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Cigarette Labeling and Advertising - 1969 Part 3

Date: 1969
Length: 136 pages

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nysa_ti_s2 TI58460017-TI58460152

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Box
9330
Author
Williamson, W.B.
Painter, Kenneth
Named Person
Stevenson, Andrew
Guthrie, Robert
Dixon, William
Thesaurus Term
advertising
government activity
government agency
Subject
TAN

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Page 1: TI58460017
Part 3 CIGARETTE LABELING AND ADVERTISING--1969 HEARINGS BEFORE THE C0~[SIITTE]~ ON INTERSThTE hND ~OICEI~N CON~[EP~CE FIRST SESSION ON H.R. 643 BI~ ~O A~D T~ ~EDEI~ CIG~ ~EL~G ~D ADV~I~TI~IN~ A02 WIT~ R~PECT TO T~ ~LI~G OF ~ACK- ~GE3 0F CIG~It~'~B. ~D FOR OTBEK PURPOSES (And Siml~r B~ls) H.R. 1237 BILL T0 DIREOT "I'H~ ~DEI~L ~OM~UNICATIONS CON~S. ~ION TO ESTABLISH I~GUL£TIONS PROH~ITING CERTAIN DR0~CASI'~G OF ~Y~RTISING OF CIGA~E~ES (And ~tmlIar B~ls) H.R. 3055 DILL TO STRENGTHBN TH~ FEDE~ CIGARETTE ~BELING ~ND ADVERTISING AC~ (And Simi~r Bills) H.R. 6543 BI[~L TO ~XTEND PUBLIC H~LT~ PROTECTION WITH RE- ~P~ TO CIGAR~TE S~OKING A~ FOK OTHER PURPOSES (A~ ~lmllar BIII~) APRIL 15, 16, 17, 18. 2L~,'~'~ 23. 24, 25, 28, 29, 30, AND MAY 1 Serial No. 91-12 Prlatctt for the u~e of the Committee on Interstate and Foreign Commerce
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Part 3 CIGARETTE LABELING AND ADVERTISING---1969 HEARINGS CONMI~T]~E ON ~TY-FIRST CONGRESS ~IR~T SESSION ON H.R. 643 B~ ~0 A~END ~HE FEDER~ ~D3At~E ~ELI~G AND AGES 0F CIGAR~ES, AND FOR ~ PURPOSES (~d Slmi~r Bfil~) H.R. 1237 BIL~ ~0 DI~ ~ FEDERAL C0~I~IU~ICATION~ CO.IS- le E~ABLISH ~GUL&TIONS PROHIBITING CErtAIN BR0~C~S~ING OF ~D~TISING OP CI~AR~E3 (Aud 3imllar Bills) H.R. 3055 BI~ ~O S~REN~N ~HE ~DEI~ CIGARE~E ~ELING (A~d :~lmi~r BillS) H.R. 6543 BILT, fie E~E~ PUBLI~ HE~H PRf~TEffPION WI~H liE. SPE~ f~O CIGAR~TE SMOKING AND FOR OTH~ PURPO[~E~ (~d 3~lar B~Is) ~R~ 15, 16, 17,18, 21, 22, 23, 24, 25, 2S, 29, ~0, AND 5IAY I Serial No. 91-12 Printed for the use o3 the Committee on Interstate and Foreign Commerce
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• OON~Elq~S ' CO~IITTEE O.N INTERSTATE AIqD FOREIGN COMMERCe1 IIARLEY Oo ~TAGGERS, West Virginia, 6'hair, on t4AM[rEL ;tT. FI~IEDEL, l~f~r~iand ~£0I~ItI~RT H. ~[ACDONALD. Massachusetts JOHN J,~IAN, Oklahoma JOHN D, DINGELL, Michigan LIO~ YA~ D~EItLI~, C~ifor~[a J. J. I'ICK~I~, ~exaa FRIED B. liceNSe, Pe~nsylvau~a JOIIN M~ MHI~PHY. N~'w York DAUII.~L J, RONA~, Illln~iu RIOI(AIID L. O~INGER, Now York W. ~L I/tiLL) ~TUffKEY, Ja., Georgia I*ET)~I~ N. KYROS, Ma~e I~OIt ECKII~tDT, Tcxa~ ItICHAItD3ON f*It~YER, North Cardina WILLIAI~£ L. SPRINGER, Illinois SAMUE~ L. DEVIl, Ohio ANCHER ~SEN, Minnesot~ HA~INGS ~I~H, Ma~chuue~a GLENN CUNNING~ Nebraska JA~S T. BROY~IL~, N~r~ ~o~ JAM~S HARV~Y~ ~l~lg~n A~BRT W. WAGON, South Cure,ha ~IM ~E CARTER, K~tueky G. ROB~T W~T~NS, Pennsylv~ DO~ASD ~. B~O~AN, Colorado CLARENCE J. BROWN, Ohio JOE SKUBITZ, FLETC~R THO~[PSON, (The ~ame table of eontent8 appears In parts I, 2, and 8) He,rings held on~ April 15, 1969 .................. A~ril ~, Io6~ ............... :_'-__ " ........................... Apdl 17, 1969 .................... ~ ............................ April 21:1969 ................................................. April 9.2~ 1969 ................................................. 453 April 23, 1969 ................................................. 547 April 24, 1969 ................................................. April 25, 1969 ................................................. 723 Ap~i! 28, 1969 ................................................. 769 April 29~ 1969 ............................... ~,~ril ~o, 1969 ...................... _" .... -'---.'-'-'-'---'-'-'-'-'-'L'~ lO6:~ May 1, 1969 ................. Tex~ of~ - ................................ H.R, 643 ..................................................... H.R. 1~7 ............................................... H.~. ~0~6 ...... .--. _- -- _. ~.~. ~3 ........"- - Z Z -" Z -" Z _- ." - Z ." ." ." _- _- _- _" _" ." ." _" _" _. - _" Z "_" ." _" _- _" ." Z ." ." ." ." Z Ropor~ of~ " Agriculture Department on: H.R. 3055 ................................................ 13 H.R. 6543 ......................................... ;.;. ..... 14 Commerce Dopartmen~ on H.~. 643, H.R. 1237, H.R. 30o~, and H.R. 6543 .................................................. 7 Justice Department on: H.R. ~2~7 .............................................. H.R. 0543 ..................... _" ............... " ~a£emen~ of~ Abbitt, Hen. W. IXL, a l~epresentative in Congress from the St'~to of Virginia .................................................... 69 And~rson, I-Ion. Glenn ~[., a Representative in Congress from the State of California ........................................... Sl Baker, Dr. Sol i%., chairman, eommittes on tobacco and c3ncer, c~m Cancer Society .......................................... 307 Banzhaf, John F., III, e,~eeutive truste% Legislativo Action on Smol:- ing and Health (LASH) .......... ~,e=, D~. _Tho,~,~ ~.,_~tor,~, Lo~ :::::::::::::::::::::::::::: ~rowning, Dr. Robert L-L, memhex, board of diroc~or~ National Ttt-° boxoulosis and Respiratory Dish, ass Association ........ 6.8, ~32 Brownlee, K. Aler~a~der~ Our~v. Cole ........ stun ........................................................ 403 B~uhle~ Dr;.¥iotor~ pathologh~, Kan~a~ Ci%y, ~Io ................. t~arr, ur. ~uane, professor of surgery~ University of Tennc~sco Cot- lege of hiedicine ............................................. $49
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Cole H ~ , - . ......... ~ ............... ~e State ~d'Uni,~9 .... ;--- ~_-~'" ~-~resen~a%ive m Oengm~ from ~ .... o~ C=]lform~ = ~l~. ~h~rma~of the~ndb chmrm~" n of the executive ~,~Dr Chafl~ L., ~.~ to th~ Governor, ~ o~ ~, 60~ ~[~"~c. , ~¢Idon, Speem~ ~ ...... . ......... ~--Yn[~,n-~ ..... ¢53 Public Health ~crwc, Farbstein. " .............. : ......... :-" e Amerlc~u ~Oll. ~. ~-* ........ " vcrmtY o~ ~t~ x~.~.~ Cr, unsel. F~aer~ ~ ..... 193 Gcllcr, ~enry, ~cn Guldb~rlb : ~ . " " • --,~ --:- ..... :~:=~" ~ ~'~~[&~ ~E ~&~ L,~,~¢.urv Di~e"~se ~ocm ~-~ Trade ~v'%[7 ~L~[~'J.. A~torneY, £~u~"t~ ~ric~ture, Sta~o oz ~u~,, 607 Gra~, osme ..... -- . ......... .~--n--~om the State Carolin~:...7 .... ~Z-~'~enr~nta~vo m ~ ~, _ ~{~d~ern, non. ~eymoa~, ~ "" ~ - .......... ~--~-~4 .... ork ........... ~ ...... e~rin hous~ tot of N~:w ~] 77"~ .... ~or Nauonal CI g , ~..'+h Edueatton, • "~¢~?,-Ith Public ~em~- ~e ..... , ............. 7Ll ...... 893 ...... 7V~lfsre ........... r ...... z'- ." - ~d ~ Dr Perry B., prep, dent, ]{lgh Tot Foundatmn, ~v Hud~zon, • 's~¢s member of the board of d~ecto~, t~ ...... ndh~ Dr. J -,. ' kin, and Health---~--r ..... mis- 261 Ryde, He . . ............ ~-7~TE~Z" Con~s from t~e jacob's, ~o~.-'-~ " . ..........:---=--~k~%~[&~o~ uRrY Dr L~qs ~., former P. tics ~{ioh~g~ ob=~ .v ...... o Jan ~, " - r of storm , • ~o~ Toba~c Katz, Dr. Le~.profes~ ,,~ uresident~pubh° rel~ , 669 IGoepfer, W~l~m, o~., ~uch, He . . ............... : ..... ~'ERvironmtmtM of N~w Yoik-:'~[~or National ~sti~to,~.~nt of Health, lth ~cicnce.~ ................... _. 787 Logger% ~ on. A~ou~ ~', Statement of--Contlnued Levitt, Dr. Eugene, Professor of Psycholo~-, Dcp~rt.ment of P~y~hk~ %ry, lndian~ Univ~Mty School of ~edicine .................... 1271 ~IcGahn, Patrick J., Sr., vlcc preMdcnt for legal affai~, American Chemosol Co~oration ....................................... 893 ~cMillan, Hen. John ~., a Repr~gativ~ in Gongz~s from th~ of South Carulins ............................................ ~{aolutyre, A. E~'~¢tt~, Commissioner, FcderM Trade Comfi~uio[b delivered by ~on. Pa~ Rand Dixon, Ghaimtan ................ 458 Mandel, Dr. Perry R., ehai~an of the Nassau County Interag~ney Council on SmoMng ~d H~lth, and vica pre~ident~ Na~:~mt Divi- sion, Amer~cmi C~cer So3iety ................................ Meyner, lion. Robert B., aflm~trat~w, eig~ett~ adverttulng code.. ~{~er, J. Robert,oomm~sL3ner of a~iculture~ St:~te of Kentucky... 254 Moses, Dr. C~mpbell, medic:tI director, American Heart A~ocl[ttio~. _. Murphy, Hen. John X~., a l:tepresent~tive ~ Con~e~ from the State of New York ................................................ 617 Natcher~ Hen. William B.~ a Representative in Confess from tho of Kentucky ................................................ Ober, Dr. William B., patholo#s% New York~ N.Y ................ 1143 O~n, Dr. ~onMd~ pha~a~ologi3t, Lo3 Angelc% Calif ............. 1115 Overkolt, Dr. Richard H, direotor~ Overholt Thoracic Clini% Bo~torh Mms ....................................................... P~klns, HeR. Carl D, a Repr~ontativo in Confess from th~ State of Kentucky .................................................. Petti% Itch. Jerry L.~ a Rcpr~entutive ia Congress from thu Stttto of Oalifomia .................................................. 70 Rigdou, R. H., professor o~ pathology at the h{edical Br,tnch~ Uni- vet~ity of T~x~ ............................................. 10IS Roseublatt, Dr. Milton B, pr~idcnt, of medical bo~rd, Doctor:~ Ho~p*tal ~ew York, N ~ "~ I%oseRm~, Lmus, Acting A~sst~,t General Counsel for FcderM Tr~d,~ Commission ................................... 453 RosoRm&n, Dr. Ray, cardiologist, S~m Francisco, Oalif ............. Roth, Arthur T., New York, N.Y ................................ Rowe, M~uricc B., Commk~sioner of A~i~ulture, Commonwealth ,f Virgini~ .................................................... Rovstmb Fred 8., ¢h~i~u%n, Committee of Growers of U.8. Tub~u... Ru~tein, Dr. David O., Ridley W~tts professor of preve~itive medb cine, and hezd of the department, H~vurd ~ledlcu[ S~hool ....... Ssiger, Dr. George Lewis, oonsultsnt ~ medimd rczc~troh, Pall'hide (Fort Lee), New J~f~v ....................................... 1178 Scott Hen Robert W, Governor, St'~te of North Carol n~ _ Sherman, Dr. Ch~rl~ D., Jr., ch~urm,m, c.tnccu commttt~:e, Medie.d Society of the S~ate of New York, and McdieM Society of County of Monroe (N.Y.) .................................... Sayder, Hen. M. G., a Representative in Cougre;s from the State ~:tf Kentucky .................................................. 723 Sommers, Dr. ~h~don C., p~ttholog~t, Next. York, N.~ ............ Steed, Ernest H. J., executive dep~rtmcnt scerct~ry of th~ D=ty Advcatist Church ....................................... 890 Sterling, Thcodor D.~ profcs~,or~ Department of Applied hI~=them~ttic't & Cumputcr Science, Washington Univcrsitv, St. Lotfi~, hie ...... ~tewa~., Dr. William R., Surgeon General, Public Hetdth 8ervict,, Department of B~dth~ Edum~.tion, and Wclf~r~ ................. Stubblefield, Hen. ~'r~nh A., ~ Rcpr~entativo in Coug~e~t frem the State ef Koutu~ky ........................................... tit; Te~ey, Dom-dd K., ~ttonxcv, Federal Trod, Commls:~i~n .......... 453 Terry(Dr. Luther L., Cha~rmsn, Nst[on~l Inter~genoy Counoll on Smoking and tle~th ............................. [ ........... 2t~l U~ll, lion. ~.Iorr~ K., s Repr~entativc in Congre~ from the Stut~ of Arizou~ .................................................... V~cent, Dr. Ronsld G., a~soolste chief, Dep~rtmcnt of Thorscl~ S~gery, Roswell P~rk Memorial Institute ...................... Wsre, Dr. George Willhm, Distrlvt of Cob~bk~ Interagency on Smoking ~nd IIe~l~h ......................................... Wssilewski, V~ceut T., president, Natlomfl Assoob~tion of Bro~d- c~tem ..................................................... 393 Wa~, Hen. Johu O., ~ Repr~ent~tlve in Con~e~s from the State of K~%uoky .................................................. 63
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~t~m~nt o~--~uued Whe,,bmk, Joha N., l~xecutivo Director, Federal Trade Comm~sion_. 453 Wflliam~, Dr. ~hbel O., formerpr~ideab, &m~r[~a G~ncer Soa[e~y- 307, ~Vo~, Ii~n. Lmter L., ~ Repr~eata~ive in Oongr~ from the Stat~ of 76 New York .................................................. Wvatt~ Dr John P, professor ~nd oh~m~n of ~he Depsr~$ of Pathology, Unlve~ity of Mauitob~ ............................ 882 Wvdler, Hen. $ohn W., ~ Rep~entativo iR Congr~ ~om the State of New York .................................................. 702 Zcidman~ Dr. I~'~g, prof~or of pstholo~, Univemity of Pen~yl- I0~7 .....= .............. ..... Americm~ Cancer SocieW: ~ ~s of me~ciae A[ban Dr. Henry F. ~o~ley, a~z]~taut ~rofe...or " _, ' Y Medical College~ ehai~n, Public Edu~tioa uommittee~ AIbe.ny County unit, statemen~ ........................... 1364 ~oc~ aq'hu~ct And 20-year research gro~h--~Ph---~r--::~- ~53 "Rt*nortin~ of Cancer of the Lung, Liver and Ut~u~, attic ";-~ ~-: ..... el °0 No 10 October 1967 .............. 357 Resolutions and position st~enm el varmus ne~m agencl~ and prof~ional mooioti~ iR the United States regarding labd~g m,d advert.i~ing of cig~tt~ .............................. ~21 Medical ~soci~tion, September 9, 1901 ........................ American Ph~rm~ccuticM ~ociat[oa~ ~Vi~m S. Apple, Ph.D., executive d~cctor, letter dated A~ril 10, 1969, to G~i~R ~temen~ ................. : ................................ I0~I Barm% Dr. ~rod~s 0., Fort Co~s, ~olo., ~n,~ Foreign Commerce Commzt~e--~ .... r--~-~ZZTZC'~Z~ZZ~ 1398 Intcr~tato and ~orei~ Oom~rce Committee- - ~ - £t~CZZ" ~s~it.~l~ lctt~ dated Aprh 2~, ~D~, ~o ~amr .as: .-~ .... 1400 vmt~ ~'dle Intcrn~timtM Corp ~ Arch L. Medsen, pz~iaen~, z~e~am B :'" . - -" c~ rc d~cont~uance of dated Aprd 15, 19~9,.to ~a~man S~g .... clgareLto advertising, p~teea m zne recora ~v ~vn. ~v,~. ....... t ~ rc~cnt~tivc in' Con~ from the St~ of Cal~ornia ........ ~ ~'P - " ur con and releaser at the Brewer, Dr. ~ym~n :~ Ili, t~t~:'~v~',..~,,~ l.~PAn-eles. Medical School or ~oma ~,,,-~ ~, ...... :' ~ = " " 1055 Brinhm~n, Dr. Geoffrey_ ~..,. Profas~°r °~t medicme~ W~yne State UnlverMt,y School ~f ~Iedtcme, s~temen ....................... hmtX e~nc~tr fit p;~tie~tt~ of d~cr~g ~o~ng n~ , ' ' - Burdi~, Ke~meth ti., M.D., St. Helen~ S~nitarium ~nd Ho~pit~l, letter 1402 d:~Otd A ril lfi~ 19~0~ to Ch~an St~ge~-: .... Bu~x., Dr~'J,~hua Harold, x~i~ing prot~sor m pnarm~uu,~s# ~,~ X. :v:~hingt~m UniverMtv~ St.. Louis, Mo.~ statement .............. 11~7 Campbc~ Mmlrice, M.D., statement ............... : ............ 1249 191i9, to Chairman St~gEers ................................... Cigare.tto Advertising Code, Inc.: Cigarette Advertising Code, text of ........................... 1309 VII Additional materlal submitted for the record by--Continued Cigarette Advertising Code, Inc.--Continued Letter dated May 6, 1(169, to Chairman Staggers re Icgltl oplnloa as to whether the FCC has the authority to ban all broadcasting of cigarette advertising ................................... 1293 Tables showing p~r capita consu~uption of cigarettc;~, whole:~ale cigarette pric~ revisions~ 1940 to date, and production workers weekly earnings ......................................... 1319 Cincinattl Interagency Council oa Smoking and Health, l,tt~zr d~ted April 14, 1969, from V. James DeFranco, M.D., to Chalrm:m Staggers .................................................... 1400 Committee of Growers of U.S. Tobacco, list of org~mlz~tlons r~up. porting statement ........................................... 655 Connecticut Tuberculosis and Respir:ttor~,, Disease A~sociation, Mrs. Eben B. Haskell, president, letter dat'~d April 14, 1969, to Hen. Emilio Q. Daddario, a Hepresentativ~,~e in Congres~ from the Stat~ of Connecticut, with forwarding letter dated April 23~ IUtO... Cook, Charles D., M.D;, Professor and Ch~irmm% Department of Pediatrics, Yale UnNer~ity, School of ~edicin% ictt~,r dated ~arch 24, 1969~ to Chairman Staggers ......................... Crissy, Dr. William J. E., Professor of Marketing, Graduate School of Business Administration, Michigan State University, statement... 1331 Dale, Dr. Charles L., Hinsdale S~nitarium and Hospital: "Evolution of cigaretto smokingtechnics in dog~/~ article from International SurgeD', November 1966 ..................... 414 "Experimental etudy ca effect of cigarette smoke condc~tato on bronchial mucosa/' article from the Journal of the Aromatic.an Medical Association, December 15, 1062 .................... 409 Nicotine effect on the brain, excerpt from The Pharmacoleglcal Basis of Therapeutics, Second Edition--1956 ................ 430 "The ill effect of cigarette smoking in dog~," article from Inter- national Surgery, December 196~} .......................... 419 DeFranco, V. James,, M.D., letter dated May 19, 1p~9, t,o W. E. William.~on~ clerk, Committee on Interstate and Foreign C~mmcrc~. 14f10 Evans, William, M.D., statement ................................ 124~ Federal Communications Commission: Appendix A.~Audiencc Data for network television sponsored in whole or in part by cigarette manufaeturem~ Jaauary 1967 ........................................... 10B Appendix B.--Pcrcenta~o of television household teenagers and children in Now York City market viewing televi~ion~Novem- bet 1968 ................................................ 197 Letter dated May ~6, 19{}9, to Chairman Staggor~ r~ FCC's thori~y to ban the broadcasting of c~garette advertl~lng, treat- mcnt of broadcast of cigarette advertising in other codntrics, and advertising of fire,arms in broadcasting ................. 237 Federal Trade Commission: Cigarett~ and health, Secretary's Introdn,tinn to Annual Report of the Department of HEW, FIScM Year 1963 ............. Legal restrictions oa minors' smoking ........................ 4~7 State laws pertaining to sale of cigarette~ to minord ............ Testing of cigarettes for tar and nicotine content .............. Fieser, Louis F., Professor of Chemistry, Chemicztl Labor~ttor~,, Har- vard University, letter dat,~d April 15, 1969~ to W. E. Will~m~on# Clerk~ Intemtate and Foreign Commerce Committee, with attcteh- ments ...................................................... Fisher, H. Russell, M.D., statement ............................. 121~ Foster, Vernon, M.D. (See McFarland, J. W:-~yne, M.D.) Friends Committee on National Legislation, Dr. J. Hu~ton We~tovor~ vice chairman, Friends Medical Society, otatement ............... 13G5 Fryburgcr, Dr. Veraon~ Profe'ssor of Advertising and Marl:cting~ aud Chairman, Advertising DepartmenL Northwestern Univer0ity~ statement .................................................. 1337 Galifianakis, Hen. Nick, a Representative in Congre~3 from the State of North Carolina~ statement ................................. | Gantz, George L, Hialeah, Fla, letter dated April 16,1969, to Chairman Staggers .................................................... 1401 Greater Winston-Salem Chamber of Commerce, J. Wil~on Canning- ham, President, and Norm~u W. Ilearn, Executive Vice President, resolution ................................................... 1405
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Additional material submitted ~or the record by--Continued I-Iarkin, Dwight E., ~.D, Clinlc~ Professor of S~ge~ Dep~ment ~f ~ur~ry~'P~trr Br~n~ Brigham Ho~pit~l~ Ha~'ard ~e~cal S~ool, t~, - ~.*,,,4 M,,~, ~ 1969 to Chairman Sta~gers~ ~th attac~en~_ 1390 He~dth~ Education, and Wclf~r~ D~p~tmont~ Pubhe It~alth Serwc~: 300~000 ~xee~ death~ ~nm~g c~g~r~tt~ smoke~s~ an explanation o~ method~ u~d in developing the est~tep~-~ .... :--r~;~--z 156 th~ Advi~:ory C¢,m~tt~:e to the ~nrgeoa ~e . Health Service .......................................... Bibliography from the Health Gonzequenees of Smoking~A Public H~:dth Service Reviow~1967 ...................... Bibliography from the He:dth Consequences of SmoMng~1968 Enpplemd~g to ~he 1967 Publi~ Heni~h Servle~ Review ........ 138 ~omment on FDA ~tudy on rel~tioas~p of oral eon~racep~ves to 176 cancer ............... 7~ .... 7~ ........................... Letter dated M~y 1, 1969~ to Ghukman ~t~ggers in answer to dated April 16, 1969, from Ghu~man St~ ia w~oh he requczt~ an~wer~ to eight questions, ~z follows: 1. Whag tiviticz and programs ~e being envied out by tho Depnrtment of ItEW to combat cig~retto smoMng (n) among younger per~one~ and (b) among ~dul~; 2. How much do ~hese pro- gr~m~:~ coat; 3. How effective h~vo they been; 4. ~avo you ~ugg~tiu~ as to any other effeetiv~ means of combating ¢i~t~tte ~mokbag habit; 5. There,has b~ ~ommen~ to cfl'*t-:~ that cigarette ~mking is physiologically addi~Live. Do ypu agreo or disagree with t~s; 6. Are ~ay other ~ottnLries carrying ou~ programs ~o disco~age cigarette smokfiag; 7. What Ira3 their experienco been h those programs; ~nd 8. ~ow do they differ from programs conducted h~e ~ the United States_. Lc~ter dated M~y 20~ 1~69, to Chairman Staggers re commits on tobacco industry phyHci~ns and scientists tcs~imon~ ~n .the health significance of ~moking, with an attacnmcn~ ~pccificatly with the te~tlmony of Dr. Theodor D. profcz[or, Department of Applied hIathematics and Computer Science, Wa~hlngto~x Universtty, S*. Lot~is~ h.I~ ........ .=--r--~ 1407 Lung e~ncer, ~oma~tloa ro breakdown oy e~tegory in ~ae c~mecr ~eetion c,f tho international system for classification of 154 eau~ of de~th ............... 3 ......................... Re~pon~:'~ ~o Con~c~maa W~t~on s co~n~ on ratio of bed di~tbility incidence in relation to quantity of cigarettes eon- :~umed, ~a~cd on PIIS national health survey ................ 176 Hender~:~on, Hun. D~vld N., a Representative ~ Confess from the State of North Carolh~a, statem~t ............................ 40 lt~:rm~m, Dr. Doris L., A~slstan~ Prpf~sor ?f Patholo~b Los Angdes County-University of Soutltcrn Calgorma ~[e~eal Center~ state- 1076 1]iglt Tor Foundation, Iae" An ~pcriment m the learning o~ "" logical ~ch,~mea .............................................. Hii~e~.,rand~E. W., M. D: Muuisiag, Michigan, letter da~d April 19, 19~.~, to Ch~irm~n ~t~g~er~ ................................... 1403 Hino, Dr. Charh::~, Clinical- Professor of ~harm~ology and Prewn%ive h~cdic~ne In the School of M~dieiae, U~wr$ity of Cal~omi~, me~t ............. ; .................. ~ ..................... llo~kctt, Roberb C., I h. D., A~och~te Se~en~c Di~cc~or~ %he Co~mcil f~r Tobacco R~.~,~m'ch-U.S.A., st~tcment ....................... 110~ Huff~ Darrell, Carmel, Ca~., ~tatemcot .......................... 978 In~zr~t.~te and For,~i~ Commerce CDmi~it~e: Letter d~ted April ~i, I~09, from Con~essmaa ~o~ers to th~ Tobacco ]n~titut% Ine.~ ~e comments from the tobacco indus~ry oIi ~ho a~fiil:d le~D[~9 provided Congr~s under the prov~ions of ~hc 19~5 Cigaretto Lab~Ing :rod Advertleing AoL and reply d~ted April 22, 19~9, from the Tobacco I~titute ............ ~Icmorandum from tho Library of Congress, Legi~]~tlv~ Ref~eq~e Survico to lhc Com~t~t~;~ re farmers' share of retdl price o~ a Additional material submitted for the record by--Continued James, George, 3I.D., Dc~u, ~.Ioun~ ~in~i School of Medidao, City University of New York, loiter d~ted May 2, 1969, to Ch~irm~m Staggers .................................................... 1398 Johnson, W. H., A~;soeiato Professor, D~partmene of Biolo~;i~al and AgrieulturM Engineering, ~orth Carolin~ S~at~ UnivcrAty, ~;t:~tu- ment ....................................................... 1[;68 Joa~s, Wing, M.D. (See bl~Farland, J. Wa)me, ~I.D.) Jones, ~on. Wal~er B., ~ R~pres~nt~tiw ~ Co~agrc~ recta the of North Oarolina, st~temen~ ................................. Kaplan, Dr. Sylvan J., stat,~mertt ............................... 1[~39 Kentucky Farm Bureau Fcderatlon, statemen~ .... ~ngsbury~ Kenneth 5, ~'LD., statement ......................... 1203 Koch, Hon. Edw~d I., a R,~presentative in C~agrc~ from the of New York: Correspondence dated February 7~ 19~9, t~ membt~rs of th, a reply from the m~mb~ of the State of Kentuel:y dMvd February 26~ 1969, and reply dated Mare5 10, 19[;U~ r,~gardtng th~ FC~ proposal to ban cigt~atte advertlstng ca r~tdto aud television ............................................... 49 Letter dated Ma~h 2% 1969, to A~ic~ture Secretary: Clifford Hardin~ re government subsidy for eigarett~ adverti~:~ng pr~ gram~ in Japan, Thafiand~ and Austria~ with reply dated h.larch 28~ 1969, from ~zistaut Secretary Clarence D. Palmby ........ Loller dated April 16, 1969~ to C~ix'maa Staggers re rcquc'~t~ for additional info~atioa by the committee members regarding first amendment protection of e~mmerci~l advertising me~ts~ source for st:~temeut eonee~ing diffel'cnthd ill lift~ pcctanev of a 25-yew-old ~mot:er, and zuppm~g medical m~teria~ for phyzlca] addic~ivene~s of ~igarettez ............... La~agn~, Lo~, M.D, profi~zzor at Johns IIopkins Universally, mcn~ ....................................................... 1~71 Leaf Tobacco Packe~ E~hange~ ln~., Penn T. ~V~:~t~orh exe~uti~'u 8eerct~ry~ letter dated hl~rch 24, 19t~9~ to ~hairmaa containing rc~olut~ion ......................................... 1405 Leaman, William G, Jr., M.D, ztat~cnt ........................ 1242 Lennon, Hoa. Alton, a Repr~entative in Con~e~z from the Stat~ of North Carolina, statement .................................... 39 ~uchtenberger, Prof. Cecile, Ph. D, biologb~ and Prof. Rude:dr Leuchtenberger, M.D., expc~mentcd p~thologi~t, st;.~tcmcnt ....... ~e, Dr. Edwin ~ayncr, a~sociate professor of clinical medicine, Chicago Medical S~hool, statement ............................ 193~ ~tfle, Clarence Cook, scieatifi~ director, th~ CouucH for Tob~meo Resear~h-U.S.h., statement ................................... hIcEarland, J. Wayne, M.D. ,left, on Medical Uollege~ Pldladelphi~.~, P~.; Irv~g Jones, M.D., Institute of Rchab~itr~tioo, Reading~ Vernon Fo~ter, hL D., Lotn:~ Linda U nivcr~ity~ ~,nd Wilbur K. Ne]~,t~u~ Ph.D., School of Public He, llt, Lom;~ Linda Univer~:ity~ Linda. Cal~.. tele~am d~ted April 17, 1~69, to Chairnmn St.:~gec-~.. h~c~'air~ Hon." Rob~ E., Governor, South Garolina~ tdegram to Chairman Stagg~ .................................... : ...... 721 bIaryl~nd~ State of~ Department of HeMth, William J. hLD, comm~sioner of health~ letter dated April 18~ 19fi9~ to ChaPman Staggem .......................................... hIelniek~ Joseph L, professor and ch~irman, department of :rod epidoraiolo~b o~oei~te dean fur graduate ~tudle:b Univemity College of Medic~e~ letter dated April tl~ 1969~ to ~hai~an Staggers .......................................... Mine]l, Hoa. WiImcr D., ~ Ropr~entatlvo in Co~gre~ from the of Noa~h Carollna~ statement .................................. Mos~, lion. John E., a ~epresentativo in Congress from the State of C~llfornia, summation of statement of Department of Public Health of the S~ate of California ...................................... ~assau County (N.Y.} Depa~ment of Health, Dunbar W. S~th, M.D.~ d~eetor of the tobacco control prngram~ dt~puty missioner of h~Ith~ lett~ da~ed April 25, 1969~ to W. E. Wfillam~on~ clerk~ ~t~a~ and ~orelga Commere~ C~mmittee .............. ~ational Con~e~s of Pareat~ and Tcaeher~, h~. Edward F. Kyan~ chai~an, Committee on Legislalion~ ~ta~emcn~ .................. 1359
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X Additional material eubmitted for t.ho record by--Continued ]Watb,nM Grange. (~ev ~or~h C~rolin~ S~to Grange.) ~afl~md Liberty Life ~ur~ne~ Company, Arflmr De ~oss~ pr~- idcnt, ~temen~ ............................................. 1351 N~tb~nal N~:wspap~r A~o~iation~ e~temen~ ....................... 1359 N~tlon~l Tuberculo~'.i~,, . and. Respiratory D~e~e" ~ooiation~ ~aph ~ntttlcd The :~x l~a~ng c~u~es of death from d~ease among mat~ in 1966 and eb:mg~ in these diseases since 19~0: U~ted Stat~" ..... 632 Nel~on~Wilbu~ K., Ph.D. (~es MoFarlaud, J. Wayne, M.D.) ~ew ~ork State ~epartmen~ of Health, Dr. ~olIi~ S. ~aham, ~ommis~ion~:r, statement ...................................... 1342 ~w York State Interagency Committee on ~azar~ of Smoking, Ho~. Ed~v~td J. Spen% ~ew York Stat~ S~nutor ~d chalrman~ a~t~men~ .................................................. 13~1 N~h Carolina State Gray, go, h~. H~rry B. Caldwe~ m~ and chuirmau~ National Gran~ Tobacco Committe~, ~atemeat ....... 1361 Penrtuylvam~ Coherence of~venth-~%y idv~tists, Lou~ Cano~, ed- ue~t[on~l ~upt.rintend~nt~ edu~ational depa~ent~ letter dated April 9, I ]69, to ~h~rman Sta.gcm - . . 1401 Phi[i~ Morri,, Inc.: ~x'ccrpt from the American M~c~l A~odazion, ~aucafion anu R~car~h Foundation repo~ to the Profcsaion and .%bstracL~ of tho Gr~n~--Yune 1968, entitled "The Projcc~ for Res~roh on Tobacco and Health, 1964-1968" ........................ 571 R~port of tho sclentifie d~rector, C~rene~ Cook Little~ So. 1966-17, the Councl f~ Tobacco Resmroh--U.S.~ ......... 559 Phys cian's l,'orum, Dr ~tark kbramowicz, Health Hazar~ Corn- mitts% statem¢,nt ........................................... 1387 Pr~ycr, R~cl~on, a Representative h Con~s from the State of Noah Caro~na, statement .................................... ~2 Print, Walter S.. AI.D., statemen~ .............................. 1229 R~ipp:tp,~rt Dr. Isr~l, st~ment ................................ 1325 R~t~il T,)ba,-co DeMe~ of Amcr~c~, Inc., Malcolm L. FIeischer, mazlaghlg d~e:~tor, ~tatement ................................. 1362 Rolenman, Dr. Ray, "Cigarett~ Smok~g, Its Relations~p ~o Cor- onary Heart Disease and Rcla~ R~k Factor~ h th~ Western ~ompared ~th eos~ r~at~d ~ smo~n~ .................... 705 ~hcdu]c B--A 1O-y~r pr~mm to z~du~e dg~et~ ~nd ~mok[ng by 5~ ~zcen~ at ~ gr~da~l rate of 5 percen~ p~ ye3r_._ S~hodu]e C--E~3~ed r~ul~ ~t ~he end ~ ~0 ye~zs b~sed on achicv~g ~ 5~p~ceat r~duet~on in smoking ................ 708 S~h~,dul,~ D--Th~ c~onomy o~ tob~cco: A e~se s~udy o~ C~]]na, the le~ding tobacco State ......................... 710 Schedule E--Farm ~eome--C~sh receipts from f~rm m~ket~, 196~G7, and index of farm output p~man-hour, 1940-67 ...... 710 ~ot~ Eric, h'I.D. ~oeia~ pathologist and coordinator of smoking cd,~t~on, Charlts F. Kett~r~g Memor~l Ho~p~t~, le~t~ Apri 1~, 19G9, to Chairman S~a~g~ ............................ 1399 ~u~h, Joseph E., ~i.D.i ra~olog~t, St. Petersburg, Fla.~ le~ter dated Aprl 22, 19~9, to Ch~Eman Sta~ger~ ............................ 1403 Ruth, Hen. Earl B., a R~pre~entafive ~ Con~ from the S~te of ~orth Carolin~, atat~m~n~ .................................... D~aths due to %oronary ~se," United S~t~ 1955-66 ....... 733 Dcath~ due to emph~ema, U~ted Sta~, 1955-66 ............ 733 ~ct~r~nee~ documontia~ th~ ~tatement t~t %hose who stop ~moki~g hav~ a lower d~ath ra~e born c~ro~ ~e~e and lun~ ~a~,e~r than contJnuing cigarette smokers ................ 737 Sachs, Bcrnic~ C., ~,LD., ~ta%em~nt .............................. 1198 Sadtlcr, Philip, p~id~nt, Sadtl~r R~earch Laberatori~, ~c., m~t ....................................................... 305 ~an Frane~o Int~agencv Commit~ on Smoking and H~lt~ Sb~r~ D~dgo, chapman, l~ttar dated Aprll 29, 1969, to ChaPman Sta~,~ ~ .................................................... 1381 San'yet, John Wesley, Ph. D, profe~or of mathema~, Wake Univ~ity, Wi~t~.~n-Salem, N.C., ~tatement .................... 960 XI Additional material submttte~l for the record by--Continued Seltzer, Dr. Carl C., Departm~,nt of Nutmtion," ~arv~rd. ,~n~vcr3itv School of Public Health, ~ta~ement and ~rticle cnt~tl~d An evalua- tion of the effect of smoking on c~ronary heart direness" .......... 531 Sevefi, Pro£ Lucio, ~LD., statement ............................. 122I SoIoff, Louts i., ~.D., s~at~men~ ................................ Sommer~, Dr. Sheldon C.. pa~hologL~, ~cw York, ~. Y.~ [o~tor dated May 23, 1969 to ChaPman Stag~em ra Surgeon Gem,ral'~ letter dated h~av 20~ 1969 .......................................... 1414 South Carolina, Depa~ment of A~icu/ture, William L. Harr~qsou, commissioner of a~i~ulture~ letter dated May 7~ 1~69~ t~ W. E, Wllia~on, clerk, ~terst~te and Foreign Commerce Committee... 1 Spence~ W. K, M.D, d~rector, Dep:~mea~ ~f Rch~bilitativn leone, ~oly Cros~ Hospit~d~ letter dat~d Apr,[ Z 1969, to W. E. Williamson, clerk, Inter~t~ re, and Foreign Com~ercc Committ~e .... 140~ Sterling, Theodor D.~ profe~;or~ Depa~ment of Applit~d M~,thcm~tic~ ~d Gompn~er S~mnce, W~h]ngtoa Uuiveraity, St. Louis, letter dated May 24, 1969, to Earle C. Clements~ the Tobacco stitute~ ~o.~ r~ Surgeon Gcneral'a letter dated May 20, 19~9 ........ 141 State, L. Jefferson, Jacksonville, ~la.~ statement .................. 1372 Television Bureau of AdvertBing~ No,an E. ~ash, p~esldcnt, men~ ....................................................... Tobacco Institute: Post~ entitled "100,0O~ doctora ~ve quit amo~ng (M~yhe they know s~met~g you don~t) .................. 676 Correspondence ~h~wi~g that 9 man~actu~ra of offered to te~t or ha~e te~ed the compo~d Chemoaol ...... 170 Letter ~ted December 20, 1968, from ~on Jaeob~, Dep~tw ~t~nt Se~reta~ for Science, HEW, to Dr. Perry D. Hudso~ High Tor Foundatlo~ In~.~ re Chem~sol .................. 672 Letter da~d h~ay 22, 1969, to Chairman Staggcr~ re Surgeon General's lc~ of May 20~ 1969 ............................ 1413 Tobacco Wprk~ Inte~aaflon~ Uaion~ Homer Co1% Secretary: Attae~ l~tide from Philadelp~a Evening Bulletin, June i1~ 1964~ ~ung c~cer deaths ia~reas~ a~ zoo; a~r suspected as cause" ...................................... . Attachm~ 2--Ad from N~w York T~mcs, Ap~l 13~ "Smoke Watch~a" ...................................... 390 Attachm~t ~ticle f~om New York Time~, April 13, 1969, "Advertising: ~bllsher, a~ 72, s~arts a new venture" ........ Ultras~iencea, Inc.~ Willi~ E. Roaen~ oha~an of the bo~rd~ meat ....................................................... 1113 Unit~ Cancer Council~ Misn Belva Green, Execufiw D~e~tor~ lcttor dat~ April 21, 1969~ to ~te~ate and Fard~ Commerce mittee with attac~ea~ ...................................... 1378 United Ch~ch~ Board for Home,rid h~strie~ R~v. Jo~cph Howe~, lett~ dated April 18, 1969, to Chairman Stagger~ ...... 1,t91 Utah Intemgency Council on 8mo~ng and Heal~h, Ra}, Wa~tori~ ~a~man, letter dated ~larch 26, 1969~ to W. E. Wilfi~a~n~ Clerk, Intimate ~d For,:ign Commerce Com~ttee ............ Utah Thoracic Society, C. DuWayna Sehm~dt, ~LD., Uta~ National ~epr~entative~ letter dated March 23, 1969~ t9 W. E. ~ il~ama~ Clerk, Interatate ~nd Forci~ Co~erce Committe~ ............ 1383 Van Dc~rlin, Hen. Lionel, a Rcpr~entutiv~ in Congez~ fron thu S~ate of Cal~omia~ extension of remarks regarSng u~ of m~rcottcs by students ~ S~ Diego~ C~ff .............................. Yincent, Dr. Ronald G., A~aociate Chid, Department of Tlmraeia S~g~y, ~o~well Park Memorial Iaatitute, article from th~ BuffMo O~GANIZATIONS REPRESENTED AT HEA~ING ~eriean Csncer Sooiety: , Bake, Dr. Sol R., ~alr~n, commi~te~ en teb~ce~ aua ~nd~, Dr. P~y R., ch~rman of the N~au Count~ IntemgonCy ~unc~ on Smoking and Hea~th, and vice ~regdcnt, N~u Division. W~ Dr. Aehbel C., former pr~idcnt.
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OItGA~IZATIO~ R:EPRE~ENTED &T HEA.RIbTG--Contlnued A~eric;m Chemo~ol Corporation Patrick J. ~cGahn~ Jr.~ vice president Ior legal A~.rican Hcar~ A~.~;~cb~tion: Fillmaa~ Jc~e~ ch~rman, legisla~ve~dvi~ory tom.tree. Jan~a~', Dr. LovS~ E, form~ p~esidcnt. Mo~c~% Dr. Campbell, meflic~ Cigarette Adverti~g Cole : Gohtherg, Daniel B., Deputy" Administrator. M~:.~ncr, ~oa. R~ber~ B, Administrator. c.mmitt~:t, of Growcr~ of U.S. ~obaeco, ~re~ S. Reyster, chapman. IM~tri~,r uf Columbia Interagen~y on Smo~ng and Heal/h, Dr. George Willh,m Wore, Fvd~.ral C~u~caflon~ Commission: Gvlh:~r, H~gy, Gea~ coun~. Hyde, Ho~. Ro~d H., ChaPman. ~edoral Tr~dc Commi~on: Bufilr~[~on, J. V,, A~s~staa~ to the Ch~rmaa. Dix*m, Hen. Paul I~and, Chair~a. Gradv, Thom~ J., Attorney. Ro~e~a~an, L~u~, Acting ~si~ant Gener~ Coansel for Legislation. Tem.~y~ D~nald K. Attumcy. Whoeb.mk~ John N., ~xccutive Director. Health, Educ:~tioa, and W4f~rc, De~r~ment Er, dlo~tt, Dr. Kenneth N.~ ~ector~ National Cancer ]n~itute. Public Health Service. Horn~ Dr, Da~del, D~rvctor, ~ation~ Clearinghouse for Smoking and Hcalth~ Pttbli~ llcalth Service. Koti~,~, Dr. Paul, Director, National ~stitute of Environmental thalth ~cience~, Pobli~ tic~]th Service. Stcw~trt, Dr. William H., Surgeon General, Pubic Health Service. ~b~h T.r ~oundation, ~nc. : DuR'v, Dr. Bcnc~ct J, Jr., professor of prev~fivc mcdiclne~ Tufts Uhivercity School of Medicine. Iiu~on, Dr. Perry B., president. ~in:~dale ~a~itarium a~d Hospital, Hlm~dale, Ill, Dr. Charles L. Ker~tu,:l:y, State of, J. Rober~ Mitler. Co~lssioner o~ Leg[dative Action on Smo~ng and He~tith, Jo~ F. Banzhaf, III, exe~utiv~ dlr~:ctor. Medical gocic~y of the ~tat~ of New ~ork, Dr. Charles D. ~hermaa, chulrm,m, caac~ commi~tee~ and Medical Society of the County of Monroe {N.Y.). Naflot~nl A~ociatloa of Broadcasters, Viac~t T. Wasilewski, pr~ident. National Int~ragency Council on Smo~ng and HeMth: IttuldJ~y, Dr. James, member of the beard of ~eators. Terry. Dr. Luther L., chapman. Nati,,nal Tubcrculo;.is and ~c~piratoD' Dise~e ~ociztion: Brow~ing, Dr. ~obc~ H. member, board of directom. _ GOn~l-,~rtz, Dr. Jo~ L,, pr~ident. ~or0t Carolina, State of: D,a:my, Wcldon~ ~peci~ a~s~tant to the Gov~nor. Gmlmm, Jamuu A., com~ssioner of a~ic~ture, Scc~tt~ Hon Robert W., Governor. Ovcrholt Thor~eie Cl~ic, Boston, hf~s.~ Dr. Ri~h~d H- Overholt. ~hllip Morrh;,~Inc, Jo~eph F. Cullman iII~ chMrmaa of the board of ~ectom tm~ chicf ex~:cutive officer. Ito~w~lI Park M,~c, fial Institute, Dr. RonMd G. ~, a~odu~e c~ef, d~ $~trtm~:at of thoracie ~urgery. ~ov(~nth-Day. Adven~ Church~ ~nest H. J. S~eed, executive departmea~ tiecr~ Tob:m¢o h~stitute: Cullman, Joseph F. III~ chairman of ~ho executive KloevfCr~ Wi~m~ Jr.I vic~oresidea~public Toba~ce Worl:er~ International Union, ~omer Colo~ gen~ml ~eoret~y. Godwin, Hon. Mil~ E., Jr., Go~e~or. R~we~ Maurice B., commi~ioner of agrlcul~e. CIOARETTE ~LABELIArG AND ADVERTISING~1969 ~v a*Tdngton, D.¢. Th~ co~ittee met a~ 10 a.m, uursuan~ to notic% in room Rayburn Hous~ Offics BuBd~g~ ~on. }I~'l%y O. Statism man) pre~di~. Th~ C~.~. Th~ cor~itte~ will come to order. We ~re in ~ continuation o~ public hearings on all b'l s , -" b~oz~ ~e committee rdatin~ to th~ labelin~ 2~ -.~,,.,--~*~; 1, Our first witnesses this morn~g will be Dr. Pens, B. ~ud~on~ pre~i~ dent~ High Tot Foundation~ Inc., and Dr. Benedic~ J. Duff ,, STATION,S O~ D~. PERRY B, ~UD~0~, PRES~ENT~ HIOH ~0~ ~0UNDATIOB, ~C., A~ DR. BE~ICT I. D~, YR., PR0~SSOR 0~ ~V~NTI~ ME~IO~, T~S ~I~S~y S~00L 0~ ~DI~ ACC0}[P~D BY PATRICK I. ~eGA~, ~., VI~ PR~S~NT ~0X LE8~ A~RS, AME~CAN ~HE~{0SOL The CHA~AN. Dn ~udson~ yea may proc~d as you wi~h. D~. ~sou. Thank you~ ~r. Chainnan and mombor~ of file ~ona- mltte8. I am hero today representing medical research from a " , tot of o~ sect • prlvata :,,,. . ety~ and represen~m~ no~ o~ ra - • ' associa¢~ and colleam~= ~, ~.~:-- , ~,- ~lfbu~my ~cdiate McCOy. ~---, ...... ,,,a~ ~. v~conz and Dr. Martin M. The task force for sm~r~ng and health under the D~:~pan~cnt of ~e~lth, Education, and H elfdr~ h~ ~cently reported ~o the ~er~: Cigarette smoM~g ~s one of ~he foremost proven[able eausc~ of death in th~ Wnited States as well as ta other par~ of ~e worm * * * There Iu clearly much ~rot~ve and preventive work to be done. . This co~it~eu has be~or~ i~ the question of adv~r is" ,~ . _ c ........... ~ve measure xor eon~umor;]. ~g~nerally agreed that~ regardless of the re~ictions on v, ~, ox clgare~s, almost ~0 ~cre~ne ~* ~,n --~.-, ..... " ~ to sm-k~ m~__ _.. _ ., ..... ~ ~,,~ ~u~ poputa~on wilt confinuo ~ -. ~m~ wu~ nO~ or ~a~o~ s~op ~ the other ha~d ineeresC of thi " . • . . , it is in tlm s comml~e% the smo~ng ~ubhc~ and the indu~.~ and
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-, • - , ............ mmends to "e~tablid~ resp_onsible adv~rtls- ......... ;,q~l;~.~ which will ~ermtt manufacCurers to a~ve~ an~ pm ot~ 1 c'~s b.~z~r dou~ c~g~rett~s mor~ effectz~ ely. ~;. ,~ . .~ :-;-+~ n-t early ia 1967 by ~ormer Secre~ ~m~ was a~,~ v ..... ~ ~;:,~_~'r~ w Oa~ner. ~h~ he tol~ ~Icalth, Education, ~a vv~,~a~ ........... - Cnngr,:z~ : We ~u...;e wor~ toward the 6~velopment of a less hazardous eigarett~an~ concurrentlY, help develop a climate of opinion so that as such a ~tte d~-w~b-q~d, ~moker~ will turn to it. ~here Is ~o other way to ~rotec~ those ll-n~ ~:*f prc~,ent ~mokcr~ who proba~l~ will never ~e willing or able to give c t ¢~k ~orce was tl~erefore real~stic when it suggested t~ the Th ~s ~ " ess the ~efleral Trade Com- ~..~i,- Health Sere, ice work ~th Con~ ..~ . . ~ . .~__ rctte 4." -dverfize. Reduction of t~s ana m~m~ ~nroug9 ?a~ u~ fiiter~ fM1 into that cat~go~. -~,~ mos~_~a~ .... ;--a .ncontrolled ~nd un~- ~ - -, in0,re~ In Clga.~ t.]m mo~t dan~erou~ c~. ~ -; ..... ,-~--,, ~,.~ b~ h~ln~ for . " ~me ex lam%uon ot Den~ot~]F~**~-%'-, . . *, _-- - ,~ f • " e dicdonu aennes • ~ • - - obtained ~rom t~r. The s~ - -~cino-cn a~ "any cancer-proauc~ng suo~au~? ~nvr~, ~enzo(a)pyzene ts one of the ~o most ~tent of t~e seven ea~einog~s t,.,'tcd tn t~l,acco ~moke and it Is present tn mu~ larger qu~ti~ ~an any of the other carcinogens listed. men bonzo (a) vrene zs" so deadly to. humans,,, .is because of ~z~ rm . ~ • .~ ....... -t~ae~ actzwting other ...... a~"l~'tr h drocarbons and cocarcinogen% ~ consequem*~ ...... I'°]Y~~c ;. Y -~ -., -m~o,~;,,~,, +hun bv ~t~elf. For this dic'ttor of the pr~enc~ or ~um~--/, .... . ~ r fi ~ is an ~%remely importan~ ~o~ht, and o~ tha~ ~not ~i~ '~' • • a enerms ~¢ or5 t-~*?~" .... ~ ~'..,_U ~__~ ~ l~-ve devoted their research ~u t.i.:~ts throug~ou~ t.n~ wu~-,~ pr~] n ; _ __ ~. w.~o~¢. W~,nder o~ the Sloan-Ketter~g Inst~ut2 for Cancer Reb~earch and the U.S. Gov~en~ Ltmg Cancer "xas~ Forci~ ha~ published: A ~l~mificamt v~duetton of more t~n 25 ~rcent ia the l~nzo(,)p$rene con- (,:~t~,ltion in the tar has ~o ~r always been fo~d to relate to the zcducfloa latho t~mozIgenicl~ of ~e t,n (Science, ~ro]. ~6~, Nov. 2~, 895 This is unusual language for a man of Dr. Wynder's staturt~. sure his stature is known to the colmnittee. The use of tlm word '%l- ways" is seldom found in scientific literature. Y¢~, Dr. Wynd,r emph~izes what he fo~4 previously using the word '%lway~." The:re is "~lways a reduction in the tmno~genicity of the ~ar." Clearly th,n, the 1~ benzo(u)p~'cne in cigarette smok% the lezs harmful tim ei~re~te. Benzo(a)pyrene is created as an end product, of comt, n~,~il~si pa~ial combustion and cigarette smokers, therefore, smokers ¢on~-~.mtly inhale benzo(u)pyrene into their bodies when they ~oke. ~d, e~l~ed previously, th~s benzo(~)pyrene ~dvatcs other feting hy~ocarbons which are concumenfly pyro~,nthe~ze4 burning pro~s. In other ~ord% tho~e temperat~es and thole condi- tions in the ea~dronment of braining wlfich f~vor the production o~her hy&'ocarbons also ~avor the production of benzo (~)pyrenc, the be~o(u) pyrene acing to increase ~he activi~ of the others. the greatest identifie~ danger to smokers is bhis cure,egos be~o (a) p~ene. . Scientists ~ and ou~ o~ Go~ ermen~ have been const~fly t~mg to redu~ ~he benzo(~)pyren~ in zmoke ~y various m~an~ ia their end~vor ~ cr~te a less h,:~zardous cigamtie..(1though flmy h~v~ s~ede4 in doing this i~ ehe laboratory, the resul~ we,~o only o~ acade~o value because the final cigarette, lo~ much ~f its flavor or tas~ an4 therefor% w~ not. acccpt~tb]e to the ~ao~cr. In other s~ the subs~unces used ~ere ¢oo toxic. We ~ our laboratories have also b~n doing research for 3~ congruously, withou~ publicky or ~an~ar~ on a ~ormulation called ChemosoL The smoke of cigarette tobacco treated wifl~ Chemo~:ol~ under properly contro~ed con~tion% cont~.fins si~ificantly ti~i~ o~ benzo (a)pyreno. Ch~mosol is nontoxic and does no~ affect. t~, flavor or aroma of cigarette% and can be economica~y u~;~'d co~ercial ciga~t~e production. Some of our tes~g ha~ been done ~ar 1~ macMne, facto~nad~ cigarettes. )ioreover, the pro~ can be used with cig,~reCtes containing fil~r~ an4 tho overall ~ is a reduction o~ benzo (a)9~ene and accum~atiw reducfio~ o~ ~ars ~d Mcofine as Therefor% Ch~osol makes po~ible the production ~ a l~zo ardous cigarette acceptable ~ the smo~ng public and tlm cigar,¢h~ iu4~. D~ing our research program~ we constantly kept the U.S. ment scientists info~ed of our progress snd soughs their tom, sol ~vice. ~Yo conducted extensiv~ che~dcal aml biological te~s to dctcr. min~ ~h~ e~cacy o~ Gh¢mosol iu inhibiting tl~e ~orma¢ion,o~ b~nzo 00 pyreno ~d reduei~ or eliminaOng tlm c~rcinogenicit.5 of cigarette ~oke. Our r~ults and progress wer~¢~dso ~viewe5 by~ a~d with~ m~y lead~g scientists such a., Dr. ,k~hur Purd~ Stou~ D~'. Oscar Aueth~¢h~ and Dr. ~arvin Kuuhekner. The la~ ~r. H~rr Gre~n~, Chairman o~ the Depa~men~ of Pafimlo~,, Sohool of Medi- cine of Yal~ Universi~ ~¢port¢4 regard~g Chemosoh • he ex~rlments are well conceived and th~ ~e~ult~ leave no doubt that mouse ca~nogens are removed from t~h~eeo tar by the apldleti~on of thl'.~ substance. The sections de~ved from the injection of untreab~d t,bacco ta~ wer~ aK typical mouse fibros.arcomas.
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$96 Tha~ iz Dr. Greene's entire statement. It is not out of context. Thos~ of you familiar with Dr. Greene's li~e and work are aware that he was on~ of th~ world's greatest biologists ever to study the ~ncer problem. In ~ddition to t~ mo~ injection test convened upon by Grc~n~ abovc~ b~ed upon elm advice and counsel of th~ NaCion~ ~,tthccr In~titut% w~ corroborated this exper~ent~tion by • long- Irma skin-p~dnting te~t o~,er an 18-mon~ period in accordttnce th? method advocated ~t~-~,d generally accepted by ~ National Cancer 1~titub~ iu the~ c~rent and ~tur~ cancer research program on hu~n hmg c~cer as rel~ted to ~mo~ng. ~he rcsul~ of this t~:~ting unequivocally ~ow that where Chemosol- tr~:~ttc4 tobacco condens~t~ wer~ used ther~ were less than 5 percent i~ance~ of cancer, bat where th~ same tobacco condensate% unt.reated~ wcr~ u~d, 20 percen~ of tim injected mic~ d~ve.loped lethal phntablo cancer~ and 25 percent o~ th~ skin-painted ~ima~ opc~ skb, c~mcer. Thc~e r~Its aro quite comparab]e~ one ~ the other. In order to ~tvoid th~ ~asting o~ time on ~ topic which I am sure you m'e ~cmili~r wifl~. I h~ve de]et~ any referencs to statistical Our inject]on study~ for example, was analyzed by ~ prominent bio- at:die, titian in New York~ and it w~ ~ound that it wo~d be siblo to di~coun~ Chemo~ol as ~ sigaific~n~ causs of t~s reduction or el~inatlon in cancer ~orm~cion. Th,~:,refor~ o~ overa}l t~ing program posiCh~ely ~d ~re~ly corrdat~ ~,h~ bio-chemica~ ~mlysis w~th,thebio]ogicu] ex~er~ent~- tion in ~ ~nner sig~lar to that reported by Dr. W5 rider. O~ December ~0~ 1968~ th~ D~p~ent o~ Heulth~ Educ~tlon~ ~:el~tu~ acknowledged that ,ur tests were properly de~i~ed, that w~ 1~4 reduce, d be~o(a)~y~ne ~ cigare~ smoke, and tl~at the mous~ t~,t,.~ ~ho~cd ~ reduction or elhaination of tumorigenicity when mic~ ~cr~ injected or skin-pt~ted with smoke conde~ates from ~bacco treated With Chemoeol. Wo were~ however~ advised by ths Deponent of ]te~l~h~ Edu~- tlon~ and Welfar~ to ~ccure independent corroboration o£ our ~md [o e~tabli~h the nontox~ci~y o~ the £ormulation. A prsdous p~trtment of Healflb Education~ and ~el~ars letter ~o us stated a new tcchniqu~ ]mown ~ fluorescenc~ spectroscopy is 4000 mor~ ~ezr~i~iv~ thorn ~h~ method wo had o~gin~y use~ ~or our che~- c~d t~£ing and added Clmt: "Until ~ are done with t~s techn~qu% th~ absence o~ be~o (a) pyren~ i~ not considered proven." Acc~rdlngly, as a ~a'[ step in th~ extensive research pro~am~ completely i"ndependent ~eries of controlled tests were conducted Fcbrua~, I969~ under th~ supe~ion oi ~ ~oup of em~ent d]sinter~4.ed ~entis~none o~ whom were ~o~ to us pemoaally ~t tim time~inc,luding ~ chemist seat ~rom the Stanford R~e~rch ~-~t, ltnt~: Tld~ chemist pemo~ally transported ~e smoke condensates tho i~titut~ for analysis by the fluorescence spectroscopy mebhod. The re:~l~ of thcs~ independent tes~ clearly ~Cablished that Chemosol~ whirr propeEy used, effec,~s u substantial reduction o~ benzo (~)pyrene o£ 34 percen~which considerably exceeds the percentage ~ound nec- ~ur~a~ being si~ifi~mt in dlmi~Mng tmorigenic]ty o~ ~ cigarette smoke. 897 In addition, an analysis of the formulation hy seienti:-~t,; in Gov, erm.nent age.sties in January 1969, show that Chclao~ol ard it,:~ combustion products are nontoxic The ex~erimen+-~ ......... :, qmred by the Govermnent, ~ therefore now completed. I~ I may at this po~ Mr, Chairm~m, I would lik~ to show with thrct~ charSs what is es~ntiaHv a summa , of rids work ;o beh~ w~th, I think at behoove~ u~ aH to look ~t this ~truetural ~onnulu ~or benzo (a) pyrene. ~Vhea we remember that in these six-sided configuration~. ~ex~gonal red line~, at each corner there [~ s carbon [ttolll~ and ~s n possibility for rearrangement not only o~ dm c~'clt,:~ them:<,lxc~, the six-membered configurations thcmselve~ into d~fforent meats, bu~ tha~ subs~i~tions can be made at any point. When we remember tM~, xve then have reemff~msim:d ~or u-~ tim fa~,tlmt maay,.many pyrmutatio~s of benzol (a) pyreac arc po~ihh,. • ao pu~one n~ pohmng this out is to delineate c/early thtt~ ~lnt t ' . "-" . - . . _ t, ~l~eos"l a/td~t.~e~has, done ~)2 the bunnng of c~'~trctte :,~,~, ~.]s stool;eel ~s ~o change the spect~m o~ hydrocarh~,~ lih~ oe~o(~)pyrene to less harmed ones than benzo(a)pyrcno iu final smoke. This has beea our objective. The second ~arC o~ tl~e objective i~ to compare fl~eze rc~nlts x~it]t biological expcrimenta ~ion. ~ the second char~, I would like to show graphically, t]~e which is produced fix cigarette smoko ~ terms of be~zo(~)l:,VZer~t~ content. . You ~gh~ say here that the tobacco used in this experimc~at obtained from the tobacco industry in this country~ ~d is ~ popular br~d oi ~ blended ei~rettc tobacco wlfich i~ widely used. You will notice that oz~ this ch~rt is a green line ~hich hn~ placed across the upper one-quarter This ~een line repre~ent,- Dr W~de~s vork at th~ Sloan-Ketterm~ Institute in No~Yov]: C]~ . Taat ~s (he poin~ at which 25 perce~ of the benzo (a}py{en~k~, ~e removed: Th~ far right-hand sido of the bar cha~ has r~'d, whh.h represen~ the amount ~2 be~o (a)pyres still r~minin~ even tho,~h 9hemosol is used. I~ is found that this is 3~.~ Dercent ]e~:s tim, penzo (a)pyrene recovered and identical from the control tob~u:c,~ of ~e s~o blend. ~ summary~ this means that we considerably exc~,ed thu men~ of 25 percent reduction in order to show'reduction ia tumori- genicity. The last chur~ ~ show you the sk~n-pa~ting te~ which E~ only the on~ mo~ u,.ed among c~ncer rese~trcher% but also ~o most widely respected by our Gove~ment. I~ is ~tTent~ employed ~nd advocated by the Cancer Yon will not~c~ in the far le~ column there is ~ ~a$ b~r sho~ng five percent or ~ little less of ~umors which d~veloped from the acetons solvent~ Mice, even tumor-reals[ant ~bred s~rain~ of such as the ones ws ~ed ia this e~e~ment, ar~ vo~ susceptible lhsplacipg of any ~orei~ substance oR the shaved skin. Even the aceton~ solver ]mre~ which r~fers to the solven~ in which bo~ ~e control ~n4 the dtemosol tobacco condcnsates were dissolved, wi~ create ~ few ]~io~. 29-236---69~pt. 3-----2
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898 Th~,~e are not. very vicious looking tumors, but in keeping with abso- lutc, reporting accuraey~ they are included here. On tlt~a far right~ the Chemosol-treated tobacco rate is practica]l~ the :-',uue ~ tha~ of-tim acetone solv~t., where~ you will se~ in the m~d~e that tim untre:~ted tobacco, the tobacco ~thout the Chemosol, produces l.,~th:,r than ~5 percent tumor~ ..... Thi~: o-~mple~ed th~ cyclo of comply~g ~th ~ose eriteH~ whica nan ]~u~,n ?~tid d~wn by the'Slo~mKette~g Ins~itut~ and which have no~ in an5 fa:~hion bccn refuted by other ~ientists. Tbt~ cigarette iad~mt~ w~ilo cooperating with us and permitting w; to u~'e their commercial tobacco, was undemtaadably skeptic1. ~ow that wt~ ]utw~ finished our research and the resets h~ve been corro~- r~t/~.d by independent scientists and laboratories~ I h:~ve been ~nfomed that ..~e~;iem~: discussions are being inifia~ed by the American Ohemosol Cewpnration, which owns the Cfiemoml pro~ with co~erei~l eom- p~mc:~ for the pu~o~¢ o~ using Chemosol ~ eig~re~o m~u~t~. 'l'hi:~ however~ ~s beyon4 my scop~ of percon~l concern. I bcliev~ that~ since the independent cotwobor~tion~ oH~ally quired by the ITnite4 Stttt.es Gove~ment and Lhe ~meri~n riga.retie i~Muv~trX; has been successfully t~mpleted~ it becomes th~ respondbili~ of Gow~rnment, to inform the smo~ng public and for the indug~ ~o mal;e ~twtilable to the smoking public, the Ohemosol-treate4 eigare~es. At, a time when the health problems a~oeia~ ~th cigare~ smok- int, ]lave reached a crisis st~~g% and the development oI a less hazardous ,-]~tl'elte 11~ been increasingly dem~d~ by seientists~ governmental ag~aeie~ and th~ public~ a practical 1~ hazardous cigaret~ treated ~ith Chemoz, ol can now ~ offered ~ the m~io~ oI ~okers who will ~t~er b~ zSlling or able to give ~ smoking. a~r~reci.t~ your ¢ivinff m~ th~s opvortuni~ to upper b~foro mid hope theft th~ mformatmn I have presented ~I assxg you m d,:te~m~nin~ the proper adve~ising pro~ ~ ~o~ only a.~ to ~lm hazards o~ ~oldng~ but also ~s ~o new aeve~opmenm ~vh~ch reduce the~e hazaras. The ~]~,~ran~. Thank you~ Dr. ~udzon. r At t~L t~e I would lik~ to cMl on our colle~e, ~o~ ~u~hy~ N ~v,, ~ ork. I understand you are a constituent of his. Jolm~ have you any remarks? ~[r. M~,~T. Y~, Mr. Chairman. ] codai~y appreciat~ the op~t~mity to in~om the co~itteo t.ha~ Dr. Hu,:~on is on the staff o~C, ol~biu Univers]k~ and hns been ~or ma]x- y.yc~tr'~,, as~ well a~ t~oeia~d~, with. .the fine~ hospitals,, of ~w York.. He dcvotc~ ~ ~ood po~ma of hts tame to ~h~, ~mmg of you~ sct- cnti~;t:~, l~e h~ts hi~ o~ independent ~oundation,md l~borato~ at ~gh * r0 Tor~ m ~ew ~ rk. I tlt~; the ~atement that Dr. ~dsoa has ~ust mad% t~k~ ~ its entirv.ty~ ce~ainly inditers the depth o~ research tryi,g'io rcm~w'benzo (a)pyrrha, as lm ~ c~re~ly n~iculated. 'I cc~a~ly conL~at~flato ~]m on ~s wor~ Th~ ~m~a~.~. Are ther~ any questions ~ Mr. ~rm~mt. Dr. ~ud~on, t~ds is quite • s~ol~ ~ta~ment. Do ),on generally a~ee that we do not know physiologically wh~t cau~:e~ can~er of th~ lungt " 899 :Dr. I-I~mso~r. Congressman, i~ you me~tn the specific e~ue, o in language of th~ modem modeeul~r biologig~ I would concur that body knows the c~use o~ ~ncer. ~¢r. Sepoy. Then wh~t I would like to ask you~ beginning on liu~ 1~ ~s about this ~tement: one of these subs~hces, which i~ ac~owledg~ by sciences a~ the, merit $ero~ car~aogen in c~arette smo~ng, is be~o (a) py~ene. ~t do you mean as a c~rcinogca? Can you tell ra~ what tt carclno- ~n Dr. ~sox. ~ carcinogen is a c~ncer-producing subsbmco without ~g~ to th~ mechunism~ either direct or ~direc% trod ~don~ or in conc~ with other t]~ings w~ch produces ct~ncer, In other words~ to s~te that somefldng is ~ carc~ogea doe,:; av~n ru]~ out tho vies .theoD: us t~ th~ production of ~t ~nnot~ ia our pre~nt state oi kno~ ledge. . In ~her words, what might be called 5y oqe ~ent~s~ ~ v~ we~ 20 yeztrs from now~ be l~rned to be s~p~y ~~ ~a~tor which ~riggered the formation of c~mcer~ and th~ acbual a~nt~ the origi~ml cau~, migh~ vexT well ~ some~g ~ other word% to say thab somefl~g is a ea~o deman~ i~ tion. 1~mn this statement is mad% I really refer to doc~ents Ilk, tht~ Surgeon General's ~epo~ of 1964~ w~ch wa~ a .compilation by, I believe, 10 disti~hed scientists, none ol waom were wor~mg withhmgc~ceratth ,e. " ........... nut they w~r~ tin~ished scientists around the world Who were ~menfly quamtl'a. That report incri~a~es ~nzo[a]p~en~ ~ th~ list of ~e~,cn cino~ens ~ven amon~ th~ hvdro~rbo~ identified ~ cig~rt~t~ But .to go beyon~ th~s pomt~ Con~man Spmn~.cr~ w~ld branh ms into the world of semantics at w~ch I am ~ar lez:~ agile than ~ in the In, rarefy. . . Mr. SPm~. I tak~ it t,hat whu~ you in ~,nc~ t~ro ~a~in~ the 1~ of a layman lik~ me that ~his is a c~m~.r-mduemg agent; is that righ~ ~ Dr. H~ox. Tha~ is co,act. Mr. S~ras~. You do not ~ow to whet e~nt it i~, but ju~ th:t~ it is one of seven; is th~ correet~ Is tha~ right? Dr. HVDSOX. ~ag is one-half right an~ one-half iucomplctt~. ~ one of seven, but ia the ascribing o~ potency to lhezc agen~ in the li~t of seven~ ther~ is an arb~tra~ But based on experimentation of one plus~ ~wo plu~ thm~ plu~ and so ~o~h, benzo( a)pyron~ winds up by ewluatioa o~ se~:,nti~,[a in top braeke~ ot po~ney in caner induction~ und~ second3 ~ it i~ ~ much larger amounts th~ any o~ the ochers ~ th~ So i~ is ~ combimt~ion o~ tho~ two ~aetors which prompt, thit~ sea.meat. Mr. S~. Le~ me se~ i~ I can get to this. We had y~erday an~ I wo~d like to see if I can put my ~.at.i~tics ~ith .the uhv~iolo~ and m~e something out of it. Testimony of th~s stat~st~cmn was that roughly ago bra~c,t:; htul a ~'eat deal to do with it~ and also there zcem~ to ~ ce~dn $actmr~ ht
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900 the physical rnakcu~ ~,,d there may be ~ co,zelation between the d~_'~ir~:~ to smok,~ ~nd cancer. Do you haw any ex~er~ents to veri~ tl~t~ Do yo~ ~der~tan4 what ~ am t~inff about ? Tb.cr¢ are t~o facf¢~rs. Fi~% the age brackek His statistics br~g out that it is probably, for %he most part.~ 61 to 65 yearn of age~ fourthly. Second: fl~ere ~ms to be a correlation between the des~r~ to ~noko which ~ person has and the cancer ~ucing wha~.ver in his ow~t ~'stem. Can you finder~tand what I am talking about ~ Dr. Hu~so~. I think I do. Tl~ou~ you didn't say s% you are refer- ring to dm incidence or the highest incidence of l~g ~ancer and its occurrence in the silica. Is tha~ correc~ ? Mr. Srm~=rt. Yes. Dr, ~u~sox. As an experimentalist, I look a~ tMs no~ so much as an ~tge fa,ztor~ per ~e~ as I do a cumulative effect of too much c~o~c c~posuro. There are types of cancer which are regarded by cancer r~earchem a~ bc~ng c~mccrs which develop in respect to subst~c~ wMch has a threshold level~ and then t~ other caners ~n wMch t~ is perhaps nottrue. I will give two examples. It is higMy questionable today whether or no~ ion~ing radiation actually has a caus~ ~ cancer, ~ the c~e of tar ctmc~r, i~ almost certainly does lmv% both in the hum~ experi~c~ and h~ experhnental animals. Mr. S~m~¢~m lie ~eemed to indicate one thing that was a s~pris~ ~* me, that there ~ probably more s~oking among those of relatively yo~er age% mor~ p¢ople~ percent..gewise in numbe~ smoking agc~ 5clew 60~ and i~ doe~n:t ~how up. -Dr. Hudson. Bu~ the~ ~ould no~ have had the ct~ulative effec~ of exposure over t~ long period of time to these cancer ~itiators amon~ ~"~ "z true ia industD,~ where there is expos~e to similar and even idea/iced zubztancez. Wher~ workers worked as daimnev sweeps ~ period :~rou~d 1875, they described ~lae firs~ occupatibnhl c~cor tha~ hnow anything about when they described the sldn caner ~a ~,weep~ i~hich were pr~bb benzo(a)pyrene ca~tcers or someth~g cloaca to it, becauso of th~ continuous ex~osur~ to the soot of e~n~vs. I c~o[, malta a ~ateraent as to how often the English bathed'in that tirae, bu~ perhaps there a~as almost 24 hout~~ exposure to the soot. But it ~over developed ia a pe~n who worked at the trade ~or 3 months and then qui~. The same thin~ is t~o in the ho~ tar indu~ry~ ]oca~d near my homc~ ia Roclda~d County~ N.Y.~ and which is an institution for the production of tumor~ as~ well as pp.i e . Mr. S~¢~. What wo~d you think, for instanc% ~ :England whe~ cancer ~ twice as great as ~ this coun~r~ ~ Dr. ~¢r~soN. Why do ] tMnk that is ~ ¢igare~[e smokers? Mr. ~r~¢¢~. ~s question w~ raised by the ~at~iclan yesterday, al~:o. Dr. H~. I think th~s is a question tha~ I um not competen~ to answer definitivdy. I wo~d wonder if ~yone is. The indica~m are 901 tPhresent. There is a higher content of benzo[a]pvrene in the tobacco a% is commonly smoked in England and tfiere ~ertalnly is a higher institute u~s~ and which I hax e u~ed~ and my colleagues, ~ th~ ~Idn painting of th~ mouse. This work was p~blished in the Ro~ewell Park ~femoEal Instituto m Buffalo~ ~.T .~ by Dr. George Moore and Dr. Bach. who ar~ m~numa authorizes ~ this field. ~' " They ~d the biaSsed.tumor production by ~is method of p~inting is e~used b~ English tobaceo~ using flue-cured rebate% and believe x% ~reedy relates to ~he benzo (a) pyrene. Almos~ all cigarettes mmmfactured in En~hmd are of that 3fn ~c~a~. Th~ you~ Mr. Chairman. ~r. ~udson, I congratuhte you on a very scholarly ~o %he eo~ittee. I am not sure tha£ it isn't al{~o~t a littl~ too zehol~rly. I had some trouble fo~o~inff ~me of the words. Trnnslated in general, I take it ~he main thm~se of your te~imony is that the present eignredes ~re no~ sa~e and ~re indueivu ~o ~he om~e~ of lun~ c~neer~ is ~hat correct. ~ Dr. U~so~. I don% t~e authority for ~at or~ghml concept. Simply as you did~ I read it ~n %he Surgeon GeneeaFs report. Bu~ I ~ill you my exposure %o it. For 10 ~enrs at Columbi~ when I wa~ on the faculty of the medlc~l sohool~I ~m ~o~ on £he faculty of pure soience--I ~orked on • daily basis with t]~e late Pro~e~oe'Stou~. In part of my that, I se~ed as consultant to ~lm U.S. fac~i[y at ~as~ 0ran~e~ N.~. This is tim home bazo for Prof Auerbach, ~hose nam~-~s ~owa to you. , Between the~e two men $ was able to observe their studic~ a~, a tater o~y a~ fhu~ time. I observed their studies on tlm ]mmaa re;p~ra- to~ sys~m. They .did the ~xporimeat which sooner or later someono ha~ to d% which is to make ~erial section~. I will explain that term. This mean~ makin.~ microscopic sections next to one another so that practically eve~ ceil in the re~plrato~ ~stem ~om the top to the bottom, including the whole lung5, examined. ~y do~g this, they found a sputum of change ~ont no=~t,1 to pathological but not mMi~,.nt and finally to ma~t ~d ~ti- mateiy malignant w~th cause of death at l~ff cancer. They found this spread and mla,ted it~o th~ ci-arett¢ habits o~ tim people whose lun~ were being examined. Thin wt~ be~ing of my being convinced that ~e~e was a relation, hip ~ ~e smo~ng of clga~ttes and th~ death ram ~om lun~ ~is preceded by some yea~ S~g. Gen. Luther Ter~,'s repr~ 1964, which summar~ed the information available and t~r~:~w the con- eluaion~ ] believe only in the ease of lung cancer~ that thert~ is a cau~al relationship. TMs ~s my authority ~or believi~ that. this is probably ~ue. Zfr. ~[AC~OXA~. But to go a step'fu~her, I t~d~e it from x our mony that you also fed that if the chemo~ol pr~es~ is a,do~ted bv tht~ ciga.retto industry~ that then there might be wh~ would be called safe cigarette, ~ that corre~ ?
