Tobacco Documents Online

B. P_rofessional Memberships Since 1957, I have served on a number of cancer research project committees. From 1958-1960, I served on the Advisory Committee on Research on Etiology of Cancer, for the American Cancer Society and in 1963 I served on the Expert Panel on Carcinogenicity for the International Cancer Research Commission of the International Union Against Cancer. In 1964, I was appointed by President Johnson to head the National Institutes of Health Study Committee Panel on Pathology under Secretary of Health, Education and Welfare, Joseph Califano. From 1967-1969, I served on the committee of American Association for Cancer Research as Representative to USA National Academy of Sciences- National Research Council. From 1972-1973 and 1974-1977, I worked on the Carcinogenesis Advisory Board and the Board of Scientific Councillors Advisory Group, U.S.-Japan Cooperative Cancer Research Program for the National Cancer Institute. From 1977- 1979, I was Chairman of the Governing Council for the World Health Organization, International Agency for Research on Cancer. From 1981-1982, I was Chairman of the Public Issues Committee for the American Association for Cancer Research. C. Honorary Membershins I have been a member of the following: 1) American Association for Advancement of Science 2) American Association for Cancer Research 3) American Association of Pathologists and B i l i t t er o s ac og s 4) American College of Toxicology 5) American Society for Experimental Pathology 6) American Society for Investigative Pathology 7) Armed Forces Institute of Pathology 8) New York Pathological Society 9) International Academy of Pathology 10) Society for Risk Analysis D. Honors and Awards I have received the following professional honors and awards: 1) Comfort Crookshank Award for Cancer Research, 1978 2) Japanese Cancer Association, Honorary Member, 1979 3) Institute of Medicine, National Academy of 4) Sciences, 1979 Claude M. Fuess Award, 1980 Page 2 of 17

Rule 26 Expert Report DR. ARTHUR C. UPTON I. INTRODUCTION My name is Arthur C. Upton. My business address is Robert Wood Johnson Medical School, Environmental and Occupational Health Institute, 170 Freling Huysem Rd., Piscata Way, New Jersey, 08854. I was retained by Plaintiffs' counsel Howarth & Smith, on behalf of Plaintiffs Lilo McLean and Mark Huth, to consult in the case of McLean et al. v. R.J. Reynolds, et al. My rate for consulting and court or deposition testimony is $200 per hour. II. BACKGROUND AND EDUCATION I was born in Ann Arbor, Michigan. I have been a medical doctor and pathologist for over 40 years. I studied for six years and graduated from the University of Michigan, in 1946, receiving both BA and MD degrees. After receiving my MD degree, I did three years of residency at University Hospital, Ann Arbor, Michigan and became a board certified pathologist specializing in anatomy. I have been a member in good standing with the American Board of Pathology since 1952. A. Professional Experience After receiving my MD and BA degrees from the University of Michigan, I held positions as Pathologist and Chief of the Pathology-Physiology Section at Oak Ridge National Laboratory from 1951 to 1969. From 1969 to 1975, I held positions as Professor of Pathology, Chairman of the Department of Pathology and Dean of the School of Basic Health Sciences at State University of New York at Stony Brook. I also served as Captain in the United States Armed Forces from 1955 to 1970 and R. Admiral, in the United States Public Health Services from 1977 to the present. From 1961- 1964, I held offices as member of the Board of Directors, Vice-President and President of the American Association for Cancer Research. From 1966-19b8, I held offices as Councilor, Vice-President and President of the American Society for Experimental Pathology. From 1977-1979 I was the Director of the National Cancer Institute. Presently, I am on the Board of Directors for both the Society for the Study of Comparative Oncology and the International Consortium for Research on the Health Effects of Radiation. Page 1 of 17

