from the consultant who selected a « , In an effort to combat this trend, Allied • •,.- ., _ .,,:;_ ._ ,. I at an additional cost. =+ percentI - to y 1995. suit which will go to court later this year. ' duit is currently being removed bythe MTA . . . .,, ~ . ~. . .. . ... . :. - . . . . ". . . • . .. . ~-r. .. .. . . Other angles to the Allied fear campaign, quate as a basis for regulations. 7` z:: CorvTttvueD ON PAGE 12 Other Charges Against PVC martly as scientific tools. They are made- Gottesman„Executive Director, of the Vinyl wnat tney ao not mention Is tnat tne reac- ment of good tests°very difficult. Although aspects of plastics." New York State Senator tions they describe will occur when people efforts to develop better tests are currently Israel Ruiz, Jr. has proposed a bill to ban are exposed to any kind of smoke. They are underway, experts in the field generally PVC in wire insulation. , not specific to PVC: agree that the current tests are of value pri- After that bill's introduction Dr. Roy T.~ nave Inciuaea cnarges tnat r v t_ pipe con- taminates water, and that burning plastics are responsible for firefighters' cancer deaths. -': The claim that PVC pipe contaminates water with vinyl chloride monomer and other carcinogens has long since been dis- proven. Full regulatory and standards approval have been granted for the use of PVC conduit for water. " 'The issue of firefighters' cancer rates is less clear~cut. It is true that firefighters have a higher cancer rate than people in many other occupations. However, the reasons for this are complex an& incompletely under- stood. There is a totaLlack of evidence that burning plastics are iesponsible for firefigh- ters' increased cancer risk. Electrical Code Controversy Allied's campaign, against PVC has not been limited to misleading publicity. ~` A h io b h not er act n y t e company has led to a lawsuit by Carlon, a manufacturer of thin- walled PVC electrical conduit, for extreme irregularities in the way PVC was kept off of the list of approved materials in the National Electrical'Code (NEC). • ,:. , The NEC, which is created by the National Fire Protection Association (NFPA), is a set of standards which do not

U pdate Suit Against the Tobacco Companies Could Be a Landmark Case With the expansion of product liability law, cancer victims now have a better chance of establish- ing the negligence of tobacco companies and their financial lia- bility for the terrible conse- quences of their product - the cigarette. By Larry White PRODUCT LIABILITY LAW HAS BEEN EXPANDED IN MOST STATES by' both, appeals courts and legislatures to allow lawsuits against manufacturers for injuries suffered by consumers of all types of products. Unsafe ladders, exploding bottles, danger- ous IUDs, and asbestos are examples. All these and' many more have caused injuries and resulted in successful lawsuits against manufacturers who were guilty of negli• gence. Curiously, it is the manufacturers of the one consumer product that is unsafe when used as intended that have never been held liable for the millions of deaths and ill- nesses it has caused. Tobacco companies have been sued in the past, but they have always been able to beat back attempts to hold them financially liable for the terrible consequences oflcigarettes. Because of mod- ifications in both law and public attitudes about smoking, this many change soon. Victims Fight Back: The Dewey Case The family of a smoking victim in New Jersey, along with several other families, has decided to fight back. Wilfred E. Dewey succumbed to lung cancer at the age of 48'on November 20, 1980. A resident of one of the THE TASJE OF SUCCESS k,Warnmg: jhe,Surgeon General Has=Determined M~ Even the present warning on packages of cigarettes is not specific enough to properly inform smokers of the hazards of cigarettes. Mrs. Dewey's case is not the first personal injury or wrongful death case against the tobacco industry. Since the relationship between smoking and lung cancer wass proven in the mid-1950s, there have been suits in several states by tobacco victims. But the plaintiffs' lawyers in these cases were no LL Curiously, it is the manufac- turers of the one consumer prod- uct that is unsafe when used as intended that have never been held liable for the millions of deaths and illnesses it has caused. » New Jersey suburbs of New York City, Dewey was one of the almost 90,000 Ameri- cans who died of cigarette-related lung can- cer that year. To his family, though, he was not a statistic. A husband and father, he is survived by his wife Claire and two children Wilfred Jr., 19, and Carol; 14. Claire Dewey decided to do something that has never before succeeded - she has sued the companies that sold the cigarettes her husband smoked: R. J. Reynolds, American Brands, and Brown and William- son. If she succeeds, her landmark case will have a great impact throughout the country. If the tobacco industry could be hel& liable for the deaths it causes, the floodgates would'open for a nationwide torrent, of liti- gation. match for the expensive legal firepower the cigarette companies were able to level against them. In the last two decades, how- ever, product liability law has undergone a dramatic expansion making manufacturers and distributors of all types of products lia- ble for injuries caused by them. Ironically, the cigarette companies, whose products are the largest cause of preventable death in the United States, have managed to totally escape liability. More than 350,000 Ameri- cans die each year of smoking-related causes, but the cigarette companies have never paid a single cent in compensation. Product liability law in the United States the future, there may be more uniform standards of liability, hopefully written in a way that would protect consumers from inherently harmful products like the cigarette. But right now, because of a state Supreme Court ruling in New Jersey which had nothing to do with smoking, that state is currently anideal place for the first success- ful litigation against tobacco companies. The "State of'the Art" Defense Decided in 1982, the case of Beshada v Johns Manville Products Corp.,, 90 N.J. 191, held that~ a manufacturer, cannot pre- sent a "state of the art" defense in a strict liability case. This means that in New Jersey a manufacturer will not be allowed to argue at trial that he didn'rknow at the time of the ptaintiff's injury from or exposure to the harmful product, that the product was indeed harmful. Few states have gone so far in holding manufacturers responsible for the ill effects of their products. The state Supreme Court relied' on a maxim of strict liability law that states that when a con- sumer sues a: manufacturer for injuries incurred when using his product, the focus of concern should be not on the manufac- turer's conduct or knowledge but on the lack of safety of the product. It is not necessary to consider whether or not a manufacturer was at f'ault. - The court went on to justify its decision on policy grounds. One of the reasons for today is a patchwork of fifty state laws. I§S^,n 0241 . CONTINUED ON PAGE 4 hat Cigarette Smoking Is Dangerous ta Your Health.-