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902 Dr. I-[troso~. That is my opinion. I think if I may, sir~ not to evade )'our quc~'.!ion but not to exceed my own c~paci~ and r~l~tiw expo~ knowlcdg% sin¢o Dr. Duffy is ho~z, he is • professor o~ mcdicine~ ab one of our 2oremost medical schools. ,~ is not associated witl~ this proc~ except as the spok~man o~ h~am of p~ople who did corroborative study. ~ ~ flint qu~tion may w~w w~llbo addre~ed ~ him ~fler a while. ~P. ~kCDO~ALD. I~ I h~V0 the ~me, I ~11 ~ainly t~e up your sug~c~',tion. I got a little eonfuse~ ~hou~ your pro~ b~u~ ~he te~ ~olumbi~ Lhdvt, r~ity got thrown in there. A~; I r&~dl, it was ~ust ~ few years ago tha~ some doctor discussed ~ i{,]l Colnmbi~ some other kind of protein thee w~ go~ to ~ke all t.]m airline ~nd t~r out o~ cigare~t~ and no~ bother with task, and Col~-tbln jo~ed with him in ~me 9eeuni~ ~rrangement M go hate the process. I m~ver did ~e.~ ~nyfl~.~g more about that proc~s a.~r it got n lot ~f publicity. You ~ not connoted with ~ ~vpe of ~ter, are Dr, Hyssop. ~gre~rn~ I am glad you a~ed,th~t ~u~ion, be- eau~::~ th~ gives roe ~ oppo~tmitv ~ ~t out to ~ ou, s~, fih~ are ~:evorM tho~nd faculty me~bem u~ Colchis University n~::L of ~, of tho~ several ~housaads, h~ve not in ~y wuy whoever btcn co,coted with the process of the filter to wMeh you haw mado rt,~:~rencet either before o~ ~ter the publication o~ ~heit meth~ or thtir I have notl~g whatever ~ do ~th i~ and have never met the w*ntor, who is named, I think, ~tHekman. Mr, Ms~A~,. In your testimony, you make reference to experi- me~ts~ but you limi~ flxem ~most complexly to e~er~eats done o~ naic¢~ trod other animals. I was wondcr~g if you had any experien~ in the field o~ o~p~rimcnts bu~ exposure to human bmn~ who might h~ve ~.hrough th~ s~m~e process. Dr. H~zoN. An experiment desired ~ elicit wha~ kind of Mr, M,~o~.~D. As pointed out in your clm~s. Dr. Hm,~o~. Do you mean ~ cancer production oxperiment ~ ~o, we haw~ uo~ done tha~ ~Ir. ~I,xc~.~. Do you have. any correlation ~twe~ th~ ~peri- ~m, nt~ don~ w~th mice~and~ of cour~ I know you are not going to bu~ p,~op]o ~ a l~boratoD, and ~tar~ ~orce-~eedlng them cancer-~- du,.ing mttt0rial. ~rhat, i~ the correlation bet,w~a ~e experiments done wi~ ~ mi~ ~:~ related to h~aan being? I do not t,~k that w~s ever ~e ve~ clear in ~,our states, eat. . . Dr, H~so~. I ~11 affempt to ~e ~t ~ e/e~r as I can. ~has ~roblem afi~:,:'~ continuousl5 in medical rt~arch. It has for many decors o~dainly will go o~ ~or mauy more. " 903 Many of the things that we all enjoy the benefits from ia tt, rm~ preventive medicine were originated in laboratories which oxptwimcnt with mice, including tim saaae s~rains of mice that we used. We have been ~mi~ed here ma~ly by the U.S. Pnblie Health as we~ ~ by ~stltutions lara~.r and more widely lmown than our . ~he cu~nt pr%n'am forlung cancer desiamed to solve, by it~ s~ement from ~hfi ~ational Cancer Iastitu~ the human lun~ c~mc~r probl~ Wolves the letting oY contracts for which laboratori~ been solieited~ including my own, to use this same In fact, protocol is identicM. This is to form th~ princip~d ~ biologi~l test~g for the h~m~ l~g cancer problem. w~L~te all e,qdence in ~a,vor of th~s would ~ako more ti~,tt, t" I can as~m~ you ~ couldst 'begin to reraember a11 the re~erenc~,:~ to aese eorr~a£ions. S~ce it to say for the moment, because thi ~ i~-~ the best flint can ~ done with yore' question, wtfieh is ~¢ very portia,at qu~ion~ that the~ are the ~t tests ~hat have been so far dt~vi~a~,l. Mr. 5~¢~a~O. In eonelu~on, to wrap up my thinki~ ~md not put words ~ your raouth~ perhaps~ your t~iony here today ~ co~t.inupd,~dvpfiisi~ without the wa~ing, or does your testimony, no~ go at aa to the ad~,e~sinff ~ Dr. H~sox. ~e references I made to advertising t~c~ually extra, d, though I may not have attributed i~ there, and X ~l~t. h~ve nsed exactly the same words~ this is e~trae~d from the and it was called mandat% frora the task force of the P~blie Service to the Surgeon G~er~d. The references $ made were in ~me instances taken directly fl'om tha~ document. ~r. ~cpox~. ~ ~y event, I qan'~ t~e up n~ more timo~ Doct.r. summing u~, ~ w~ll just s~y that it was my fee]irtg in your tt,:-~l i- mony ~hat you 1elt fl~at if tMs process which you a:~,em to ~'e~ faith m, to ~ake a safer, ~mll we s~y, cigm~tte, wen, ~y tar clgare~¢ i~du~,ry, then you fee] fltat many of the that are fac~g both the Co~gsess~ the industry andeigarel te in general would be alleviated. Is that correct ~ Dr. H~sox. Tha~ is correct. In regard to advertising, I think I can s~y it h one sentence, in two halves. I think that laws concerning* 1-,r,- M~i~ion in o~ society have failed, and to toll the ~od with the [:ad ia ~ea~e e~c~tionnl ~rogr~s, includ~g advertising, and tiffs i~; ia ~eppmg wiVh ~e pubhe health se~icCs roundest% is i~lligent, ~. ~o~a~. Tha~ you~ Mr. Chai~. The Ca,x~tAx. Dr. Daffy, I notice you have statement. Do you wan~ to give that statement now ? Dr. D~m'. Yes, si~: Or I can plac y it into fire record fo save sonlt~ time. The Caroms. X believe i~ would be better for the conuaith,t, if you could give it now so we can questio~t both o f you.
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904 STATE~ElffT OF :DR. BEN:EDICT J. DUFH, JR. Dr. D m~rr. 3[ flfink I can be quite brief. I thank you ~or the 9pportuni~y o~ m~marizing tiffs statement, an~t partielflarly before Congre~man Preyer, with whom I eoexiste~ at ~m ea~rn ~stitut~on o~ learning and also Congressman ~aedonaI~ wh,:,~ d~trict includes Tufts University. t.lm h'.~zards of cigarette smokh~g. Our dep~rtmeng of preventi~ e medi- cine ~.md epidemio]o~,, spon~'ored ~ seminar by Dr. Da~el ~ora the clt armg house on smoking and health and the leading authoriW Oll ~moMng behavior. Followin,- Dr Horn's ~eminar, it became obvious tha~ we might better coneentrat~ our effor~ on changing the e~garetle rather eh~in~ tlm behavior o~ the smoker. Inlo0kh~g back upon these matters, I was impressed by a m~nt o~ Dr. Philip Lee's, Undersecretar7 o~ ~W ~or health and ~ck-nee and quoted by Set:retary Gardne~ in the 1967 congresNonal hcltring~ aa follows: Th~,rt~ ut'e goi~g to be a grea~ many people who wi~ nev~ .stop smoking ~d w~ luunt ~e[ going wflh the Idnr] of resear~ that will persuade the tobacco i~,]u~;try to pur~e that kind of re~eareh ~at w~l result In a ~afer cigarettm Unfortunately~ there has n~t beeu much research on a safer cigarefita :~td tbo~o of us who strongl~ agt'ec with Dr. Philip Le~ have become over more cm~cerned. I~ tl~crefore, welcomed the invitation ~n Februa~, 1969~ ~o be memb~r of a t~un of scientis~ who would visi~ the High Tor Fmmda- tion aml paveieipate in an actual exparimen~ desi~effto demon~ra~ the cff~'et of Chemosol tream]ent o~ places on the level of benzo(a)- r~yrcn,~ in cigarette smoke from Oheraosol treated ~d ~ated e~cmr~.t te. Tlm oth~r member~ were Profi Paul S. Larson, chaiman of the department of pharmacolog~ of the ~ledical College of girgNia, ~ reco~ized leader in tobi(dco cat~inogenegis and chairman of the smoking trod healtl~ committee of the Educational ~es~rch Fo~da- gio~t of ~hc xkmeriean Medical Association. A chemist member of our team w~ M~. Frances ~ of ~h6 ferd ~/,:~earch I]~titute. Anofl~er partteipan~ was Dr. Gio Gori~ asmciate scien~Nc d~ector~ etiolog3, ~rea, National Cancer ~stitnte. , An6(her participant who requested his name no~ be ~ed is a re- ~care~ director ~)~r one of the l~ading cigarette eompaMes. The eonditiono of our program of corroboration were based upon a letter which had been received by the High Tot Fotmda~on from the ~ealth, Education, and Welfare Departlnen~ in wMch it was ac~owI- ed~z*~'d that the subnfitted data indica~d that Chemosol reduce benzo- (~£)pyrene in cigarette smoke and the biological e~eriments showe~ flint ~],ere w~s ~mrkcd reduction o~ t~ori~iei~ h mice pa]nt~.d or ~j~ctc d with the treated tobacco condensate. Tlm letter ~urthcr stated that th~ ~igh Tot r~ul~ wo~d ~v~ ~vid~r accept~nc~ by the scientific community i~ ~dep~ndeat co~obo- r~.~tion coaM b~ obtaiacd. 905 Our task, therefore, was to respect" the laboratory¢ te~ts~ de.:,_r,"|wn,.d .... me~s~e ~ effect o~ Ghe.mo~ol o~benzo (u)pyrmm content of smok~ ~d arr~go a parallel analysis by th~ Stanford Re,torch stitut~ by the mor¢ s~nsitivo fluorescence, spec~oscopy t.cct~que. I must s~y flint some of us were quit~ skeptical whea we came% tMs la~mW~ experiment. Frankly, I had not p~id enough attentioa to tho sp~ific impedance of bcnzo ~,~) p~one. For example, ia tiffs deihitixe text on tim subjec~ entifl~d "Po]y- 9yehc" Hydrocarbons" by Clar S~hoental. .°f the lfi~lfly,, ., Medical Research Co~cil of Great Bmtam states: Thr~e-fourth~ be~o (a). pyrene, is ~ most. u~ul. in,cater of the. ~vP~__ of compound~ present m carcinogenic materlals even though ~t may not be ~le ~or a~ or even ~he main part of their car~og~i~ ~c~iviky." ~" - . ~xche~ during ~is time sad before that, for ex~aple~ ~or~m of had been mMres~ ~ the qu~ion that had b~n rui~vd her% t.ht~ tionship o~ th~ biological ~,~, to t~he clinical area. " I was al~ ~. cry ~terested to read a statement in the Journt~l of National Cancer ~stitum (3i: 490, lfl~5) in ~ paper from th~ P~rk Cancer InRitu~ in Buffalo~ N.¥,, that th~ "bio~:~vt;'~ w~ch you have seen before you today have ~deed Wen ~sults wi~ epidemiologic p~tte~." We have therefore a strong ~min o£ cviden~ from be~o(tt) h~s md~cato~ to the t~or m the an~a~, ~ the h~aaa postulation. Some of ~ese li~s a~i~e~y need to be stre~encd. Th~e ~ews which I hold now cam~ through a~zocia~ion wifl~ others in the work of this s~udy. They at6 per~nal and do not sarily reflect the opinions o~ the others who v~ited the Hi£0~ Tot labora~ ~ witu~s the te~ ac~vity. The experlmcntal te~ ~ro~-am wa~ ~nm on Fcbraa~, ~0 19t~9 and2u.Aprfi 1S~ 19~ Dr. Lateen ~d I~ a~ spoke~.nmn ~or th~ p~ment team, reported ~s fo~owin~re~l~: 1. During our ~sit to the High ~or Foundation w~ had torily demonstrated to us the professional c~paci~ add the ~tegr]ty of the pevsonnql o£ the High Tor Foundation laboratory. 2. The co~ercial to~cco used for th~ ¢*xper~ent~ conceit;ted o~ three pa~s from ~be same batch of t~btacco that we o~med: t.w, trols, one of whidt had no treatm~,nt at a~, and the ~ther which sprayed with water. Identical tobacco from ~e sam~ batch wa~ with" tim Chemo~ol fomulation mtder controfied coaditions: " The results showed ~ the High Tot laboratory th tt there, wa~-~ reduct, lon of approximately 25 percen~ o~ benzo(~]~yrone crom trea~d samples'and the sa~e condensates that ~e ],'[d tc~h~d which wer~ also amflyzed by the St.auroral R~earch Instilafl.~. wldet~ sh-w~t 3~ percent reduce.ions'of bcnzo (a) pyrene. Although it was noC s~ecifically one of our facts. I reviewed result o~ biological tezti~z on n~ce and the repo~' of tlm effec~ and the recoMe~ results of the tes'~ indic~in~ .~ hb,lmr reduction m concers in mice treated by the Chemosol ~roce~. Photo- ~aphs of the aairaals and slides of the t.umom were, I wo~d flmre~ore repo~, to you tha~ as a m~flt of our operations~ there wo~d appear to b~ a si~fica~ reductioa o~ bcuzo- (a) pyrene as t~ result of treating cor~ereial cigarette tobacco wflh the Chemosol £orm~ation. ~t is my option that such Chemo:-:ol
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906 nt~qlt wmlld result in a safer cigarette. It is in the public interest that • ~'atYr ciza.rettes [~ mad~ ~vail~ble and the public m ~form~. (Dr. Duffy's prepared st~ement follows:) ~TA~E~tEN~ 0P ~ BE~EDI~T ~. ~, g~, P~0~EBSOB OF PEEV~NT~E Thank you f~r inviting m~ to ap~ar before ~his Committee which is con~rn~ with th~ amoklag and adwrH~i~g ~f ~garettes. ~ a Professor of Pr~tive M~MId~ and Epidem[olo~ at a Univa~tty medical school, I am conically ~ad~ awar~ of the c~gara~te smo~g problem and ~e need for a lass hazardous ~lgar~ to be ~de available to chrome smokers. T~s Is no~ a new ~roblem bu~ it i~ on~ which has be~n dramatized to the American people. For ~ampte, t~,t~ying befor~ Congress in ~fareh, l~T, Secre~ of Health, Eduction, W~,lfar~ John W, Gardner quot~ his Und~r~ereta~ Philip Lee, ~I.D.. as low~ : "There are going to b~ a ~aa~ many people wh~ wilt ~ever ~op smo~g a~d ~v~ mu~t ~et going wl~ ~e kind of rebirth ~at ~ll pervade the tobae~ l~du~t~ ~o I~ursu~ th~ kind of r~c~reh ~at wig ~esult In a ~er elgaratte." U~fortunat~ly, ~r~ has not bton mu~ r~eareh on this problem ~d ~hose of u~ who t~tr~gly agre~ with Dr. Lee haw become ve~ concerned. I ~'a~ a ~tmb~r of a t~am of aeienti~ ~vited by Dr. Perry Hudson, ~es~d~nt of the H[~h Tot Fo~dat~on, t~ corroborate the laboratory fln~ngs of the fo~- datio~ which ~d bc~n ~ubmit~ to ~e Health, Eduction and Wel~are i~art~nt a~ ~,vidcnce of ai~ficant benzo(a)pyr~e redu~on ~rough trea~- ~'nt with ~¢mot~ol. The o~r memb~ of th~ team ~ho al~o agr~d .to ~artielpate in ~s tide Jnvct~tl~:a~on wcr~: D~. Paul S. ~a~on, Professor and Chairman of the D~at~ent of Pharma~l~ of ~e ~iedieal Collage of ~i~n~, as well as ~h;drmau of the Co~ttea on Smo~g and Health of ~e Edu~fional ~eareh F~:~ur~dation o~ tho American ~edi~ ~oeiafiom Dr. Larson eo-author~ me the, fln~l r~po~ on the t~ul~ of our inves~gafion. In edition, another mem- I.~r ~f ~ur t~am who wa~ with u~ during the entire e~riment w~ Mrs. D,hn o~ tho ~ord ~e~areh In~tu~9. It wa~ our unders~nding ~hat ~tanford ~,~a~h Inafitut~ wo~d do the final analy~s ~ ~erefora tt was l~I,~rtant that ~om~one from that labomto~ be prosen~ during the en~ oxI~rlm~'nt~tl ~rogram. ~noth~ ~arfieip~t was Dr. G[o Go~, Ass~ate Sden- t[l[~ Director. Eti~lo~ Arab, National Cancer Institute, who w~ sent by C~trl ~¢a~or of that dapa~man~, However, Dr. ~rl only pa~c~ated for a few day~ bc~aut~ ot other appointments. In add~on, ~e Re,earth Director of one of the, b~rg~ c~aratt~ manufacturar~, who ~aquest~d tha~ h~s name not be flon~d, wa~ ~ra~cut durir~g mo~t of the ~er~m~n~l ~Hod, as well as Dr. Edtntr B~,r~an, prlvat~ m~di~l ~on~ul~nL '£h~, con~on~ of our ~rogmm of eorro~rat[on ware based upon a .letter whi.rh had b~a r~'elved by ~ ~gh Tot Foundation from ~e ~lth, Educ- tion and Welfare, Department in whl~ it was ~at~ ~at the l~r.gr4~a ~-~du~,d by Dr. Hudson did ~deed show ~at the ~e o~ ,a tobae~ dIfl~ by the na~ of Ch~mo~oI rodu~d benzo(a)p~ene in dg~e~te smoke a~,l hh~ biol~gleal ~x~rlm~n~ sh~w~d that ~ere was ~ elim~a~on or redu~ lion ~f tumorigenicity in mice ~kin-i~ainted or inj~d with the ~eat~ toba~o ,',:o~d~,n'~at~,~. ~he letter further s~ted that for Dr. Hudson's r~ults to be ac~:~,itWd by the ~'e~:,ntifie community it would be necem~ to have '~ indep~dent v, rr,~borati~-,~t of hi~ work. Our ~sk, ~erefore, w~ to do t~s. We were to inset ind~/~ndcut laboratory te~tz d¢~Ibmed to measure the eff~t of Chemo~ol on b~*~2o(a)pyrcne e~mtent o£ cigarette smoke and help arrange a parMlel an~is by the ~t;mford Recearch Ins~tnte w~ch uses the sensitive fluorescence s~c- lr,:"cepy t~hntque. ~e ~tI~ from the 8~nford ~search Institute then was t~ he., con~:iden~l by us to be of prime impudence and ~co~orated in our repo~ I mu'.:'t cenfe.~s that I and my colleagues in t~ ex~,~ment were ve~ skeptical ~-h~.u we t,~ok on ~is a~tig~ent be~u~e the reduction of benzo(a)pyrene. wbih~ it had already been acce~mI,li~hed many tim~ by ~enfi~s. had never ~n r~.duccd wlth a n~n-toxlc formula~on which would not affect ~e flavor ~r aroma ,~f ~-b~arc~tc~. H~wever. we all agreed, and the representativ~ of the c-~aI~ay had per::onally told m~ that ~f more than ~% of the I~ezo(a)pyr~e wa~ rc~n¢,w~l, ~heu thi~ was ind~d si~ificant and ~e result would ~ a l~s h~2ar~b,w~ cIgar~:,ttc. This was thercfor~ a ~cienflfic challenge. In addi~on, ~ub~'cribcd t~ the findiagz of Dr. Erne~ L. Wynder who has co~istenfly reported 907 ~ha~; a ~gnificant zeduction of bcnzo(a)pyrcne (more than 25%) in tars has '~lways so far b~n accompant~ by a ~igniflcaut rcd~ctinn tn t~odgeni~ty vf the ~ars. blore~,ver, t~s 0£ course l~n the bl,:~chcml,~l y~s ~th biolo~cal angel ~sts an~ is therefore of considerable ~ e~bHshing a relationship of scientific aecep~ce between ~l, two ty[~J e~ental methcd& Therefore, ~e prac~l tm~r~mce of ~:d~, ty[,, uf jus~ o~ accepting ~e assignment and in dcte~inlng whether or m,t Hud~n's work woulSbe corroD~ted. In Feb~a~ 1969, we p~ei~at~ actively and con~nuou~ly In ~t~ ~f thee ~n~ol~ bio~hemIcal test~ under ~ c~_~ndition that we wo~d a ~port s~ting ~at ~ey were completely 4ndepende~t. The re3ult~: then ob~alm,d should be ac~pted entirety on their merit. ~e ex~mental testing program was begun on Fcb~ary 10, 1969, and .Kgri118,19~ Dr. Lamon and X, a~ spokesmen for ~e indet~=dent team, the following results: (1) Daring our visit to the High Tot Foundation we had satisfactorily -s~ated to us the profe~ional capacity and the ~cientlfic integrity o~ the ~nnel of the High Tot ~oundation l~bo~to~. (2) ~e commercial tobacco us~ for the ex~eriments ¢~nai:,tcd of ~tltrt,c ~m ~e same bat~ of toba~o ~hat we o~ned : two control~, one of ~vhh:h had na £reatmeat ~ all. and the o~er which was sprayed with w:tter. tobacco from ~e same batch was s~ray~ wi~ ~e Chemos~l formulath~n con~ol~ed con~cns. The ~e~lts showed In the la~grato~ tha~ there wa~ a ~l~l~eant (mere than 25%) of ~zo(a)pyrene from the tr~teM sample and ~he condensates that we had test~ which ~ere a~o analyzed try ~c ~ear¢~ Institute ahowed si~tficant reduc~ms of benz~.,~a}pyrent,. reared to us a 84% ~eduction. • herefore, we r~peat ~at .the inde~ndent re~aarch pro~am conducted us ¢orr~lmrated Dr. Hudson's re~ults and is in accordance with acc~,phM tide 9mc~ures and t~hniques. Xu addison, I had an excellent oppor~nlty to observe ~e re~ult~ vf ~gh Tot biological-testing on rai~,e and the dramatic (S0% } reduction In in mice ~eated by ~e Ch~ozol pro~zz. I ~ therefor~ pleas~ ~o relmrt ~ you tl~at az a m:~ul~ of a c.mplctcly ind~ ~end~t con~o~ed test, ~e is no doubt that there i~ a ~i~ificant rcductlr~n of benzo(a)pyrene as a result of treating commercial cigarette tobacco with the Chemosol formulation, and in my ~pini~m this does indeed produce a hazardou~ c~arett~ I~ is in the public interest that thi~ t4tfer cigarcth, made available .and the public ao informed. The @AIm~X. Thank you~ Dr. Daffy. ~r. ~elsen~ have you any questions? ~r. h'~. Only ~or ~l(e purpose o~ cmpha~is~ Dr. Hud~on~ v,:,u mfer~ on tim fir~ page, to the statement of John Gardner~ "We work ~ward the ~evelopment of le~ hazardous cigarette~." This has been referred to several timcs~ but ~ th~ put]m:.:~ emphasis I repeat it now~ and also the observation that you ~here will., be many..~ ~an.~ people who continu~ to .~rno~e~ remtrdb,~ ~'-~ ~f advertmn~. I think ~h~s ~s a very honest ob~crva~on., I gathe[ that in ~our ~estimony you are emphatic about the for developing a le~s hazardous cigarette, admitting at the zamc that people ~ continue to stuck% and time ad~-ertising ~dom~ ~t:~ll not cure tim problem. Do you believe more emphads chord be ott elm development of a cigarette-~" that is les~ hazardou~.,~ Dr. Hv~sox. Yes, sir; tl~rt is correct. In fact~ that rcmarl~ mdud~ m S~reta~ Gardner's prono~ac~en~ ~n 1997. He said that some small gains had been made though to con~c¢ peopl~ not to ~ake up ~raoking or ~ gi~c it up~ bu~ fh~ it had become obvious to the Depa~ment of Health: Education~ and Welfare that. this was not going to suffice.
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908 In the mater of failure of peopl~ to give up smoking on a mass b'a~i~ I believe we have a living experiment in Brik~'_m., in wbic~cou~- ta3, practically all th~ cigarette advertising has been discontinued, an~ in ~pit~:~ of an immediate drop in cigarette eonsumption~ it climbed to a~proxim~;~tely ~ho same nut'hers of millions of people who smoked bet'or~. ]: doubt that our habits ar~ ~ different from the British that you could ~xpuc~ a different result. ~Ir. N~r. It i~ very possible that mor~ g~ins could be made as far a~'; human health ~s concerned in the area o~ developing a less haz~rdou~ cigarette than can be gained in ~he advertising field by th~.~,banning~t cigarette advertis_[ng. _ "~hat i~ perhaps tru% ~s it nob tha~ the gr~azes~ Den~c ~ us be ~n the ~evelopm~t of a 1~ haza~ous cig~e~ Dr. H~so~. I ab~lu~]y belier6 that that ~s true. h~r. Nn~s~m ~a~ you ve~ much. TMs h~ b~n ~vered DecOr, but ~or the purpos~ of emph~ I wanted to br~ it up a~. ThaM~ you. The C~z,*x. Mr. Mr, Di~e~, Thank you~fr. Chai~an. Gentlemen, I have m~d your ~atem~ ~th some c~. I ~d no plac~ whom you haw indicated pr~i~ly wha~ tMs subst~ Ch~ ~ol i~ that you have alluded ~ ~ the way of ~rea~ent. ~ do not lmo~ whether you have a ~tent or a trad~ark or whether ~,ou ar0 unprotected, or whether you mi~t w~t to ~lge this. But ~ think it wouht be useful for us to ha~e ~or the record the precise nature o~ the substance. Is it a ~roup of many sub~ances~ Ys it a s~g]e ~bstance that added to tim cigarette ~ Dr. Hu~:<o~[The question i~ Mr. D~rm~, ~at is the ~b~tance you are t~ng about ? Dr. ,Ht~,~o~. Perlmp~ you would be able to answer this qu~on for m~_~ bct,ter th:m I can do it. I ~]1 tell you~ if I may~ first, what my ob]]zatiou is. Our laboratory is a nonprofit laborato~ and ~ am unpaid am not a ruemh~r or o~ccr of the corporation, tim ~kmer]can Chem~ol ~ . Dm~. Tha~ is no~ my question. I assume you ~s an pond.nt re~earehel'. Dr. I-I~so~ That is correct I be~ievo i~ is related to your ::it, b.t when ~ began thi~ exp~rimenea*ion I ~ed ~or one tEing I wa'~ r,~,ived to t,,~ke on one ob]ign¢ion in doingit. __ I a~=~,d ~omplete free~om ~n ~he rese~reh.Y ~s ~ve~ flush Th~s a~r~:,omon~ ]m~ been ~dhered to all ~long. The ob~g~iou ~ ~a~ m¢~ to divuh,e t]w uah~r~ of Hm formulnfion it.~elf~ ~]~¢h pat~-q ~1 od privet eh,, H,-,w~ver, I rn~v arid that this regulation was ~solo~d by Edgar I:~erm~l to two brauche~ of the U.S. Gover~ent, to their scien- ti~t~, who were given the entire fomulation and have Wen opinio~ on iL Mr. D~n~L~. Let me ask you fide, and perhaps we c~ get to the other Farts Lhat, may help the record almos~ as much: Is the that you ~lludc to ~n additive proee~ or an extractive process ~ Dr. l=J[voso~r. It is an additive mid it is in liquid form. It i9 com. pletely combustible to carbon dioxide and water. ~4"r. DEqOELL. Then the function o~ the process that you ax~ allud~g to here is one whereby we essentially make an additiw to th~ tobacco w~ch in the combustion affects the production of bcnzo (a) pynmu; ~s that correct ~ ~. H~ox. That is correct. Mr. DI~o~. Did you make any scm~t~y of this sub~,anco t,~ find whether it has any other end products or combustion or oxidation products which might othe~ise affect the quMity and character of smoke so ~ to assure the ~afety o~ perzon~ who would u~;~ a cigarctt~ treated by ~his substanc~ ~ Dr. H~so~. Yes, sir; in two ways: One chemically and th~ ;ccond biolo~ca~y~ an~ extensive biological toxicolo~ expefiment~ haw been ca~ed out. The resets are consis~nfl$ in one dir~ion. Without knowia~ m~hanis~ hxvolved~ I will l~ve au example. ~he amount o~ coade~ necessa~ ~ ldll t~ mouse, tim amount necessary to do thi~ is considerably ~cre~ed if the ¢obac~o is treated with Chomo~ol. ~r. D~. By what ma~itude~ By what order of m~£~itud~? Dr. ~VDS0~. Fire, old. ~r. DIN~. Can you ~11 us what the end produc.t~ ar~ of ~he amtte that is smoked ~th Chemosol t~t are different than flt~ end ~hrOduc~ of combu~ion of a cigarette tha~ would be burned withou~ o presence of this~ Dr. H~SON. I c~nnot ~l all of flmm to you any more titan I can you an answer io that qu~tion without Ohemoso~. I doa'~ bolicv~'any- one, ~ywhere~ knows aH of ehe comb~tion produet~. ~. DIN~s. You ~a into ~ l~rge number of higher tars tlmt quiM d~c~t to id~ti~ Dr. H~soN. Tha~ is corre~. ~. Dmo~s~. I would like you ~ tell us, if you please, whct.h~ not you ~do any sc~Liny o~ whether or not ~hls ~ub:~.t~e~ production of ~bstanc~ inside ~he cigaret~ ~hat wo~d k'ad, let ~ ~:~a~, ~ some of the oflmr identifiabl~ effects o~ smok~g~ such as mrdio- vascular disorder and thin~ of ~]s kind. Dr. H~sog. I th~ to answer that ~uestion from a ~ientist'~ o~ view would haw ~ be that I doaZt ~ow *h~ substanct, s re~po~ibl~ 1or c~rdiov~ar patholo~ ~ the p~seat smoke. ~. Dm~ss. ~at we could corrm to would b~ an inference., w~e this ~ght affeo~ th~ level of one weH-ka~wn an6 ident, ifitvbh~ carcinog~ in cigarettes, that we would probabl3 not be ablo ¢o ~ny as~r~ion w~th regard to p~iblo otlmr carcinogens that might bu p~s~t, and also with regard to other actiw.agents which would other ~culti~ in hum~m b0di~ m~h as emphysem% different pul- mona~ disorders~ ~ ot, her cardio~ ~c~ar fli~rders. .~ I correct? Dr. H~soN. 0he-half correct and one-hal~ I would have to wit, h, because I t~nk that tim overall reeling biologi~lly hm~ mt,r~ than one puxT~e. It d~n'~ just corroborate tim wlue of benzo(a)p~,rene as an ~di- cater, but it gives an overall ~est for the to~al carcinogens prezcnt, m, explained previously in my testimony.
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910 .~aw ~ ,~infinff with whole cigarette residues, containing all If you.. P.- • -" ,.-, ........ nt on the second half of your " in~ h~ not been done ia t~s ~eetion. _ . and t~% ~ ~ ' • " " of the sub~.~c~ ~.h~ tobacco, whil~ i~ m~gn~..~ W,ff~ re ~, L--:~ht v6~ well ~oN I wo~a agree w~t.a ~-,, ..... Dr. t .., ~. ~..~, #.l~3~t this ~roduces • s~fer or l~s huz~r~o~ g ,,..., --, ~,~ i~ i~ the. comparative. Thi~ does~ g ~e~n.~h~t accompan~ ~moking. r A~ ~ Will ~he g~fleman yield ~ hi' • ' ~ ....... ~--~ ~wouldEke~kone quc~tion~ and then $ wifi y" Ar~ there, other ido~t~able carcinogens ~ ~obaco ~oke? Dr. ~o~. Ther~ i~ ~ list in the S~geon General's ~porb o~ Mr. D~em~. Ahov~ and b~o~d th~ be~o (~) pyreae to which Dr. H~o~. Yes. Mr. DI~o~. A~d thi~ sub~t~e.e ~o~d not aff~t thos~ other carc~o~ens ? Dr. H~o~. I don~t know tho ~swer to that. ~e~ may well reduced. ~fr. D~. Bu~ ~our ~udies m~o no ~dic~tion ~ ~ ~hethor' o th~ wer~reduc~d~ orn t y ." ~ b D~o~o Dr. H~sos. Onl~ mte~ of tho o~eF~l ~s: .g y .. ~ mc~m~. If tlmy aro ~re~ent, th~$ are ~Y ~o~ mcrease~ m om~ts that would mak,~ them b~ol%dcuBy impotent. am ~ , . • ' ,~ stud o~ reduction Mr. Dr~. ~ thin ]udgment b~ed on ~h~ .Y .2 . - of lmown carcinoffenm or is ib simD]y a s~dy ~asea on ~n~ mve~ ,~nc~r prod~cedi~s~ anhnals~ - - Dr. Hw~sox. The later iatwo sep~mt~ se~es o~ ~s~. Mr. Dm~)~. Th~nk you. Dr. ~o~. ] was born ia)[acon, ~{r. WAtSOn. I thought I detected t, ha~ ),ou ~oul4 be u southe~er cc,rrect~ or for your te~ts~ You ao have an ~nce~ lZr ~n do you not~ • ~r. H~sox. ~o~ ~ can ~l~ri~ that. I don ~ own a sh~re of sto~k ~ thi~ time nor do~ my wife, ~ any in~us~ry in ~he wofld~ bu~ w~ ,t, .~ , ,? ~,i~tin~ ~italism I ge~eve ~ the developm~ of thin~s lik~ t~is from the pnva~ ~tor, but wo don ~ ne~a~y part icl p":~te in it. 911 In our laboratory, there is no payme, nt to ot~ice~r~ of the Foundatim~, 6yen though they may ~ ac~vely engaged in r~earch~ ~ time or ~1 time. We f~ll ~ that c~tegory. ~. W~TSON. You h~ve received no financial benefit ~rom the periment~tion or ~yt~g relative to Chemosol up until this po~t ~ , Dr. Hv~sog. I~ ~ou would identify the benefit, I will ~mswcr th,~t que~ion ve~ directly. The Foundation h~ h~4 6xpense~ p~dd ~o d~tc. I personally am ~ r~ther bad ~ancial shape ~ u result o£ rids en~ir~ pro~. Mr. W~o~. I detect that you yourself smoke. It seem~ to ~ a small cigar. Dr. H~so~. Yes~ sir, I do ~noke cig~.rs and pipe o~y. Mr. ~V~rso~. ~sthat been tre~ed ~ ith Oh~mosol ~ Dr. H~sog. I~ has not. We h~ven~t tried it on oigam yet. ~. W~wso~. You state on p~ge 3 of your ~t~t~ent~ in th~ fir~ pant- ~p~ "~erofore, the ~ut~ ideat~ed d~ger to ~aok~m i~ the c~r~ogen ~lled b~a(~) pymne." So ~ha~ we might ~er ~,de~and it~ ~nd you ~r¢ w~y abow m~ in this field~ ~s ~r~ muay of ray colle~x~% ~m I to underat~nd theft this ~o (~) p~ is $ pm~qt of the combustion ~r~s ra~cr tho profluc~ o~ the tob~o itsel~ ]. Dr. ~og, That is co~ect. h~. Wxwso~. ~ o~her words, this be~o(~)p~ene, which ~ tim g~te~ identified e~rcinogeniv danger, is ~ product of any combu~:tlon~ whether i~ b~ ~bacco or whether it b~ erom industry, whe~ther ~t ~om ~ automotive motor proce~. That is a product o~ combustion ~nd not from rebate itself ~ ~. ~sog. It is • pmdu~ of comb~ion o~ org~i~ which would includo ~o~l~ imfludo ga~line~ ~cludo p~per~ ~ad, cou~, ~t ~ould indud~ Mr. W~wso~. $o we .~re not dealing spec~cally her~ with whid~ ~u~ relates solely to the rebate. I ~ ~ ~th ~ ~t ~d~ial~t~o~ the ~c~ ~ the of ~utomobiles, and so fo~h, they ~w produced quite ~ bit of benzo (n) py~ne, hwe they no~*~ Dr. ~sog. That is co~ect. Mr. W~sog. D~r, what m~tion d~sy~r hb h~vo ~ ~ho Ohcm- ic~l ~esearch and Devdopment Corp. of New York~ Dr. ~sog. None~ exccp~ that we did research ~or fl~em. The oril~- in~l nama of tho corporation which owned the origlna] Chemo~M ~ormuht~on was tim Chemical ~e~rch aad Development Corp, ~. W~wso~. In other words, that was the original owner Chemosol; so there is a relationship between ~em~ol~nd tim Ohemi- ~al Research and D~velopmen~ Corp. ~ D~ ~sog That is ~ect Th~ were ono and fl~t~ ~t, $ belk~vo Th~ ~hemosol Co~. is, I beheve, or the ~er~ca~ Chemo~ol Corp., is the suceeding name tor the Cheraical Rese~¢ch and D,:,ve]opm~*nt Corp. ~r. W~so~. This process has been offered to the major tol, aeco compa~es~ has it ? Dr. t]~sox. I don'~ know to ~hat extent. ~o research people th~ major tobacco companies havo consulted with us, and h~ve us on n~erous occ~io-ns. I hope wo have be~ of some help to We haw ~lways waned to cooperate.
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912 Mr. WATSOm But, you state in your testimony, your prepared testi- mony, that at ]east discussions have been initiated between the tobacco companies aud the ~ners o~ Chemosol. Dr, H~o~. I be,liev~ I said it like thi% Congmssm~ that I had been informed of thi% and this is t~e, Th~ ~t~m~v ~or ~hat corpora- flea is sittin~ on m~ right at the present t~% and'his iformatio~ to ms ~s that d,~cusmons haw ~en ~mtmted. I have not pa~o~pa~d m thc~o discussion. Mr. W,~om Is hisname ~fr. Tennebaum ~ Dr. H~,~so~. No~ sit, iris not. It is MoCha. Mr. ~fcG.~n~. I am Patrick ~[c~lm. Mr. 2Va~c~. What about Mr. Tennebaum of New York~ N.Y. D~s h~ haw any inter~t or has h~ ever represented the Chemosol Co. or any of fl~e owners of any rights of Chemosol ? Mr, ~r~N. The t~g is that fi~e other day a le~r was put ~to th,:~ fil,~ from th~ a~o~y representing inc,.of the ~or tobacco p~mies in z~nerica, producmg~ as I recall~ some ~] p~cen~ oz an cigarette% where the, r atto~ey offered to submi~ tMs Chemosol at their cxpem~ to ~t. . "T],:: ~mn. i~ ar~ the~fore wi~in~ to underw~te th~ cost of the ~fl ~nflcnendcn~ t~tin~ ~ro~r~ to have t~s process teste4 at do~:s co~iderable re~trch for th~ Government. I w~ j~t wondering what h~ppened to that offer which w~ made on kug~ 1~ 1967. Dr. H~sox. May I answer that~ £ am ~amiliar with it ~Ir, WATSON. Y~. I~ yea are no~ ~mili~r wi~h it~you hence ~he medical end and p~haps you could refer the legs[ pmcess~ to Dr. ~v~sox. This d~It with &e me&ods w~oh would ba usM an~tlysis. Thu~ is the mason I offered ~ answer the qu~ion. Mr. W,~. ~I ~ght~ sir~ you go ahe~d~ then. Was there not the offer made by an a~tornoy repre~en~mg ~e of the major ~bacco co~- ~ni~ to h~a this Chemo~ol test~ by an ~de~endent laboratory, the Hazelton Research Center in Fa~s Church~ Vs.. Dr ~so~ Y~; ~at w~ made. 1 ~ see • copy o~ th~ offer~ t~s suggestion. I ~as in ~uch personu~y wi~h ~hs scientific personnel tho]lazclton L~boratvry. I went to iheir l~bora~ry near Wash~pn and conferred with ~ g~tleman whose name ] don% rec~H~ the che~s~ who prop~:cd.to set up protocol ~or this t~ing~ w~oh he ~bsequently did so. His protocol was subsequently sent onto me. ~o o~y difficulty t.httt~ bccau~ the ~ttzleton Laborato~ ~ u ~e l~bor~to~ w~ we wanted to m~:et the requiremen~ w~ch had b~a laid down ~or u~ by the ~W in the form of suggestion% i~ we w~n~d this informa- tio~ accepted by the ~clentifi~ co~u~ thu~ the fluore~en~ spec- troscopy method be used. That was not in the ~T~leton proposal Th~ proposed to ~ame technique which we had used. We went back to the Gover~en~ and the h'at~onal Cancer In~kut~ and asked ~or a Ii~ ot laboratories. ~on~ the lis~ we ~ound or we felt that it would be d~r?ble mcc~ th~BW requirement of • specifiq r~uesC on the types o~ mcntation. The laboratory which me~ the~e requirements~ und was 913 the list provided us, was the Stanford Research Institute. That the reason they were chosen. Mr. W.~TSO~'. Th~mk you. I might s~ty in re~pon~e theft if yon lmv~ such ~m ~ffective produc~ a~ Chemo~o]~ and as a ~cient]~t [ cannot wit~x ~ou, and it can reduce the incidence of caucer in tho peoph~ who smok~ and I do no~ smolm~ it would appear to me that you would mo~ a~lous to have it tested ,at any laboratory m order t]att might move ~orward and g[v~ this benefit to th~ ~nerican pcoplt~. Th~kyou. ~[r. hI~c~o~a~ (presiding). Mr. 3It. ~xc~.Thank yo~ Mr. Ch~tir~an. Dr. ~udson, i~ is refreshing to h~ e ~ witne~ ~ppearinff bef,r~ who smokes as he test,~es. I am glad to seo it is ~ You ~re ~eouraging to me~ i~ it is leading toward tim product, b:,t o~ ~ l~s hazardous eiff~ret.~. I want £o ask ~ou ~is quest, ion: ~rour experiments e~ho~ thut baeeo treated by ~hemosol could result in ~ reduetion of be~w~-~t~n 25 to ~ perc~t o~ the demerit benzo (a) p~ene. I assume this, as you ~dd~ is one o~ ~he dement% when combined with other~ that migh~ ert'~t~ or C,a~O t~OrS. ~fy qu~fion is: Though tha~ is ~ reduction o~ 2~ ~o ~ pt~rce.nt of presence o~ that element~ how do~ that rolato to the reduc~on of cer~ ~ssuming ~ha~ cigarette smo~ng e~uses e~ncer ? Dr. H~so~. The work tha~ I ref~wed to~ and other work which ~d earlier that Dr. Duffy has referred to~ consisted ~ff ~ corrchttioa between ttxe le~-el o~ benzo(a)pyrene in the, tobd cigarette tar~ pared ~i~h the power to produce ~mor~ in experimental anlmal~'., treated~ or what percent ? Dr. H~so~. ~V~ dealt k~ow thag percent except ia expurhnental ani- mnls and there it is ju~ stati~ically si~ificant beginning at tlw ~5 percen~ level of reduction. However~ I think it is worth while to remember ~ometldnff ~d~ont benzo(a)pyrene ~t was~f~ stated here in eifl~er my testimony or Dn DuffY~s" , , This has not ex er been re.ted in tlm years that thi~ factor ]m,~ in ~e medical seient~e fiterature. It is tMs: That the co~,ctL~n benzo(~) pyrene w~th other promoter~ of cam, er i~ so gig, at, that it i:~ of ~ order of 40-~old, that, the c~rc~ogenie effect of t~,~_, combination excee~ tho eareinogenle effect of benzo (~)pyrene alone, This has been done both posltive]y [tad negatlvely~ by addinZ ~aceo eondensates ~ ~own amounts of benzo (a) pyrene, w~ l~,.w tht, ,tmo~m~ necessary ~ produce cancer~ and ~dso hy removing it. It is the reach that th~ statement from the Slo~m-Kettering Ire-~tl- tute is u sta~lin~ls ~pox~snt ~utement. Theu' statem¢~nt the word "alwass." ~aen Sou reach the level of 25-perc¢~nt in be~o (~)pyreno there is always a significant reductbm in tuntor:~ ~nitia~d by the tars. That is th~ ex&e~t of tho know]edge~ I beliers. Mr. F~c~z~. Do I under.and yo. to say that if Chemo~.l were the chances of producing cancer would b~ reduced 40-fold ? 29--2~6--09--pt.
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]Dr. H~Dso~-. I did not say that. I gave the experimental evidence that dl:lineates a 40.fold increase, if you wiH~ in the carcinog~ic effect of benzo (a)pyren~ when it is co~biaed with th~ other components cig:.trctte tars. Th~.~ rev~r~e i:~ true. When tim benzo (u) pyrene is reduced~ the tumori- genicity ~_~oes down. Mr. Pmi~. Would you venture an estimate thu~ ~ Chem~l we~ u~cd in tobacco~ that chances ot c~ncer activity woum oe 5~ or Dr II~,soh-. I don~t believe I can give ~ percentage except as s guess. If y~m want ~t gue~:s~ [ wall g, ve you one. It would be thin, that ~ere ~ o[dd be ~ stafistic~dly dcn~mstrable decre~e in the deafl~ rate from lu~ Callcer. Mr. P~c~. ~mt fi~re would you ~e~ that might be~ Dr. H~mso~. Xhat ~-ould have to depend on the n~bers of people :-rooking cigar~ttes before we could ~cribe si~cun~ to • p~ic~ar Bun~iJer. ~[r. PicKLe. You would not hazard a gu~ then ~ Dr. ltVDSoN. I would guess it would exceed 5 percent. It wold co~d thaL That is a Mr. PxcE~. ~hank 5ou~ ~. Chairman. M[. C.,n~. Wh~,~k you, Sir. Chaiman. Certainly, 1 ha~ e eni%~ed heating t~ scienfifi~ repo~ from a dis- tingui~h,~d,, dt,ctor.,f have u few questions, though, about ~o or t hl'et~ di ffert~n/~]lin~s. It is tru,~ that in mo~e ~perlments you h~ve produced cancer on the ~kin of animal. Have you ever produced them ~ the lungs by ~hflatioa o~ ~bac~ Dr. Horace'. ~[r. C.~a. Thank you~ sir. In ch,:,cking o~,a copy of your report~ the result of analysis per- forme,t at H~gh Ior, )'~bruarv 10-18, 1969, I notice ~ your consols that b~nzo(a)pyren~ ]n micrograms per gr~ of dried eonde~at~ 1.17 and In the portion of wt, tcr treated controls~ %hs con~n~r~gion bm~o (a) pyren~ wa~ .95~ .33, and LOS. Th,.~ addition,/~, of wa~,~r, of course, would ~u~matie~ly, wa would think~ rcduc~ the matter of benzo (a)pyren~ relatively; wo~d it not~ Dr. HwsoN. Yes. Mr. C.~n~n. Then further on in the r~port I find that tho content~ according eo your figures, o~ Chemosol trea~ent~ a~ez tobacco had been treated ~{'ith Chemoso], 1.41 micrograms per ~am of ~ied con- cemrate: 88 mi~igram% 1.~9 ~md 1.53, which am lfigher ia each ,:a~c than tho~c nt ordinary ~ebacco, a~or~ng to your fi~res. I am tit tt 1OS:~ tO account for this. Dr. Htmsox. Are dtese benzo (a)pyrene figures you are rea~ng@ Mr. C,~I~. Ye~, sir. D*'. HUD~O:~. And when vim say they are higher than ord~a~ to- bat','o, ar~,'they bein~compa~ed " ~[r. C.~;{. I h~ve it right here. The results of a~]ysis performed at ]ti,zh Tor~ Feb,malT 1~18, 1969. 915 Ma.. M.~cDo~.~. Can yon fi~td that, D~ct or .~ Dr. H~so~. Yes. Wotfld you give me the numl ,or in the leR-hand eohnnn ~ ~[r. CA~w~. The first is 1.17 milli~'~s per gram o~ dried denesate. The ne~ fig~r~ is 1.3~ micro,,r~ns vet ffr~ of dried con. densa{e. The next ~s .35. This is water-treated controls. And then wader-treated controls: 1.08 water-treated. Then we get to Cheiosol treated ~nd we haw 1.41 ~,icrogram:~ gram of dried condensate; .88 microm'ams; 1.~9 and 1.53, which r~,ally doesn't show tho reduction we would{ like to see. Cerminly~ I welcome research along this line and wanb to see n,,~r~ of By the way~ I wo~d like to ask you, Docfor~ wher~ ,lo yoR do 3,our ba~in~ Where does Chemosol do its banking~ Dr. I-Is~so~. American Chemosol Co.? I don'~ know. ~. C~m.}m. You do not ~ow ~ Is ~our b~nking done with ~he Frn~]i~ Xational ~ank of Yo~k~ Dr. ~SDSO~. ~fine, yes. ~[s. C~. The pres~den~ of tha~. srou~ tesfiged on the eft,: sts dg~rette smoking hst x~(~ek; is this ~ t~e~ Mr. Arthur Ro~,~ pres~den~ of the bank with whom yon do ~us~ess testified las~ week' ~ this no~ t~ue ~ ...... ' Ds. ~sos. I don'~ know. Mr. O~. The record shows ~nk you, ~r. Chai~an. ~fs. ~C~S~D. ~r. ~1usphy. 5Is. M~. T~]~ ~ou, Mr. I no~ my colle~e ~ibuted lfis, lntellectu~l abiH~ies to hls bh'th- Dlace in ~eor~, bu~ I ~fink the record will note tha~ he moved to ~ew York shelly. ,~ ,, Mr. W~so~. It is ju@ once yo~ ~ a ~ood beginning, my ~iend, you do not lose i~ even if ~ ou-go noah. ' hit. h~. Dr. ~ud~n~ you s~, on pages ~ ~md 5 that tim ment of Health~,~ducation~ ~d hV~]f~re letter to ~,ou stated that ~ technique known as fluorescence spectr~cop~ ]s ],000 time~ mor~ sensitive th~n the method you ori~inallv ~qed f~r chemical te~ting ~ow many laboratories in tl~ United States h~v~ that t~,],[, of ~st~menta~ion available ~ ~r. HvDso~. Not ve~ man3,~ and even fewer when ~vc s~,ek a tory that has the techniqu~ and the in~m]ment~, and th~ personnel~ ~ also has experience with tobacco condensaf~ chemi~...t rv which is a prime requiremen~ as well. Very few. A search was made for laboratories quglifyin~ in both r~pcct~: by the National Cancer InstRutc for u~. I believe there wer~ m~fi or tw~ in our geographic ~egion. 3Jr. ~P~. Was the use of fluorescence spectroscopv r~.commcnd~,d to you by the D~p~rtmeat of Hea]th~ Edueation~ an~ Welfnre ak: means of determ~n~g the amounts of benzo[a]pyreae ~ Dr. H~so~. Yes, ]t was ~r. ~f~v. Did you do any occlusion feting for th~ effect~ of Che~osol on tobacco? Dr. ~DS0~. I didn~ he~r the qua~tion.
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916 ~h'. ]~IIJm'HV. Did you do any testing on mice as to the effects that Chemo~ol-treated cigarettes would have on coronary occlusion Not specifically= on c~ronary occlusion. We don't know the sub~.tan,:~ s to test for~ to begin ~ ith. But ~ection sNdies of ani- mals with condensate were done and results lmve been recorded regard- in~ the i,~wer o~ the total condensate to occlude a~eries and c~mse tim t~,nc to become, dead. Ihere ~s u considerable difference between ~tm Clwmo~:ol-treatcd conden~ates m~d the untrea.~d ones from the :~;tnle tobacco in that the Chemosol offers a margin of i~rotect.ion. But I ~ould not want to extrapolate from that to human coronary dis- ca:-;t~. I know o~ no w~y of doing that. 3ft. ~rt~n~v. Thank you~ ~ir. Chairman. I have no ofl~er questions at this dine. 3It. ~L~c~m~.~. Mr. Brotzman ? ~{r. Bnowz~A~. I will reserve ~, time~ ~Ir. Chaimam Mr. 31ACDf, NALD. Mr. Satterfiela. , ~Ir. S.tv~'n~L~. Doctor~ the one thh~g I wanted to ask you this: $ ca rc~rred on page t of your report to the e~erimentatioa that you aprJarently conducted in terms of skin paintNg~ as I m~derstand it, ,:~ mle,~ over an If-month l~riod to produce tumors. I~ that what your laboratory did~ Dr. H~s~. Ig did two "biological tests for t~orige~esia One wa:~ by injection of material fi'om cigarette smoke. The oilier was by painting the skin. The one for which I gave the chart today wins e skln-p~Ntlng ~esg. Mr. Sx['v~mvlr:~). 1 ~z:~ ~:)rry, but I have nu chart. T)o you mea~ up there on the easel ? Mr. Suw~m~mr.~. To what extent or in what quantities were injec- tions made or ~ldn painted? Dr;. 1{~,~x. The skin-painting *es~ seems moment ~;o ~I will refer to that ~uantitatively. The total condensates fl'on~ lO mechanically smoked cigarettes wit~ d~ ~co cold traps, ~la~ ~pparatus, this to~al condensates -I,4,,.],arctee~ was paint6d on thB dorzal skin of C~L ~ threo gimes woeldy~ . ~h'. ,..~XB~I~D. ~OW WaS this condensate ob~a~cd~ Dr. H~,so~. "£hrough the mechanical smo~xg of the cigarette with " ~ 5-~lhmeter puff and ~'ith th~ standard puff. ~[r. S,XaYEIt~ELD. WaS any effort mad~ to relate th~ condens:tte to ~he eqaiva]ent nu~nber o~' ci~rettes that We ha~u b~en ~iven figur~ dur]ng these hear~gs o~ this type of paht- in~ o~ mic~ ~lEin being the equivalent o~ mo~g 100,000 cigarettes lltt~ Ummdties you used on these mice might be as related to the smok- iu~ liabitz of a'man ~ De. Ht~,so~'. N% sir, and I would know o~ no w~y o~ m~king that eonll)ari ::oil. Mr. S vv~m, mr.D.X.tually~ you are not really s~ylng that benzo[a]- pvr,..ne tha* c~mc~ about flxrough the l)nrning i',)al cml~'al col~ltcerion with cancer of tlm luug, are you 917 Dr. HtlDso~. Tlmt benzo[a]pyrene causes Calmer of the lung, per .~:,~ $[1'. S,vra'~aemSD. Yes. Dr. H~so~. ~o. ~. S.~r~m~D. I only have one other T~estion. In answer to th~ gentleman ~'om South Carolina, you mcntiom~d ia your experimentation that you had gotten into ~ I;ret.ty bad fin~oially. ~2ou talking ~boue your Foundation or yoursdf'~ Dr. Hm~so~: The Foundation was beam in 1959- It "wn~ ,,~*-~-,~ , ~s g memberslnp corporation under tim ~ilws of the S(ate ~f Nmv Y,-,rk It has tax ~xempfion ~sofar as income i~ enncerned. It is nonprofit. " It was e&ablished as a tea(,hinc experiment ori~hmlly and ~till~ lhe learning of experimental bio]~>~D,. If I may put int~ your record • description of tMs Foundation, [-would be deh~hted to'do so, Dr. ~Im~so~. Th~ ]as~ two pixies are noL p~rtine~tL to a eentrM d~- strip,ion, but ~h, ey are hMuded in it as an appeal for fuu,ls, t.~l,M:dly ~or retired professors and SUPT .... " " "p°rt (rf~tu(. .~ lents.. . ~ ~s ~mboraiory whmh ~s engaged pnl~c~p:tlly b~ cancer search..ks I ~nentioned earlier~ o~cers and directors are not paid. Dr. McGuffy and I fall into t}~at eatego~2[. Dr. Vieelli. who has worked extensix ely for 31~ years on thin prob- lem~ does not fall in that category. He" is a full-time research hi,:,. chemist and worked with me a~ Cohunbia l'~,iverslt • , ~ " " . S1 e i.~ in charge of the transplantation binlogy andt therefore, also in charge of the animal experimentation fo~. tl~~ production o~ b~mors. I} is a l@oratoKy which exists through private gifts and conrracts~ Mflmugh we have never had a ~ornml contracb out~ide u~, Government support. At the present t~ae and for the past 4 or 5 years there has no .Go~:ern~ea~.~ppo~ in the laboratory. Our board of or trustees ~eoiaee to ~ry nongovernmental suppor~ for ~ period of Mr. Sa~En~D. ~m I tO understand that the moneys you expended in this effort were strictly motivated bs, an hont,:~f and ~tyort. to get at what you would ]mpe Eould ge some eure~ of m~:?e~ts::n~::. ~oL~:::~ of certain things, specific,ally Mr. 8ar~n~D. I flxlnk th:~t is an admir~Ne unde~aklng. I con. gl'abd~te 3,ou. Mr. )~o~xa~. Do you offer that to be inserted into the record at tMs point? Dr. HvDsom A~'. ~[AODOXALD. Without objection, i~ is so ordered.
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918 (The, document roferred to fo]low~:) II]~h To~ Foundation was ~ounde4 at Palisades, Rockland County, New York hi ~W,~h It i~ boO~ noa-pro~ and ~tx exempt. By charter, the Foundatlou is an ~du,,atlo/~aI and rc~earch ~tablishment. Tl~, Foundation takc~ a n~w direction in hie-medical educa~on, lls "product" 1~,, chiefly, Imople. Ilere all ideas are given ample breathing ~ace and ~owing ~..m. A v.v,~uteen-year-obl chemi[.try ~tudent may work side by side with a retired ~role~or of biology, an a~mowledged au~o~ity in his field. Studen~ aml ~eientb, t~ of many di~viplin~s are encourage~ to strike out on their own-- ~:~t to confirm ~omeene el~e's theories, but to work independently in any of n-.~dicin~ or biology that intere~ts ~hem. O~e ~f the innovations is the u~e of the enormous resources of two largely lit,gb-cted age gr~up~. The very young ~e eminen~y receptive to new ideas and teclmiqnes. And tho~a~ of ret~ement age are, by then, J~st approaching flw peak of achievement in that most complicated of ~1 sciences, biology. ~cir,ntl~:tf~ are given a well-eq~pped place to w~rk on whatever may interest ll.,la Tlwre are no rcqulremerds h) publish or teach formally. For the student, "t~mqd.~" i~ dl~placeql In favor of teaming. And all the stafl at High Tot live by 1he truth;m, "Learning is doing". Formal lecture~, courses, and seminar~ whlh:~ la~ght by ~ members cl~ewhere~are not offered ~t the FoundaGom ~he ~:taff have com~:~ from nniver<ities, BotaniCals, and o~er ins~tutions. O~hers ~-~om~ to do ~ctr pcr~onat reso~eh, or to spend a sabba~cal leuve from their ~tutl~,nt:~, of course, come mainly during the Summer. whe~ they are free from ofhcr ~ tudie~. ~be youngest ~tudentg are eleven years oI~ while o~ers are work- tn~? on gr ~d~ate degrees. ~he 0~y requirement for a wor~ng relation~ip ts verbal a~ee~ent between t~ or more individuals. There are no fo~al entrance requiremen~ or terms of ~erviee for ~tudcn~~. No degreeo, ce~ficates, or credi~ are given. colla1~orat, with one another whenever they choose, ~d dee~ne to do so at Th,, "pioneers" at High Tor were recruited by ~ord of mou~ from among the founding profe~;~or's own s~dents. In the ~ext seven years, the n~ber ~;tudea~ applying has ~o~ to oae-h~dred each gummer. At p~esent, ~e~e are facilities for only ha~ a ~'he Fo~fl~ttlon now owns a~.d operates a Droperty which includes ]abora- torle~ equipped for research In endocrtnolo~, biochemis~y, microbiology', exper- mental m~rger~, and physiology, as well as animal quarters ~ud office spa~. ~q[r~Imellt~ and equlpamn~ are valued at more than ~G0,~ and real property nt ~I~0,0~. The, fou~der¢~ o~ thi~ effort were impressed by the need for ~conraging fl.-mght tn r:t~dent~ ef medicine. ~hey felt that most existing laboratory co~ses ~m:T~l$ f~',rced the :indent 1o prove a thing already k~own. TOO, st~lflen~ quent]y deplored their lack of ~r~onal contact in work with professors. High xvar~ e~:tablished to bring the young and the e~erienc~d into ~rect working ~rmtact~o~e that would or~lnarlly ~ot occur during ~e students' ~uly tire ReOring professors welcome the removal of burdens related to ~ormal preparation and administrative work; su~ burdens .do not exis~ at High Tot. ~I:~ny have ~dlcat,~d a keen ~[erest In the younges~ students entering the bio- lnedical world~indlvhbmls ~qth whom they commonly have no contact or joint w.rk, A fiw-year bl~ck ~f ~me proves acceptable to these scientists, and is flci,mt f.r a meaningful continuance in a research life of quality~the core of tl/~ll Tor'~ "let~ning program'. The ~:~r,,at n~,ed lu to create a climate of total scientific freedom--to sti~ mlafe lr~lly ~-,r]~dn:fl research, rather than to Drove points already made. Students mn~t be exI ~:':ed to front-line research, not the second-hand information Omtfs merely p:r~,,:'~,d ul,:mg in trio ma~y conventional university ~nrses. Gynic~m finds no audievce at High Tot. Learuing is for one's own yleasure, a~d it~q ultimate ~.,neli[, loa ~tudent demaud~ no discussion. The l~etime tora~ ¢hu~ acquired form the foundatimts of ~ue scholarship. High Tot stands a~ a workable alternative ~o cyni~sm, its aim is to raise a generation o£ sciea- ~ i~ta tha~ ts truly alive. 919 The stories of three studeut.~ at High Tot indicate the dl~ercnt way~; h~ ~ hleh early assoeia~on with working ~;cientist~ hm~ borne fruit. Stuart ~1. ft. L., at 22, had a mediocre nnd~rgraduate rv~#,rd at ~owever, his persisten~ interest in hiological science led hlt~ to enroll three end~nolo~ $ourses at Columbia. Sherry ~ereafter. the m~Jr~r o~ endoc~nology for ~h. D. caudldates was eliminated a~ Columbia. Diseeumged and at loos~ ~d'~ for a new academic appr~)ach, J. L~ ¢o High Tot at the suggostlon of one o~ hi~ profe~ors. Here, J, L, wc~:t to work ~n steroid homnoa~s. Helping him learn ~e biochemical method~ h~, was a Iullt~e st~ff ~Icche~st. In addison, another of his teacher,: at a~ experleBeed endocrine physiologist, soon move4 to High ~£or for a ~abbatle~tl year of research. • . Z, Iormed a close personal arrangemeut fr, r hi~ laboratory work wllh fhe ~ree staff m~n, ~.o of his £o~er teachers and the biochomb.t. Aft~,r tha~ a year, the three r~ommended that J. L. go to Stanford to work with world-~amous endocrinologist whom they knew there. Now if, L. is ms.raining an A record at Stanford and has won a Wliea he gets his Ph. D., he will enter medical school. Although his h,arnhtg program will have ~ken up many years, d. L. will emerge ag :in exampb, of the profe~ional laboratory scientis~ physician to whtutl ~e future tff ~ttedlc~fl ~riaci~lly belongs. ~igh Tor provid~ direetimt at a crlthqd point In student's ~r~r. It seemed to the st~ that accepting him qlflt~ Stuart ~2. Al~ough High Tor gives no courses ar examination% sev,~teea. yea~ old )Iaggle managed to get college credit for her work tht,rta At ton, where she was a freshman, the middle third of cuch year b; spent at work off c~pus. M~g~qe worked at High Tot with the plastic vmT:eon In of the tissue Wan~lantation laboratory. Sim~ta~mously on lmr ow~, ~he de- reload an ex~erimental aptwoach to behavior patt.rns in the anim~fl~, with which she worked. As a result, she now leans toward the behavioral acience:~ the fu~;r~psychology or ~sychlat~% Re~rts on 5Iag~which she was given to read hcr~elf--~vere ~;ent to college, so that several months' full-time college credit could be giw,n, The Foundation looks forward to more ~dcntu in thi~ category, as lndimtte4 by incoming queries from rariou~ co~eges and universities. Ztudvn$ ~3. A girl barely 1-t yearn of age came into the laboratory m~flnly to establish that the areas of schoi~xhip o~er than uclcnce ~ere th.::e suited to her interests and proclivities. (She is the daughter of ~t widely medical labomto~ research director elsewhere; ~ence, the n~ed t~ ~atl~,fy herse~ and her father). Jo Ann bcga~ in the la~lcate experimental of parabiosls. This t~q~nique involves surgical creatk, n of artificial twos" f~om pairs of baby mice. This technique alone led her into imlivldu~d, unsupervised e~erimental sciet~ce and prl~eu i~ th~ No~, York World~ Scien~ contest, the Nassau County Science conte~t and eb;:ewh~,r~a~ within one year following her summer a~ High Tot. She will eater college n~,xt as ~ Dremedical student wiLh plans for a career combining laborato~ ~d me~e~e. 8~dents have gained Imowledge and experience ~ mauy ul'e~)~ Some In taw?~, 1961-~lk.robtologicaI research on deep ~oa cort~ and ~ml water {prr~vhb,d by the Lament Geological Obser~'atory whh'h adjoins the F~:,mdatlon prolo,rtyl. Students searched for antibiotic a~ivlty in thence materials. ~hf,y lear~rd niques and procedures in b6th bacteriology and biochemistry. Utub,r p~rth'llhtP study are the biolo~cal effects of steroid hormones, a ela~s of c,*mpo~lufl~ fro- du~d by m~e and female gonads and adrenal ~[alldq. HorHione:~ regulate body ~CEJ[~y, ~d [hll$ the body's ~;rowth rate and structure. Thl::~ work tn 1967 and has involved work by :many students. l~Students experimented with new surgical proceflurc:~ on d.:?,¢. TI.T learned animal care and operating-room i,ro('edere~, ~urgicul teehniq~le~;, pre-operative and post.operative care of the anima,(~. 19~l'wo problems chosen for inve~tlgatio~t were homotransplantatlo~t animals, and the use of an adhesive as a subtsitute for sut~]re:~ in ~ urg.ry. dents a~in worked wi~ the animals, setting up and maintaining their as we~ as learning such ~ur~cal pr~edures as skln-grafting.