33) Lorillard Creative Research Director Writes Professor Charles Seide, Cooper Union re Creating a Package Appealing to Kids, 8/13/70 34) WSJ Article (7/21/95) "Letter From a Tobacco Company to an Art Professor, August 1970" 35) B&W Letter From David Hardy, Shook, Hardy, Ottoman, Mitchell & Bacon, to Debaun Bryant, 8/20/70 37) RJR Memo From Mike Jordan to S&H Attorneys, 4/29/88, "John Robinson's California Cases" 38) Letter From John Heller of New England Institute For Medical Research, Inc. to Dr. Robert N. Dupuis of Philip Morris 39) Lisher & Company, Inc., Marketing Management Consultants' Proposal For Low Delivery Project For Brown And Williamson 40) "Tobacco: The Controversy Is Real" by William Kloepfer, The Tobacco Institute 41) "Survey of Cancer Research With Emphasis Upon Possible Carcinogens From Tobacco" 42) Tobacco Industry Research Committee Report, Statement by The Scientific Director, November 8,1957, Attachment #2 43) RJR Scientific Advisory Board Luncheon Meeting Minutes, Informational Memorandum, November 11, 1957 44) Philip Morris Memo from J.E. Lincoln to R.R. Milhiser re "Two Complexes, a Compound and a Campaign", April 23, 1958 45) RJR Report "Research Planning Memorandum on the Nature of the Tobacco Business and the Crucial Role of Nicotine Therein" 46) RJR Report "Strategic Research Report - Younger Adult Smokers: Strategies and Opportunities", February 29, 1984 47) RJR Memos to Sales Reps From J.P. McMahon re Young Adult Market Targeting High Schools, January 10, 1990 48) RJR Memo from R.G. Warlick to All Representatives re Young Adult Market-targeting High Schools SIS Accounting Group, April 5, 1990 Co tV (N Page 10 of 17 ~D ~ ~ c.n rn

5) IBM-Princess Takamatsu Cancer Research Foundation, Lecturer, 1981 6) Failla Memorial Lecturer, Health Physics Society, Greater New York Chapter, 1983 7) CHUMS Physician-of-the-Year Award, 1985 8) Basic Cell Research in Cytology Lectureship Award, 1985 9) New-York Academy of Sciences, Honorary Life Member, 1991 10) Fellow, American Association for Advancement of Science 11) National Council on Radiation Protection and Measurement, Honorary Member, 1992 12) Lovelace Medical Foundation Award for Excellence in Environmental Research, 1993 13) Distinguished Life Membership, American Registry of Pathology, Armed Forces Institute of Pathology, 1993 14) 1997 Distinguished Achievement Award, Society for Risk Analysis E. Teaching Positions I was an Instructor of Pathology at the University of Michigan Medical School from 1950-1951. From 1969-1977, I was the Professor of Pathology in the Health Sciences Center at State University of New York at Stony Brook. From 1980-1992, I was Professor and Chairman of the Department of Environmental Medicine at New York University, School of Medicine. At the University of New Mexico School of Medicine, I was Clinical Professor of Pathology from 1992-1995 and Clinical Professor of Radiology from 1993 to the present. Currently I am Clinical Professor of Environmental & Community Medicine at UMDNJ-Robert Wood Johnson Medical School. III. PUBLICATIONS I have authored over 350 published articles, books and reports. These include: 1) The Radiobiology of the Cancer Cell, Federation Proceedings, Vol. 17, 698-713 (1958). 2) Current Trends of Cancer Research, 6th IBM Medical Svmnosium, 591-600 (1964). 3) Summary Report of the Chairman. National Cancer Program Planning Conference, National Cancer 00 !V Page 3 of 17 W ~ ~ ~ .~ ~