i Landmark Case CONTINUED FROM PAGE 3 imposing strict liability is that the manufac- turers and distributors of defective products can best allocate the costs of resulting inju- ries whemthis system is used. This is fairer, ;~ the court ssid, than imposing the cost on "the innocent victims who suffer illness and disability from defective products." According to Alan M. Darnell, who argued the case for Beshada in the New Jer- sey Surpreme Court, he and his opposition realized at the same time that the landmark decision made the legal climate in their state favorable to lawsuits against cigarette manufacturers. David J. Novack, one of the Johns Manville lawyers, says that he and Darnell were "opponents but not enemies: " Now they are cooperating with ea& other. Mrs. Dewey is represented by Novack's Newark firm and Darnell represents several other lung cancer victims. L L When the case finally goes to trial the primary issues will probably be causation of Dewey's lung cancer, the impact the tobacco industry's mar- Zting and advertising strategy on his smoking habit, and the question of tobacco addic- tl on.' Y The Dewey case will not go to trial at least until next year. Tobacco industry lawyers are using every delaying tactic they can find. They argued in federal court in April in a similar case that the cigarette labeling act (which requires warning labels on cigarette packs) "preempts" lawsuits based on state law. Judge H. Lee Sarokin rejected this claim in~September, but the industry is sure to appeal his ruling. The ultimate decision may have to come from the Supreme Court. Meanwhile, the plaintiffs have been tak- ing depositions (sworn testimony out of court) of tobacco industry executives. They grilled Curtis Judge, president of Lorillard, for four days and K. V. Dey, president of Liggett and Meyers, for two days. Unfortu- nately, the trial judge has imposed a gag order on the depositions. When the case finally goes to trial the pri- mary issues will probably be causation~ of Dewey's lung cancer, the impact of the tobacco industry's marketing and advertis- ing on his smoking habit, and the question of tobacco addiction. Darnell and his col- leagues believe that they will have to fight, the issue of causation against overwhelming evidence to assert that the causal link between cigarette smoking and lung cancer is not yet proven. (The fact that no reputable scientist supports their position does not prevent them from asserting it.). 4 A Misleading Image Darnell and the other plaintiffs' lawyers believe that it is important to show that the cigarette companies' marketing practices and advertising misled Dewey and other smokers into believing that smoking was not unhealthy. The image of smoking and cigarettes projected in the media by the tobacco companies carries the message that smoking is fun, enjoyable, refreshing - and anything but dangerous. If the defendant cigarette companies argue that smoking is a matter of free choice„the plaintiffs' lawyers will argue that information is needed to make a reasoned choice. By deliberately misleading the public about the hazards of smoking, the cigarette companies have in effect tried to conceal the critical informa- tion needed for a free choice. Dewey and the other plaintiffs started smoking,before 1965, when the government began to require warning labels on every package of cigarettes. Failure to warn of a hazard is a critical element of product liabil~ ity suit, so actions on behalf of pre-1965 smokers are considered the easiest cases to win. Both the "preemption" issue and the effect of the warning label are uncertain but Darnell and Novack think that this will not stop future plaintiffs from winning cases. For six years the label merely said that smok- ing "may be dangerous" and even the pre- sent warning is not specific enough to prop- erly inform smokers of the hazards of cigarettes. New warning labels being considered by Congress in this session are much more spe- cific. They warn of lung cancer, emphy- sema, and hearrt'disease. Such explicit warn- ings may make it more difficult for smokers to sue inithe future, but the latency periods for these diseases are so long that even if the new warnings become law, as seems likely, they will not have any effect on the current litigation scene. The tobacco companies have used all their potential muscle to stop or water down all warning labels, but they nevertheless can be expected to say in court that they fulfilled their duty to warn with these labels. Product liability law in New Jersey is now very favorable to plaintiffs, an& attitudes about smoking are changing. A significant percentage of jurors can be expected to understand'the dangers of smoking and its addictive properties and be sympathetic to eharges that cigarette companies will proba- bly fight a no-holds-barred legal battle against Claire Dewey and other smoking vic- tims. No doubt each legal step will be liti- gated to its most, extreme conclusion and everything that can be appealed will be appealed. Every canceivable argument about every possible point will be raised. Few plaintiffs' lawyers have the stomach or the resources for this. But Alan Darnell vows, "They won't starve us out." Larry White, J. D., is Executive Director of the California Nonsmokers' Rights Foun- dation. 81210242 ('nmmPnta e Th rea of Scientific=111itera ewT,~i-r,. Half of the bills constdered by ~ n S-i Congress' deal . with science .;or technology. `,Yet 93.3 percent o adults ncluding mosf, U S . , v ' d isl r oters an many aeg ato s : ~ ~ are "scientificall illiterate " =~ y ,,~;~ ;. . , : .- .. z-.-:. By Cathy Becker Popescu "?S"?'