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Governor's Citizens'panel on Smoking & Health
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- 85645816-5817 Governor's Citizens' Panel on Smoking & Health
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- 85645820-5835 Minority Report
- 85645836-5837
- 85645869-5870 Memorandum of Understanding Between University of Michigan School of Public Health and Michigan Deptartment of Health
- 85645871-5872 Governor's Appointed Citizens' Panel on Smoking and Health
- 85645875-5878 Citizens' Panel on Smoking and Health
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- 85645903-5907 Citizens' Panel on Smoking and Health
- 85645911-5957 Smoking and Health in Michigan
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- 85645959-5973 the Smoking and Helth Controversy: Another Side
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- 85645987-5988
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- 85645999-6000 Citizens Panel on Smoking and Health
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- 85646002-6003 Smoking and Health - Attention Public Heating Calling the Governor's Citizens Panel
- 85646004 Citizens Panel on Smoking and Health
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- 85646007
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- 85646009-6011
- 85646012-6013 Governor's Citizen's Panel on Smoking and Health
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- 85646016-6017 Summary Research Findings on Health Effects of Cigarette Smoking
- 85646018
- 85646019 Position Paper on Smoking and Health
- 85646020-6021 Smoking
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- 85646023 Citizens Panel on Smoking and Health
- 85646024-6025
- 85646026 Testimony to Citizens, Panel on Smoking and Health
- 85646027-6028 Testimony to the Governor's Panel on Smoking and Health
- 85646029-6031 Statement Governor's Citizens Panel on Smoking and Health Submitted to the Office of Health Education Michigan Department of Public Health in Behalf of United Connunity Services of Metropolitan Detroit 801008
- 85646032 the Governor's Citizens Panel on Smoking and Health the Metropolitan Detroit Coalition for High Blood Pressure Control Public Hearing Comment on Smoking and Health 801008
- 85646033-6034
- 85646035-6038 Statement Givenby Dr. Murray Jackson in Behalf of the American Lung Association of Southeastern Michigan to the Citizens' Panel on Smoking and Health - Wednesday, 801008
- 85646039-6045
- 85646046-6047 Open Letter and Statement to the Citizen's Panel on Smoking & Health
- 85646048-6052 Cost Effectiveness and Benefits of Smoke Stoppers Program As Compared to Two Other Popular Smoking Cessation Programs
- 85646053-6056 Statement of W. A. Wickman, General & Legislative Counsel Michigan State Chamber of Commerce to Governor's Panel on Smoking & Health 801008
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- 85646059 Panel Report & 'illustration'
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- 85646078 Citizens' Panel on Smoking and Health
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- 85646091-6092 A Proposed Michigan Clean Air Act
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- 85646098-6105
- 85646106-6107 Smoking and Insurance
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- 85646110
- 85646111 Update on the Resource People Selected to Represent Various Bureaus in the Michigan Department of Public Health
- 85646112-6113 Citizens' Panel on Smoking and Health
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I
REPORT TO THE GOVERNOR
BY THE
GOVERNOR'S CITIZENS'
PANEL ON SMOKING & HEALTH
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CONFICENTfAL 1
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Michigan Tobacco & Candy
Distributors and Vendors Association 1nc.
Affiliated Organization-Music Operators of Michigan
523 WEST IONIA STREET LANSING, MICHIGAN 48933 TELEPHONE (517) 3722323
MICHAEL R. SPANIOLO
LEGISLATIVE AND
GENERAL COUNSEL
October 30, 1980
Mr. Sunny Sun Nai Fong
Chief{ Office of Health Education
Michigan Depaxtment of Puhlic Health
P,O. Box 30035
Lansi.ng, MI 48909
WALTER P. MANER I11
EXECUTIVE SECRETARY
Dear Mr. Fong: There'is enclosed the-mi.nority report of the Citizen's
Panel on Smoking and fiealth. Professor Warner has assured
me that the minority report will be submitted to the Governor,
along with the~majority report, on November 15, 1980.
