Tobacco Documents Online

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I I I I I I I II I I I I I t IL IL I LTT!'RCC{~'ICN It Aculd be easy to accect t^.e widely held asstm:~ticrs regardi.-ig snck --Lng and health. ?dverse cc,=ents about s-neki.zg have been caiTcr_place for many years. Fiowe<~s, these asst..=tions icrrzre many rnuest:.cns that remain regarding clairrs t'zat smok:ng is the estaDlished cause of varicus r=an diseases. For ec=-~ple, if s;~cking has been proven to cause heart disease, hnw do we explain why a superbly corriiticr.ed athlete who has never sncked, has followed a strict diet, and seens to have avoided all of the htmtian "vi ces" requires open heart surcery in his early thirties? Further, if smoking causes lung cancer, how do we explain that the rate of lung cancer am=q nflnsmkers appears to be i.-Yxeasing?' 14bre- over, if these diseases have been proven to be caused by smoking, why do federal health agencies continue to plead for millions of dollars every year for research on their causes? Perr.aps because the scientific answers have not been fct.*nd after all. Perhaps because there is another side to the smoking and health ccntroversy which is frequently ignored in discussions of this issue. It is a side that eoncerns scientists and researchers who ;Q:aa that easy answers are not always the cnly answers or even necessarily the right answers. it is a side which mist be ccazsidered in discussing legislation that may aFfect raillions of people such as the proposals made by Dr. Kenneth E. Warner in the paper he prepared for this panel. In his paper, Warner urges that "the =r.ble:n" of smoking in Michigan "be at}acked". Zb justify making his rec=merzdations, he has presented only one side of the smoking and health controversy, that side uti.ch appears to support his own personal beliefs. in ccnsizlering legislation, however, especially in suh a centraversial area as smoking and health, both sides of the issue should be heard. Sir.,ce Wa.rner has discussed only one side of the ccntzoversy, this paper is in- tended to present the other side. Consequently, it should not be viewed as a camprehessive analysis, but as an effort to highlight often overlooked info=na- tion and to demanstrate that the convenient terdwcy to blane s:mking for disease and death needs to be carefully evaluated. To acazmplish that, this FaDer will address the major health claims made by Warnes: those relating to "excess deaths" and "excess costs," cardiovascular disease, lung cancer, and public sncksr.g. A brief description of the tobaccb industry's ccnmit:nent to scientific research in the smoking and health area will also be given. "Ea--ess Deaths" and "Excess Costs" Pmong Warner's major asser..icns is the ccatenticn that each year in the Cnited States, "cigaratte smmking is responsible for 350,000 premature deaths and in excess of 80 mi 11 i r,n L idit•ays lost frcaa wcrk. " Apparently by r.akir.g "extrapolations frcm nar ic*+a 1 data, " Warner further crntends that each year the state of Michigan loses "over 15,000 men and wanen" to smking-related diseases and many mi 11 icr,c of dollars in medical care arx2 cu-oductivity costs. Not crily is .er's source for these stataments sameahat vague, his discL:ssion of these claims does not even allude to the problem wh.ich have arisen regarding the use of st:ch figures. I ~

I A brief revie~a of the historical develap)e^.t of c'_a:-.:s recard.ing "excess ceat'zs" is i.-~ortant in detey-r.i-iir.g ,,i:et':er t.ese sra~_-,v_^.s have e.ny scientidic vali.cit'r. Claims such as Warner's have b-ee.*: made in ccnrec-._icn with ~:.e =ricir:g and health controversy for more than 15 years. A1:noLct th e nu-bers tend to vary depe.-r:ir:g on who is giving them and when, they have been `roclaimed, cuoted, and r°peateu so often that many people accept then as fact. _--ven t^.cug'r, it is almost iir,pes- sible to dete=nir.e accurately where or how these figures origirated, esti.