~r ._~ Si`r ti9ss',r~r^~ i ~ Sc?fj°fytt~ M ORE THAN TWO.DECADES AGO. AUTHOR ' C:P. SNOw LAMENTED that most western intellectuals had never tried, wanted, or been able to understand two of mankind's most significant achievements = the indus- trial and the scientific revolutions: -He attributed this ignorance to what he called the phenomenon of the "two cuitures." - +Y w. - Snow observed that the whole of western society was split into two polar groups that had ceased to communicate: scientists and literary intellectuals (or more "generally, non-scientists). While acknowledging that many scientists' ignorance of the humanities. was unfortunate, Snow was most concerned with the inability of many otherwise.well-`. educated individuals living in an increas-o ingly technological age to understand even' the most basic scientific concepts. : Since ; then, the : situation "' has ; not improved. If anything, the gap between'the two cultures has widened as technological, innovation has proceetied at a nearly expo;_', nential pace, while the ability of non=scien= tiststo understand it has not Shocking Ignorance ;_~ fi ; F1 lY!`J stucly by the National Science Foundation (NSF) provided a quantitative estimate oCthe American public's shocking ignorance of science. This survey of Anieri-: can adults indicated that only 14 percent were -able to provide even a minimally acceptable definition of the meaning of sci:~ entific study, while only half could differen-.' tiate between science and a pseudoscience` I such as astrology. ~ n ` In the same study, just half of the resp - dents showed evidence of possessing a basic vocabulary of common scientific terms nec- essary to follow public discussion about sci- entific results or policy issues. Less than half met study criteria for knowledgeability about scientific and technological public policy issues Altogetheri a mere 7 percent of adults fared well enough on the NSF test to meet minimal criteria for scientific literacy. Even among individuals,.:;holding '.;advanced degrees, only one-quarter qualified as being, .-....4 Y~:~l:r.'•'fANTINIIFII nN PAfF13

Raw Milk: Back to Nature, But With a Warning Label By Richard A. Greenberg The image of milking a cow and immediately putting a pitcher of fresh, tasty (non pasteurized) milk on the table was blurred in Arizona when people who con- sumed raw milk, sold in cartons, suffered food poisoning infec- tions. RAW MILK IS AVAILABLE FOR SALE AGAININ' ARIZONA. The Grand Canyon State's legisla- ture passed on May 8; 1984 a bill permitting the sale of raw milk in containers carrying the warning label' "Raw Milk: Not pasteur- ized and may contain organisms injurious to your health." This has apparently settled' a two year argument between state and local dairy and public health officials on one sidee and raw milk producers and health food store owners bn the other. The latter groupss want to be able to continue selling raw milk because a market for this product persists among people who think that raw milk tastes better, believe that pasteurization reduces milk's nutritional value (im fact, it does not destroy any nutritionally signifi- cant component of milk), or simply don't like the government telling them what they can or cannot consume. The first Arizona dairy to get back into raw milk marketing is a suburban Phoenix plant owned by Arthur Beals. Coinciden- tally, it was the Beals Farm ~ Dairy that pro- duced the raw milk consumed by a large per- centage of the 200 people in the Tucson area who came down with an intestinal infection called campylobacteriosis in May 1981. It was this outbreak of illness that first brought the health consequences of drinking raw milk to public attention in Arizona. The organism responsible for the outbreak, Campylobacter jejuni, is a common, con- taminant of raw milk and is destroyed by pasteurization. The stage was set for evenigreater public attention in December, 1982 when 26 Phoe- nix residents came down with salmonellosis after drinking raw milk. The product came from the Happy Ours Swiss Dairy, located in nearby Glendale. Salmonellosis is a food poisoning infection caused by a group of bacteria which inhabits the intestinal tracts of man and a variety of animals ranging from cattle, hogs and poultry to pet turtles. The symptoms include unpleasantries like vomiting and diarrhea and usually run their course in a few days. However, the resultant dehydration is a serious and often~ life- threatening problem to the very young and the elderly. There were no fatalities in the LL Milk as it leaves the cow is free from microorganisms. However, in this imperfect world, it comes immediately into contact with assorted forms of microbial life, some of which are capable of causing serious human disease. » December episode. Seven more people came down with sal- monellosis in March, 1983 after consuming some Happy Ours raw milk and this time a 72-year-old Sun City resident died. There are at least 2,200 different strains of salmonella, the microorganism that causes this disease. Each strain has its own speciall characteristics, which can be exploited in laboratory tests that distinguish it from other salmonella; The specific type isolated from the fatality was also found in raw milk samples taken from Happy Ours dairy. Thiss is convincing, but, not absolute proof that the Sun City resident got her salmonella from the milk. Public health officials in April, 1983 increased their frequency of dairy sampling to a one per week basis and in August, found salmonella in a Beals Farm Dairy sample. The local papers and electronic media had a field day. Both Beals and Happy Ours were affected so adversely by the publicity that they went out of business. The Arizona House Agriculture Commit- tee subcommittee which convened in August, 1983 to consider what, if any, steps to take about raw milk, heard Mr. Beals raise the issue of "government protecting everyone from every peril." Another dairy- man, a state representative from Mesa, com- plained that the "raw milk industry is being punished" and noted that salmonella can also be found' in pork, beef and fowl. It is probable that someone mentioned that these meats are rarely consumed raw, which is precisely the point of the controversy. Milk, as it leaves the cow, is free from microorganisms. However, in this imperfect world, it comes immediately into contact with assorted forms of microbial life, some of which are capable of causing serious human disease. Before the advent of pasteurization, milk consumption was often the source of diar- rhea epidemics in children, as