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920 19t;~-(16~The biggest project currently underway is an experiment wi~ tobacco to t~" to e~inate th~ major caneer-produ~ng ~o~cals in cigarettes. & visitor dropl',~g into the laboratory any evening ~ght fred ~'o undergradua~s tending ~e vmoklng machine. I£ daily "~mokes" l,O~ cigarettes which have been t~ated to cl~nate ~nzopyrene. l~lleved to ~ a p~dueer of ~sncer. WhiCh the cigarett,~ have t~n smoked down, the condensate ]s eotleeted. This condom:ate 1~ then l,~c~ted into mice. ~e mfee are ~atehed for si~s of t~o~, on ~) chance that auotlwr cardnogen was created by the chemical With which th~ toba~-o w~; treated to remove ~e benzopyrene, a~ut the most dangerous of the ~met, r-producing substances. • he ~tudont~ at work on this ex~r~ent a~ also involve~ In private projects r~f lholr ¢~wn, One Is expor~eufiu~ in D~ablos~ of mice to leara ~e reasons why digesting blood ty~e~ cannot be Wen ~ ~ansf~ion ; she ~ eleven years of ag,~, Another s[ud~nt, a Junior at Co.ell In gened~, to determlno how color is inherite~ Ee ~11 coa~aue this M the summer of 1967. M,,anwhH,~, ~s animal colonies are kept intact and thriving by technical person. m:l vt High Tot. Mr. Ma~oh-mm. Dr. Carter. Mr. C~m I should t~ Vhat ce~y tim research is :fine. How- ev,r, I ~lmu]dn% he surpxSs~ ]f there ~s not u little profit mo~iw thi~, too. Is thcr~ not, sir ~ Dr.,Ht~,~t,~-. I would say that thea~ is a c0~iderable profit motive in the entire promotion o'~ Chomosol as • tobacco additive. I don't think fl, ere i~ any doubt, d~ut t~tt. All the ~unds for research were made privately ~d not ~9m any gover~eut or public grants. Mr. Cmt'n:m Tha~dt ~'ou, sir. ~[r. ~[ac~,~,~u. M~. Adams. Mr. Ao.x~s. Thank you~ Mr. ChaPman. Doctor, what is your spe- cialt.y or diecipline? I have some questions and did not want to go into 'an rtre;~ that is not your specialty. ,De. H~so~-. in the ]:t~ratory it is cancer research for the last y~ar~. In clinical medicines, ne~rolo~cal surveys. Mr. A~x)~s. l'ha~ you. Doctor~ the first thing ~ wan~ to ge~ ~o is the e~;enti;d~ and that i% is it ~'our tcstimonr that cigarette smoki~ ]laZUrd)us to your Dr. I-I~so~. I didn.t make fhat statement, but ~is is tlae testhuony of the Federal Government and the scientific comm~it~'. Aft'. Au~Ms. I mean vourfpinion. ~[e ha,re talked al~uL ~rrecCin~ thc~a~ things~ so I thfi(k the other side of the coin is that you th~ IhtW are extremely dangerous to smoke. Is that right ~ I)r. I-Iv o:<,~. T~mv ar~ extremely dangerous to smoke ft,r some peolfie~ and I ~,au't t~:d] whi~:h pimple. ~fi; Ao.u~s. But becan~e o¢ all ~his, you have ~ ori~ial position that the Government would be iustified~ then, ia piing on cigaretlcs that go out to the general ~ublie, that ei~are~e smok[n~ i;. ha~ardou:-, und cart hurt you. Is that rig]~t ~ - - R~,. HuD~;o~'. Thai is co~ect. Mr. Ao:x~rs. We have been talM~ th~ morning abou~how we might make ~es~ less hazardous. Would it be your medical position the{ ~u~;t.ifiable ~tatement might be eomething liks this: Cigarette ~aoldng ~, hazard,ms to your heMth~ ann tlns c~g~ette contains Chemosol width will reduce rite cancer-producing ~n~edients by 34 ~erc.ent. I~ theft, correct ~ Dr. Ht~osox. The benzo(a)pyrene w~ reduced by 84 percent chem- ically, The treated condensates were applied to experimental animals. Mr. AD.X~Is. In experimental ~imals. ~ine. 921 :In other words, I agree witk you that I thil~ tlle eigarettc,-smokin~ population is going to remailt roughly the same, and a tremendot~:i number of people ar~ no~ going to be automatically tnrncd off if vet t.ising stops. I t~k tho industry might stop its expansioR mnong the young people, bu~ [ am trying to got from you what the duty of this corn. mitte~ and the Congress is toward the general public iu tellin~ them about this product. From your testimony, I g~ther that, firat, the genond public shouM be told that e~garette smoking is hazardous, and seeom], ~omo kind of ~t statement ~ith regard to the inffredieats o~ the cigarette should made ~o either indicate that i~ mi~2xt be s~ier to ue~ filte~:s or to Chemosol to tobacco or to any one of a number o~ D'~atmeat~ so ~f th,,y treat tobacco ~ ~ pafficular fashion we should tell tim public about i~ if it is safer Is that ri Dr. H~sox. That ~s correct. ~[r. AD.~s. So in the c~e of Chemo~ol, ~ would h~vo to ~nk it~~ effects to e~cer~ ~c~use yo~ t~t~ony h~ ~ to cancer, and that. Ch~osol ~ill reduce t~e cancer-pr~uc~g ingredients. ~mt do you ~xy abou~ it~ Tho word "carcinogens" is too big ~ word to put oa ~ package. ~qmt would you say about it if ycm go out and ad ve~i~ it ? Dr. Krises. I can't ~I1 oa advegisinff ~xperience. As a matter comlaonsense, I wouhl advertise tlmt ~ Chemoaol-treated cigar,it, leas hazardous becaus~ of chemical laboratory tests and in re~'.p~reh ex~erimental ~nimals. M~ AD.~s. We would have to tie it to cancer, because I want to into the heag effects in a moment and I undergand they ar~ not, voh'ed. This weald reduce the cancer-producing effects bf the cigar- ette in e~erlmeats with laboratory ~mimals. Dr. HP~so~-. That is the price'pal demonstrated phenomenon, but it i~ not the only one. 3K. ADapts. I ~ust want to know medically what is proper to ~y abou~ this. Dr. ~sor¢. That it is less hazardous. 3it. Am~s. That it i~ less hazardous in producing cancer. Dr. ~I~sos. This lms to be ~ally :~ matter of opinion. 3It. ADA~ZS. Of course, That is why you ~tre here. Dr. ~so~. It is my ophfion ~n~l "~*ther scientists that, tim cigarette smoke condensate from a Chemosol-treated cigarette is lt~ htm~rdou~: accord~g to several ~nds of tests. Mr. ~,~s. ~ow I w~l shi~ you over ~o t,ho hea~ cfft~ct~. We had a number of doctors comt~ in and tesei~y and the information that we get is that in their opinion there are two possible heart effcch: pro- duced by smelting cigarette~. One is that the dissolvim~ (ff nicothm into the bloodstream, tt::~ doctor describes it, is deleihrious to ths tone of the ct~nt,ral system and~ therefore, produces a cons~icth,e e$~ct, upon bbmd aZessels and arteries. Chgraosol, as ~r as you know, wouM httvo ao effect oR tha% would it ~ Dr. H~sox. As far as ~/~ow, Chemoso] does this: It reduce~ nico- tine. But whether the reduction in nicotin~ is sigaifican~ I do not know.
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922 ~h'. AD.~.~s. That is why I was trying to get your speclal~y, lye have to cunceutrate wilh Che~m~ol jua~ on possibl~ cancer proble~. The other tql'eCt~ a~ ] m~derstand, is that interaction between chole.~eroI s~rum~ a~d nicotine within the blood supply which may increase ths cm~]trictive effect on th~ arterie~ by the-bu~ld~ up o~ fatty tismms. { hemo~ol would hot--as far as you ~ow~wo~d not effect that. Are you ~-~a~:ing that it has any effect on that possibili~ ~ ~ Dr. ]]t~:ox. Only by ~;educlng nicoth~e. ~h'. ~l~cr, oxa~.,. :~h( Brown? Mr. B~Iowa-. How much Chemo~o] would be added to tobacco to a,.complish this g4-percen~ reduction in ~rnm o~ the cost per carton or co:~t per p~ck ? Dr. ]t~so~. Any legit.hnate to th~ cost of cigarettes would ~e vast- lv lc~:~ thau the di~erence between#o~t of cigarettes ~twee~ d~ffer~nt ~ommunities in America t~d~y. %~ ~ are talking in ~rms o~ peames. Thi~ is no~ a expensive proce~. . Mr. B~ow~ How many pences wo~fld it require to area ~.o ~ne cost of ~t p~mk of'~igarettcs t~ reduc~ this be~o[m]pyrenc content o£ Dr. H~o~. Do you mean~he co~t o~ the ori~nal materi~l % do ~his or the cd:~t that might finally be put on the package~ itsel~ Mdch I am really not ablelo answer ~ I weald eay we a~ lalking about a penny or ~ penn]cs~ ~ometMng like that, Mr. B~ow~. For the cost o~ material ? Dr. H~oy. No; hy the time yo~ got ~11 the w~y through. Mr. B~ow~. In otl]er word~, flint includes tho material aml the cost of the procesz~ of mldin¢ Dr. H~so~'. Thtt~ is my Mr. Bu, nw-. So we are'talking ~bout ~ pennies a pack. ]~at would Dr. Hm~o~'. I don't know that. We purchm~ed it as puro reagent chemical,~ and the cost wouldntt bear any relationship to what it w~uld ,.u~-t induqrJallv. Much ]¢,u¢ ia q~mntity. I would haw) to look it ~p lint it i~ vastly more cxpmis~v~ when you buy in ~)lantities you do for a rcsesrch lab. :~lr. B~ow~, I {vas ~,ryin~ to get to whst tlm economi~s of [l[[s uoul~ ba in ca~e the ~ederal Government. would require the add~tmn Chcmo~ol to tobacco in cigarettes~ whether we are tal~ng abou,~ mul{ imillion dolh~r industry or m~tibi~ion dollar industry. Dr. Ht~Dst x. Sh'~ I {hin~ the co~t on that basis ought to be nominal )~r. B~,~wN. That is what I am trying to determ~ what yo~ deft- ~,i~h-m of nominal is. Dr. II,_'D~ON. I thh~k if this were put into all tobacc% I d~ink the fi~ure I gave you would be high. Mr. ~ow~. Let us ~av a penny a pack. Dr. I~vDso~. i wouldai~ think i'~ weald exceed that. Mr. Bm-nvm ~¥hat is the economics o~ a penny • pack of cigarettes "Dr. H~oy. L~rd~ $ have no ide~. Mr. B~-~ow~. Mayb~ my colleagues might, be able to assist me. ~h'. ~f xc~,~xaL,: Substantial. 923 Dr. HUDSON. I don't think i~ is possible foe me to calculate sotnethint_: like that.~ because although no major change~ in m~nufuet,urinff are required, I have no idea what nfinor changes do cost in tlm ei~ar~,tt,~ ~dus~ry. ~r. B~owx. We will try to find out the precise fi~ure. Porhap,~ w,~ crux pug it into the record. All we need is t-he total'nmnbt,r of sold a year ~nd multiply that by a penny. Yod used the term "~ome. .P Ie~' ~le". in ~t]~cuss~... . ~." ~lm. .P°~ible" . .... eff~ ets cigarettes on those who consume mgarettes~ and th~s m ~ point we ha~e. had recumn~ly. Is it possible that some people have no ill effects from cigarctte~ or no perceptible physicM effects ~rom the smoking of cigarett,_'~-,? Dr. ~vDso~. I th~k flta~ is ,ux obvious fact. - ~ir. B~ow~. And some people could smok~ rMatiw~ly modorat,,~y and subject themselves to a high risk of cmtcer or some other beet~use of the n~ture of their p2~ysiological makeup ? Is thab wlmt. are suggesting ~ Dn H~so~. Yes. Mr. B~owg. To those o~ us not medically trained, is that what you ~leau '~ D~ II~DSOX. Th~zt is what ]: mean. I think there are people who can smoke heavily and nor be harmed by it. I think there are lnans, wh,, ~II'. BRow~'. Let me go to }}fis question that relates to the you have with ~ir. Adam, s. lhat i~ the quest}on of h}~ that ~mok~g may be hazardous, or dangerous. ~ ha{:e a ~eelh~ that hazt-,rdou~ and dangcrou~ ~,,n~ raft words which there is no ~ecifie connotatio~t o£ the degree cff po~'~ibi~ity. And~ therefore, there is a yew little difference }~etween tim worn qs" and "m~y be." But u~]nZ tl(~ word "haz~trdous~ or ~'dan~cr,-m~? to health, are you suggesting'that ~or ~'ome peopl~ c]garctt¢,~ a}o gerous and for other ~ople they are ~mt dangerous ~ ~ Dr. }Ira)sea-. Ye~, sir. To tt~c ~tverag'c ~moker, ~Ir Baow~- So if we m~t a label 3n the paekaa'e that trie:~ to aI.,ply t]£ d~gr;e o~'danger of t'hat product to all pc,@e, and I ,uu ,:m'e is f~ q~iestion we will have to r~soh'e in tlds committ,,e ev{-,ntuallV~ then i,~na ~rylnff to geg ~tt, wh~,~her/hat label ough~ l,~ say "iv: ~erous or "nm~q~e dan~erouf depending on the persou who tea, l,-, it. Dr. ~c~som In the matter o~ cmneym~ the hteral trutlh it wuuld have to be "mt~y be hazardous" or "ma3,~be dange~'oua" or "may bu deadly." There would b,~ ~b~olutely no way of Sayillg "this will be" or "thb~ is dangerous or lethal in ?;~,ut' ca~e" to ~'sp~ifie buyer. That i~ possible. ~fr. BltOWN. Even though for some people it may be, hut for uther people it may n~t. be. Dr. H~S~h'. that "~ 1. correc. 5it. ~[AeD0~tLD. The time of the gentleman has expired. Mr. Pr~ver ~ ~Ir, P~m~m I have no questions. I wang to thank Dr. Hudson for being here~ and especially for lag my former ch~sn'mte a~ an eastera htstitutiou~ Dr, Duffy, My reeNlecgio~ of Dr. DuffS was not only that he was an excellent shMeng but was a ~ cry effeegive cheerleader i~ the institution.
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924 I am glad to see t.hat he is now not only ~ free scientist but g very ttrticulate one. It is zooa to have you with ira. Mr. Mac~o~4~. ~{r. Skubitz." Mr. Sx~mrz. I have no questions. ~r. ~Lx C~O~ALD. ~r. Watson. Mr. ~A~so~. I want to ~ay again that I apprecla~ your candor ~d {r,mkn~ ~;s ]u answerin~ these qu~tions. ~ou have ~t it righL on the head when you ~id ~he only hone~ statement you co~d make ~ *hat. ~mokin~ rna3 be hazttrdo~s or deadly, or so fo~h, to your health. I commend 3,o~ for that. -" " - I hope fhaf fhe owners of Chemosol will }m abl~ to move forwar~ with the industry and give seine protection to *base habitu~ :-anokers. I agree with ~'ou. We have tried the ~xperiment of prohibition iu the past ~nd iL just did not work. I hope that we can move re,yard. A~ I undor~ea~d~ accor~ng to your broch~e~ you are professor of zoology. That is animM life ? Dr.-~I~Dsom Tha~ is correct. We have recently changed the name ~f/lie department to the department of bMogi~l sciences. It is the ~aroe people. :. ~tr. ~VATSO~. Who iS Wilfiam A. Metz! Dr. H~so~. IIe is an a~orney who resides in fh~ co~ where the laboratory or foundation is lodated. I fh~nk he is g cot#oration at- ~$rnc~. }Iis offices are ill ~eW York City, with the firm of Palmer, ~m, rel~L Mr. ~raw~e~. A~ I hastily peru~c your little brochure, I ~m impressed with your u~:c ot even youn~ p~o~fiv. I notice where an ll-year-old t&'l i~ h~voh-~d ~ exp~rime'-~ts oa the reasons why d~ffer~ blood ~ypc~ camkot b~ given h~ tra~ion~ and a l~-year:o]d gh'l ]~study- in~ in ano~er are~. I tbi~¢ it is quite, remarkable that you are us~ the~e students. I rill ~nly conclude by hoping tl~at you ~ll%ot get bogged down~ or at h.,a,;t, the owners of Chemosol wiil not get bogged down~ in th~ finruMal nrran~ement buk can move ~orwar~ if t~ere is efficacy ~ tlfi~ l~articular producL Thank you. Mr. K~-~os. Thanh yoth Mr. Chaffman. I ~ield my t~e to Mr. Adarnc. Mr. A~,~ts. D~tor~ you are ~ medicM doctor in addition to ~ profes- sor of zoology l Dr, H~s6~. Thae is correct. Mr. Averts. Followinff ~Ir. Brown's questions, because this goes to the es~eat, ial of what this cot~ffnittee muse do~ on the general pa~tern of ~moking, in other words, inhaling this ~oke and the effects of smnld~lff can you say, medically, it is good for anybody ~ Dr. Hw:~ox. Psysiolo~icallv or p~vcholofficdlly~ Mr. ADapts. One at ~ time. ~hysioio#ea]ly fi~. Dr. Hvozo2~. Physiolo~cally, I'believe not. Mr. ~A~ts. And psycholo~calky! Dr. H~zox. Psychdlogically ~ I am • subj~t my~lf Itis wonderful. Mr. ~Axs. We have the problem that there aro ~ l~rge mimer of peopl~ in the United States that t~s product is avaifable to. I do not 925 think anybody on the committee has suggested that they he outlttwod or that there be a cigarette prohibition as happened wi{h hard l~quor back m the 19z0s. ~ut the question as: ~tat does the Federal Co~issioa or the Federal Comm~ications Commission, or, iu tht~ alternative, the C~ress, say to th~ general public M)out this product. which is us~ the public Mrw~ves to advex~ise 1 We have not gone into the printed rrmterial yet. Is i~ your poAtio, ~ae we should, in effect, just let the ~aerican people go alert% perhaps saying on the package tlmt it m~y b~ huz:trd,,u~ to 'health is s~cient in light of your cor~nents that it contains se, ven and ~at benzo (tt) pyrene placed on mice causes cance~ oi the ~t:in ? I am trying to get a medic:fl opinion ~rom you becauva~ w~ ]mve t~nsl~te the medical opinion o~ all of the me~ who ht~ve,' be:m in ~to something that the public shoifld b~ told. ~t is yo~ medical opinion abmlt it~ Just that wa ought to it that% or that it is sufficiently dtmgero~ to the population a~ a whoh, that we should s~y something else on flla~ package and say ~:om~=,thing on the aim~ ayes ~ Dr. H~sox. I don~ believe that. a communication between the Gee. erment ~nd its opinions on publ~o health problems like ~his alld public ought ever to be stopped. ~ at, I believe that any warning mu:~t be coa~tion~l bec~us~ it cannot possibly apply to ~11 people. Mr. ~x~s. Do you think tMt ther~ should ~ ~ warnin~ about thi:~ product ~ Dr. H~so~. Yes; I d~. 3Ir. A~a~zs. And do you th~k yea ought to let. iitdividual decide what kind of w~rnlng they want to put on i% according to the mescal opinion in thdr SLa~ag Dr. ~sog. ~o; I do not. ~. ~a~s. Do you fiiink we ought to let the Federal Trad, ~ssion~ whi~ is ~n charge generally of dangerous substance~, ~ decision as they do with o~her substances and carD, out their tioM Should we let there do i~? Dr. H~sox. I would #re ~ conditional affirmative tmswer to that b~a~s~ it has been my impression that this is the £unct.ion of th~ Ft, d. er~l Trade Commission. But I would no~ lik~ the e~abli~l~ent in my eoun~ oi any commission that, could go b~yond those points at ~dth:'h our elected representatives want them to ~o. This statement isn% made ~or the ~enefi~, of,the people, he,re. Mr. Ana~is. I am ~use t.ry~g to get ~ronl 3ou mcdically--;n,1 is your field--what we do. ~ 6i~ have said it ~s danfforous, Yon h we s~id you think the people shou]d be warned. '- ~ ou said you tMnk there,,hould be. sore e eomment~ n tatle, when :.;~ thing is sa~cr than th~ oilier. But then you said to Mr. Brox~a ~ha~ caus~ some people maybe could take this and it would not kill that we should say only thrtt it "may be" hazardous ¢o your health. I wnut to know i~ ~lmt is gong to be ~,our final po~ition, that will he used as a medlcM fl%c~ when we deb~te tlfis matter. youYe staying that all you httvo to s~y to the peoph~ is tlt~t il, "may hazardous" fiec~nse otherwise you m~y be one o~ the luck~ one,~ i~ hm't. Dr. Hwso~. In inte~ity~ this is as much as ~nyone could say. ~r. Aw~ts. Is t.ha~ your position, too ~
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926 D,r.. ~t~:~r. This is the only time I would respectfully differ. It may onl~ b~. ~t semantic difference, but a terribly impo~ant one. ~t i~; d~n~erous sinc~ it may canse d~ase, and we do not know to whom. ~ut'~he fact that it has danger in it~ the fact that Jt has hazard ia it i~ beyond rcaeonable debate. It ~ dungerous. Nol,ody doubts that rea~ do they ? Mr. A~,~[s. I do not ~mk s% but I am trying to find out. ~'e~ ~;tatement made by eve~T ~octor will he used iE this debar% and I to be honest with the opmmns flint ~e end up I lmv~ heard from others that say whal: ~'ou m~'~ and I believe I have heard ~omethiug different he{e and I ~m try~g to get where we are with tho medical profe~ion. , Dr. HuDson. Ma~ I comment ~ I don't thi~ there is u difference. think the diff,~rcnc~ is in what we ~re describ~g, ~nd E just learned what it is. I~ one is describing the ~oke, then the smoke muy be ~'alled.. . d~n~erous'.~ ~ but if we arc t.a~dng, about ~m effects, of the ~]oke~ that ~ rt d~fferent mutter. I~ we mean to carry tim connection along ~ith hazardous or ,,~,rou~. and if we ~,~v it is d,tn~erous or h~z~rdous, thut caa't~ in blank,~ w~y, b,~ apphed m t~ms of damage to the ~ndtvtdual. There ma~ not be any resultant damage to the individual ~ho buts that ~acka~e of ciffarettes, or 10,000 of those packs. But i~ we are zcfer~inE t~hc smdkc ~rom the cigarettes, it is dangero~. ~lr. Dmo~. Will the gentl~aan yield~ Mr. A,,x~rs. Yes. Mr. D~e~,~. I want ~ get into ~l~]~ semantic point at an priat~ time. If I go over ~iagara Fal~ m = barrel or wa~ oa a nga~- r,pc ~tcro~ Niagar~ Fa~s~ that is dangerous. I might get s~dely {o the el:her side an~. I might ge~ over ~he ~alls to ~afet~. But it Js hazardous. T]~ dange~ does not n~ces~arily me~ that I a~ 100 percent certain oY gett~gkilled~ but maybe ~ 10-percent chalice o~ gettin~ ~lled. It i~ ~ rea~oaaS]~ conclusion that • reasonable man would m~ke. tlmt correct ~ Dr. }~so~'. Right. ~.Ir. Dx~c~. E~ you take a population o~ 100 million smokers and put them all out amokin~ ther~ will be • ce~aia percentage oY them who will s~ke safely[. ~ere is no medical ~t ye~ to dete~ino ~ bich o{ tho~. puople ~ i~ bo able to ~afely smoke. Am I correct? Dr. Hv,son. Tha~ is correct. Mr. D~o~[.z,. Bu~ it is e~ti~tical]~, provable that a l~rger percentu~e of the ~rnoker~ will be hurt from t~fis than nonsmokers, whether it~e cmphy~:cm~ cancer~ circulatory di~order~ or ~rhatever it might be. ,~m I correct? Dr. I-I~,sorr. Correct. ~[r. Dme~. So then it is fair to say that. even though the hazard may not in all inst~nces be realized in terms oY emph~em~, cuncer, or ~vhatevcr it ~ght hap~n to b~ ~u~Rna~ 2r car~ova~?ular ~s- ordcrs~ ~tt lease that entire pop~t~oa oY smokers~ depen~g upon ce~ia local differenc~ or differences ~ heredi~ ~d genetic, ~H of them are in ~ ce~aia peril, = ~a~n hazard, so there is d~ger to th,n~ in smo~g, even though it might nQt ~ ~ch i~ce be re,l- izard in the ~en~ that they ce~,ain]v will die xrom smo~ng. 927 Isn't it fair to s~y t,h~t it i~ dangerous rather than to ~ay tlmt it ma, y be dangerous? ~r. ~so~. Congressman, you made ~ 5{}-percent inversion in my thi~g just now. ~r. DI~, I am not tD, ing to do that. I would lih,~ t(~ get. an~e~so~ ~ I specify what this means~ Yes; it is bu~ ~ot if ~n~rapola~es beyond the point of simply sa]'ing ous in • generic ~ense. If one should vo o~ in to include specific dleeases, death, aml fo~h~ then there as no proof that that danger doe~ exi~:t. ~r. Di~o~r.~.. I ~m not s~ving you ~zt~t l'allen :,rche~ if ~,,~u but medically you will ge~ ce~rtain ~hin~., Mr. ~c,o~-~n~. Th~ time of the ~enth,mau frora Maine has expir~~d. You suy the smoke is dangerous'Sut the cigarette is not. Tbcr¢~forc, would ~our position be to p({t ca the pacl~tZe or ~'hatever it be h~bch~d that this cigarett~ is not dangerous unless ] it ? Dr. D~v. Or eaten. Dr. Hwsom I dida'~ say that, but ~ wm~ld have to tt~eo tha~. true. ~r. B~ow~. I am sorry my quest,~n ln~Cipit~tted ~l] thi¢. fascinated by the semantics, b~it I hnvc no de~ir~ to get into that until we go into executive session, '~'lm very act ~,f lighting {he ciga~'ettc is d~mgerous, is that rlght,, it may b~ d~ngenms ~ Dr: ~so~. St may be. Dr. H~so~. ~o; I ~my be ~uilt~, b~t ~' tt h~ ~ to pr re it, if accused o~ something. , Mr. B~ow~. But guiltx is ~ firm, clear word i~t terms of what guilt. means But dan~er is s¢~mething eh~. Th~ vercentag~', ~]m d,~:~r~:, dan~er is the s~gmficant thing. Mr. Dmgell brought tllaf, out 1 think relat~ively dear. Now we are talking ~bout two different, things and this is th~ only point I wo~d 1~ to raise, and somebody etso can kk~k this arotlud nmch as fl~ey wish. " For ~omo ~eowlo i~ m~v b~ 95-percent dangerous; ~or other p,~*:,ph~ it may b~ 85-p~rc~nt dung~rous; ~or some people 100-percent deadly. ~or some people you could say on the pack "Smokin~ thin cigarette is going to c~use you to haw c~cer," or "m:~y t~" you could sa, v that. ~or somebody el~ you could e~y, "Smo~dng ~ ci~ar~ttt~ ~din~ to causo ~ou any p~icul~ problem." ~ T~ "is" ~nd "m~ be" ~]ates no~ only to the indi~,idu~l involw~l, ~pparently, but it also relates to this broader quezt.ioa of ,~tati~tic~,d e~denc~ which there seems to b~ some le~timat~ dispute ov,v medical researchers in terms of tho ~xplicit proof of ~milt of thi~ product, Is ~hut Dr. D~. This ~r~en~ h~ beea going on and on because of pur~ly ~hilosophic question of what consGtutes proof.
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928 :It. is ~ very mtcre~fJnz e~ercise ~md has been ~oing on for sore2 thn~ in out~ido scientific circle~ ~ts you ~re ~ell aware. The as~iatmn of cj~rett~ smoking and various di~e~es is no loner doubted in any me,lic~l ~chool of w~ch I am aware. In fact~ the ~ooi~tion between cln'oni% ~u~ cig~ret, te ~m~l certain human diseases has now pro~'~ed to the po~t where w~ ~o~ crm actually p~ck out {l~e sick person to whom cigarette smok- i~ ~ ab~olut~fly.de~tdly~ ........ by th~ magi ~ hen I s:t~d ]t was ~ulI o~ ~a~er, 1. ~a p~rp~ex~a.. ,, • • tudc of i~ uml vet ag;dn by tim pectflianty of thin ~[a~ve~y ~ow ~evet ,:~rch~ogea. Frbbabl~ onli: about ~0 percent oY the people who smoke h~avilv act~ull~ get into ~roubl~ ~vea ~ter 80 or ~0 seam. But' th,~y do "Eet into trouble with .~n increasing ra~ ia the 60 y,~ar ~ouS. Th=t ~.s where you look ~?r ~t. Th~e is~ p~,~?~la~ly~pi~ O}l~r,t a~d pro~'e~ion ia ~ome oY me.s~ carma~ msu~um~ m ~m~.&~r~. To ~ompremi~e with anything sho~ of the most s~ecific warnin~ i~ poor public healt~ Th~ American MedicM A~ociation and the American Public ~Ith A~:<,:iatioa both ~t~ree that cig~rette.smo~fi~ is ~ Sl~e~i~c, ~or, d~ugerou~ health hazard~to aa umdeat, Jfied popular.Ion. xne very unidentifi~bilit.~ o~ ~he pop~flation would m~e it necessa~T to arrh;e .tt, ~,'~mcthin'., ~ l{ke c]a~ret~= ,~mokin~.is, d~g~ous.. ~ and m~', c~u~ you c~uwcr~ ]H~art di~ca~ and ofl~er ~s=bfi~t~ or something equally cheerful. I won~]er ]low l~-~anv people read the~e firings aKyway, Con~nan? Mr. Bm.*wN. 3[aybh we ou~h~ to mak~ ~ ~l~io~ on vhe~er ?~.npt il. ]q significant. That is not ffur business to decree now szgmncan~ z~ ~s. Tlm amdo~v was u~ed sometimo ago in tim commi,~ee~ h~ regard to l.yphoid~ be[~:een tho night, air~ the swamp~ ~he mo~ui[o, and the aclmd ~erm that cre~ted tim disease, _ . 'Wodf~ you care ~ con~ent on lha,t analogy ? For your s~tis~act.mn~ is the ~mo]dng o~ cigarettes identified clearly as the go*~ in this Dr. D~?~ ....... I believe ~o I would also.. ~oint ont th~ epidemiolo~i~s..,. have ],~r*~ known E~at the tubercle bacillus o~fly c~us~ ~aberculos~s m ~'ome individuals with tho appropria~ constitutional disposition and 1)¢)dy d~,~en,'o from fl~e oa~t of the dise~e. In tlmt sense, smoking" eiEarettes pro~d~ th~ pathogen~ and some- thh~ i~ flint t [~r~ w]de]~ we have c~dled ~a indicator~ measures some ,~f the, unknown ~ub~nca flm,t triggers disease mechanisms in For ,example, miners who work ~ the radioactive n~nes of this cotm- trr have • particular exce~ of hmg cancer. This is most marked in ll~,~ :<rooking ~roup who a~ workh~in_~ rEdioagtive ~,mo~p~re, in t},~ ch~,:~,,~ terminology of cance~ production, th~ r~d~oacuv~y pro~- al,lv potenti~ttes the devalopment of the cancer due to ciga~es whose action probably only initiates the proc~s,s. C,nEve:~sman Springer asked earlier ,tbout the excess oY lung caner and lung dieea~ca ia ~reat Britain compared ~ t.hg ~teR States. On,~ ~:~asan might be. that. they have less corona~ disease, We ,~l,vinn~l} don~ kno~x" the final answer to ~ny o~ these qu~.ions. $ fldnk it is hevause of tl~ese co-factors whid~ you h~ve brought out in your analyaing. 929 As Dr. Hudson mentioned in his testimony, this is a ',-'y,~tem, and in such ~ multi,~age ~ystem~ i~ you can interrupt~ it mor~ than place, it m~3' be po~ible to ex~d the efl'ectivene~s to control it not o~e by significant pmven~on. I am sum that is the reason Yor these hearings. ~Ir. Wa~o~. D~tor~ do yon mean to s~ty that one reason that th~ British h~ve more pulmonary diseases is ~ecauee they have. 1~ diao dise~s ? Dr, D~'. Preei~ly~ Congressman. If you let a man live ca fr.m the age of 40 to ~[~:: ~rawso~. Slow do~ a litt]eblt. Dr, Do~'~. ~ lmve been working faster beca.use I was under impression that you wtu~ getting me off. It takes m~ Mr. W~om I am t~,ing to under~t~d this ~n~ th~,~g t.~,~ longer. That is quite an astoun~ng ~utemen~ that they h~ ~ morv pulmonary discuss because the$ have less cardiac diseases. That is a new injection. Slow down ~ little bit where ~ can ~and. ~[r. ~. E h~ve mentioned th~t thcr~ ~re ~ mmx~.r o£ ~ae~m ia the cause o~ these ~se~es in the United Sta~e~ and Bfi~. At the same time ~h~ t,h~ Bribish ha~,c prob~d~h, t.wic~.~ many deaths and these fi~He~ are not too ~ar off~ in male~ ~f ~_ to ~rom dis~s o~ ,bhe 1~ Jnelud~g lung eanccr~ they hr~ve r~ marlo defiei~ey~ come,red ~ ~ ~om disuses of the he~ and cirouhd,:~r5 sy~em~ p~m'~ly eorona~ ~e~e~ ~d remrn-~ably to the ~:am~ ~[r. 3V.~Tsox. Can you factually state that tim reason tlmv have ~:~u'~, p~on~ di~ is bee~us~ t~ey have les~ cardiac di~e~t~e'~ Them, no ~lation. Other medical docto~ tell us if yon havu a dise~ tim likelihood oY huv~g c~rdiac di~cul~v inc~a~'es, You ~ra ~li~ ug j~t the rever~e. We have l~ad so many of sh~te.men~ th~ am just pick~ out of the a~r. Dr. D~. Your question is ve~ well raised. I would comment the 1~ p~. Witnesses have ~doub~d]y ~ppearcd to s~ak abou~ the. dise~ secondu~ ~ l~g di~eu~ that occur~ in particuhtrl~, clm_,ni~" ~oke~. I ~n a0t t~l~ ~b¢:ut that ~n~ of hea~ dis~,a~:,. "~h,t o~ h~ dise~ d~s not fi~re p~nent,ly ~ th~ American m(,~:t al~t ~. The kind of he~r~ di~ts~ '~ab is tl-~ I~romimnt part,o~ oux h~.art ~s~ morality in yo~ger m~l~s is coron~ heart di~t a~e, wl~ieh act ~onda~ to pulmonary dise~e at all. ~xy is it tlntt, we ha~c p~ie~ i~m~ I c~t answer that. Is it b~use we h~ve l~s oY the o~her ]s what $ said. and I think was .a bit too flip, ~ad I meant by it that it you have th~kiad of lem ~at you have in Brit~iu of increased I;ulmonarv di~'¢ aa~,,,.-ia or i~ you ~at to ~rn ib around and say Why don'i we have a? much as th<v h~ve~ one reason might ~ bec~m~ a ~auc~ ]ar~cr ~har¢~ ~:ff pulmoa~ ~p~ible gronp~ lung cancer susceptibl~~roup~ i~ dvin;r of coroa~ hea~ dis~ titan would be i~ we had the:.~Htlsh r~d~,. Mr, ~ i~om ~ other words~ you are telling us th,tt th~ ~,~-a we die beYore we get ~he l~g cancer. Dr, D~v. ~fr. S~m~. ~ou]d the genflem~a yield on ¢hag g~. WA~oy.
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93fi Mr. S.t~n~I~r.v. I have just one question, Doctor. If this bc true, then I would like you ?o tell us what si~ificance you ~ttach to the relationship between th~ decr~z~ incidence o~ dea~5 ~rom ~berculosis and pneumo~a~ to tlm ~creased incidsnce ia lung Dr. D~er. I doa?t attach any si~ifieanc6 particularly ~o Mr. S,x~~. Ba~ you did between the he~t ~d t~h~ lung. Dr. D~F~'. Becau~ it]s current. I can b~]anc6 the two. The decrease in deaths due to tuberculosis has been ~ s~ady deer~se since 1910. The:~o two that I am ta~ing a~ut are going up(and they are going up ht :~ peculiar way. I ,~co with you Congressman Watson, tha$ we do nob ~ow any rela~.ionshi~ between a comna~ hea~ disease and l~g cancer and woul,t likJto withdraw my fheory tha~ the re,on we do hay~ 1~ 1,rag cancer than the British i~ because we haw corona~ hea~ dlseas~ in youn~er males in our count~. ~fr. ~Lxc~.~. The time of th~ gentlem~ h~ exp~ed. ~ want to thank you gentlemen for being here. I did not hav~ a ch~nca to wdcomo a representative from a mfiversity t:~t happens to be in my c,:,ngre~sional dist.~ict.~. 1 ~m pleasc~ that you naw ~een nere. Tlm~ you ~ e~ much. The co~mittee will stand in recess until ~ o~clock this afternoon. (~q~ereupon~ at I~:18 p.m. the committee rec~ed, to reconvene ~ p.m. the ~:ame day.) ~ RE~SS {Tim committe~ reconvened at ~ p.m, Hon. Harley O. S~ggers, ~ha]rman~ prc~i~ng.) Th~ CxL~.~. Th~ committes will come ~ order. W~ are in ~ continuu~io~ of the public he~rin~s on aH b~Is before the committee related to the labeling ~d advertising o~ ciga- rvtte~. Our first witness this ~fternooa will ~ ProL Theodor D. Ster~g, Wa~:;h~oa University~ St. Louis, Zfo. ~TAT~ 0~ THEODOR D, STERL~, PR0~SSOR, ~T~T OF A~P~D ~AT~TICS A~ C0~PUT~ SC~C~, T0~ UNIVE~ITY, ST. ZOUIS~ Tim Cu~m~r,~. Wo ar~ hapW to haw you ~fl~ us. We are that wo haw to run the~e hearings in th~ a~ernoon~ but we have to Mr. S~n~. I under~tan~ hit. Chai~. Tlm C~,~m~n~. Ve~ well. You may pro~ed. ,Mr.~ S~n~]~. My nam~ is Theodor D. St~rling, and I am pro- ff-~~r b~ the Department of Applied ~I~thema~i~ and Computer ~ch_ncc at Wa~hin~on University~ St. Louis. I haw been pm~essor ,-~f blo~ati~tic~ ~or 8 years at the Colle~ o~ Me~cine~ at the Uni- vcr~ity ~ Cinc~a~i, I am the ~ormer chai~an of th~ Biologi~l Procc:~:~-~ing Or~aniza~on. I haw served for 6 years on ~he ~eri~n M~flmmat~c~ A~oci:~tion Conifer on Under~aduate Pm~s in Maflmmatics. I am at present a member of the Com~tt~ of 931 ;kraerican Assoclation o~ Phy.~icists in ~fedieine dealing w~t.h com- puta tion m attem in medicine. The field in which I teach and in which ~ conduct the majority of my research concerns the collection, processing, and btterprctation of .~ large number o~ my research efforts haw concentrated specific, ally on the analysis an~ ~terpretation of data concernhlg envlron~tntal health problems such as the effect of le:td on industrkd worker., th~ effect o~ low doses of radiation on the subsequent appearttm~o neoplasia, and the effect o~ pollutants on community health. And, cidentally, the effect o~ smoking on the health of th~ general public. I am also serving now, and have serve~ in ~[m past, as ~ consultant public agencie~ on problem~ related to data acquisition and analw~i._:. These include the National Science Foundation, tim ~at.ional Ae~,~emy ~of Sciences, the VeStal' Administration R~earch Center~ as as a number of universities a~d industries. I am here~ on my o~m hal~ and at the invitation of several cigare~o manufacturers, not behalf of Washington Univem:ity. It ~ inevitable that conclusions may sometimes he reached b~, Publi~ Health Ser~ce or by inves[igators sponsored by it that ~:ill be in disa~eement with those reached by persons affected and by o~ht, r scientists. It is in,the, intere¢t of thd public that *h~3e instance., of disa~eem~t be resol~ ed on the basis of merit of the d:tta and lhat rei'~ant analyses be made av~dlable to all interested pa~ie~ ra~h~T ~han re~olved by the clash of exper~ in ~ront of congre:~sional com- mittees_.. When I was asked to~ review. . the, PHS publication~ "Cigar. Smoking and Health Charactermtm~¢' prepared by Ronald of the Division of H~lth Interview Statistics of t~e National Cent.vr for Health Statiatics, and ba~;ed on tlm re~ult~ of tho ~'ational Health Survey, it was a~eed that whatever conclusions my ~malysis produc~,d would b~ made available to the Public Health Service~ as well a~; the iudust~. Indeed, three reports dealing with this study h~rv~ submitted to the Public Health Sem, ice. ~Iv conclusions are based on a detailed study of t~o info~atlon published by the National C~mter Yor Health St~tis~ics and o~t addi. ~ional analyses conducted on the vast collec~on of data on which t,hc. repor~ "Cigare~e Smo~ng and ~ealeh Charac~sti~" is These conclusions were detailed ~ tl~e¢ lengthy reports. All rcport~ and supporting da~ were forwarded to the director of the ~atkm~d Center ~or Health Statistics. hfy conclusions were forwarded ah~,~ to committee oY the National $m;tltutea of Health concerned with ~vahmt- ing data on smoking and health My statement, then, cover~ nmt~al wlfich the Public Health Service has been mad~ aware ¢om~ tim~ at~o, ~Iy concern he~ is with rec~t claims that ci~mrett~_~ smoking a wide variety of c~oni¢ and acute diseas~ a~ well az di~abilitic::, and with the procedures by which tlm sourc5 data wera collvct~,t by w~ch morbidity and dis~bili~, rates were produced for o~ compar~g smokers to nommokers. There are a number of flaws ~ thes~ data and in the~ analys~s that are so sc~ous that eu~ conclusions sho~fl not b~ dra~. A thorough ass~sment of the mpo~ C~gare~o Smolani~ and Health Characteri~ics" mus~ d~al iu dethil with~iolations of ~6~ti~tical Copies (ff all relevant corre~ondenee have been ~laeed in the record of thl~ hearing {vee p. 941},
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932 ~cicnt.ific procedure~. I will endeavor to summarize briefly the sub- :-:tahoe of the major shortcomings which exist in that report~ There ar~ three meier objectmns to the repo~ and to the u~ of the d~t~ on which it ~ based for ~t~ag~g the incidence o~ disab~ty : 1. It is not clear what the basis data actuMly represent. As an index of health or disability~ ~ i~ormation collected bs, the National Health Su~zy is beast with errors. These errors arc o~ such demon- :-,tn~ted mag~tude that inferenc~ dra~ from such ma.~rial about diff~cnce~ between population ~oups such as between smokem and nonzmoker% ar~ probably im, a]id. Certa~y esthetes tha~ ~ pa~icu- lar number of d~bilit~%s~or tha~ aKv disabilities~are caused by r:nmldng ar¢ m~ningless. 2. The dat~ obtMned by the ~a~onal Health ~terview S~vey are comple.xly affected by ~ variety of contending variables. What dif- fercnc~ may appear ~twe~ disuse and disa~}lity counts ef ~nok- ~-~r~, and non~mokers depend on the ma~er b~ whic]~ the da~ are di~ ided into categories a~ording to health: sex:'ago~ ~plo~ent, and other population ch~act~istlcs and by which obse~,ed disease counts :m~ "corrected" acceding to ~fferences in the distributions of ~os- ~ibly coMoundinff f~tors.be~ween smoke~ and nonsmokers. The com- p~r]son of "raw~rdise~ c'o~ does not ready show ~ythb~g a~u~ the effect of ~mo~g~ nor wo~d th~ cons$itate ~ proper comparison. On the other h~d~ ~ is well k~own ~at the multivariate data may be made to show almo~ an~hing~ dep~ding on how they are divide~ u~ ~r compari.~n and depen~ng on what 5~es am used to '%djus~' oh~-:ervcd numbers. ~e unaly~e~ performed on these complex de.to fail to adju~ for so many so~c~ and faetor~ of confo~%g that their ,:onchMons lack commotion. TMs weak and uns~sf~to~ ~lysis O " f data, l~ckmg already in v~idity ~d reliability, d~ not demon- str~t~ any health cons~uences due to ~mo~ or ~oeia~d Mth it. 8. Even if tM c~leulated d~abflity r~t~ are accepted 'on ~eir face ~alue~ which they should not be, they do llOt~ in fact~ show that smok- cr~ suffer from ~mre disabilities than do nonsmokem. ~ ~act, ~emale c.mokerz for whom much more reliable dat~ are ~vail~ble than for male smoker% have fewer ~sabilifies thou do nonsmokers. Also, the con- :~i~te~t, pattern with ~hich fo~er ~okers appear to suffer from the highce~ ~abiIity ra~ is ~ contr~etion not only to the conelusio~ o£ thi~ rcpo~ but also to she i~istence that one of the m~jor pieces of evldoncu ~or the ha~fful effect o~ smo~ng is that stopp~g will be followed by ~ r~vers~ o~ ill effects. ~. THE EXTENT 0]~ ~P~RORS IN" T~E sOmtCE DATA When ~wo groups are compared on some mez~urem~t~ the obserred difference should b~ evMuated with duo regard ~or ~e accuracy of lhu tool which is used to rnea~. Tiffs is u yew commons~ns~ ~ule. L,~ u~ t.nkc au instauc~ in ~h~ch w~ are m~surxng the heiffh~ of in- dividuals by asldng children under 5 years o~ age th~ height of "daddy." A:~urac tha~ if we compare the height of daddy as estimated by ~ g-year-old to daddy's real ~eight, ~ 5-year-old is wron~ on the average by as ~uch as :~ feet. We would h~r~y pay much ~ttemioa h~ a r~por~ which claims that the average height of daddies who are firm di~dDiinarian% measu~d by bhis un~rtuia me,hod, differs by ~ 933 inches from the average height of daddies who arc soft di~:ciplinta.ian~. We would insist flint ~Im difference of 2 inches in tlm average reported height o~ different types of daddies is trivial when compared to arerage e~or in the method by which the helmet i~ ac~alh, We woul4 b~ ev~ more disinclined to take~his reDorte~ ~eriously i~there i~some suspicion th~tt being a hars'h di~ciplimtr]~t~ ha~9ome effect on tl~e way a dtild pereeire~ ~he height of tas Iath,r. The method used by the hoasehold-intetMew survey pr~luced rots o~ such ma~tu~e i~x counting ~he incidence of di~abilitle..:~ our analo~ is not unreasonable. To understand better why the data a.re. so ~suitab]e, ws might beNn by asMng ourseh-ez wlaere exacllv did they come from~ ~vl~ose illnesses do they repzesen% ~tnd to • e~eng do they measure accurately the incidence o£ disabilitica in the populatioa~ ~e report proceeds ~rom the ~sumptioa that its findings arc baml on a repr~entath, e sample o~ the U.S. population. In fact,~ ~tis in "Cigarett~ SmoNng and ~ealth Characteristi.c%" on paga 6~ that: One of ~e advan~ges of thlu study is that the data on relation,hips cigarette smoking and health are ba~ed on reapo~ses from u pr~*babillty which is representa~ve of the civilian, aoainsti/utio~l ~ff.~httion .f the Slates, thus tfllowing the data to be present~ in the lena of national The cla~ that the data art~ representative of the U.S. form% in Iact~ the basis oR which the "~ealth Conscquenc~ of Stack- in¢" makes its eutlmato~ on the m~mbor of disabilities due to smokinz. We find on page A~ the p~mary source of da~ In the United States on disability, the repo~ being based on a national probability sample, lax~ridee~ a ~olld ba::e estima~ng ~o excess overalt disability" associated with cigarette ~mohtng, Are these statements 5ustified ? .~he me~od qf samp]h~g us,~d by ~xe NationM Health Sm'vev wa*~ ~xrure. oK random and nonrandom sampling. C(~st and xaeto~ had to prescribe so many compromises with what ~r~ normal rando~ .samplmg procedures t]m~ t]m final result can b~ e~tllcd ~robpbfi~ty sample only by s,)m~ stretch of the imaginati.n. In fact the designers of the National Health Survey pointed oat, from fit, 13e~inning that the dixdsion of th~ land mass of a coun/~, into fo~ whic~ samples ate to be drawn was an "a~." r~tCt~er th~(n u ~cicnccY The sampling procedure resulted in the list of addres~a~s of holds whose members ~)~ere tr~ bo ~terviewed and not in a sample noninstitutional~ed ck ilians. But who is usually lmmd in the hold d}~rin~ actual working hours~ They ar~ housewives, children, uncmptoyea persons, retired, elderly, and temporarily or pta'ma- ~ently disabled ~dividuMs. Th~ largo p~ o~ ~e rinds'and ti~t~ cur- rent]v employed female population could no~ be expected to be in mdst instances when the inter~ iewer ca~ed~ ~d thus did not ~torm~tio~ about themselves. 'l~s part~cular shortcoming hrtd From the smnd~int o£ reliability of response~ It would be ideal Ira hold inter~qews ~f ewry adult could be interviewed ~or hiram',elL The ea:~t ~ Th e ~$atfstica; Design o/the Health ~ouschol~.lntervl~ ~urvey. serh'~ A-2, V. 10.
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,~alch a procednre, however, i3 quite high since more recalls to the household are r,quired. Tbp ruh,a adopted re~re~en~s a comprom~e between ~he method that l~ lea~t c~Dm~4vc, i.e. o~e red.adept ~or a household, ~d the metho~ m.~t rcBabb:, Le., every adult r~ondh~ for It. is iml:,m~ant to keep h~ mind that large pa~ of the data ave ~mlly ~ccoadhand~ or proxy~ hfom~tion. Th. repm~ "Gigarett~ ~rnoldng ~nd ~eal~h ~mcteI'isti~" indicates tim ext~t to wMch ~roxyrc~ponsc~ were u~ed. ln~ormution w~s collected direcfl), only rum 40 percent ~ th~ males but from 83 percent of fl~e f~a~es. a,ldi~hm, if is ]ikeh, that. ~hose mah,s who were directly interviewed carat, rm>tly fron't the disabled, tim i11~ the elderly and retired~ or unempl%ved. Ethers in surve~ sampling ar~ lmox~m to be l~rgc. Errors ~1,-i~f°rmat'i°n obtained fl'o~,, proxy ~te~ews average a~out. ~wice as, great :m those obtained b~ dirce.t interview.= Prox3 interviews al::;' known to be much mm'~ e~}dly affected by a wid~ range o~ social un4 l,~:yehological factors,a Thus;~ the method of samplin~ obtaine~ informs*ion from indivld- m:ds who an~ not repre:~ontative'Sf the U.S. noninstitutionalize~ popu- lation. Al~:., the method ended up with two levels o~ reIiabilit~ in the :ourc~ &da. Data abou~ fonmle~ probably have less titan ~llf the trror a~ d:.~tt~ about mah.s.~The fact that differences b~tween {em~e ,.moker,: and non~mokers for most diseases are either trivial or favor v'moker,% as we shall see later on, ought, to have received special attention. I)is.=>'~, ,,r dis:zbili6es counted i~ the repoz~, wer~ not, based on medi- cal t, xaminatim~ or on records of medical examination. Instead~ n,ed M~]I v tmrrai~ed interviewer queried an iaforman~ or reapond~t .l:.mt whed,vr or not tim respondent, or tim individual about whom he informed, mlffered from a disease or showed pa~icular sig~ or symp- toms. Th. tabulation of disease depended on ~dividuals who c]ffimed r. h:tv,, a, ,li:<ease dr.hvr because the doctor told them so or bemuse the. h-m,ai,,,,d ~t, or ,',q,¢,ffed ce,'tain signs oI~svm~toms which ,,'e{~ tauten 1o i~tt~c;ttc that a ~p~,cilio disease was pl'ese~tt, l'he agreements o:,lnl~ of disease obtained by such interview survevgand by inspectioR of medicul records am small indeed. " A mmtber of stndies have compared conditions re~orted in or fevrvd l'r,,m the ~ational Health Sm'rey wi~ those fwom clinical" rcem'd~. Of tho~c disen~s that were covered by the hmmehold interv] in ferns that mad~ mlsunderstan~ig on the pa~ of tim ~espondent In tim rtq,ort "ltolmrthl¢ of I1oaDItnllzntlon In the l:Ieixlth Interview 8u~ey" ~P.H.S. .% li~ll~tb,'r tat vnllSlty vt.dl0n have compsred the rates of errors for Dro~" and ~If- re~r.,mlonrw. To areriht~ onh" twlee the rate of error~ to pro~es Is moat likely an ~mder- ~dttee I~nd has t.,.n .u.ie avMlnble to the Public Health Service). Th** r*,p.rt 'qleporting ~f Ito~-Ditalizatl~n 1~ the ~ealth-I~terview ~urve~" (No. 1000~ ~erh.t~ 2~Nu, 6) compares accuracy t-ff reporting illnesses flint are in some 'way "tl~renten- ntld [turin7 va~t dlffcr,,t~ee~ he~'een the ueenracy Of reporting different disabilities arid larger O~erouees ~:,tween ~elf and proxy respondents. Con~ldering tim vast amount of p~bllelty eoncer~dn~ the beallh effeet~ of ~;mokln~. Jt Js unreu~onable ~o suppose that stmb 935 y ~-~ percen~ were reporten correctly. Agreenmll~ between less c/early defined diseases sank to its low as 20 p~'rcent.. Rehttivel~ dramatic mescal event% such as a comact with physician durin~ weeks preceding inte~iew, were not reposed 86 percent ~f the Only ~9 percent o~ ~e population rpported their len~h of hoapibd ~av ~ectly. The~act flm~ hospitalization occurred was incorrectly z~o~ed la Dercent of the t~le. Even an event which miffht be siaered t~ be the most ~'amatic medical experience in a family, bir~ o~ a child~ was reported with a ;1 percent error by hou~ehoId surv~,s. As inaccurate as interview dat~ area, flmy become doubly so they use proxy respondents., One study flmnd that errors fl'om proxy respondents were ,:,v,,r five ti~es higher than errors from self-rep's<ins indisqdna]s. How. ~_3~most .cflses e~oz's ~rom .pqoxi~s are ~'oughly twic~ that s ~rom se~r-reporung. ~ne sntdy found thab ~or ho~ ,ifal s • r 9 to ~ flays, proD, respondents made error~ ~pprox~nate.l~a~l percent o~' tile tinm wher~ st]f-respondents made such errors onlY, percen~ o~ the time. When the weeks between hospital dLech~trge between 21 and 40, salt-respondents made a 5-percent error; proxy r~:~- ~sp~nd~Sn -~. made ~t 12-percent e~Tor whm~ tlmy reported ~or tlte~r" :~ " • a a.~_ ~e~fent error when they reported for other -,~,.*~ ...... respect, to ~em,er. of a c~ • ~ " • .~ _ .... ~. .. ld, self-re,~pondents failed to re orC ddi ,~ , o pcrcen~ or the tram. proxy respondents failed to te mr~them 8 cent ofthe tim..z " "1 " - ~ ~rrors arc not llnfited to Ihe count of diseases. The cotm~ o£ smoked and who did not is also subject to considerable doubt~. Thor, are t, wo large-scale sm'vev~ t]m~ have t'nrnished a p;ttrcru of the " ~ ..... u~ msa~rc~ witl-t numht~}~ t,f estimated by the Xational Health Snrvex: by ~s much as a:> ~er , ' ' so~m m~tle, a~l ~3 percent for some female, d~e ermms.~ 1 e, at for • ~ y!ew o¢ the large error~ and the miee#.;,JT, ..t .~. :_ ,~ .. : . -~r ..... ,2~{t?,t to es~lmat~ the numl,er of dlsoa~v, that ~.~*~Lo. po~{m~uon to s~g~3lothing of ~eribinz a given llulnbtT .te~ m ~ par~mmar poputa~ma group. Uer~ainly we eam~ot {usti@ a comparison between smokers and nonsmokers. ~ ~ A1}7 comparison ~e~ween groups ha~ to be done with due re~ard a'or rn~ accuracy with which disease rates are estimated. ;,' , samph., is a t~b" random sample, and whe,t the me 1 " -, 2~,{'~ n men~i.." ' -,, . . , tmd,f ,~, ~ rehable, then bhe ,*ecuraey of eshmates mm lm {i~1~ me, aSt~Ye,~.}~se to ~e~er~b~ t~e ,m,mr~e~, is the "stu,dku'd error." ~]t.~te;tnn~ w~na ranaom samples and re/tabh:~ motho@~ oP n ,~ ~++ tr ,- ~cnt, the esh~tes of standard errom, oe ,ff ~lte ~o~sil,l~ varialt,~ ~ ,t, ~ tim estimate, i~nore th~ eo.tr;,.;.~+ .~ .... ,:-, ",-~ ] ;* .Jht3 Pf :;.,,,,mu~ ~y.um me~s~re ~s Mtown to be low, if is necesst,r~ to ~ne u~ai e~snmate of the st~d~rd error by the size of tJ-~ reliability ~ trails and references ~ee my re oft " ." L1nklng Cigarette Smokm~ t6 ~$ner,fl'~r~tm+~,~;~q~?n.~n~ Crlthl~h* r,f tlm ]te tort ~ * "1'here are : Hammond: le C S~,~fi;;q;~:~,,~f:~,~:~'aP~a'~' ~n.~lo with thla t, na Women National ~.n~ i~+t+..~"~-=" --'='.,qa,~t.~0 ..~e ~ea.tn Rote of Ozlo ~lilli,:m • obaeco Sm~Mnz Pattg~'i~ ~"~d¢~.'~t~[~J'~ ~L" 1!~ 19~, and ~aen~',~,q. W. ~,t hJ,
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936 c, ~flleient. If, as in the present instance, the size of this reliability co- ~}iei¢~nt is not lmown, although it ~ ~ow~ ~o be small, and if, m addition, flmre are eons~derabi~ doubts a~u~ the v~i~ o~ the me~- m'e ,nd t]}~ randomnes~ of the~sample, then g~e usual ~t~a~ of ~t~mdard error is simply hog xalid. ~s is e~en more ~mo ~or male :-reekers an~ ~r working ~emMes for whom dat~ w~ obtained mostly thro,,~h pr,~x~ intem~iews. The reliabili~ and wlidity of their i~ kndwn ~o b~ ~;maller by ~ magnRude flx~n for directly obta~ed d~ta. Thu:-~, ~ i~ ~imply not pos~ibl~to evalua~ differene~ begween poEu- l;,t },m ~ronp~, e~pecially ~trnon~ m~l~ and currently employed fema]~ ,zainr~g tim e~t.hn~ ~f gho ~[~ndard errors as Wen ~ ~bo repo~ "~ig u',~#~o Smoking and Health Characteristics." Be~ddes tim uneer~in~ies aboug the dat~ ~hemselv~, ~here ~ ~ re~l qa,.,~-ti,m if such dat~ tha~ were eoHee~d ~ally suppor~ fl~e eonelu- ~.~i,:,ns wlfich wer~ disseminated. a. F~:ma&,~: It was I, oinUd ou~ hefo~ thag data on femxles are moro reliable than those for m~l~s. While most of th~ info~tion females eame from self-resp~nses~ mo~t of the info~agion aboug males ,*am~:~ from pr~xieg or from males who were ~om~d in flxe home d~ing workin~ hour~ and who ineluded~ flm~fore~ any ~ployed, elderly~ ~:iek, and disabled individuals. Th,~ comparison between femal~ smokers and nonsmok~ would appear ~o b~ of speeial ~o~anee under the eireum~anees. ~'eh compari~;on of femMe smokers ~ nonsmokers does not yield ~ thag ~s ag a~) in ~in~ with tlm stated conclusions of ~h~ re~o~. 'dmo~ all instane~ where a~e-speeifle rates are eompa~d, tho ~on,~mker3 show • highe~rat~ of disea~ and disability ~ha~ femal~ ~noker& ~en ~ comparison was mad~ not between the moro reliabl~ aee-:~eeifia rat~ bug begween age-adjusted r~es~ ~hes~ ~m- pari~ons e'-ha~ged flightly. I will aiseuss ~i~ pee~iar result of age a l'n*tment~l_ more fully..in ~ moment. Bu~ even if w~ aeeepg. . the age-.. adjusted rate',~, then d~et~e r~t~ for femM~s a~ still h~er for }~on~.mokera for some of those d~ea~s for whmh tim re~o~ C~garette ~moklng and ~ealt,h Characterist.ies olaims ~ho o~posife. This is o,~ cc ,all for hearg conditions ~mre differences m ~ravMenea • 1 ' Y '- . • at. r~:x,:,r~.ed by the a~e adjustmeng ~ed and f~ale smokers h~ve hi~,'her ,ee-ad(uated diseas~ rat~ than nonsmokers, th~ differene~ am trowel. Aimed4. LXaetly the same r~l~ are found m eom~ar~ of di,.~ability dav~, for rest~etefl aefiviKy~ ~bed d~ys~ and work-loss dew. In genera]~ female non.mokers show a higher rare of di~biliey d,~'s thrm do female smokers. :D,~re is on~ veeuliar manifestation amo~ female smokers with r,,:,pe~:t, to work-loss days wlfi~h is especially worth mentioning. male ~;moker.~ are restricted to home or bed ~or fewer days th~n non- :m~,:,keq.s. Yet~ currently employed female smokers show • ~igh~ yate ,ff wnrk-lo~qa dav:~ than do non~oker~. Thi~ reversal is rather eurmus slate it would h~:~.lee little sense to conclude flm~ employmeng ~uses ~ lar~er ~creas~ in ~seas~ among smokers than among no~oker~. Anofller~ and mor~ obvious, e~l~agion is ghag fem~l~ eu~gly em- ployed had data ~n~e~ing fl~eir health and w~-be~g mpplie4 937 through proxies while femal~ who were not employed supplied th,at information themselves in the majority of instances, b. Adjustments for co~fou~i~y ~a~iab~vs: There are a nmnb~r of so~ces of differences ~ the sample populafi~ between disease and disability rs~s o$ smokers and nonsmokers. Ihe fiv~ obvious soumes oI differenc~ are: 1~ sex; ~ age; 8~ proxy responding; 4~ ployment status~ an4 ~ charae~emstic~ of informants for proxy spond~ts. Adjustments were made in the analysis only ~or differenc~s in sex ~nd age di~ributions be~e~n smoffers and nonsmokers. The otlwr thr~ major confounding favors were ignored. But pm~ resining, employment status~ and ehar~teteristicz of respondents all are rdated to th~ iYequencies with which di~easc:q are reposed2 Now~ a~ these effects on reported di~ase frequencies; du~ to a~e, employment, proxy reporting, and due to other eactor~ interact ia ~,~ e'om-plex ~a-~te~ an~ m~fresult in larg~ difference:~ in tlm po~ed disease frequencles~ dependin~ on whether or not provisinu'~ for adjus~g for flmir effects are included in tim analyses of the data and on the kinds of adjustments used. In the prescn~ hlsIanct~ adju~ments were of paramount impo~ce. Smokers differed very much from nonsmokers in the National Health Survey s:tmple. Tl.:v d~ere~ in their availal?il~y fo~ di~e~t ~te~'iow~ in their cmploym,dt s~a~s, m the eharaeterlstws o~ md~wduals wb~-~ reformed about them, and not only in their age and sex di~ibutions. Butmany of the effects of these confounding variables ara such th.t ~teractions among them could caus~ larg~ differences in f~-cqavnciy:, of disabilities to appear for groups aceident~flly ~d~o related to in~ and nonsmoki~g. ~roper adjustments for the~e confounding factors can b~ made,, ~ lie most reasonable adjustment would be to provide separ~t~ age :ulju~.f ments for each "d~rectness or lntervmw~ employi~ellt statns~ H~fOl nl~ 1 characteristic" constellatmn and compare these~ group by group. better woul~ be to compare age-specific rates within each of th~::- co~tdlations. However~ neither the~e nor any other appropriate adju~,tment~; ~0~ The analysis only used imtirect a~e adjustments for category ~quenci~s. ]ndirec~ age a'~ju~tment i~ the weakest ~f thre~ commonly used ago adjustment procedures. This procedure i~ mo~t easily a~ected by ~onfohnding variables such as proxy' reportin~z, plomnent status, or tl~c char~e~eristics of infonna~)~. ~ is most curious that the National tIealth Sur~ cv does not, to care either for indirect aze ,dinstment metlmd~: The report ¢~garette smo~ng and health chara'~te~ ~s~cs ~s the only one m ~ • ~Iy report, "Evaluation of the Aualysis Prne~dures nf the :NH~q I~tervlm~ Into. ex. amines In detail the different dla~lbution~ of the sample population a~o~g a~¢-::~x. the dlst~hutlo~ o~ smokers and ~oa~l~t0ker$. Also, each of tl ese e~tego~e~ had an appre~*l. able e~eet on reported dlgabillty freq~.iencles To th~,'~e effeetu must b~ aflde~ the bb~; ~u. It, smoking and other personal charaetvrlstlcz of the informant (for the v,.anF pr.~y tnt~r- views). AS a resu]~ the compoattlon of the smoking and the nouamokl~ff ~tmp,~ ~rc ~t* smokin~ can be ]8elated. The rel~ort referr~ to was ~ent to the National Center f.r lle~llt~ ~tatis~cs and haz been placed on file v~th this committee.