•nates of 300,000 deaths, mcre or less, were already being made in 1964. F?owever, it is iirpor}..ant to note that even the Advisory C=mittee which prepared the 1964 U.S. Surgeon General's Report rejected the theory of "excess deaths" : "Zi^.e total ntart)er of excess deaths czusally related to cigaret}..e s:nokir.g in the U.S. popula- ticn cannot be accurately estiaated". 2 An explanation of why the r'dvisory Caamittee took this position is rele•rant to this discussicn: "The Carmittee considered the possibility of trying to make such calculaticns, but it involves making so many ass=ptions that the Cammittee felt that it should not attarwt this..."3 And-five years later, a distinguished physician bluntly dis;~issed such claims as "fanciful extrapolations and nat factual data."4 Over the years, hcwever, those cautionary state:rents were ig:.creL and clair,s about "excess deaths" continued to be made, very recently by former Secretary of Health, Fi:ucatian and welfare Joseph Califano in announcizg the release of the 1979 U.S. Surcrt.~cn General's Report. However, even this repoz t recognized the uncertainty that exists regarding atte=ts to establish a causal relationship between =nJsir.g. and disease: It has been only recently that data have aZso become avaiZabZe that indicate a relationship, aZthouah a s*atisticct reZationship and not an established causal relationship, be~een cigarette srr.oking and disability and_ other health indicators. 5 (Flmphasis ac:ded] Moreover, an examination of the report reveals a lack of data dealing with the relationship bet-aeen morbidity and those diseases which have been associated with snnkirg. For example, a review of the tables contained in the chaptFr on morbid- ity shcws that no data relating to such diseases were collected after June, 1965. Even when data are available, rnmxrous questicns about their reli.ability are noted. Chne such example is ill•.aninating: Most Zarge scale studies on smoking and health have tended to investigate the rote of smoking independently of other behaviorat variables, such as alcohol consumpti.on and other lifestyle factors, occupa-ionat and environ- mental hazards, and certain osychoZoarcaZ factors. These vcrtiabZes are 'a~ to be related to health status ar:d mcnu are related to smoking habits. Thus it may well -!-,e .hat the eLi:rrna-cion of smoking without any crran.ges in the other factors will have only a ra_Tt iaZ -_~=ac-. on health stct-.cs3 6 F3ence, the authors point cut that impor'rant data have not been collected and suggest that the sole eiphasis on the Pl;ndnaticn of s:mking as a panacea to the prevention of illness might not provide the desired results. Perhags the most thCUght-crovGkir.g statF_-~ent on this issue was made by a researc:er in his review of clai.~ns that excess m.rbicity and disability can be ascribed to stnkir.g : -116- I I I I I I I I I I I p I ~

i I I I I I I I ?erha:,s ar:y Zesson is to be Zearr.ed =rem this issue, . ~ -_~s nct smoKir~.c causes unroZd diseases and disa.,iZi:ias and Zoss ;'rcm :.;ork, -;-at ti^.a~ ci :ims ac,ou:: such controversiaZ tcpics need to be ca_re;'aZZu cnd inta Z Ziaent;,y rev iewed, even i f they are made :,y rubZic cgenc'_ as or _;-u orner yeneraZZy reZiaz Ze scurces.7 - Ccnseq,:ently, it is ap_r.arent that if clai~ of excess deat'^s and mCrbiditv based cn nati.cnal data are cuesticnable, "extracolations" mace on a state-wz.de ~asis are Li rcely only to caa=c=d such prcb1ems and - raise even .:rre rn:esticns. Given this unreliability, it seeris illogical that such evidence shzuid be used to justify restrictive legislation. lung cancer. Iimg Cancer warr.er's discussion of this subject is brief, but he does state that "the Fublic's major smoking fear is lung cancer." Instead of providing the cbjective discassicn which would seen to be requi red, tJarz:er sinply asserts that ever 3,500 lung czs.ce: deaths in 2tichigan are due to cigarette s-mr.k•ing, without citing a source other than making a vague reference to the 1979 Surgeon General's Report. Perhaps he assLSred