• Carcinoma of the Lung", published in the British Medical Journal in 1950. The scientific evidence and literature also confirms that cigarette smoking causes approximately 30 diseases, including various types of cancer, as well as vascular diseases, respiratory diseases, and gastrointestinal diseases. For example, see "The Relationship between Human Smoking Habits and Death Rates", By E. Hammond and D. Horn (referenced above)and also "Effect of Smoking on the Production and Maintenance of Gastric and Duodenal Ulcers" in Lancet Vol. 1 (at pp. 657-662), By Doll R., Jones F.A., and Pygott F. Based on the Declaration of Ted Huth, David McLean's brother, the Depositions of Lilo McLean, David McLean's widow, and Mark Huth, his son, in addition to the smoking history in the medical records, David McLean began smoking cigarettes in approximately 1934, when he was 12 or 13 years old. He continued to smoke approximately one to two packs a day, although he occasionally smoked as much as five packs in a day in Marlboro commercials, up until 1993, when he was forced to quit smoking because of surgery to remove his lung cancer. it is my medical opinion that David McLean's lung cancer, cardiovascular disease and chronic obstructive pulmonary disease were caused by his cigarette smoking. Based on my review of David McLean's medical records, David McLean's pathology reports, David McLean's Death Certificate, and the slides of tissue samples taken from David McLean's thoracoscopy and abdomen surgery, it is my opinion that David McLean died from carcinoma of the lung, and that his lung cancer was caused by his lifetime history of smoking cigarettes. 3. Mr. McLean's Addiction to Cigarette Smoking Dr. Matthew Connolly, M.D. and clinical pharmacologist, who treated David McLean for extreme pain in the last stages of his terminal cancer, has concluded based on his personal knowledge of the patient and his smoking history that David McLean became addicted to smoking in his early adolescence, at approximately 12 or 13 years of age; I concur with Dr. Connolly's diagnosis based on the materials I reviewed independently, including Mr. McLean's medical records and smoking history, and based on the medical literature on addiction. Page 14 of 17

Institute, National Institutes of Health, U.S. Department of Health, Education and Welfare, Washington, D.C. (1975). 4) The National Cancer Institute and its Redefined Mission, Grants Magazine, 1:113-128 (1978). 5) "Future Directions in Cancer Prevention", (Preventive Medicine 9:309-314, 1980) 6) Cancer, By Upton A.C. and Golumbia N., Medical and Health Annual Encyclopedia Britanica, Chicago (1979). 7) Consensus Conference on Screening for Lung Cancer, By Fink D.J. and Upton A.C., Vet. Human Toxicol., 21:339-352 (1979). 8) "Environmental Causes of Cancer" (In: Anticarcinogenesis and Radiation Protection, edited by O.F. Nygaard and A.C. Upton, Plenum Press, New York, 1991, pp. 13-20). 9) Cancer Induction and Nonstochastic Effects, British Journal of Radioloav, 60: 1-16 (1987). 10) Carcinogenic Risk Assessment in Proper Perspective, Toxicology and Industrial Health, 4:443-452 (1988). IV. CASES The following are cases for which I testified as an expert either in deposition or at trial within the last four years: Glen James, et a1. v. Southern California Edison Co., United States District Court, Southern District of California, Case No. 94-1085-J. (Deposition testimony, March 24, 1995; trial testimony, September 7, 1995.) V. MATERIALS REVIEWED In preparation for forming the opinions expressed below, in addition to the pathology research and cancer studies I have personally conducted over the course of my career, I have reviewed the following materials: A. I have reviewed the medical records of David McLean from the UCLA Medical Center, the UCLA Pain Center, Saint John's Hospital and Health Center, California Rehabilitation Medical Center, Hill and Cornell, M.D., American Eye Institute, Veteran's Administration Hospital, Cedars-Sinai Medical Center, Marvin J. Rapaport, M.D., Brotman Medical Center, Martin Cooper, M.D., CC) ND Page 4 of 17 w w ~ ~ cn O