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988 of 42 reports on the s,anm,~r slmH'ar data that uses this indirec~ method. All others c,~mpara a~e-~pec[fic rates or rates that were age-adjueted by direc~ methods. c. ~rlm~ ha~p,~ns to former smokers? Th~ report, on cigare~e smok- ing and he~dth characteristics contrasted ~xfi-former male smokers, th.:ze. ~¢ho quit within 1 year and within 5 years or more, to pre~en~ ~,mokt~rs and to nonsmokers for one or more chronic conditions, for acutt~ conditions, and for restricted activity days per person per year. .....k c~m.~i~tcnt p,,tttern is, quite obviousl..$ apparenf..Fo'r all cateaories pre~enb ~mol;e~,~ave ::~ rauch lower incidence than do former smokers. Although no detailed comparisons were made ~or females~ former :~moker~' ~buw also t~ cortsistently higher incidence o~ disease and dis- ability than do pre~ent smokers. Tht~ fact that the incidence of disability did not deelin% but rather increa~ed~ for tho~e who stopped smoldnz is of utmos~ ~vortanco. Thez~ re~ stand in direct contradietion~o other ~d~gs a~d to the expectations tha~ generally morbidiky would decre~o if it was caused by ~mok~m One of th~ ~aajor clai~ that smo~ng is u hazard to h~,:tlth is b:wed:;~ on the argument that stopping resdts ia an apparent iw:rca~ in lifo expectancy. I~fact~ "The Hhalth Con~quence of~mok- ing" goc~ ~o far as to s~tte tha~: t'r,,vlo~ fln~3 on the lower dea~ rates ~tortg those who have discon- firmed ¢lt~ar,,tto umoki~g are confirmed and stren~hened by the addi~onal data r*'vh'wt~l... Th~ findings.., suppor~ the view that epidemiolo~cal data show- i~:~ lower d~-';tth raten among fomer ~oker than ~ong eontinn~g smokers can ,~,,t b. dL~mi~cd as due to :~elective ~ias and ~a~ ~o benefits of giving up smok- Ing have probably been undemtated Yet, the one finding consistent for all sexes, ca~gori~ of ~seas~ and typ~ of disabilities of ~he ~ational Health Survey was ~ to stop ~aaoldng was a~,~ociated with an incr~sing ineiden~ of iHn~s. ~Vhat lbtding~; are we to credit ~ CONCLUSIONS The re~or~ on cigarette ~okin~ and health eh~raete[,isti~ ~ based analS ~io procedur~ ,rod it lacks conviction that it really demonstrat~ any difference between ~okers ~nd nonsmokers. Ye~'the same data fr~-~m the ,::amo repo~ ha~ ~ been u~ed to estimate a number of d~orent td'p,'~ :rod ~,m~gorics of disabilifi~ suppo~dly e~msed by smo~g ';The Health Cbn~e~ucnce of @~oking,'~ which is a. 1967 follow-up pub- lication b~: the Pubhc ~ea]th Service to the ~96~ ~epor~, Smo~g and He:tlth. q'his report m~d¢cs specific claims about ~he total days ~eri- t,an:~ ar~:~ ~uDp~'.cd to have lo~t, from work or spen~ at hom~ or in bed due t,~ ~n,~kln~'. Thc:~c fi~ure~ a~ large: 77 million days losb from work, 88 million ~:pent iu b~*~l, ;~06 million eh~ya of restricted activit.y, all "due 1o" ~mokinff. None of these fi~tres even appear in t,h~ o~al s~udy~ thc~ anz e~tiintate~ enid t o be based on much smaller fi~res contained tha~ study. T]m~e ~:une tighten also are u~d continuously in pamphle~ ,qretd:ttc~, ~ 't.h¢ N~ttiom{1 Clea.rinffhouse ~or Smoking and Health. If :tny lc:.~,u is to be learned from this i~sate~ it is not that smoking ~,au~:es ~uto]d die'eases and disabilities and los:~ from work, but that chtim:~ td~out. :-,uch controversial topics need to be ve~ carefully and int, dligent]y reviewed even if they are made by publi~ agencies or by 939 .other impeccable sources. Such claims lead to actions that r my ~he health and well-bein~ o~ large numbe~ of citizen~. If, wouldZ~pp.~tr that a thorough review ~ the quality of d~t% the qu~lity o~ of these data~ ~d the soundness of ~onclusions h~ve to ~o mo~t fully established before they are used ia suppo~ of public policy, (Attacl~en~ t~Mr. S~rling's ~atemea~ follow :) ~dllCa~on : A.B. ~with honors}, ~nl~r~ity of Chicago, 19~9. M.A. Unlverslty of Chicago, 1952. P~ D., Tnlane Unlver~ity, 1933. 2~ro£essional Affilfa~ons : Prof~sor of Applied 3Iathema~es and Computer Science, Wa~hlngtna T:nl. vcrslty, S~ l~uis, Missouri ~ Visiting Profc~r In Computert~ and tI.ma~d- ties. Hebr~ Union Collog~, Cine~natl, Ohio; Pre~:idcnt, MEDC031P Research Co~oratiom Cincinnati, Ohio; Se~or Uon~l~g E~[tor In pater S~ence, Macmillan Company, N,.w York. }'errantly Prnfe~sor of Bi~tati~tlcs and Director of the Oom~utlng Co~ege of Medicine, University of Cincinnati, Cincinna~, Ohio; At{~dntaat Profe~or of Statlstl~, Del,a~ment oe Statistlcs, ~[ichigan Star. Unl- v~'sity, East Lansing, Michigan. ~rnfessinn.1 activities: 296~7: ~[ember of ~e Panel for Biology, Management and Social of the Mafl~ematics Ass~lation of America. 1963: Chairman, Committee on A~Ivltle~ of Blind Profe~slonab~ of tl,~ eiafion for Computing Maehlnery. ]fl~5: President, Biologlcal Informa~on Proco~Ing Organization. 2966: Member.of Commltt~ on Radiation Do,merry, American Asf:oclatloR of Physicists in Medicine. 296~67: Chairman, Committee on Accreditation, Association fi~r Computing Machinery ; Consultant on computer data managem~nt ~md ,t~ttif~tlcal pr~:,l,- ~ms to the National Science Foundation, the V~terans Admini~,tratlon, and other health agencies. • rof4ssional and H~orary $oete~e% Honors. Awar&~ : Amer. 3Iath. Assoc., ~lath. See., Instit. ~ath. Star., Amcr, 8tat. As~.:oc., Ill,. metric See., Southern 8oc. Phil., A~s~ Computing Maehlm,~, Amcr Univ. Prof., N.Y. Acad. Sch~nee, Amer. Assoc. Phys. Med. Slgmn Xt, P1 Mu Epsilon, Morrison Cressy kw~d in Natural Science. 2cr.mnaZ: ~orn : 1923, Married : 1948, Two Children : 1952, 19~5. BIml',I'0gP.AI~Ky OP TIIEODOR D. ST~L~N0, BOOKS ('omputer~ a~ the Life Se~e~.ee.% CMumbia Prez~, D~ember, 196~. 1ntrodttvti~ to Ztat£~t~ea~ Data Processing, Prentice-~all, A Gafde to PL/I, Hol~ ~lnehart and Winston, Feb~a~, ~ompu~ing ang Oomputcr Science, Mac~llan, 1970 (in pre~). Oo~putat~on in Radiology, (T. Sterling, ed.) Thomas ~ablishen:, 1971 .%RTICLU5 Air Pollulion~/h~ Indos~ial Viewpohlt : A comment. JO][. ~obot Da~ Scroening~An b~lqnitons Automatic Search Tt~elmlqm~, son. Aprgl~8~O, 1969, tin pre~). Mensuzing the Effect .f Air Poltution on Urlmn M~,rhidity, Ar~,h. Envfron, (in press }. Disph~y Devices for Computer Tran~4at~l Braille, P,'occcdl~g¢ Confcren,~,, Proccssc# ]or Braille Manufaet~rc, 1968. Center for Sen~.ry Aid~ and Development, Ma~:sachusetts Institute of Teclm.lo~. Automation of ~adiation Treatment Planning VI : k {;enernl Fit.hi Eqnatl,m Calculate Percent Depth Dose in the Irradiate, l V.huoe of a C,-,t,alt Brit. J. RadioL, ~0: ~63~6S,
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94O Urbau Ho~¢p[tal .~Iorbidity and Air Pollution, A S~eond Beport, ~ r~h. ~c~Ith, 15: 862~74, 1~67. A Nm~- Direction iu Rehabilitation Througll Advanced Instr~mntatioa and Computation, JAMA. 2~0: 6~L~, ~Iay 15, 1967. I,'in~l h'a~ative Rep~, Traf~in9 o~ tl~e Blfn~ tot ~ro~ess~onu~ ffomputvr Work, lh,pt, o~ ~.E.W,, RD-1585-~-67-C2~ 1967. Robot Dat~¢ Ser~:<~nlng: A Solution to ~IultivaHate Ty~ Problems in ~e cal and Saelal Science, ffomm. AffM, 9: 5~532, 19~. A ~loloZtcally-Oriented C~mputer Language~ Ann. ~.Y. AceS. o~ Sd., I~8:7~ Cane~:~r ~hcrapy--Computation an~ ~isuallzafion of Dose Distributions ia Ex- ternal Be:~m ~aerapy, $. ~hroa. DI&, 19:~89,1966, U~:*~ 0f th~ Computer to Teach Introductory Statistics, ~o~m. ~.~, 9:27~276, Automation o£ Radiation ~eatment Planning, V. Calculation and V~ualialtion .f the Total Treatment Volume, B~t. & Ra~io., 88:9~913, C*m~putem : No Longer a Big Bargain ~or Uneducated Users, Oomputt~r8 and marion, 15:1,1~. (With S. ~ollack as senior author). ~Tt'lcetfnn, Training and Placement o] Blind Oomvuter ~rogrammer~, Re~rt of the &s~oclation ~or Gumputing ~lachlne~, It; ~Iedieal Diagnosb~ a General Oomputer Problem, d. Ame~ Mcd. a~8oc.. 198: Urban M,¢bMlty aml Air Po~ution, k First Report, Arch. Environ. HeaJtk. 13: The Blind a~ Computer Programmers, Rehabilffatfon Record, 7-10. 196~. Role .f 8ta~;tle~ In the World of Computers, A~. ~.~. Acad. 8c~., Cat, y,T Timrapy~ompu*afion and Visualization of Dose Distributions in Ex- ternal Beam Therapy, J. ~hro~, Di&, 19:5~3-~39, Praeccdlttg,~ on the Braille Research and Developm~t C~tere~e, Sensor Aids. Evalu:aion and Development, Massachusetts Institute o~ Technology, Novem- lmr, 19~3. ]0,bet Data Procez~ing Techniques for Multivariate Epldemiotogical PreTKctbms, Dr.a N.Y, Ace& Science, 126:77~T~, 19@~. ComImtatioa o~ ~a tla~on Dosage~, S~cy, R. and Wasman. B. (ED), ~omput~ in Bkmwdtca$ ~esearch, Academic Press, New York. 1965. (Ohapter 17). T.ward aa Un&rgraduate ~athomatics Program tot Fu~re Researchers in the Fh,ld~ c~f Biolo~ and Medicine, Fed. Prec., 24:5-9' 1~6. Careers 5~r the Blind tn El~tronic Data Proc~siug, Oc~,~. Oarlock QusW., 9: 1-t, I fH;3. The Blgnd In ~DP, AC~I Committee on Professional Activities of the Blind, Dt,Hgil and 0porati.n of a Medical Computing Center, Ann. ~.g. Acad. Set.. i15:5~1-599. It1¢14, ( With E. Saenger as senior author). Plunnlui; Radiation ~reatment ca the Computer, Ann. X.I'. AceS, 8dcnce. I1~: 97t~9~ff. 196.L Prof,~;~lolt~tl Co~puter Work for the Blind, Oomm. ~ OM, 7:22~231,19~4. Computer Work for the ~lind, d. Rchab., 30:6:2~21, ~. Bpidmniology of Din*:a::e A~iated wt~ ~ad, Arch. Environ. Health,8.,~.~3~8,'~0 ~la~,,matle.1 AnalyM~ of Lead Burdens, Arch. ~tqron. HcaZth, 8:4~51, 19~. Automati.n of Radiation ~eatmcnt PlanMng, ~. Derivation of a Mathematical E~lm'::~i.n fer the r~rcent Dept Dose 8u~aee of Cobalt 60 Beams and Visuafi- 2nH.n of 5Dfliipb. Field Dos~ Dis~ibu~ons, Brit. J. Ragio., 87:54~5~q. Locating Placenta Praevia. Prec. of the Roehesto, flour, on Data ..teqnisitio~ any t'roccssin,¢ In ~iology and Medicine, Pergamon Press, pp. 103-111, 19~4. Do Mallgauanch,s Result from Dialectic and Thin.uric Relation?. ~enetie.~ an,l tlw Ep[ffcwMology el Ohronie Dise~e, U.S. Dept. of Heal~, Education and Wt,lfare, pp. 35~371, 2[ED~OMP, Part 1. h'tatl,~tfcaZ ~y,~tem.~. ~i~dical Computing Center, Cellege of ~l~lci~,, Unlver::Ity o£ Ci~inna~, Ohio, 1963. ]tor~m, Ca~lum, Chromi~, and Nickel In the Blood and Urine, Arch. HcaRh, ff :28~293, 1963. (~. Imbus, as senior author). Pot,~nUal Hazard o£ Exvo~mre to Lead, Arch. Environ. Health, 6 .-,m--~-, (~ Keh~ a9 senior author). Carei~ogc~ie Effvet; of 1-131 Compared wi(h Xqrradiafion~A Review. Hearth ~h#sic~, 9:1371-1384, 941 Automation of Radiation Treatment Planning, IlL A Simplified Sy~,;tem of Digit. izing Isodo~os and Direct Print-Out of Dose Distribution, ~rit. J. 86:522-52% 1~3. ~avenous Motho~exate (Ameth,~pte~n) Therapy t~ the Tre;ttrno~t of ~ia, Pediatrics, 81:83~889, 1~3. (with ft. Perle. senior Auto.ninon of Radiation Treatment Planning II : Calculation ~ f Non-C, t R~eld Dose Distributions, Br~t. J. ~adtoL, 36:6~7, obot Treatment PlauMng, Prec. o] fhc Roehester Uonf. o~ Data Aequf:dtian Proce~Mng i~ Biology and Medicine, New York, 1962, Perg~ton P~v',,:~ 2fl~19, 1963. ~o~t Data Scr~ning, ~r,m. o] t/~e Rocheatcr ~nf. on Data AeqttL~iti.u Proee*slng fn Biology and Medicine, New York, 1962, Pe~am,:,n Prc:::t, pp. 0ccu~tional ExD]sure to Organic ~ad Com~und~, Arch. ~nvfro~ a :~2-~36, 1~2. (R. De~rlvllle, ~:enior authr,r). New Developments In Chronic Dis.use Epldmuiolo~, ~ompcHng Rh:lm anti Elf ~bility, Amer. Ind. ~ygie~e Assoc. J., 28:4~3~46, A ~ractical Pr~edure for Automa~ng ~diatio~ Treatmea~ Plannings, ItHt. RadioL, 35:72~7&q, 196L Epldemlologleal Methods and Commm~ty Air ~ollu~oa, Arch. E.riron. 3:267-275, 1~1. (~. Phair, ~enio~ author). Competing Causes of Death in C~I Tar Workers, Ketterlng ~,port, 1061. Cesim-~7 ~tentio~ and D~tfibudoa i~ X-Irradiated Rats, U.S, Army M~ Rogea~h La.boratory, Fort Knox, Kentucky, ~eport #~05, 19(~. (O, semor author). Seasonal Y~latioas in the Birth of the Mentally Deficient, Amcr. J. Pub, ~0:95~965, What is ~ ~uliar About Accepting the Null ~9othesD,?, PsyehoL XeopIasia Fo~owiag Therapeutic I~a~ation for Benign Co~dltlon~ t~ Childhood, Radiology, 75:88~9~, 1960. (E. Saeng~r, senior author}. PubIi~ations Decisions lind Their Po~s!ble Eff(,et~ tm Infert, nee~ Drttw~ Te~t of Signiflcane~or Vice-versa, J. a~ner, Slat. Assoc., 5.} :30-34, Pulmonary Function in Children I and II, d. A?lcrgy, 80 :Gl~[~t3, ' " 13o9. (L. Itt,r~. stein, s~lor auHmr). Tal.:es ol Normal Pulmonary Function Values in Chlldre~ Age:~ 6-1t, Printing Co., Cinci~afi, Ohio, 1959. tL. Bernutein, ~enior authf~r}. The Anorexlgenie Aetien of Dex~o-Ampbeta~ino ~ulfttte lq~oR Re~VOllSeS of Di~ering. Strength, d. Getup. add MhyMol. ~,~l/ehol., o~'.1 "'~O-Is.,''' 1959. (P. Siegel. senior author). Sources of Contextual Coas~ntnt upon Words In 8e~tem.es, d. E.p. 5; :l~l-lS0. 1959. (H. Abo~, senior author). Eff~.t of Irrelevant Drive on Extinction, PaydmL, Report #a, 1957. A Central Surveillance System Meam,rement Model, Part I, II, ProJ. Ml,:hb:a~ Zgla, Z914, University of Michigan, 1957. A General Su~ey of Statis~cal Decision ~heory, ProJ. Michigan Z915, Univeraitv (.f Michigan, 1057, " ICoples of relevant correspondence with the National Center for Health tisties and :Dr. ~-~dicott's committee.) D~TMENT oP ~KTH, ~UCA~ON, AND Washington, D.C., March 1~, Prof. T~ooo~ D. Deportment o~ Applied Math~a~ any Gomputcr ~cicnees, ~eltool o/ tng any Applies ~ci~ce, W$'~hington University, ~t. Louis, Me, DEAn Pno~ssog STEB~'O : ~e appreciate ~e opportu~ty to ~:eo [m early of your recent eri~que of ~e Center's rep.rt on the eol~ddenee of elHttrette smoking habits and sel~ted health ~a~cteristic~. .Mthough it would be possible ~ reply in greater dekdl, I would like to only sever~ reactions of a more general nature. First of all, one of your major criticisms s~em~d to ~ply that we are business of testing hypo~eses. For example, in your letter you ~ay "the
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942 vl~,w tcehnique~ and n~ethod,~ by which the Center operate~ f~imply do not lend tlwr~,~clve~] to te:-~ting hypothes~ concern~g differences iu disease frequencies." ~,, wl~h t0 make It clear that we have never formally tested by.theses us~g ~,~ ,~tta and do not claim ~hat ~ey can be u~ed for m~g formal te~ts of the hypother, c~ that A causes B. ~ such te~ts are made, ~ey are made by others ~lt~g ~ur da~. ~re do frequently point out whether differences that show up within the data are explainable as chance results or not, and ~is ls co--on practice In descriptive ~urveys of the Health Interview ~urvey ~y~. but ~is is a b.~g way from the k~d of hypotheses testing ~at one does in an ex~rimeatal ~itaation. O~r da~ are n~:~t even quasi-experim~tal ; ~hey a~ de~erip[ive. It is unly by vt~wlng our da~ in the ~ers~ctive of all that has gone before ~at one x~,uld, tn ~y op~i~n, be jus~fled In corn,lading: here ~ one more p~ce of evi- dence that t~ consistent wi~ the easuat hypo~es~. I think you know that we rece~lze that inte~iew su~eys have problems of uwa::~ur~*ment erre~r, as do all types of data collee~on me.anises. We have been the.. rival to I~olnt to the~e measurement erro~ in our Health Inter~ew Survey, as i:~ ~:vldcaced by our methedolo~ series. (We use ~ese as a basis for coa~aued h,~provcmcn~ of the survey). You have ~ointed out some of ~ese measurement ~:rrt, rs, but yen fluff to ~oint out that none of them would have si~fifi~nce unless 1~ had been :;ho~t that it yielded a differential bia~ in responses for smokers as t~ppnxed to non-~moker~. W~, ~ce no evidence of differential b~s. Laek~g su~ e~iden~. It is more. r,,m~t,nablo to acce~t than to discard the indication of apparent relationships r~,fl~t~d in the rc~:ponden~,' replies, particularly since the d~er~ces are con- ~l*~t~at with tho~e ~hown in ma~ other stunts, Finally, the descriptive findings of this survey, far from emphasiziuff the u~nkn~::'~c:~ og an interview ~u~'ey. ~em ~e stren~hen the e~dlbllity of SllCh ~,urvcy;~, because the findings a~ eons~tent in so many places with those from ~.~*rtality ~tudiez. For example, jading from what mortuary dat~ ~ow, one wtmld ~)xpec~ to find much larger d~erenc~ for chronic xes~ira[o~ disease, and third, In fac~, ~howed up in the Health Interview Sur~ey. Shouldn'~ the sta~sticlan 1,,. ~,nceuraged when auch Ioglc~ ~formation s~ms to be count through despite Ih~ "noble" due to imperfeette~ns in the ~ethod? I suppose it is quite an under- ~tc~nt to ~:ay we were disappeared at the absence o£ ~y recognition of the above In your critique. Nce,dIe~ to say, we shall continue to examine wi~h great interest the analy~s and conclusions pre~ented In your re~or~ It is o~ continuing concern for us ta t~,~.k w~y~ of improving ~e data whi~ ~e collecL Allow m~ to thank you again for sending ~s ~e repor~ Slnc~rely yours~ ~o~ D. Woo~v. D~rector. $~u~r 12, 1968. DtT.~rlm~r~t of Radiati~ Thcrapff, Ch tease, Ill. D~u G~.~-m~: About three months ago I was asked to review a PHS repo~ ~'rditb~d ~iffarcth~ Smoking etn~l Hcalt~ Characteristics. The r~uest came ~rom a gr,:~up of attorneys representing t~e tobacco eompanies. ~ter a careful ~view and evaluation of this rel~ort I ~neluded that its authors were carried away by th~dr z~,al t~nd public ~drit, very much to tbe derwent o~ sound scientific reason- l~*~C Tim ¢'.nclu~lons advanced by the ~ves~ga~ra simply have no basis in Tb. ~2.*rt w~,uld probably not be of any consequence if it were ~ust anotl~er l~qa.r publb;h¢~ afb*r in~uffieient review. However, cigarette smok~g and its -t6~m on h~,alth are volatile i~sues and the findings of this study will g~t more th~n pa'-:-:ing attention. Whether the ~dustLv (or ~e~ representatives) u~. ~,f my report or tind ~omeone else who is perhaps more tom.tent than r~'m]or them the ~ame dceisio~ is really beside the B¢~tnt. Sooner or later the t]wm.d/hle shorb.o~ings of the report on Cigarclte~ ~'nzoki~g ant ~ealth Charac. t,rL~tics will be~'~me an unplcavant issue lm]ess properly ~eviewed and corrected On~ uther cent, era which I am sure you share with m~ and many others o~ our ,.:~lle:~gu~:'~ tu that h~oxene~s In reasoning in one report may have serious con- t;tUlUt'~lo~xl4 111 other :treas. If we acce~t the methods and procedures in the report 943 on Cigarette ~toki;~g and 21~alth CharacicrL~t~c~ we will have to accept at ~ame time Kreblo~n as an established ther~py methud m~d ~:aa.y otht~r which now cJutt~" up tl~e market as proven medication~. Again thin d:tngcr espe~ally because considerable use is being made already of ~hl:3 rt.port to ~te the "damage" done t~. the ~onomy. C(msequ~lly I have requested from the repre~entative~ ~f the vl:raretie panics and have ohtaiped their agreement to my demand that my critique presented to the Public Ileal~ Service. ~owever, rather than p~sen~ag this critique directly to the *)tti~ ~-. of the geon General, it would be very help~ut to the Public Health Sere'ice If the comings of the retort would be reviewed first by a body ~ whom the Publl~, Health Service has placed a considerable amount of tru~t. I x'cfvr here t~, tln. conu~ttee headed by Dr. Endicott of which yo~ are a mem~r. I ~n-lll appre~*l~tt,, it ~us ff you were to draw this critique to the att~tion of Dr. Endicott aml .f th~ committee so tha~ the Public Health Service may obtain the .pinion .~ qualifi~ body of exports. I think ~at i~ thi::~ way the ~hortcomi~gs t,£ the, may bes~ be eorr~ted. Became of the length of the repo~ I have also abstracted ~md ~uu~mariz~,d ~y findings. I am inclu~g t~ee copies o£ the report and three copiv:, of the mary for your use. I w~ ap~r~te anyth~g you see fit to do In thl~ ~tter. Sincerely yours, THEO~On D. S'r~o, DEP_%RT~ENT OF HEALTH, EDt'OATION, AND WELFARE, PUBliC ~EALTH ~ATIONAL ~NTEa FO~ HEALTH STATISTICS, ~ash¢ngton~ D.G., Fvbr~ary ~, 19~. Dr. THEODOR D. STE~G~ W~hlngton Univ~slty, .~t. Louis. DEXE DR. ST~LI~G: This iS to acknowledge receipt of your latchet repo~, "Evaluation of the .%naly~is Proe~ure~ of the NH8 Intcxwt~,w Dat~u" Ar~ you probably know, we are all quite Interested in reading your rep.rt. Wt.~ld be possible to acquire some e~ra co~ies ia order to expedite this I~r~ce::~ our sta~? Also we would llke to receive a copy of your palmr mentlmmd in bib~ography en~tled "An Additional Eealua~on and Critique of the Li~g Cigarette Smok~g to General ~Iorbidity aud Disability" (Item bet Sincerely yours, ~]LI JAII L. D~revtor, 9fvision o~ lIcatth I~tervh'w Mr. S~~ (presiding). Thank you~ Dr. Steding. ~lr. Eogers ~ Mr. R~z~s. Eo questions at thi~ tim% ~Ir. Clmirman. ~r. S~~. Mr. Watson ? Mr. WaTSOn. D~ Ste~ling, a~ I understand it now, tim technical reason that you question ~everely the accuracy o~ both the thding~ and th~ concl~ions o~ this particular report is based upon tim ~act t]mt you had, accordin~ to 3,our own a~i~ion~ a 60-percent, proxy in,of ~tion ~ re~ere~e t~ all of the males. Would that be your contention ? Mr. S~,~. It would be one of there; yes. Mr. WAtSOn. Earlier we h~td asked a stat~tician as to whet, her m" not a repo~ would, be considered: , ve~ reliable ....from whid~ 60 la'r~'~mt,, .. o~ the in~ormshon was gamed by proxy. He,s~a~d thjt~ }~ hr~ i~ would not be so. Do 3,ou ~ow o~ any credible statzsucmn or mcmt,:,r o~ your socie~y~ wha~ver it might be~ who would recommend ing"data gained from such a rep~!
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944 5It. ST~xm~rrO. This is not a matter of opinion. There exists a report published by tlm National Center for Health Stati~ies which shows what the error duo to ~roxy reporting is. Errors are ~ven in great de- tail and analyzed according to different t~cs o~ d~seases and other factor~. ~fr. ~VA~so~. ~ab document is that. Does is sp~ifical]y gi),,e any 1,'r,~t-mta~e ratio of reliability er unreliability as it rela~ ~ percentage htformafion gained by p~oxy ? Do [ make myself de~r ~ 5ir. W,x~sos. Dc~,s i~ give any de~itive percentag~ .5It. S~r~a. Y~i it does. A study performed by the Michigan Rc~:e:~rcl~ Council under the auspi~s o~ the ~tiona] Center ~or ~o~dth 8tati~t,ics ~ive~ many tables, many o~ them ro~owed in my report :~abmitted i0 th~ Pu~llc He:dth Ser~ce of exact percentages. 5Jr. ~V,x~so~. Doctor, do you ~ow ~hether or not of t~'s 60 ,~ tl~t~ information relative to male% ~hether it was gained ~om wives o~ ff~tincd frora children? I believe tim Surgeon General contends that raost o~ ~t was ga~ed ~om wives. Do ~2u ha-~ oan$ information as to how i~ was g~ed ? ~'. ~u?~. I have the ~at~ ~rom th~ actual report. In examin~g thc~;e data, we ~ound that most o~ this in~or~tion was given by ~ves. Sir. W,~so~. I fl~k you brought out • very ~terestmg point, that of tlm men who wer~ actually ~mr~ewed~s~ce it was ~ dayt~e w~5'~ ib wa~ only 40 percent. D~ 5 ou ~ow whether or nob it w~ day~ime ,~r',,w, nin~ or when the sum oy was made? Mr. Sw-;nsr~. The survey procedures are not that specific. In going through the teelmique~ used, a woman interviewer was hired. She xx ~:nt, fo the neighborhood aml she tried to fiud someone at home. If she found ~omeone at home abe wouhl interview that perso~ concerning ~tll olle~r adults .... [~re~eut m d~e household. Somettmes sho would come back in tlm evening, but mo~t of the time if she could complete her information during the day she would do so. .kff~dn, it i~ clearly stated iu a description of the procedure for the hou,ehold ~urvevs~ {his wa~ felt to bo ~ big problem ~th the repo~ but budffe~ limid~tmn:~ would not permit" a more exact, survey. ~r. ~ ~ .vrso~. In the so.ealJed morbidiW s~udy~ of com'~o, there were uo cit~z,~ns of the military or any other institutions interfiewed, were thor~?? So far ~t~ I can re~d]. ' Tle,~-;~ were only noainstitutionulized individuals. I m*~y mention flint there were a lob of people not interviewed be- e~u.:~t~ of lhe ~Mection of the ~rimary ~ampling units. If you would like to interview ~x repre~entativ~samp]e of the U.S. pop,flatten, you would :-vlect ~adividual~ at random~ let's ~ay, from ¢l~e census ~es. This would b,:* extremely difficult to implemen{, because you would huva to send an interviewer, let's say~ into the Ozarks to inte~iew one pereon. Th,:~reforo, admi~strativ~ unit~ counties and usually populated ~:~mnt.h-% wert~ selected. The selectmn procedu~ are stated by the tional Health Su~ ey~ incid~:ntally~ and do not have the word random in them. The. basic sampling units were heterogeneous a~inistrative unit~ u'~ually counties, which have as much ~s possible ~ heterogeneous population. 945 hfl'. WA'J'~ox. So, in an efforl; to try to capsule your testimony, the. methods of gainiu_- this information were dubious at be:qt~ so far as a general statistiea~ method used for gaflmring such data. Th:t~, woulffbe No. 1, because of the high percentage of proxy information. No. 2~ even the i~ormation ~at was g~ine~ 50 percent of it on males by pro~, even the conclusions that ~ere ~ained or made on tha~ information are highly contradictory. I~ that, ~n essence, fl~e tl~st of your testimony ~ ,~ , ~'. S~. I would ~ay that this report contains t~t~e~ ~hich apparently have been read by very ~ew people. I would ,,uspect that many individuals who hays t~:~ified concerning this report have ve~ little, perhaps no mor~ than to read tho eonehsio'ns from to cover. But this report contains tables giving exacg breakdo~ n~: of how many indhdduaIs were counted~ who ~moked, who di~'t and how ma~y ~s~ses were counted. According to the breakdown,~, very often nonsmoket~ showed mor~ diseases t~an smokers. Formt~ smoke~ showed uniformly most diseases. ~ ~ ~r. WAwso~. I personally looked at this u little bit., Of coun~,:, I h~v~ never made the in-depth study of this repo~ as ~ ou have. But even with a cursory e~amin~tlon of that, I saw just glari~.g contradic- fleas, and even information flm~ was starting so far as c~tradictinl, the position of the S~geon General. ~en they were ~ueried about it', somehow or other they attached little si~ificanco to tHo~s fi~aare~:~ th, at. seemed to repudin~ their positions, but they ~d ~v~ ~ lot of Cmphtw, i~: to ~ose fi~res that .upported their ~omtiou. I was raffler distressed at~m~ it. I thi~ it is helpful that a m~m i your position would give us your inte~retation frets a prof~.~ion~d st~ndpomt. The~ you yew mucl~. ~. S~~. ~. Pickle. Mr. Pm~. Tha~ you, Mr. Chairman. Pro~essor St~rl~g~ your dive,cement with th~ su~ey mad~ by I~W is ve~ r~veal~g~ and somewhat s~rtl~ng. You take eontra~ction with some o~ their findings. I notice ~ your teatimbm~ and I haven"~ had ~ chance ~ read all of your test~ony, you z~ia p~ge 1, "I w~ asked to review th~ Public ~ealth Ser~ct, publit'~:d~km of Ci~rett~ Smo~g and ~I~]~ ~aractorisfics." I wanted to you, who aske~ you to mak~ this survey ~ ~r. S~o. Thes~ were :~ number of gentlem~ who represent at leas~ told m~ they repr~ented some of tim eigaretto complain. Mr. Pm~. How many sampling~ did this survey repre~',~nt madt~ by the National Center for ~eal~h Statistic~ I see it is full of centage% bu~ do you have ans idea how man] they actually su~e~,c,1 Mr. S~Lm~. They clai~ 144~000 indi~duals. Howeve~ on read~g it t~ out tha~ 5 p~rcent of these individuals wer~ n~ver iu- to~wed nor was any member o~ their ~amily ~ter~ewcd. It simply a~umed that if i~ a s~pl~g se~t a household wa~ e~pty and nobody ~as there~ that the people who lived ther~ had the ~anto characteristics of the people in the general population. Second~ these do not represent 1~0~000 ~nterviewed whatever 5 ~ cen~ less ~vo~d b% bu~ actually only hal~ of them~ becau~o tlm who were int~ewed were o~y some of the male~ and mo:~t )~f ~em~. So your question is d~cult to answer becaus~ tim report. 29-23~6~--~. 3--5
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946 it d~:~cribcs illness aud disability among 144~000 people, while in actu- ~dit,~_~" n 'ob"ablv~ no mor~ tha~ 60 ,000 or 70 ~000 wer~ actuary interviewed. ~ . ~[r. Pxc~. I ara ~ little bit con~sed now by ~,our testimony. ~ ou '-:aid it covered as many as 144,000, 130~0 to 140~00 people; but these i~eurc~ were arrived a~b~ k~kin~ re'cups and blocks and pu~g them m by ~rev~ous studies. You ~a~d no~ more than 5 percent were a~t~fiy Mr. S~a~. No. I ~aid 5 percent were not in~rviewed ~ all. That is according to the~o fi~res. Y'iv~ ~rcent we~ not in~i~wed at a~. ~Ir. P.tc~. So approxima~ly 50 ~er~nt of them were actually intcrvi~wed~ or in that neighborhood? Mr. Swa~ir6. Let me repeat: ~ive percent were not inter~ie.wed ~lor any information obtained about ~hem. They were simply added t~ tlm ~amplo becaus~ they lived in the sam~ s~mpling u~ that was ~::~,lcctcd,ior sampli~.~. Of some 185~000 individuals who re~h~ed, only ,t() percent of the males were interviewed. So if we assum~ half of the popul~tion ~ be male~ which is not u~ikely, there should have been about 67~0~0 males in this population~ o~ which o~y 40 percent we~'~ hd ~.rri~v~'d, which is rouglfly 25~000 males. Mr. Pm~. Did ~oa conduct a survey on a similar set o~ questions or ~imi~r ~ac~ based oa tho Public Health S~vey ~ ~fr. ~:~m~. No. I u~d data pr~uced by the National Center ~or Ht~alth 3tat]stics~ i~el~. Tha~ is~ I actually obtained copies of that da~, ~::~ ~'~:,]l a~ coph'~ of otlmr sur~ eys which were conducted by the National Cc~ltt, l for Health Statistics ~elative to glfis study. Mr. ~lc~. Did you interview people persona~y ~ ~Ir. ST~m~NO. No; I did not. The~ were two contrac~ let by ~e m~tion~d health survey to match th~ accuracy of their counting pro- c~.dures against medical counts of diseases. It is these data which I used. Mr. Plc~. In your test~l~onv you s~y that ~wo preview, s sh~dies hav,_~ ,~)~mons~te~ that medically documented illnesses and coun~ obtained by the mcd]ods o~ the Public Health Service su~,ey may dis- ~gr~¢~ as much as ~0 percent ~n the case of some illnesses. ~Ir. ST~a~m~¢~. They may di~agre~ in as many as 80 percent o~ the Mr. Pm~. That is quite a challenging statemen~ to the survey nmde by. the ~ublic Health Service. Mr. S~:I~I~'t;. That is correct. These figur~ came ~om the follo~dn~ ::,tudv. They came from the ~ational Center for H~lth Statisgic~ :-~ ud), t~titled "Ilealth Interview ~espo~es C~mpared With ~fedical /~:~,:ord~ Vital Health Statistics," Publication ~o. 1000, seri~ 2, ~o. 1, Publ(e Health Service. That was produced in 1965. It has direct qnotes ~t:-: w~.ll a~ ~ho~dng the actual amomxt of error. It tur~ out ~at for some dise~es the amo~m~ o~ agreement between inte~]c.~ count and the known count of dise~ in ¢he pop~utiou was only ~0 percent. Mr. PmK~. If ~our fi~ and your statistics are correct, and I ccI~y dont ch~l]epge ~em--I would be ia ~o p~ition ~o do ~a~ if _~hey ~re co~t~ thenyour sta~men~ o~ht to be chiseled or tlmy ought ~ ~ fo~urded to t.he ~ubli¢ ~ealth Se~ice ~or ~ response. ~ d~)~t't think th%v have t~ifi~ ia suppo~ o~ the~ sMgi~i~. If your ,~tub~ments are ~b~ ~is ~ ve~ ~v~B~ and ve~ ~~g~ ~d I thinly, helpS]. 947 l~r. ST~.~.~NO. They were forwarded to the Puhlic Health Service. Mr. Pzc~,~,. Thank you. Mr. C~R~. Thank you~ Mr. Ch~iman. You are prof~sor o~ the Depu~ent of A~plied ~I~emati~ trod Computer Scienc~ WasMng~n Univemity, ~t. ~uis, Me. ? ~. S~s. Yes, sir. Mr. CA~. That is quite ~ position, an outstanding position. I thinl; ~ mm~ should l~ow ~s s[atish'~ ~nd computer scien~ ve.ry well to in such a position. I was quite interested in several thing~ ~vhich you have brought out here, ~ pa~cul~r ~bout female smokcm ~ewer disab~ties thm~ do nonfema]e smokers, i believe tim figur¢~',-; the Public Health Service bring that oat. Mr. S~a~wa. Yes. Do you mean ~em~l~ smokers and non,rookery: ~. CA~. Female smokers have ~ewer ~bilifies ~ do non- smokers. ~oder~ smokem and males, among males, for instance~ have a ~bility r~e ~aller than that of nonsmokers. You ~o~d the o~ the Public Heal~ Ser~ce to bear this ou~ is that truest ~Ir. S~s. Y~, sir. There ~re tabl~ ~n~ined in tim later part o~ ~ repo~, som~ 23 or 2~ t~bl~, w~ch simply verify, the ~c~ ~at for many ~seases female nonsmokem show ~ higher disease rat~ th~ do female ~mkers, and that ~or some disea~s ma]e nonsmoke~ show a higher dise~e rate th~ smoke~. ~m va~om~ o~r ments I m~e come directly ~om an insp~tion o~ thee table~. Mr. C~. The Public Health Se~ice in obtaining their stati~:ti¢~: h~td part o~ it done by proxy~ di~ they no~? Mr. Sw~:~.~go. That is correct. Mr. C~m~n. About what percentage ~ ~'. SW~L~O. Sixty perc~t o~ the males wer~ obtai~md by proxy and 17 percent of the ~fi'. C.~m Sixty perc~t. That is, ~ second perso~ tes~itied as to effects o~ smokin~ on 60 perce~lt of these people. I~ that not true ~ 5~[r. Sw~m~. ~hat is correct. 5fr. C~a. 0nly 40 percen~ o~ this evidence was between the i~tcr. viewer and the person concerned ~ h~. S~a~'~. That is correct. But this is only for th~ malc~ the female. ~. C~a~. Yes~ I noticed that. But that s~ms so weak~ that would b~ ~ flmh" s~tigi~ on an b~te~i~w of 40 pprct, nt and le~ off 60 per~nt~ and say that the "conclusio~ we arrlv(~ ~tt ~re based on o~y, a 40-petit ~sponse. Eighty-three pvrc~nt of women, I beliex c you state~ ~d respond ~rectly. Is that Mr. S~. That is corrt-~ct. Mr. Ca~n. Of ~he men who responded~ I believe you ~t~ted tha~ ]argo percentage of them ~,ere elderly~ sick~ dis:tbled~ or unemployed. ~s ~)lat true~ Mr. Sw~o. That is correct. 5It. C,~. And~ f~ther~ you state that a~ agreement betw~'::~ the su~y ~nduct~d ~y ~e Publi~ Health Servic~ an~ the medical rccordu~ the morbidity tables~ which I have her% is onl5 44 percent~ i::~ tlmt correct ~
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948 l~fr. S',~r,,xo. For some diseases. There were two studies, one of them c~raparing population with known medical recor~ and one of them a l~?,pulatiou with known doctorg cxm~atip~% and doctors~ r,~eords. The inten, icwer walked ~to tim house not ~owing that the information about tiffs population was known. The intervie~ver con- ducted ~ survey and the responses about the ~port o~ diseases ~ven in thoea interviews were then compared to fl~e actual ~own ~requency of flw~:c di~ease~ in the houselmld. From this i~ ~as found that for such ~eases as diabetes~ asthm% hear~ troubl% only 44 percent of tim eases a~eed. ~. Cau~. D~or~ I h~ve hera ~om~ of the mo~allty ~bles~ the ]at,?r~t I could get~ for 1967. I wa~t to te~ ~ou that as compared ~ ext.rapol,~tion:~ and interpretations ~hich the U.S. Public Health Sets, ice has placed upon their su~,py, yo~ fi~re~ seem }o ,~ne}o b2 ~pproximately correct, or even modest. I ~ant to ba pe~uy ~ra~ ~ ~ay~g fl~at mo~t of the~ figures ~%ve been m~ed ~ ~s su~ey ~ar beyond th~ ba~is o~ a true extr~olatlon. Thank you, sir. Mr. S.,~'m~. Mr. Adams. ~Ir. Ao,x~xs. I will reservegmy timh ~. Cha~man~ because I haven't had t~ chan~ to read the witfiess' statem~t yet. }It. 8,~~. ~Ir. KuykendaH, have ~ou ~y questio~ ~lr. Igv~A~. No qg~tions, ~. ~naxrman. Mr. S,~m~o. 5~. Echhard~. ~Ir. ~m~. Mr. Sterling, you are, o~ course, refer~g to .r:mg~, volume, Ci~ar,~tte Smo~g and Health Charactensttcs, 1964. ~. S~mzs~. That is co~ect. Mr. EclAt. It i~ ~e re~or~ of the U.S. Depa~en~ of Ed~cation, and Wdfare. Do ~ou conclude from all o~ your examina- tion of th~ sgudies ~ ~at t~em is no s~tistical basis ~or the con- elur, ion that there is an association between such ~ngs as l~g cancer~ corona~ heaN dise~e, and smo~g ~ong m~ ~ ~i~e ~om the qu~- tlon ~f *whether or no~ this is va~ t~g, I am asNng you do you eoncluda from all the examination of this do~ent and ~ch source matcrb,ls :-,s n,ay be available to you tha~ flmre are no statistics that would bear out those conclusions ~ ~Ir. S~L~. Ther~ are questions which ca~ot be answered with ,r no, but I shall use three sentences. ~lr. Ecotone. ~swer ~ you ghi~ proper.. ..... Mr. S~a~. Information on l~g caner m not wen. here. ~h~ daal~ only with ce~ain chrome diseases, ceNaln acute d~seases ~a dis'~bilitics The tabl~ given here do not bear out statemen~ made co~cc~r~in~ dizabilities and diseases based on tNs report. They ~;imply do not bear them ou~ ..... I h~ve heard te~imony about smoking caumng more dtsabfl~t~es or more chronic illn~se~. H~wevcr~ I am testimony ~th r~pect to ~his report., ~nd this report only_. These figures are m~ply not ~thc repprt, or they are in flmra only if you selec~ certain fi~res and not ~lect otlmr ~,rr. Ec~a~. Is it ~our ob~e~a}ipn_of th~.inf~ation_~n this re.- port that there is no basic statistical mfo~a~oa fhat ~o~d support tlm conNusion that heart conditions occur more frequently in Ne case of mal~ ~okers than ia the case of male nonsmokem ~ 949 , $fr. Sa~2-r.~o. Let me quota te you t.he following: We haw'~ o~pa~,~.(~ 3~. table 5, cigh~ ~pecifie death r~tte~ for clu'oaic conditions. cohditi~ns incfi~ding rheumatic heart disease for ma]es~ pe~.~ous xvlm never ~oked, 4.6 p~rceat; patens who ever smokcfl 4.0 percent; eat smokers ~.5 percent. I c~n'~ see how yes, can ~rom that make a ment that male smokers h~ve mo~e he~trt diseases. Former smokcr~-~ have 7.5 percent, but fomer smokers ar~ pecu~gr. I mean fogner smoke.m all tN'ough this repoN have the highe~ disease ~tte. On ~ble 5 it states ~a~ hea~ condibions including rheuma~c he::~rt di~eas~ for persons who never smoked~ the incidence rate is ~:.6 per 1(10 ; fpr who are present smokers~ the incidence r~te i~ 3.5 per 100. ,~gain~ ~or hyperte~tsion, the incidence rate for u person who never ~moke4 4.4 oar 100; the incidence rate for prescott smokers is ~.5 p~,r hIr. ECKtI~DT. IS that the only place y~)u lind any about, heart conditions in this repo~'g ~r. B~. No; ~here are other places. There is a breakdo~ for--well, I was here when Dr. Rothste~n was hem and he said tics arc simple. You connt t, he. number of smokers, you collllt tht~ n~ber of nonsmokem~ you comet ~e n~ber o~ dlse~ ~d there are. Well~ this is exactly what I am doing. ~is is the w~y fltesa were derived. TMs was the ~cid~ca actually obs~ved in fl~e. d~t~. I am no~ testifying to my oplnion~ sir~ I am testifs, ing to what dat~ say. Mr. Ec~. I realize that. Of all chronic condiiions~ the would indicate ut least some rise between pemo~ who never smoked and present ~okers at 65.4 as compared to the present smokers o~ 80.:1. So at leas~ it would bear some ¢e~imony of an association smo~ ~n4 all chronic condi~ions~ I t~sume. You would conclude that; ~uld you not~ Mr. S~ge. No. I~ you look ut all ~ronic c~ditio~ Mr. Eckhard~ where ig s~ys all ~es 17 years and over~ u person who never smoked~ ~ rate of 119.3~ thepresent smoker's rate is 111..6. These are reported for 100 individuals. I am not s~ing that tl~ese dut~(~h,uld be t~en ~a~ seriously. But I am s~5,Ng e~ en if you ~a~l((~.~h,~..? ,dat~} seriously~ even if you for~t about the errors both of tb,_ e:.tn.lal¢ co~N which occi~r ~) tliese data~ they do not imleed bear out claims m~de. ~{r. Ecxx~ano'r. F~nkly, I don~t, see where they get. tho~ all-a~ ~g ures ~'hen each of the specific ages seem to indicate ~ considerable In the case of present mnokers over persons who never smol:ed~ ?t~.~t But 1 suppose flint is something I wo(fld have to look into myself. I rice 17~ years has a rise froM-60.5 to 80.1) ; 45 to 64, 1~4 to [41~ and and over ~9 to In eadt ca~ there is a ~bstantial rise. Yet tim overall figures don~g seem to show it. I don't know why. ~[r. S~a. There is much in this report which has puzzl,d also. ~fi'. Ec~n~r. There are ~lso other reports. For ~n~:t~tnct~ in ffacts on Smoking Tobacco and ~[ealflb you have U.~. Departing,at Health~ Education, and Welfare, which is a compilation of tion from other sources, there is referem~e to the Hammond siudy~ chore is ~ table in that document on page 38. I don't kn~w wh~th~,r are familiar generally wit.h this vobm~e or not.
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9~0 Mr. ST~ro. I have skimmed thro~lgh it. I am £amiliar with it, but not to the point that I could testi~, conceding the Ha.minored study. ~fr. ~c~.~rxr. With respect t'~ overall dea.t.h rates ~or ~ormer :,mokers ve~mq nonsmokem~ there is rather remarkable ~fferen~. Tho:;~ who smoked 20 or more cigarettes seem to have a rate which is :~onmwhcr~ around double or more than tMt of those who never sraoke4 rc mlarly. . ~ . . ~Ir. S~:n~z~. I would find it diffic~alt to ]u~t~ th~s compared to t~s ~ort, bec~tu~a in this repo~ it is fairly,clearl~ sho~ that in many llt~ar~ces tho~e who do smoke modera~ have a smaller chronic dis- ca~:~ rate t.httn those who do ~mt smoke at all. Bit. EcKm~. So it is hard, then~ to know why the deaflx ra~e seems to be higher. h[r. S~r¢~. That is a questlo~ which I think needs answering. ~Ir. EcK~t.xr:nw. I notice in this report that ~-as predated to us ves- tcrday~ I ~,hink, by ~[r Rosenman, there is an indication on page with resp~ct to c~ronic Itet~rt condition, and thee ~rere clinical cas~, actually examin~ and lumwn~ that the), r:m about thre~ times as high amo~g tho smokcrz ~s the nonsmokers." Mr. S~x~. I find it ~ifficult to compare. ~, test~ony or my a~n~u~t ~:as concerning this study, s~. The problems with mortality :-,tu~.tit~. x ~mve no~ saia anything about proble~ concer~g mor~ ~tudie:~, There have ~en a lot of as~u~'mathem~icians w~o h~v~ rc~p~:ct in their statistical c~ram~ity~ who have poin~d out a n~ber of faults with the mm'talit~ data collected by Hanunond and others. ~vo.ld~ay that one ~f the l;oints that was mgde and made repea~dlv is ~ha~. h~_aiy s~okers are probably also heavy eutem, hea~ d~ers, ~nd m fact i~ is l(~mwn that they are, and also peEaaps people who are no~ nto,t~rat,~ in ~ther ways. ~ find it rather interesti~ that ~ many in~q[ance:~ in this report moderate smokers have tim lowest disease rat~~. Mr. ECI~IIAI~Da'. DO Vn~l say there is no corre]ation~ flaen between the two, between smokin~ and the dieeases~ Mr., r~:r~. Not as ~t appeared m th~s repot. ~ Ir. ~cn~.~a~r. Do yo,~ know any report that ~ows thatg ~fr. ST~nr.~. I kn~w a n~ber of reports whid~ have concluded ~]t~t ~uch an a~sociation has been demo~tra~. Mr. S.x'mn~n~,~. The gentlem~s time h~ expired. Mr, ~mmp~on ? ~Ir. ~,~zo~. Will the ~entlem~n vield~ Mr. T~m~tP;3ox. I yield to the ~entlem~n ~rom South CarolYn. ~fr. Wazsox. I thank the gentleman. Jn~t to have this matter in proper context, pursui~ for one step ~dher tim lin~ of que~,ioning o~ the ~nt]em~ from Tex~ the black bound volum0 to which ho referred is the one that I used e~r~er pointing out ~ome tabl~ whic~ absolutely contradicted the conclusions ~hat w~,r~-~ made by ~h~ Public Health Servlce~ by Dr. Horne, in the llttb~ p:unpMet w~ch re~ived ~ch wide cire~iom As I recall tho testimony o~ ~. Stewa~, the Surgeon General. he ~Taid of the black bound volume much o~ it Was taken)rom a comvfl~- lion by Dr. Horne~ and much of that informa~on w~ ~ained ~om tho orango or the yellow bo~d volume~ the so-called morbidity studies, upon whi~ your asses~ent was made. 951 I think the record will show that. I didn't want to further com. pound the problem, but I think it points it up very well. ~£r. Eo~rraarmr. WiN the gentleman yield ? ~. 2~A~so~. I got the time ~rora'the,~ gentleman from Gcor~la. tM~ ~hat it ~ o~y ~air that w~ let hire m~ko th~ cor~:.n~. Mr. Tao~o~. ~yield to the gentleman ~om Texas. ~Ir. E~. I referred to ~e H~ond repor~ whi~ i,~ not t ~,~n ~om the orange bo~d volume.. I thi~ the witn~ unde~:tan~ that, ~Ir. S~. Yes. I would l~ to finally ~i~h my an~4wer. There ~re m~y probl~s with the Hammond re, ft. The~e prob. lems h~ve been pointed out by people who are much more m~tute than I am~ perh~ps, or perhaps certa~ly I can only concur with thrum. Th~ thin~, el.though pointed out repeatedly ~nd oftcn~ h~ve~ ~n really Caken seriously by ~ople who claim that ~I~. ~amnmnd s~udies do not demonstrate that such an nsaoeiatloa oxi~. Thor~ ~oplo who are not ~ffeeted by d~t~. I do not happon to b~ one of ~hcm. believe ~ going back to the actual ~fo~atioa and dat~. Th0 ~ond study has ce~ fl~ws which are ve~ gl~Hng, Dr. Beyk~:oa,,, who is ~id~red the outstand~g biostati~iciaa in this couatrS, Sir Roland F~her~ who is considered th~ tat, her of statistics, p~inh~d out many ot ~e flaws which lmva n~ver [~ea clarified. The o~y ~ ny to cl~ there is to get, tho dnt.~ from Dr. Hamr~:mnd and t~o ~ look at .tho thugs that were actually £ound. Until time, I don~ think I would like to s~y anything about th~:~ da~ seated by ~[r. Hammond~ except that they rtr~ full of quc~tiom~ not fu~ ot ~nswera. ~Ir. W~so~, Will the ge~leman ~'ield ~rther ? ~lr. T~o~rso~'. I will ~i¢.]d the'rest oI my time to tho gentlem~m ~rom Souflx Caro~a. ~r. ~V,~Tso~'. The book ttmt the gentleman ~rom Texas was makin~ ra~erence to is the vmT one that the Surgeon General did s~y wat~ ~n~}]ed along with Hanmmnd~s report, but prinmrily the nm~'bid[tv at.u~, or fl~e orange ~und volx~me, to which you rarefied. I e~rlier~ the Surgeon General and Dr. Horne, as to ho~ they c~tegoric~y state as they do, ~nd thi~ is ~t Goverm~ent publie,tt~on, on pag~ 48~ that tlm dat:s of disabilities and the days ot re~tric, tt~ acti~'i~ ~ere greater with the smokerz than the nons~aokers~ whcrea.~ we t~ over behind tlm backside ot tha~ pa~ ~d fi~ro 2~ that days o~ bed dis~bi]i~ we~r~ 5.0 with those who smoked frc~m to 40 cigarettes a day~ wherea:~ flmy were 5.1 ~or the non~mok~rt~. Mr. S~o. If I m~y mak,~ a comme~t~ sir~ Mr. ~rawsox. That. is llte thing that conft~ tdl of us W~ hr.;t out figa~res tha~ support our ~onteatmn and then w~ dmt,~gard tho:'.~.~ which do not. Mr. S~axa. I would liko to poi~tt out that the figure~ ia report, and the reason I did not use this report, but di~,c~rded- tt~ because they are bm~ed oa wh:~e is called adjusted numbcr:~. Dr. ~o~hsteia says statist.tea are simple. You eo~ people and count dise~es~ divide one by the o~her and ge~ rat~. Howevt~r~ thit~ wa~ no~ the procedure followed in this report. The reason tim tab]e~ at th~ ~ront are ~t varianco with the tables ae th~ back is that an adiu~tmt~nt factor was introduced to produce the~e fi~n~
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952 Tlmrcfore, there is more than1 one incidence that m.a,~, be obt~Jned here, or more than one rate which may be obtained here': I would call thc~:o tq~mares complexly ~naccurate that you h~ve ~ tMs black repo~ bccauzc they were based on a peculiar method of a~e ad~ustmen~ which the ~ational Center ~or Health Statistics obv~busly" does ~ko and has never used be~or~ in any o~ its other stu~es. Mr. Wawsog. You are right. In fact~ to show you how ~culous thi,~h~ has gone, ~ccord~g to the moribundity~tudy~ ~d X have mado a little ~tudy of this~ tho repo~ that you ha~ e, wh~ they were ]~uk]ng ~he study ~nfl asking about chronic ilhes~es they even ~cluded ~ao~e who woro gl~scs, t~osa who had hearing defects, those who had t~ mi~in~ fin~er~ all Idnds o~ things flint could no~ bo remotely related to the zmo~in~ o~ c~g~rettes. That is another mis]ea~g ~actor. Is no~ that trim? Did nht they list the chronic conditions in the back of d~at study which you made~ They included ~11 o~ these ~ld ~]ag~ th~ coul~h't remotely be related to smo~ng. Even club ~eet ~ ere lmted in there ~ a chronic condition. Was not thut even listed th~ro? ~fr. S';~m.~n~. It w~. Perhaps it should b~ pointed out that ~or bo~h arthriti~ and he;tring,lmpairment, rockers ~ g~eral do better than nonsmokers, according to the figures published here. ~Ir. S,~xn~. The gentlem~~s t~e has ~ired. ~fr. Preyer. Mr. P~. I am try~g to get thee titles ~might ~ my own mind ~inco they all ~ound ~ lot alike. You a, re di~cussing the ordinal repot, "Ci~are~e Smok~n~ and H~:alth Characteristics, ~ ]~own as the morbldi~ study? ~r. Sv~L~a. That~ i~ correct. " ~{r, P~m~mn. And ~hen th~ findk, gs from that were taken up in the pamphlet on th~ "~ealth Consequences o~ Smoking?" ~r. Sw~.:~. That is cnrr~t. Mr. ~m~n. ~at was 1967. I~ was in ~at latter pamphlet, but not in ~he or]~nal s~udy, that the 77 ~]lion excea~ lost work d~ys due to ~mokin~ was mentidncd ~ Mr. S~,~o. That is correct. Mr: P~. So it seems we h~ve an example o~ what Dr. Katz wa~ h ~.~fying to ye~erd~y~ ~here ~e original ~act mighb be and z~[~yded p.nd s~ated propeEy~ but as it passes tMough different ~;tag~ a~tortmns enter into it. By the t~e ~ gets to the pamph]eteor ~tag,=, we haw~ ]o~. track of the o~nal qualifi~tions su~otmd~g fact. ] ~v~]I ~ust sa~ it,seems to me that vo~.~r testimony here has ~]m morbidity* s[~dy ~gI~t ou~ o~ tim ~ater. You mentioned that .~en~. fl,~;~ rdr~ort~ to th~ Public ~Iea]th Service H~ve you any r¢'~Iv from them? It would see~ to call for"a re~lv: Mr. S~nr.~o. I have ~ent the~e reoorts to ~fr. W6olsev, who director of *he National Center for ~ea]flx ~ta~ist~cs. I ~eceix~ed w~r~ eonrfeous reply from him. I have also sent these studies to Endicott'~ cmmnift~e, through a member of ~ha~ committee, and I haw~ ret-r~ived no reply. I ha~;e copies of three reporfg which are b~sed on ~ wfudy of the ~ational Health S~,ev, a~ well ns the or~.~nal data which were all ~orwarded ~o the Public II~lfh Se~ce and 953 National Center ~or Health Statistics. I have cupie~ to file with th~ committee if the committee so wishes. ~Ir. Pm~m~. Would the gentlem~n yield .~ ~£r. Prcxr~. When did you receive the reply from tim geatlem~n you mentioned ~ ~ff. Srarm~x~. The co~espondenc~ con~'nlng th~ studie~ inciden- tally~ ~ included with my statement. You wi~ find MI the l~t~r,~ th~ back o~ ~V s~atement. 2~r. Pm~n. Was ~eir ~ply ju~ a ac~owled~ent of yo~ or did they ~k~ issue w~ you on some of your finding~ ~ ~r. 8T~m~. h£r. Woolsey replied to me and made ~ number statemen~ concern~g ~e actual repo~ ~ reply to my fir~ critique it~ ~es. The letter is enclosed wifl~ my ~ta~eraent. ~Ir. I~mXL~. Mr. Chairman, I wonder if I could inquir~ of ~,~ pro. ~essional s~ff if we have received copies of any of tho~e~ Mr. ~l~'~n. We have not. ~[r. P~c~. Thank you. Mr. P~. Along the lines o£ wh~t ~fr. Pickle ]~ say]n~z~ seem that there ough~ to b6 some way lot r~viewing and ~valnatin~ re errs such as ~h]s be~ore th,~v ~'et to th~ st.~,-~e wher~ x~ou b~ ~b~ pubhc~ ~md claims are made based on facts whmh do no~ ~upport. th~ claims at Leaving that for a ~omen~, we had a m~m te~tlfy re¢'~m~ly wht, ve~ refresh~g in sa~ing that he felt smoking was good lot you. Th~t was Mr. Roys~r. W~u]d Mr. Roys~er be right, ]~ I understand your fi~res here~ in put.tin~ out a pamplflet and citing Public H~alth Semdce figu~s and say'g: (1) female nonsmokem lmv~ le~ than female sraokcrs~ (2) tlm highea~ rat~ for all di~ca~ea occur~ ~ormer smokers and therefore if y~u or~c~ s~rt~ whatever you do give it up ; ~d (3) the lowes~ rate for diseases is reported by mod~rah., smokers, ~d therefore, the best way to stay he~dthy is to smoke mod- erately. Is ~hat about what you are saying thee Public Henlth Servic~ ures support g " ~£r. S~g~. I am a~Md that although I am tomptcd to ~y I must say no, ~cause I don~ thi~ the data on which the figu~'~; based am re~flly anything mor~ than a pleasant invention and bear really only little relation to reality. ~Ir. P~'~:n. But what I am saving is that ~Imt sta~eraent is on~tsface, whichshows ~ ~ " ~ ' " " • , . how maslead~n~ t~s r~port m ~n~ lto~ les~ it is. hit. S~. The repo~ is only interesting to flm~;o who react it, I am a~raid. ~fr. ~a~. In other words~ if you accept the d~ta in the re~~r~ beln~ accumte~ fl~en those thr~ things that I suggeuted Mr. cou]~ put in his pampMet would foHsw~ ~[r. Sw~. If you accept the dat~ as aceurato~ w~eh you then you could. ~fr. ~. Thank you. ~£r. ~s~s. I have no question:~, ~. SA~r~D. Mr. Adams.
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954 , Aft. &D,u~ts. IXfr. Chairm:m, it is obviousl~ difficult to question when .~ou arc goin~ into raw data, an¢l we do ~of have all the raw dat~ I haw noticed, however, that the reply that came back to this ~¢ness from the Department of ~ealth, Education, and Welfare s~ys ~hat, tq~eet, "~ nots that you have pointed ou~ differentials which exi~t in Ihi:~ study, but have not established thai, these differen~ia~ are n~l~vant to ~ho study" that we made, and therefore, our study is ,accurate based upon the fac~ tha~ your differential bias is not relevant. ~a~ do you sty to tr~ mely competent perzon~ I would hardly~ a~ the fi~t sign of a criticue~ fall over bacl~ard and say, "~ood God~ Professor Sterl~g, ~;oahre aI**~olutely eorrecL" ~ would make a statement sa~'in~ "We disagree with you." Mr.~Aoa~is. You would so3: t]i~ certain fKctors, we~e relevant differ¢ ntial and he would ~ay thai they are not. So tLe two of you would then disagree, righ~ ~ 5ft. Aoaxrs. That is whathe does. ~{r. S~a~x~. ~ think that the lack of jus~ca~ion for bit. Wool- ~'ey's reply is clear from many o~ ~he tables which exist in this report. ~fr. A~n~ts. I mean~ that is 3our opiniou as a ~.atistician and says that these diffe~n~ials are no~ relevan~ to the statistical scatter and so on flint was used, and therefore~ t~e in our jud~ent have used them" and you and he h~ve a ~fference of option on ~. ~fr. S~nLrno. No. If I ma~ point out~ s~ Mr. Woolsey says, right~ the~e large e~ors would'he of a consequence if you would constantly the same rezu]y~,': but he does not in ~ac~ ~eg couPon*Iv the ~amo res~ults. H~ does ge~ ~e~ o~en that nonsmokers have more disease than do ~moke~. Mr. ADA3~Z. ~0U keep using the word disease. I haven't considered that we have been ~ing to establish acro~ the board ~at eve~ kind of ~ disease w~ ~]ated to cigarette smoke. You could have al~ k~nds of different dise~s in the population ~n4 all k~ds o~ different types of ~moldng in the populatisn, and the~ might no~ h~ve any rele~'ance on~ to the other. ~cn you go to the mortality tables you don~t have ~o worry about w~ur measurement factor or your differentials at ~11, that set of hnd :~ati~ti~ is pretty sol~d, is i~ not~ the morality tables?'You wouldn't disagree at all if you take the a~e brac~t from 60 to 80 and how many people died and how many pgop]e smoked, and that set ~:tati~tir~ ]s absolutely valid~ isn't ~t ? " Mr. Ag.~xs. ~y not? 5f~: S~a. For instance, I compared the actual number of smok- cr~ c,tima~ed in this report wi~h other reports. People went, out and a~krd. "Do ~ou smo~c~ Do¢~ your husband smo~e?~ There are two reports, due'by ~aenzel and o~e b~, ~ammond. I found that for some ag~ categoric~ the~e repo~s disagree with the morbidity ~udv by as much ~ 33 percent. , , ~fr. ~a~s. You are talking about sur~e~s. $ am not gong into v~urvey~. $ am tal~ng abo~f a mortality repot. A man dies ~t lhe age 955 o~ 65 and we have had pathol,~gist after pathologist testify they look at the lungs and see if the man smoked and how much. ~e is dead. He is dead at ~ parHcular ~tge. ~e either smoked or he dldn~t. Tho~ ~actom don~t involw survey~ measurement errors or anythin~ do they ~ Mr. S~a~-o. Yfis, they do. You still ]mw to aek somebody wh[:th~r or not this person smoked. Since he is dead~ he is umtble to an~w~:r f.r himself. Mr. ~s. Th~ pathologisi came ~ clea~qy and said you ca~ look ag the lungs and tell by ~e ~pregnation in them. We had three ~,~ Vnt~olo~ts tell ~s ~ey could, not o~y tell you :~hether th,,y smoked~ but hey, man~ cigarettes ln~ smoked 'per da)'~ afte.r he is dead. Mr. PIC~. ~ ould the gentleman yield ? Sir. Aa~s. Yes. ~Ir. ~ic~. I remember test~o~xy the oflmr day when one witnr- passed out hmg tissue o~ a man who had been smoking fur ::~5 year~ ao ~ed at the age of 65. I~ shelved heavy pigmentation or di~;coloratiou the lmlgs. ~e also l)as~ed out a tissue of ~nother man of 65 who had not smoked. Both died at 65. 5~r. AdApts. This is precisely the point I ~ malting. We are about statistics and maflmmatics, that you didn'~ haw~ to survt.~y hav~ a measurement error or anything. 1 agree mith my colleague from Texas. ~he two men are dead. One smoked and one ~tidlrt. ~ ou can tell that by looking at the ~£r. PIc~. If the gentleman will yield~ I was going to add that looked to me like one man enjoyed smoking ~or 35 yems and tht, ha d not. 3It. ADAPTS. I dd~t deny that. But. statistically they ar(~ a fact~ with- out any measurement error at all. )ft. S~INU. I am not a p~thologist~ sir, and I cannot testify a~ to whether or not ~ pathologist can tell whether or act the brag to ~ smoker or no~,~moker. However, it is my understamting that there arc mt~ny paflmlo~ists who cannot make that stl~tement. 3{r. ADAPTS. We had one in here who said flint he couldn't tell, but we had a series of other who said they could. I have oae last set o~ questions- Air. Cxm~. i~ the di~in~i~l~ed ge~tleman would yi~ld, I will we h~ve had an eqaal number ~ho lm~ e said they could not. Mr. ~zs. We had~ Dr. Ca~er, one, ~nd I a~ked him ~ftor li~, fin- ~hed whether or not he could~ and he said he diffn't ~ow whether ~re~e smokin~ was ~oo4 or bad~ and I ~ked him i~ as a thoraem surgeon he told anybody who had a ches~ m~olvement, ~rrdahon otlferw~e, if the~: sl~ould continue smoking. Mr C.a~z~e 2hat is not sayin~ avhether he could tell what a ~molwr ,, lung was. One was Dr. Carr~nff~lerc was one other patholog~:-:t--and there was one this m~ning who said he couldn't ¢elL Mr. Ag.x~ts. All right, Db~:tor~ I heard cue. ~r. CArom There have been several who testified tn that effrct, mtd Dr. Buhler. Mr. ~s. On your poing the other on% as I understand it~ your criticism of the survey or the study is that you believe ther~ are too many factors~ I thi~ you mentioned five that should have bec~ taken
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956 into th~ amoking versus nonsmoking categories. Isn'~ that correctS. That the~e were ~tatist]cal ~actors that should be taken ~to acco~t~ You~menfioncd age~ ~ex, ~hether or no~ people would or wo~d n~t red, pond to ~he su~,ey. I th~ you had one'other~ did you not~ Mr. S~. Two othem. Mr. AD.~rs. Sew age, pro~, respond]ng, employmen~ ~tus ch,~racter]~tics of informant for pro~ respondents. Mr. S~o. Righfl Mr ~x~s. ~at vou, then, are basically saying ~ ym, r mony ~s £bat you believe these people, bec~us~ of the~ ~t lch~t thre~ bf the factors--~onld We you ~n~orma~on thst wasn't fellah] e. They would, in fact~ ~immy ~e survey. Is that right ~ ~Ir. ,S~[:~m It ~ not a question o~ helid~. ~e ~nal~zed ~h~ dat~, ~or iDstance, ~or differences ~ employment. W~ fin4 • large dif- {crc~cc~ ]n ,mp]o)[~ent ~ith respect ~o d~sease. We find ~ large age difference. ~ ~ere not able to analyze the date on th~ effects of wl,,~t}~e.r or no~ tim informant had certain characteristics. Mr. As~s. [ will a~k you on~ ]as~ question: You believe then~ ~ ~¢~a~ist]~an, flt~t there ~s po w]i~ty ~ h~ving inter~wed a lar~ numbs[ of smokers and • large ~mber of nonsmokers ~nd then com- pare ,~,.ath rates at particu]~ ug~ ~or smokers and non-smokers to ~.~t;tbli.;h any type o~ cauml r~lationship stat~tica~y between wha~ happcn~ to tim smokem and no~mo~ers ss ~r as d~ath ~om cancer, hm~ cancer, or heart disease? Mr. S~n~o. I fall %o see how you can interview ~v~dua]s and flwn coun~ their death rate. I am sure~ Mr. Adams, you mean their il]nc~z rate. Mr. A~zs. ~, I am t~l~g about the fac~ that a~ pa~icu]~r ag~ lcvc]~ ~ g~,.ater number of p,~ople who are smokers die of hmg cancer th~n nonsmokers at that ~ge l~vel die of lung cancer. That ~s ~ll. ~Ir. S~n~*No. Sir~ ~t h~been pointed out ~n th~ study that mor~ pcople who smok~ am ill than peopl~ who do not smoke, ~nd I Imve md~%a~ed thu~ the figures in the repo~ do not suppo~ ~at. Mr. S~a~z~o. I know o~ no such ~res wMch show a higher mor- taU tv rat~ for smokers ~an for nonsmokem~ without ambiguity~ wi~h- out ~lll~culties of interpretatioa~ and without le~n~g ve~ heavily upon a ~:c]ected number bf in~nces ~or presentation and hi~ng some o£ the. other~ which ~r~ probably just as impo~ant or ~ust as coa- trover:~ial. Mr. ~.~zs. I will ~u~ go back to the simple que~ion. £f you have, as has been ~estiiied?, u large number of smol~ers and nonsmokers, and at a~ particular a~ level a ~uch ~ter number o~ smokers die o~ c~mcer~ or of he~ disease~ than the non~okem~ would you say as ~tati~ic]an ~ere i~ no validity in m~ng a mathemufic~i c~us~J tion,ldp between the two~ Is flmt your testimony~ Mr. S~z~zJna. Sir~ are you ns~hg me about ~he testimony people hare ~ven bore ? Mr. S~m~. I ant not ~w~re of ~uch • ~act, sir. Mr. A~A~fo. W~ will take care of ~e ~acts~ pro~essor~ ~bout wh~ther or not tim facts are ~e. I am ~ust asking yon ~ a stati~iclzn if you 957 could make tt causal statistical relationship betwecu t, lm two, or you would deny it existed ? ]~£r. S'r~mx~a. Could I have fl~e que~ion clarified ~ I am thoroug~y con~used: sir. Mr. ~s. You have a ~'oup of people who ~e aao~, and ~oup of people w~o are ngn~okem~ anal compar~g the mm~b~,r people a~ a pa~icular age that ~e frora Imtg cancer or hca~ ~nd yo~ ~fl ~hat ~ much larger n~ber of the smokcr~ die than nonsmokers, oo you say, as a stat.istie[an~ thttt you can noL In~d~c causal s~tistical relationship between the two ~ ~'. S'~:~'¢.~ot necessarily, sir. Le~ me poh~t out t]mt the world is ~1 of coincidents of various ~orts. The very fao~ tha~ two ztatizticz haw s~m peculiarities in no way reflects a ~usal reh~fioa be~wc~a For ~, tim divorce ~)fe in ghis co,try is higher in Sta~z with wa~r tha~ is harder than ax ert~e ~an in the sof~ water Sta~zs. ghat mean tha~ hard water ~us~ more divorces ~ Mr. ~A~s. I ~m ~Mng you if you are uwar~ of the relationship tween the two. ~r. S~o. Some questions ca~ot b~ ~wercd wlgh ~t y~ ,,r ~o~ sir. ~. Agora. TMs is your b~siness, Pro~es~or Sterl~g. Your bu:~ine: is ~,tisti~ and ma~emati~. ~r. S~r~I~ I do ~mt ~d~mtand your question. .rr. ~A~S. ~ou ~ke a group of people at 60 ye~ of age under ~e mo~Mity stati~i~ and you have, we will say, 100 of them zmoker~ and 100 nonsmokers. More die of lung cancer and hea~ diseas~ a~ ave 60 cha~ are smokem ~aa are nonsmoker. I am using do you den~ that you e~ make a caus~ ~ati~ical relation~Mp between th~_~ ~,w,:) We ~ wo~ abou~ whether they ~o accurate. Wo ~H a~k body rise. But do you deny that there ~ causal stafis~,i~l relafiom:hip ~. S~. Under the ~e you mention and no other tion~ I would say ~'. AgA~m. There is no causal relations~p, or ther~ ]a ? ~. S~x~¢. Sir~ if I urn clear that you have za~d in the event had two ~opulations of 60-year-olds ~th higher dea~t rah,~.~ caned nonsmokers, coma 1 ~rom tlla~ aura l~self de~e~lino that fJ-mr~ is a causal relatio~hip betweea~ ~. Avx~zs. ~ statistical rela~ionsMp that could lead to a relabions~p~ you as a Mr. S~xa. Are you ta~ng about a statistical relations]d p now Mr. ADonis. Yu~; that is what you are here to te~ify about, i~-t'~ mafics, whid~ does not necessarily make rue a statistici~m, to be 0r,z- cite. A statistical relationship ~ I don't lmow what a ~:tatistieal ~ionship is~ sir. There are certain fes~s whid~ we can perform. ~st~nc~, ye could com~te,.the valu~ of ~omethin~ called the Chi- ~quared. leg us say, ann ~ve you tha~ wtlue. This value i~: n,.,t re3at~on~hip ~ its~lZ The term statistical relationship is whic~ ~ simply do not grasp. I~ is not a temx whirh ~ w,uhl professionally under any cortd~ions. Mr. Ag~, Any kin~ of rela~ionsl~p.