it was unneoessary. After all, almost eve.rvor.e has been told t~at S=kir.g causes Eut what do we really lmow about the nature of the association betwem smoking and lung cancer? Marny people do not realize that most of the data used to sugport clauns abcut cigarette smoking and lung cancer canes fram epidemiological (pocula- tion) studies. Such statistical studies can provide a great deal of infornaticn, but it is iVortant to renanbes that, accord3ng to one statistician, "cancer is a biologic, not a statistical, pLnblem."8 Although peogle have probably becane accustaned to saying that "statistics prove" sanething, it is a well-recognized principle that statistics can never prove causation. Even the 1964 Surgeon General's Report recognized that "statistical methods cannot establish proof of a causal relations.liip in an associaticai. "9 - Scientists have expressed concern about this tendency to equate statistical associ.atian and causal relationship. As early as 1969, aCanar3; an pathologist asserted that "in the a;ntext of smoking and disease, association has been con- fused with causation."10 bbre recently, a physician addxessed this same point, observing that a statisti.cal association "can lead to hypct'^.esis foanaticn" but it cannot "prove the truth of the hypothesis."11 rur'ther, , the population studies fran which these data have been taken are not tnassailable. Irr-egularities have been fcu-~d and publicized, utLi•c.h show that the case against smoking is not as sinple as many people wCuld 1ik.e to believe. For examle, if smoking causes lung cancer, it wail d be reasonable to ex_r~t hi~er rates of the disease in countries where mcre cigarettes are sirk,ed per canita. But that does not always happen. Cne scientist Ad-o found that lung cancer mortality rates vary significantly fran oo<mtry to camtry detP~r.iined that "t'vese large differences in mortalities cannot be explained by differences in cigarette _ , typps of tobacco used or the variation of smoking habits in these coimtries. 12_" If cigarettes do cause lung cancer, it also would seem logical that the earlier a person starts to smake and the mcre he sm.kas, the socner he would develop the disease. Yet nonsncicers and smokers (whether they smcke a lot cr a little) all -117-

acoear to Ce`-eloo the disease at acorc.~csatelv the sare age. ~=,ccordi.c to cr.e e~e..-t: at hath the ace of st,~s-ti.^g to smck.e, and t':e~rate cf &-,cki±.c, s'r.culd have no ap: reciable influez-ze on the ave..Yace ace of cnset of lung cancer creat.ly taxes, if it does not destroy, any causal 'r.wctzesis."14 As a conseq;.ence of similar irregularities in his cwn analysis of male and ferale iung cancer mnr}ality patterns in anglan3 and Wales, a British .*nedical physicist argues that "no definitive cor.clusions can be reacized, as yet, about the e_xtent of any causal link bet~A---n smoking and lung cancer."15 By assmir.g that smking causes lung cancer and by ccaiparing erpected lung cancer r,icrtality trends against cbserved trends, Professor Philip Burch atte*r~ to deteatune whether the associa- tion bet•ae°.z sncl:ing and lung cancer could be causal. But in his wor-~.s, "cbserved and expec~.~c3 trends cor.fli.ct with the causal hypot'^.esis.16 In another analysis of similar data, Burch reiterated his beliefs regarding the scientific basis for claims about smoking and health. In the absence of "suitably critical eviderxe" fran other sources, he concluded that "the contention that alimst all cases of luaig cancer are caused by cigarette s-rnking seems to be un- Froven and prematwre."17 In light of Warner's assertions, BLSch's ccncluding re:narjcs regarding the general axeptance of the causal hypothesis should be carefully considered: As we are all well aware, rr=y emmnent persons,.ccr.m*ttees and cc~rissions have unanimously concZuded that Zwig cancer "is aZmost entirely due to cigarette smoking." I once shared that view, but having now stuciied the evidence in more detail and from-new angles I feel unable