well as tuber- culosis, gastroenteritis and streptococcal infections. Immunization and testing of cows has virtually eradicated•these diseases. However, there are many avenues by which bacteria, viruses and other microorganisms enter milk and pasteurization is by far the most reliable way to ensure the destruction of any that may be present. Just how dangerous is the drinking of raw milk? The federal government's Centers for Disease Control, (CDC), which investigated some raw milk-associated illnesses for Cali- fornia„ealculated that raw milk drinkers are 158 times more likely than non-drinkers to contract illnesses caused by Salmonella dublin (a strain of salmonella often associ- ated with dairy cows which produces a sometimes-fatal human illness). And Sal- monelltr dublin is only one of the many dis- ease-causing organisms that may be found in raw milk and are destroyed by pasteuriza- tiom According to the CDC, the only reason why the number of S. dublin cases in Cali- fornia (which permits raw milk to be sold by so-called Certified Raw Milk dairies, manu- facturing and testing their product accord- ing to American Association of Medical Milk Commissioners' protocol) is not larger because the population that drinks certified raw milk is very small. The CDC, in its recent report on the risks of contracting S. dablin from raw milk, concluded: "Salmo- nellosis from raw milk is a potential hazard that merits greater appreciation by con- sumers, producers and health care pro- viders." To that, we add, Amen. As this goes to press, the Department of Health and Human Services is reviewing the future of raw milk production4nithe United States. Indeed, although the federal govern- ment published its first Pasteurized Milk Ordinance in 1924, the PMO does not carry the weight, of law. While it says that milk should be pasteurized and tells how, it is a so-called "Exemplar Rule" to be applied as local governments see fit. We think the Arizona experience and California statistics are two good reasons for HHS to tell us offi- cially that drinking raw milk is a bad idea. Richard Greenberg, Ph.D., is Associate Director of ACSN.

Does Vasectomy Cause Heart Disease? ;csuIrs af recc'arrh should ease fears of 10 million Americans who have had vasectomies. By Kathleen A. Meister VASECTOMIES ARE AS SAFE IN THE LONG TERM AS THEY ARE IN THE SHORT TERM. That's the basic finding from two major studies, bothi completed this yeaq which investigated the health status of American men who have been surgically sterilized. The results of these studies should be very reas- suring to the ten million American men who have had vasectomies and who may have been frightened by earlier reports suggesting that vasectomy might increase the risk of atherosclerosis (the disorder of the arteries which is the underlying cause of coronary heart disease) or, damage the immune sys- tem. Monkey Experiments Arouse Concern Two experiments on monkeys, performed by researchers from Wake Forest University and the Oregon Regional Primate Research Center in the late 1970s, first indicated that vasectomy might influence the development of atherosclerosis. In the first experiment, ten cynomolgus monkeys were fed a diet designed to induce atherosclerosis rapidly. Five of the animals were vasectomized; the other five were not. Several months later, the researchers found that the vasectomized monkeys had devel- oped more extensive atherosclerosis than the others. In the second experiment, ten rhesus mon- keys that had been vasectomized many years earlier and fed a normal monkey diet were found to have more extensive athero- sclerosis than sevenimonkeys of similar ages that had not been vasectomized. Although these experiments involved only a small number of animals, they aroused great concern, because monkeys are so simi- lar to humans biologically, and because vasectomy is a very common procedure. Approximately half a million vasectomies are performed each year in the United States alone. More than 40 million have been per- formed worldwide: If long-term health dan- gers truly were associated withi this proce- dure, then 10 percent of the adult men in the United States might face these dangers, along withimillions in other countries. The Immunity Connection How could vasectomy affect the risk of heart disease? One possible connection between the two involves the body's immune system. A few years before the monkey experi- ments, it was learned that after vasectomy, many men (and male animals) develop anti- bodies to their own sperm. Antibodies are 6 substances formed by the body's immune system in response to a" foreign"'substance - something unfamiliar to the body, such as an invading virus or bacterium. Sperm cells are "foreign" because they are not produced in a man's body until, puberty, and the immune system decides what's foreign and what isn't long before that. In a man or male animal that has not had a vasectomy, sperm cells are made in the reproductive tract and released from it, and they never come into contact with the immune system. After vasectomy, however, sperm cells are made but not released. They remain in the body and break down into their components. Some of these compo- nents may find their way into the blood- stream, where they ean, attract the attention of the immune system. Antibodies may then be formed. At least 50 percent of men who have had a vasectomy develop sperm anti- bodies. - The scientists who performed'the monkey experiments speculated that these sperm antibodies might be the link between vasec- tomy and atherosclerosis in their experimen- tal animals. They suggested that the anti- bodies might form complexes in the blood- stream which could damage arterial walls. There is no direct evidence indicating that~ sperm antibodies damage arterial walls; this in just a hypothesis. But it does provide a possible explanation for the results of the monkey experiments and it adds a neww health concern as well: if having a vasec- tomy triggers a response from the immune system, could it increase a man's risk of developing diseases of that system? Human Studies In response to the monkey experiments and the theoretical concern about vasecto- my's effects on the immune systemi, at least eleven~studies have been done in humans to see if vasectomy has adverse effects on health. In most of these studies, vasec- tomized men were compared with other men to see if they had an increased incidence of heart disease, immune