As you will see, th:e-minority report exceeds the two
page limitation tentatively imposed by the Panel maj ority.
The reason for this is- that the issues before the Panel are
far too complex to be'discussed intelligently and responsibly
in two pages. While'I have attempted to make the minority
report as brief as possible, to submit anything less than the
enclosed report would deprive the Governor and the citizens
of Michigan of important information to which they are entitled.
Accordingly, I respectfully request that the enclosed
minority report be'submitted in its entirety to the Governor
on November 15, 1980.
Sincerely,
P
Walter P. Maner III
Executive Secretary
ericl;
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cONFlDENT1AL
~~`~~[[~~'\)
~ \I T
R1._P \ODU{~ ~.~I
COPY...~L~d ._.OF....(~.1...._.c~oIPi E8
October 31, 1980
MINORITY ?,EPORT
The majority report recommends a series of costly
and wide-ranging measures designed to curtail the use of
tobacco products in the State of Michigan. In view of the
drastic -- indeed, sometimes punitive -- nature of the
recommendations, the Governor and the citizens of Michigan
were entitled to a searching analysis by the panel of the
majority's factual assumptions and a careful weighing of the
probable costs and benefits of the measures being considered.
Regrettably, this did not occur. The result is a series of
hastily conceived recommendations that would disserve the
citizens of the State of Michigan.
The majority report contains several statements
as to the health consequences of smoking on smokers as well
as nonsmokers. As demonstrated in Part II of this Report,
these statements are not warranted by the available medical
and scientific evidence. Indeed, the theory of "excess"
deaths or disease relied upon by the majority has been
criticized repeatedly. The majority's assessment of the
"costs" of smoking stands on no firmer footing, as explained
in Part III below. Finally, Part IV of this Report sum-
marizes some of the more glaring problems and objections
associated with the majority's major policy recommendations.
I. The Majority Report Is the Product of Hasty
and Uncritical Deliberations by the Panel
The idea of creating a citizens' panel to consider
a particular public policy issue has much to recommend it.
Such a panel can be composed of people having diverse exper-
tise and interests, and can take advantage of its members'
sense of community service. But these benefits cannot be
realized if the panel is unduly limited in focus, is denied
sufficient time or resources to complete its work or is
controlled by some preordained notion of what would be an
"acceptable" result. In the latter circumstances, the
citizens' panel is little more than a charade -- with the
attendant danger that the panel's recommendations will be
given more attention than they deserve. That is precisely
the danger presented here.
I
2
The ability of the present panel to contribute to
the dialogue on smoking and health depended upon the panel's
willingness to investigate, as comprehensively and objec-
tively as possible, the available scientific evidence and
then to recommend to the Governor any policy initiatives
that seemed warranted by that evidence. But instead of
proceeding in that manner, the panel engaged in a headlong
rush to judgment.
Prior to the first meeting of the panel, which
took place on June 19, 1980, the Project Director, Dr.
Kenneth E. Warner, sent to all panel members a memorandum
that addressed in summary fashion a variety of smoking and
health issues. The note that accompanied the memorandum
pointed out that the memorandum was "a first draft" that had
been prepared during the preceding "week and a half." The
memorandum was entitled a "discussion paper," suggesting
that the issues covered by Dr. Warner would be the subject
of investigation and discussion by panel members. This
suggestion was strengthened by the statement in Dr. Warner's
covering note that "[t]he attached paper is intended to
provide [panel members) with background information as a
common starting point for the Panel's deliberations."
Rather than providing a "starting point," the
panel majority uncritically, and without the necessary
examination, accepted the factual assertions in the Warner
memorandum. In announcing the first meeting of the panel,
Dr. Maurice S. Reizen, Director of the Department of Public
Health, referred to the Warner memorandum and then informed
panel members that "[d]ue to the limited amount of time to
make recommendations to the Governor on a Statewide plan, we
will begin with a discussion of policy options during the
June 19th meeting."