to reach a definitive conclusion, apsrt from re,7ecting the "pure" causal theory. Zs In acditicn to epideaniological st-uiies, clinical and laboratory data are used to supoart the assertieai that smoking causes lung c3ncer. However, the valiciity of such data also has been challenged and inconsistencies noted which do not "fit" the causal hypothesis. A Yale physician and epide:niologist, with an extensive background in the smking and health controversy, summarized several of these "loose stratY3s" : 1. The supporting evidence in hwr.mzs rests entirely on statistical analyses of observational data, and has not been (because it can- not be) confirmed by randomized experimental trials. 2. No we Z Z-designed and we Z Z-conducted ew;,eriments have shown that q cancer in animaZs.19 cigarette smoking causes Zun 1vxreover, it mist be considered that the same type of evislenoe which has been used to lirik cigarette smoking and ltmg cancer also suggests that many other fectors may be involved in the develc~.znent of lung cancer. These inclivde occapa- tiar.al exFosures, viruses, diet, food additives, pollution, stress, aging and II~'.37.z2d by defense mec'_han i cms, In s=.ation, the simnle assertion that sm.3cing causes lung cancer does not take all of these points into consideration. Therefore, it•seems premature to ccnclude that smoking causes lung cancer. The type of one-sided attack on cigarette smoking made in Warner' s discussion does nothing to advance the search for causes and cure of lung cancer. -118- I ( I I I I I ~i I I I

I I I I I I I II II Cardiovascular Disease War:.er's dis.:.:ssicn of cardiovascular disease, whic'i he ccnte--r-Is is "by far. the ntmicnz cr.e s-roki^.g-relate3 lciller, " is oversiz=lified and larcely ur.sz:=pcr-e.'. Basically, he asserts that each year, sr,ioking causes a large of deaths f-cm caxr?icvasc.:lar disease, apparently on the assum: ticn that no one wculA disacTee with that state:nent. F.x7wever, t~ scientific picture surrcurxiir.g t".e etiology of hear` disease is sinmly not as clear as Warner's paper suggests. In fact, many scientists and researchers oft.en nn refer to the "naltifactorial" origin of ca~iovascuLar disease, rneaning tiat mare than cne factor sast be included in discussicr.s of its develcp- ment. In this ccntext, the tean "risk factor" has been used to describe those characteristics (either bi.ological cr behavioral) that have been statisrically associated with the develogment of heart disease. Cigarette smk:.ng has been reportsi to be a risk factor, but so have aging, sex (i.e., being male rather than female), elevated levels of cholesterol aryd of relate3 fats in the blood, hypertension, diabetes, parental history of heart disease, obesity, perscnality type, and physical inactivity. To Michigan researchers have suggested another possible risk factor - "job dissatisfacticn."20 wr.at is inpartant to remenber, however, is that "risk factor" does not me-an "cause". This was illustrated by Dr. Theodore Cooper's testi:mcny before Congress when he served as the Assistant Secretary for Health of the Departrent of health, Education arri Welfare. Dr. Cooper was given the cr_-portunity to identify cigarette smoking as a cause of heart disease, but he declir.ed : Senator 3art: "I would merely ask if ctiaarette smoking causes heart disease?" Dr. Coover: "Yo. " Senator Hart: "It does not?" I I i I L Dr. Cooper: "No. I think to be absolutely candid with you, the risk factor does not mean cc:cae ...... 21 [Empi, .asis added] A ffiitish Medical Jour.+al editorial differentiated even more strongly between cause anT risk fictareq:~hasizing that the presence of risk factrxs may have little significance in identifying future heart disease: "We mist therefore realiae that risk factors cannot be causal and that they have very pocr pre- dictive value.