disorders, or other medicall problems. In a few, heart disease patients were compared with otherwise simi- lar mewwho did not have heart disease, to see if there was an unusually large propor- tion of men with vasectomies among the patients. The results have been consistent: with the exception of some genital tract pro- blems occurring soon after vasectomy, prob- ably as complications of surgery, illnesses have not beeni found to be more frequent in the vasectomized men. Two of these studies are of particular interest. One study, calle& The Health Status of American Men4 is of speeial' importance because of its unusually large size. The larger an epidemiological study is, the more likely it is to detect an effect (such as an increased risk of disease) if there really is such an effect. This study compared the health status of 10,590 vasectomized men with that of the same number of non•vasec- tomized men of the same ages who were liv- ing in the same neighborhoods. The vasec- tomized men had rates of heart disease, diseases of the immune system, cancer, and most other diseases (except for genital, inflammations) similar to or lower than the rates experienced by the other men. The second study, performed by the Bat- telle Human Affairs Research Centers in the state of Washington, is of special impor- tance because the period of time between the men's vasectomies and the survey was par- ticularly long. In most of the other studies, the majority of subjects were questioned within ten years after their surgery, and it is possible that, adverse effects of vasectomyy might have been missed if they took longer to develop. This is particularly important - for atherosclerosis and heart disease, which are known to develop over a period of years before symptoms become apparent. Early atherosclerosis can easily be detected in ani- mal experiments by killing the animals at the end of the experiment and examining pieces of their arteries under a microscope, but obviously this approach cannot be used in humanistudies. In the Battelle study, the men were ques- tioned an average of 15 years, and in some cases as long as 37 years, after vasectomy. It was found that their risk of heart diseasee was no greater than that of a group of simi- OD lar men who had not had vasectomies. The Battelle researchers also tested some ~ of the men in their study to see whether they lo.i had antibodies to sperm in their blood. They O foun& that many of the vasectomized men N did, but that vasectomized men who had ~ coronary heart disease were no more likely to have them than vasectomized healthy men. This casts doubt on the hypothesis sug- gesting that sperm antibodies cause arterial damage. Fifteen Monkeys vs. 22,000 Men Alliof the evidence indicates that despite the similarity between monkeys and men, vasectomy produces adverse effects in the CONTINUED ON PAGE 14

Professor, Department of Nutrition, University of California, Davis Education: Sc.D., 1970, S.M., 1966, Har~ vard University School of Public Health; B.S., 1964, Cornell Uhiversity Recent Book and Popular Publications: Your Diet-Vrtamin Supplements (1984); "Your Diet and Migraine," Vogue; "Eat- ing Right Does Not Mean Starving Your Senses," Glamour; "The Weight-Loss Diet for Your High Energy Life," Redbook. Research and Professional Interests: "Obesity in man and in other animals. In my research group, we use genetically obese rats and mice in studies which look at factors such as composition of the diet, exercise, and what choices an ani- mal makes when given access to various foodstuffs. Iniresearch performed in col- laboration with Dr. Barbara Horwitz of the University of California, Davis, we have found that the contributions that brown adipose tissue makes to the devel- opment of obesity can be quite impor- tant, especially when animals eat high fat diets. - "I also serve as the Director of our Food Intake Laboratory, a multidiscipli- nary, research group working, on the question of what controls food intake." Turning Point: There really hasn't been a turning point in my career. However, there have been three major, consistent influences on it. "The first of these is that I was a 4-H club member, which taught me to set short- and long-term goals and to criti- cally evaluate myself and others. It was through 4-H that I became interested in foodAnd nutrition, too. "Studying under Dr. Jean Mayer at Harvard University was the second major influence. I have great admiration for Dr. Mayer both as a scientist and a philosopher. He is a truly educated man in the finest sense of the word and he inspired me to do good scientific work at Harvard. He also, by his example, showed me how important it is for a L L I believe in moderation in all things, except love offamily and friends. 35 nutrition scientist to speak to the public and write for lay audiences. I view this as a professional, and moral responsibility. .The third major, influence on my life was working with Dr. Jules Hirsch atThe Rockefeller University. Dr. Hirsch is a fine scientist and a Renaissance man and he reinforced in me a commitment to the ethics of science." ~ In your field of nutrition, what do you see as the major problems that Americans face today? "I would hate to list some- thing as 'the' major problem. From my point of view, however, the problem of eating too much and weighing too much is one of the major nutritional problems in America today. Also, I'm tremen- dously afraid of oversupplementation with vitamins and minerals. [ think that we don't know enough of the hazards involved and when we find out about them it may be too late for some people. Judith S. Slern There certainly are other problems in nutrition in the U.S. Certain segments of our population may not be getting enough iron, vitamin B,, calcium, or fiber, to name a few areas of concern." What accomplishments in the field of nutrition do you expect to see in the coming years? "In the nextten or fifteen years, I expect to see on the market a pharmacological agent that alters metab- olism in a way that will help people to lose weight and keep weight off. I don't think that this will be a drug that acts on the central nervous system. It may be a drug that, acts on brown fat to stimulate the burning of excess calories. "A1so, I fully expect that in the short run there will! be a no-calorie fat substi- tute, sucrose polyester, available in this country, but I don't anticipate that this will make any difference in the number of people who take weight off and keep it off. "In addition, Lexpect that we nutrition educators and dietitians will finally move away from the use of the Basic Four Food Groups as an educational tool. This concept has been helpful!in the past, but we know much~ more now about micronutrients, and just telling people to eat a variety of foods from the four groups does not ensure optimal nutri- tion." Personal Health Code: "I believe in moder- ation in all things, except love of family and friends." : 4