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958 Mr, S~ra~a..A_ ~tatistical relationship? Th~ only w,.,ty I can think of it is as between husband ~d wi~e~ who are both ~a~sticia.ns. Mr. A~.~s. Any other kind of relationship~ Would more die in one category than another'~ It d~sn't mean anything? Mr. Sw~. You hmw~ ~ir, t~ nmnber of terms have been bandied around dm'ing these hearings. I can only testify in terms of n)Y q~n competence, i can tell you that such u term as ~ati~ical relahonslup is really not among the vocabulary which I use in the classroom. Mr. D.~*~s~. The time of the gentleman has expired. There are othcr~ ~ ho wan~ to a~k questions. Dr. Ct~rter. Mr. C~.:m I hav~ been w~ much impre~d ~" soma.of t~ ~sti- mony~ particularly som~ o~ the references to n~9rtal~ty iaolys. I have th~ only copy q~ mortality tables ~ th~s house toaay, u~e one tht~t is i~zucd by tho'U.~. Department of ~ealth. Here i~ is. It is not in ~ brown hmk. ~ is no~ ~ • brown book or anywhere else. I~ we cheek it, we can look thezu and ~d the number of people who died v:trious disease% all the diseases. On this list w~ch is based on receipt o~ cc~:t.ificate of deaths lrom the vario~ depar~uents throughout the country~ is labeled the ca~e, age. and so on. On none of those does it, ¢-~ay whether this ~rson ~ho'died was a. smoker t,,r was not a ,:reeker So if we ~fer to true morality table% we haxe no bmsis on ~lm reai ~]mrtality tables pnt out by the-Public I-Iealth Semite. What wt, arc doing with tho mortality tables we are talkfi~g about is looking at a compihition by Dr. D~mie~ IIon~e and offsets ~ that gt'oup. it i:~ true. that. wc can draw ~tafistical relationships and many have I,~,~n drawn and have ~:hown the~elves to be. ~aulty. That h~s b~en br,)tv, ht out. So many times throughout the South pellagra was asso- ciatt~'~[ with tl~ inge~[ion o£ cornmeM ~or many, many years, ingestion of cormm~d ~vas supposed to have ~en the cau~e until ~ was foand oat tlmt ~ deficiency in the diet was the cause o£ pella~a. Then timt ~:iati,~ical rdationship was disproved eompletely~ tot~ly, then and ~orcverlnore. Then we have yellow lever and malaria, which have been related ,-tati~ticallv to lo~; zround, marshy zround/over tim years. There was ~ ffr:,at rel:."ttionship~ EverYwhere ~n~amhes you livt~ they had these di~:~:t~e~. Bu~ tlnalI~ thrdugh research, som~ o~ onr scien~i~s found ,u[~ the ~wtual eat~* ~f malaria was the bite of the mosquito ~d~ likewise, the cause of yellow fever. There again this statistical relatmn- :~hip wa:~ proved falze. Ptofe::.or do you a-tee with tlfi% that, st.ffistics are often mis]ead- in~, and have been m th¢~o two eas~. Mr. S~n~n~o. Yes; statistics are o~ten misleading, but so are all ,,fl,t.," meihod~ by which we t~, to obtain in~ormationhbou~ what goes ,m iu nature. ~n~ortunately, n~tur~ does not publish textbooks. It. u.uht ~::[v~ us a great deal of work. 2h'. ~.u:wm¢. Thank you, sir. 5It. S.xm-~mn~o. Xro there other questions~ Mr. W,x~om Mr. Chairman. Mr. S.t~r~m~. Mr. ) It. W.~w~o~. ~n one o~ your attacl~en~ you give a letter under the dab, cd Januar~ 1~, signed by you to Georg~ B. ~utehison, Mh:b mfl Ree~¢,-~-tIospital~ in Chicago. There was one question you raised, 959 and it is the first time I have seen it, a point which has not been thus far. I wonder if you might make a quick comment on Briefly, you sta~, "If we accept the methods and procedures in th~_~ repo~ on ~igare~e smoking and health characteristics, w~ w~ll ~ ~ ~ • . , to accep~ --and I don ~ a~ree we will have to acceot but you say "we will have to a~qep~ at the sa~ne t~e krebiozih as ~{~ ez~gii~hcd therapy method and. many other drugs, which now clutter up tho 1 g~e~ since you atta~t it here~ that i~ we accep~ this report givvu by the health del:,artment as ~actu~, then we aro going to tmvo to giving som~ credence to this report in referenc~ ~ krvbiozin and ~ther'ma~ters sud~ as that ~ ~Ir. 8~. I have many friend~ in tho Public Health Scrvlco ~nd I h~vo done u g~d deal ol work with them. I have alw~(v~ pu~hcd tiffs one po~t. This is that the truth o~ a connection between environ- mental ~ac~rs ~fl health is ~ difficult problem to establi~h. It i~ to fl~e adv~tago of the scientific comnumitv to loosely affack t~ ~uch pyobl~s becauso we ~sh them to be tru~ or because w~ are con- vmeed that they ~r¢ true. Scientffic methodolo~, is ~ difficult and cannot be ~4olated with impunity. ~ " , - If we open the door to accept the findin=3 of this ~:tud5 ~ wt~ open ehe door to accept the ~diugs of many a lunatic ~Ko to make parHcular statements concerning the'effects o£ ~uch factom ~ radioactive chicken £at or krebiozin is good for the t~ca~- merit of cancer. Mr. ~V~ox. ~4 i~ could very well result in ~ fldlur~ t~ explo~:~, ~rther experhnenfally [he real causes of cancer ~md thes:~ diseases because w~ have la[ched upon a theory and we are going to rid~ this horse for ~ w~le. Could ~at not be the result ? Mr. S~a. We have had many such demonstrations in medicim,, y~. Mr. WAwsom ~mnk you. Mr. SA'n~m~. 5Ir. Adams. Mr. ~g~xs. Referr~g ~o a letter, 5ft. Wa~on~ jnzt referred dated January 12~ 1968~ ~ wani ~o find the point in statistics that you tMnk is ~val~d. It says: " About t~ee months ago I was asked to review a ~S rct~ort entttl~,fl r~tte Smoking and Health Characteristics." The request came from a group atto~eys rep~en~g the tobacco companies. After a careful review and uatlon of this vep~r~, I concluded that its authors were cattle4 awtty by zeal and public ~irlt, very much t0 the detriment of s~.*und sclentl~e The ~:onclusions advanced hy the ~vestiga[r~rs simply have no ba~i~ i~t . h'o~ (s your.crlticism tl~at the unde[lying ~formation~ the ~.urvey, ~s at ~ault~ or the statistical methods that they applied t~) the lyi~ material is at fault, or both ~ Mi'. S~'~. &ll three. Their finding% e~en i~ we forgivo them the first two exrom, do no~ justin, the conclusions which were re~xelwd. This is a point that ought not be overlooked. Mr. A,,~rs. Would you say that even if the underlying mat,:ri:d was valid, you ~sagree with the nse--and I have to ~ve ~.tati:-:tical
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960 cau~al relationship, I don'~ Imow what else you would call it, or r~mthenmtical relationship---factor is not a l~r~I)er thin.~ to amply te~[~s o~ making ~eci~ions on public health~" Is~hat rig]~t ? " " Mr. Sr~x¢~. ~ his report goes out of its way to state ~a~ it mak~ no shttement about a relationship between smo~n~ and health There- f~r% this is not ~ problem that aris~ here. ~ am~ply s~g that tim conclusions reached on the front cover of this report ~re not~orne ou~ by tim fi~mres givenjn ~¢ fab~es i~ the body o~ t~s repo~. Mr. A~,,~s. So y~u ~av their .h~ti.,fieal method or application is wro~g, bu~, you do~t qu~[Jon the fact that you can use a statistical m~th~id fi)r ~tpplication to ma~crs of public health ? Mr. S'~a.~a. Certainly. We do ~is all the time. _ Mr.,A~a~s. That is what I thought. So you don~ ques~]on ~he ~acf th~tt ~ e do that all the time; we use ¢l~e statistica~ approach to large ~mo~[s o~_pe~)p]% and if certain things happen you ~r~tw a ~ion from that. Mr. S~nr,~. Tha~. is correct. Mr. £o~s. ~ank you. N, ~r~hcr que~t~onz. Mr. S.~n~L~, Tha~fl~ou, Doctor. ~ th~nk you mentioned two reports there. Was it your intention to lcaw~ then] with the committee ~ Mr. S~%u~. ~ wouI4 Iike to leave all three o~ them with the com- mlth:,e~ ~f [ h~r. S,~a~r~o. If there is no objection, we will accept them th~s lime ~or our file~. Mr. S~z~o. I wish ~o thank th~ committee ~or hearing my state- ment. ~[r. SA'I~. And we appreciate your attending today~ Doctor~ ~ give us thu benefit o~ ~,o~ ~fr. S~. Thank ~ou. " Mr. S.~r~z,~. Before I ca.ll the nex~ witness, I am ~nformed two witm,~ses who would have appeared at tlfis time have offered their ~h~temcnt:~ for ]n~er~ion into the ~cord at this pooh. With~ut ob]ectlon~ they wi~ be receive~ for that purpose. Is ~he,re a~y objection ~ If not, th,:~ reports will b~ entered ~to the re~ord a~ this point. I am [~rofe~or of ~fathemafic~ an~ ~e Dlre~or ~f the Comput~ C~ter at Wnke F.re~t Univer~i~. My fields of specialization are Stafls~cs ~d Opera. tious Rt,;~,,arch. I have taught, written, and lectured ext~sivo~ in the~e fields u~4 ~ ~Iuihe~atieu year, rally for more ~an ~enty ~ear$. The following Critique,, ha~ed upon my ~ow/adge and e~erienee in ~hes~ fi~lds, is submi~ed far ~he c~IdcratIon of this Committ~. A~ pa~t of its c.n~inuing ~pai~ agn~s~ tigereye zmok~g, ~e Uni~d State~ Department of Health, Education and Welfare, through its Public Health He,vice, pabli~he~ in May 1967 a volum~ entlfled "Cigarette Smoking and ~eal~ ~araet(~ris~cz, Unit~)d S~ates~uly 196~J~e 1~." ~e work was subtRIed "~qh~ti~:He~.~ on the prevalence of ~elected chronic conditions, ~ctdence of selected ae~b) ~cmdiflo~,:, a~d days of di~ablli~ by cig~ette smoMng habit, se~, and age. Ba~ed on f~a collected in household interviews cluing the ~lod of July Jun¢~ lf~." The volume has been ~ometimes referred ~o as ~e "Morbidity 961 The conclusion of the lkIorbidlty Report, that cigarette ~mokh~g i'~ harmfol to health, has received extensive pabllcl~: and the ~eport Is widely regard~ as impor~t evidence on fl~e relatie*nshtp between c~a~ette smohin~ and health. Recause of ~e sheer mas~ of ~umhers used, many per~ons have b~,e~ clin~ to accept, without £urthe~ question, the concluslons projected in ~eDor~ Under these circumstances, It is approp~ate to :mbJcct fl~c Morbhltty ~epo~ ¢o a careful nn~c~tical analysis, and particularly to ~',crut~Ige ~e o~s employed to collecf and to analjze da~ and to ~e~ort In doing so, one po~t m~ be kept firmly in mind. ~he Morbhllty Rt, port was a stafis~cal analysis ba~ed upon sampfing. It i~, of course, Irnpo~Hdo sample with 100 ~ercent assurance of exa~ditude, although careful planalng scrupul~us analysis of data, with no preconceived outcome in m~d. can ~e possibility of ~ e~oneous coaclusio~ If thin is done, ~amp~g teeht~lqu~,'~ ~ be pawer~l tools 1or drawing inference~ abo~t a I,)p~ation. If thl~ 19 done, ~y ~feren~s dra~ ~11 be mlslead~g, unfair and even SU~MM~Y The methods o~ sampling, collecting data and reporting dRtR employv~l In ~Iorb~fity Report are inherently condudve to wide vacation uml ther~,f.re ~rdiab~i~ an~ e~r~e error. Not a ,~fn#l~ item o~ clDffca~ ~ata wa~ ~ the Morbidity ~cp~t. Rather ~e Report was ba~ed entirely upan medlc:~ options ~pplied by l~ymen, The enormoua error htrodncc~ by the absence d~nical dat~ was compounded by the large incidence of proxy reporflr~g. An ~dividual who happened to be home when the interviewer came ~o~aea hill o~ me~cal dlagno~ts and also a medical ~a~o~is for all other member.~ te household. S~ilarly ~e smok~g habi~ of ab~ant household member3 obta~ed from ~ose whom the ~te~iewer foun~ at home. In a~dttion, ~e analy~a of the data in ~o ~Iorbidlty Report wat~ an~ biased. Comparisons of different groups (such aa "~ver 8mok~,~r' "Never Smoked") were based upon populations o£ diffe~nt average aget~, there,by ]~oring the fa~ that age is a highly significant factor in a~alyzing couSCous. ~otal ~sregard for error analysls, whle~ Is fnndamen~l to pemittefl conelu~ons whi~ war~ simply n~t supported by the data, Iu sh.rt, the ~orbidi~ Repo~ was based ~oR a survey loosely conducted and so as to be wholly ~slead~g an~ unr~iabte. It is ~omaflc ~at the conclusions dra~ in a s~ti~t~cal ~tudy e~n not be accurate than the data upon ~hich they a~e ba~ed. Poor data, b:a~ed upon proper me~ods of sampling and re~orting, can only lead to poor an~ conclusiong. For t~ r~on It ~s necessary to ~amlne In ~ome d~hdl the methods of samp~g and re~Ing data used in the Morbldi~ & camplete ana]ys~s of the ~Iorbid~ty Repo~ could be made only aft~,r exam~ ~tion of va~ou~ materials which have ~m$ been made available to ~e publb,, su~ as the completed qu~onnair~ on w~ch ~e data ~a~ flr~t However, even within ~e Moth[dRy ~e~o~ Itself, the "intcrviewcr% fo~ ~ s~ey, ~d a booRle~ en~fled "He~lth Statistics" whh'h conta~n~ a de~il~ accost of ~e survey d,~slgn, several major defleienete~ in ~, i~ Report emerge as inescapable. The char~. In Appendix ~ to this Critique ~e[t~ forth tho~:e def.]]:~ .r sample desi~ o~ the surve~ de~crlhed In the ~Iorbidity ~e~o~ Many facts about ~e sample desi~m were not ~eveale~ by the ~Iorbidity ~rom ~e ~ac~ disclosed, s~ieus deficiencies arc ~eadity Several ~ccessive selections were emI~loyed in choo~h~g the ~amp]~) $~*r Morbidl~ Report. F~s~ t~e United States was divided h~to ~0 geogral~hb.ally defined areas called Pr~ary Sampling Uni~ (PSU'~) i 3~7 of the 1j ~~ ~ere ~electe~ for use ~ ~e su~ey. The Morbldity Report did not ~dlcafi~ these 357 PSU's rep~esente~ a cross section of the country. Ninety PSU'~ among the~e 357 PSE's were randoml~ ~elected for each week ~f sampli~g ~g the 52-week zurvey. The ~Iorbtdity Report did not reveal ~'at one partieuhtr PSU was not selected m~ny more t~es ~aB the o~er PSU%
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962 Within ~.ach ,~.eleeted PSU furthee random ~election were made to choose °'~:egmcnt~," that is to ray, eluster~ of six to nine neighboring households, in ~vhieh int~rvlew:~ were conducted. Ea~ bed of a "flophouse" wo~fid be con- : ldcrcd a~ a hou~hold for these purpose~. The, re i~ no demonstration in the Morbidity Repor~ that the households ly r*qectcd were rcpr~'cntative of the entire ~pulation in demographic charac- t(,ri:~tie~. Ba~;ed upon the facts di~closed in the Morbidity Report, it ~imply can- n.t I., ~.ald that tim r,~pon~es received in this ~mal[ number o£ hous(~hold~ ac- .nrately r~flected the responses which would have been received in the entire P~:U, and ultimately In the entire United States. Mo~-ow.r, on~ extremely significant flaw in the sample design was the e~- cluMo~ of all military per~onnel, even those living at home. It ~ prohable that Hm health of military per~.nuel is better ~haa that of the ~opulatiun as a whole. partb-,ll:wly because miH~-~ry ~,r~onael mu~t meet eermln physical and health :;tamlards ~lmn entry into ,the service and periodically while in m~tary ~orv- ie~,. Aidr,, It Is well known tha~ thl~ gro~p smokes a large n~ber of cigarette. C.f,?l~.eq~ently, tlt~ elimination of thi~ gin)up, likely to conta~ a large proportioa of h,,althy t~mol~rs, biased thin survey wbieh purported to give comqusions as to ~efldng and health for the population as a whole. II Is f~mdamen~al Ihat tl~e slze of the sample used In a survey Is ;Hways a erl~le~d faci~r In determining it~ accuracy. The overall ~ize of tlle ~mIfle n~ed hy the P~flfllc Health Service was 134,000. or about mm-tent~ of ano percent of the i.,iml',ltion wh~}~e eharaeter~tles tlle ,survey was supposed to de, ermine. This .w:r~dl ~fz~ of ~urvey might ha~'e hecl~ adequate [o determtue smite ehoraeterls- ties r~f the I~co~le of the lrnited States, but i¢ wan not adequate to draw the con- eluqo~u in all ~.;abc~l~gorles reported in the Morbidity Report. Th. s:m~i~le was nc~t ude~lUate for {hose purposes beeau~ It was not la~'ge em-mgh to yield a s,~fiieien¢ number vf versous in v~Ious important categories. Thh~ t~: ct,,:~rly :'hewn by an analysis of Table 1 o£ the Morbidity Re~rt whir~ project~xl the ~urvey flgure~ to population figures for the KVnited States. This ~able, with its flgure~ In the millions, is quite impressive at first glance. However, tt I:~ ~:;o of intere~.t to project backwards from this table to determine approxi- stalely what the original :q.mple looked like. A chre~-p:~.ge table ~ving the deflated figures corresponding to all the large ltg~rea ia Table I in the 5Iorbidity Report is attachmt to this CriHque as I.'ndtx B. The ~trll;lng fact disco)'ered by an examioatlou of Appendix B is th~ small mmlber of entries in some important categories. For example, the number of f~,male~ lu the entire ~,ample who snmked two packs per day or more at the time of the ~,urvey was only 207. Only 21 females In the s~ple betu'~en the a~ges o£ 17-24 5earn smrfl~ed two packs of cigarettes per day or m~re. Only U0 males were f, omd, b.~:een the n~e~ ~:,f 17 find 24, who smoked this milch. Xet, conclusions ~w~re drawn a~: to each ¢,f these categories. Al'~o, It Is lntere~tlag ~o nnt~ from Appendix B that the number of cigarettes , rooked I.~r day wa~ unknown lot a sixeablo percentage of porous. In fact, t;~wp~al ca~e~, the entries in this category of "unknown" were larger than the ~ntrlea In ~;ome of ~e number of cigarettes smoked categories. The lituited size of many of theso and oiher categories, together with the complete~e~;~ introduced by those persons whose smoking f~cquency w;m un- krm~v~, ~oggct~t that the projections of ~ese categories and the resulth~g con- ehr,4ons eontai~md substantial error. Such limited data is no pro~er basis for ~e m.mnmth and dire projections made. Ctcarly, a larger ~mple, thereby iucreasing the :-ire ,~f the~:c critical categories, should have been N0~RES~0~E Flv~ p.rcen~ of all households selected for a household i~tervlew failed to rc~:r*oud becaw~e no one was at home when the ~rview~ came. What was ~e d~:po~-ition of lhe:~,:~? Did lh~ survey deziguer~ then add other households to be :~.rveyed in pltl¢,~ of thesel Absolutely not ~ The responses from the missing house- lmbJc~ were guc~se~ on the ba~la of the responses of the other households in the ]t ma:~ be a~sumed that the Public Health Service was cognizant of the effect ,if th~ inaccuracies introduced by ~lessing what would have beeu the responses 963 from those households not lnte~Tie~ved. The Bureau o£ the Genhus which acted as Collecting _~gent for thu U.S. Public Health Se[vh~e. ia its "'National Health Survey--Interviewer's Manual," defined "TyDe A aon-latervlew~" a~ tho~;e sis~g of households occupied by l,ersous eligible for interviews, but for ~h~ no interview was obtained. This ~Ianual ~en s~ted on page D-18 : "TYI.~ A inte~'iews must b~ held to an absolute minimum. Every Type k nen-intervb,w means tha~ we are losing valuable l~omation ; and, ¢] the number t8 ~arg¢,, sample reSurn~ ~aay nO~ be repre~e:n~a$ive o? the e~tlre population." (Empha~A'; added.) Is five ~reeh~ ~y~ A non-interviews not a largo number? Is 2,100 42,000 households not a large num[~er~ Is 6,7~ l~r~ou~ out of 1~4,0~ not a larg~, number? PRow If the interviewer found anyone over nineteen years of age at home in om~ the ~el~ted household% hs was able to avoid the problem of noa-res~n~. Hox~ ever, another serious source of err~,r wag introduee4 when memb~r~ ef th~ hold who were at home were a~ked about the health and smoking habits of ~l~y absent adult member. The inadequacT of this method of proxy ~'e~po~e is demoa~trat~d by elm that o'aly $0 p~ve'~t of all males included In this survey wc~ actually viewed. What about ~e other 60 ~cent? AIr data for ~i3 la~c ~als:dn:: gr.up w~ suppH~, frequently from supposition, by proxy by tho~e who wer~ at when the intervlewer came. How many women ~ow exactly how many per day are smoked by thor sons? By ~elr hu~band~? Haw many wom~n report a slight cough as bronehiUs in ~eir husbands or ~on8 when the slight eeu~ would be overlooked by ~e male re~orting for h~clf? How nineteen year olds know their mother's and fa~effs sm~klng habit~ and dl:,e;~: which may have occurred before th~ bird? As an example, extreme l~,rh.p:,, young bride living in the home of her h~sbaaffs parents might be asked, t~ were at home alone when the interviewer a~lved, to reI~-~rt on the r~mol;l~ habits of her mother-in-law and father-in-law, a~ well as their health history, iaclnding habits and health conditions of many year~ ago, perhap~ t~t,n bet.re the young lady was borm The m~gni~do of the error caused by this use of '2,foxy" rc~l,c~e~ e~,thnot precisely determined for the 5Io~bi~ty Report, but it wa~s certainly particularly wl~ resF~ct to queslions abou: I~havlor many year:~ in th~ Moreover, the ~ffect of "proxy" responses in health i~terviews has boca and red, ted ia other publieatlons of ~e Public Health Service. In a ffuly pt~blicatlon, "~ealth Interview Responses Compa~'cd ~-lth Medical ,I-lecord ¢' a comparison was made between interview responses and actual mcdlcal & ~ble on ~age 19 of this Dublieatioa in~uded a listing of 32 h~,alth cat~_,gorie;~, together with iaformai, iou as to the correspondence between allmentt~ by relapses ~d Chose re.reed by fi self-res~ndeat. Ia 26 of ~hese 22 heal~ catego~es, inclu~ng all the illnesses ~n~ted with cigarette c~ol:lni% by ~Iorbldity Report, except asthma and hay fever, there wa~ a ~fft,~elte)? ~:)f least ~ ~rcent when reports by ~elatives and self-re~:i~ndent~ were wi~ actual medical records. There is no ~eason to believe that the "proxy" re~,ponsc~ tatho M~,rhhlltj Repor~ were any more accur~te than those in "H~:alch Intem'lew Ite;;poa~e~.; ~ared with ~Iedlcnl Records." SI~t;fdE~TED ~ECALLED A~D Paean" SELF'DIAGNOSI~ Tl~e me~od for obtaining data in the Morbidity ~eport eon~i~tvd o~ aa ~e~viewer visit those househol~ selected. Every member of the over ninet~nth years of age who happened ~o be at home when the lnter~h,~ver came was asked questions about his or her health. If ~ome, l~,r~:o~s In the hold over nineteen years of age were not at home, the ~emfilaing mp~,/b~,r~ the household were asked about the health and smoking habtt~ of the members, MI health condiHons reported in the s~rvey were based ~trictly up.~ di~gnosis. ~e major inaccurm:i~ introduce~l by ~elf-dla~o~i~ r~lre discussion. The differences between medical f~~ct ~ad self-dla~o::~a are ~pl~arent. Even the 5Iorbtdi~ .Re~rt, on page~, state~ that : "~h~ prevalence eMima[es of chronic comlltions u~ed In this repor~ tire to special limitations inherent in ~ta collected In household hcal~ intervipw,~,
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964 Chr~~li|e eolidlttou,~ rep.rted in interviews ~qay be deseribe~ us the~e of which tim n,~pnndc~lt J~ aware, and is willing [o reporg ~o ¢he interviewer. The n-,~b" accuracy o~ reported eoudi~om~ is dependent o~ the ~forma~on atteudln~ ph~Mehm has ~a~ed ~n to the ~nily, or, in the absence o~ medic=] attendance, on ~e previou~ e~perienee or education of the Iamily. For these Nob~ her,~ the w~nlng ~o ex~]ielty ~ated, but so complet~y ~nored, tu draw- Thl~ t~a~,u, W~ing ~s r~:Teated over a~d orer ~n o/~er tmh]tea[io~ls of the Pub]i,. H~,aith ~,rvie,~. For example, in a 19~i publ1~tlon, "Henllh Survey P~e**.'edurc~Concopt~, Qnesttonuaire Development, and Defl~tlon~ In the Heal~ lato~qew Survey," the following statement is famed on page 1: of ~aorbfdffy. Thh~ means tha~ morbidity is measured along an ax~ for which tl,~ ~'ahz k~ in terms of the impact that the morbidity has upon the ~ves of I,:o~,Ie eonce~ed. ~uch a scale, it ehould be pointed ou~ may ~ff~ in a num- b,r of way,.~ from the ~cale ~at m~'dica~ 8c~c~cc ~e,~, which t~n be hroadly de- ;~erlbod a~ a ~ntlau~ of petrological change. Mcasurem~t along both of these ~.,'aln~ t~ w ,ful for differ~m~ pur~et~. The NaHonal ~ealth Survey int~ds to t,~pl~]y ~,~tJ~:ticz based upon both ~pes of me~suremea~ ba~ tcckni~es other than tlm householgdntcrvk:w survey must be used to otbai= ~tat~tlcs ou mor- Mgfty in term~ of me~ic~ ~tc~¢." ( Emphasis added.) ~ it net, ~hvJou,~ that, [a the ~e~Mdity ReporL r~ults of the househeld-~ter- ~.h~w ~:urw y were, in feet, used fo obtain statistics in terms of medical ~lteria~ I~t It not t~uo ~at the dire wa~i~gs as to use of clgare~es were based on ~;~ptlon~ of eon~nua of patholo~cal change ? • h~) un~:liablli~ of the basic da~ employed lu the Morbidt~ Report has ~ conceded by other ~ublicatlons of the Public ~ealth Service. A 196~ publica~on, "Iloalth I~t~-~rvjew Rogpon~e~ Compared Wi~ ~fedical Records," stated on ~age rf~n rcpo~b~. ]t woulR appear that th~ ~ck of ~nfomZty cannot be by ~ffmplo population attribute~ and characteristics of the intervlew ~tua~on. Age, sex, ~ocloeconomic s~atus, respondent s~s, ethnic back~ound, and o~er conw,ntloaal demograpMc atfribu~es exert su~in~ ~ttle ~fluence on the d~g~e~ to which th~ knowl~ge that ~ physician has about the existence of Illness 1:~ rcflcc[e~l ~ a household intervM~. Furthermore, ~e fact tha~ a ~hysiel~ lure recorded a diahmoMs of a disease usua~y thought of as serous, or con[a~- tag all the., vlem,nts of chroniclty {£or example, dl~etes or heart disease), by no m~:,ans gives a~urance that the condition will be lden~fied by the res~ndent an iniervlew." (Emphasis added.) Thh; 1~1(;3 publication concluded that only 40 percent of aR chronic eondiHons r~p,~rted by re~;pon dents were ~t~ed to condi~ons ~ferre~ ~om ac~al medical Th. ,10 vcrcent figure was cenfi~ed by another Public Health Se~ice publi- ~'tltbm, 'qntervic~v Data on Chronic Conditions Compared ~ith Information Derive4 ~rom Medical Record," publ~hed in 1967. A table ou page ~5 con~ tt fl~or~-~ of 37.~ percent fop the matc~ be~een condiCions reported in an inter- VIew an~ conditions reported in ~ediea] records. Page 41 of the same publication gay,, an ,,v,m marc ~triking result. Even in cases in which a physician ha~ v.crlb~d the condi~on to the patient ~n the exact te~inolo~ used in the inter- vh~w, only 41 percent of the ~te~iew-reported conditions matched the medicaI records:. This publication eonclu,~ed ~th the z~temeut ~at: "The number of chronic c~nditlon~ a ZeSlmnden~ has tn ~is medical record does not see~ ~o be vlo::'e]y nqatcd to how well hI~ con~tions are reDorted." (p. ~) N~*cc~arlly, ~ome me~ ~re of t~abflng is needed to interpret Interview answers 'qn obtaining the ~swers to ce~a~n q~estfons specified by the questionaire, the) interviewer perform~ a f~e~on ~nt ~ simply one oZ report2ng wh~t she ~,ar:~. Thh~ function does ~o~ include any element of interpretation. ~or this rcx~on, lay lab~rviewezs are generally preferred to me~cally ~rained inter- vlew~r~, d*~pitc ~e nature of some of t~e ~fozm~on ~at Is berg bandied. ~r~e,n wlth a m~lcal eduea~on Is trained to inte~r~t wha~ ~he patient says, and thi;~ lnterprctatlon is dl~cul~ to standardize for statistical Purposes." tqorw,y Pr~ ccdure." (p. Z1). 965 In the tabulation process on the :rdorbidlty Report, a clerk many mlle~ away wan forcc~ to interpret what the person inte~iewed said ~ order to a~,I~ prope~ numeri~l code. ~ effect, the interview gave a symptom, and a clerk made a d~os~s ~ The Morbidity Re~ort also provides ~ apt illustration of the ~roblem of eel rect ~eport~ from interview data. The Report ten,deal ~at the reported at bronchitis were "no,necessarily the same as a phy~cian's dlagno:.~ts of chi~s. It is quite ~os~ble that some of the self-dlagnosed cases may tn f~ct 'smoker's cough'." (p. 12) ~e ~roblem thus was reco~izefi but apparently att~p~ was made to ver~ the a~wers r~eivod with ~he 2emily phyMclnn or wl~ available mescal records. ~he earlier "Health Interview Responses Compared Wl~ Medical however, made ouch a study. 0n page 59 a ~ble ~ve the result o~ a eomparh~.n of interview data with medical records for many categories of lllat~. In titular, for bronchitis, only 16 percent of report~ case~ matchcff km~*wn medle~d records. 0~ all re~iratory ailments the highest ~reentage of matching, that for asthma and hayfever, was only 49 percent. The "Interviewer's Manner" for the Morbidl~ Report directed ~at, re9o~ of a health condi~on, ~e question : "Did you evc~ AT ANY TIME ~lk a doctor about year... ?" (capital letters for emphaslu are ~helra) vhould asked (p. ~8) No apparent use o£ ~ question was made, hov,'c~vor, to tinguish betw~n ~e~-dlagnosts and ~ue m~ic~ history. Gr~at emphas~ was placed u~,n symptoms. Thus, the Manual ~Intcd out that when a ~ersou had symptoms, he was ~ai4 to be ill. QonsequentlF, a or condition was more or l~z arbitrarily as~i~ed to a reported symptom by tht* aforementioned clerk. ~ues~o~s ~e ~ked ~n ~he s~rvoy ~bout th~ ~m~a~ haM~ o~ th~ dents and ~ember~ of their households. I~ormation wa~ ~ought ~a to who:their these people smoked now, whe~er they ever smoked, and what wa~ their rate of cigarette coasump~on. No effort was made to establish ~e l~9tk el time during which a per~ton had ever smoked at a particul~ rate, or when he had smoked at this rate. The futility of any a~empt to draw conclusions from the type of questhms eel:c4 parent from ~e follo~g e~mple: Consider a fifty year old man who smoked for one year only while in but, during a pa~ of that time, smoked in excess of one pack per day. ~iq 3~ years ago. ~e has not smoked since thaC time. ~owever, he ww~ cla~lfled the study as a former he~vy smoke~ because ~e study did not distlngul:~h bm tween long-time exposure t~ s~oking and casual ex~sure. It e~,ntnln~:d lately ~o ~formation about total ex~sure. Further, assume that this man, classifi~ as a former heavy smaker, l¢~t tl~ ~rom work last year after being scalded when a ~fety valve fell ~rnm a ~owing steam to escape. This unrelated event ~oul4 have shown up in bidtty Report statistics as work-loss days by a person ia the 4~t~t age bracket u~der "Ever Smoked" and "Former Smokers" in the 21-40 eigart, tte~ per day category. ~e would have ~n a sta~s~c is Table £~, page 52, of the R~,port. In effect, by the implied ~¢erpretation of this table, his injury, due to a wh*dly unrelated mechanical accident, would be at~ibuted to hi~ ~mo)zing 31 earlier ~ 0n ~age 56 of the Morbidi~ Re~rt, in a di~cu~ion of the sarapllng XdRn, th~ statement was made: "The overall sample wa~ desi~mcd iu such a fm~hhm tabulation could be provided for each of the major geographic reglona and for urban and rural sectors of the United State~." However, .~tteh a tabulattn~t ~t provided! Perhaps su~ a tabulation, wi~ lacl: of consistency in would have weakened ~e ~osition eft the an~-smo~erz) Or, p~,rhn~ t~o serene design precluded ~y meanin~ul ~alys~ of such data ? A parted an~-er was provided on page 6: "The main tOm, an for re~trlcth~g the analysis is the lack of su~ci~t casc.~ to ~l the approl)riatv ccll,~ In eross-~bulation~, ~a~ticularly in terms of the number of clgar~te~: per day." (Emplmsis addS) In other words, au earlier dlaelo::cd, the was not good enough to do what had been intended. .~ter abrading the raw data from .~e ~ample, how wmt It tab~Mted if In the manner originally intended? The shocking answer is that it wee not lares! This raw da~ was not evaluated. Instead, It was s~re/vhvd, comprc~ Weighted, to fit a predete~e~ mold, Just as one wolff attempt 40 1*ut a Vo}kswagea fender on a Cadillac ~
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966 A valid ,~'ampllng plan must be representatlve of the population it purtmrts to portray. This a~tudy recognized the fac~ ~at Its sample was not represen[a~ve. Con~cqu~ntly, a ~rocedure of weight~g each response was ~ ~ an attempt ?~ for~, the sample to be representative. Actuary, the data was a~usted at l~'ar~ three t~es ~ Engineers frequently re£er to this t~ o£ adj~tment as using If ~£~ weighting t~nique were ~ffectly yard, one could sta~ wi~ a ~mple o~ one tndIvldu~ and weight it to fit ~e general ~ere Is what was done: • h~ Uuited States was divided into eleven ~bula~on areas by geographlcaI dis- t~lct~ ranging from thrc~ t~ eight e.tatcs in each are~ If Are~ ~ive, f~r example, w~c~ not t~u~dently represcnt~ ~ the s~ple data, instead of get,rig more data from Area ~ive, this study 8imply muttiplled the avai~ble data by any r,~:~:z~zary factor to b~g the to~l in line. ~his, of cour~e~ tto~al data ob~c~ would be exactly like that alrea~ obtained. No Justifica~on wtt~ ~Vlven for th~ assumption. Ta lllustr~te what ccmld result from appllcaHon of &is ?vincible, consider a my&lcal ~urvey e~ United States Senators from the 9~t Congze~,. asking &e ~imple q~cstlon; "A~e you Dare.rat er Republican~" Suppose ,~at, with a random ,~,:,l~tton, t~e fo~owing Senators were eb&~ed as a sampler Boggs (R}, Delaware; Domlaick (R), Colorado ~ EasEand (D), ~issippt; Eltender {D}, ~o~laaa; Gore (D), Tennessee; ~a~r~ (D), O~oma; Jonah Idle; Thurmond (R}, South Carolina; Williams {D). New Jersey; and Yar- burou;~h (D), In k;~-'l*h~g with the techniqu~ used ~ this ~ena~rlal Survey are ~bulated by ~e g~a~hical areas d~ned ta "H~al~ S~aUs~cs." Number of ~ura~er ef ~lected Senators from each Sample data re:ult~ In this azea by area the su~ey Oem~ra~ Rep~bl~ns ,~euth AlllnfIc ...................................... lG 2 0 2 I~$t zou|ll-cenhal ................................... 8 2 2 O Wc~t s~t~-centr~l .................................. 8 3 3 0 M~ua}zln .......................................... 16 2 0 2 P, aw t~tals ................................................................ 6 4 N.te th:tt the raw totals, with six-tenths of the data results iudieatiug Demo- ~rat;~, glw:, the approximate distribution of party representation in the Senate. Now, wate2t what happens when the data is weighted. 'ISae sample was ~0 out #)~ l(S), Each Arc~ ~ll be weighted so that its sample ~11 be ~ of its ~e r~prescntation. ~ls, then, according to the weighfi~ technique used ia the Morbidity Re~)~, should ~ua~ze the samples saluted from the variou~ ,treas. For ~mIde, the Mld~kflantic Area ~cluded one of its ~x Senators in the sample, or ~ of lt~ ~uc representation. To convert it to its "pro~r share" of the ~ample, that is to ~:ay, 1~i~e, we must mulUply its re~lts by 6~leo. That is, U; multiplied by e~lr~ gives ~00, the de,iced "proof share." Similarly, each other Area is weighted in the same fas]~lon. This proee~ yields : Sample data re;ults Wei£hted data Area Demo¢~a| Republican facl0z Democrat Republican 967 .Note that the Republicau count of 320/100 is now ~.~J perct, nt ~:~f tim ttd'~.l .f 5,t0/10~! '£he w~ghted Survey rc~,ults ~ow ~voald ~dmw n 59 to 41 Rel*uhllc~t~t majo~ty in the Senate after weighthtg raw datn showing a 6C~ to 40 ma]orityl In other words, a relatively good result wa6 completely roverjcd bY a~tfl~ weighting ~mllar to ~at tn ~e Morhldlty Repor~ ~r~e~ore, the da~ In the Morbidity Repo~t was weighted by re,;Ida,nee age-~.x-~lor as well ~ geographic section, "~ealth Sta~ties" (pp, 12 a~d ~or example, ~ ~e r~idenve adjustment, responses by ~ural ~e~oe~ within "standard metro~litan area." in Missouri, say, in the viclniey of St. Lo~d:~, counted at only 0.3S of the raw data, while re,peases by white fartu~rH tn rain ~ates were multiplied by 2.~. In other word~, the latter re:~p.n~:;L.:~ vve~{, value, and computed, as about &6 of the ~ormer ~ Si~]ar adJus~eats were made for ~ age-rex-color ch]~zcz of the ~e a~us~ng £actor8 ranged from 0.61 to 1.:~G, with "PIIS ezth.a¢ca f.r G2 ~.~f the ~ classes coming wfthin 12 perc~t o] the controls." (Empha~l:; added.} ~he .~eEi~n~n public may have been brainwashed and mi:4ed ca the bar, b; uf the~ muddled After ~e ~'o weight~gs for geographic region and for age-~ex-color, a third type of review adjust~ the sampling f~acLlon for hou~:clmlds ~md I~r~oa~ fr.a~ special dwelling lflaces such as a ~foEmatorlos. homed for the aged, or h~t~bj transleats. Apparen~v ~ adJus~ent was s~bjectlve. So det~ll:~ were ~Ivon to the procedures employed In making thls adjustment. ~rhe~ ~ ]~ manipulated in thi~ f~hio~ using statistical tcchnique~ which are open to qu~fien, it is elementarx that ~e raw data sholdd be ~ad~ so that others may examine ~is data and ~rhaps drmv other inf,~renee~ from H~re, ~to ~Iorbidi~ Repo~ contained only ~ data a~ It appeared after "t~hnicaI" "adjuStments" and "weightJngs." No tabulation of raw data made, &llowing ~e data to be "weighted" and "adJusted" by a governm~,ra~ agency which is far from neutral in the cigarette-health eoztrow, rzy b~,5,~, It was released to the public introduced ~ bias into the study which prevent~,d ~mpleLe and objective analysis o£ the study. For ~1~ reason alone, the rt~lwlll- ~o~ of the Morbidi~ Report are open to serious challenge. ~eoptng In ~d ~at th0 orJ;~iDSI data was not tabulated and that the flnaly~s w~ made on ~all~ wotghte~ da~, there are several p~lnt~ which ~e face at the Morbidity Repo~ cast doub~ upon the validity of the ~,aaclu- siena 2t advance~ ~robab~ ~e most impotent ~:Iggle item In ma~ng a valid ~=tath=Ueal ~arlson between two categories of ~rsons is ~hat the two eategorleq eompar~ must ~e drawn from the same or similar t~tal ~pulaUon~. In any ~ey eom~ng two categories as to hoal~= conditions, it i~ es~ntlal theft ~o cathodes have the same age distribution. It take~ neith~,r a ~a[l~.=tlelau nor a doctor ~o appr~late that health usually depend~ upon age, Older adult~ ~mpl~ have more il~ess than youager adult~. In r~ognl~on of the im~rtanee of ago, the architect~ of ~e ~Iorbldity ~eport arbitrarily "~g~adJusted" the data, that is, weighted Jt ]a aa to cover the imbal~ce by age groups, to try to make ~e age dl~trib~H~,n r,f all ~rsons in ~e su~ey r~emble the age distribution of the ~puh=tlon a~¢ a whole,. The flaw ~ ~18 t~h~*tue 18 that, while ~e number~ of ~z~n~.¢ in v~rlou¢ ~oups may ~semble ~e age distribution ~f the entire pop~latlon, the eontraetD~g and ex~nd~g of various age ~ou~s as~umes that all charaeteri~:tlc;~ of the sample age group ~1l be ldeottcal to ~oze of a largvr or ~raalb.r ~)anWb. ~e same age ~u~. In ~ther words, compressing a Cadillac to Y~dkaw~tg~-z~ d~s not make it a Yclk~agen. Several ~blcs were Wen in ~e ~Iorbtdlty Report showing ref~ult~ and ~ter ~is "ag~adJust~g." Tables 7 through 15 each eoa¢~tned eight The rates ~or morbidity were Wen for "Never Smoked" and "Ever ca~orie~ Under this weighting process, rates Sot the "Never Smoked" were decreased tn 5~ en~l~, increased la only nine. On ~e oth~r hand, for ~e "Ev~ Smokeff' ~oup we~ d~rea~ In only ~lne tm~tance~ and ~cr~se~ ~ ~6. In many Instances, the "Ever Smoke~" group had rates mo~ £avorable than fl~ose of the "Never Smoker' until the "ago4~dJur;t-
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968 tag" took l~ltlc~). ~. good example of this is in Table 13, page 40, which reported proval~'r~co rates for arthritis. 13el0re adju~ng After adjusting Never Evgr Never Ever smoked smoked smoked smoked M~[~ .............................................. 7.3 6.9 6,8 7.3 Fcr~=lu ......................................... 15.4 9.7 IZ9 12. S A w~ry crucial fact Is that th~ average ages of the persons in each of the ;;~mklng cat~,gorb,,~ in the ~urvey, Le., ~o 9opulafions which were compared, w~,re not the :;ame. Age br~e~ presented in the Morbidity ~eport were b~adin~ if the reader assumed that each bracket represented an equal or com- p;~rablo group, at lc, a~t as nearly ~o as can be accomp~shed wt~ ~mp~ng. phadl~ x~'a~ placed upon ~mo~ug ~tatus by age g~up, bu~ ~e Repo~ included ~vldeuce ~at the age o~ groups of different smoking ~tus were indeed not cquak The average age wi~in groups, as esgmated from data in Table 1, ~age 23, wh~u weighted by the number of respondents in ea~ ~oup, indicate~ for male~ the fo~owing e~timated average ages : Total population .................................................... 42. Ever ~;mokcd ................ ~ .................................... 42. Former =~mokerz ..................................................... 47. ~xer;cnt vmokcr:~ .................................................... 40. 9 N,ver ~molo~d ....................................................... 41.9 A ~:Imilar tabulation £or females gave : To{~1 r~I~l~fion .................................................... ~. ~]~,r :~okc~ ..................................................... ~. For~er ~nk~r,~ ..................................................... ~. ~r~mt v~m~cr~ .................................................... ~9. Ne~e~ ~k~ ...................................................... ~. ~e~ ~at for male~, ~e "Never Smoked" ~oup averaged 5.6 years younger them ~h,~ "F,~rmer Smokem." It Is to be expected, ann can be so shOWn, that 6.6 yc~r:~ :,Ide~l cont~ide~tbly to the rate of chronic conditions even if p~xy re~ort- 1~? w~*re r,:~motely reliable. Ai~p,~ndtx E of this CriHque conb~ two grap~ ~f the v~ious ssmples, with the percentage of each sample falling wi~in each ~ge ~ou~. Note that for tn:~le:~ the "Never Smoked" group had a l~ge proportion of 17-24 year ages and a ~malt propt~rtion of the 45-~H year group. "Former Smokers" found them- ~h'f':'~ wi~ almost no ~T-2,I year olds and a large ~oup of persons over 65. Obvi,,l~ly. the "Former Smokcr~" had considerably more il~es~but, obviously b~'cau:~e of ago alone and not d~erences In smoking habits ~ At vari,m:~ places in ~e ~Iorbidity ~eport, att~pts were made to raGona~ze the fact that female "Former Smokers" had a zmaHer incidence of disease than "Never Smokers" in many compihtions. It was not necessary to rationalize this result; one need only look at the graph ~ these samples In App~:adix E. Here the, "Nc~er Smoked" group contains a dlsproporGonate num- bvr t~r ~q- year old I~rsons ; hence, the health condigons of ~is group compare unf:worubly with tho~,~ of a younger group. This is due simply to the d~erenee In avermzo age. not to any dlfferenco In smok~g habits. The ~or~ldlty ~p~rt did comha~ statement~ which indicate ~at there is a ,leflnito effect of ago upon illness. However, this was glossed over and not analyz,:,d. A care, ful ,~tudy, without a specific axe to grind, wo~d have eontMned analy~d~ of the effect of more than one variable, such as an analy~s of variance f,r og~ and ~moldng habit~. This is a ~ell-knowa statistical t~hnique for detez- ~*~lr, lnl~ which, i~ either, of two variables affects si~eanfly a thl~ variable. This technique may be extended to a larger number of variables. The author of tht~ Critique did just this. Using data from Table ~ of ~e BIor- bkllt~- Re[,,rt a3 to the tbr~ levels of age and the three inde~ndent smo~ng factors of "Never ~moked." "Fo~er Smokers," and "Pre~ent '8moke~." he cal- culated by ~taudard methods the statistical si~tfleance of age and of smokln~ 969 status for various of the conditions listed in the :Report ; that is, whether there is a reasonable probability that age and/or zincking status contributed 3tgnlfl- cantly to the chronic condition in question. The results of such a caleulatlnn are shown In terms of the so-called crlttc~l F-ratio. This, simply, iz a calculated value which can be compared with standard table values. If the F-ratio value kt higher than the appropriate table value, one Is not able to ~ay that the variable truly affects the ehronle~eondltlon, that the effee~ is no more than could bo peered by chance. For the ealeulatlon'~ made herein, statistical significance would be indicated by an F-ratio value above lS.0. Aralysis of varhnca Aga H~peflensts n ................................................................... Sinusitis ....................................................................... t 0. 03 ~ 0, 78 I Pepge ulcer .................................................................... Arthrtti~ ....................................................................... 1,~98.3 I Heart conddlons ................................................................ Bro~chit~s/e_mphys~ma ........................................................... Acute conditions (table 16) ....................................................... R~trlcted activity (table 20) ...................................................... 167 t 11.0 Bed day= (labia 21) ............................................................. ~4 t ~. 0 Wor;~ loss days (t~ble 22) ........................................................ t 17. 8 I lnoi~nlt'mnt l~e~zusa vaIue i~ [a~s than 18.0. = I nsulficlent data for analysl~. This analysis shows a statistical significance betweeu five of th~ eondltll:,n~l listed and ~he a#e of ~e ~rsons interviewed. Thus the ago dlffer~,nee~ In smelt status categories not only are Impo~aat~they are vi~l [ The above table also ~ows that there was no statistical st~Iflcance a~ to smo~ng status o~ the ~erzon interviewed ~or any of the conditton~ llstod. In shor~, as to these countless, the Morbid[ty ~e~o~ ~6mply dld not e~2bHsh even a ~taflsflcal ~e~tionahip between zincking and the illness. An inherent pa~ of any samplying study is control of the ~nm/,lt~g or exp~ men~l error. The e~or in turn depends u~n the size oe the sample emplnye,l. In ~e Morbidity Re~ standard e~or evaluations were made which slri~ply assumed that each of the approximately 134,0~0 persoa~ in the t~mple wa~ "independene obse~atlon," that is, ~related, random observations. A~j tat~,rre~ lations~ps emerged, the number of independen~ observationn decreased, cau~g error ~ the results to ~crease. That was p~i~ely ~e situation In ~e ~Iorbidlty Report. ~e ]21,(~0 ~epo~h~d obse~ations cer~ly were not ~dependent. These ~,0~ ob~crvatlon~ from truly 42,~0 households. Five percent were guessed to be llke othe~. All fa~ly members 17 years and o~er in a single household were included; terra.IS were not independent a~ to health characte~tic~. Su~ceptiblllty lo some illnesses is a matter of heredity, and contagious dizea[~ez may ea~lly be communicated to other members of the same household, ~or are :.~a-toklng h[tblt~4 of f~Hy meml~rs ~dependent. ~et aa ladeI~ndent sample ~lzc of l:J4,0f~} assumed in making error evaluations. The e~or a~alyzis u~ed ~ the ~,Iorbidity ~eport ~an al:~o Inadt,quato f-r other reason. ~taudard errors were approximate~ to cover a wide variety staHstics rather ~aa by attempting to make individual ~alculft~Inns nf the, c~e error involved in any tn~ividaal figure in the survey. That 1,J ~dmlttod page ~8 of ~e Re~ort, which stated: "In order to derive relative errors which would be applicable to a wide of heal~ statistics an~ ~hich coul~ be prepared at a moderat~ t~l, a nu~d,,r approbations were req~red. At~ a resuIt, the ~hart~ provldo an e~timat¢~ t~e approx~ate relative standard e~or rather than the precise error f.r any specific aggregate or ~ercentage." In o~er words, a careful evaluation of accurac$ was not carried out. With- out such an evaluation a statls~cal s~mary ~ased upon zampllng ha:~
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970 With the many flaw~ in the compiling and reporting and weighting of data, it ~:hould be difficult to calculate s~ndard e~or~ for each of the results in the ~or~ddlty ~I~orL "H~alth Sta~sfic~," which described the ~urvey design o£ the ~orntdlty l~port, at~mpted to Justify omitting t~s e~senfial o~ration by "Even wlth hlgh-~i,~d com~utar~, th~ co~t o£ calculating variances £o~ each t:¢'larate e~timate wo~d ~ prohibRive. Further, such a ~tep would ~ unde- ~Irablo In that It would yield ~'~tlma~ed ~riances ~v~ch b~aus9 of their own ~R~pl]~g err, r, would appear at times to be inconsistent among ~emselves." Au a ~hT n~ ~act, w~Lh high-Sl~ compute~, cRlcnlnflng v~rinnce~ enn be v~ry i~,x~ms;lw) whett compared to the cost of acting upon a wrong conclusion, Th, r ~:.~r:on f~.~r calculating variances in the first place Is to as~mate the re~bili~ t~f t}.~ apparent results. If they appear to co~adiet themselves, it probably toca~s thug the ::ample Is too vm~l or is badly chosen or poorly administered for the rc~ult~ tu be ~nclu~ive. To Ignvre that fact, and to u~e only error e~timates which fat to reveal flaw~ in the sample, suggests et~er l~orance of basic statisti- cal prlneiplvs or an unworthy attempt to achieve "tavorable" results without r~'gard to the true facts. The emly #)trot analyt~is In ~e ~orbidity Report was based u~n some so-caH~ ~Iver;-al error curves w~leh are sup~sed to fit all samples of this ty~. The ~:e o~ ~uch curves is not valid nnless ~e sampling p~n of the survey in which the curve~ are employed is identleal to the sample for which the curves designed nr drawn, ~mre was no demonstration or even any claim that this wa~ th~ ca~e for the Morbidity Re, or/. in a~y ~t~tlstb:al analy~,Is based upon s~mpHng, particular care must be given to errv~r ~aly~is, ~o project an imputed value from the sample with a high dvgre,, og ¢.nfidcnce, one can say only ~at the true x~ue has a high probabtli~ ot f~Isg v~mewher~ within the range between the imputed yarns minus three ~tu~dard errors arid the iaq~uted value plus three standard errors. For p~mple, if an imputed v:llue ~rom a sample i~ i0, and i£ the standard error Is 2. one can r:.~y u,lth a hlgh d~r~_e~ ~ :, of confidence only tha6 the true value lle~ somewhere bctw~n I0 mlnu:~ 3 times 2 and I0 plus 3 times~,° or between 4 and 16. Thl~ 1:~ illustrated by tho .table iR Appendix C to this Crltlqu~ The conclusion tak~'n t'r,~m Tabh~ I of the Morbidity Report that 17,~28,~ males 17 years ag*) or older hav~ never ~nmked, means only tha~ ~ere Is a strong probability that the aotual number falls within ,the range from 10,415.~92 to 17,~0,~)S, ~prt~ad of 1,2~,t,016. In a o)m[clrb-on of ~tati~tieal data by a careful and ~b~s~ group, two values urn, not con:ddercd to t@ different i~ their ranges o~ values overlap. Yet, us~g f'vcn the inadequate error analysis of the 3Iorbidity ~I~zt, one can point out t~t c~,~ln result, iu many place~ within the study, were eons~der~ as berg • ffervnt wh~n actually their ranges ovarlapped~ and hence it could not ~ con- eluded that there was a real difference. Apr~mlix D ,to this Critique shows clearly the over~pp~g of ranges; and h~,nce the lack of true difference b~eea the values concluded to b~ diffezen~ the ~I,:~rbh~ty Re.ft. A ~imilar analysis could be made for many ot the other valu~ reported in the M,Jrbidlty L008ENE~S 0F T~E D~A O~e ege~ of all o~ th~ w~ightlng and adj~gting o~ the da~ was a looseness th~ l;~rc~ of the ~lorbidlty Ro~rt w~leh is disturbing in a s~udy of such t¢~nfiaI ~por~nc~. A ratho~ amusing e~lo, yet annoying ~ ~losing ~urh loosenL,~3 e~mld ~xlst, is ~ound by combining Table 3, page 27, "Percent ~alc~ 17 year8 and ov~r, with on~ or more ~hronic tensions," ~th T~ble Pag~ ~, "D~:~rlbution og ~o ~puhxtion by ~moking ~a~us." ~i8 combination d,~.oa~tra~e~ ~hat ~.~ ~r¢~nt of the total ~ulation had one or mor~ e.~dR1ons, and eorre~p0ndl~g ~r~ for ~r~ons who necer smoked and those xvh,~ had ever smoked were ~.8 gercen~ and ~8.7 ~r~nt res~tively. In con- travel tb~ I~re~n~ago cf ~r~ons having on8 or more ehro~e eon~ons for whom It wa,, n~t Rm~wu if they had ever smoked was o~y 18.2 ~r~ut~ Hen~, ~h9 971 logical conclusion would seem to be to try to e[hleate th~ poptflatlon not to km~w whether they had smoked or not ! Of course, th~ ~imply i~ an indication of tlm lo~~cne:~ of th~ Public ttt,~dth Servl~ proj~onu. In fact, one may question immediately the accuracy and appll¢ablllty ~f nique8 whic~ lead to dl~ect contradictiong au Illustrated by two exRmplcu another p~Oon by the Public Health Set.co: In "The Health ~on~quences of Smoking," al~o published In 1!~7~ the fcdlow. ing statemen~ was made on page 7 : "The d~a~ mt~ for pipe s~;okers are little i£ at all higher ~an f~r non. smokers, eveg Ior m~ ~vho ~v~ok~ 10 or mor~ pipe~ul~ a day and for men who have smoked plies for more th~ 30 years." (Em~ha:&~ • he very next ~age of ~he s~e publication stated : "Curren~ smokers of Ogarettes, cigars, ur g,ig~s experienced a risk si~ific~ntly greater than that for non-~mokera i] ~hcy ~mokt~d than ]our pipe~ or youc ¢lgaes daigy or more than an ~ca~lon~l cigarette," (Emphasl~ added,) 3~ile ~is CrRique is concerned with coneluglong a~ to cigarette ~;molflng, mus~ no~ forge~ that the same int~,rviews, same analyses, and the :~amc c:K apgzaisa~ a~ npplied to ~garct~e data le4 to ¢h0 quot('d contradictory clustons as a~pli~ to pipe smoker~. Considerable sttention w~s Wen In the )IorbldXtF Rc~ort to the use o~ ~tflo Any stR~stioisn knows ~n~ ~re~ c~n b~ distort~d, disliked, ~d msde ala~ing by using ratios. The ~Iorbidi~ Repc, r~ went further trod u:~c4 of ra~os, that i$, ra~os of rates. Thus, an incidence rate of 0.Vd~ per hundrc~l gersons for "Never Smoked" and 0.75 per hundred for "Ever Sm.ke4" 0.75/0.50 or 1.50 or, suddenly, th~ incidence rate for "Ever 8mok,'4" l~; 150 Is,r- cent of that for "Never Smoked." ~hls, o~ course, disguised the w,ry ~mall her of occurrences ~nd the di~eul~ of mea~u~ng a true differential the two ~tegories. The statement is made that such rages then are diret, tly eomp:trabh,. I]1 tlo, 1908 Presidential race, DOaware ~s carried hy Nixon aml N~w York carried by ~ump~ey. In Delaware the ratio of vote~ for Nixon to tho~(~ Humphrey was 1.1. In New York the ~tio of the Humphrey vote to that of also was 1.L Are these ra~os r~lly meaningful when compare,d, con~.Iderl~g tho vast dist~rity in electoral votesin these two Conclusions involving percentages were dramatized by the careful ch.lci-~ base. For example, m~ntlon was made that, "among women whe smok~'d ~1-10 etgareltes a day at rhetr heaviest rate, the number of tho:qe with ~t ~r chronic condition~ is 51 percent higher than that for 'never smok#'r~3~.'' ~hla was achieved by projecting the Dereentage o~ "Never Smoker:~" wl~ Owce more chronic ailments at 20.2. while the 21~0 cigarettes ycr day ~meker:¢ listed as ha~ng 30.6 percent in the s~me category. U~ing the "Never ~en~ge as ~e base, the ratio of the two percentages is 1,51--hence the ~cent "higher" Now, if th~ p~blem statement ia reversed, that is, expressed in terms of who do not have three or more chronic ailments, we find 79.8 ~2rccnt og "Never Smokers" and 69.4 percent of the 21~0 cigarette smoking group ia thk~ Then the ratio of the ~ezeentages ls 0.87 or 1.15. depending up, m ebb:dee of base ~.e., a ~ffezence o~ 13 p~rccnt or 15 percent of the selected ba~ instc~.ld f,f percent de~v~ from the same data ~ CONOLU~ION There are ninny other comme~ts one could make about the ~Iorbidity One could point out the unforgivable sin uf statistics, that or dzawtr~g conclu- sions from da~ known to haw much tee great au error, Thts was done on 11, footnote 3, of the Re~rt: "Even though the asterisks in this column fl~res wi~ large sampling errors, each o~ the six of the replaced ratios larger th~ the ra~os for the lower smoking amount." In ,:,ther words, the ~orbidiCy Repor~ expressly conceded Chat errors In sume of th~• results were too
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APPEBOIX B TABLE LP. 23.~DEFLAT£D TO ACTUAL SAMPLE SIZE [This t,lbie In its deflated form is subject to the some percent error as is table 1 in the morbidity report] Persons who Uni~nown if never smoked ever smoked Total population clzorettes chmretta~ Total smokers Under]l 1! to 20 21 to 40 41 and over Unknown faALE All ege~, 17oplus ynar~ ................. 17 to 24 ye~rs .................... 25 fn 44 years ..................... 45 to 64 years ..................... ~5-~|~ ~¢ars ..................... All a~e~,17-~us yen~s ................. 17t0 24 yn~r~. ................... .tSto 44 ye~ ................... 451o E4 ye~r~ ..................... 65-f..lusy~s ..................... 17 to 24 ~tors ..................... 25 to 44 ye;~ ..................... 45 Lo ~4 yc~s .................... ~-~::~ )'~s .................... Ever smoked-heavlest amo=nt 63, 204 18, (;90 156 ~,, 3+0 8, ] (~5 19, 549 12, 481 ;3, 204 2, 10, 9~ 4, 71 6, 03~ l, 64~ 2,594 1,197 2~ 3~7 ~. 722 5 32 18,2~3 2. 816 7. ~55 5. 7~0 1, 3~1 20.191 4. 35 ~,325 2,410 6.355 4 587 1.221 755 63,20~ 18.(;91) 1~ )2.]5~ 3,2]7 4,5~6 2,G14 E(;9 ~51 --4 Z3,7ZZ , 4,2l] 1,E9! I 57[ ~ ~55 302 20,197 4 35 4,~6~ 1,072 1'~73 1,12~ ~9 ;~o 8.35Z 31 17 2,342 734 '~3| 392 )57 2~ 53.204 18.690 1~6 3Z,~0t 4.94~ 14,044 9,~6fi 2.156 L, Igt IO,~Z4 4,8ZS 71 5 310 1,32~ 2,3~7 1,0~I l~ 33~ 23.72Z 5.4~7 32 14'~ 1,725 ~,~4 4 [~1 ) 0?~ 27~ 20,197 4.~3~ 35 10'457 1,537 4 477 3'45~ '~ ~ 8,,~2 3,6Z] I7 2~372 ~S! 1~115 '5[~ 101 19 TI58460064
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Sex at~ FEMALE Ever s~ake:~--h~avi~;! .~H aEes, )7 pl~s yea~ ............... 7D, 7~5 41, 4~ 333 29, 020 9, ~60 12, 242 5, 519 727 17 to 24 yea ~ ..................... 12, 44~ 7, ~25 l~ 4, ~5 I, 8~4 2,~2 ~26 114 ~ to 44 yza= ..................... 25, $97 12, ~ ~0 J~ 843 4, 27~ 5,~9 3,~ 4~2 177 ~5 t~ ~4 ~a~ ..................... 2[, 727 12, 8~ ~3 ~ 797 3, 107 3, 8~5 I. 475 175 2[5 ~S ~I~s y~3~ ..................... 10, ~8 ~. 055 g7 I, 4~ ~1 5~5 172 G All aEes, ]7 plus years ............... 70, 795 41,443 333 5, 53t 3. 069 ],,587 17 ~o 24 years ................... 12,443 7 425 123 682 394 210 60 4 14 ~:~ 25 to 3~ years ..................... 2~, 5.~7 12~ C~4 C~ 2, 515 l, ~39 754 45 to 64-yoars ..................... 21,727 12,$67 63 1 856 1,044 4~0 G5 plus years ..................... 1.0,628 9, 055 87 ' 479 292 115 41 2 29 Present. smokers--heaviest amount 70, 795 4I, 443 333 23, 48~ 6, 892 10, G74 4,902 63! 3}0 A, II a£es, 17 plus years ................. 17 to 24 years ..................... 12,443 7, ,~25 123 4, 212 1.430 1.793 766 I00 114 25 to 44 years ..................... 25, fi97 12, 094 GO 1. l, 328 2.940 5,155 2. 742 375 | 1.5 45 to 64 years ..................... Z1.727 12, 867 63 6,9~0 2.062 3,33fi 1,264 142 137 ~5 plus ~,'eaz~ .................... 10.628 ~. 055 87 l, 0~6 ISg 391 130 4 24 Present smoEers--preaent amount ~ll ages, 17 plus years ................. 70. 795 41,443 333 23, 488 9, 404 10,461 3,041 207 375 17 to 24 years ..................... 12, 443 7 425 123 4, 212 2,015 1,732 338 2I 106 25 to 44 years ..................... 25, 997 12'~ 09t 60 ] 1, 328 4,075 5, Z41 I. 759 IZZ l~Z 45 to 6( years ..................... 21 72~ ]2 ~67 (~3 G 940 2, 731 3,151 8~0 63 I16 65 plus years ..................... IO: 628 9', 055 87 1', 006 583 338 63 I 2:1 T158460065
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~o 976 20 lo ?E~C~T o~ SA~ 5o ~o ~o 977 • Pe~cen~ of Se~ple Y~om~ach A~e'Grou~ 65+
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978 Bern: ~,]~qgh, Nor~ Carolina, ~ovember 2, 1917. Educatir~o: R~lelgh Public Schools; A.B., Wake Forest College, i988; Wake Fo~e~;t College, 1~3; A.~I., Universi~ o~ Missouri, 194S ; Ph.D., Unirer- ~lty of ~ll~:iouri, 1951. ~,a~g e~ri~nce: No~ C~ro~na Public ~ools, 193~1946. Instructoe ~:matic~, George State Coll~ge of Business ~4mints~on, 1950-1952. Profc:~or of ~Iathematics, Georgia State Co.ego of Business Administration, ]9~2-1~2~ ~-:~ocIfite Professor of ~I~thematics, Univer~I~ o~ Richmond, 10~. ~,:~ciate P~ofe~:~o~ of Mathematics, Wake ~ore~t Us]vermin, 19~1959. Profi';::~or of ~I~thcmattc% Wake Forest Untver~[~, 19~9-present. Director Co~put~,r Center, Wake Forest University, 396~-pr~sent Other ex~rlcnce : Lecturer in gratifies and O~erattcns Research: Invited ~,,aker, Operation~ Re~car~h Around The World, ~I~drid. S~a~n, Au~mst 1~67. ]nvlb:d ~,~p~uker~ National Con~ention, Opera.one ~esear~ Socie~ of l~,~Lt ~l.'aker, IB~I Computer UaeFs Grou~, New ~ork CI~, 1~0~. Invited ~'~ker, NalionaI ConveaHen, A~ociation of Deans o~ Bu~iae~s Colleges, Invl~d lecturer, IB~f ~ecutlve Seminar on "Manag~t ~eience Applications in th~:~ T¢,xdle and Apparel Indu~es," 1~. Invited lecturer~ IB~I go.tsar ~n "Iudu~:trlal Processes." I~. ~vited lecturer, Univemtty of South Dakota Faculty Convoca~ons, 19~. Invited lecher, Wake Forest Unlvgrsi~ hI~~afigc~,nt g,,minars. 10~4. 190~, 1~6. Invited locater, Sou~eastern Coati,fence ~f the Soc~e~y for A~vancement of Management, I060. In~ed ~peaker, Pb'~mont ~ec~]on, Certified Pu~Hc Acco~tants, 29~0. In.ted ~peake~, Cen~l ~.C. Ch:,pter, .~erican In~tute of Industrial Engineers, ~6. Invited speaker, ~.C. Ch~q~er, Data Pr~¢s~ng ~Ianagement ~s~ociagoa, 1967. Iuvlted speaker, Wln~ton-b~lem Engineers Club, ~960. ~vit~ s~aker. Cen~al N.C. Chapter, Sr:~tom~ and Procedn~e~ .~ocia~ion, 1967. Speaker, North Ca~ol~a Academy of ~cIcnce, 20~7. In.ted ~pe~k~r, A~och-~on of ~Iathematics and Scienc~ Tc~cher:~ of ~o~h Carolina Baptist Collegeg, I9~9. ~ta~i~tlca[ Consultant, North Careens Advancemen~ School, 196~-1~67. n~3 eon~ul~an~ in gta~ti~ an~ O~e~atlons ~e~ea~ch ~ce 19~8 fn ~exfile, t.bacco and banking ~dus[rie~. Direction of nine ~eses fo~ ~aduate degrees. Publication o~ various Indus~ial Re~earch ~epo~s, ~nd ~c~res in ~nutes of varlou~ meet~g~. A pa~r~ "~imulation of a ~a~o-Dl~pa~h~ T~ck ~ee~," will form ~art of a book Op~a~fvn~ a~g ~yst~s A~aI~sts: ~ S~mu~H~ p~ach, to be ~ubllshed by AII~ and Bacon, Inc., in 1970. (~ ~tatement, of Darre~ Huff, follows :) I am Da~ell H~, of Carmel, Ca]italia. As a w~ter and editor I have been ~onc~4 tar m~ny y~ars about the widespread mlau~e and mis~der~tand~g ~ta#i~L,~H lnfo~a~on. Th~ t~ u ~ub.~ about ~hieh I have written a~: tndb,ah~l in the a[tached bi~grapbical summa~. Mcdk,:d siatl~tic~ :ire prone to distortion, more often by accident than by intent Tho~ ~:~atistJes having to do with ~zstble relaHonships be~een smo~g and h,,nHh ~nditi.mu haw proved to be especial~ open to mk~interpretation. I had the privilege of speaklug abou~ abused statistics to members of the Commer~.e Commit~t~ of th~ United States Senate in 196~. I t~ok some of my ~amph~::~ from ¢h~ report of the Surgeon G~eral's advisory carefree and from cenclu~b-ms that had ht~n drau~ In and from iL Rather than rep~:~t tho~e examples and comments tha~ rem~n as valid they were four year~ ago, I shall today iaclufle ~ome instances ~om the more r~,cent major re~ort ca~ "'Cigarette Smoking and Health Characte~istlcs." ~cre a~lin a numt~c~ of ~ferenee~ have been dra~, particularly in widely pabl~h~.l ~ummarleu and new~ re~% that are not J.sHfi~l by the data lhb~ :.~urvey by home interview of health compIain~ and flmir possible statistic~ r+qatlon~hip to We can m~st <.asily look at tho~e, as ~ as at a va~le~ of exam~le~ ~om the hl~.:tory ~f statistical erro~, by ~k~g six questions. ~ese are test ques- tl,~nz I Dave e~olvcd in writing abou~ sta~s~eal matters for Medfe~l Econ~fe~, Rcsb~,~$ Phy,dcfan, Harper's, the New Yorl: Times Magazfne, and other sD~lal- ized and gestural publications, I oleo ~ed this approach in my book "How to Lie Wl~h Statistics%" which Is c~rrently ~n use tn most Amebean universi~es and has been translated into Genaan, Portugue~o. Z.'tpane..;o, and many oibt, r guages. These six basic questi<,ns are : 1. Is the sample biased ~ 2. ~s t~e sample large enough to ~ean anything? 3. How g~ i~ the reporting beh~d ~e data? 4. ~e.we~ealing with semiat~chcd figures ? 5. ~o me ngures £ully$uplmrt the words? 6. Has causation bc~a a~sumed ~thout proof? TO establish the vl~a[ Importance of each of these question% I ~haH give, from a ~'ariety of fields, e~amples e~ how ~eeminglv re~ctable ~',tati~tL:al tes have nflsled ~ ~n ~e past. " I sha~ then apply e:teh of the~o six qm~tion~ [o the staffstfeal mab.HM "Clgar~e Smoking au~ Health Characteristics.- &s I do thi~ we shall note how bias has entered the sample ~hro ~gh failure to get respo~e~ from others, and by the presene~museh°hl::~' from the, acc~:ptance of pro~y re~l,onsv:~ of self-selection in the ~ample, We ~mll find that, ns the ~z~mple in this ~tudy i~ broken daws into it~ cab,. fortes, its size of Ion becomes dlsturbingly ~malL This f~c~ Iz aekm:~wledged the body of the report bu~ unfortunately not ia the s~lm[uayles that $~re aft pt,ople ever Ia respect [~ o~r thinl question, that of reporting, we ~hall not ~, nesses in t~e study--ms ~ ~e ¢.1~ m.., ....... , .... *~ . o ~,~Hou~] with no distinction made between fact and uecond-hand reeolh,ett.n, Since many of the figures reposed In the Pa~phle~ are ~:emiat~ehed nature, it foHow~ inevitably that there are differences between ::one of the clusions ~d ~he ach~al data. Our fifth question, that of ~elati nship between ~he figures in the report ~e words used to summarize and lnterpre~ them, will-reveal interesting erepanctes. In dealing wi~ the meaning" of ~atistieal aszociattor~, our goes to the he¢~rt of most exi;~ng statts~ea on smoking and health, l.;ey that wllen two events oct:or ~ogether, one ha8 neee,usari]y caused the, other. Tim important principle iuvolved.is~,,aetu'~lly s~ated in ~e Pamphle~ "Cigar retto lag and H~al[h CharacteristiCs, ~" only in Pas~ing. But little att~,ndon t,: to it in ~e subsequent pages, We are ~w rea~ to apply our fir~t test ques~lon : Is there blau In the Ideally ff we wnnted to ~ow z~methlng shout the health of tl.~ people, we would s~dy eli o[ ~hem. We can't ~f ¢o~r~e~ so we ~dy a people ~nd ho~e they will represent the m~my with ceasonable accoracy. This method demands ~ha~ we u~e a random sampl% which i~: defined a~ ~ chosen ~at ev~one h~m an equal chaace ta be ia i~. ~f our sample i;~ selected in a one-sided way, we may fall into the trap of psychiatrist who announced tha~ pr~c¢ical~y eye.one i~ neurotic, ~c wa~s mb~h~d by a sample that consisted of ~s patients. ~or another example. I am tndebt~d to the mag~ine $fe~Ieal ~c~mmh:.~. A s~dy elmwe~ an average hosplt~ fatality ~te in lobar pneumonia of 14 la, r cent. ~or patients who stayed home it was only 7 ~r cent. This was taken to pr~:we hospi~ls dangerous for such ~ses. But of course it was just an~dhcr of a bias~ sample. The hospitals go~ the se~lo~ eat~es while the ~lld one~ hom~ To ~ake this important paint ab~mt self-biasin~ samples very clear, what Would happen if you should se~d, [oa purely ~andom sample of Om lotion, a questionnaire that included this uestio •, fionnaire~V',, i ' q " n. Do you like to am~ , . ,. S nee most of ~at lar - -wet, tl~nnmres w ~ ~e gr~u~ ~ ~c0ple who do m:~t earo ~., ould have tos~ed the thmgg Into ~e near ¢~ wn~t.~,~,-::. _f~r q~: be abl~ to add up the returns and announce ~at "a ~u~ey of a typical ~ec~on 02 the populaffon show~ mo,.~.~ peoDIe like to answe~ ~is Pa~cular ~nd of di~[oetio~, which m~ez all I~IIing di~eult--and ~Hlng appallingly e~en~iv~ls co.manly referrc~l to az ~onre~;p m~e blare. In reference to house-to-house ~IHng, as with the s~dy on which "Cigarette ing an~ ~ealth Characteristics', is based, t~ means ~at ~ ~ome hou~e~ ~obody was home and in others nobody would Nonres~nse in ~his study amouated to ~ per cent, and th~ a~umpttoa made that if these ~eople had been home, or willing to talk, they would
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98O t~ both arbitrary and u~afe ~hould be apparent from the preceding examples. and ~f the coneltlzioas that have bern drawn from it--aug the ~tafisfieians o~o~l':~ who pt,rmittcd iL The fac~ ~z that such bias can neither be entirely pr~ ~~.nt.,d am" coml~cn: ated f~r by a~y ]~nown modred. It ~ simply an unavoidable ~w~al~mr-,~ that should be kept in mine by anyone looking at resets of surveys In thi:~ partlenlar study o~ ~3moking, the pierre is further clouded by som~- thl~g that is described by proxy-resl;~nso. It seems flint more ~an half~0 per cent. in fact--of the replle:~ a~'eril.~l to men who ha~ ever smoked were not 1Tlv, al by the~:o me~ at all ~oy wer~ o~ered by o~er household members in the ttb:':,lleo o~ ~1o men them:~etves. We'll ]o01c at ~ts problem ~ur~er In a £ew utv',l wh~,n we tal;~ up the que~tioa o~ reporting. .k third ldlol o£ ~;eleetio~, to which studies of s~oking are by their nacre l,ar/tctflarly Drone, 1~ ~e~-zdeetion. ~his teeter is so ~po~a~t and so provaleng that t1: l~ lu itself .ul~cient to ca~ substantial doubt on aa the conel~ons that haw, I,.,,n drttwlt ~rom studiet~ o£ zmo~g. Nel~.;,eleefi.n refers to thls ~aet. ~£emberz of a sample of ~mokers differ ~rom It ~ll~lldO og ItOn~.llloke~s in at lea~t one major respect other ~an in having m~ohed: they hav~ cho~'n to ~molte. lu what ways a ~an or woman who would choose t~ smoke ~ght differ Item o~to who would ehoo~a not to do ~o Is ~omething no one really knows as mttch about a,J we'd ~k~ to. However, we do have a ~'e~t mo~y sdenfi£e studies ta~0~,er.ting that a number of dt~rencea exist. 'i'd ~:ev how this faet.r of ~elf-zdleetlon amy ~ave ~ztorted the results of not oldy thin s:tudy of smo~ng but oC all similar smoking stll~es ~ well, we only l~wntt.n tim "~trcs~ type" hYlmthe~s. ~hls says thug some ~ople tend to I1~ ~a~tvr, harder, and lllorc r~klessly than others, ~at su~ ~ople are v~w'eqlwn~, lllOrO likely to become ill or to be injured or to die early; and ~at :,~,:h l~,Olde arc also more lil~ely to ~oke or drink heavily ev~ in the og warnlags that It may be dangerous to do so. If thi:~ i~ true, or le ::omething d:~e o~ the ~nte kind is true, it is inevitable that any ~.tatlstical study wtil show an aszociatioR ~veen zmo~ng and Yet there may be no cau~-and-c~cct ~lutionship a~ Our ~oeomI qu~':~tion a~s: Is ~e ~a~nple large enough? Whether a sample lnclnde~ enough ~ople .to support a gh, en conelu~ion Is ~;tati~th.~d techniques. For exu~lple, when an ear~ te~t of Dol[~ vaccine was made with a sample of 150 children, the experh~tent wa~ doomed to wor~le~srmss from Hie beginning. l~x,a~l~.o of th~ low incidence of this disease, even during what turned out to be au t:p[d~,hdc, a ~nmplc some twenty ~mes that large would have b~n r~uired t*.~ Dr..dne~ ~;l~-dflcant re:mlt~. In the co~plex ~'ampl~ often found in studie.~ o$ populations ttts ta dFttngui~h b~~tweeR the size de the toter ~mple and the S~zes o£ various ~ab:~vmpi~;~:~. In the f-urvey of ~mc~klng and heal~ charaeteri~i~, ~he ~mple in dc~t.ribed az being made Ul) of "approxi~tely ~,~0 housohol~ contain~g abt~ut 134,01~0 porzon~." But when ~ome s~ple calculations are applied to the ~blc:t It i:. found that tht~ sub.ample of female~ said to be eu~ent~ smo~g two tie itltt¢t~ packs a day mu~t have consisted of on~, 209 women. Since ~7.2 F~rr t~:llt of ~e intervic~ with women were ob~lnefl hy pro~. it appears tn the entire Unttt~l ~tates~ouly ~me 172 women listed as hea~ smoke~ we~ m:tually ~F.kea t. by interviewers. A waralltg bath that thin condition of Inadcquate sample exists in the smoking ~tudy and t~t tt Is of p~me im~rtanee is actually to be found tn the published t-~tudy. Unfortunately. warnings such .~s ~is d~d not spear in any of the s~- hx:lrlc~-~ an~l reports theft reached the ~ublie. "Particular eauflolI must be taken," says the anl~or of the l~nphlol, "in lnterpr~41ng tl,~ followlng result~ re~fing specific acute tendinous to cigarette :~aold~g becaw3o of the relattvel~ ~rge samplinff e~or connoted with the esfl- t~at~-t for the ~ovt:,ral typo~-: o~ acute conditions. Although many of the ratios ~tble E (which dealg with smoker~ and nonsmokers in respect to dlseas~s) would t:c**ra ~¢~ indicate u ,sub~;tantial dlfference bed.eta pemons ~ the different smok~g eatogork~ and the 'never smokers,' the actual number of reporte~ eases involved wtwo quih* ~mall and, in most ca~es, significaat differences were not demon- 981 Our third question asks : How good ts fl~e reporting? Says a recent writer ou sampling techniques; "It is a well-knows .~latisth.al paradox that the average age of wonlpn o~er forty iS lllldt'g forly (us ]'elmrtvd by the ladies)." This phenomenon is more than a J~dce. Let me mention a fen- thhlg: flult lmvc been widely aeeeph~d, ye~ have no basis Dt fact whatsoever. Each of theft, Is a product of faul~ reputing. • he state of Iowa fo~n~ o shoeldng 300 per cent rise in tr~tffie avt.id~,nt~ ~947 and the following year. ~Yh~'? A moro complete meth~ of accident rt,l-,nrt- ing had b~n Introduced. Coun~tieut found that 2 per cent of it~ auto aeeident~ were f~ttnl io the year that Georgia reV~wled 17 Fee c~-:nt. But it was not Orb'Jug lmblts th.t dif- ~ered~only methods of classifying. star.ties on virus eneephatitla became so alarming one summe~, ht Califor~da that farmers began p~eking tlmir families off to di~bmt rc,~ort~'. Then ~¢mtcone noticed filet although the reported incidence wa~ nearly trll,le Ihat ef previous peak year, the musher of deaths was about normal, All that had hap- t~e~ed was that four te~ms ~ram the PttMie Hv~dtb Sere'ice had l,~eh pculred the area. They had uveorered bu1~dl'eds of low-Reticle cases that wollld l/or ~e~ spotted at all i~ other yeae~. 2Xt~ a medical reporter oventually potnWd out. the area had had "more an outbreak o~ sleeping sickness reports thmt of Even these few cases out of the hundreds ,m roee, rd ~lmuld eon~tltuto a ~.¢harp w~ning against treating reports az face~. It i~ a warning fltat applie~ lit ways to "Cigarette ~mol~ng and Health Charneteri~tie~," Here we are dealing with two kinds of reporlv. One i~ on tlm s'm-lci~z hablt,~ aml ~x~3erienee of ~e members of the sample, and fbe olhor t~ ou ~hat :~Bmeuts and disabilities. ~ both eases a substantial part of the roporHng fs second ha~td : of lh.t ing to do with males wh~ had ever smoked. 60 per cent was obtained by what the author~ of the ~tudy call proxy, That is, someone else supplied tt. thL~ introduced errors is aclmowlefleed In the slnd~. ~lle reporting of medical conditions, from a~erlosv]erolic he;~r~ fll~.a~:~, chronic bronchitis (with which is lumped emphysema) becoaies n em'b.u:-~ bh.lol of second- and third-hand information, wil:h ~OllO of tlu. data et~llttll~ froht pl}ysiciass. Thus the ailments we find tabulated real a~mlyzed net,. for ,lit tout of the men who have ever smoked, ailments they third: t~oy lmv~,, either ~rough se~-diagnolz or as they rcraember having been told by their And for the other 60 per cent of the men wln, have ever gmoked, pro~:y rt,lt.rlllt;$ intorI~oses one ~urther step betwixt an actual medical deterndnatlen and went into ~e stadsties de ~e study. You wo~d have to read the report with some care to realize that thl: b; the ea~e. The persons who gave their owIl gllO~'~ or recollcction:~ nnd the for whom others di~ the remembering or estimating are lum~ed toe,ether iu report. You ~uld be aware of none of this If you alertly read tlm eonelu~ion~, or the newspaper and magazine articles based on them, or exa~ned 1he many tabh':~ with lheir alwnys-impressire deeim:tls. Our fourth question : Are we dealing with ~malattaehed ~Ieasudng one thing~howevor neeuratoly~and then do~erlbln~ It ns [taothor ~ one of the most commoa soure.s of error in v:tudle~ of Dnpulation~. A German pathologist ha~ be0ttght to mg attention a study depl~rh~g fact that while 79.5 per ce~t of American~ finish bi~h sob,Jr)l, oldF S 1.'r of f~ermans complete J1ochsclmle. But the~e t~t.hool~ nee not e~mlmrahh,: and equating them because they so~Rd as if they are can produce 1~o results. Census fi~res In this count~ have shown an e~ormou~ increa~t, ]n thp ulatioas of metropolit:-m areas In a single ten-year period. ~o marked n atwely needs to be tnkert into oeeount~ar ~o it seemvd ulttil It ~1~ lx~t(,~l something ~lao had occurred in that same period: the Bureau tffth,. had changed iL~ &,finitlon o~ a ~etropolitan ~rea. The' new one tt.d~ In more territory. It has been reported that prematur~ blrth is more comn.m among than Whites ... whe~er for racial reasons or ~mldy from l~fferior prenat~d ~are. But the truth L~ that the studies have u~ed birth weight a:~ the crlh,rhm of ~l~nm~rter. So all that was ae~mdly discovered w~s flint Negrov~ lu
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982 ~mHd*, t,~ndr, d to weigh less at birth, ~vhi<,h may not be the ~qme thing at all. ~I~'a~url~t'~ one thing and reporting it as something else, with however honest l~ent, has again ~0duced irom a ~ta~tlcal study a c~,mpletely unw~'ante~ A ea~ ~ga~t rail ~avel was once ~ade on the basis that the number d~,:lfl~:~ ,:lmrgeablc to raflroad~ in the previous year w~ 4fi12. It is an impressive tlg~r,,, but a ~cmiattat.h~d ~me. A breakdown zhowed that. almost ha~ the victims w,~re p~ol,le ia eax't~ that collided wl~ trains and mo~ of the rest were xiding ihe rod~. O~13" 132 victims ~'ete what the stat~ent seemed to ~ply all 4,712 Thc;e examplc~, are intended to 8how what a semiattalchefl fi~re i~and l~,~w ~dsl,:ading 1~ can be. That the ~ures producad by the Public Health lq~,~'ice ¢1~ 5rooking and health characteristics often fall into the sem~t~d ~:~{~'i~¢~D' Is evident Irom ~e reporting me~ods that have already Th~i~, ~aeh statement by a re~[~ond~nt that he or ~h~or ~me o~ melaher~uffercd Item hy~rten~ion or peptic ulcer during the previous week t~',~ i~ tr¢.atcd as I£ it were ~ actual medical ~ng o£ that condition. It ~:hould be ~otefl that a further odd change h~ occurred with some of chr¢,~lc cecadltio~ hibulated ifl the stuffy. They app~ in ~e ~r~ without havh~g b~.~u mentioned ~ ~at form in the quesgonnaire. The repo~ cites "br~nehi~ and/or emphysema/~ although ~he word emphys~a up,am who,re tn the que~tlonnaire ~at was ~s~. What the report lis~ as "~erios~erotic heart dlaeaaff' app~nfly is a lumping of ailmen~ ~r symptoms descried by r~;~p~ndents as "hardening of the arteries" or "heart ~ouble." On top cf that, informal e~t~ates of smoking histo~ or client cigarette con- ~ ump~lon are treate~ as @ they were preclse~ ascertained amoun~ of tobacco ~. St~ml~,ne's recollection of hl~ ~o~g habit--r. ~th the majo~ of the ~l[liph~ flf male ~okem, ~meone's r~ollectlon of som~ne else's ~o~g b~lblt'~--l;~ all thae actually lles beh~d s~ch eat~o~les as "present hCavf~t amount I1-~ clgare~es ~r flay." It is all t~ easy to forget the quality ~:~f the, dala from which that neat t~x .has gro~. Tl,at the bazie flgure~ whi~ thi~ ~urvey produced are ~mia~eh~ at best 1~ m,t denied by the author of the report. He warns, for ~ple, that "bron- cMtt~ a~ reported in the household interview is not necezmrHy ~e same as phy~.~lelan'~ diagao~i~ of b~onchitiz. It i~ quite possible ~at 8dine of the ~If- dia~m~;~:d cacses may ~ fac~ be %~oker's ~ugh'." And confined ~thin ~.~:tlo]~ lwadcd "Source and Limitations of Dat~" are these two key s~tenees : "The dlagno~Hc accuracy of reported condition is dependent on the intona- tion the attending physician has passed ~n to ~e family, or, in the absence of ~,dicai attendance, ~n the previous ~rience or education of the fa~. thc~, rea~o~s, the prevalence estimates pranced from tnte~iew data ~H, :;em~ ¢,aidltio~. ~ffer markedly from estimates ha, seal on medial repo~s ,,r clinical ~xaminations." The nr*f,.,rtunate thing, of eo~se, is l.hat this warning lu availablo only to tho~',, who read the entire report--and who do so with care anti attention. Nei~er th,~ ~um~arles nor the tables hint at this vital qualification. And, since most of the ma~y new~:pap,~e and magazine storio~ that hav~ b~n publi~h~ aboa~ rep,-,rt hav~, depended ~I~n the ~ummaries, they overlook it too. ~m:~ th~ many who meet the re~r~ only in ~e Iotla of arti~es ~nd news roI,-,rt:~ cannot ,~vahg~te it pro~rly. The ess~tial warnings never reach them. (h~r fifth te::;~ i~ : Do the figures bear out the words? A ,in~ele mathematical ~act may be verbally expressed in more than one way, A jtlg dc~:cribcd by e~e ma~ as half-full may be seen by zmofl~er as ha~-emoty. "Five can ride fer lhe eas~ of one!" e~aims a ear-rental advertisement. But a ~,-ditary euctomer may remark that in his cane one is paying the cos~ of five. A :~tmly ~,f the comr~araflve~ rare phenomenon of preventable maternal deaths pr~dneed ~:~me zen~atio~al figures~ as presenled by a midwi~,es' orga~dzatiom for 3(~.7, and midwives for enkv 2.2 pereenL F~om the ~am~ dat~, the New York 0bs~etrical Society produced quite a differ- eat picture. The p~yglclan wa~ found responsible for 47 p~cent of the dea~s occurrl~g um~-~? l~tlents attended by a doctor, while the mldwge was respon- ~ibh, f~r ~;0.4 percen~ of the deaths ta women attended hy ~ midwife. Why ~hl-~ :~trlking difference7 The first ~et of fi~res ignored the fact that phy- ~leh~ns haudle far more obste~ical patients ~an midwives do in our society... 983 and thus may he expectetl to show up promln[~ntly in a~ ~/ figure's coa~ernlu~: childbirth. ~hrou~h emp~asls, aeleeflon, anti o~[$~ion of ¢'ontradlctor~ fl~ure~, rvport~ statis~ea[ ~udi~s ca~ b~ m~de to lmint to con¢'lus~on~ ~h~t are m:~t in f;~ct warranted. Contradict~on~ within the 19~ repert on smoking are a ca~c in 1,resent smokers of up to a pack ~ ~y--acarly two t~trda o£ fl~*~ pol~ulafion--w~e found to have no more of the ailments lutnped t~:,[~ethor m~ "all c~onic conditions" tha~people who have never smokes a~ all. Tht:-i xvat~ found true ~or men and also for women. To learn ~ls you mu~t go to the tabb:,:~; ~o hint of it reached the summaries or th~ news repo~t~. ~Ien and women now smo~ng whc.t',e heaviest amount ever smoked was tit, ~wo pac~ a day make up ~ome 95 l:,er cent o£ a~ ~:moker~. ~he r~'~)~ fall, show higher incidence among ~e~e people than among tho~v who have never smoked, for such ailmen~ ~ heart condition~, hypertension, ar~rlfl~ hearths impairments, and "all other chronic conditioriv." The re[~,rt itself ~Ints out that for heart conditions "the pre~ent ~moker~ smoked up to a pack a day had a rate about ~e ~ame as tha~ ~or the smoker~.'" H~e, then, is aa instance of the data ia thin report coatradle/lng the, conclusions in it. Tim data show that ~ople who h~ve given up ~moking have higher rate:, most of ~e ailments covered~oth chronic and acut¢~an do i~eople who have continued to moke. This, the author notes, "spears to be contradictory" to results from other stafls~cal studle~ ot smo~ng anti health. This brings us to ~e last of our half-doze~ questions : ~Ias cau,:~atloa been assumed with,.,ut proof? When it is found that two thln~s tend to happen tt~gethtzr It i:~ a human ~il~g to a~aum~ that one i~ causing the other. We all lmt:*w better, but we still do it. ~ ~palaflon study, such as the one behind "Cigarette Sm,:d¢lng and tI~:alth Characteristics," can at most ~roduce indications of a correlaHon or It cannot produce pr~f that ~he relatlon~Mp is one of cause ned hx the recen~ Public Health study clear warning i:~ offered again~:t causation.., offered, but ~ort~mately buried aml forgotten so that 1~ crept into few, if ~y, newspa~r or magazine re~s. The authe~r 0f Stooling and Health Ohataete~istica" puts It ~t~ way: "The most these ~a~ can do is demonstrate the lack of or the e~lutenc~, of rclat~nshiB between cigarette smoking and various health ~atacteHstics; eanno~ eshablish any exiutiag relationship a~ u causal one." We al[ accept this fact cheeff~ly when ~ irffereace of causality lead~) to tmpalatable or absurd cenclusion. Bu~ it is important to do so equally with con- clusions that we we,~d like to accept. Zet me give an example. In a 1~ StUdy, two ~tngs were £,mnff to be approxloately equally with mortality rat~: the use of tobacco and the u~e of tranqulliuere. sense tells us to doubt that the ~ue of tranquilizers really contributes to a heavy dea~ rate. I~ is more reasonable to assume that i~ople ia bad hcal~ are likely to use these drt~gs and also ure more llkel~ to die. So how can we assume cause-anti,fleet In the similar figureu relafi~? smoking~ The e~denee of causality i~ ~ual for both assoclatb,ns. That t~, it 1~ The t~e is that when events -& and B occur togel:her we must co~aidc~ possible explanations. ~e association may be pure charade. Or A may havt~ B. Or B may have caused k. Or b~.~th A and B may be product~ .f an factor. It is very eommen for this last possibility to prove tt* be the cm~o, u I ~;~r,~ instances will show. The A~}tcricau JournaI o] Oard~ology reI~rted that 34 out ,:,f 50 a~.~na ~ improved after ligaflon of certa~ a~terie~, a surgical procedure in vogue at ~e. S~ely this ~roved that the ol~eration was u~ful? Two subsequent surgical s~rveys answered that trues*flora Contr,:~ln were pa~tenta who were g~ven sham operatien~ with only sl~it~ incb~lon~. '~et~ p~tti, found e~u~,l improvement in ~hei~ an~a:.The 2}~tsld~.fa~to~ tl~: age-old source of COllUsion, Ele p~aceoo e~ect. '£ae I~auenm nan xcpor~co bet~e~ ~cause they thought they ,ught to fecl bet.ter. And what would you make of studies showing association~ between a chances of bearir~g twins and such su~ri~ing factors a~ her ,,ducation, rellg~on, bet husband's income? Here th~ outslde factor is age of childbearing, which ~appens to be associated regularly both with twi~mlng and with tlm~',c factors.