^22 This point was clearly illustrated by the results of Keys' recent tax'.ate of the Seven Countries Study. Zn his on-going study of over 12,000 men, Keys found that "the differences among the cohorts in the incidence rates of carcnaiy heart disease and of death fran all causes are not explained by, or related to, the differences anong the cohorts in their src.lun hanits. "2-3 [IIqiiasis added] In the context of Warner's statements about smoking and caxdiovasclar disease, Zeys' observations regarding smking as a risk factor are rbot.ewcrthy: "The fizdircs about cigarette sanakiuzg as a risk factor irdicate that here, too, relaticnships are not as ssmle as first supocsed. ^24 (IImpt^asis aV;,;ed] M ~ In acd.ition, an editorial by The Iancet foaLsed on reZ t data di_~icslt to re- . A V ~ _ cor.cile with the causal hypot~esis. In its cccrnx--:ts on the renr„r~-~ decline in caronary heart disease irr,rt~ality atmng pmericans , the ed:.terial noted that: ~ -119- L

I :rends in smcking it tne icec.r±-cisease „rer.cs -7ess .;ell. :i:e orocor.:icn of Ar,:er'_ecr: men .;i:o smoke r.as Cec:'easec zuo :'r.2 pro^^r~icn o; ~;cmen ~::o smoke has inereased; ye ~^or-a? i -• has ~ec 7 ir.ec morev ::n L;cmen z-r.cn tin men. 25 Tvo recent reperts by the National F?eart, Lur.g ar3 Blood _Tnstitute (NHI.EI) dis- cuss the scie.^tific ~ncerta.inty abcut the reasons for the rexry.ed decline in coronary heart disease mcrtality. For e:canple, in 1979, an tiF~...3I wo.rkisx3 group concluded that "the reasons for the real decline in cardiovascular morta.lity rgnain tmr3etermined, and Friirarily because of inadect:,ate data, it is uncertain whether chax;es in any of these risk factors (inclLrl.ing cigarette smking) can accouit for the decrease. "26 The szuimar7 report of a 1978 ccnferer.ce held by the i+=I similarly ccncltded that "alt'^.ouc,-h t.ere was general agreeT~ent t'aat the decline in ccrcnary heart d.isease is real, the probable cause or causes cou1d not be precisely identified."27 R,eparts and caaments by irriividual scientists atterdirxg that conference fur~t!^.er highlight the lack-of tnderstanding about the decline in ccronary heart disease martality. (ne scientist who has argued in the past that smokirig plays a role in oorcne.r-y heart disease develo_rsrnnt stated that "the reality is that we wi11 have to wait scane years before hard data are available ec`.ce_r.^:.rig the reascns for the mcr*a1 ; ty dawntrerri. "28 Another researcher who has also exaresse3 anti- sroking sentiments obsezved that "the re3scn or reasons Fcr the decline in c~ID marta].ity have not yet been establisi~. "29 And perha_,s-rmst relevant to this discussion are oatments made by researcizers who noted that the reparted decli-ue could not be em-alair.ed by charges in smkinc- consuTption trends. For ex-mple, the director of a maj or research and develcrsr.ent center stated that "coe don' t 3mow enaugh about what is happeni ng with srLking. When we lock at sroking changes by race and sex, we den't see the consistent patterns one would have expected with the observed mortality trends. A great deal mcre wzzrk is necessary".30 What can one conclude f±-an such observations? It is obvious that because of the extreme ccnplexities they den=mstrate, heart disease contimes to pose a irultitude of unanswered questions. Consequently, Warner's oversirrplificaticns of this pro- blen do not provide an objective evaluation of the situation. Public 97noking Warr.er's discussicn of the possible health effects of tobacco snnke on n=snokPSs in public places is extrenely short and ignores significant research findirqs on this issue. Howmver, Warner sesas aware of these other studies when he admits that "for years, the evidence on this question has been limited and mixe3..." This is, of course,= consistent with a ccr:clusicn ccntained in the 1979 Surgeon C'eneral' s R+epcrt: "Healthy ncnsmcker s exposed to cigarette smcice have little or no physi.ologic response to the smake, and what resacnse does occi.•r may be due to psyc.'lological factors."31 Many irde aent scientists have made similar deteaninati.ons based on their review of the existirig literatsre. For exa=le, Dr. Siraa T. Ianqstcn, a former president of the American Pssociation for ;~h=acic Surgery and prese.Ztly Cli.-iical Professor of Surgery at the Nar~~1:Aestern University Medical School, e='rasized, in testi.*ricny before the Ciicago City Council's Catr mit}..ee cn Erriroririeztal Control, his conclusion that: I i I I I I I I I I L L , ~