In fact, beginning with the June 19 meeting of the
panel, and at all succeeding meetings, the panel majority
simply ignored the acknowledged limitations of the Warner
paper and, at the same time, refused to consider any opposing
views. The panel majority seemed to view its responsibility
solely in terms of identifying all conceivable means of
curtailing the use of tobacco products in Michigan or pun-
ishing the users of such products. At no time did the panel
consider whether such goals were appropriate or feasible.
After having challenged this restricted and mis-
guided view of the panel's responsibility at the panel's
July 17 and August 18 meetings, the minority summarized its
3
concerns in a letter to Dr. Warner dated August 26, 1980.
That letter pointed out, among other things, that --
°Many of the statements in the Warner memorandum
concerning smoking and health are highly question-
able,*and are based upon unproven medical assump-
tions, dubious social accounting techniques, and
unbalanced economic rationales.
°The panel's decision to restrict public comment
to a total of 1-1/2 hours effectively prevented
any constructive public dialogue on the funda-
mental issues that should have been of concern
to the panel.
°The delegation of much of the panel's work to a
small subcommittee, which was not representative
.of the entire panel, and the failure of many
panel members to attend scheduled meetings,
robbed the panel of its proper deliberative
character, making the panel little more than a
rubber stamp for staff and subcommittee decisions.
The letter ended by noting that "unless the nature and scope
of the Panel's deliberations are altered significantly to
include a comple'te airing of the smoking and health issue,
the Panel's ultimate recommendations to the Governor will
represent a disservice to the citizens of the State of
Michigan."
On September 2, 1980, Dr. Warner wrote to the
minority to make clear that no questioning of the factual
assumptions being relied upon by the staff and the panel
majority would be permitted. According to Dr. Warner,
"[w)ith a lot more time and a commitment of significant
fiscal resources, I am sure that we could refine our under-
standing of policy needs and alternatives, but not, I
suggest, of the basic smoking and health facts." In the
same letter, written almost a month before panel proceedings
had concluded, Dr. Warner suggested that the minority
consider f iling a "minority report" -- thus leaving no doubt
that the panel would pursue but one course, the course
charted by Dr. Warner.
In keeping with this attitude, the panel discour-
aged participation by representatives of the business
cor,ununity in favor of participation by groups with views
4
identical to those of most panel members. Few business
groups or emoloyer-related organizations even were apprised
of the panel's meetings. Indeed, of a group of 28'organiza-
tions that were notified of panel meetings, only four were
business related; the rest were almost entirely health or
health education groups.l/
The panel also refused to consider evidence, sub-
mitted by the minority, that disputed the principal medical
and economic assumptions contained in Dr. Warner's original
"discussion paper."2/ The minority's complaints concerning
the panel's failure to consider this evidence went largely
unheeded, as did the frustration voiced by the minority over
the panel's failure to consider fully the ramifications of
the policy proposals advanced in the majority report.
In sum, in their zeal to immose their views
regarding smoking on all the people of Michigan, the major-
ity failed to consider the propriety or wisdom of doing so.
Because of the panel's failure to analyze the factual assump-
tions underlying the majority recommendations, or to engage
in a meaningful cost-benefit analysis of the proposals, the
recommendations can only be viewed with substantial skepticism.
II. The Medical Assumptions Relied Upon To
Justify the blajority Recommendations
Reauire Critical Evaluation
The primary justification for the restrictive
measures advanced by Dr. Warner in his original memorandum
(and repeated without substantial change in the majority
report) is the theory of "excess" deaths or disease due to
1/ The minority's request that business groups be notified
of the panel's meetings or involved in the panel's delibera-
tions was rebuffed by concerns about "time constraints,"
fears of "disrupting" the panel's schedule, and the sugges-
tion that any response by the business community could be
put off until the panel's reco:nmendations were submitted for
legislative action. .