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984 Unlvor~ity ot Tsrontn investigators chose men at random antl tested their Id~.w-dval capaelty. 3. ~i:~niticant as~oeiafio~ was fo~d bc~veen this capacit~ and flu, a]uoullt uf .x,,rci~e the man was accustomed to ta~ng. In a health arti~e puhli-hcd In two of our leading magazines, a pro~ent science writer concluded that ~it~ roh0hm~hip ~:lmwed that re~r exercise increases physical capaci~. iIow,-~ver probable that conclusion, the study had not proved it in a~ way. If ?h,,r,~ i~ a ,:au~ e-aml-effect relationship here it may equally ~vcll operate in the ,qq,o~lte dlrccti,m. Pe~)ple who fc~l s~'o~g and heal~y because of high ph~slcal ,.apacl~ may b,. more inclined to ~im. play tennis, or otherwise exercise r~ ,g~flurly. Uu~a:qficlously believing that when one ~ing follows another it has been causo~ hy it--tim a~wient fallacy of post lice, e~'9o ~ropter hoe:~is a major ~nger in vvaluatiug population ~tudies, such as those dealing with smo~ng and healfll. The prlaviple that av~ociatIon is not causation Is so ~portaut that a~ost every ],m~ who ha~ cvvr written un statlstivs at any len~h has repeated it. One of tho;:e, the ,-udnent t:tatisiictan Sir aeneid A. Fisher, went on to disc~s what fide ,-,u~hh~ factor m~ht be in the ease of smoking and various be~th matters. It ul,pe:~r% he po~ted out, that ~ol.de may differ gene~caily in resistance to : i.'cl~h' dVoa~:;es and I.~rhapa to disease in general. It i~ able true flint l*vOple differ ia res~,ct to choosing to ~moke or not to smoke, iu du,,:du;~ to ~moke ~mderateIy or to ~m0ke heavily. The fact that this choice ha,:~ l,.en made vnhmtarily b~ th9 ~r.~ons in each sample that has been studied h,a,l~ l,~ flu, kin~l of Fell-bias in fl~e ~ample that was mentioned earlier. ~ per- ~,-m~ who fall Into the group having lower resistance to disease also tend to be mot,nt~ tbtr:,~ who eho,:~:,~ to ~;mo]~, ~le~ an a~soc[a~on betwe~m ~mok~ng and ~or h,,alth b; bound to crop up In any ~atistical Mudy of the two. Thl:~ as~oclation w}H appear even if there is no cause-and-eRect relath-msldp ~hatover 1,~twe,n~ the~'e two thing~ia ~hort, even if ~moldng L~ in no way harmfal. Now It happen~ that we do have a good deal o[ evidence that smokers as a t~l'O~ll~ d}ff,,r froln now-mlokers ~n w~ys ~hat the act ,f smoking could not eon- ,'vlvably have brongh[, shoat. The re~@rt to the Surg~.m General listed sm.h thin~'s uu /hct:~ ;~:~ havln)$ lwe~l fonl]d to be l'elate~l to smol~g pattern~: socioeconomic h,vcl, ta both En~dhmd and the Unite¢l Stat~a: t~To of occupation: t~ndency to tl],'c~ l]~tl 5~lt'h 1,sYe}lologlca[ dlfferenco~ as the tendonvy found ~or smokers to "Live fa,.b,r and lnor,~ Infen~ety, and to be mor~ socially outgoing." ~ore m~eh I mu,-~t ~emind you tlmt we have no proof th/tf thi~ d~orontlfitlon of geno~pe~ I~{ trnly rc~qmu~lble for the indk~tion~ of an association between stooling and c,,rtrdn ailll~-.IHs nr d~lys off w0rlL ~Vo do not lmow it this is producing the ap- l,lr,-nt u~t-:.eiatie, n. or contributing to K, any more tlmn we know if there is a ,,ant a[ rvhttt,.,n>:hip hetweea the two factors themselves. ~tm'hm~:ly enough, how~,ver, the ~ublic Health Service pamphlet im.lude5 form.a{l,m fl~a~ may l,dnt in thk~ direction of differentiation of g,mo~2,es. One piece ,f ~ueh information ~ the differences ia health patterns follnd among ]~rt,:ent, f,,rmer, ~nd Ilever ~mokers. Another is ihe zepor/ed associations be- t~xee,l :.,molting lind Lllch thlng~ as ~njurles, ar~rifJs, and the catchmll g~oup ealh.d "all other chronic eolnHtion~.'' AHh,n.l~h the ;alrvey doe.~ not sl~ecifically list the~e "other" conditions, it ap- Iv'tit;, fl'Ola the qltt-~liOtlrtaiVe itself flint flle~ in¢-lude epilepsy, hernia, prostate Iv,tobit,. nti-Mm: Ih~:~,~r:~ and toe~, cluh feet, clear palate, and many other condi- tlOll~ lqt,;~*,llt ~inep birth. ~iw,, it h, virtually imp,~sllfle tha~ smoking has produced some of these con- dIllon~, the alternative explanations must be given careful consideration. If. is ot I;Oo~ uo :~In,-,klvZ nr to ~moke mor~ hearty. Smoking is no~ cause, then, but All thb; I~ sIlnl,ly ,:peculation. It~ Importance Hes in the strong stlgge~ion it Ilia] p:~ tll~lf if eatl~ality is imprnbalfl~ or of uneerlain {~reetioa in some of the ~},~:,,.-.te,l a~ioeiatiotr.~. Ihe~ eatl~ali*y surely should not be taken for grented in th,. ,,th,'r :. For the t-rldonea lg of precisely tile ~ame Idnd. ICy :tpplying' ~]x te~;[ qne~tion~ we have seen how statistical data not rigor0a~[v (*~al~til~o,l o~lll ]e~td to en~chl~iOnS for which there is noL adequate sup0ort. I hollo that ull thb: will ht:lp to Oll~ll-c[ Olle major question . . . the qaestion of wh~ 985 vast dm]bt on the conclnsion.~ about health and disability offered In the i,ampidet -'Cigarette Smoking and ~ealtl~ Characteristics." , ertal as we have discussed here~public-health studie~ of ~:moklng ffust such mat _" .... , ....,- *,-~ ~.-Hfsl~ ]lcdieuZ Journa$ a~ far bacL 1957 to warn : "It will he as clear in retrospect, as it is now r do not warrant the qmclusions ba~ed upon them." ~°~3~at wanting applie~ eqMally today. The temptation~ are gx'vat. &n 3Iark Twain observed about ~ome simlhtrly questienable ~taflstlea he had come up,m, gets such wholesale returns of conjecture out of such a ~ifling ]nvc~tnteu~ fact." . . L~¢ oln and ~hird, Ca~lel, California. . .... Residence: .- ' .... . ,~ ...... ;~ la~,, ~'a~er. ~hool supcrin[elttt~nt; ~cho01teacher. Marrlc~ ~'rances ~e,$on ~w, .......... daughters. Educated ~ubfic schools ~ Io~a, II]inois~ C~lifornla. B.A. (With Dk~tinetion) nnd C~tificate in $ournallsm, ~938. an& M.A., 1939~ State Univert.ity of Iowa, One year of ad~tionaI work on graduatc schohx~'~hip in child an~l socht[ pt~ycho. fogY, ~tate University of Iowa. Elected to Sigma Delta Chi (professional), Kappa Tan Alpha (honorary Jour- mflism}, and Phi Beta Kappa. Reporter, Clinton (Iowa) Herald. 1936. Publicity director, Depar/mt,nt of Iowa Xmerlcan ~gion Convention, 1936. [~porter and feature w~ter, C*,da~ Rapld~, t Iowa) Gaze~c, 19~7. associate Editor and Ilousiug Editor, Look mngttzlnt,, ~93~0. ~ditor-in-Ohief, six David G. Cook lnterdeaomim~ttomfl magazines, 1~4t~. Manag~g Editor, Better Homes & Garden~ Magazine, X942- ~. Executive Editor, Liberty magazine, 1~5. Partner in OavedMe Craft~mcn, organization produdug technics[ manuals (e.g., Eastman I{od~k Dat~ Book) 195~55. . • " ~'ree-lance writer an~ editor slncc 19~. TravelcO in Europe two year.--19o7-.,,- 1069-63. Aufitor of a~tlcles tn newspaper~ (Boston }Ie~ald, St. Louis Poat-Dk, patch, Philadelp~a Inquirer, New 2"ork Herald Tribune, Sow York Tlmcs Sunday Maga* Mue) aml magaz~e~: Hurimr's, Esq~rv~ Reader's Dlgc~t, ~e~book, S~tb~day Evening Post, McCalrs, Woman's Ilome Companbm, American tograghy, Industrial plmto~aphy, Better ~oma~ & Gardens, Th,, Amvrlc~tn Ilome, Sa~zday Night (Toronto), ~oman & Beauty (Lo~tdoa}, Lnndon Daily Herald and o~er British, Dutch and Australittn publications, POlmlar Monthly, Science Digest, Christia~ ~e~],l, YFW Magazine, Amorb'au Magazine, ZIedical Eeonomics, Resident Phy~ician, Woman's Day, ~htnk, Writez's Digest, WrlteEs Year Book, Amerlcas, Author & Zoaraali~,t, ~ou~(,hohl, Good ~ousekcping, Catholic 1)ige~;t, $ou~al of Living, pa~cnta Magazine', Steehvflys. etc. Book columni~ : Chicago Sun, Iow~ publlsl~er. Invited to speak on interpretatk~n of statl~th'u to mee~ng~ of Amerlc'an Statistical Association, New York Society ~or General Semantics, Office ExeeU- fives Association Of New York, American Marketing Association, Chemi~l Society. Received 19G3 Na~onal School ~ell Award "for dlstlngul~hed ~a..rvi,'.e interpretation of edllcation." Biographical i~ormation in Who'~ Who publi,.al[on~: Monthly SnDplemrnt "ho's Who, ffanuary, ~945 ; Who Knows What ; ~o's Who la the, f°~says on statisgcal sRbjects reprinted in many nnthoLogies tint[ toxtbo,,k~* fta" ,.ollege }:nglish and communications courses; reproduced for courage ~,rk at Fresno State College, Augustans College, Black ~ills Teuchors Coll~,ge, Army ~'innnce School, Bo:~ton University, U.S &Iv ~orv,~ Munagement Statis~cal Branch, San 5o~e Clty College. Florida State Univer~;ity, Uniters;It5 Cal~ornia School of Public Health. Ham'ar~ UnivcrAty Seho~,l of pflbllc IIealth course ia biostattstlcs, etc.; reproduced for distributhm by Tem-ws~:ee Valbw Authority, Northern Ill~ois Gas Company, ILS. Air F~wce Pacific Air Traders Finance Corporatto~ of Toronto, Nuttonal Shoe Mannfacttlrer~ tlon, ~o~efeller Foundation, All~tato Insurance ComTmnY, Navy ~hlrett]t Ordnance; and reprinted in such specialized publications as tIo:,pltal CanaircommentarY of Royal C'anadiau Air Fore{,, English D1;;*'ht, R¢,~,~ntr
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986 T,:cbnical L~hrary, New Jersey Business, Supervisory Management Mngazlne, }h,l[ Tol.pho~o Co~pa~y Blu~ B~ll, Industrial Editor, t~e Copenhagen news~a~p I~T, Unib~d Automobile Wor~er3 Ammuni~on, Truste~e Journal for l~o,k'~: Pictures b~ Pc're (Dodd, Mead, 19~4). T~ Do~ tl~t ~ame True (Mt'Graw-~ll, 194~ al~;o published In ~ranco), ~Ow to Lie ~ith Statistlcn ~N.rton, I~4] ; alz~ published ~ College Edition and adopted for use in mo~t m:q.r unlw.,r;~Rie~; I 9ubltuhod be Gollanez in h~gland and ia Pelican paperback ; and In tqe~um, Dutch, Danh~h, Swedish, Spanish, and Japanese editions. t. 'Pal:c a Cheap: (Norton, ~959); also in Norton Library ~o~teover, British hardcov,,r u~d Pclicun, and Swcdi~h editions. ~core: ~hc ~tra~e.qv o~ ~ah:fng Tc~ {ApI~h~t,m, 19G1) ; ah~o in B~ti~h hardcover and Pclican paperback editions, l¢~dlantine cdRlon, ~ych:s {~ Your L{~¢ (Norton, 196~) ; al~a in British and Swedh~h cdttion~. How to Be t~e Parcn~ of • Suceess[u~ ~rva~iv~ Chilg (Ma~a With ~'ane~,:~ ~u~: Twent~ ~arccr~ el Tomorrow (~IcGraw-~lll, 1945; also Ar~ed St~rvice~ ~dttion). ~ow to Lower Your Pood Bills (Ma~adden-Baztdl. Mr. Saa'rzt~z~. Our ne~ wieners is Dr. ~rthur Furs~ ~reetor o~ the In~i~ut~ o~ Ghemical 3Biology, Universi~ o~ San Francisco. STA~ 0~ A~THUR ~ST, 9I~ECT0~ 0~ T~ INSTITUT~ 3Ir. F~:~;~. Thank ~ou. Before I pro~ed~ Mr. Chairman~ I wo~ like to sta~ ~ha~ I am h~re at the rcque~,~ of representatives o~ tim ~bacco ~dusCry. Mr. Waz,~o~.~, Mr. Cha~man~ we earlier tried to quest(on abou~ how much they made and RH of this ~nd of thing. ~ don% im- pum.~ any man. Th%;are professional men ~d regar~of ~ho pays thcnt they will tell the t~th. Because they reprint the tobacco in- du~;try~ to thin~ that their ~ony i3 tainte~is jus~ as wrong as ~;:ty that tlm t,e~timony of t, he Surgeon G~eral is ~d~ becau~ are paid b~, tim Federal Gover~ent, or some o~ ~ese o~her doc~o~ testimony, ~s tMn~d because ttxey receive grants from th6 ~vernment. I hope we will not explore much further about who pays wha~ and ]~t~w much. ~r. ~A~ERrmLD. I am co~d~t ~RL your .La~emen~ ~s one ~a~ can readily tt~¢o to. ~e accept all ~tnesses on ~heir face value. We kuow the~ l~dvt~ us the benefit o~ their best efforts. Mr. Ecmr~n~. ~Ir. Chairman~ I would l~e partly ~ dls~oeia~ my~clf from Chat ~atemen~. ~ don% impune any witness' ~stimony~ but,~ don't think that ~ person coming ~om ths Sutton ~neral~s O~c,.~ i~ in precisely the same position wigh respect to bias as one ,:omin~ here for ~lm cigarette compani~) Mr. F~-tsr. May [ mak~ this renmrk ~ I am hog being paid a fee ~or /lti~; t czLhnony. Mr. S.~,n.mv. Thank you~ sir. Mr. F~tsr. I am &rthur Furst, Ph.D., director of ~ho Institute o~ Chemietd Biology, University of San Francisco, San ~raneiseo, C~. I h~tvc b~:en engaged in cancer research since 19~7~ and have published o rt,r he ~perz ~n the field since then. M~t~, 1 pre~ent my background. My university education was received prim~rily ~t U.C.L.A. and S~anford; my bachelor's and master's de- groa were obtained in the ~ormer institution, and my Ph.D., in ehem- l~;t.ry from Stanford U~versity. 987 I have held academic positiogs_at various,Cali~fornia univerzitie3 - - ^~ ........ fn 1957 I w':~s names professor of medicin~ chemi~ ~% Stanford Univ~sl~ ~n ~t6 ~epartment of plmrmocolo~, bei~ ~only person to be promoted to ~e rank of full professor on Si~larly~ I have ~or ~everal years boen the o~ s~ nt ~ !v~thout mescal de~ee on the a~end~g staff o~ ~ount ~mn ~ospital~ and ara uber of the minor board ab that hospital. In 196~ I was on~ of t~e~aliforn]a sc~en~s~ named a fellow o~ the New York ~cademy of Science. X detailed cnrriculum vita~ is attached. At Sganford Univers[~y~ among other ~ec~re assigmaents~ ~ wrote and presented the ~our~: Biochemi~ry of cancer. Ju 1961~ I left Stanford to org~ize al~d become the director of tlm ~tute o£ Chemical B~olo~ ae the University of San Francisco. • ~-- ...... a.~ ~ ......~,.o ~tate College This is the University of San Francisco, au entirely d~fferent mst~tutmn.) The institute cttrrle~ on both teaching and research ae~ivkies ~n var2ous scientific field~. At ,,re,eat, for example, the insfitu~ ~qs~ ~m-,}pletea,a.pro~ec}, for3ho National Aeronantie~ and Space A~nmstra~mn, rcmt.mg to rim .... t.. ~, hinoh~na]strv [his will have application to the O~ ox~e~ O~t t~l'a ................. ~, , • , .... ~{'t~n~ of astronauts who ar~ Jn a pure oxygel} atmospger~~. We ~"'e'~ ~r that same ageuey, evaluatin~ ~ynU~efic caflmuyuratc~: to see i~ they are ~fituble for the astronauts d~et when ~m a ~rolongcd flight. Ia addition we have another join~ project, o~ts3 nthe~is of cial compounds. & fou~h project rdates to the m:ho~ of detecting llfe oa Moon, Mars, at eetra by the identification o~ an-tino acids. For the Air Force we completed a study atterapting ~ find meehmxism of toxicity of liquid rocket fuels; and, for the National Institute of ~iental Healt~ we are conducting reseurch into brailt cbem~t~' The Institute of Chemical Biolog~ also does conside~'abh, researeh'i~ th~ field o~ cancer, inelnding work o~ metal caEciaogenesis for th~ Xational Cancer ~stitute. For the p~tst ~ew years I per'zonally haw been engaged ia projects which involved smo~ng. The healflx problems of ~he h'ation are ex~remdy complex and of course merit congressional a~eatlon. In particular I should like to di*cuss certain aspects of some questions r~at~ff to mnokinff and " ," ;~ ~-~ :- ~o doin~ I should emphasize that these questions interrelated with basic problems concerm~g, not.only s~veral hnpor- rant diseases, but also many other factor% also under study~ as caus~ly relate.d to thos~ diseases. " 't'~ ...... ~ *o- research with rezard to these diseases are eltormous~ ul~o':s~, t'~)~qx~(~eseription. And, x~deed, despite muc~ public notoriety, the sam~ ts true with regard to questions oi stop]sin~ and he[dth. Tl~cr~ ar~ many, many faceLs of these ~uestions that haxe not bten inve:~ti- o.~.a. ~, mush about thes~ ~roblcms appears in the pt~sa~ so little ~ ....... :~ ,~ ......... -c~ent~fie hter.tture D~l,]te all the ~ions necessmT to detenmne whether there are any relatmu~lup~ twcen smoldn~ and tlm v~rious diseases which h~ve been a~;ociatcd '.- .~ ..... :~, ,.-~;+ rf an,, cau~al relationships are di~oovered, it would be important then to find out what in the smoke is causing the problera, and how it is doing
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But in order to determine, the answers to these questions, much more lu~t~t, l,~ liuo~n about flit, basic na~ur~ of the disuses themseh, es and tht, me,rhauism by ~hich th~ develop. Additionally, much more he kn,:~wn about what effe~t~ other factors in ,the environment~ to say n,-~thinv¢ of internal ~actors in human beings, may have in the caus~tion ,ff th~v;c di;~ea~e~. Experimentally, it is necessa~ to devdop models by which the di~ea~e~ m~ty b~ 9reduced in th~ laborato~T, and then to tc~5 '.-,n~pectcd facto~ by u~ o~ the~ model~ Then, it will also ne,'e~'~_~aD- to deh~rmine whether the findings are applicable to human X~ aa example to help clarify your thoughts, I shall address mvsdI t,, ont~ asI~.ei of the problem. ~Vg need much more organized research i~ the experimental aspects of the smokln~-lung cancer ox~blenl: w~ d~,t}il ,-.omc of the~ tho}}ghts : Tim ~u~'~:,n~ Geuoral s re.port on smok~g and hea.lth states that i~ not.l''.~:~lb]~. to. induce., tumor~. ~ in mammals by smoke. Bu~ no p]am~t},m ,or tlns £afluro ~s offered. ~n th~ 1967 r~ew emphasis l~latl,~ that red,catch is needed [o "iden~i~, ~d ~eparate tim tumor initi- utin~ ,ml tamor-},romoting ~en~ in t~bacco smoke * * ~:''' and that it could not~ b~ s:nd that "humhn zquamou~-ccll l~g cancer(s) * * hav~ hee~ ,~xperimeut~dly produced" (p. $5 ). 'l']m ]9~;S ~upplenmnt s~cds no moth light; no new e~eriments ~tre. ,:ilvd tha~ rclat~ the dire~t ,'~uze o~ hm~ tumors by smoke. Amfin, "more r,,::.earch is needed to elucidate t]te'biom~ehanisms invoh'~d in the pa01,:,genes[~ of lung cancer caused by tobacco W~ mu~t o~nc]ude tha~ between the yea~s 196:~ to 1967 a~d then to ]9(;8 ~a gol~ more compilations o~ rceearch, but no good evaluafions~ amt ~-~ riam]v no corre]atioas~ and no insights into causes. . ~V*~ km~w much raoro a~o~]~ fundamental aspects of smok~g than xyw ~,.,ax~ ago. Therefor~ ~t ~ portable to ~nstruct smokh~g machines that ,.an elo:~,,lv nfimio hmmux smokin~ p~ttern~. These unit~ ~bonld b, h,ilt and c~:ahmted. Are mice and r~'i'ts which are the comn~o~ sub- je~q~,; the ~you~ te~t aninmls~ Can n. significant quantit~ of cigarette ~moIo~ g,~g rote IIm animal's lungs~ If it does, i~ is capabl~ o~ produc~ hllltl~tlt't,Vpe *~n~aor~ at tfll~ These questions ~an be answered only i'f • her~ are additional problems which must, be invesfiiga~d iu re- /zard ~'L ~mok~ng trod lung cancer. Thes~ are urgent~ and pet'h~s ~pvcial xmn]~ sheuld be Mlt~a.ted. I shall be happy to ~ive more 1. ~,~-,~ work ~ho~s tha~ trace meta]s may b~ import~n~ in the ~. Some ~cicati~s have suggested tho possibility that volatile ami~w:~e~pcciaIly the nitrosa~ine~x~t ]n cigar~te smo~ and ~houhl be inre~tigaced to se~ wha~ sign[ficanc~ ~hey hay% i~ ~,hev are flwn,. Are they really artifacts. Can they b~ cocarc~ogenic wi~h ~ther ~L S~:mm wm'kers c]~im Iha~ ~ee-rad]ca]s are hnportant. ~ns~ are :t ~ ailable to ~lake precise me:tsurmen~. t. S~mae xvorker~ claim that particle size o~ smoke may be important. 5. St:m~c workera chtim tlmt the distance ~rom the end o~ Hte cJga- tel I~, re tlw hmffs of llm animals may be important. 989 6. Some workers claim that the state of nutrition of the ~utima[ amy be important. Vitamins may play a role in,he etiologT of vaneer. " 7. I feel tha~ ~udies of low level c~,rcinogens mus~l,h made. 8. I feel that we must study comblnatious of carcinogens and smoke oa a~maL~. 9. I feel we must inves~te the sign~cane~ both of differences in species of exper~mefitul ammals and d~fferenc~s m resulls depending oJ~ the species used. 10. ~¢e must determine thab we are a~finistering the t-t~nts in the 9roper form und on the proper ti,~sues. I am not convhxctd tlmt tim t)laeing of t~rs oa the skiu o~ mice show~ tmythin~. Teclmiques appropriate administration mus~ be developc~ and then t.ht~ e~n be evaluated. I ~anot ~v~tigate all fl~ese myself--many other research zcienti:-.l~ m~ be ~volved. I have given exampl~ only of exper~aent.~d problems theft deal ~rith the smoking aspect o~ the lung cancer question. Similar 1)rob]emq ma~ bo ~aced in reg~trd to many suspected enviornmental contami- nants-air pollution, mnog~ and occupational tm~ards--and ,~vea to broader problems o~ urban living and ~n~:t, ics--basie con~titut]oual differ~e~ between ~vidu~ls ~ay be ]m oh ed. A~d, constantly, it must be kepe in miner that experimental research ~ill often produ~ ~otnHy ~expceted and ~rpris~g n~sults. L~t m~ ~ve you ~ ex~mp]~ ~rom our work wi~h the Air Force ,~n toxicity of ~ oc](et'. ~ue],,,.'. ~ ~'o of three, them" ieals, comi..~rJsing the vil~tmin B~ ~,n'ou*~ could somewhat act us antidotes to flue toxic effec~ of flxe,rneke~ pro- pellant, UDh~I. Logically the third shotfld be th~ mos~ effective ttal agent. Yet, when t~ted, the surpris~g result was t.h~t, it nmdt~ tht, fuel 10 tim~ nmre toxic. ~o c~n anticipate ~nd predict ! We n~d more and more research. And~ to,be candid, I~must. po,]~tt out flint not o~y money is needed~ ~ut so ar~, time and ptople. ] tell you w~in ~t month i~ ~ chemical c~n b~ a potenti~fl compound. In contr~, the s~udy of form~tion o~c~lcer .t~d:e~ each experiment t~kes b~ween 6 mon~s and 2 year~, ~nd iavoh.t~ the ego,s of several scieut~. I am ~nce~ed that public~tt]on o~ prema~re conclusions has hel to creat~ an hnpre~ion that the answers have already been found. is mesh unfo~te, became it is no~ cermet and it malice, it more diffi- cult to get ~he ncce~a~ r~e~treh done. Scaentlst.s ar~ generMlv dismtcr- ~d in i~fi~iut~g studies of problems which, they ~tre told~ ~(ra al~cad v solved. Granting a~neies them~olves are reluctant to give funds proi~ rims ~ro apparently solved ,nd ~urehermore, t]te~~ m~ feel that ~ey w~uld be subject to critiei~ for comnfittin~ re, ~hch areas. Therefore, ~ hope my statement has c~nveyed to you my conviction that the problems hem have not been solved. To summarize: hfueh more r~rd~ is necessary. 0nly n ~aing h~s be~ made in the answers to the m~ny question~ a.Imu~ the wtrious dise~ with which smelting has bceu ~zoeia~ted. ~e£her smoki~ or ogheg environmental f~etors h~tvo anythim~ do ~vi~h E~e c~usa, tlon of these d[s~ase.s are questions t.hat, t'~r~nin t~:, answered by ~uture work in ~e Inborn, tory and by other
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990 We ~hould not pre~ttm~ to predict th~ answers that will emerge from tha~ work, Secant6 experience has const~tly shown us how u rong~uch p~dicatio~ can be. ~d, in tim meant, hoe, ~c should re~ain from ~ublicizlng prema- ( ~ "~ s t~ ~. ~umt's st~ment follow :) lh:,rn ~[tna,:,apo~, Mlnae~.o~, Dec~ber 2~, 19~. ~t~ied. Four c~ldren. Lo~, A~gtq,~ CI~y College, l~32-g~Psyc~ology, ch~mis~y~ Univt~r~dty of California, ehemts~y, psyeholo~, a~ Lo~ Angeles 1035-37--Phy~lez, education, UCLA, 1927-39~hemistr~-, ma~ematics, UCLA, 194~Cheml~try, ~LA. ~ tin, f.rd Uair,~r~:ity~ 19,tT~Chemtutry, Ph.D. l[}37-39--Teaching a~ststant, U~lver~tty of California at ~s 1[~30-.l~T,:,ucher. aclence and m~oma~cs, Pa~flc ~Iilitary Academy I010-17--1~ truetar, che.~d~try d~partment, San Fran~sco City ~Hege. -~ Y~ll'Ii~g war, part-time at: UniverMty of Cal~or~a war tra~g ; San I,'rancl~;co State C~llego ; Universi~ of San Francisco. ]947~}--A~lztaat profesmr of cheml~try~ University of San Francisco. 1949-52--&~cciate preferrer of chefs,y, University of San Francisco. 191~t- ~Re~carch a~-o~atv, Mount Zion Hospital, San ~ranctsco. ]052-t;l~L,~cturer, chemb~y d~partment, University of San ~raaci~co. 2952-57~A~:~-oclate profc~zor of pharmacolo~ (medicinal chm~try), S~- ford U~dve~ity. 1957-~l~rofc~or of medicinal chemistry, pharmacology departm~t, Stan- ford UniverMty. 1961- ~Dlrvctor, Institute of Chemical Biolo~, UnivsrMty of Am~qqcau A~oclatfon for the Advancement of Scienc~ Am~'rlcaa A~o,la~on for Ca~eer Research, Amvrlcan Ch~:mical ~ocicty (m~mber, executive bo~d, ~ee years). Anwricau S -~ q,,ty of Pharmaeol~ and E~imen~l Th~aDeufl~. California Cheml~try Teacher~ (organizer, first president). New Yo~k Academy of ~cience {fellow, Phi Lambda Up~41on {honorary acholaafic chmleal s~laty). &¢panc~e Pharmaceutical Association. ~ocb:~ 81g~a Xl {l~cmember). We;~t~rn Pharmaeolo~ Society (~arter member). Lf~tcg Am~rloan Men of Science. Wb.':; Who tn American Bducatlon. Who's: Who OU dm Pacific CoacL ~o'~ Who In the Wc~t. WoH,l'~ Who'a Who in Science. AS of ~1~; date: I0 March '~. 122 paI~r~ In print. Iu lh~lds of: ~hemical synthesis, ea~eer renenr~, ~sYChOpharmacoIo~ and ehvmothcrapy o£ tubereulozlz. 991 2. "Balancing Oxldatio~ Re~luctaon Equations" J. Ch~:,m. Edue., I~, 3~7 (l~tO) 2. "S~ety Guard" J. Chem. Edne,, 18,147 (1941) 3. "An Improved Dllat~mete~" 5. Chem. Edue., I8, 335 4. "An Adjustable Safety Shield" Ind. and Eng. Chem., I$, 158 (a~) 5. "Suggestions for ~e~res" A chapter in ~ok for Air Raid Warden Service, S.F. Civili~ l)efe~o Council, ~Iarch 1~2 (prig<tie printing) 6. "~ Outline of Laboratory Operations" Syllabus, 118 page~, September 1~2 (private 7. '%ibra~ Project in J~ior Co~og~ Chemistry" Calif. J. ~ec. Educ.. 17, (10~) 8. "The ~ighlighta o~ O~ganie C~emist~y" Syllabu~:, 123 ~ages. October 10~ (private 0. "Water is ~oloHess" (~ l~e demonst~a~o~) School SeL and ~a[h., ~ff, 10. "~ 8m'vey o~ Laboratory Operators ia ~ San Francisco Bay A~ea" ( 1041- 19~ (~rivate or~ting) San ~r~i~slsco Ju~io~ College, 80 pages, 1L "Calculations ol ~nuLvffeal Chemistry" .~ ~llabus, 137 p:~ges, Augu~ (private ~Hnting) 12. '~he ~uek-$eaF' ~he Chemist ~alys~, 8~, ~4 (~04~) 13. "Qua~a~v~ O~gante ~hemis~y" ~ ~yll~bus, ~16 pages, Oe~ohe~ 191~ ~a~ ~i~tlng) ~. "~ $~m~i~o Bolling-~oin~ ~es~ ~b¢" J. Ohem. Edu% if2, ~o. ~1~ (19t5) ~rith John W. Bohner 16. "Displacement in ~he Halogen Serie~" J. Chem, Edu~., 25, 445 (1947) 16. "The R~ueflon of 2-&cetylpyrldin(~ to 2-Ethylpyrid~C' J. Amer, Chore. 17. "The ~cture Demonsttation~Its Advant~es Over Student ~abpratoD. Work" V~ex, ~0, ~2 (1949) 1~ "A Modified Continuous L2quid-L~qu~d Extractor" Chemist ~mly~Jt, (1~9) With Cecil Lacy 19. '~e Effect of NzSubstltuted Amino Acids on the Gro~ o~ Lactohaetlll" ~h. Bi~hem., 2~, ~7 (19~9) W~ Harold A. Harper and Richard Neve. ~. "Chemical Inventory Form" J. Chem. Educ., 27, 41 ~ "The Eff~t of PhenybSubst~tute~ Phenyla~n~es on the Orow~ of a LaetobaclSus Leuconosto~ Mesonteroides, P-f~' Wasma~ Y. Bt~., 8, 2~ (1950) With ~arold A. Harper and Manfr~ D. Mo~s ~. "A Convenien~ Synthesis o£ Xanthurenic Acid" J. 0rg. Chem., I6, 412 With Carl J. Olsen 2~. "The Preparation and ~lcrobtological Evalua~oa of the Inhibitory Effeet~ o£ Some Ac~lic A~d De~vatives" Arch. B~ochem, and Blophy~tcg, 1~ (1~1) W[~h Harold A. Har~r, Robert J, ~etwald, ~Ia~fred Mo~i~ and ~lehard A. Nev~ 24.-T~sethylene-lmino-s-Ariazine (Trie~ylene Melamine or TEM) ~ Treatment of ~eoplastlc Diseases" Calif. Mcd., 7g, 2G (1951) With Mi~a~t B. ShrinkS, Howard ~. Bt~an, Ke]th H. Kelly and Elizabeth ~enhaupt ~. "The Ultraviolet Abso~on S~tra of Some Hete~y~e Pho~phorou:~ Compounds" Science, ~1~. 330 0.9~1) ~ith Rober~ J. Horvat 26. "Chemotherapy of Experimental ~ber~losis with Derivatives of I~ran &c]d Amides and Related Com[o~da" Wasmann J. Blo., 9, 355 Wi~ B. L Fr~lander 27. ~he~lpho~phine" J. &met. Chem. See., 7~, 562 (]952) ~lth ~obo~t Horva~ 28. "laaetive Compound~ i~ T~mor Chemo~ernp~" Ca~cor ~e~., I$, 2.11 { 29. "Chemotherapy of ExTerimental Tuberculosis with QutnoHn~ Proc. ~oc. Exp. ~iol. aad ~cfl., $'I~ 66 (1952) With B. ~ ~rccdlAudet D. Baleom 30. "The Action of AminobiphCnyl D~Iva~ve~ oa the Growth of S~coma-~7" S~ford Med. B~II., 10, ~0g (19~2) With B. L. Fr~edlanfl~,r ~L "Eff~t of ~ran DeHva~ves o~ Transplanted ~arcoma-180" ~tanford Med. Bull., 10, ~10 (1952) Wlt~ B. L. ~re~la~der
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992 :~2. "Eff~,,,t of Substituted Y.I.vdrazines and Related Compounds ou With B. L. Freedland~r ;¢3. "II,:)w 31ueh?" (i b~ttet to tl*e Editor) Science, 117, d~S (1952) 31. "]l,actlvo CompOUlMS" Cancer ~ezcarch, Sup~. No. l, p. 12 (19~) With :¢;~. "t~h*,moth,.,r~l~y Stu~ies of Varlo~s ~[ou~e Tmnot~ and Sere~l Myeloid I~-,ukemlns" Cancer Research. 8Ulq). No. 1, p. 2a (1D~2} With B. lereedlandet ;{~;. "S.l-'hrcn~ipyrroHdlne" .LAmer. Chore. Sac., 75, 3~6 (1O~) With Carl t~7. "]b'd~,,H~m,,~ wllh ~ydra~in~ ~ydrate Catalyzed by ~anoy Nie]~ol. I. ni:~th, Xllro Ci,ml~m~ds to Amines" J. Amer. Chem. See., 75. ~a4 (]953) With D. Balcom ~< "p DIr, v~thy}~mimq,h~nylquinaldyearbhml" J. Xmer. Chore. Sot., 75, 5415 (lf~53) With F. ~r. B~,vg~trnm ;~9. "D,}rlvativw.~ of .l-,kmh~obipheny~ in the Chemotherapy n¢ Experhne~tal q'ub,,reub~i~" W.asman~ ~. Bi~l., i1, ~67 (19~) With B. L. ~re~dlnnder 40. "Tlm Effvvt of Azo DerivMive~ of Sulfa Drugs and ~latod Amines M~rtm-mry Carh:lnoma 753 anti ~Iyeloid Leukemia In C-57 Black Mice" Stanf,,rd Med. BulL, 12, 33 (19r~) With B. L. Fr~dlander and Peter P. T. 41. "Dc~lcc for 5Icasuring Cha~es of Optical Tran~mit~ance wHh lung" A~alvfica[ Chem., 26, 10.~2 (]gg~) with Justin J. Shapiro ,~2. *'Efft~ of Irurfnr~dac~t,ne ~nd Relat~ Comr~ounds on Ehrlich Ascltes T~lm,,r" Stanford Mcd. Dull., 12, 2[~ (~9~) ~ith ~. C. Cutting and R. H. Drclqbach ,13. "Effect of Acetic Acid Hydrazide on Mammary Carc~oma 755 In C-57 Black lander and F. A. Wrench ~upp. No. 2, p, 73 (1955) With W. O, Cutting ,l~. "lb~tardatt,m of Grov,'~ of Ehrlich Aseites Tamer by Formamide~ anti R,:hffed C(,m~ounds" Cancer I¢esearch, 15, 294 (1955) With W. C. Cutting and ~. ,16. "Coll*'t~ptf~ It,d To,,hntques in Teaching the Org~ie Chemistry Labora- retie4' Science Coum'elor, 18. 92 (1955) genlclty of Ultraviolet l,ighU' Prec. Cancer R~se~reh, ~, 109 (1956) With B. L. Frve,llander and F. k. French ,18, "t~-me Mcrcaptodihydropyrimidlnes as Possible Antltumor AgenLs" Prow. Am. A~:~. Cam~er Res., 2, 109 (1956) With W~dsor Cult~g and Hudi 49 "Q,duo~alho}-2-Thlol~Y 3. Org. Ch~m.. ~I. 470 (1956) With D. C. Z~orrlson ~0. "]nhlhl~,,n of Mammary Carclnoma 755 by Malonic Acid Derlva~ves" Prec. ~,,,*. Ex[n Blol. )led., 9~, ~33 (1936) ~]th B. ~. Fteedlnnder ~d F. A. I¢~ 51. "Comh[m,d X-Irn~dlation anti N-Methylformamlde Therapy of a T~l~mted Mouse ~mnr" Sta~ford ZIed. B~llettn, 1~. 21 f1957) With B. L. ~'re,,dlf(~doL S. R. R~dvb. L, Folton. J. ~vltln ~nd F. A. French 52. "Tim Carclnostatie ~ffctt ot fl-Olethylaminoethyl Diphonylprol~vl Acetat~ Hjdroehloride (SKW 525A) on l~)hrllch k~citos and 0fl~er Tumors" Aurar. A~::,~. Cancer Res., ~. 202 (1957) With B. L. ~ze~dlander and F. A. 53. "Cor,lblm,d X-Rmtiatlon and N-Me~ylformamide ~herapy on a ~ans- ~,lantc,1 Mouge Tumor" Prec. Amer. &~soc. C~eer Res.. ~. 203 (3957) Wllh B. h. ~rccdltmder, S. B. Rei~, L. Felton, J. Le~q~a and F. A. Fr~nrh 5L "Ab~{enro of Effcct of Myo~mine and Nieotr~e on the Development ~p~,n~me,)us Pulmonary Adenomas in Strain A Mi~" Prec. Amer. crower ~e~., :2, 203B (1957) With ~. A. ~ench and B. I~. ~r~e~nder. 55. "l]-Ethoxy-~-Ketebuteraldehyde (Kethoxal) as a Garcinos~atic Agent in Mmme Tumor:¢' Prec. Amer. As~:oc. Caner Res., ~, 2~ (19~7) With I, Fre,,llander. F. A. ~reneh, Hudi Gross and ~lores D~sber 56. "An Ehrlld~ A~cltes ~mor Resistant to N-Methylfo~amide" Prec. ~er. A~oc. C:meer Res., ~, 209 (1057) With Hudi S. ~ross 993 57. "Reductions with Ilydrazinc IIydrate Catalyzed by Ilaney ~lckcl. Aromatic Nitro Compounds to Intermediate Products Amer, Clmm. Su~'., 79. ~4~3 (l~}57)'Wlth Richard E. ~Ioore 58. "Development of a Strain of ~hrllch iscltc~ Tumor Cells ~e~i~tant to N- Methyfformamide" Science lZff, 926 (1957) l~qth Hudl S. Gro~s ott, l S. Gt'oss 59. "Chemo~apy of Spont~meous Mammary Cancer In MIce" Shm£ord 51ed. :Bulletin, l,ff, 316 (~957) Wi~ Wl~;or Cu~Ing and Hudl 60, "i ~ew Me,he4 for Preparation of Dialkylamino~tyryl Derh'ath'e~ o~ Pyridine ~d Quino~ne and '£heir N-Oxides" 3. Org. Chem., 23, 20t (195S) With Elizabe~ D. Parker 61. "Quinoxaline-2,3-dithiol ag a Colo(mie~ic RougenL Determination iu moniacal Solutions" Anal. Chem., 30, 365 (195S) With D. A. and Min-Oon 62. "Similarity of Action of N-Ziethylformhydroxamtc Acid to N-methylforma- mide on the Ehlrich Ascit~ ~um~r" Prec. Amer. A~,c. Cancel' Re% ~27 (1958) With James ~. Miller 63. "Drugs Affecgng ~e Psyche" KMser Foundation Med. Bulletin, 6, 123 (195S) With ~V~dsor.Cut~ng 6& "Anfiviral Chemo~erapy: Current 'Status" Antibiotics & 8, ~1 (19~) ~'ith Windsor Cutti~g 63. "Tests of Compo~d:~ Against the }]hrllch A~cites Tumor" Cancer Rcs,, I3, 417 (1958) Wl~h Windsor Cutting aria Hudi S. Gross 66. "~duc~ons with ~ydra~e Hydrate CataJyzed by Raney Nickel. IIL Iect of ~e Catalyst on the Reduction of 2,2'-Dlnitroblphe~,yl" J. Org. Chem., 2~, 1~ (1958) WI~ Richard E. 3Ioore 67. "DL-3-D-Am~ophenylalanine, Nil:rogen 5Iuztar4 ~4 Other DorlvativeJ' Org. ~hem., 23, 1568 (195S) ~¥]~1 G. E. McCaslaad, Robert Horror, $oyce Korntvedt 68. "F~oyl and Furfuryl Derivatives of Pyrldoxumln~ (Kinefln Analogs)" $. Org. Chem. ~, ]570 (195~) With G. E. McCn~l~md ~tnd Erwht Ulftllz. 69. "The Use of ~h in tlm Evalutlon o£ Drug~ Affecting ~e Central ~st~n" J. Clio. and ExT. Psychopath., $~, 26 (~9) Wi~h Windsor Curing, Mo~is ~aslow and Dorothy Read 70. "Phcnyl and Chlorophenyl Derivat[ve~ of ~,~D~ydro-2-Pyrlmldlncthlol" J. Ozg. Chem., $~, 999 (19~9) WI~ G. E. Mc Garland and Emvln Blan~, ~. "Some Urea and Picrate Dcriva~ves of Pyridoxamine" J. 0rg. Chem, 1(~ (19~9) With G. E. Mc~h~s]and nnd Ez~R Blanz, Jr. 72. "Evalua~on of Com~unds AffectiRg the P~ychc" Arch. int. Ph~rmacodyn., ~i, 14 {1959) With Windsor Cutting, ~e~rietta Parkman, Gcor~c Dorothy Read and John Cutting 7~. "The Use o£ Fish in the EPaluafion of Drugs Affecting the Central Ncrv0us System" (S~tion in book) 1959 With W. Curing ~4. "Phenazine DI-N-O~de as a Carcinosta~e Agent" ~*a~Ire, 185, 908 With Claire ~a~sner and ~indsor C. Cutting 7~. "Stt~cture-Aetiou Relationships of Plmnazlnes as Carclno~ta~c Prec. ~. A~see. Cancer Rc~., March 1~I0 Wi~ Chdre K~u~ner 76. "Chelation and Cancer~i Speculative Review" Chuptez in Mct~l {n Mcdi~c, ed., Marvin J. Seven, J. B. Lippincott, 1~0. 77. "A New Carc~no~tatic A~nt for the Ehr~ch Ascite~ Tum, r" Aeta Un~on Int. Con~e le Cancre, 16, 625 (1960) Wi~ James Millcr~ Hudl G~as Windsor ~S. "Comparison of Excited Pha~es after Sedatire~ and Tranquili~cr~}" P~ycho- phnrmacologia, 1, 3~ {19~0) With George W, Read u~d Wind~,.,r 79. "Circling Syndrome Produced in Mice by Dimcthylamhwhexo:~c (%58~)" Pr~. Soc. ~or ],~p. Biol. and ~Icd., ~0~, ~S~ { 1~60t With Cutting, Dorothy Read, George Read RRd Henrietta Parkman 80. "E~ect of Chlo~romazinc ~d Thiouracll on the Circling ~yndrome duced in Mice by Dlmcthylaminohexose Redactoae" Stmffurd ~[cd. ~nll. ~8, 125 (1960) WiUi Dozo~y Read and W]nd~r Cutting SL "Antlvlral Extracts from Proplonlbacterla" Antiblotica and Cheamthcral,y. ~0, 623 (1960) With Windsor Cn~ing, Doro~y Read, Dale Grant, Hclmuth Cords, John ~legna and ],~arl Butterwotth $2. "Effect of Phenazine ~-~:oxlde and Phennzlne on Total CcIlular Dry Mouse Ehr~eh Ascltes Cells ~ts Measured by Interference ~llcra:~copy" J. National Cancer 1~sL, 26, 435 O961) Wi~h Hnn Lee and Vh.tor ~]chard~ 29-236--69~pt.
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994 ~3, "Chung~ in Dry ~Ia~s o£ Ascites Cells after HN2 Treatment" Prec. Am. Assn. Canc#~r R~_*:~earch, 3, 24 (19~1) With Hun ~o and Victor Ri~ards ~t. "I~croa:~o In Dry Mas~ of EhrHch A~cites Tumar Ceils ~ter ~ea~ent With Nitrogen Mustard" Cancer Research, 21, ll0S (1961) With Hun L,:c and Victor Rlchar~ ~IL "4,5.DI~1o ~nd 3-~mino ~alog~ o~ ~yrldo~ne. New Route to ~n~th Go~wald ~tt "Chaogo in Ehrlich ~cl~es Cell Size Induced by Phen~zine di-N-Oz[de" Yr~:.~. Am. A~'~m, ~ancer ~esearCh, 3, 320 (1962) Wi~ N. Barker and G. H. Nccdham a~ D~tcrm~cd by I~te~ferenee ~Ii:roscop~" Nature, 194, 78~ (1962) With ~uu Lc~ aad Vlcto~ Rtcha~ds ~S. "A ~i~pliflcd I'roccdure for 0bta~ing Fluorescence ~ Tt~or Cells Us~g tim Conventional Laboratory Micr~ope and Lighting" Prec. Western Phar~, See, ~, 25 (19~2) ~ith ~. Ba~ker and G. H. ~ee~am ~9. "Antif~r~lit~ Effects of Guanylhydmzones" Stanford Med. Bull., ~0, Ili~[~} With Wind,or Cutting and ~rederic ~rea~ i~0. "Synt]w~b~ .f ~flf~r A~mlogs o£ Inosltol (Dimercaptoeyclohe~anetetrols), Nucb'ar Ma~e~c Resonance Co~g~aflo~I Proofs" J. Org. Che~n., 28, .156 II~i3) Wi~ ~. D. ~cCa~:land, Stanley Furuta, L. F. Johnson Z. ~. Scht~olcry i~l. "h~hibit~ry Effvc~ of Antivlral Compound~ on Viruses in wive, and in A',clt,-;-~ C~,II~ tn vitro" Free. ~a, 112, 6~7 (1963), With E. Fu~sawa an4 ~V. Cutting i~2. "The Ex~,~rimental Use of Streptococcus as an Anticanee~ ~enff' P~oc, We..~u~rn Plmrm. Eoc., 6~ 27 (1963) With M. ~ ~ertm~ ~d Fertm:m 9:{. "Cht,~i~Wy In Chelation in C~cer" C. C. Thomas Co., Spr~gfield, I~. 9.L "Direct Ehrlich £~cltes Turnout ~1l Diameter Measurements by Projection ef a Micro::;cope Image" J. Royal Micros. See., 82, 51 (1963) ~ith Barker and G. H. Necdham ~5, "Anomalou:-~ Reduction of an E~o~cyclohe~netctrol to a Cyclohe~ano b~trol by Potassium Methyl Xaafimte" J. Am. Chem. Soc., 8~, 2$66 (1963} Wi~h G. E. McCa~dand and Stanley Furuta I)~], "~ynth~la ~ ~.Halo-~-Methylcineho~eronic Acids" J. Pha~. S~., 52, 1009 (19~3}, With L. K. G,t~vald and G. E. 5IcCasland 9Z "An Ino~it~l Analog Containing One Sulfur Atom (Mercaptocyclohexano Wn[ol). Synthe~t:~ a~d Nuclear Musette Resonate Charact~xizatioa of lh~rivativc~'' J. Org. Chem., 29, 72~ (1964), With G. E. McCasland and ~ta~ley Fur~ [*:~, "Inhibitory Effect of Antlvlral Com~*ounds on Columbia SK, LCM, Yaccinia u~.ol Admm TYlU' 22 ~riruses O~ vtfro" Chemo[hera~ia, 8, 95 (1964)~ With l~llvhi Fum~au'a and Wind,or Cutting }*~~ "Tr:wo Metalu, Chcla~on and Cancer" Vort~, ~6, ~8 (196~) loO. "Hydr~(zlae a~ a ~cffuel~g A~nt for Organic Compo~ds" Chem, Review~ ~;5, 51 (1[,65}, With Rr)ber~ C. Berlo and Shirley Hoo~on 1,1. "Studb~ on the Grou~th of Ehrlich Ascites Cells" ~er. Cancer Soc. Biology Ex~,riment~ for High ~ool Students, 1964. Wi~h Windsor Cu~ng 102. "M~,thod~ of P~od~ci~g Depressant Effecff' U.S. Patent No. 3,190,800. Sept 103, "The ~tudy of Nickel in ~elation to Smoking and Lung Canceff' Pro~ A: ~. Cane~r R,~:-:earrh, 7, ~ (1966), Wi~ Waldcmar R. Gnstavson I**L "Blue Light Fluor~sccnce Microscopy for Cell StuSes" ~Va~n Y. Biol., ~.i, 1 (19[;6), With Nydia B. Luthy-Meyers and George H. Needham 10~, "Quality Tempting t~f Ch~mato~aphic Data ~ith ~e .Md of a S~t~tical Crit~rl0n" J, Chromatog, 22, 376 (1966), With George Lodin, Jr. and Waldc~ar :R. Gu~tawon l¢tl}, "l*~q,,r Chromat~zraI&y of ~-Substituted T~tophans" Y. Chromatog., 22, 4~;¢ ( l~lt:;fD, With Shal:n ntia lo7. "In ~ff~o Studies ,f ~ydrazines and B~-Hydrazone Induced Con~lsions" Prec. Wc:;t~rn Pharm. S~e-, 9, 29 (1966), Wi~ Waldema~ R. Gus~avson 10~. "/fiochcmical and Behavioral Effects 0£ Some Substituted Tryptophans" Arch. Inte~at. Yharmaco~ynamie et de Therapie, 268, 149 (1966), Wi~ l~ob~,rt S. do Ropp 995 109. "Effect of Analogs of Phenyla!anine and TryI, iophan on K|neties of DOPA Decarboxylase in Rat Brain': Brain Research 2, ~23 (19~9), Wi~ :Robert S. de Ropp 110. "VaCation of R~ of Vitamin B~ Group with pH" J. Chromatog., ~, 28~ (1966) 111. "~ect of Hy~az~es of Vi~min B, Levels in the Mouse Brain" Medical Re~ch. Labs., Wright-Patterson A.F.B. AS~R~TR-6*~135 (Sept. 1966), With Waldemare R. G~tav~.on 112. "X Comparison of ~kylhydrazines and Their B~Hydrazones as Convuh~nt Agents" Soc, E~per. Biol. & ~Ied. 12~, 172 (1967), With Waldt~mar Gustnvson 113. "Inhibitory Effect of Hydrazlnes en Brain Decarboxylase~" Proceeding:i Western PharmaeoL See. 10, ~ (1967 114. "~sponse-Tlme Con~iderationn and Mathema~cal Aspects o~ Coavul~lom~ Induced by Hydmzines" Free,dings Web, tern PharmacoL S~c. (1967), With G~orgo Le~n, Jr. a~d Wald~mar R. Gustav~on 115. "~ New Nicket Carcinogen" Proceedings .~er. As~:o¢~ Cancer Re:;ch. 9, 28 (1968), With Richard T. 11~. "StucCos on ~e Acute Toxicity of ~ickclocene" Proceedings Western Phar- macol. Soc. I1, 39 (1968), With ~ichard T. Hard and Han~ L. Fall: ~7. ".~ Atmosphere Expo:sure Chamber for Small Animals" ~rocceding~; era ~harmacol See., 11,136 (1968), With ~erbert B. Cherm~lde llS. "£ ~Iath~mtical Mode[ for Convuldons Induced by ,~lhydraz~uc:," Pharmacologist~ P, ~o. 2, 1967)~ With Georgc Ledin, Jr, and Waldcma~ Gus~t~'son 119. "In Vivo Staining with Acridine 0~ange" Wa~mana J, Biol., 2~, 1 (1968), With A~iana Bond ~20. "Preparation of A~yli~ne and Alky[ Amino ~ci4 Esters for the Gas Chrom- atograpMc ~aly~is o£ ~o &c~ds" Aualytical Chem., ~0, 190 (1968) 12L "Higher Fa~ Acida In Blood Se~m ~d Liver Extrac~ from ~ts De,client in Vitamin B, ~d Essential Fatty Acids" Wasmann J. Biol., 26, 2~17 (1968), With B. R. Najil, D. E. Bog~ and J. Wrlston 122. "Ma~emaficaI Considerations in ~e Carelnogenteity of ~Iul~plo Subcar- cinogenic Doses" ~r~dings Amer. Assoc. Cancer Research, 10, 28 (1969), With George ~diu, )$r. S,vr~v. Thank you~ Dr. h~r. Adams ? ~£r. ~.~)~s. Yes. Dr. Furst, I gafl~' the t~rus~ of your st~ment that you are involved in projects and flm't ~ ou thi~ flnt~ re,,'.~ar~ berg cut off bec~uso o~ statements thut have been published. Yea mention on ~a~e 2: "For the past few years ~ haw pen:onally b~n enuaged ~ ~ro]ec~s which inw,lved smoking." ~o~ you ~n~;olved in these prelects ~or and what ar~)hey.? Dr. F~T. We h~ve ~en attempting ~or m~ny years to induc~ lung c~ncer in experimental animuls. We have develpped our own smo~:in~ machines. We have gone through ~t long, evolutionary proce~:s try~g to build machines which will sim~ute the human mechanisms of smoking. The research ia wlfich % am ~ga~d in in this particular aspecb ~s aa u~pt to produce lu~g c~ncer in ani~a~s with ympk% ~r A~ ~ you indicate thut there is a problem with the ~ac~ tha~ ~eopio d~nSt waist, to research ~ this. Who ~-'s sponsoring this? Dr. ~v~T. This pa~,icular project was sponsored by tht~ Council for Tobacco Re~xrch. h~r. ~z~s. There is some que~:ion that perhaps th~ ~act tl)a~th~ro is ~fficul(~ in this ~e~ and ~actors have been rinsed that. an that ~s tiffs much at stake might b~ interested in doing it, pu~ting money into research. Several ]nen in the course o~ the he:~ring on the committe~ and of the committe~ h~ve mentioned that they ~hd. this source o~ ~unds been dryh~g up because of the public statement~ that h~ve been made ?