i Morris, Inc., Liggett & Myers, Inc., Liggett Group, Inc., Brooke Group, Inc., R.J. Reynolds Tobacco Co., Brown & Williamson Tobacco Co., The American Tobacco Co., B.A.T. Industries P.L.C., British-American Tobacco Co., and by the Council for Tobacco Research - U.S.A., Inc., and the Tobacco Institute, Inc. Please see below for a list of documents reviewed: 1) Advertisement: "All the Fuss about smoking got me thinking I'd either quit or smoke True. I smoke True" 2) Memorandum from J.K. Wells, re: Document Retention dated 1/17/85 3) Memorandum from J.K. Wells, re: Southampton Smoking and Health material dated 6/15/79 4) Memorandum from J.K. Wells to E. Pepples, re: BAT Science dated 2/17/86 5) Memorandum from E. E. Kohnhorst from E. Pepples dated 8/16/84 6) Handbook For Leaf Blenders and Product Developers dated 2/1991 7) "Can we have an open debate about smoking?" published by RJR 8) "Youth" dated 1987 9) Statements by James Johnston dated 4/14/94 10) Letter from J.P. McMahon dated 1/10/90 11) Letter from J.P. McMahon dated 5/3/90 12) Memorandum dated 7/3/74 re: records an act, condition or event at or near the time of the act, condition, or event. 13) Letter from Jo F. Spach dated 1/11/90 14) Research Planning Memorandum on Some Thoughts About New Brands of Cigarettes For the Youth Market 15) "Frank Statement to Cigarette Smokers", 1954 16) Conversations With Dr. S.J. Green, Head of Research at BAT, 1/81 w Iv Page 8 of 17 Cni ~ ~ Cn .p.

Nicotine-Containing Cigarettes" by David Kessler, M.D., House Subcommittee on Health and the Environment, March 25, 1994 and the "Statement by David Kessler, M.D., Commissioner of Food and Drugs on th~e Control and Manipulation of Nicotine in Cigarettes", June 21, 1994. 12) "Smoking and Carcinoma of the Lung", Preliminary Report, By Doll R and Hill AB, British Medical Journal, Vol 2, 739, (1950). 13) "Cancer of the Lung in Relation to Tobacco", By Da ff M.E., Doll R., and Kennaway E.L., British Journal of Cancer, Vol. 5, 1-20 (1951). 14) "A Study of Aetiology of Carcinoma of the Lung", B y Doll R. and Hill A.B., British Medical Journal, Vol . 2, 1271 (1952). 15) "Smoking and Carcinoma of the Lung", By Doll R., Acta Un internat contr Cancer, Vol. 9, 495 (1953). 16) "Mortality in Relation to Smoking: Ten years' Observations of British Doctors", By Doll R. and Hill A.B., British Medical Journal, Vol. 1, 1339-1410, 1460- 1467 (1964). 17) "Mortality in Relation to Smoking: Forty years' Observation on Male British Doctors", By Doll R., Peto R., Wheatley K., Gray R., and Sutherland I., British Medical Journal, Vol. 309 (October 8, 1994). 18) "The Relationship between Human Smoking Habits and Death Rates", By Hammond E. and Horn D., JAMA (August 7, 1954). 19) "Prying Open the Door to the Tobacco Industry's Secrets About Nicotine", By Hurt R. and Robertson C., JAMA (October 7, 1998). 20) "Effect of Smoking on the Production and Maintenance of Gastric and Duodenal Ulcers", By Doll R., Jones F.A., and Pygott F., Lancet Vol. 1, 657-662 (1958). E. Tobacco Company Documents I have reviewed a number of documents, including internal memos and studies, and reports, articles and advertisements published by the major tobacco companies, including Philip Page 7 of 17

Dennis Evangelatos, M.D., Diagnostic Radiology, Antoine Hage, M.D., Lebovic, Schwimer, Goldberg, M.D.s, Richard M. Protzel, M.D., Michael Levine, M.D., Country Villa Westwood, Bob Hope Health Center, Mitchell D. Covel, M.D., Melani Shaum, M.D., Gray Bellack, M.D., Kenneth M. Tokita, M.D., Tower Radiology Medical Group, Neurological Rehab. Associates, Mason Hohl, M.D. I have reviewed a letter from Dr. Matthew Connolly concerning David McLean's addiction to tobacco. I have reviewed the death certificate for David McLean, identifying the cause of death as "metastatic carcinoma of the lung", and two pathology reports on David McLean, from 1993 and 1995. B. Tissue Sambles I have examined prepared and stained slides of tissue samples taken from David McLean, sent to me from the UCLA Pathology Department. The tissue samples were taken from his thoracoscopy in 1993 and his 1988 abdominal surgery. C. David McLean's Smoking History In addition to the letter from Dr. Connolly, I have reviewed the following: the March 3, 1998, Declaration of Ted Huth, David McLean's brother, which states that David McLean began smoking when he was approximately 12 years old; the February 16-17, 1998, Deposition of Lilo McLean, David McLean's widow, which describes, among other things, his smoking history and his medical treatment; and the February 17, 1998, Deposition of Mark Huth, David McLean's son. There is also discussion of his smoking history in the medical records. D. Medical and Scientific Literature In addition to my education, background, training, and experiences in cancer research, I have reviewed medical and scientific articles and studies on: (1) the link between tobacco, including cigarette smoking, and cancer and other diseases; (2) the medical community's awareness of the causal connection between tobacco and cancer, including lung cancer; (3) the medical community's awareness of the causal connection between cigarette smoking and other health problems related to cigarette smoke, including but not limited to, chronic obstructive pulmonary disease, including emphysema, and cardiovascular disease; and (4) the medical community's awareness of nicotine Page 5 of 17