I I f I I ~in assertion that coCacco smoke is a ;~.ec'_'ill t2aza_^.^. ';a ,the ncr'^aZ nons,^'CKZr is unrer,ao Ze. The wei5izt o:' ev i,;:ence as i o e=s ~s in :%e ~;cr?c ? ~arct ~^e cces noc supror: a claim o,•' adverse ;4eaZtn e;'.'ec:s ; or :'r:ose exscsea :o "-assiue smokting."32 Tharr:er f~ ~':er asse.r-s "that certain 'riich-r=sk prpilatic.-is (e, g. , those with heart or lung disease) expcsed to concent`ated mr.ke ccad suffer sianific ant adverse corseGue.-ces." This assertircn, as it relates to pecple with heart di- sease, relies heavily on articles publishe3 by or. Wil!hkeart r'1rencw. In his mest publicized st~y, P.roncw exanined 10 patients with ancir.a pectoris and reporte: that they Ceveloce.d. heart pain sooner after exercise when they had been expose3 to tobacco smake.33 f~.cxaf.'ver, Aronow's study design and results have been pub- licly criticized. The sa=le was extre:nely smail, no allowance was made for the possible effects of psychological stress, and alt'^.oucn Arorow attributed some of the results to nicotine, no measvrements of nicotine absorgtion were publisi^.e3. After revieTwing these objections, one professor of nathnlogy called the experi- mental design of Aror.caa's work "exceedingly poor,"34 arr3 a Ires Angeles chest physician concluded that the study is quest:.or.able. "35 Dr. Suzanne B. Xnoebel, Prrof essor of MecLcine at the T*dia*+a UnivQrsity School of Medicine, stated: There are no indications that tobacco smoke in the at:nosp'nere either causes or acceZerates c=diovascutar disease in the heaZthy ronsmoker. Nor do avaiZabZe stuciies estabtish that atmospheric tobacco smoke under reaZistic conditions adversety affects nonsmokers with preexistent cardiovascuZa.r disease.3o I r I I I I L With respect to patients with lung problem, Canad; a*+ researchers studied the reactions of asthmatics to levels of tobacco smake typically foand in public placeas.37 After two hours of exposure, no systenatic lung changes could be observed. These and other findings prampted a w+e.ll-known pulmcT3a=y expert to say: "I must ccrLClude that there is no proof that smoking in public places adversely affects patients with lemg-disease either acutely or chrcalically."38 Warner also alludes to one study which reportedly f=-d that "G~ildren's health can also be harned by living with parents who smoke." Again he seens to ignore the results of studies with reported conflicting findings. Zeboaritz and Btsrozas, for example, found that %tvPn the presence of sy=t--ns in adults was takm into account ... no statistically significant difference renai.ned in children's syrrvtans related to the hcusehold stnking habits."39 Dutch researchers, after a five-year study of respiratory ailrcents in 428 children, concluced :"3rr.king and zonsmking parents have abcut - t'ze same proportion of children with respiratory syrrptas. The zunber of cigarettes smked by the parents has no influence on respiratory srTtcms in their children."40 In one of the largest studies on the subject, Sc. 'h~ng, et al.,ccrbclude3 that "ex_r_ost=e to low levels of saoke p:rocuced by cigarette sar.kers does not result in chronic resniratory sysrptuns or loss of lung ftmctir.~n amcr.g children rxsr among adults. "41 cansideri.*x3 these and several other stUCbies with si m; 1 ar f1SdlI1gS, Warner hardly seSils jLlstif ied in te3miTKJ the associaticn between parental snaking and childhood respiratery disease as "definitive." Thus, Warner's recatnrzidaticais of legislation restricting s;ne.king in public places is based aimost entirely on the findings regarding the "l=*+ary functions of office ow=kars rer.:orted earlier this year by i~ite and ~oeb. `~2 By ~paring t~.e test results of ncnsmke.rs who said they worked for mrare than 20 years in of fices where there was no srnking with the measzranents of rcrmrakess who had rerar}.edLy worked the sane lerl3th of time in offices where s-tr•icing diL occur, White and Froeb asserted that "chrcnic exacsure to t.^;: acco smoke in the work e:Tvircx=e_nt ... sicnisicantly reduced sma11-airways _`uncrrcn. "43 _121- 1