By Densie Hatfield HOW WE EAT. WHEN WE EAT, WHAT WE EAT, AND WHrWEEAT are generally referred to as our food habits and attitudes: Each individ- ual's particular habits and attitudes about food and nutrition are developed and refined as a result of many, influences; eth- nic background, family preferences, socio- economic level, and education. While the other factors are "built-in," education can be influenced. Good nutrition education, provided in the earlyyears, lays a firm foun- dation on which pQsitive food habits and attitudes can be built. To get a good idea of what and how stu- dents are learning about nutrition during thee extremely impressionable high~school years, the American Council on Science and Health (ACSH) has reviewed several books that are popular for use in high~school health courses. All' contained chapters on nutri- tion. Each text was critiqued for its style, its weak points, and its strong points. We found that while some of the information that was presente& in the different books didn't always agree, the most notable differences were subtle ones pertaining to the style of presentation and editorial viewpoints. The styles ranged from very dry presenta- tions of nutrition principles, complete with descriptions of the classical nutrient defi- ciency diseases, to highly editorialized sec- tions on the "dangers" of foo& additives in our food supply. Included among these was how "to reduce your intake of possibly dan- gerous additives" with no adequate discus- sion of what, in their opinion, constituted'a dangerous additive. While none of the seven texts reviewed were way off target as far as the accuracy of the information in7the food an& nutrition chapters, there were a few crucial misleading statements and omissions. Each text con- tained its own strong points too. As a result, each one should ultimately be evaluated based upon the students that~ will be using the text, and the topics that are to be the most emphasized. You and Your Health by William Fassbender; John Wiley & Sons 1984 Style-This text approaches nutrition mainly from a consumer's viewpoint; dis- 8 H EAITH TEXTBOOKS TEACH I NG ACSH's review of health textbooks reveals accuracy L L While none of the seven texts that were reviewed were way off target as far as the accuracy of the information in the food and nutrition chapters, there were a few crucial misleading state- ments and omissions. 9 ~ cussing shopping, reading labels and plan- ning menus. The approach to good nutrition is through the basic four food groups i.e., l) Milk and milk products 2) Meat and meat substitutes 3) Fruit and vegetables and~ 4) Breads and cereals. It stresses the impor- tance of a balanced diet over vitamin supple- mentation. Information is presented in a straightforward manner. Strong points-Contains entire chapter on weight control and dieting. The topic is cov- ered from all viewpoints, i.e., psychologi- cal, sociological, exercise, and fad diets. Very little editorializing is presented in this text. Weak Points-Doesn't cover the most up- to-date and/or controversial'l issues to any extent. Gives little practical information concerning the actual diet planning needed for weight control. Almost no mention of nutrient needs of teenagers. Very little infor- mation on how the vitamins and mineralss function in the body. Understanding Health by William Kane, Peggy Blake, and Robert Frye; Random House School Division 1982 Style-This text brief ly covers a wide variety of topics im a relatively short space. As a result, little detail is provided on any one topic. Again, good nutrition is approached from the concept of the basic four food groups. Very easy, if not exciting, reading. Strong Points-Covers a wide variety of topics. Gives some practical information for weight reduction. Provides a useful'chapter summary and thought-provoking questions after each section to check your understand- ing. Easy to read but not too simplistic. Weak Points-Very brief discussion of spe- cialinutrient needs of teenagers, who are the target audience of this book. Very little men- tion of current nutrition issues other than a slightly ambiguous section on foodAdditives and preservatives. Turner's Personal and Community Health by Stewart M. Brooks and Natalie A. Brooks; The CV Mosby Company 1983 Style-This text contains one chapter on nutrition and diet that more resembles infor- HEALTH A WAY OF LIFE HEALTH AND SAFETY FOR YOU INVESTIGATING YOUR HEALTH MODERN HEALTH mation for a basic nutrition course than for a general health course. The style is very dry, using a number of tables and charts to illus- trate points. 'Iltrner's uses the five food group guide rather than four. The fifth, or "others" group consists of' foods that pro- vide few nutrients except carbohydrates and fats. In keeping with its style, the questions at the end of the chapter resemble exam questions. Strong Points-Presents facts with no edito- rializing. Does discuss some consumer con- cerns such as fast foods, fortified foods, fatty foods, health foods, nutrition labeling and food additives. Weak Points-Little practical information for actual' diet planning or shopping. Depending upon the level of the students, it could be too technical. Health and Safety For You by Ted Tsumura, Lorraine Henke Jones, and Thomas W. Bonekemper; McGraw- Hill, Inc. 1984 Style-This text provides three chapters dealing with food and nutrition. Uses the five food group plan combined with the 1980 U.S. Dietary Guidelines for Americans as a guide to good nutrition. The writing style is very simple and easy to read. Covers a wide variety of topics in these three chap- ters. Very much consumer-oriented approach to nutrition. Strong Points-Gives some practical infor, mation for diet planning. Most detailed explanation of the use of the five food groups. Discusses topics of interest to teena- gers i.e., diet pills, fad diets, diet and sports, and vegetarian diets. Instructs on how to read and use food labels. Included in this section is a list of food additives and their functions. Weak Points-Does make some misleading statements, mainly as a result of omissions regarding processed foods, unsaturated fats, and vegetarianism i.e., discusses how everyone should lower their intake of food additives (chemicals) by eating more fresh foods, but doesn't mention~ the naturally occurring chemicals in foods, or the conven- ience and'time factors to be considered with