49) RJR Memo from F.H. Christopher, Jr. re "What Causes Smokers to Select Their First Brand of Cigarettes", July 3, 1974 50) RJR Memo re "Research Planning Memorandum on Some Thoughts About New Brands of Cigarettes For The Youth Market", 2/2/73. 51) "Implications of Battele Hippo I&TI And The Griffith Filter", 7/17/63 52) BAT Co. Ltd - Minnesota Tobacco Litigation, Draft Report - Key Areas Product Innovatior. Over Next 10 Years For Long Term Development, 8/28/79 53) Arthur D. Little, Inc. Report "L&M - a Perspective Review"' March 15, 1961 54) Philip Morris, Motives And Incentives in Cigarette Smoking, William L. Dunn, Jr, w/chart 55) Memo From L.L. Long to R.B. Salignon re "Project Review 1960 Cigarette", June 3, 1960 56) Phillip Morris "Outline of The Research And Development Objectives For 1961" Presented to The R&D Committee by H. Wakeham, January 12, 1961 57) Philip Morris Advertisement, -What Does Philip Morris Have to Say About The Allegation of 'Nicotine Manipulation' 58) Philip Morris "Facts You Should Know" Advertisement 59) B&W Meeting Notes For 12/17/65 re Ctr, Expenses & General Counsel 60) Tobacco Industry Research Committee "A Frank Statement to The Public by The Makers of Cigarettes, 12/28/65 61) The American Tobacco Company President Paul Hahn's Letter to John Hill re The Policy of The Tobacco Institute 62) Memo from Fred Panzer to Horace Kornegay re the Roper Proposal, May 1, 1972 63) Memo From C.V. Mace to Dr. Dupuis re "Brief Comments on a Program to Produce a Low Delivery Filter Cigarette With Flavor", July 24, 1958. Page 11 of 17

0 17) Phillip Morris Inter-office Correspondence, 3/31/81, Research Center Report on "Young Smokers - Prevalence, Trends, Implications, And Related Demographics" 18) Philip Morris Inter-office Correspondence, 9/17/81, Memo From Myron Johnson to Harry Daniel re "Teenage Smoking And The Federal Excise Tax on Cigarettes" 19) RJR Inter-office Correspondence From E.A. Horrigan re "Smoking And Health Briefing Document" Interview Qs&As For Tobacco Executives 20) Philip Morris Memo From Myron Johnson to Dr. Al Udow re "Still More on Trends in Cigarette Smoking Prevalence", Charts Attached re High School Smokers 21) Letter From Sylvester Stallone Agreeing to Feature Brown And Williamson Tobacco in 5 Films For a Fee of 500,000. 22) RJR Statement "We Don't Advertise to Children" 23) Philip Morris Memo From A1 Udow to J.J. Morgan re "Why People Start to Smoke" 24) 27th October, 1976, "Cigarette Smoking And Casual Relationships" 25) Lorillard Memo From R.E. Smith to F. J. Schultz re "Lowered Nicotine Project", 11/9/76 26) Philip Morris "Report on Policy Aspects of The Smoking And Health Situation in The USA", October 1964 27) R.B. Griffin, Report to The Executive Committee 28) Brown & Williamson, 10/25/88, Smoking And Health Research 29) Brown & Williamson Memo From Mick Mcgraw re "Nicotine Delivery Systems", 4/24/92 30) Brown & Williamson Report "B&Ws Public Issue Environment" 31) Press Clippings From BAT, 1960 & 1961 32) Butler Research Associates Memo From Shirley Witkins And Bud Roper to Steve Fountaine re "Suggestions For Research to Answer Questions Raised on Philip Morris Benchmark Study" 00 Page 9 of 17 N) w ~ ~ ~ Cn Ln