2/ Dr. George E. Schafer, "The Smoking and Health Contro-
versy: Another Side," August 1980; Letter to Dr. Warner
from Walter P. Maner III, dated October 1, 1980.
cigarette smoking.l/ The paper of Dr. George L. Schafer,
submitted by the minority, amply demonstrated the highly
questionable nature of that theory.
. Although the majority report assumes a causal
connection between cigarette smoking and death or disease,
no such causal relationship ever has been established.
Moreover, the Advisory Committee that prepared the 1964
United States Surgeon General's Report expressly rejected
the theory of "excess" deaths or disease upon which the
panel majority has relied.2/
The questionable validity of assuming that "excess"
deaths or disease are caused by cigarette smoking is demon-
strated by a few simple facts. For instance, if smoking
causes lung cancer, it would be reasonable to expect higher
rates of the disease in countries where more cigarettes are
smoked per capita. But that is not always the case. Lung
cancer mortality rates vary from country to country, and
many countries with low tobacco consumption patterns have
high lung cancer mortality rates. Moreover, the age of
onset of lung cancer is independent of the age of initiation
of smoking: In fact, on the average, smokers and nonsmokers
get lung cancer at approximately the same age -- a fact that
is curious if smoking indeed causes lung cancer. There are
1/ Warner, "Smoking and Health in Michigan," p. 1; Majority
Report, p. 1.
2/ The Advisory Committee stated: "The total number of
excess deaths causally related to cigarette smoking in the
U.S. population cannot be accurately estimated." United
States Public Health Service, Smoking and Health: Report
of-the Advisory Committee to the Surgeon General of the
Public Health Service, Dep't of Health, Educ. and Welfare,
PHS Pub. No. 1103 (1964).
In explaining the reason for its refusal to claim
"excess deaths," the Advisory Committee stated:
"The Commit~ee considered the possibility of
trying to make suc'rh calculations, but it involves
so many assumptions that the Committee felt that
it should not attempt this ***." Hundly, J.,
Transcript, News Conference, Released by United
States Public tieal:.h Service (January 11, 1964).
i
6
many other factors linked with lung cancer such as occupa-
tional exposures, viruses, diet, food additives, pollution,
stress, aging, and impaired effectiveness of body defense'
mechanisms.l/ Undue preoccupation with cigarette smoking
can be counterproductive in searching for the causes of and
cures for lung.cancer.2/
Likewise, it has not been established that ciga-
rette smoking is Causally related to coronary heart disease.
In addition, there is persuasive evidence, as reported by
Dr. Carl Seltzer in "Smoking and Coronary Heart Disease:r
What Are We To Believe?", American Heart Journal (September
1980), demonstrating the unreliability of the conventional
view that cessation of smoking reduces the risk of death from
heart disease. Dr. Seltzer also has pointed out that,
despite many years of research and experimentation, a causal
connection between smoking and coronary heart disease has
not been established.
In reality, cardiovascular disease is multifac-
torial in origin. There are many suspects: high cholesterol,
high blood pressure, diabetes, aging, being male, obesity,
personality type, physical inactivity and stress. Dr. Ancel
Keys, a noted scientist, emphasized in his recent book,
Seven Countries Studv, that the relationship between smoking
and heart disease is not as simple as first supposed.
Others have found that the mortality rates for cardiovascular
disease have declined markedly in the past decade. These
declines are even more marked in women,than in men. Yet,
during this same period, tobacco consumption by women was
reportedly on the rise. These reports are difficult to
reconcile with the causal hypothesis. Several national com-
mittees have considered the decline in cardiovascular
disease and have not been able to attribute the decline to
any known factor or group of factors.3/
1/ For example, the incidence of lung cancer at General
riotors Corporation's Coldwater Road plant in Flint is more
than double the national average. A signif icant number of
lung cancer deaths at that plant occurred among people who
worked in areas where chrome, nickel and,cadmium were used.