I Cespite the widespre...ad ~;edia att-enticn the xce_ :ece_.-ed, many rredical e.rnerts have cuestioned whel:':er the reported firdi^-s pzoof of any real harm to ncnsoeke.rs. For ~.le, Dr. Michael J. L:a?~-st~,-st~, a weL-;mcwn rredlical co1;-siist, said, "•,vize*..her or r.ot this study will be ccnf^-'.ed cy other irnvesticaticns, ard whether cr not actual diseases accear in ncns,-,ckir.g -,,~-ple wt.o wcrk in a s:,iexir:g envir=nent has yet to be resolved ."44 Dr. Claude Lenfant and :2s. Barbara Liu of the Naticnal L-istitues of F:ealth noted in an editotial ecc.arcanying the 4vhite/FYceb article that "G2zerally speaking, the evider.ce that passive s.-roking in a general envi-rcrr,ent has health effects remairs sparse, inc=lete ard sanetimes unccnvi.cir.g ... there is no Frocf as yet that the re_ e3 reduction in airways furzticn has any physiological or - c1.irLi,cal, conscqi.ie.^.,..^es. "45 Fecently, several cther experts have criticized the Svhite/FYoeb study. In a letter to the editor of the journal which published their study, one doc},,.cr questioned their e.raerimental premi.se: "It is difficult to believe that the researchers have been able to identify a truly representative group of subjects who have uork histories of 20 years or more but have never been expose.ad to tobacco s;:nke. "46 Another researcher asserted that Gdzite ar,d Ftiroeb did not have reliable estimates of anomt of smake to which t' :e nonsnekers were e.~csed because "carbon ~ide is not an ' actvrate' irr3ex of sRrke exposure ..."47 Ansthes doct.ar stated tY.at their study was "flawed" because they used a lung fu^.cticn analyzer wh.i.ch "fails to meet the technical reccrarer-dations of the Arrr--ican Tttoracic Society."48 So it wou.ld seem that, based on a review of the existing scientific literature, Dr. Iangston's evaluation of the legislative aspects of the ncrosncker issue is sti11 valid: "The -regulaticn of public smking, ureer the guise of a mandate to protect the public health, is without scientific justificatica:. "49 Lenfant_ and Liu a'cc.ressed the same issue in their editorial. They asked &.etcrically whether this ne,q evidence was "sufficient to initiate new legislative ac..ions that wvuld further restrict snokirsg in public plac~.s ." They responded with the obsezvatlcn that this is a "difficult and delicate question" and ccrcluded that the Stihite/7toeb study "is ccnfined to onl ene aspect of an issue too oaplex to be resolved on such a limite3 basis."5~ Once the alleged danger of these "potential hazards" has been put into perspective, the difficulties urderlying such legislaticn beccme nuch clearer. At h,earings on bills proposed to restrict smaking.in public places in other states, experts have repeatedly underscared the prcblew surrounding such prohibiticns. Clziefs of police have discussed their concerns over the diffic.alty in enforci-ig such laws; cwners of restaurants have predicted their loss of ir.come when esstariers becane dissatisfied; office ma nage•-s have anticipated urmleasant canfrcntaticns between smoking and ncri.-tckir.g employees and the dest_^action of harmony in the wczrkplace. Warner hinself int_*cduces one of the mcst discuietir.g points involved in this issue: the increas=,g t of gcve=.w.--nt into inatters of personal choice. As he puts it, "police monitaring smksg behavior has a distinctive vl wC.L.l.la11 fl3v0'r. . " - A danger posed by possible gove`nanent excess is made clear by the results of cne such law regulating s:mki.*x3 in public places. An analysis of one month's ocera- tion of the CZicago ssckers' court reveals that cut of 279 peoQle s-umm,rr.ed 248 were 31eck. A colunist uho is h mset f an anti-stcke* has ohsE.Ywed : "The suspicicn is strcng that Czicaco's s=kers' ccurt has absolutely nothing to do with ;ranctir.g clean aublic air. "51 -122- f I I I I I I I p IL