64) Eimo Roper And Associates "Volume I, a Study of Attitudes Toward Cigarette Smoking And Different Types of Cigarettes" January, 1959 65) The American Tobacco Company "Suggestions For Industry Public Relations Policy", June 18, 1959 66) • Philip Morris Memo From Dunn, Johnston, et al. to P.A. Eichorn Replans For 1972, 9/8/71 67) Philip Morris Memo From T.S. Osdene to File re "Recommendations For Long-term Plan For Ctr; 11/13/78 68) Lorillard Memo From Richard E. Smith to Ave, Flinn, And Spears re "Goal to Determine The Minimum Level of Nicotine That Will Allow Continued Smoking" 2/13/80 69) Leonard Zahn And Associates Letter to Henry Tom From L.S.Z. 70) Letter From F.H. Christopher, Jr. July 3, 1974 re "What Causes Smokers to Select Their First Brand of Cigarette 71) Report of Conference by C.S. Muije From Louisville Kentucky on September 16,1974 re Young Smokers 72) B&W Minnesota-Memo 73) Memo From JCB Ehringhaus to William Kloepfer re The Tobacco Institutes Project re Teenage Smoking, August 2,1979 74) Philip Morris Memo From Myron Johnston to R.B. Seligman re "The Decline in The Rate of Growth of Marlboro Red", May 21, 1975 F. Tobacco Company Representatives' Statements I have reviewed the transcript of the 1994 Congressional Hearing on Tobacco entitled: "Regulation on Tobacco Products", and the April 14, 1994 witness testimonies submitted by the tobacco companies to Congress as follows: 1) William Campbell, President & CEO, Philip Morris USA 2) James J. Johnston, Chairman and CEO, RJR 3) Joseph Taddeo, President, U.S. Tobacco Company 4) Andrew H. Tisch, Chairman and CEO, Lorillard Tobacco 5) Edward A. Horrigan, Chairman and CEO, Liggett Group 6) Thomas E. Sandefur, Chairman and CEO, Brown and Williamson 7) Donald S. Johnston, President and CEO, American Tobacco Page 12 of 17

0 addiction. Below is a list of medical and scientific articles and studies I have recently reviewed in connection with this case: 1) "Smoking and Health" - A Report of the Advisory Committee to the Surgeon General of the Public Health Service (1964). 2) "The Health Consequences of Smoking" - A Report of the Surgeon General (1988). 3) "Commentary on Nicotine IS/IS NOT Addictive Debate", By Jaffe J., Psychopharmacology, Vol. 117 (No. 1)(January 1995). 4) "Nomenclature and Classification of Drug and Alcohol related problems: a WHO memorandum", Bulletin of the World Health Organization, Vol. 59 (1981). 5) "WHO Expert Committee on Addiction Producing Drugs - Thirteenth Report", World Health Organization Technical Report Series No. 273 (1964). 6) "Drug Dependence: its Significance and Characteristics", By Eddy N., Halbach H., Isbell H., and Seevers M., in Bulletin of the World Health Organization, Vol. 32, No. 5(1965). 7) "Perceived Risks of Heart Disease and Cancer Among Cigarette Smokers", By Ayanian J. and Cleary P., JAMA (March 17, 1999). 8) "The Scientific Case that Nicotine is Addictive", By Stolerman I. and Jarvis M., Psychopharmacology Vol. 117, No. 1 (January 1995). 9) "Is Nicotine More Addictive than Cocaine", By Henningfield J., Cohen C., and Slade J., British Journal of Addiction Vol. 86, No. 5(1991). 10) "The Nicotine Addiction Trap: a 40 year Sentence for Four Cigarettes" by Russell M_, British Journal of Addiction, Vol. 85, No. 2(1990). 11) Hearings before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representative (103~d Congress, 2"d Session) - Testimony of David A. Kessler, taken on March 25, 1994 and June-21, 1994, including the "Statement on Page 6 of 17