The Tr:ashington Post, Sept. 23, 1980.
2/ Schafer paper, pp. 7-9.
3/ Schafer paper, pp. 10-13.
7
The second major flaw in the "excess" deaths and
disease theory is the unreliability of the "extrapolations
from national data" used by Dr. Warner to arrive at smoking
and health statistics purportedly meaningful to the State of
Michigan.l/ Many of the national figures themselves are
questionacle because they are out of date2/ or were the
result of studies that -- -
"tended to investigate the rate of
smoking independently of other
behavioral variables, such as alcohol
consumption and other lifestyle factors,
occupational and environmental hazards,
and certain psychological factors."3/
In view of the questionable nature of the national data,
"extrapolations" from that data must be examined with
particular care -- all the more so when such extrapolations
fail to take into account factors unique to the State of
Michigan. The majority did not examine Dr. Warner's tech-
nique of extrapolation or data base with regard to smokers
at all.
The factual assumptions underlying the*majority's
recommendations to "protect" nonsmokers from tobacco smoke
suffer from a similar lack of critical examination. For
years, evidence on the possible health effects of tobacco
smoke on nonsmokers has been limited and mixed. In fact,
the 1979 Surgeon General's Report concluded: "Healthy
nonsmokers exposed to cigarette smoke have little or no
physiologic response to the smoke, and what response does
occur may be due to psychological factors."4/ Many inde-
pendent scientists have reached similar conclusions.5/
1/ Warner, "Smoking and Health in Michigan," pp. 17, 20;
Majority Report, p. 1.
2/ Schafer paper, p. 4.
3/ Schafer paper, p. 5; quoting from United States Public
Health Service, Smoking and Health: A Report of the Sur eon
General, Dep't of Health, Educ. and Welfare, DHEW Pub. No..
79-50066 (1979).
4/ United States Public Health Service, Smoking and Health:
A Report of the Surgeon General, Dep't of riealth- auc. and
Welfare, DHEW Pub. No. 79-50066 (1979), at p. 11-28.
5/ Schafer paper, pp. 14-16.
8
The panel majority, following Dr. Warner's lead,
choose to ignore this.evidence 4nd to rely instead on a
single, widely-criticized study by White and Froeb reported
in the New Enaland Journal of Medicine.l/ Although the
report of the stuay asserz.ed that ciiror.ic exposure to
tobacco smoke affects the small airways of nonsmokers'
lungs, many scientists have criticized the study for flaws
in design, methodology and techniques -- and also for the
conclusions drawn. Dr. Claude Le_zfant and Ms. Barbara Liu
of the Heart, Lung and Blood Institute of the National
Institutes of Health cautioned in an editorial in the same
issue of the New England Journal of Medicine that contained
the White-Froeb report:
"The question must be asked whether
White and Froeb's new evidence is sufficient
to initiate new legislative actions that
would further restrict smoking in public
places. This is, of course, a difficult and
delicate question. * * * [T]here is no
proof as yet that the reported reduction in
airways function has any physiological or
clinical consecuences. The study is confined
to only one aspect of an issue too complex
to be resolved on such a limited basis."2/
In sum, there is substantial reason to doubt the
factual assumptions underlying the recommendations in the
majorityreport as to both smokers and nonsmokers. In
recent years, smoking has become an easy target for people
anxious to solve our nation's health problems. But these
problems will not be solved by ignoring the scientific
complexities surrounding the smoking and health issue. But
that is precisely what the panel majority has done.
1/ White and Froeb, "Snall-Airc;ays Dysfunction in Non-
smokers Chronically Exposed To Tobacco Smoke," New England
, Journal of Medicine 720-723 (March 27, 1980).
2/ New England Journal of Medicine, pp. 742-743. For a
representative listing of other critical discussion of the
White-Froeb study, see Schafer paper, pp. 17-18.