NUTRITION: SUBSTANCE OR STYLE? A. mixed with omissions and some misleading statements. TURNER'S PERSONAL AND COMMUNITYHEALTH LL Good nutrition education UNDERSTANDING HEALTH provided in the early years lays a firm foundation on which posi- tive food habits and attitudes can be built: 5y YOU AND YOUR HEALTH processed foods. Also says that less pro- cessed foods may be more nutritious than canned or prepared foods. The reverse may also be true depending on handling and cooking procedures, but this is not dis- cussed. States as a fact that dark breads are more nutritious than white breads, which is not always the case. States that plant food sources have fewer saturated fats, but makes no mention of the saturated fat plant sources of palm oil and coconut oil. Gives a very negative impression of vegetarian diets, saying that it is very difficult' to get a balanced diet and that nutritionists don't recommend them. Puts undue amount of emphasis on sugar, giving the impressiom that it is the major contributor to several dis- eases and states of ill health. Health a Way of Life by Marion B. Pollock, Candace O. Purdy, and Charles R. Carroll;, Scott, Foreman and Company 1982 Style-This text contains one chapter with a large section on why people eat the way they do. Uses the four group plan in explaining a balanced diet. Extremely basic information, with, very simple reading style. This one chapter is divided into four sections with titles such as "How does food become you?" Strong Points-Provides the simplest of presentations of basic nutrition informa- tion, if that is what is needed. Emphasizes each person becoming aware of his or her own eating habits. Gives a few practical sug- gestions for weight loss. Weak Points-Makes some misleading statements as a result of vague generaliza- tions due to its simplistic nature, and also as a result of some omissions i.e., gives the, impression that water soluble vitamins such as vitamin C and the B vitamins are totally excreted every day. States that "fats that are eaten and not used immediately by the body are stored as body fat." While this is true, it doesn't mention that it is also true of pro- teins and carbohydrates. Makes very vague statements about particular vitamins such as "vitamin B, is essential for healthy off- spring." While this is also true, so are all of the nutrients essential during pregnancy. Gives little practical information on how to use the basic four groups in order to plan a nutritious diet. Investigating Your Health by Edward B. Rosenberg, Henry J. Gurney, and Vivian K. Harlin, M.D.; Houghton Mifflin Company 1980 Style-This text contains one chapter enti- tled, "Eating." The presentation is very sim- ple. More concepts and ideas than practical information omhow to plan a balanced diet. Approaches food and nutrition from a glo- bal viewpoint discussing world hunger and the world food crisis. Also takes somewhat of a consumer-oriented approach. Strong Points-If a simple, basic presenta- tion is what is needed this text is ideal. Is geared toward encouraging students to try new foods. Encourages seif-evaluation of eating habits. Emphasizes reasons why we eat besides hunger. Weak Points-Highly editorialized sections ow food additives and pesticides. Gives an alarmist view of our "contaminated" food supply. Recommends avoiding as many food additives as possible withmo qualifica- tions. No mention of the basic four or any type of classification that wouldbe useful in planning a balanced diet. Modern Health by James H. Otto, Cloyd J. Julian, J. Edward Tether, and Janet Zhun Nassif; Holt„Rinehart and Winston 1985. Style-Most up-to-date of the texts. Very visual. Uses U.S. Dietary Guidelines in additiom to the basic four + one food groups. Promotes nutritious diet over vita- min supplementation. Covers a wide variety of topics in an objective manner. Strong Points-Wide range of topics cov- ered simply in an easy to read style. Also provides some practical application of most of the information. Very informative and useful table of vitamins and minerals. Objective presentation of controversial top- ics. Weak Points-Very little specific, usable information concerning serving sizes, etc. for planning a balanced diet and a weight reduction diet. In contrast to the text, there is a table in the appendix that lists food addi- tives marking those thar they recommend to 4i avoid. No explanation or scientific back up information for these recommendations are given. The Verdict The jury is still out on many issues dealing with nutrition, and because of this, present- ing a slanted view of nutrition issues is unfair and limiting to students. Omission of important issues because of their complexity or controversial nature is a poor approach to nutrition education. Nutrition texts„as with any textbook, should be designed not only to inform but to raise questions. A student given an objective presentation of the facts and encouraged to discuss them is learning to think independently. We realize that it is no easy task to incorporate all of the basics about nutrition, in addition~to current con- troversies, in one small section of a health text. Nevertheless, this is how ACSH has evaluated these publishers' attempts to do so: - Substance & Style-Of these texts, none is perfect, but in ACSH's opinion, Holt, Rine- hart, and Winston's Modern Health stands out above the rest as most objectively cover- ing a wide variety of nutrition-related topics in a style that would appeal to high school- ers. Next in line, though it still had some weaknesses, is McGraw-HilUs Health and Safety For You. It provides basic informa- tion while touching on~current issues. Substance Only-If more detailed, advanced nutrition ~ information is wanted, Turner'sPersonal and CommunityHealtlt is your best bet. Simple Style; Simple Substance-The three with the simplest presentation of informa- tion are Scott, Foreman and Company's Health a Way of Life, Johm Wiley & Sons' You and Your Health, and Random House's Understanding Health. These three books offer little detailed information. They dis- cuss food4nd nutrition in the most general terms. Style Only-Of these seven texts, the least objective and therefore the most objection- able was Houghton Mifflin Company's Investigating Your Health. Much of the information was presented in a highly edito- rialized manner, while providing little prac- tical guidelines for actually planning a bal- anced .',iet. f Densie Hatfield, Ph. D., R.D., is a Research x Associate with A CSH. _ 6 e_ 9