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DI'. Fvns~. Au far :,~s ~I knmv, no. I flbnk rher~ is more mone [rom l)l%Coun~i] for Fol)aCco Re~earch than ever ~.v .... , ~ ~o 1~1o ~; I (tin the only one on the wont. ,,~,~'~..~-. ~'W~" *o~tutdh revolved m tlns problem. I tlnrfl~ ~ere are man ' ~ ...... . gP m. . It. A,~s. But, t,]n8 m what I am ~ym,~ to ~et at Th- w~m...~- .... ~, .~ ; ;. l...n~ Is th,it the~ e should be more research and . , 1,11111~4 ~:.UOUhl I)~ , " that ,~ . e haH)emng aud they ara not, and I understand fh they w,,re and ,it ,o " • • - ...., . - .... y ~., ~ [u ar~¢ md~eatmg to me thai the~e ~.'e~' ¢ --~ -~ ~ ~t-ota you ~nitc me ~acts of She situation Eith~r money i~ flowin~ hi to do +~: .......... ~- ......... ~a~[~["t[.°Pmm~2n2ae~ ~ limited, i~ that correct? Y . ed. ., ~. ~' v~t:~.v, well, thwe is certainly some limitation o~ t,,,~ - 1)~obl~m I have is tha~ most o~ the cancer scientis~ do ft~q ~hi~; is rt fruitful area because I ~hink they hear too o~n that it alrvady a fai~ aecompli. Mr. Ao.x~s. In other words, you have had a t;cit~nt.h~ta say ~ 5"ou tha~ they lJeI~-~ ;~ ~ .... ;__~m~er of Dr. Finance. Tlmt is thegi~t of ~ome attitufl~; yes, sin ~r, AD;l~[s, ~tl tha~, incidentally, reflects" some . .. • tha~ we have had lmre so T a~,,,~ ..... ,;-_ ,, .... . of }he testimony ~o i,'e, th~ causal connection has been established ~d I ((at]Tr now what you are savin~ is thai w~ ~x~--~ ..... • • ~s any e~ms:u connectzoa ~nown or estabhshet/between smoking and ]u~ cancer ? r. Fm(s~.. Sir, I have no e~per~ental evidence to s]mw an r . - t.io~::dii]) w]),tf:~evt% and this is the agonizin~ -oiat I -':~- ~ow, when tim scientists talk to other *.'xlu,rh~lvutttlly entablishe,l.- Mr. Ax,.t~r~. I think the men that have come in ha . don't, kttow what facto, ......... a ,, .......... v~tated ~ now. ~ ' :' ~a t.nac ~s way tiffs comm'ittee ~ looking int'~ I am hT~n~ to deternfine ~rom you whether you thhak flu t ohonld" ,, ~ ~ -~gnor~ the studies or the ~atements ,,"'" ~u~*' ...... pus~r~on:~' o~ ta~e" t~. ,:am:~ ~ .:'cu nt~sts that there is ,~ co,cotton and wai~ unti " l,a~p:,n:~y~u ind~eat~ that research is -oin~ vet- o, .... {'),':?lUu areu t m,,vn,g rote i~or wllethe~w~l ..... ~.t~ ~; ....... tml}~ now to protect the nubile und~ .... ~. a.~_ :~:'~'.~ ,.r~ ~o u~ so~j~e- what i~ happening • ........ ~uu~ a.~ i esearcn c~ aeve/op ~ lalt~ is yo~, r posit}on on that ? 997 Dr Fur, sT Fir.~t to answer ,ourTr uestion in terms of )rote(.tilw • ., • . .... . ~ " 1 ' tim pubho, I t~nk the Imbhc always ~lmuld be protected. At tim time, however, we arc speaking so much-- in te~ns of a conjecture hero rather than any~ing ~],,hich be~rs on the problem. " 5h.. A~)~s. Then $ou drink as ~ matter of command decision that this con~ittee ~ould sjust say nothing about smoking and let, it go on jus~ ~ke if, is now ih the l~ope fl~at sometime ~ou will tint[ thi~g or one of ~e other laboratory men will~ Is flm~ what you think we should do ~ Dr. ~s~: I thbflg sir~ ~he committee has ~aid ~bat ~ l~d)el warning aliquot exists. Mr. kmx~m. We ur~ t~lking though about adve~i8ing warnings which is effect would take the label warni~]~ and would make it appear wherever tha advertising is carried on. ~fiat is our precise, problem right now. ~r. F~s'r. I am an exper~ent~ist and I work wit~, data ~ven to me wMch makes sense. At this particular moment I ha~e no informa- tion whatsoever that there is any real ~elat,ionship between ~vh~tt wo ,arc t~lking about,, and. .an exp.erlmental: .m°del, nor are there, ..pex eat- mental data wMch mdmate a relahonslup~ so L really can t gtvo you advice in that r~specL ~ir. S~'rv~rx~. The gentleman's time has expired. ~[r. Broyhill ? $fr. B~:o~z. Thank you. ~, , Doctor~ I gather what you are s~ing is that tlm ~ew e,~idtnct, which was presented to tgis committee in 1968 and also bofort~ thi~-: committe~ ~ these hearings this year really sheds no newJight the cause oY cancer or the other diseases an~ what you ar~ z:~;ing that ~hero may ~ a cause bu~ you as a scientist have not been ]ible prove one ~ Dr. F~'r. Sir, I hear the terra "new evidence" all the timu and may I now quote ~rom Van Duuren entitled "Tobacco Carcbmgene~i~" published for the scientists in Cancer ~exc:u'ch ~ By the way, this i~ h'ovember 1968. "It is surp~sing that in spite of efforts in several laboratories no new cardnogeus ~ave been isolated from tabacco or smoke condensate since th~ appearance of the U.S. Surgeon General'~ Rcpo~ ~mokmg and Health. So, X have act as a scientiz~, a~ a laboratory man, any new iaformt~- itch. May I also point out someth ing which perhap~ makes rm~ uniqnu. i think ] have had my hands ca every single publication that cited in the Surgeon General's Report.: and eve~T single pub]icatlon cited in the two supplements, I have been going to the library. I have ind~ed ~nd coded every single reference and I am still locket for ne~ information. But thumb through card after card a~er card and I am looking for nuw information. I haven't found it. ~r. Baoxm~,~. It cer~a~ly seems to me that is whet~ we art* now,. Mr. Chairman, th~ proem that, this commi(te~ enacted years which said cigarette smoking may b~ hazardous to health an4 t:o labeled dgarettes. I~ semns to m~ tha~ we should continue flint approach until such a time as we have a finding ~rom the scientists. Thank you very much.
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998 Dr. Femur. Sir, once again may I point this out in terms used by .~:,d,'nti~t'~ to ~ci~ntists. This again is Van Duuren, Toward a Less Harmful Cigaret[c~ ~ational Cancer Iastitu~. )Ionograph No. Li,-~t,.,.n t.o th~ words scientists u~ in ~ alldng to scientist. H~. talk~ about aromatic hydrocarbons. He t~lks about their car- ,:ino~onicity. Now, I have liste~ the exact wordh~g. "Thc~:~ ~ding~ imply flint noncarcinogenie tobacco tar hydrocar- boa~ may b,~ tumor-m~tmtm_ agents. This i~ 1968. This is what ~mean by no new infomatioa. Mr. ~-~o~m~. T]mn~ you~ Mr. Ch~rman. Mr. S.x~r~m Th~nk you. Mr, Ecklmrdt ? ,~'[r. Ec~.~,~xm~:. Doctor~ I ~sh to call ]~our attention to thre~ sources 1, re: O~lc ~ the ciga~etto ~nokin~ article iatr~uced here by Ro::.~nblatt~ and~ incidentally~ I t.hi~k ~Ir. Rosenb]att appeared her~ at tht, in~d~tcnce of the tobaccb industry, and, as ] ~marked, I ~hought wa:~ one of the mo~t candid witnesses we have had. di~-:va.~[:~ ~y ~:mokh~g category and several behavior typ~s which indi- ~:~h,:~ i~t b[:hz~or t~p~ A~ w~ich is th~ rather ~netiz person~ occur~ ~bout thrc~ ~imes a~ frequently iu smokers as nonsmokers. In that ~ather c~[~ typ~ B, this same percentage rel~t~onslfip e~sts, a.]:,out thre~ ~o on,, for th~ smoker as compare~ to th~ nonsmoker. tim repor~ called cigarett,t smoking~ health characteristics~ U.S. De- p~trt.mcnt of He~lth~ Education, and Welfare~ thero is ~ tabl~ tlmt ,'i,.h,ntally wa~ not referred to by one of the previous witness~ Dr. S~erlin~, which ]~ t~tble 3, show~g ~ rather m~rked incre~e ~th the altlollllt- oZ cigarettes ~moked respeet~g percent of chronic conditions. The nonsmoker fi~ure runs around 54.3 percent ~ then ~ong ~:moker~ of all agc~ 17 years and over~ 58.7. Then~ you take the number of cigarettes and you get ~m increased percentage~ 4~.4~ 4~ 57~ and p,'r,'~:ah indicating mx iacreas~ of chronic ~seases with ~cre~ed ~-~mokinz. The~ the report flint ~as re~erred to ~r]icr as the ~amraond ~hows ,r marked deelin~ il~ the overa~ death rares for ~ormer smokers L]m~ ]mvc qu]~ ~mok]n~ ~ good number o~ years ~nd~r I year it is flfirly high. $~ t~oy qm~ ~rom I to ~ ~ears if, drops off; if they quit {rein 5 to 9, even more; i~ they quit up [o 10 ye~:~ ~hc~ are nearly to the nonsmokers level and so ~orth. ~ ow, r~_eo~izing th a~ there is no identification o~ the ca~e o{ diseases r~.latcd to ~moking~ do ~,ou not ~eel that all of tim literature indicates at lea~t ~ warnin~ that'~mokin~ causes iaju~ to yo~ health and that tlm incrc~-ed am~m~t of ~moki~g as inSicut~d by these studies would h~crc~-o the danger to heal~ eau~e8 by ~mo~n~ Dr. R~s~. I am not going to evade the question. $ am an experi- mcntali~t and ,my tield has been cancer. ~en I hear ~at~fical 5,rm~h:m I r~d]y am not comfo~able~ ~o I h~w to go back to my quantitafivt, basis, ,~omcthing which I can sink my tee~ into and e~,all.~atc, If a doctor sl~tOs o, ~atien~ on the back ~nd s~vs, "How are x, ou foiling," and he says~"I re'el better," this may mean tha~ a m~n has miproved, if he slaps hnn harder and lo~ er lie may say, $ es, I h~ve improve~ more." ..... 999 Then yea say, ~qVell~ he has improved more." I ara not comfortablo with these figures. Mr. ECK~T. I under,rand and I think you are perfectly righ~ in lool~g at this t~ng objectively. A scientist ~lw~[~ must ol:,~erv~ lationslfips between one' se~ o~ data and another se~ of data to dr~w conclusions as to the relation, is that not correct ? Dr. Fvms~. That is cbrrect, yes, sir. Mr. E~m~..~d theft th~ ~m~her Im goes, tlm mor~ he ca~ tablish • relationship or establish that there is ~mae, and we are at the s~ge whci'e we ~d an association between various and ~ao~ng but we know, as many of the ~-~tnesses have indicated, that, other factors could be involved. You would liko to elim~xate some of thes~ other factors altd make 3,our data accord with oflxer dat~ received~ I assume ? Dr. F~s2. Yes. Mr. E~A~. But in the inter~ when we find ~ number o~ various courses ~oHowed~ though some o~ them ma~ b~ faulty in their t~ch- niques, and we come out at generally the sa~xe conclusiou, may w~ ]ogica~y ~arn tim public Lhut the condition which we h~vc ~b~:erved is uss~iated with hazards to th~ health and that pending our furthest discove~T of th~ precise reason for the injury to health that the public sho~fld be cautioned ttm~ tiffs relationship exits ] Dr. ~s~. Sh', are you not doing this right now ~ ~£r. EcK~i~w. I ~hiak w~ are but I wonder if w~ are doing it ~rongly enough when w~ merely say "may b~ httzardous to your health." Don't we h~v~ enough evidence now to indicate that it h~z~'dous to health though we m~y xxot know exactly how it hazardous or ~hy ? , Dr. F~s~. If I were to be a real cold experimentalist I would no, you do not h~ve s~ciont experiment td evidence. MI~ E~.~. Do we have anv experimentM or statlstlca] evi. deuce that zlg~rettes h~ve nothing (o do or th~ they lmve a ~avombl~ affect on health with respect to the field of coronao, diseases~ or cancer, or omphyson~, or any of the lung diseases? Do we have statis~l e~dence ~ oppo~i~ioa to ~o evidence I rarer to hero in co~ectioa ~th the Surgeon General s examinations, th,~ Hammond :Report., the report I refe~ed to by Jenkins, Rosenman and Cyk~ms!$y Do w~ h~ve any contrary e~dence statistically or otherwsic ] ~ ou have exaralned a great numMr of studies as I understand._ . Dr. F~s~. Ye~,; but I hopoyou ~ppreciate th~ fact th~tt tho s~zt~:~- fi~ ar~ out o~ m~ field. ~ s~y I~e,d not comfo~abl~ with them. I statistics ia the w~y o~ asking "is my ~xperiment valid or hot, and But when it comes to thes~ statistics~ and I sat through 3 or 4 days ]isten~g ¢o statisticlans~ I really have to de~er to tlmm. I cabot honestly give you a real ~wer. Mr. ~o~I.~. I am not asking for )-our j~dg~nent with to the statistics, but do you find any r~port ~hatsoever that come:~ out with statistical or any oilier ~vpe of evidence sho~:ing no tionship between smoMn~ and the diseases thug I ha~ e de~crlbed Dr. F~sr. Mr. ~c~. ~at are they ~
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I000 I h'. FtrltsT. ~ years of my work trying to induce ,hmg cancer in totMtll:~ with ~m~ke and no~ ~ing successful; Dry. W~nder and ~off- mamG I.~ok, which i~ really a remarkable book, ve~ help~l to th,, peopla who work in th~ field: ~obaceo and To~ee~%n, oke, ht E,~p,:r;mcnta~ ~arcbwgene,G% about 3 pages o~ detai~g sm(&ing oxp.rim.~fl~ from all over the worl~ No m,~ has Atowa experimental tumors can be induced. So i~ is a~ nepcative~ sir. Aft. b:,~ u.t~n In.~,~h~r w~s, you are saying that the attempt rb.w that emoke direet]~ cau.es cancer in aa experimental situation Ira-; no~ bt.,n esbtblizhe~t? Of tours% you reco~ize tha~ t~s is a raflwr ,lii~c~tlt ~rca in which to establ~h experimental data with t'esl-,.q, to hnman:~. For instance, you can% take a o~Id 18 and induce him ~,~ ~,mok~ heavily until he is 65 and take another id~tical tw~ and not permit him tO smoke, and compare ~o~B two facts. You can't ~',q, idea~ clinical data in this field~ can you~ Dr. l, ~s~. I a~re~ with you~ sir; an~ t~s is wha~ I said before, it i:~ ~o agoalzin~. May [ take a moment to ~ about biological models ? Now~ ig ]m~4 been known for ~any years that miners who work nickel min.~ get lun~ can,:,.cr a~ ~ rate roughly 10 times the normal p,:qmlation. S~ientifid papers have been wri~en on the subject. There is a paper in the ~'~tzsh Jou~al of Gancer which says, "Well, tm wander, look a~ the hizh arse~c content o~ t~s mckel ore. Some- ol~e can dcaw all ~ort;~ o~ inferences. I am now gong to ta~ about' hi, do,iced models. Dobi.r Gilman in Canada injected some nickel ore into the muscle of ~t r,t and got a tumor right there. Dr. Sunderman exposed rats to ga:'eouu nickel compound ahd he got metaztasyz~e lung cancer. In our hd.-,rait,ry we took ibmlv divided nickel powder, injected it h~to the hind ]cz nma.lc of ~t rat. ~n four months we got large tumors at the site of tht~ inh:ction M1 the aMmals we tested had lun~ metasta=is ~ ra.q~l, nted tl m t,~tmor:~ into od~er rats and they dmd. W~ look anoth¢r nickel compound and injected it in fhe muscle of ral in t]:. right h,~ and we got no tumor at the sKe. W~ got a tmnor in t he face. 1 am talking abou~3iological models. Now, wo took :,ciVic mice and injected nickel powder or the nickel mmqmund and wc in&wed tmnors, We then spent tt year painting the b,,,ks of the:-** m~co w~th mckel comp~ds and got nothing. We look at humans. They get lung cancer~ and ~acial cancer. We have I.,,n abh~ ~o duplicate this in tl~e laboratory ~th both mice and rats. Itowevt,r~ wheff we painted the backs of t]~e animals we ~o~ nofldng. Thi,~ i~ ~,hat I mean by experimental evidence, I know ~ c~ i~d.ce im~' van,-t r in mi... I cam~ot do it with smoke. Using other chemical$~ I ,'nn in, luc~ ~'q,~:nnou~:-ccll canm~r in the~e animals. Mr, E,'t;n.~v. I~ one of the factor~ whether or not you have to the prt,::,mi time, nl~d this i~ certainly no reflection on ~our ~carch because tthvav~; there i~ a question of stqJ~eieat innovation'in research, have not qnit~;hi~ fl~, Yormnla for your experimentation ? For in,4,nce~ ~nppoad t-l~a~ when we observe more cancer in the Br;t i::h I~h:,:~ fltau we do in the ~nited States with less smoking, sup- p,,,-:e wc w,r,3 t,~ discover that smolm in not moving tim mucus in the thr.at at ~t s~cien~ rate permitted som~ of thes~ ~o~d-~ke~ for 1001 stance, par6cles o~ nickel to remain ill place over a given period tinle. You could have these complex relationships. ~ ~v Thatisright. _ - "~ ~ ...... ]on~ a~ ~,ou find ~$'~__.~ ....... ~rlfich might induc~ m ~v u.~ ~ ' L:~ ~,,,r,l~ ,, 7, " indication o[ ~ reta~lonsu~p ~, ........ - ~ ~ ..... el'e should ~.~ .i=arettes ~ou cerc~y so ~ ..... r' = b~ more expe~e~tutum m tins d~recblom Dr. F~T. Absolutely, yes, sir. , . . bit S ~m The gentleman s time Ires exp~re~t. ined tha~ ¢~garette smoldn~ ":~ s s ~ . haw already d~t~: ..... ~.~ -~1 o~ the=e other problems,.q,~}t '~ eter ~r~her ~e~rc~, ~um .-:..-Te;: ......... ; %~,.t you state o~t ,~.,ge that scienhs~ ~r~.gene~'~'~" already solved and the g~ 9roblem% wmcD~ racy ,~ 2 ~__2 ~ ....... akin- ,~mts ~or ~o~pe [~encies themsctves are ae~veu ~"T:~h..l~T~nular field here aS :~.1 ~wt.her. too, we are no~ m a paruc2~,.~y.,Sy~i:.a ..,~.ou~h I n-dt~ht :"%" :J~?;= I%1= bid tobacco industry aml ~o xo~ ~, ,~.,,:_,,1:~1~:~, ¢,'an~lv ~ am dishea~ened to hear nlax. u,tv ........ 'hu'ther empha~s.. ...... ~.-~ ¢. iar as s'ou kaaw as ~ htbora- Do I understana correcuy noel vp,.., 7" ," - "~ : tory scientist, that ~ou ~}:~:our laboratory wherever u. ~r.Fvas~. Sun'ran "'. • . . -, . . "--ow mnldng Mr Wa~o~ That you :tr~ the omy one so tar as 5ou , ctcrm~ed ]ttboratory study i~t this particuh~r fie]~l trying to induce ~ d --.~- ..... zh the inhalation oY cigarette smoke. 1ll~ ~ on.ricer t.~ ~-~ .- -:~ --- *~-~ Wo=t coast ~.. ~'~ST. l men~OlleU tmt~.~. ~ ~ - " ,.. ....... ¢ any oa the ca~t. Mr. ~:xTSOX. On the wes~ coast. Do 3 ou ~--- coast ~ Dr. Ftms~. At this moment, I don% know what the situation ,. atory ~heO~er he is conthxnh~ his ~moking cxpqrl- Dr.Wynder s ~ab~r .c ' ...... ~ ..... ~,-. ;~ aoin~ omne work on mhalatmn .~die~ tr~,imr ro see ~f 13~ can t ..........n~... ~ow~ if you tal[~ about mo~2cuh~r biology I cal~ spend ~ hours telling • " ",. ,~redo~n it~ you wluch scie~xt~ ~ts y .... ~ .... ~. ,. ¢~.vim~s thin~ I wonder wh~: " ~Ir. WATSOn. BUt. nns a~ :"~*t:,~;.~;,~",.;,,'ht'bff that are magmg wou)dn~t be able to mime xa uwo~ ........... • , - "~ ,.. but x-on em~t offlmnd tell nm any otl,.r~ stud~cs m tll~ 0~ea,~ " " e t.omffrv any l~htc~"~ the west coast, east. ¢oast? ~.,.d,3l~. o~ 3h . ~ *,, ~,Ioove,~ by t~,t, Tob"tc,'o kntl did you ~aot. tell ~ae that yours Is b~.nt~ .~ t ..... ., ' - ~areh ~ouneil, is ~t,: • .... " -- :-.' v(s ~ir. tim Cotm,:il for Tobacco l~es~'~rcl2,~n~2 .... ~.~ indusbw that is h.ying to be xr,- Wx, rso:¢. ,tnct Tncy a~ ...... , ",-, ..... ~-,,,, anvwltcre that
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IOOB ] , ~ ,..a: ~, -. I ..... • o~,~.-av~/n]ellt ,~rant trying to produce these caneer.~ th ~v ~ re not. I ]u:~t don t, lmou. ,. ~Ir. W ~T~:OX. Do you ]mow or any ~ Dr. FXa~'r. I ~:~o pot; .......... ontentions by the Surgeon G~eral. ~ ,~tt I i ;,,:~,1 ........ ~;"~2~ ....... '~{b4eee the wron~ test ammals i,~t i,,~ nf t[w ti~aue of the lun¢ of g rat are mmuar to that of ghe humgn Dr. F~-asa'. Itbaa not. Mr. Wx~oa-. It has not been established bat, yet all of it heaven Dr F~vr~r I ale ~orry, ~ir. Did I misunderstand your question. ~I~ W.,:£~;)~. I ~can ll~s it been establiehed that the tissue char- a 'h r~stica of a hmg of ~ rat are the ~ame .as a Dr.~F~. I wo~ld say~. there is a ~eat si~Iarity,, y~. Mr. Wxr~o~. There i~, Fvw~. Yes. . ~': ~Vxrso~. Good. I thought ~:ot) v'd ~'~tabl~shed float they got Dr. ~u~csv. I thought yon asxea has lm~g can,'or. ~ • . ~ ~on ~ think everybody a~ees there ,~t h,a,,~t, wo ar,~ toying aro~ll(t al~u l)la~I~g arnuna or someday z md with ~a~,b~ the right ahimal and so fo~tu playln~_ aro[ . -,-,~- offba~e 5. tha~. "Some scientists Yonr ~:ccona recommenr~[tt,~':[~ .*h~%,-i-~s ~sn~iall~ the nih'osa- ~ exist in cigarette sm." , ~ mn :~, .... ., - , =e-~-e,, '~re there Are they really artifacts. ~iyuineance ~m~v nave~ ~, ~ " ~ a,, " tI'~', b~~ carcinogenic to other agen~s~ 'Y - " ' [, zo a yrene~ . . Ia that of a ~mflh o~ ), ~en _~.~+M,, Aifferent t~e of earcmoeemc Dr, Fr~-~aT..~oI;~r, ,, ,~ +~ It h~ been mentioned. There was a~ent ~nd i~l~a~.t~eep,~}uJm~',~'2~',~m,n a Zess Harmful di.qare~te," (li~,c~.smn of/hat, m ~n~s ~)o~- ......... rd . _ ~b tt tlm~ ,-xid wa~ thls : .... and " ~ . ...'.%, " - ~ --;tros,amme~ in inhaled Clmxrette smoke "~'o e,~tal~,~a.~ne pre~c~cl~ ~rom their pr~ence ~ is necessary ~ ~o )redlet, int~ pos~lme ~,~ '- - [i " ~ut:l ~ - ,--,~ ~nditions simulatinff as c.osely as po~lble They are ~n~'c tellh,- ~s that we 5ave to go to work. Then it says~ ,w,,,~j ie tl;, nitro~a~dnes are identified ~.d uncquivocall~ est~b- .... • - ' - • -"-i-.xrette smoke a~ a certa~ level~ ~hen 1Mu:,l as beh~g l~re~n~. ~} ~ev contribute to the total to~ie activity llltl~t, ~0 hlVe~-tl~fl~Ctt wbet~w . fh,, tohacco ~llloke." . • . 01" pX'ollor~lOlL £lt('re, Jtt~d ' out. r ..... ~r .... I ~k you this one final que~ion? Ton ~,tate on page l~, p~r~,~ +h,~t ~an olos61v mimic h~an pu:.stblc tr, consh uct F~mok~ 1003 .~'e you busily trying to do such as that and if so, durin~ the experi- ment that. prod[rues hm~ eam',er regardless of w]lo is pa~;in~ you will you get the govern~t and the American people into your honchisions~ '- Dr. F~s~. Oh, certainly. I am doin~ this, ~Ye have developed ~ maclfine which is not ~ hm{dred percent'perfect. We read what we can about how the human smokes, lie takes a puff and it lasts a few seconds. ~en he takes the cigarette out of Its mouth that smoke i~ not beN~ inhaled. It is np iu the air. Our madfine permits t~e smoke to escu~g during this interval of time. ~mn the smoke machine is operating ~e animal has his nose into the main ~ream and is f.rced to breathe. Now, I hear that the an~ml holds his breath during smoking, that is why machin~ are no good, but when you tes~ ~e animal ]m ia breath~g. Now~ some of the p~oblems: I~ ~o~ tMow smok~ on the animal you ~ay find that the nicotint~ and t~rs, or in reality the smok~ condensate.~ ~all on th~ fur. ~m real lick~ himself so therefore raay be eating the materiM. To ~voi~ t~s our annals ar~ placed in glass ca~ettes.-Only the nolo protn~des into th~ main stream and the~ he h~s to breathe. Our aMmal is few inches ~om the end of the cigarette so if there ~re particlo size cG~n~ he gets the same thug ~ human cets. If there are ffee-radlca]s h~¢dfs the s~m~ ~hing ~ hum~ acts. ~his has already Seen done. This is what we ar~ doing now and it is availabl~ to ~ybody. ~Ir. W~sog. ~ th~ far you h~ve not been able to produce lung cancer through fl~e inhalation df smoke agen~ ~ Dr. ~sw. And no unimul gets l~ng ~aneer. We do fiv~ aninml~, pr 10 animals, at a tlme for eve~ day for days, ~or months. 2Ye take an equM m~her of anim~]s ~ su~ect the~ to Mr so we h~ve ade- quate controls. Thin ~s extremely ~mportant. ~ou e~n .e~ nothing different between the animuls e~osed ~o th~ smoko and Mr. Tlmn~ hear somebody s~y~ "Well, fl~ey ~on~t breath~ the smoke." ~e tes~ blood ~rom the tip of tim animaPs tail. ~en they smoko there ~re cede.in materials that ge~ into th~ bloodstream and we can pick these up in the blood o~ the t~il of the anim~. ~mrefore~ we know tha~ ~hc ~nimal is breat]finV the smoke and yet at the end of the exveriment you check the animMs, and ~11 the animals are accounted fo~. An~ma]~ are sacrificed and ~he lungs are examine~ microscopically. ~re Mso have pathologists who can verify what ~ ~ea; no lung cancer has ever been produced by smoking. Mr. Wawsom But yo~ labor~to~ a~ the exoenae o~ th~ tobacco iadu~ry itself, is stil~ seeking for an answer to this critical problem? Dr. F~sw. Oh. yes; I am very persistent. Mr. W.(wsom ~d~ o~ eours% you are getting ~an~ from the ernment in referenco to o~her ar~as bu~ you have'no~ received a grant from tl~e Federal Governmcn~ to help you speed along your study in this particular field ? Dr. F~sw. Tlmt is correct, sir. On the other hand, in ~11 I have not asked ~or • ~rant to help me on fl~e smoking and again wanb to m~o reD, plain I am not "here to criticize. I have no fl.x to grind at all.
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1004 When I poin{ out, tdl the re,earth projects going on in my sm~dl tt I " " ~ ' 0 mtiv r~-~i y~ ~ m(hcate we haw adequate re~earch mo~ey. But t go off tim bealt,~t path~ I hear people talk about benzo(a)pyrene being given in milli!~ram .quantities. I k~ow tha~ fl~ere is le~ th~ on~ hma- dr,,dtl-t of a m~crogram per cigarette~maybo we are doing the wrong thi~. I:'erhal,s h~stead of era]uatin~ massive doses of be~o (a)pyrene why ,t,m't ~vJl,~,l~ at ~rnall do:~e~..~ human doesn't smoke a thousand ei~- tlrette~ a ,lay : he smokes a. tiny. ~q~y don't we ewd~mte subeare~nogemc do::.c:~ on a daily hae:o:~--when I proi)ose a project l~e that i~ is consid- ew*,l ~dd ball. Mr, W~w:*o~. Thank you very much. Mr, S.~w rz~aa~o. ~lr: Preyer ~ ~h'. Pm:x'~r. Thankyou, Dr. Furst. I think it wa:~ Marl~ Twain that said it is not what we doa~t know that, ]mrls us. It, is wlmt av~ do ~now that isnrt so. So, what you are ~',aying I gather i~ that many of ~ our ~el]ow scientists thi~ tiffs ques- t,i.n ha~ hi-,ca answered. " Dr. Folt~,v. Ye~, sir. Mr. ~ntx,:~'~. And therefore it is di~cul~ ~o get them to research this t.,t:~ ~ hi]~ if you eouhl gel fl~em to look at the fac.~ as scientists they ~ould their x:ecognhe that additiom~l research is needed. fir. F~I:~S. I think there are many scientists Sat more eru~te than l~ wh. rt~all3 zholzld be in the field~ bu~. are not. Mr. P~,:x:~. So~ ]n~t~ a~ we see tha~ judges "read the election returnsr" and are alI?'ct,~d by wha{: goes on hx the general society ,tronnd them, would yon sa3 it i:~ fair to say scientists also l~t~ to ~ometimes com- lllerci;tl~ al~dt ~auokiuvq read pa~aphleLs from the l~ub]ic ~t~a]th Serv- i~,c, I],:~ Americ, n Callcer Societx ~ and so fortlh and ~bsorb the g~era] idea-, about ~anoklng that are ci'rcu]ating in fl~e world around them Dr. ~tm:~w. That-i:~eorre~t. A couple of wee~ ago the American ~:~oci,tfion ~m' C~mc,.r ~e~earch had its national mcetin~ ~ San } ran,:i:~o~. [ wa~ ~ little concerned, and I was mnazed to find ~w malty .f my fellow v:cicnti~ts ia this ergot nization--remember, this is nee ~-u'ganizatlon h~ ioin becauze ~'~ do cancer rezearch'~it is an organlza- tion whcr,-~ you ]taw to prove hv vent publications you are worthy meml,~r,~l~i~--reacte~ when ! s~if~ I ]rove not induced ]un~ cancer with ~hol~2 :m~okc or any pare of iL nor has anybody e~se. They gulped; they ttre amazed. Mr, P~tl,:aq~It, ,I~[, because ~,ml are tt ecieutist or just because you are ,t doctor d.e:m't put you in ~ueh better position t;~ l~ow titan ~nyone Dr. ~'~'r. Tha~ i~ correct, sir. ~[r. ~lll,:Vl~I:. ~'Olt arc one of lhe few witnesses I have seeu that ap- {~ttl'Cllf.]}' ha!q gone through all of this materi~l pub]igaed since tnd I t]tke it~ th~tt you ~([tte flaL]y that there is no new expcrhnenta] cvi~h.nv~ developed ~;inco ]9(;4 ? Dl'. Vv~:~w..Xn,a I limit it in my field o~ smoking and lung cancer. Mr. P~marm:; :~mokin~ and hmg cancer ? " Dr. Ftmsw. I hat is right. Mr. I'm;a~t. Perhaps you wou]dn~ want to conunent on this, but in l, lw lb,hi o~ ztati~2ica] z:elatlonships~ has the case been made ~ronger fr.m l~)~l,~ by ~my new information ? 1005 Dr. Ftms~'. I really cannot ~y, sir. I don't know. M_r. Prmx~.~. Letme ask one f~u..d que:~tion. This is u xery impressive lis~ o~ papers which ~'ou read he~ witk more names that I c~m~t pronounce than I t.hink ~ have ever ~een one place, and lmdoubtedly som~ o~ the longest names in the laaguage~ bu~ I thougke with perhaps th~e backg¢ound you n~ight ~ust help us on one question w]ddx we diseu~ed some here in the com. mittee, a-rid ~hat is the question of is smokin~ addictive g We ht~vt~ had a wime~ who testified that it is addictive ~il:e heroin. Dr o~s'- N ,-," " . F s'r. ~'o, I ~d as u plmrm~tcoloe~st, lust to put on tumther ; .... '.p " 's : q " " "" g. sere, 9h~rmacolo#cal sense, can mm talk about slacking ~s b~:~ing ad~etive. rh~ add~etxon goes through the dependence, the phys~c:d dependent0. There has ~en some experiment with tissue eultt]r~. One took simple cells and then added morphine to tlwse cells and cue couldn't ~:ee any difference, but when morpbhm was withdrawn the cells withered they were broken. Ther~ was ~ actual physical dependenc~. This is no~ the case with smokdng. Mr. Eo~m~Dv. Will the gentleman yield £or one question ~ ~r. P~v~. Yes. ~£r. E~an~. In this semi, cocaine is not. addictive either, is it ? Dr. F~. Well, I lutv~ not had I~th~d experience with coeMno ~r. Ec~a~. ~ understand that these are no~ from tim medical doctor who di~cts the Federal inseitu0on ~zt ~t. Worth where addie- tees nro t~ated. Now~ of tours% it is considered narcotic m~d it create~ certaia situations which result in persons wanting it a-sin because is attractive to use~ but ~ understand i~ doesn~ have thh~ vomiting and withdrawal s~'mptoms of the type :con are hdkinu" about. Dr. ~ ~s~. ~Ve]I~ I hax e no~ had hrst-haltd experience ~ath c~,cautu hub I ate almos~ wi]ling to b~ thu~ i~ f~)hnvs the opium type of tion and in the pharmacolog5 books i~ is l~ked with it. In any number of pharmacological books( Solmarm, Solo~,~n, (~oodmau," Carr~ Kranz~ you will not see tobacco ]i~ted as ~ddictive for th~ pha.rmacologis~ but you will se% I Chink. and I may stand corrected I think I can ~d cocaine hsted w~th l~e opiates. ~[r. S.~mhv. The ~ntleman~s time has expired. Mr. Brotzm~ ~ ~h'. Baorz~a~. Just one question. You mentioned i~ I understood you correctly &a~ there ~ a ve~ ]~ited amo~ of e~periment~l egbert, being put ~o~.la to t~ to ,~eter. na~e whefl~er there is a relationship between the inhalation af ~,moko and cancer.
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1UU~ i:; it. corv,.,et to ~tato that this doesn:t mea~x that it is not going on in Dr. Ft~}t~:~. That is correct. Yes, sir. Mr. Bm.o:z~.~. ~at is being done in the~ othec areas relative to cuvironmcutal contamination~ tot example~ Dr. Fm~w. Ilclative to the environmental coataminants~ Mr. Bw~a'z~L~. Ye~. Dr. F~s~. There have been experiments were em~ro~ntal ,~han:J~cr~:~ have been u~ed; in the~e, enviz'~nm~t~l conditio~ such as nitric oxide, ~_~lphur oxides, are added to ~ee how th~ animals respond to fltat and just let~ Mr. B~c,~:¢. Tak~ one o~ thoee now. Have they determined flwr,, b~ any rehztionship between ~ome of theso others~ For instanco ~ believe you mend,ned nickel ~ moment ago. Dr. F~s~. Ye~, sir. Mr. Bxx~Tz~t ~x. This would b~ what you refer to in your testimony hlX'. ~Icox'z~m~. ~ would undc~tand ~rom your re~r~% however~ that there w~s no~, ~ detcrmlnable causatioa ~actor thez~ ekher becaus~ ,you ~aid iL ~-as induced by injection bu~ perhaps not by the smear on tim ;qciu, i~ that correc~ Dr. F~_i~sv. That is correct but. i~ you take the gaseous ni~d com- poumt y,m can induce lung cancer in ra~, so in thin pa~icul~r case ha~ bceit :~hown t]m~ lung cancer can be made~ or can be ~duced, pardon ~h'. I{I{O'I'Z~IAN, You can do thCq by i~lation of something ~ls% Mr. Bw,'rz ~t.~. Inhalation o~ what again ~ Dl'. ~ln~r. Th~ nickel compound which is in • gmseous ~orm. It i:~ a,:, mq,:,un d called nickel carBonyl. Mr. B~cn'z ~t.~. Did you conduct that particular experimea~ Dr. Fvi~:r. No. tha~ was done by Dr. William Sunder~n. Mr. Bxio'~'z~.~( Bu~ i~ ]tt-~ been induced by ~hal~tioa o~ somet~g Dr. ~c~ts'r. It h~s ~ot been inSueed by a~y eomponen~ o~ smok~ or a~y n~pee~, of smoking. Mr. B~o'rz~,ax. ~rom a broMer standpoint ~r~ w~ re,ring ahead,-, experimen~all~ to de~emi~ i$ r,q~ttion~-;hip Ix4w~en other e~viro~m~entM ean~amhant~smog Dr. F(~)t~'r. ~ow. ~or instance, St~ford Research was mentioned thb-' m.rMn~. Stlmford ~esearch hos a fairly lar~ project t~g to ~imnhd t~ ..~,moz and air pollution pr~le~, and e~pose the ~nimals to ~:et~ what, will happen~ yes. Th~ ~ni~ erslt3 o~ Southern California doim~ it.. In this parHcu]ar cas~ there ar~ many laboratories studying the: ,, :-am ~ problems. What (ht~ ma~litudt~ is I don'~ hmw. I do lmow that ~he InstituM .f EnvJronnlcntal Science:; is very concerned wi~ this so I ~eel thez~ i.., much morv. goi~g on. Mr. Bl~o~x:l~~. ~lat. was this gas ~ mom~t ago that you men- ti,~tcd that was u~:ed to cause cancer by i~alation? 1UO7 :Dr. ~'u~s~'. It, is ~t nickel compouzM. It is called nieke] carl:,mSl. Mr. B~zr, r.~. Nickel carbonyl? Dr. Fv~. Yes, sir. 3Ir B~owz~tA~-. Did they us~ lhe same device to keep tlm animal from ~oving ~ Did they use ~ sn]oking dt:,vic$ ~ ..... Dr. ~'~ST. No, they just t~k an open cl~am~r~L am eor~-, closed chamber~and ju@ allowed s~rae of the gaseous ma{erial to go h~ this environm~tal chamber. The animals were there moving free. Wo haw done • little work on this projec~. W~ took ~t five-~Mlon clam w~ is ad~uato and had a curcent of air going h~to it~Thc,~ i~. is possibl~ ~ inflect th~ nickel carboayl into the d~m. Tlm ~nimals will breathe. T hen we look ~or lung c~ce~. ~. B~o~. Do you think that there is aqothcr ~,yl~e o~ e~D:ri- mental a~mal ~at might have tissue more simfl~tr to a htmmn ~emg than ~e mice you ar~ using now ~ Dr. F~sT. ~rc ar~ ushxg mic% rats~ h~msters. _ ~. Bao~t.~N. ~iice, ra~, h~nsLem..~re there others tna~ wout~ beperhaps more sinfilar to human 1~ tissue ~ Dr. F~s~. Well, here I am referin~ to what ~riends told too. I am uotin~ Dr Joseph Gast of tim Veterans' A&o~dstration o~ ~ng q ~ " " Beach who s~ys flint the horse lung ~ much clo~:er to th~ huma the way it ~s sc~ up, flx~a mos~ any othe3 ani~a~. ~[r. B~O~A~. But it ~ irnpraetical to use horses. Dr. F~SV. ThaL ~ right. ~[r. B~ozzx~. Harder to Dr. F~s~. Very d~e~t. ~[r. B~thx. ~hab ~s a~ I have. Mr. S~m~. -~3' other questions ~ ~r. Xc~urdt ~ ~nor ~ the t~k force re~o~ narcotm~CS and ~g abuse~ coc~ ~nd this drug is )ncluded as • n~rcotic under )~ederal au~ other laws "but m~ke the ouiat~ is a powerful at~ulan~ ~d 4oe~ no~ crea~e toler~ce or physi~M ~ependence." I believe you wiH ~ that to be correct. Dr. Fm~sr. Thank you, sir. As I say, I may stand corrected on that becaus~ I w~ go~ t~ough my pharmoeolo~ ~ok in my rather than the exact details. x~.~ E~Aa~v. I wo~d liko to ask you. ono. other thing. ~ t~bou~ nickel carbony]~this is mI extremely po~verf~ toxic agent, is xt not? Dr. ~ST. Y~, sh'. Mr. ~OK~A~. I think many thnes mor~ powerful th~ carbon monoxide ~d ~as ve~, much tim sam~ affect on Lhe ~d ~tream. Dr. Fcnsv. ~ e~. I~ is one of the more toxic gase~ 3 es~ ~Ir. XC~HA~. It contMns an irritant tha~ ~eates ~ter absorp- tion. someflxin~ very similar to carbon monoxide, doesn't " D~. ~U~ST. ~es. ~* is actually a comlmtmd of ono nickel atom and four carbo~ monoxide malts. h~. Ecxx~um'r. S% when it attacks the human body it brct~ks down so to speak~ ~]~ releases ~his tremendo~s do~ of carbon monoxide~ plus th~ nickel irritation. Dr. Fu~sr. That ~ correet~ sir.
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I008 ~ [l'. ~:,'ml:l~Vm~.D. Are~ t]m,'c anN ,~ther que~tions~ ~f no~, doctor, ~ {hank x.,~ far coln]llg today and for the benefit of your/esfimo~y and y.~r D~'. 1' ~~~ .... Thank ~Y°u, Mr. Chairman. May I sx'.~ ,,m a citiz~n~ I bm'k t,, { ahiornn~ with much grea~r undemtandmg and respect uhat th,~ ,x, mmittec has in tim way of problems. I al~o h'~w been much nnl.,rc*, t,,1 by the penetrating" queshons asked me. ~ sometimes thought I ~,~ >fftin~ with ,~ kn'oup of my ~e]low ~cientists. Thank you, sir. Mr. ¢; ~n~,rn:).v. Thank y,u, sir. I am informed that ~r. Charles IIin,~ h,t~ lik.d ;~ ~tatcment with the committee. Dr. Hbm is a professor of ,,linb~d ldmrmta, do~• and preveittive medicine at the Medical ~t'] ~,}O] Of I]U} Univ,~rsit~ 6f Californi~ at San ~ranoia:o. If th,.re b~ no ,bjectmn this time we will accept i~ as ~ pa~ of the r~,.r~l tm,[ l,ht¢,~ it in the record. Ther~ is no objection and tt is so (Th,. ~;~t,:ment ¢,f Dr. ChaHes Ilinc follows :) I~0:Vt'~IV~ ~h:DIC~E I~" TI~ SCHOOL OF ~IEDICI~, U~qFERS~Y 0~' QU~ICATIONS ~[y na~ne ~ Dr. Charle~ I{ine. I am CHnical Professor ~f Pharmacology Pr~.~,.u~Ive M,~dlc]ae ]n t~e School of 5[ediclne, University o£ Ca]ifor~ San Fr~Hlci~.e,~ ~[~,~]Ical Center. I have been a ~ta~ momber a~ that institution r,.'-,vin,b In my ar,,a ~ 0£ :-;peci~dty, I am ]~oard-~ualified in Preventive Mediehie all,1 ToxI,,,d,,;;y. I ma the Prugr~ Director of a ~aining grant in Toxicology ,l.m~:ere,1 hy the ILK Public IIeal~ Service and have predoctorate and post- d,,,,l-orah~ Mu,lcnts under my direction. I teach in {he ~oola of Medicine, lqmtma,.y, and P.bIIc H,,alth In ad~flon, I am Consultant in the areas Db#trm~,.h:,gy, Tuxlculozy, Occupational Mediehte and ~vironmental Heal~ t,, . number .f Industrial concerns and to several S~te and ~ederal agencies. I h,tve puhlI~lwd .x er 150 papers Jn ,the fields of pharmacology, toxicology and (nn-lrolm(m~l health, ~{nd have been a member of ~e various scien~flc s~eties #~F~tllIzrd for the pr,.,motlon ef ~cientIfic endcavozz in the fields of pharmacolo~-, b,xh,,d.gy ;tad environmental health. I am a ~ellow of ~e American .~cademy nf th:,'npati,mal Medicine an~ of the Indnst~al Medical Association, as well h,*l,llng mumber~hip in 1~ other scientific and professional societies, and am (',:m.nlh~u~ ~,, Ihe California State Department of Pubic ~ealth in ~e area ,*[ T,,xlv,,Io#~y. 1 am a foraler member of the Natlonal Research Count's Corn- ILK l'nhli~" Health Service Pnbllcatlon No. 1103 entitled "Smoking and IL'Mth" ~whteh i~ a report of the Advlgm~, Co~ittee to the Surgeon General ,,f the I'~d,ll. H,~alth Service) In it~ 387 pages ha~ devoted 1.5 pages to the p,~.~41de ben,,lMal clfec[~ of tob:leeo. Au comprehensive as this study was p.rh.,l h, h., ubviuu.ly very little effort was spent ~ re~arch~g the beneficial ,,lfv,'tu .f tobacm~, although ~ete are a number of references in the ~terature ~ bl,'h d,:~crlt.- tlwv,~,. The obvious beneficial effec~ listed thcre~ are the matnte- II;Hwe ~,f hlt¢~thlal tone and the anti-obesity properties restfl~ng farm ~e r~uc- ll,m nf app~tltv. ~he monograph suggested that it was not ~n easy matter to r,,w'h a ~Iml,le and reasonable conclusion concerning the mental heal~ aspects ,,f ~ ~u,d;h,~ ~Inee thence p~rportc~ benefits were reputed to b~ tn~n~ble, illusive, ,~.otrov,,r~i.1 In nature, and ~:, difficult to evMuate medically that ~ew scientific ~r, mps htol aItemi,t,~d to study the subject. Admittedly ~here was no answer" as to ~he meth,~d of vatl~fyl~g the psychological ne~s of 70 million Americans u.re Ihey ~m,ldenl}- to be deprived of their access to tobacco. It w~ p~dicted, lU,,te.v,,r, that m~m ~uld continue ta utilize pharmacologic aids in a search i,,r ,,ontentm,~nt, hut that in the bes~ interests of public health these should be 1009 accomplished with substances which eam:y ~inimal hazard to the individual and to soclety as a whole. In sum~ry, then, tim Committee concluded that medical per~pectiw re,luirca recogni~on of the si~ifieant b~efidal effect~ of smoking, primarily in the area of mental health, but ~at benefits ~vere mea.surable ~ terms of individual harlot, and ~at since there ~ no means of qu mtltating these benefits, it was not l~saible to Judge ~em in terms of the po~ibh~ hazards of sm,~klng as they al,ply to the general poputation. While a scientific eommittea may not be re,lulled to evaluate, weigh and judge beriberi versus ~ssibl~, non.beneficial effeeb~, It does behoove those who are considering res~ietive legi~latl.n to evaluate matters full. ~O~-.%DDICTI~ E~FEOT o~ Benefi~ ~om smoking ~eur prin~pally In the areas of mental health. habit i~elf originates ~rgely in the search for contentment. A ra~id tolerance develops to smoMng so that those acute effect~ of tobacco smoklng (as seen in the novice) which are due ~ost en~reLv to nicotine content, are transitory, alarming, and not seen in the habitual u~er of tobacco. Habituation may oc~ur with smok~g, but not addiction. Physical dependence does n~t develop either to nicotine or other cons~tUent~:~ of tobacco. F~ther, there is no withdrawal ~ymptom following the ces:mtlon of smoking wMch leads to anti-serial behavior, Many heavy smoker~ who stooling abruptly may retain ~e desire to smoke, bug de* not cxporienc,~ nificaut signs or symptoms ~ting towards physical dependence. ~HARSIACOL0~IC ~CT~I FROM All of the ~harm~cologIe effects from smoking are due to the absorption of the active alk~oid, nico~n~ Smoking in normal people does not lead to nervou;, dis- tnrbances; on the contrary, it acts as a sedative and ~anquilizing agent. It is difficult to categorize or explain all of the actions by which smokin~ give:i rise to contentment, safisfaetion, ~d pasltive pleasures. Contributing to thence may be the rihml associatefi with smoking ~d the element ef rhythm which plays its pa~t. It is reeog~zed ~hat many people operate in rhythmic movement which facilitates thought an4 ~ves sa~sfaetlon Sigh~ and smell are ale~,:, ]}ox'~ant factors; the fragrant taste aml smell of got~d tobacco are stimulating. and the amuunt of nicotine is not the deh~rmining factor of this pleasur,:'. ~m total plcas~e depca~ on the reflex st~ularioa of the touch,us membranes of the nose and throat, the rhythmic complexe~ in which people engage, anal the tranquilizing and stimnlating effec~ of the active alkaloid, ~icotine. Supar~en~i[Ive [~eOlfie become ca~ and lo~e their irrltabili~y, and the ,lull and apathetic are ~timulated hy smoking. Through the psy,.h~,logica[ e~ idenee clearly point~ to ouch . [,n~itive effect, the physiological explanati,m is yet to be f,~rtheoming. In the dull nnd ~tless, the sl3mula~on of thought pr,-,ducefi hy ~moldng ia clearly bene- ficial. Smokers t~~ ~ico:lne to c~mbat hunger, thirst, rain, heat, cold, irrihtti~n, ~ud lone~ess. If thi~ adds to the agreeableness of life, such a fact sh,mld eoasldered in any evaluation of smoking and health. PEES0~Y OF Ana]ys~ of the personality of ~mo]:er3 by Eysenck led t~ th~ conclu~doa tha~ smokers are generally ex~over~ and live accelerated ]Jve~. Mack~n~Ae noted smoking pro~des a sense of relaxation ta leisure hours anti hclp~ a pera~,n Is engage~ in in[ellectua[ work concentrate when he is working. Yame2 and Rosen- thai state ~at smoker~ cho~e to ~mol{e t~,baeco produc~s because of the pleasant aromas and ~ensations produced by the ~moke, as well as the p~ychologlcal and emotlonal factor~ ~ raring ~portance ~o the indi~dual. .ks smok~g frequently decreases the appetite, i~ exerts a positive f.ree weigh~ teductkm. It is a (~mmon e~pe~ieacc In persona who have stopped i.g 1o g~n welgh~ rapidly, sometimes to undesirable levels. A study by Brozek and Keses reeealed a statistically significant increase in body weigh~ in men 2l]-23~69--pt. ~9
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1011 1010 who volUlHarily ,~topl~+~d ,~tuoking el~arcttes and ca whom weight data were avail- abh, fro' two ~eurs la'lnr and t~¢~ ~ear~ a~ter the year in :,'moklIl~. ~XlV~rlmeatal observatJo~ on ~he inhibition of gas~.i~ hun~r con- {rav[halt~ by ~k]n~ und the accompanyln~ increase o~ tobacco consumption among h~dlvidual~ who nmintntned a r~ducvd caloric ~take suggests that stuck- InS i,,nd:~ to ,k-~prc~s the p,~yehh' need for food. The increased level o~ bloo~ sugar wbb,h Iollowa smoking may al~o d~crease the appetite. All of these factors op- cran~ In a p,;,:,itive direction to nmintain a m~re 0grimm body weight in indlvldu~ll~i in who~ Increase4 body weigh~ Is detrimental to the general health. Anal~M~ of city, arctic tobacco ha~ not revgalad tim pre~one~ o~ any eareinog~n~. l,:quivoral flndi~g~ have resulted ~rom the study of th~ possible earOnog~nic prop~,vti~ of tar~ obtained ~'om tobacco sraoke t~mdensate. Occasionally poly- cyclic hydrocarbont~, which in tlmir pure form can be demons~ated in lahorato~ tt[lIl~l~(]~ to lm.loce cancer, ca~ be identified in these tara. Thls is not surlwiaing, how,.rer, ;dace these n-mtvrials can be produced by combustion of as simple a ,~ll}.v:;Iaiw¢* a~; ~ucthane ga~', are found h~ the smoke of barbecues, and are adherent h~ fact there has been llOt~l OU]y a weak en~arelnoge~fi¢ effect ~ mice which hml la'(,vh~u~;]y been p~tinh~d with tim highly carch)ogentc martial, 3,-t-benzypy- rose. The,~t~ rc~orts (,onflrnmd the findings of Pas~ey In Great Britain. W~dee bnmd a marhcd difference in tl~e percentage of animal~ affected by experlmootal Amvrh'aiI mumffoetnre, It is pott~ibl~ to 9roduc8 cancer of the skin ~ Some ant- are ~normouu and not comparable to whale smoke. The ~cnlonl~e~ of animals to ~moke and its components do no~ vat5" as a ~un~- [loll ~:~f the do:-,~. Th~ qualitative Identification of a im~leular agent iu a ¢ompl~ lnlxtnr~, dm,~- no~ me:in that it is ])r~sent ~ su~elent quantities to prodn~e a bhd.gl~ud effect; neither does the effect in a particular species mean that it may ,..+cur elth,+r quantl~l.i~ely or qualitatively tu man. t*IIII~$1,]IN frnm other :;ources such as those occurring hi the general atmosphere. i,~xporlmvntal evidence for thls bypothe~:ls is lacking. Britl¢fl~ Invoqttgator~ have been es~eially unsuccessful in their attempts to pr,.luce ~-:kin tumors tn animals when tars ~rom cigarettes ~rom British were alqflled ow,r long periods of time. Steiner and Folk have reviewed the litera- t~Ir~ ,-on~,~Tn]ng data elleitt~ from exporimentg Involving rations c~mbinationg ,~f ch[qalcal earelnoge~s, tumor-producing viruses, radiant Ollol'gy and tramna. ~oate og the;~,, exlmrlamnt~s showed summation of effects, others did not, anti a third group ~-howed inbibltioo. ~imultaneous administration of two potent e;trchmgen:~, when inje~ed together, sometimes were inhibitory. These equivocal t,~.cl,+ ~t~,~v~,t fl,v ~lc~drability o~ reviewing the problem of anficarelnogeneMz and compound~+ tested in combination. lnhiblti,m ,,f th~ action of ~,tont carcinogens has been r~port~ hy a number of uwt,?~ttgM,~r:~. Retardation of the rate of tumor induction has resulted following apldleatlou of non-carcinogenic .agents, c~oely related eom~ds and agen~ found hi tobacco :~moke. ~alk ha8 demonstrated the hflflhltloa of earclnogenic at:fixity by adminb~h'ation of c~de sam~les of cigarette smoke extracts. It apl,~treat from lhe experimental work o£ many iav~tigators that the orcinogcnic potml,~y o£ crude mlxtur,~s Is le~s than the s~ total of antidpat~ carcinogens; anlb.ar,,lll,,golllClty a~ well as co-earchmgenieity inust be r~-ognized as an ubiq- illtilll~ plliqiCililOllon. Inhibition ~)f exl~erimen~al careinogenieity is >relnted to a lilllOlu~ lif fllt<lor~, tm.ludln~ the vehicle used. the ratio of the anttcarclnog~ the varelno~on, tim rt,lallvo structural relationship v£ these two substances, and t]te Ilaw Of administration. The above it{ cited to empbasiza ill,it tlmugh eareinogenic substances may be Idelltlllt, d ht Iolmceo ,~:moko and tar.~, the presence of other constituents of tars muy them.-el yes I,e vtron~qy inhibitory of damaglnff or toxic effect. Sh~otine has been indicated a~ the mo~t important con~Aituen~ of tobaec,). The dryer the tobacco, the greater destruction of nicotine during the smoking proceu(~. The smaller the moist are~ behind the I:oint of combustiou, which mcan~ the cooler the smoke or the more complete th~ combus;thm, tho le~:~ likely It L~ that the smoke which is ~haled wilt contain nicotine. The condition of tht~ and ~e £o~ In which i~is smoked are more important factors in determining tim amount of nieo~ne ~ ~e smoke than the amount of ~cotlne pre~cnt tn the originat ~bacco. Nicotine can be removed from tobacco by solvent extraction or oflmr de-nieotinizing processes. Hang showed that ~0% less nicotine wa~ found ia the ~moko of low-nicotine ctTarettos, but ~at cigarettes made ft'o~_~ such tobacco a~e likely to tran~er a greater amount of the a~alold than rcg~lhtr cigarettes; in ad~tion, ~or-nicotine is present. By de.easing the amo~lat nicotine in ciga~tte~, • measueable pharmacologic effect such au that on blood pressure can also be reduced, bu~ the amount of nicotine available sufficient to exert a positive and measurable effect. Compounds which are ~tended ~or internal use and which are to be u~wd ill persons should eonta~ a complete description of l~osslhle adverse The ~ou~ehold Labeling .ket exempts substances which are n*~t injurious unlo~q a~sorbed ia excessive amounts. Alcoho~e beverages, cocoa, tea and ct, ff(,o do not require warning ~tatemea~; all of these materials contain active and exce~ive use o£ any of these substant~s can give rlso to disturbance:, may lead to coma and de~th. The potency of an alcoholic beveroge a~, eXlWe~,sed ~mmal body physiolo~ and biochemistry of varying degrees of severity. Some In terms of its alcoholic contea~ is a s~ught-after factor since such bevet'age~ are consume4 9t~n~pally for the d~g effect produced by the alcohol they con. ha~. The theory of the labelinff of alcoholic beverages, however, is not derlvetl from warning of i~s Dotency. Similarly, other stimulatory sub;~tano,r, de* not require a statement of the 9ereeatage of the active ingre~ent present. It is my opinion ~at labellng of ~garet.tes as ~o the content of nlcntlno tars does not serve a useful purpose. I/}; relevancy to health la qu¢,atbmalde, any event. ~urthermore. the center a~d the absorption of ntcotln~ m~ abo~vn by ~ smoking ma~lne is only rote of the factors which determine ~e amonnt of nicene absorbed and the forma~on of "t~" in a laboratory smoking machine is completely u~elat~ to lndtvidu~ ~o~ng patterns. ~0~0L~BI0~ Ther~ is a necessity for aa unbiased evaluation of the effects of smoking. The majority of the ~ubR¢~tlons on smoking and health have failed in6iea~o ~e extent to which smok~ la benefle~L There Is no question but that a ~eat deal of pleas~e, and certainly much ~anquiltty, ]s obtalnt~ from the smoMng of tobacco. It has not been established that the tar ann nicotine yiola of cigarettes ~elatea to human healS. No safe level has oven been claimed to h8 e~tablt~:lted by those who say there is a relatio~hip. There L~ clearly no proof flint a label show~g the quantt~ of tar and nicotine,, as determined arbttrarl~ by a doyle% would have any relevan~ in terms of human t:moking. It enuld be leading to require such a label. THE PR0~SSIO~AL QUALIFICATIONS 0~ C. II. ~I~E, ~LD., FILD, ~dueatlon .eL ~orbert College, ChemL~try, B.X~1937 University o~ Wisconsin, Graduate School ~hemistry, Unlversll:y o~ ~Vizconn~, Graduate ~chool, Pharmacology and Toxicology. Universlty of Wisconsin, Medical School, ~edlcine, Inee~ship (Rotates) U.S. Navy, San Diego Naval Hosldt~H, ~e~idoncy ~edicine, U.8.
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1012 Wi:~coa~ta Alumni Rezeareh Fellow--1938-42 I~t, ad o£ Toxlcolo~ ~etlvlty, ~aflonal Naval ~eseare~ Chief Toxic.legist and ~e~ln~ Hoe0 of Radlologieal ~onso Laboratory, U.S. Naval ~pyar~% San ~uasco--194T ~'ch~ol o~ Medtc~o, U~verM~ of Ca~fo~a, San Francisco ~edlcal Center; L~turer in Pha~acolo~--l~7~ AfJr~i:-~mt Pro~ez~or o~ Phar~colo~--I~52 A~;~:ociatc Cl~ieal Professor of Pha~a~lo~ and Toxieology--1952~ ~z~;oeIato Clinical Profczzor of Preventive (OceupatlonM) Medicin~ ~957-6.1 CHnieaI Professor of Preventive (Occupational) ~[e~eine and UnIvcrM~ of Caltforn~, School of Public Health A~tant Profc~or--191~52 ~oeiate CH~cal P~ofeszor--195~62 Lecture~--l~-prez~t Indue;tHai Hygiene (To~leole~)--1962 ~¢teventive (Oeeutatlonal) ~iediefn~lP~6 Military service U.8. NaW Medial Co~: Ll~mtenane (~.g.) ~i~5 Lieut~:nan~ Mcm~cr~h~ ~ pro]es'siona~ Amcrlcan Academy of Poren~ie Science (Fellow 19~7) --1950 American &cademy of Occupational Medicine (Fellow 1~0)~1957 Am,,rlean Chemical Soelety~19~0 AmtTlc~m Board of Indust~at ~ygl~l~2 ~rlca~ Board of Preventive ~ie~1956 ~erl~n Ind~trlal Hygiene A~oeiation--l~9 American ~ledlcal Association~1946 American Public Health ~;~oeiatloa~lO~ American Society for Pharmacolo~ and Experlmen~l Therapeutie~l~ ~crican Therapeutic ~al~ornla Academy of Pre~enfi~,e Medicinal957 Callh~rnia Medical As'sociatton~l~t8 Colh, ge of Preventive lnd~lztrt~d Medi<~l Association (~ellow Internati~mal A~oclatlon of ~orvnsic Toxicologk~ts--1963 ~lcdlcal Advisory Committee of the American ~e~oleum Instit~t~1952 ~an leg~ncJv, co County Medical l-~tiel*,ty for E~erlmental Biology and 5Iedtein~l~7 ~~tc~ o~ Toxlealogy (~k, unding W*:*:~t,:.rn Iwlustrlal Medical Assoclaelon (Cer~ed)--lP~2 Independ~nt Mc~tcal Examiner for State of Callable Workmon's Compen- ~;aflon Appeals Board I'racticlng Phy~Iclan, licensed I~4, USN ; 1~6, State of CaHfo~la l'rv;~Idtmt, The Hine LaboratoHeu, Incorporated ~*oxleedo~l:~ to ~o Coroner, City and Co~ of Sau Franei~o Ctm~ultan~ In Occupational Health and Toxicolo~ Con~ultan~ to Ca~o~ia State Department of Public ~ealth in Toxicology Certified by the American Board of Preventive Medi~e in the field OccuI~atlonal ~Icdiciae (Foundeffs Group)~1956 l,~evatcd to FcUow in the American College at ~venfive Me~dn~1956 Eb~vatcd to Fellow In the American Academy o~ Occupational hIedtcta~1960 Elevatt, d ~o Fellow ia the Industrial ~Iedical ~$odation~1958 I$oux~l o~ Industrial Hygiene, certified in Toxicolo~--1962 1013 Reeiplent of the St. ~orl~ert alma mater award given to outatandlng gradu- ate~ for succes.~ lrt 0rofessmnal aOm~emcnt~. ~t~t,I Cla~,t~an ~t~m~--l~61 Founded member o£ ~e So~ety of Toxicology~lPl~0 I. So~ obscm'ations on the determination of ~oap In refined ell (~'Ith H. Schueltte). OiI and ~ap 16: 13, 1939 2. Study of tim cumulative eff~t of ~ioharblturic acid dertvath'e~ (with F. L. Ko~Ika). J. PharmacoL Exper. Thcrap. 6G: 20, ~P39 3. ,k method for the qx~antitative determination of dilantin in biological mtdorlal (with F. L. Kozelak). ~. PhamacoL Exper. The~ap. 69:290, 1910, 4. Dis~bution, rate of disappearance, ~i:ud excretiim of Dilantin (with F. L. Kozelka). ft. ~harmaeol. ~per. ~er;tp. 69: 292, 1940 5. Stu~es on the metabolim of ~phcnyHtydantotn (with ~. L. Kozelka}, J. Pharmacol. Exit. Therap. 72: 20,1~41 6, & method for ~o determination of fifi-Otphenylhydantoin ia biological terial (wi~ F. L. Kozelka). Y. Pharmaeol. Exper. 2herap. ~2: ~, ~. Distribution and rate of metabolism of 5,5-dtDhenylhydantoin (~th ~, Koze~a }. ft. ~h~macol. Exper. ~erap. 7~: ~0, 1941 S. ~le~od for de~em~a~on of ethyl al,:ohol for medtcolegal purvo::'.et:~ (with F. ~ Kozelka). Indust. Eng. Chem., ~ml. Ed. lZ: 90fi, 1941 9. Metabolism of some derivatives of Dilantin (with ~. H. IIolmnn aml F. Kozelka). Fed. ~roc. 1; ~53, 20. Anticonvu]sant proDerties of the metabolic product~ and ~ome d~rivariven tff Dilantin (wi~ ~. L. Kozclka and M. F. Brelbor). Fed. PreC. 1: 156, ~952 11. Degredatioa produc~ of Dllantin (with F L. Kozel~a). if. Exper. Thorap. 77: X75, 1~. Metabolisat of hydanto~ derivatives closely related to Dilantin (with F. Kozelka). Z. ~harmaeol. Expcr. Therap. 77: ]80,1943 13. The e~ect of peritoneal irrlga~on oil methyl alcohol toxicity (with W. Blakemoro). Fed. Prec. 2: 310,1947 14. An accurate calorimetric method ~or the determina~on o£ methanol ia bloo~ (~eh % E. Shea, fir. ~d W. R. Al~dorf). Fed. ~r~. 1: 338, ~947 15. Resplrato~ excretion of methyl alcohol by white rat~ (with T. B. ~hea Fed. ~roe, 1: 8~1~ 16. I~uence of ~me analegtt~ of obstetrical ~portnnce upon respira~on uf ma~re human #acea~x ~ v/fro ( H. P. f/ames and E. W. Page). Fed. Prec. 7,1948 17. The toxicity o£ polyallyt alcohol (~. R. W. Barne~0. Fed. Prec. 7. 1~. ~he eff~ts ~£ 2,~ni~op~enol and ~aiouraeil on ehrou~c meth~mol ~ng (wl~ T. N. Burbridge). Fed. Prec. % 194~ ~9. Tim comparative activity o~ some a-substituted glycerol an~ #yeIdyt (with H. E. Christenzen). Fed. Prec. 7,1948 20. Comparative toxhel~es o£ fire subzHtuted glycerol ethers (wlth P. C. ~eb) Fed. Prec. 8,1949 21. Comparative musele-relaxiug activity o£ seven glycerol ethet'z o~ i~olatcd nerve-mus~e prept~ratl0rL~ (wtth H. Davis ~nd F. J. ~urphy). Fed. 8, ~949 22. Un~ver~i~ instruction in toxicology. ~. Assoc. Am. ~Ied. Col. March, 1919 23. A modified ultraviole~ spectrophotome~lc metho~ for quantitative de~er~l- ~mtion of barbiturates (wi~ T. C. Gould). J. Lab. CIim ~Ied. 3~: 1~49 24. ~hv comparative mu~cl~paralyzing activity of some ~ubsfituted glycerol e~ers (wl~ H. E. CbEstensen, F. J. Murphy, nnd H. Davis). J. Pharmacol. E~r. ~erap. 97: ~4, ~949 25. An analysis o£ ~e comp~a~ve to~c~e~ o£ related allyl nnd acrylic com- pounds (w~ H. C. MeDanle~ and H. H. Ander~on). See. Pharmactd. Exl~cr. Therap., April, 1950 26. Pha~acolo~ and toxicolo~ o£ ~:ome imgortant economic 9oh;ou~, Adv. Chem. S~. No. 1 : ~9, 27. Some ob~erva~on~ on the effects of smatl do~e~ o~ alcohol In [,atlent~ r~ ceiling tetraethylthiuramdisulphide (Antabu~e) (wit~ H. H. E. A. Maeklln, A. Simon, T. N. Burbrid~e, m~d K. M. Bowmnn). J. Plmrmacol. Ex~r. Therap. 38 (1), 19~0.