4. The Medical Community and General Public's Knowl_edge That Tobacco and Cigarette Smokina Causes Luna Cancer I received my medical degree in 1946. At that time it was not universally accepted in the medical community nor set out in the medical literature that smoking caused cancer. There was no appreciation in the general medical community that cigarettes were physically addictive. The first studies identifying the causal link between tobacco and lung cancer were published beginning in 1950, including studies authored by Dr. Richard Doll. The evidence continued to mount and more studies and reports confirmed that smoking cigarettes was the primary cause of lung cancer. In 1977, as Director of the National Cancer Institute, I was asked by Health, Education and Welfare Secretary Joseph Califano to brief him on the National Cancer Program, and in the course of my briefing I brought to his attention the articles by Richard Doll and others on the health impacts of smoking. These studies and reports clearly demonstrated that cigarette smoking causes lung cancer, as well as other diseases, and the National Institutes of Health instituted further studies to confirm these findings and programs to educate the general public about the dangers of tobacco and to discourage them from smoking cigarettes. Until the above mentioned studies were published, the general medical community was not aware that cigarette smoking was carcinogenic. Neither did pathologists generally recognize the causal connection between smoking and cancer before this time. It did not become commonly accepted among the medical community until the late 1950's that cigarette smoking was carcinogenic. Up to this time, it was not common knowledge among the general public that cigarette smoking caused cancer. Indeed, warning labels were not placed on cigarette packages until after the 1964 U.S. Surgeon General's Report on Smoking and Health. Prior to the 1950's, a member of the general public would have no reason to believe that cigarette smoking caused cancer or other diseases. After I, as Director of the National Cancer Institute, first briefed HEW secretary Joseph Califano on the health impacts of smoking, in 1977, he requested additional briefings from me and other officials at NIH. As a result of these briefings, the Secretary ultimately decided to declare "war" on smoking, characterizing the cigarette as "public health enemy number one". Recognizing that warnings themselves were insufficient to address the serious health problems posed by smoking, he also banned smoking in all HEW buildings, except in designated areas, and he mounted a campaign to strengthen anti-smoking efforts by the Page 15 of 17

• 1970's, although the medical profession did not appreciate the addictive nature of smoking tobacco, the tobacco companies had conducted research on the subject and were aware of the addictive nature of the nicotine contained in tobacco products. The tobacco company documents reveal not only their awareness of tobacco's addictive quality, but their plans to capitalize on it and to conceal it from the general public and the medical community. I have reviewed studies and articles related to tobacco since the 1960's. At no time from the 1960's through the 1980's have I seen the tobacco companies, the Tobacco Institute, or the Council for Tobacco Research, publish any findings, studies, articles or reports warning or admitting that nicotine or tobacco products are addictive. In fact, the tobacco companies publicly asserted that tobacco was not addictive in their testimony before Congress during the "Hearings on Tobacco Regulation" in 1994. Having reviewed both the medical and scientific literature, and the internal tobacco company documents, and based on my personal experience with representatives of the tobacco industry during my tenure at the National Institute of Health, it is my opinion that the tobacco companies have withheld and negatively impacted the scientific literature on the health hazards of cigarettes. The failure to disclose information about the hazzards of smoking was unethical and detrimental to public health. The companies disseminated false advertising, concealed knowledge, stifled and misdirected the medical community's research on the carcinogenic and addictive properties of nicotine, and pressured and lobbied to keep information out of the public domain. These methods set back the public's and the scientific and medical community's knowledge and appreciation of the risks and dangers of tobacco. It would have been valuable and important to me as head of the National Cancer Institute and advisor to the President and to the Secretary of Health, Education, and Welfare to have been aware of the "confidential" documents describing the health hazards of smoking authored by the tobacco companies which have only recently become public. 0 i t Arthur C. Upton, M.D. Date: "I 'I `~- 3I Page 17 of 17