Product Liability CONTINUED FROM PAGE t • You decide to redo your bathroom and instead of separate hot and cold water faucets you put in one of those mixing valves thatstarts our cold as you turn it on and the water gets hotter and hotter as you continue to turn it. If you turn it too far, and'ryou get burned, is the man- ufacturer of the faucet liable? The Fifth U'.S. Circuit Court of appeals said a jury could decide that a single-control shower faucet is unreasonably danger- ous since a person could turn it to the point where it delivers only hot water which couldicause burns. Therefore, in the Fifth District, depending on how a particular jury might feel„you might or might not get paid by the faucet~ manu- facturer for burning yourself. In other districts, you mighv not have a case at all. • You~are a farmer and want a machine to load supplies but because you are wor- ried that the loader might not get' through the low barn door, you have the protective cage around the driver's seat removed. If an injury then occurred which would have been pre- vented had the cage been left in place, is the manufacturer liable? In Pennsylva- nia, the jury held that the manufacturer had sold a defective product.. • You buy a used car on which the former owner had replaced two of the worn non-radial, tires with radial tires, even though the manufacturer of the radials cautioned in its advertising against mix- ing radials and non.radials on the same vehicle. The West Virginia Supreme Court said that placing such a warning in advertising wasn't, enough; it should also have been stamped on the radial tires themselves. • You, buy a substance or device which was thought to be safe when you used it, but was later found to constitute a health hazard. Would the company who sold you this be liable? In manyy states, yes. This is the basis for the asbestos and DES (diethylstilbestrol) suits. Against what company or, com- panies do you bring your suit? When can you sue? Are you likely to win? The answers to these questions depend on where you live. Ini some states you1 can sue all the companies that made the substance without having to show you bought the substance from any particu- lar one. Inisome, if the companies can show that as of the time you were exposed, nobody knew there was a haz- ard„they would not be liable. In some, if sufficient time has passed, no suit~ can be brought, and in some, companies can be held liable even if the product is knowingly misused. A State of Confusion How then can people know what~ their rights and liabilities are? They have to find out what the law is in their individual states even to know, whether a product would be determined to be defective. For example, in Georgia a productv is defective if itis not "reasonably suited to the use intended." In Pennsylvania, a product is defective if it lacks any element necessary to make it safe. In Nebraska„a design is accept, able if it incorporates "the best prevailing technology reasonably available."' In Arizona a product is adequate if it conformss to the "technical, mechanical and scientific. Performing on a balance beam. Why should a company sell a product in an area where it would be liable regardless of how a person used or misused it? (Photo by E. O. Jones) knowledge of designing in existence and rea- sonably feasible for use at the time."' How- ever, across the border in California, a prod- uct is defective if it "fails to perform as safely as an ordinary consumer would expect." Confusing? Yes. Equitable? No. Why should a consumer's rights or a manufactur- er's liability depend on location? Why should a company sell a product in an area where it would be liable regardless of how a person used or misused it? New Bill Could Bring Order to Chaos Senator Robert W.' Kastens Jr., (R. Wis) and 28 cosponsors (as of July 17, 1984) have attempted to bring order to this confusing state of affairs by, proposing a uniform national, standar& for product liability. Their proposal has received varied responses. Most proponents of this bill (S-44, 98th Congress) are organized into two major coalitions, the Product Liability Alliance (189 corporations and trade associations) and the Coalition for Uniform Product Lia- bility Law(252 corporations and trade asso- ciations). Coalition members include the Chamber of Commerce, National Associa- tion of Manufacturers, National Federation of Independent Businesses, American Insur- ance Association, Alliance of American Insurers, and the American Legislative Exchange Council. Opponents of the bill include the Ameri- can Trial! Lawyers Association and Public Citizen's Congress Watch, as well as other labor and consumer groups. What does the bill (S-44) provide? It attempts to substitute one uniform defini- tion of liability for the multitude of defini- tions that now exist. Liability woul& result if: • A product is unreasonably dangerous in constructiomor design; or • There is a failure to provide adequate warnings or instructions; or • The product d'oes notl conform to an express warranty; and , • The unreasonably dangerous aspect~ of the product causes harm. Very precise language is used in the bill to define these terms, i.e., what constitutes unreasonably dangerous construction or manufacture, thus placing the burden on the 00 manufacturer to exercise reasonable care toM„h discover potential hazards and to utilize an jV appropriate design within practical techni-l.i cal feasibility. With regard to warnings, theO manufacturer must warn of any danger thatlV was known or should have been known, ando'l if such information becomes available afterGb the product is placed on the market the man- ufacturer must warn of any danger that is discovered or should have been discovered. Sellers are •liable if they do not exercise reasonable care in handling the product or if they make express warranties that lead to harm. They are also liable if the manufac- turer is not reachable legally. 10