i I I I I I I s I u I I t L L Cne :;a:st ask, then, whe*.her the real issue here is the crese_^zaticn of the :.ea1Lh, or the atte~--.t of single issue activists to "save smckers -,~-'an t.e:rselves." wari:er hints at this hidden iaativaticn. L7rediately after asser-._i:.g t'^at t-.ese bills sippcserlv will "rrotec t" ncns;nicers,he ac?cs : "Ne•re--tneless, cne :nich t expect that sr7c}c::.c-restsic...icn laws, par-..icalarly the iLiq~ly res'csic},e ive cr.es, wnuld force a re~ti:c-._.icn in total cigarette ccnszu=ticn, sirr--ly because r-nc:cz-s - wculd be cr^..nibited fran --,rickir:g in unavoidable designated places." The cov:ous cLestion is wt.,ethe.r laws should be used to control or p:nish --mkers. Another we?1 recognized facet of this issue is that certain peoole -simply do not like cigarettes or cigarette smake. Scrm seek to justify their anncyance by claisning that they are allergic to it. Yet the fact is that no scientific re- serach has proved that people are allergic to cigarette s:neke.S2 Certainly t'^.exe are "c'.Qezniented" cases of annoyance and di.scartfort, but how etensive are these camplaints amang the general public? According to one naticnal sutvey, adr.ini- stere3 by Respcnse Analysis of Princeton, New Jersey, only three percent of the annoyances Listed by ronsnakcss were related to cigarette snc'rs.5~ Those results should prrnp t a ntIInber of questicn.s. Mbst importantly, it can be asked whether the high visibility of t`Lis issue is the result of certain "anti- smcking" group tactics. If so, should laws be passed to satisfy the preferer.ces of a sma11 minority? Single-interest factions can be blind to the larger concerrs of society. But policy makers cannot afford to be. Irdust..,-v-Spcnsore3 Fesearch As previously mentioned, this discussion was intended to raise questions about srroking and health issues. But the tobacco industry is not satisfied wit.1i sL=ly raising cuestiarns; it is also concerr:ed about furthering scientific understanding of disease causation and developnent. To that end, the industry has cumLitted over $85 million to researdh designed to expand our }mowledge in these areas. In many years, tobacco industry sncking and health researc'z spending has exceeded that of any governmental department as well as the ccn~bir.e3 grants of the major voluntary health agencies. - Brtad research grograms have been supported by industry funds. For eximple, with the help of $2.75 million, the UCIA School of Med.icine is exploring lir:g defense mecisanisns and early detection and treatment of cancer. nie research teatn is also studying novel concepts of treatmezt (inclur'' ng recarbinant L'NA) of other diseases such as sickle ce11 anesnia. Anot'-~er grant for $5.4 million to Washinctcn L'nivPSsity in St. Lcuis is underariting a study of possible inn~ logic factors in cancer. And a $4.7 million commitment to F.arrar: :2edical ScI=l has nurxied wor-c on pulmcnazy and cardiovascular diseases. Other projects have been funded through The Council for Tobacco Rese~~h - U.S.A., Inc. (CIR). Although its financial su_oport is provir3ed by the tobacco industry, CTR is autcr.amus in awasd; ng grants to scientists for the stuc.'y of sm.,king and health euestions. As an actmnistrative agency, CTR evaluates research _rscoosals through an advisory board of independent scientists; it does not operate a re- seach facility. As- of Nlarch 1980, n~e than 390 scientists in 250 medica'_ schools, hcsaitals and ir.stituti.cns in the U. S. and 10 foreian calntries have been funded. They have ca.mlete scientific freedan to conc:uct their st-.:dies, and they alcr.e are respcnsible for report-ing or r.ublishing their findings. In total, these re- searchers have pubLished 1,772 scienti-fic papers. -123- I L