I have also reviewed the January 1998 Congressional Hearings on Tobacco, including the testimony of officers of the tobacco companies as follows: 1) Geoffrey Bible, Chairman and CEO Philip Morris Companies 2) Steven Goldstone, Chairman and CEO RJR Nabisco 3) Vincent Gierer, Jr. Chairman and CEO United States Tobacco 4) Laurence Tisch, Co-Chairman Loews Corporation 5) Nicholas Brooks, Chairman and CEO Brown and Williamson Tobacco Corporation While I was Director of the National Cancer Institute, I met with representatives of the tobacco companies about the health consequences of smoking. VI. OPINIONS AND BASES The following opinions are based on my education, training, personal experience, research, and review of the above listed materials. These opinions are based on a reasonable degree of scientific and medical probability. 1. Diagnosis: lung_cancer, advanced cardiovascular disease, and chronic obstructive nulmonary disease Based on my review of David McLean's medical records, David McLean's pathology reports, David McLean's Death Certificate, and slides of tissue samples taken from David McLean's thoracoscopy (lung surgery) and abdomen surgery, it is my opinion that David McLean, after a heavy smoking history of more than 50 years, died from carcinoma of the lung with widespread metastasises to his brain and other organs. He also suffered from advanced cardiovascular disease and chronic obstructive pulmonary disease. These conditions impaired Mr. McLean's capacity to function, required various levels of treatment, and caused differing levels of disability and pain over his life. All these health problems were caused by his addiction to cigarette smoking beginning in early adolescence at about the age of 12 or 13. 2. Mr. M T an's h ai h o obt ms werQ cauGed by 50 years of heavv smokina I have studied the causal connection between smoking and lung cancer as a medical doctor and pathologist. The first studies suggesting that cigarette smoking causes lung cancer began to be published in the 1950's. One of the ground breaking works establishing the causal connection between tobacco and lung cancer was authored by Sir Richard Doll, entitled "Smoking and Page 13 of 17

nation's public health establishment at large. These developments soon prompted Congressional hearings, at which the Secretary, was called upon to explain and justify his actions, and to which I and the Surgeon General usually accompanied him in support of his testimony. To counter the Secretary's anti-smoking efforts, the Tobacco Institute sent a delegation to my office at NIH, to persuade me that the evidence implicating smoking in the causation of cancer and other diseases.was inconclusive and that the Secretary's anti-smoking efforts were therefore unjustified. When I failed to accept their arguments, the members of the delegation informed me that they had "powerful friends in Congress" who would take away NCI's budget if the Secretary and I did not cease and desist. The meeting was also followed by intimidating telephone calls to my home at night from unidentified callers, which eventually became so distressing that we had our phone number changed to an unlisted number. 5. ea Knowledge of h Add iv ob r of Toba o ~ OMM f and General Public's When I was trained as a doctor in the forties and as a practicing doctor into the sixties and seventies, I was not aware that tobacco is an addictive substance. I did not advise Secretary Califano that smoking should be treated as an addictive drug like cocaine and heroin for example. Before 1964, the World Health Organization described cigarette smoking as a "habit." In 1965, the World Health Organization redefined cigarette smoking as an addiction. Up until 1964, the medical community considered smoking only a "habit", as evidenced by the U.S. Surgeon General's Report in 1964, and many in the medical community continued to debate whether or not the nicotine in tobacco was "addictive" through the 1960's and 1970's. It was not until 1988 that the U.S. Surgeon General's Report was published identifying smoking as addictive, as opposed to merely habitual behavior. When I was Director of the National Cancer Institute and working with the Secretary of HEW, Joseph Califano in the 1960's, I myself did not appreciate that tobacco was physically addictive, as contrasted with merely habit forming, and I did not recommend that Secretary Califano take action to require that the warning include the addictive property of tobacco. 6. Tobacco Companies' Knowledge of Addiction Through my review of the internal studies, memoranda, and reports, as well as the published statements and advertisements of the tqbacco companies, it is my opinion that in the 1960's and Page 16 of 17