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1014 ~lnl and 3-ethnxT-1-i~npropr, xypropan-2-fliol (with H. Davin, F..T. MurphyL ft. Pharmaco]. Exit. Therap. 98(1 ). 19~0 fl~lid~ (with T. N. Dnrbridgo. K. P. Bo~mmn. A. Simon, E. Maoldin, anti A. ~,-hiek). J. Pharma¢~l. Exper. Therap. f18 ~1 ). Iwith H, Davi~ and F. Z. MurphyL Arch. int. Pharmaeodya. 8~: ~Ofl. 1~0 :dml4e ~pee~rophotometric metlmfl f~r determining of te~ra-ethyl thiuram- Mint,h, npeetruphntnnmtrie moCb~d for t~e deterro~ntion of aeet~]dehyd~ iu biota1 (with T. N. Bnfl~ridgo and A. F. ~chick). ft. Lab. Clln. Med. Comp;,rtlvo toxicity of fi~'a glycerol ethers (x~th P. Loeb and H, H. Antler- ~[m ). Arch. ]~dast. ~yg. Oemao. Med. 2: 574. To~lcM,-,gy o]~aeatlon in the accredited colleges of pharmacy of the United Stah~s twlth B. Rice). Pharm. Admin. 15: 41. Indn~tri:tl hyghmo and toxieolo~ (with L. Lewis). Encyclopedia of Chemi- t~ll Tc~,hnokt~y. 7: ~7. The, 4n *qtro meMbe~lism of ethanol by rat tissue slices (wi~ T. N. Rm'brldze. H. W. Elliott and V. ~. Sutherland). ft. PharmaeoL Exper. Therap. (1), 1951 Prt,wmtton of i~lrv fr.rn x.radlation (with F. R. Holden, E. Tochilin. and l,. Lewlt;}, Calif. Med. 74:1S~. C]l~h.al ,vahmtinn of tota~ethylthinrnmdi~lfid~ in tho tr~¢m-nt of drinker~ {wlth K. ,3£ Bo~an, A. Simon. E. A. Maeklin. O. ~. Crook. T. Bnrl,rhlge, und K. IIanron). Am. Z. P~vehiat. 107:&~2. 1951 Di~trllmtion ~gur~,~ on blond and brain alenhol taken from postmortem :q~e~.lmenr. Proo. &earl. Y,3rens~e ~el. 1: ] 61.1fl51 The toxle, dogF of ~oroo of the important economic poisons. The Vortex I3: Toxle.la~.qo studio~ on srnfltotle glycerol (with H. ~. Anderson and Mtlv~'lq. J. PhnvmnooL Expev. Tbera0. lO,~ 14). in the rat {with T. N. Bnrbridge}. J. Phatmmeol. Exp~r. Thorap. 1951 Rmm,l-hible dh~t.nsdnn on "The toxlenlo~ut'~ mmroaeh to the analy~t~ of a gtmt,ral unlm.wn." Prne. Am. Aead. ForPnrh, ~oi. [:273. 1931 ~tllllO wq~eet~ .f the hllm*ln pharmaeolozy nf ~otraethvlthluramflisulflfle(au- tqb~e)-alcohol re:wtiom~ fwlth T. N, Bm'bridg~. E, A. Maeklin. anti A. T.xlr'ity in rntlenf~ am1 nntlobol/l/o~tarn¢o aelivitr of organn-nhosnhm'na ,'nnlTtn~lld~ (with ~. ~. Shaeh. 3. K. Kodama, and M. S. Mar,e), Fed. C.nver:4,m nf ethanol to aoetahlohvdo In ,'th'o fwith T. N. Bnrbrldg~ and (wlth P. P. ~Jg¢~t fllld E. l,eon~ IV:ly). Aria l~harnlneol, et toxleM. 8: 290. lnothylnho}mxy) twopane.l. 2-diol (3Iy:~no~fn) {with IT. T)avi~. Noal, H. E. Ohri:dvn~en. nnd F. ~. 31urphy.) Arch int. I'hnrmaeotXvn. 143. 1952 ~hnnlo meth~td for th~• dotormlnatirm of tetrfloth~lfhiur~mdi~ulfi~e ~unn ~with K. ft. Divz~tla, aml T. ~. ~urbrldgol..L Lab. Cliu. Med. 1 fG 2 ~vhi~k, L. MareolN. T. N. Burbridgo. and A. Simon). ft. Phaxanacol. ~Wl~m'. The~alt. lOa: 2~. 1952 nmm~ry Jrrltnnt [CBP-35) (wt~h U. E. Peters. R. ~'ugamo. and 3. Hmhnna) 3. Pl~:trmaeoL Expr,r. Therap. I06 i 4). 1015 ~'¢~. T0.Xleology and safe hamlling ,)f CBP-~7, ITetqmie-'d ]-ehloro-R-hrnmo.pr.- N. W. ~acob~vn ). ~'eh. Indust. Hyg. Oecnlu .Mod. 7: llS, 1953 ~4. Auute toxicity og :i-mvthyl-5-hoptanone (with M. S. M~ r~e, J. K. Kodama and M. K. Dunlap}. Fed. I~'oc. 12 ( 1 ). 55. Comparative toxicity of two vlnyl-substituted nlkyl phov:phate;~ {with J. Kodama and~l. S. Morse). Foal. Prec. 12 (1), 1953 56. Comparative to~ei~ of synthetic and natnral gl3"eerin (with II. ~. Amh,r son, H. D, Moon, M. K. Dunlap, and M. S. M,rae). Arch. Imlu~L IIy1~ (.)ceup. Med. 7: ~$2, 1958 57. ~o~eol0gical appraisal of laboratory chemicals and i,ersonuel. Prr*e~ Industry Regional Safety Conference (Berkcley~ May, 1953 3S. Stndles on the toxicity of two alkyl a~l stflfotmtes (witlt H. H. Ander.:nn, L Finley. and ft. G. Moore). $. Am. Pharm. Assov.., Sol. Ed~ ~2: 4~fL 59. Emergency treatment uf poi~ouh~g. Bull. Am. St, e. tIosp. Pharm..Tnly-.kng, : 270. ] 953 60. ChoHnestcra~-inhibitlng properties of two vinyl.~ubstituted plm~:vhafv,,,~ ~with 3I .S. Murse and 5. K. Kodama). I'roe. See. Expor, BtoL Mt, d. 7~5,1953 61. The toxicity of g-chloronllyl nhmhol, and eomparts~m with allyl aleoh.I, tt- chloroa~yl alcohol, nnd CBP-55 {wllh J. K. Kodama and II. H. Ander:..,n 3. Pharmacol. Expor. Therap. 110 (1). 1954 @Z Tnxtcity studies on diglycidyl other (with .L K. CHtchlow and ft, K. .Z Pharmaeol. Expor, Therap. 1 I0 ( 1 }, ~. Comparative to,city of two vlnyl-~ubstituted plm:~phate3 (with ft. Kodama. M. S, Morse, H. H. Anderson, M. K. Dunlap). Arch. IIyg. O¢'eup. 3Ied. 9: 45, g~. Acute toxicity of four eI~xy emnlmunds in r~dent~ (xvllh ,1. K. Kodamu H. $ang.) Fed. Prec. 18 (1), G~. Some effects of ethanol ca the metabolism og cerebral vortex b; vitro (with V. { '. gutherhmd). Fed. Pre,.. ld ~ 1 ), 611. Safe hamlling proeedures for ~.mnpmmd~ develo~t~ by tile industry ~with ~. ~. Jacol~sen). Anh Intlust. Hyg. A. 0hart. 1,7: 141. BT. Toxicolo~eal ~tudies on ~-tertiary-hutylttduene (with IL Ihtszttl'. H. Ander~on, ft. K. Kodama, ~. K. Crltt.hlow, and N. W..lavub:~on). Induct. Hyg. Ore'eL, 3led, 9:22T. 1954 I~q. & radial method fur the estimatinn nf morphine ~with $. 3I. FuJimoto nml L. Way). Z. L~tb. Clin. Med. ~: 62~. 1954 (;~. S~udie~ on tim aeuroto~h* a~d chollnestera~.inhlblti~g t,ffeet~ of organo-phosphorus eomlmUnd~ (with E. ~ Guterber~, M. 31. t~tmt'~,y, Se]lgman a~d R. 3L Grns~). if, PharmmmL Ex~er. Therap. ~t3{1], 70. Method $~r ~hnultaneous determination ¢,f phermbarhit~l mtd dlpht,ltyl hyda n rein in blood ~ witll G. L. Plaa ). Fed Prec. 1 ~t 1}, ~ ~l. 3I~tnbolle studies of a]lyl alcohol. I, Effect on ,xyge~t uptake of sliee.~ (with J. K. Kodoma nnd V. C, ~t~therland}. Fed. Prot-. 1.~{1 }. 72. Toxicity of allyl :alcohol (~ith 3L K. Dmdap). ~'etl. Prec. l~{1}. 73. Effect o~ acetaldehyde on etlmnol uptake by cerehr~tl cortex in ~-i~to x-. C. Sn~herhmd). Fed. Proe. 15 (a), 74. Inhibition of rat cholinestera:~e by ~ome ~nlyl pho~plutte~ (with M. Cour~ey nnd L. G. Rice), Fed. Prec. I~ { 1 ), 1955 75. Ceutral nervons systwn effeet~ of certain aronmHe hydr~umrbon~4 Cwlth N. Malmnud. B. Garoutte, and D. W. Furnas). Fed. Prec. /~(1). 1955 70..~ ¢,linical evflltmtlon of tetrt~ethy]thiurnntdtsullflflde (Attttthuue} In treatment of Droblem drlnt:e~ (with K. M. lCDW]lltlll, .k. ~lllltm, E, 31a(.klilh O. H. Crook. T. N. Burbrhlgo ~tml K. Hanson). 3[am,gemtmt of Addictions ~ed. 15. I'othdsky MD) Phlh~sophlcal Library, N~w Y~n,l~. 77. ~europathtdo~ of rats exDerime~tally lmlsont~d with l~-terthtvy-lnllyl- toluen~ (with H. Ungar. ~. I~ Kodarn:t, aud II. H. Ander;~:on). Aruh. Path. 60: 189, ]955. 78. Toxicity of organoldio~phoru~ eonipollntl~ I SLrnoh~r~-~tetinn rolati,m~:hlp., in animals and i~xaJ~ (with d. K. Kndama, H. H. ~n¢]01';J011, ttllti At, DunlaD). Arch. lnflns~ ~yg. fweu~. Meal. 1 I: 4S~, 79. The neurntoxlelty and antieholinesteras~ prol~ertles 0f some phonyl phesphates {with ~L K. Dunlap, b]. ~. Rtee, ~I. M. t',-,m'~;ey, R. M. Oro~, and ~. H. Ander~on). ~. Pharnmeol. Exper, Theri~p. 11~: 227, 1956
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1016 ,'~0, ~[~h';duuth~n of procedure.,j u~ed in determining the cau~e of m~exDla]ued vb.dt,ut d,~ath: l toxicologic approach (with F. Hall, H. Turkel, m~d H. D. ~h,.ll). J. For,nsic Set April :tll, 195~ ,Sl. The effect of ethanol on cerebral cortex metabolism in ~itro (will ~'. C. ~u/lo,rlund aml T, N. Burbridge). J. PharmacoL Exper, Therap. I16: 469, s2 A me$1md for the simulbineou~ determin;~tion of phenobarbital and diphearl- hydaut,iu ~ bloom ~Wlth G 1, Pla'~) J l,'~b CHn 3I~t ~7. " ~3 '[,xl, lt~ .f 1,2 dlbromo 3 ~_hlornpzo~anc (J. K. Kodanm and ~£.~. 649, 1956 Dtmlap}. ~1, lfl,..,l leveb~ ~ff bydaut~ln~ and phenobarbi~fl (wi~ G. ~. Plan). Fed. Prec. ~ h~_, toxicology o~ glye~d~l and ~ome glacidyl ethers (wi~ 3. K. Kodama. Wtlll~gton, ~l. K. Dunlap, anal H. H. ~derson). Arch. Indust. ~ealth, 1~: 2~0, 1950 ~:~(. Ope~ing Addre~;~, Proe. First N. Calif. Air Pollution Syrup,, 7 Sept. 1958, p. 1 ~7. ,~dnt Ib:'p~rfi .f tile P:tne~ on t~e tra/n~g 02 ~ysk, ians £or Enflus~ry at ur, lcrgn~duat,~ lew~l (member P~mel A}, D. W. Clark repor~ng. J. ~ed. Ed~c..?I: 47, 195~ ~ ~h't~,l Yet }~ler~de[ermi~atlon of allyl alcohol and est~ation of clrcnlat- tag b~,,~4 lew,l~ in the rat (with $. K, Kodama and A. J. Valerga) Fed. Pr.r,. 16(1), 1957 ,~:~. Cm~qs~.raHv¢~ hepatotoxicity of ~cve~ halogena{~ hydrocarbons (wl~ G. L. Plan and E. A. Evans0. Fed. Prec. 16(1 }, 1957 }~. D~hibltbm of rat eholinc~:~tcra#:ea by ~itolyl phosphates (~ M. bL Conrsey an4 M, I~. Dunlap). Prec. ~oc. ExTer. Biol. bled. 86: 6~3, 1957 t~l. Dlff~,r~ritlation of barbiturates for clinical and medicolegal purposes ~2. The oaeogenie activity of two representative epo~ rests (wi~ R. J. Guzmun, M, ~I. Cour~ey, J. S. Wellington, and H. H. Anderson). Cancer ~3, Th~ t,,xicolog~ of eI~o~ resins (with J. K. Kodnma, J. S. We~g~on, D. W. ~ho,:~n~,~, and H. ~ Anderson). ~ch. ~dust. Health 17: 129, 1958 0£ Toxicological cvaluution of epoxy rosin~ (wi~ H. H. Ander~n and R. Le~go}. Int. Cor~. Oecup. Health, ~el~lnkL 3: 268,1959 05~. ~ff~:ct ~f carb~u tetrachlorlde on pertain-liver ~ction (with G. L. Fed Pr,~ 17: 403, ~"}, Ncur,tuxtclty ~-~f somo ~elected hy~ocarbons (with D. W. ~rnas). Arch. Indu~L ~ealth 1,~: 9, 19~8 t~7. R~q;fflVe h,:'pab*toxicity of ~e, ven hal~genate~ hydrocarbons (with G. I'la;t and E. A. Evans). J. Pha~acol, Exper. Therap. 1~: 22~, }~S. Tonieily of nllyl alcohol {wt~h ~. K. Dunlup and $. K. Kod~ma). Arch. ~n,lur~t. He~flth 18: :~03, 19[;8 ~[~. Phar~:~cr~dynamic n:~pccts of allyl alcohol toxlcl~ (with $, ~ Kodama). J. l'h:~rm~t(~l. Exit. ~hcrap. 12~: 97, 100. lh~port on the toxicity of primidone (Mysol~e) (wi~ G. ~. Plan and J. F~Jl~oto ). J.A,M,A, 16~: 1799, 19U8 10L Chc~ieul injury of the hem6poletic s~tem induced by epo~ a~ylating ngcnt~ (with J. K, K~dama, R, J. Guzman, H, H. Anderson, and G. S. Loquvam ). Fed. Prec. 18: { 1), 1959 102, S~:~me a~ct~; of ~e metabolism of alcohol t~ vitro (with T. ~. Burbvidge, V, C, Sutherland, and A. Simon). J. Pharmaeol. ~d Ex~. ~erap, 126: 70, 1959 103, Dbcu~don : Health control in the ceramics indust~. ~dust. Med, Surg. 1~1, 1959 ~£ Cardh~toxlcl~ of alIyIamlnes (with R. Guzman, $, K. Kodama, G. Loquvam, and H. H. Ander~:on) Ab~tract~ of paper~, Am. Ind. ~yg. A~.~ p~ge 42, April 1959 ~0~5. Indu~;trlal tnxlcnlo~. L General prlnciple~ and ~ew developments M. I~. Dunblp and J. K. Kodama)..~LY Ar¢~. In~. ~led., 1~$: 81~, v,,mh,~r 1959 ~¢~, An vvnluati~m of occupational health services and necdu in the city and county of ~:m ~ranei~(~ (with £. G. Churchill, T. R. ~olden, ~. C.llfn~, H, K. Dunlap, S. S. 8herrlll, ~. F. B~mbtno, E. D. So~, and E. S. lt~rrh). R-pert t(, the State o£ ~alifornia, Dep~tment of ~ublic ~calth, D¢',:ember 1959 I017 I0~'. ,k study of the effect~ of air pollutant~ on the eye. ($. R. Merrier, It. l[~.. Be.vet, and W. K. MeEwen) i~lA Arch. Ind~lst. Health, 21: 1, 10S. The effect of carbon tetrachloride on isolated perfused rut liver function (wi~ G. L, Plan} AMA Arch. Ind. ~e:dth, ;H: 114, February 1960 109. Eye irritation from ai~ pollution (with ~i. J. Hogan, W. K. )leEwcn, H. 51eyers, S. R., 5Iettier and H. K. Boycr). APCA J., 10: ~7, 110. ~e to~ict~y of aily~amines (with :L K. Kodama, R. J. Guzman, and G. Loquram). Arch. Euv. Health. 1: 343, 1960 11~ Hydantoln ~md barbiturate blood lvvels observed in epileptics (with O. P~n). Arch. Int. de Pha~ma~dyn, et de Tlmr., 12~: 1:75, ~. Studies on the toxicity of glycidaldehyde (with R. J. Guzman, M. K. Dunlap, R. Lima and G. S. Loquvam} AMA Arch. Ear. HeaRh, Z: 23, 113. Effects of ~glycidyl ethet on blo~d of animals (with J. K. Kodama, R. Guzman, ~i. K. Dunlap, R. Lima and G. S. Zoquvam) AMA Arch. Ear. Health, ~¢ 31, 114. Some effects of epoxy compounds on the blood (with ~. K. Kodam~, R. ,~. Guzman, ~I. K, Dunlap, O. S. Loquvam, R. Lima) AMA Arch. Env. Health $: 50, I~i 11~. ~ly~s produced by allylam~es (with R. J. Guzman, G. S. Loquvttm, J. K. Kod~a) AMA Arch. Env, ~e~fh, 9: 62-73, 2961 ~6. Toxicology of epoxy t~mpound~ (with V. K. Rowe) chapter ft, v Patty',~ Iudust~al Hy~ene and Toxicology, ~terscienee Publishers I1Z Surrey of occupa~onal health need:~ in an urban area (with A, G. Churchill, E. D. Sex. and E. S. tIarris), Thirteenth International ~ongrc:.~ on 0ccu- ~ational Health, p. 281,1960. 118. Toxleologlc investigations of 1,2-dibromo-3-ehloropropan~ (with T. Torkelson, S. E. Sadek, V. K. Rowe, J. K. K¢~dama, H. H. ~dernon, O. S. Loquvam) ToxicoL £9pl. Pharmacol. 8: 545, 1961 119. The effects on the eye of a~ pollutant mixtu~,s (with S. R. Merrier, ~. K. Boyer, ~5 K. 5IcEwen, F. Ivanhoe and )'. H. Meyer~). Arch. Ear. Health, $: 103, 1962 120. ~oxicology and oeeupationa~ healtl~. ~. Oecup. ~Ied., ~:457, 121. Studies on ~e effects ,ff XO~ ou animal and man (with ~% H, I, Icyerz). Proceedings of the ~r Pollutio~ ~Iedlcal Resf~arch Conference, December 1961 122. Some exper~ents with the human subject in air pollu~on re,earth ~. H. Meyers). Proceedings of the Al~ Po~utlon Me~c~ ~e~:earch Con- terence, D~ember 123. Research, regulation and reason with regards to tdr pollution (with F. H. 5£eyers). Proceeding~ o£ ~he Air Pollution Medical R,search Con- terence, December 124. Studies in deto~cation by means of the isolated perfumed liver (with A. Evans ~d G. E~enlord. To~icol, AppL Pharmacol~ 5:129~ 125. Est~ation of ~e absorpOon and elim~ation of volatile solvents by o£ the e~ired air (with C. Co~n, M. Gardner), &ba~ct, AIHA, CIn- clnnatl, Ohio, May 7-10, 1969 126. Worn, sic Teleology and ~e p~acticing physician. ~IA abstract, meeting, ~s Angeles, Norther 1fl62 12Z E~ co~n9o~ds (wl~ V. K. Rowe), Induct. Hyg. and Toxi, $: Interscieace Pub., 1962 128. Physiolo~e effec~ and h~an tolerance, Chapt. in Symposium on Toxicity ~ the Closed Ecologic System, Stamford Press, :1963 129. ~e Effects of solvents and tra~qulllsero on c~ordinatlon, Jud~ent and reaction t~es (with F. Ivanhoe, S. Walker, E. A. Evan[i), Fourteenth International Oceupa~onal Health Congress, 1963 130. Research ¢ff the scientific litera~re and reports on the effects: oa mar of alcohol alone and ~ combinatio~ with other drn~, 1963 181. Studies on the Biotransfovmation o£ 2-Ni~oaphthalene (with M. L. D~wey, E. A. Wahrenbrock and Y. H. Prince), Abstract, J. Toxtcol. Appl. Phar. 1~2. £ Simple Method for Evaluating Effect of ~flmonary Irritants on the take of Solvent Vapors (with M. E. Gardner, R, N. W~dts and E. ~ans), Abstract, J. To~col. Appl. Pharmaeol. 6: 360,1904. 133. Localization o£ the site of convulsant action of selected hydruzim,~ (with ~. W. Weir, J. H. Nemenzo, W. F. Ganong and B. L. Wi~:c), Ab~.~tract, J. ToxicoL Appl. Pha~mcol. 8: 362, 19~.
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1018 IIH Puhllonary ('hn)lge.~ lu anlm:lls expc)~ml to nitrogen dioxide (with F. H. Meycr~. R. W. Wright, and M. L Dow(,y), W~,st~ru Pharmaeol. Pr, weedings. 7:19, 1~ I'hh,rhmh,d Hydrocarbon Irm~tlehles In Human ~ody Fa~ in th~ Uni~e~ St~tt~ (with 3I. R. Zavoa aaff K. D. Parker), JA3IA 193 : 837~S (SepL l~.l~L I'~flmltlcm of M~thodu for the Treatment o~ L'it~oge~-Dioxlde-lndtlced ]))Hmmlary Edema (with D. CavallI, J. DetHng and J. Irish), Abstract, J. T,~xb'ol. AppL Pharmaeol. 8:336, 1966. 1:¢7. Eit,,vt.: ,ff AlecdaH, ])rugv~, and Lowert'd Envlro~ental Tmnperatures ca L~.uditioned Avoidance Resl)f))~ue h~ Rat~ (with G. 8. Stone and K. C. .1,o)mg). Abstra,.L ft. Toxicol. AODL PharmacoL 8:357. 1966. vo[ie~; und ~hdr Correlation wRh the Nalorphine Test (with K. I'~rk~r, X. Nom,~f and IL W. Elliott), J. Forensic SeL 2:152-165. 1966. I::~L Trb.hlox~n,[lmm, Infoxieaflon: A Report of Two Cases (with ~. B. J. Forv~ic Set. 8:4~-413, 1~6. ~4o. 51amml f.r lhe Def,~rmim~flon of Narcotics alld ])ange~us ])rugs in the l'rh~e, Xathmal Clearin~hou:~e for 5Iental Health Information, 3:1S (1~]6) (with K. D. P~ker). 1ti. 3hqhod,,:~ de ~b~tcrmiuation de~ ~tupofl~nts e~ drogues nuisables dens l'urine wl~h H. D. t'arker), ExtraiC du ~ulletin des Stupefiants, XIX:~9 ( 112 ['.],vulqlolis in ~flo,lan Workerg (with T. S. Ely, J. W. 5In,arlene and W. P. ~alon), .I. Oee. ~Ied. P:37~37 143. Eli'v~.~:~ ,)f Sc)lv,,nt Inhnlatlon on Conditioned .~x'oidaace Response in Rats [with ~L S. S0-me and K. U. Leuag), Abstract, .L Toxicol. Appl. ~har- ma,:,ol, lfl : 3~; 14-1, Effe~'t of Chlr~rpromuziue. Phenobarbital, and Iproniazid on the Po~phasie Mortality Curve .f Aggregate Amphetamine [with D. E. Smith and O. M. Fl~h~,rL Ahstmtct..T. Toxlcol. AoI)L Pharmacol. 10:402 (1967). I]5. Fmhw~ Influencing Memmrem,mt of Ethyl .kleohoi ia tim Expired twlih J. P. Aitddson and K. D. Parker), .kbsttact, J. To~eol. AppL Pharmm'ol. 10 : 403 (1967). 1 hL A S) ~h*ra for Idenflflvatlon of Compmmds Pro~ont in the Microgram Range Vtillzh)g Ga~ Lhluld Chron~atogral)hY in Combination ~ Simultaneous Fr~wHml Collovtl¢)n and Separation by Thin-Layer Chromatography (wHh K. O. l'ark~,r and J. A. Wright), .T. Forensic Sd. 7:162-170 I [7. Ihm,~n T.ler;mee h-) ¢he Avuto and Sal)a('uto Oral Administration of Poly- vh~yl,'hlorhh, Formulatltm of Diehhwvos (V-3 and ~12) (wi~h 3f. Slolnk:t 1, Al,~lrm,t, The Pharlaaeologist 10:222 (Number 2) ¢Fall. 14~, The T(,rad,,genleity of Rome lmlustrlal Chmnk'als (with 8. hi. Roche). Ah~Irm.¢. J. Toxicol. App]. Pharmacol. 2:11 (1~,~). 1 I~). Effe,.tu ,)f Trace Aul,)uat:~ ,-)f Toxic 5lvtuls on Hepatic 5Ilero~omal Ellzynles [with IL A. Ribetro), Abstract, ft. Toxtcol. AppL lqiarmaooL 2:11 15It, l'rvdletvd aml Measured Ul)hfl~e of Thr~,e Solvoutg in ~umon S~lbjeet~ (wilh J. P. Aitchisou), Abstract, ,~. ToxieoL AppL Pharmaeol. 2:11 ( 151. Fm',~ie Toxleolo~y and thr, Praetlelri~ Physielan (~vi~ ~. B. ~al[ and II. W. Turk~*l), Clln. ToxlcoL 1:~ (196$). Mr. S,vrrv)wn~L)). Our next wltnes~ is Dr. R. H. Rigdo~ Dr, Rig- d~m, x~{, weh'olao )'Oil to Otl[' comn/ittee. Do you have a prepared ~'tat('lltt'ltf~ :~h' ~ STATEMENT OF ~, H. RIGDON, PRO~SSOR O~ PATHOLOGY AT T~ MEB~CA~ BEAN~, UNI~RSITY OF TEXAS I h'. Rm,Nx. Yes, I haw a ],r~e~ summary her~ o~ my commen~s, I)r, ItI,~,iX. I am R. H. Ridden, Professor of Patholo~ a~ ~s M,,dica] Branch of tim l'niversity of Texas at Galveston, ~exas. -],tairwd my degree in Medicine f~om Emo~" K~aiversity in 19o1."* My 1019 postgraduate training was obtained at Duke University. I have been on the medical staff at Vanderbilt lYniversity, the Unix:ersitv o~ Ten- hesse, the Univemitv of Arkansas, and liave been at ~h~- medh'al branch at Galveston slnce 9 " 1,4,. I ran' ~ex'tified bv the American Board of Pathology. I am interested in pathok~gy reported o~("the subject%f smokin~ a~d health to committees of the tfouse o~ Representhtives and the ['.S. Senate. For your informatio~h may I say (bat I have been interested in ]a]l~" cancer for ll~ItlW years: gu 194~. I published my first paper on th~ frequem.y of ('~h~cer in 7,500 autoi)sv cases Sin~e tl at time I have ~mb]i~hed 19 mdudmg a (~iscuss~on of cancer, the stuck I a" l abits of college shldeuts, and a d~scusslon of ~noldng and &~ease. Ia three of these, I have reviewed the problems of hmg cancer before ln00 (10), the zecond to lung cancer fl'om 1900 to 19:40 (16), and the third to lung ca~c¢.r from ~930 to 1960 (~8). _ The fir~ case of lung cancer was reposed fr.m France in 1810 (21). Storer (22) published a case of lung cancer in America in 1S51. Ac- cording to Wolf (23), lung cancer i~:reased in ~r~luencv in Germany from lS52 to lSSS. Bonser (e4), however, did uot find hn increase in the ~equenc~, of ~is lesion at postmortem at Leed~ between 1891 and 1!~7. King ~nd Newsholme (25), in ~893, expressed the opinion that tiffs increase fit the frequency of cancer was only apparent~ being due to improved diagnosis and more care.ful certificatiba of the death. The diagnosis and etioh)~, of lung cancer were frequently discussed before 1900. Boyd (26). ih" 1887. za~:e an excellent aiscusslon of the differential ~a~osis of'cancer o~ th~ hmg. Adler (27), in 1912, how- ever, eommente~ that "even the die,moses made ca the ~mtopsy.table are not always reliable." Weller (2S), in 1~)29, a~ter reviewing a zroup of 89 dkses, found tha~ the correct clinical dla~osis had been "made.. m.onl~'. , 10 cases aml ~.mggested that "w~th" the addttmnal" " a~d~:" now a~ affable the proportion of diagnosed cases should lx~ very much increased." Wells (~), in 19fi8, forum a die,rustic error of :~;.5 per- cent. in a m'ouu of 5 ~8 cases of cancer. Fried (30), in l!)~5, found only two eaaes3n a.'b¢oup of 10 corr~tly dia~osed clinic.ally at tht, Bent Brigham Hospital in Bostm;. After reviewing cancer diagnosis on death certificates in the Prox4nce ~£ Saskatch,wan, Barclay a~(l Phillips (31), in 1962, concluded that "death certiticate dia~nmses are insumcientlv accurate to permit their use as a r~,liable indi(,ation of the incidencdof cancer." The estabfishment of the frequency of cancer of the lung from Yital Stati~ies has been and still is a p~:~blem. A statement, made in 1955 by o~eials of the New York State Health DeI)artnwnt (32) i:~ im- l/ortant to know in the evaluation of death certificates used for Vital Statistics: less than one-hal~ of the deaths attributed to imeumon~a in a) a'roup of cases they reviewed achmllv had pneumonia. The Dir~.ctor (~'the Bureau of X~ital Statistics of ~he Wisconsin State Board Health (38) said iu 19¢;0 that "an e~imated 20 percent of all records in the Bmvau of VitM Statistics c.ntain errors or omissions." Waaler and Grimstvedt (34), in Scandinavia in 1958, using the autopsy, found ~at the d~ical diagnosis was correct in percent, and doubtfnl in 10 percent of the cases. There were 4[~ caes,~ of unreco~fized cancer in their group of 4,104 autopsies. Korns and
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1020 Lintz (as), in 19~ a, concluded from a rewe of 500 autopsies recorded from fiv~ hospitals in New "York State tlmt ther~ was a~ 11 to ~0 per- cent db~ngrcement between tim medical statement on the death cert~- ,.at0 a~d,the p~thologi~:,a~ findh~gs at autopsy, in 1963, we ~o~d in 19{ ctmccr c~cs a difference of ~0 percent in the diagnosis made by the pathologist at the autopsy table and the diagnoas giv~ on the death ccrtifib~te, which of toni'as w~ used for Vital S~atistics (19). Klmwing tlm problems in the dia~iosis o~ l~g cancer, I hare no ,,thor choic¢~ but to be critical o1' the'statistical d~ta obta~ed in ques- tionnaires ft'~,m surveys made by nomnedical individuals in which tim d~aGmosls of lung cancer, empay~ema, and the hke Is obtained ~rom pati, mb~ and family for statistical purposes. Tlm merits and harmful effects o~ smoM~,~ have ~eu ~equcntly dis- cm:,-:ed ~htc~ Columbus flint observed ~xdian chiefs among ~acco l~:aw'~; (ad). Ia 1707, apparently the first tobacco controversy occurred in England: "half of the town was on on~ side.~d half on the other." In ~ :econd controversy hi ~857~ it w~ said that tob~o ~cts on the mind by producing indbilit) to thi~ loss of memory, insanity, and tin irrita[;]o temper': It acts on the resp~ato~ or~a~ by c~using con- mm~pfions, hempt5,.ds,,and, an i~ffiammato~ condition of ~h~ mucous membranc~ of t~o ]un~z~ trachea, and broncO. Otbem contended t]mt sucking wa.~ a useful ~edativc in c~es of insa~ty. Tim word "cigarette" was first used as an English word in 184~ (:~7). Two ~,ear~ later it was stated that the cigarette has bu~ li~]e :~trcmzHi, it ~aR do you uo harm. Cigarettes were first made ~ ~xerica abtmt, l~b t Shortly, a~er 1o81 a X ~rgmmn, James Bonsach, invented ~ rata:hum lot making mgare,tes (38). Tooacco has bee~ considered as ~ po:~ail.de ~4iologie agent in cancer o~ the ~ung since 1900. Oth~r agcn% o:mdi~im;~ and occupatimxs considered to cause luug cancer havt~ been tub~:~rculosis (3~)~ svphil~ (40)~ influenza (41)~ ~phttmri~ and rm~a~Jes, (4~)~ chrome lml£mnarv inflammation (43), occupational ~'Xl,>ure b) iron workem (~), ro~d dust (43), du~ from ~rooming heras-, (46), motor exhaust (~7), war g~ (48), worMng as a laala:r and,tarter (49) ~ arsenic (50), chromim (51), asbestos~ (5~), ,ili,:o~=,b; (53), meeuplasia (54), tar (5~), heredity (56), tra~a air p,?llutlon (58), and inhalation of printer's ~ wh l~ re,din mm'nmg ncw@aper (59). There is t~ wide variation in the $fferent studi~ ref~r~bls pcrcena~ of the pop~Rtioa th~ smoke ~d the frequency of cancer. Tim U.S. Public Health ~e~,ico (60), ~ 1950-1952, r~porMd a ~;tudy on tlm incidence of cancer of t.h~ bronchus ~d lungs per 1~000 popuhttion in 10 American citi~ for the years 1938 ~d 1968. It is ditllcult to account ~or the wide variation'in th~ fr~u~o), cancer of t~m lung in tlt~ 10,cities. In South Afric~ wher~ the ~ver~ge white mule ]~ ono of the, hca~ iest smokem in tlm world, the uge-~ec~o death-rate for c~mccr of the re~pinttory system is~ if ~ything~ less th:m ia Denmark where tlm average ma~e smokes less than ~ third tim luunber of ci~:trettes {61). An article in tim Oanac~an MeScal eal~cer~ wt~ ~h,ml,l expect t,~ find many case~ in E~os and ~dians wht~ almost all :minks quite, hearilv, mostly c~garettes~ in recent decades, No bronchogenic ~mcer has beel(~o~md~ ]loi~ever~ in ~o~hern natives by our X-ra~, aur~,ey ~eams." 1021 There ar~ some interesting problems that have arisen refera'ble, to the statistical association between cig;~reLte smoking an, d lung ca~aet:r. In a group of smokem, Doll and Hill (63) found that 34.4 percent of those %dth lu~ ~ncer did nob inhale, but of those with no lung c~mcer 66.6 ~rcent d~d ~ale. This obsen~a*;ion is contra,T to ~he smol~g- l~g:c~cer relationsh%~. The l~g cm~cer death rate ~ England is o51 net million, while ~ ~erica the rate is 11~. The consmnption ~l~ar*ettes er ahult male is higher in the United Stute~ than it i~ in England. ~he Surgeon General:s ~eport ~ 19~4 (64) and the 19~7 report "~te tle~lth Consequences 6f Smokh~g" (65) suppo~ the sta~tical a~ociation between lm~g cancer and c~garette ~mok~, bu~. there are mtmy scientists that do not accept this relationship as c.m~m as shown by th~ cements ~vea at tt congressional hearing ia Wash- in,on in 1965 (66~ Biographic data and tim opinion of several of thes~ men are included m my l~ pubhcation referable to cancer of the hmg and smok~g (20). Joseph Berk~n (67) ~ a statistician and member of tlm Ms) o Medical Complex~ told members of the 85th Congress: "I have studied carefully the e~dence that has be~ advanced for the theory that smoking lung cancer . . . ~ find no reason to modify my previous opim%n that the evidence, taken as a whole~ does not esta~ii~h~ on ~y reasonabl~ sdentific basis~ t~t cigare~e smoking causes lung cancer. On thc.con- tra~. I have fo~d more and s~zanger reasons to doubt this concluaton2' Sir ~onald A. Fisher~ a statistician pf unquestion~b]s reputations re- pored ~ detail his objections to the thesis of smoking ano c,,mcer" (68~. ~'isher, in an ~ticle published in July of 1957 sa~d, "In recent ~ars, for ~xa~p~e, we. lm~e sqen ho~ u~sc~pu~ous~y. ~modern devices o~ publicity are babls to be u~ed under me l~put~ of Year~ and surely the ~yellow periP of modern times is not tht~ and soothing weed bu~ the organized creation of ~tates ~f. fr~m~i~ alarm. ~ cm~oR td~vic~~ is to point ~ ~ real causa ~or anxnety: such as the h~creased ~cidence of hmg cancer~ and to ascribe it in urgent tones to what is possibly an entirely imaginary cause... The phrase qn tha ure~nc¢ o~ the ~a~akiu~ inve~at~ons of stati~.iciau~ that s~-C~n-~v-~- closed ~ver'y loophol~ of es~p% ~or tobacco as th~ ~qllain ~ the place~ seems to be pur~ p~lit.~eal rhet~c~ p~:~n to t.h~ curiom practice of escaping t~o~gh loopholes . . . ~s nor m¢ matter serious enough to requ~e more serious ~eatment Morris ~ishbein (69), ~n 1967, said tha~ the use, and ~bu~ of sta- tis~ics~ par~iculaEy h~ medical research~ was recently dimmszed by two lead~g autho~ties who pointed out tha~ the statistical relationship does not necessarily establish a cause-and-effect relationshiu. ~-~fi~ermore these ~tatisticians emuhasized that medieval invc~tiga- tor~st co~4antly ~eview their ~n~tcrial with a critical eve, and publish ~1 the data, including a~" results or observations ~hat are inconsistent with the generally accepted ~omt" of V~e~.. . ,,- £ have beer ~sappo~ted ia my failure ~o ~d m the ~urgFon ~aneral~s Re~ort of 196£: (dA~ and h~ the 1967 HEW report to Con- g~s:"Tlm II'ealth Con~equ~n&~of Smoki~" (65), a discussion o~ tht:~ published reports o~ those that disagree wRh their conclusions. There are outstanding members ~nd past members o~ the National Cancer Ynstituts that do no~ accept ~h~ Surgeon GeneraPs report. Dorn and Cu~ler (70) ~ in 1955~ ia t~¢ "Pubic HeMth ~[ono~aph No. ~9," pag~
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4, lL~U~,~m~ lm~ nmc~r stated : "The princioal a~ents tha~ lmve :~.u~'~e~;tt~d (~ tlm etiology) are cigarettes, ai~. po~ut~nts, and ~l)ec~u~ ,wcupatlonal hazards. ~[uch more work llee(ls to be done before tll~ prt~ei~:e roh~ of the:~e or other factors in the ri~e in the incidence of lung ~:ane~n: can b~ ¢)ehni[ely evaluated." Gil~am (71)~ chie~ of tlle epi- ctcmlolo~y ~ectmn of the ~rational Cancer Insti~t~ ~ 1955, said: "Prior to 1030 th~ term bronchogenic carcinoma was lumped with 90 ,.,th,ryancers o~ various sites... It was not until the FiTth ,:,n~t~ rote ~t~o i~I D);~9 that deatlm which physicians charged to broncho- t:9'n~c c~r,:~nom~ were ~eparate]y ]dea¢.i~ed in official statistics." Glllmm v~tated that. "the rate of increase iu recorded mortality ~ as greatr~4 ~n this country behveen 1914 nnd 1930 ~d that it has been d~.,:]hiin~ ~,ince,'~ Heuper ,ud Conwa~, (7~)~ in 19~4, in commenfin~ on {]ti~-t ln,obhmt~ ~aid~ "Although it ha~ been claimed by thece ~d inv,~tig,ttom, ~mtinly on the 5asis of statistical cvide;~ce, tidal :-~molfinff is llm prhMpal canoe of lung cancer aecountin~ for up to 05 lx, rcont, of all pulmonary cant'.ers in ma]~, tm obiectl~'e and soho,. mmls:-~m of all m{ormatmu on the eptdemiolo~ etiolo-'-" and harold Stewart and K'derinc Iterrold (7~ from the National ('.n hr:titnte, ~:tatt, d in 10t;2: "~Verc it I, OSSi[de'~'egtilarl~, to induce n:try calt[:~rs i9 laboratory a~timals by exposure to ~flla/ation of rrtto ~hmkc~ tlns would coustm~te good evidence that ¢iffaretre smoking ,:,nlld eau::~c cancer of the ]unff iu men." ht "The Ht,:dth Con~:eque~ces of Smokin,¢' nubli~hed in 1~67 we find tho statmnent that, "a,t unpreceden~dqmo~t of ,e[:t~e,~ catch lm~ byen completed, continued or imitated . . . This research ha,~ been reviewed and no evidence has been revealed which brin~ into tlll~,t.ltll~ tllc ctl[o:lusltllls of ~]te 196~ Report.-' ~esearch carried on since Expt, rimental attempts have failed to support t,hls ~atistical a.ssocia- t l.n. Th ,r~ is far too much which [~ unexpla~ed to be dismissed. The t',:,n~m~,n~ of all inve:~tJgators is to el]courage m~d to coati,me scientific ~t udy of the cause or caus~ of cancer and especially that of the lungs. :ntil we van obtain experimental evidence to suppot¢ the statls~ical a~:-oeiatio~b. the. r@~tion, of" lung cancer' to mgarette" smok~g will relllailt a ?tat}~t~eal associ:~tion." Every .effort~ however, shotild made ~o :~:cmntfl~eally estabhsh whether cigarette smoke is or is not ya~-;ually related to lung,cancer. Certainly, no such relationship has I,.,-.n eatablished to date. Fhis scientific effort shouht iuclud% without fail, tt broad inrestigation of the effects of eoa~tu~ional factors on the dew,lopment of lung cancer. Thank yqm for thi~ opporhmity to pre~ent these data ( I he :tttaehments to Mr. ~l~gdoz s ~tatement follow.) 1. Rl,qdol], R. H,, and Kidder, b. A. Frequency of cancer in 7~ routine autopsies l,'rfor~ed over a perlo~ of 43 y~r~ at Th~ Uuivccsity o£ Texas Medical Brn~rh. Trxas Rept. Biol. 3Ied., 7 : 237, 1949. 2. Rlgdon, R. H., and Brlndh~y, Paul. Primary carcinoma of the lung in Texas. Toxw~ ~t. J. 3led.~ 4G : 8S3, 19;0. 1023 3. Rigdon, R. II., and Kirehoff, IIelen. l%equeney of cancer of the lung In all malignancies studied at autopsy. Southern Med. ft., ~t4 ~ 5~, l~fil. 4. Rigdon, R. H. and Kirehoff, ~Mea. Accuracy of death eerttfleate~ for lishing tlm frequency of cancer as ~hown by autopsy. Texas Rept. Blnl. Med., 9 : 6~2,1951. 5. Rigdon, X. H,, and Kirehoff, Helen. A consideration of some of the the.flea relative to the etiology and incidence of lung cancer. Texas Rept. Biol. hIed., l0 : 76,1952. ~ 6. Xigdon, ~ ~., ~rchoff, ~elen, and Walker, ~Iary I,~. Frequency of cancer in ~e white and colored races as observetl at autopsy between 1920 and ~9 at the Medical Branch. Texas Rept. Bh~l. Med. 10: 914. 1952. 7. Rigdon, R. H., ~d K~hoff, ~elen. Smoking and cancer of the review the facts. Texas Rept. Biol. ~Icd., 11 : 71~, 8. Kirchoff, H~en, an6 Rigdon, ~. H. 8mo~ng habi~ of college ~tudtmtft in Texas. Te~s ReDL Biol. Med., 12: 292, 9. Ri~on, R. H., ~rchoff Helen ,rod Martin, Norton. Where cancer ,f the cecum in Texas. Texas Re9t. ~lol. bled., 18 : lf;2, 10. Rigdon, R. ~. Cancer of the l~ng before 1900: a historical review. Texa:~ Rept. Biol. Med., ~3: 993,195~. ~1. Kir~off, Hel~, and Rigden, ~. ~. Smo~g habits o2 21,612 tndlvidunh-a ~exas. ~. Natl. Cancer Inst. 16 : 1287,1956. ]2. ~rchoff, ~den, and Rigdon, R. tI. Fretiuency o~ cancer In the white and negro: a s~dy based upon necropoles. 8ou~tern M~. ft.. 49: 83-1, 23. Rigdon, X. H. A consideration of smoking ~tml cancer of the l~l~g with review of the literature. Southern bled. ft., 50: S2~, 1957. 14. Rigdon, R. ~. Cancer of the lung and smoking. A review *ff some of the data. Proc. of 1957 ~minar~ National Assn. of Coroners, Louisville, Ky., Aug. 15. Rigdon, R. ~., and Kirehoff, Itelen. Smokln~ and disease. A study upon ~,050 individuals. Texas Rept. Biol. 5led., lt}: llfl, 195,% 16. Rigdou, N. ~., and Klrchoff, tIelen. Cancer oe the lung from ltt0O to 19~0. Su~. ~. Obst., 107 : a0b, 1958. 1L Klrt~hoff, ~elen, and ~igdon ~. ~. Cancer of the lung--sex ratlo..k review of the ~roblem. Texas ReVU Biol. 3Led., 17: 29, 18. Rlgdon, ~. ~., and Kirehoff, Helen. Cancer of the tung 1930 to 1969..k rovlt, w. ~'¢as Re~t. Biol. Med., 19: 4~3, 19. ~lgdo~, ~. IX., ~d Kirehoff, ~elelt. ~rital ~tatisttea and the frequene~ dlseaso. Texas St. ~. Mad., 59: 317, 20. N~don, ~. H. Cigarette 8mok~g and lunff cancer, ak eonslderatloa o~ thl~; relationship. Southe~ 3Ied. ~., 62 : 2~2, 1969. 21. Bayle, G. H. N~h~rs~es sur la I'h~isiu PuN~0naire, Park~, Gabon, ]810, luted by William Barrow, ~iverpoo/, ~ongman & Co., 22. $tor~. Cardnoma of right lung with sylnptoms resembling tho:~e o~ hydre- thorax. Am. & Med. Sel., 21 : 46,1831, 28. WoN. Kurt. ~rimar~ 9ultaonar~ cancer. Fortsdter. d. AIed., la: ~23, 765, 1895. 24. Bonser, Georgimaa %L ~he inelde~ce of tnmours of the resplraIory tract Leeds. J. Hyg.~ 28 : 340, I028. 25. King, George~ and Newsho~e, Attar: 0n the alleged inerem~e o~ cancer. Prec. Royal g~. London, 54 : 209. 1893. 26. Boyd, M. A. ~ncer of h~oaehIal glands a~fl lung. ~ncet, 2 ; 60, 1887. 2~. Adler, I. ~rimary M~ignant Growths of ¢l~e Lungs and BronchL London, Longma~s~ O~een and Co., 1912. 28. Weger, G. ~'. Primary ea~c~oma of the lung. ArelL Path., 7: 478, 1929. 29. Wells, II. 6. ~elation of eliMcal m necropsy dlagnesia ill cancer and value exis~ng cancer zta~stic~. ~.&.M.A., 80 : 737, 30. Fried, B. 5L ~rimary carcinoma of the lungs. Arch. Int. ~ed, 35: 1, 31. Barclay. T. H. U., and Phillips, A. J..keeuraey of cancer diagnosl~ ~,1~ death certificates. ~ancer, 15: 5,1062. 32. $ames, G. et al, Accuracy of cause-of-death statementu oa death Pub. ~eatth ~e~, 70: 39, 1055. 33. Aasa, Z. E. ~ow meanin~ul a~e dea~ eertilleates? Wisconsin 5Icd. ft., 34. Wflaler, E., and GHmstr~t, 5I. Clinical dia~msl~ of causes of death and theh' rOiabillty, Aeta ~ath. 5Iierobiol. Stand.. 43 : 330, 19~8. 35. Korns, R. ~., and Lintz, W. B. Deu?h certifieate-~ utopsy noaeorr~datlons ~ttMy, New ~orR grate DepL of Health. Unpublished, 1941).
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1024 :I~. Editorial. The Lancet, I: 270. 276, 308,1S57. 87. Garrison, W. H. X brief for the cigarette. Mcdic~gal 3. 15: 280,1897. ~% }~,,bl ~crlcan~The ~Ir~ Fifty Years. The American ~obacco Co., 19~. t~. Ewi~, ~amc~ B. Ncoplas~e Diseases, ~ Treatl~e on Tumor. Philadelphia, W. ~. ~aunders C~:~., Brd e&, 1928. 40. Pilot, R*]g~r. ~e cancer prlmifi~ du pontoon. ~prlmerie Bosc Fibres & Riou, ,IL lh,rblln;~.r, W. DIe z~nahme de:~ prim~ren hmgenkrebses in den ~ahren 1920-21. Kiln. Wch~schr., 4 : 913, 1925. ,1~. M~.K, nzie, Ivy. ~plthellal metaplasla in broncho~neumonia. Xirchows Ard~. D~tth. Anat., l[~¢J : ;~50, ,l;l~ T~)]~aid, $. ~ Tho incidence of intra~oracie tumo~s tn Manchest~. Lancet, 2 : 111, 1927. ,1~. ~l.rrl~o~, S. L. Occupational mortality In Scot~nd. BriU Y. Ind. Mad., 14: 4.. W~,.hl, St,,Idmn. ~ho ~ncream~ of pulmoaazy carcinoma. Ztscht. Kre~£~orsch. ,lt¢. ~1,1~0~, IL V. The} so~lled branehiogenetlc earcinoma; i~ occupational iucldt~m~) a~d orl~n. ~rlt. J. Surg., 14: 2S0,192~27. ,17. ~I,:<c¢~e,T~. Correspondent. Y.A.M,A,, 127 : 120, 1~5. ,1~. Brnckbaak, William. ~c occupational inddence of prima~ lung cancer. QuarL ft. ~Icd. N.S,, 1: 31, 1932. 4t~. }trlnkmau, IL From Stmons, Edwin J., P~ary Cancer of the Lung. Year- bo,,k Psblbihers, Inc., Chicago, 193~, p. 50. Ncubaucr, 0. A~cnical caner; a review. BriL 5. Cancer, 1 : 192, ~947. 51. P~blic Health Service Publication #192, 1033. Health of Workers in Chromate Pr~dueing Industry. 52. Lynch, K. M., and Smith, W, At Pulmonary asbestosis. III. Carcinoma of the lung ta a~t~-ato-silico~ts. Am. J. Cancer, 2i : 56, 1935. 53. Fire', M. J., and Jaso, ft. V. Silicosis and primary carcinoma of the bronchus. J.A.M.A., 10}: 40, 1935. S,L K,ttz. Karl. ~tativ~tical eontrlbution to the knowledge of pulmonary carcinoma ~tceordtn~ to ~t' aut~i~v~y m~terlal of the Heidelberg Pa~ological Institute. Ztsehr. Krebsfe, r~ch., 25: Z¢~, 1927. h~. P~,:,b~t, Rebor~ The frequency of pulmonary carcinoma. Statistical investiga- tions on the matc~ of the PatholoMcal Institute of the UniverM~ of Zurich. Ztqchr. Krebsfo~sc~. 25: 431,1927. [,t}. ~ehwyt~.r, ~L Uct,)r alas Zu&ammentre~en yon ~moren ~d ~bfld~ger dot L~gen, Frankfurt Ztschr. f. Path., 36: 148, 1928. 57. XVtqb~, H. G., aml Ca~on, P. R, Primary cardnoma of the lung following traur~a. Arch. Path., 9: 8~9,1930, 5~, ~Illls, C, ~ Occupation as a factor ~ ~e comm~i~ health hazards of air pollution. Am. J. Med. Scl.~ ~ : ~77,1953. 59, A#ik Upmark, Eric, Brouchia~ cazc~oma in printing workers, Dis. Ohest, 27 : ,t27, ~. t%~ucer ~Iorbidlty Scrtc~. Federal Security Agency. U.S. Public Health ~-10, 195~52. ~1. P~u :~oy, ~ 1L So~-, ~roblem~ o£ lung cancer. Lancet. 2:107,1962. ~2. ~:~,:hacfc~, Oft.. Medtcul obzervatioas and problem8 in the Canadi~m ~ic. Canad. M.A.Y,, ~1 : 3~% 1959. ~L D.II, Richard, arid Hill, A Bradford. A study o£ the aetIolo~ of carcinoma of tim lun~. Brit. ~Ic~. Y., 2 : ~271, 1952. ~. ~]~kln$~ and Health. ~cport o~ the Advi~gry Committee to the Surgeon Gen- ~,ral nf t/,~ P~bllc It~alth Service. Public Heal~ Service l'ubHcatlon No. 110w U.S. Gow,rnment Prlnflug Office, Washington, D.C.. ~965. ~:,. The Ht,alth Con~:~:,qtlenc~,~ nf Svmkl~g. A P~blic Health Service Renew : l~ubIl. Health Service PnbHcatlon Nn. 1696. U.S. Govenlment Frin~g Offic., Wa~:tdagton, D.C. 1968. fl~L F:tl~c and Mi,teading Advertising (Filter-Tip Cigarettes). ~earlngs before a ~,ubc~mnnittv~* on the Cmamlttee oa Gove~ment O~ra~ons. Ho~e lb,la'~,~{,nhdiv~'~, Eighty-Fifth Congre~, flint session, July 1~26, ~957. U.~ Govcrnm~'nt Printing Oflh'~, Washington, D.C., ]957. ~]7, l~erh~:-~, Jo~;eph, Exhibit ~0A In Hearings before a Subcommittee on the C~,nmdtte,~ ou Government O~ratioas. House o~ Representatives, Eighty- Fifth Cevgr¢~% first ~*cc~lon, ~uly ~26,1957. 1025 68. Fisher, Sir Ronald k. : a. Dangers of cigarette-smoking. Brit. Med. J., July 6, 1957. p. 43. b. ]}angers of cigarette-smoking, Brit. Med, J,, Aug. 3, 1957, p. 298. c. Lung cancer and cigarettes. Nature, July 12,1958. p. 108, ~ Smoking--The Canc~ Controversy. Oliver and Boyd, London, 1959 (Includ~ lecture~ deRvered at Michigan State University) 69. Flubbed, Morris. Editorial. Medical World News, Oct. 13, 1967, p. 120. 70. Horn, ~rold F., and ~tler, Sldney. Morbidl~ from Cancer In thv Uni~d States. Public He~tlth Mon.gra~h No. 29. Put*lie tlealth Service Publication No. 418. U.S. Government Printing Ot~ce, Washington, D.C., 71. Oi~am, Alexander G. Some aspects of the lung cancer problem. Military Mode, 116: 163, 1955. 72. ~ue~r, W. C., and Coaway, W. D. Chemical Carclnogenc~:i~ and Cancer. Charles C. Thomas, Sprinb~eld, Ill., ]9~4. p. 144. 73. Stewart, H. L., and Herrold, K. M. A critique of experlment~ on ath.,mpt~ to ~duce cancer wi~ tobacco derivatives. Bull. In~t, Stati~. Inst, (P~t~s), 39 : kept. 135,1962. ~AYMOND HAr~0N RZOV0N Office: The University of Texas )iedlcal Branch, Galve~tua, Texas. ~ome : 1328 Ball S~reet, Galveston, ~o~n : ~uly 30~ 1~5~ ~u~ella, Georgia. EducaHon Gordon Instttu~, Barnesvfile. Georgla, ~922-2ff. Emery University, AOanta, Georgia, B.8.~929 ~ M.D.~1931. Intern, Duke UniversiD" Hozpital, Durham, North Carolina, Assistant ~esidont, Duke Universi~ Hospital, 1932-3~ Resident, Duke University Hospital, 193~35. Ac~d~mf~ a~g ~ro]e~siona~ ex~eri~ Professor of Pathology, The University of Texas Medical Branch, Galve~ton, 1~ ~ Graduate Faculty, 1961- . Senior Consulter in Pathology, M.D. Anderson Hospital and Tumor s~ltute,~ouston, 1957- . Consultant ia Pathology, U.g. Public ~eal~ Service Hospital Galveaton, ~957-65. Clinical Professor of Patholo~, Postgraduate School o~ 5Iedicine, The Unl. vemi~y of Texas, Houston, 295~ . Director of Laboratory of Experiment~fl Patlmlogy, The University of Texas Medical Branch, Galveston, ~947-57. Professor of ExperlmentaI Pathology, ~he University of Texa~ Medleal Branch, Galveston, 1947-48. Pro~e~sor of Pathology and Chairman of Department of Pathnlo~T, Uni- versity of ~'kansas S~ool of Medicine, Little Ro~, 194.~17. Ass~'iate Professor of Patholo~, University of Tennessee Medical College, Memphis, 193~3. Instructor and Assistant ~rofessor of Pathology, Vande~bilt Unh'craity, Nashville, 1935~9. L~censeg to ~ractic~ Georgia, 1931 ; Tennessee, 1943 ; Texa~, 1947 Diplomate, America Board of Fa~ology, 1~ Fellow, College o£ Amerlcaa Pathologists, 19~ Certified in Forensic Pathology by Amebean Board of Pa~ology, 1961 Fellow, Amezican College of Legal Mc~ic~e, 29-236--69--pt, 3--10
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1026 G.I~ e~t-r~ ('.u~*l:y Mcdieal Society State Medh'~d A~oclatio~ of £m,,rl,.au Medical A~;~oci~tioo T,,xa~ ~*,clcty .f Pathologists Am,.,rl~:an S,,vh,ty of l,}xl~men[al Patholo~" £ni,~rl,'an A,~*ciath, n of Pathologists and Bacteriologists Al~lorie~ltl A~oclution for Advancement of S,,vi,,ty ~or Exla,rlmental Biology and Meflieiae Pr,, ,blent, Tex{.ts ~oclely of lhi/hologist~, 1061 Cha~wcllor, Ln~v-S¢ b'nt'e Acltdt*my, Universi~" of Texas, 1959 Chairmao m,l Secretary, $oufl~westera S~'tion, Society for Ext, erlmental Bitt{,,~' and Mediclrie, 2951-55 ¢Thalrmun a,id St~:rctary, Section of Pathology, Southern ~Iedical .ksso,.qa- tl,n, 193~14 C,,rtlflcate, Luw-Scleneo Institute, tu ReeogMtion of D~tinguish~l Sevrieo, Who'~ Who in ~XmerIcan Education, At,,,,rlean Men of Science, 1949 W],:t'~ Xmportnnt in ~fedicine. 1945 WI,~'~* Who lit South and Southwes~ Medicine Certtlk~ate of Merit, ~eientille Exhibit, American ~Icdtcal ,~ssoeiation, ~o~,I,,t~* of ~ignla X[ Phi ~,~t;t PI ~Icthodl:;t Ctlldllnry Pt.rttieal~ility in Aro:z~ of Inflammation. TII~ ~IeeIInai~m 0f luflam- mitt {tin, milled by O. 3asmin ond A. Robert% .kern, hm., Medical Publi~her.~, M,mtreal, Canada, X953 Role o£ Attoxia in the Pathogenesl~ of the Le~ions in Acute ~[alaria. V. t~ongre;~; Internationaux de Medeehm Troldeale et du Paludkdue, T~lrk~,y, lt~4 L~aphold Hypvrpla~l~l Peodoecd in the SIdn of Chk.keas by Methylchol~- threno, ~veond lnt~rnational $yml~o:dum on the ReHculo-endotheUal t o~, ~o~ton, 3950 :<l,,nhmeow; ~cgre:::don of Tumor~ Produced by Methylcholnnthrcne Jr{ the Skin of Fowl~. ~h'~ Pan American Cancer (?y/elegy Cou~rca~, ~HamL 1957 ~hdmonary Nl~opla~ms Prodacefl by ~Iethy](.bol;mthre~e in the White Pekin Tu~n,,r~ Pr,duced by Methyh-bolanthrene in the RcsI{lrator.v Tract of the White, I'tqdn Duck. Third Quadrennial International Conference on Cancer, Pcrugia, Italy, Pu bll eet fo~l,~ X'UBLIC,~TI0~G~D)L ~. 1[. Z~IG~0~ A~D .~S~0CTA'I'ES 1. Atlon,~lityoma {Aflenomyosl.~ of Frankl) of fh~ Uterus with Tuhereulosis Infevttm~. ]tigdon, tL ~.. Aim ft. Obst. & Gyn. 25 : ~02. 1933. 2. On th. Rolaticm hotw~l{ ThromboI,hlvbitis nf the Inferior Vena ¢7~va and t )eelu:irm of tho H~I,:ttie Voins (Endophlebiti~ Hepatic Obliterans). ~ig- don. R. II., Bull. Johng HoI~kil~s H¢)sp. 53 : 4, B32, 1933. :{. A ~tudy of the Action of a Filtrable StaI*hyloeoeeol 'J'ox~a on the Kidneys .f Normal ~rtbbit~. ~igdon, ~. H., ffoyner, .L L., and ~icketts. B. T., Anl, d. Puth. 10 : 3, 193L .l. Ghtrdia Inf~t,tioa [~f Gallbladder and Inestinal Tract. Calder, ]hTall ali4 Rigd,n, R. II., Am. J. Med. SoL 190 : 1, R2.1935. 1027 5. Early Lesions following In/ra~euous Admini..:trall,,n oi a Filtrabh, Stapb~- tococcus Toxin. Rigdon, R. H., Arch. I'ath. 20 : 201. 1935, 6. Renal Le~ions it, Stal)hylococ¢'u~ ,kureus lnf~,.iioas and their ltolati,m I. Acute Glomerular Nephritis. Rigd,n, R. H., Ar¢.h. Int. Meal. 57: llq, 7. k Gastro-Intestinal Lesion Associate4 witb Staphylococci IlffeetlOlt lt~ ~lalL Rlgd0n, R. H. and Left, W. ~k., .Arch. Path. 21 : 29S, 1936. 8. The Age of $exmal Maturity In 2~} Albino Female Rats (3ius Norregh'u~ Aibieus, Wistar Sh'ain). Xigdon, R. H., J. Lab. & Gila, Med. 21 : 11, 11~2, 1936. Vanderbil$ U~tivvrsfty--Z" ash, vtl~e, Tc~m. 9. Effect of Stavhylococt'us Toxiu on tlm Dog's Blood Pressure. Rigdoo, It~ .~rch. Path. ~2 : ~06, 1936. 10. Inhihitory At-~ott of SotHum Chloride on Skht X~eroT.i~ Prodneed by ]0~ccus Toxin. Rigdon, R. H., Arch. Path. 22 : 7t13, 1936. 11. Inhibitory Effect of H~rtonic Sol~ltions of Sodium Chloride on Staldtylo- coccus Hemotoxin. Rigdon, R. ~., J. hffeet. Dim 60 : ~5, 1027. 12. Production of CoHtiS in the Dog with Staphylococcus Toxlu. Rigdon, R, lI, Arch. Path. 23 : 634, 1937. 13. ~ect of ~taphyb:woecu~ Toxin on tl~e Knee Joint~ of Rabbits. Rlgdon, R, Arch. Path. 24 : 215, 1937. 14. A Study of Immunity h) tSaphylococcus Toxin ht the .Albino R#tt. R. ~, ft. Lab. & Clin. Med. 22 : 11, 1141.1937. 15. ~taphylocoeel Immnnity--Resume of Experimental and Clinical Rigdon, R, H., Arch. Pa~. 24 : 233,1937. ~6. Effet.t of V~rious Salts ou ~enmlyM~ and Skln ~'ecro~is Pr~,laeed by $htphylocoeeus Toxiu. Avery, Roy C., Rlgdon, R. H. and Johlin, J. M. Prec. 8ot~ Ex~rL Biol. & 5Iod. 37 : 131.1937. 17. The ~ffeet of Staphylot~oeuu A~titoxia on ~abbils given Broth ~hflturc~ t,f ~taphylococci Intravenously. Rigdon, R. ~., 5. Lab. & Cliu. Mt,d. 23;2, 189, 1937. 38. Ol)~et'vatlon~ on 1)olman's Te~t for Determhtin~ the Presence of ~tfllfltylo- eocenl En~erotoxin. Rigdon, R. H., Prec. See. Experl. BioL & Med. ~¢8: 193S. X9. Deteriora~on of StaDl~yhg'o~wal T.xht i~l ~aline. Rigdon, R. H. alttl Htlrrlr:, Heo~y., Prec. See. ExperL Biol. *¢ Med. 30:585, eoe(-u~ Toxin. Rlgdon. R. H., J. Lab. & ('liu. 3Ied. 2~ : 2, 142, 193s. 21. Capillary pelmleabillly iu the Sldll of the ~al)bit. Rigdou, R. I~., fro,. E~Teri. Biol. & Med. 42 : 43, 1939. o~. Failure of an Acute Inflammatory Process re, Extend into Area prevhm~ly InjetCed with India Ink. Avery, lXoy C. and 2tgdon, R. H,, Proc, Sot-. ExperL Biol. & 5Ied. 42 : GT. 1939. 23. Experimental ~ephritis produced by Staphyh)~'occus Toxin In the R~don. R. H., ft. Lab. & Clin. 5Ied. 24 : 9.935, 193!L 2~. Legit LeMons ~roduee(t In Mice by Stnphybtffoeous TOXilt and b~ Toxin al~d Non-toxin Pro(hxcing Strain~. Rigdon. R. H., Surg. 6: 1, 91, 1939. _..~. So~e of the Experimental Losion~ profluoed Icy S/aphylucoccu~ don, ~. H., Soufltern ~led. ft. 32 : 79S, 19~9. 26. Hemolysis produt'ed by Staphyloeo¢'('ns Colonie~ and Toxin Oil Agar Media eonkqining various Animal Bloods. Rlgdon~ R. H., ft. Lab. & Ciin. 5h.d. 24 : 12.1264,1939. 27. ~apillary Permeability and Inflammation on ~arcotized Rabbits. Ralph D. find Rt~don, R. H., Arch. Surg. 39:386.1939. 28. EffccLu of Intra~erltoneal Injections of Stapbylocoecn~ Antitoxin on cutaneous Staphylococci Infection in Mice. Rigdon, ~, H., J. Lab & Clio. ~ed. 25:3. 251. 1939. 29. Btaphylococeu~ Toxin--~ Resume. ~igdon, R. ~,, Am. ~. ~Ied, S, vi, 199 1940. 30. Demonstration of a Capillary ~t, rmeability Factor In ~auo E~ractn from Normal Rabbit~. Rigdon, R. B.. Arch. Surg. 4I :t~. 19~. 31. Capillary Permeability tn A~eas of Inflammation produced by Xylew'. Rigdon, R. H., Arch. Sarg. 41:101.1940. 32. The Detoxification of StaphylocOccal Toxhl by £bsorOtion on Organic Liqt~ds. 3ohlin, J. ~I. and Rigdon, ~. H., ft. Immunol. 41 :~3,
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1028 Ore,ping E~pttoa (A~kD'lo~toma ~raz]liense Infest.orion) ~th St~n- tah~:,)u:~ Rcmt~sion~ and R~rences~Re~ort o£ two Cases. ~gdon, R. IL) J. Pedi. 1~ :5) ~7,19,10. ExI~,rlm~,ntal Study of ~he Effects of Su~q~yridine on Staphyloe~ei and Ntal)byl~c, ccm~ Toxin. Rigdon, R. ~. and Freeing, P. R.) J. Lab. & M~'d. 23:11, llfi~, Loealh~ation of ~tayphylococei in Areas of Inflammation produeed Xyh,m~. Rlgdon, R. H., ~eE Sung. 41:879, .k ~I~dy of Caldllary Permeablllry a~d ~flammation in the Skln of Rabbi~ given 5dr~n~llin. Rtgdo~, R. H., Surg. S :~9, 1~0. Itehttion .~ Capillary Permeability to I~flammatio~. Rigdon, R. H., South- era ~Ied. J. ;{~t :292, Ob;:~rvaflon~; on Capl~ary Permeability i~ Areas o~ Inflammatloa pr~ fluo~d by St.uI~yhylo~ocel. Rlgdon, R. H., Surg. 9:3, 4gG, Efft'c[ of S~Ifal,yridino on Staphyl~occuz Toxin. Rigdon, R. H., A~ou,, and IAp':comb, Alys., J. ~ab. & 01in. Med. 26:7. 1111, 19~. lllA,vt of Alpha E~tradlol Bengoate on ~cal Areas of Inflammation In the Sldn of Iht~ Rabbit. Rigdon, ~ H. and Chrisman, R. B., Jr., Endo~inol~gy~ 28:5, 7[~% 1~tl. Capillaey P~rm~ability and InflammaHon in Rabbits gtven He~arin. Rigdon, R. H. and Wll.~on, Harwe~, Arch. Surg. ~ :~, Amniotlc Fluid (Amfctin) in its Relation to ~flamma~on. Rigdon, .and Warrc~, J. W., ~n, J. ~urg. 53:381,1941. L.calizatl,n ~md Co~centratlon of StaDhylceoceus ~ntito~n in areas Rabbi¢':~ Ski~. Rigdon. R. H., I. Lab. & Olin. ~I~. 27:37~ 19~. P~,t-Vaccin~ Mcni~go-Ence~halodlyelit~. Report o~ a Case. Dunn, a~d ~Ig~lo~, R H., ~. ~. Olin. Path. 11:10, 7~, 1941. CaI, illary Pt, rmcabtltty .and In,ruination in Rabbits with Staphylococcic ~tp~lcemia--.~ Exl~er~ental Study. Rigdon, R. H, A~ch. Surg. 44;129, ~912. Ob~:t~'ations on Capillary Parmeabili[y and Inflammation in the skin S,~;itlz~d Rabbitc. ~igdon, R. H. ~d Ha~es, Ann~, J. Zab. & Olin. Pathn~c~e~fls o~ Arthritis following the In~ravenous Injection of S~aphylo- ~-~I ~}~ the ~,~1~ Rabbit. RIgdon, R. H., Am. J. Surg. ~ :~a3, 1~. ltelcntlon o~ ~onprot¢~ Nl~ogen in the Blood of the Rabbit following lmravcnou~; Inj~tlona of a hypertonlc Solution of Dextrose. R. H. and hloare, Frances,, J. Lab. & Clln. Med. 27:~9~ 1942. Remd Le:-;lon~ following the Intravenous I~Jection of a Hyper[onic Solu- tl,m ,f Sucro:,c--A Clinical and Experimental Study. Rlgdon~ R. ~ and Cardw~ql, E. S., Ar~,h. Int. Med. 69:670, A ~[udy of [h*~ Pathological ~ions in P. Knowle.~ I~ection in M. ~hesus 5Ionkey~. Rigdan, R. H. and Stratman-Thamas, W. K., ~. J. Trop. 22:329, 1~t2. Effect of Hepartn on Phag~cytosis by the ~lls of the ~eticul~-Endothelial Sy~/em. Ri~d*u~, R. ~. a~d Schranta, F. S., Ann. Surg. 116:~2, 194~ A S/atb~tical .~/udy of the Number of l~ite Blood Cel~ in the Bl~d of the I~bbit. ~aynes, Anne and Rigdon, ~. H., Anatomical Rea ~ :~ST, 1942. Tho Eff~w[ of Y~ Blood Pressure upon Copilot Permeability and Inflam- mation In th~ Skin of Rabbit~:. Rigdo~, R. H., Miles, ~obert M., and Bland, RIvhurd P, Surg. 12:3~2~ C:qdllary Permeability and InflammaHon in the Skin of Rabbits. Wii~on, H~rwo}l aml Rigdon, R. H., Arch. Surg. 45:416. Ol~:~*rvatlon~ ,f th~:~ Effect of Hls¢amine Phosphate on Capilla~ Perme- ability and Inflammatl,m, ~igdon, ~. ~., J. Lab. & CErt. 3Ied. 27 :~, 1 OIv~,rvatlorm on the Failure of Heparln to Inhibit the Clotting (ff Blood in Vitro by Staphylococci. Rigd~n, R. ~. and ~aynes, Anne, ~nn. Surg. 116:420, C~v~:hleratlon of Therapy ia Staphylococcus Inf~tions. Rigdon, ~, ~, and ~ ,,.~k~y, Paul F, S~rg. 12:4, ~, C.a~ Ideration of the 5Iechanlsm of Death in Acn~e Pin,medium pam~m In~cctlon: Report of a Case. ~Igdon, R. ~., Am. if. ~yglene, 1029 59. Failure of Ileparin to Inhibit Coagulation of Cltrated Blood and Pla.~ma Presence o~ S[aphylococcL Rigdo~, R. H., Prec. S~c. E~peri. Bbd. & Mcd. 50:324, 1~2, Irradlatioa ,n Capillary Permeability and lnthtmnmtio~ 60. Effect of Roentg~, Rabbit. Rigdtm, R. H. ~-md Curl, Howard, Am. J, ~ fl~e Skin of the ~oentgen. & Radium Therapy 49:2Y~, 1943. 61. Effect of Ethyl £1~ohol Intoxication on the Development of Lcwal matory Reactions in the Rabbit.. Rigdon, R. H., J. Lab. & Olin. 28:714, 1~. - .......... ~: "~-".~ of the R.~bblt Rigd0n, R. 62. ~ffects of In,rares lrraamrmn o~ ~uu x~,~._ ~ ~3 Ewi~g, Frances. ff . " ..... ~,~.,~,~-ooccua knti~oxin In Area~ L~a~za~on ~d Concen~ra~lon o~ ~,,r~, 63. RabbW~ Sk~ Treate~ with Ultraviole~ ~adiation. Rigdon, R. H., Am. ,T. Roentgen. & Radium Therapy 50 :~01, 6~. hneurysms of the Corona~ A~erie~Review of ~e Literatur~ and Report of u Case. Rigdon, R. H. and Yandergriff, ltarrls~ Am. J, Surg. 6~ :407, 65. Aneurysms of the Ye~ebral Arteries; & Consideration of their EthlologY. Rigdon, H. and Alien, Chester, J. L~b. & Clln. Med. 29:28, s~ter Produced by Shigella Alkale~cen~--Report of a Case with 66. A~r~y Ridden, R. H., Miehelso,, I. D., and Allen, ~rauk, .%m, J. o Med 4 135 67. & Pathom~cai ~maY ~ ~v Lophurav ~ young ~dte pekin Ducks, ~i~don, R. H., Am. ~. Trop. 24:371,19~ Unfver~Y o~ Ar~ansa~--~ttlv ~ocl¢, Ark. 68. Effect of Heparin on ~hagocytosls--Obse~aHons on P. Iophurac In the "ck. ~igdon, ~. H, J. Lab. & Clin. 5[ed. 29:8~, 69. ~ ~side:atioa of the Mechanism of S~lenic I~arct~ ia Malaria Rtgdon, R. H...On. ft, Trop. 5Ied. 24:349, 1944. 70. ~e ~a~ological ~sions ~ the BrMn ~ Malaria. Rlgdon, R. H., Southvrn ~ed. 5. 37:687, 19~. ~. ~sio~ h~ the Brain Associated with Malarla--Pathologlc ~tudy on and Experimental Annals. ~igdon, R. H. and Fletcher, D. E., yeu~ol. & Psych. ~ :191,1945. 72. ~o~cy~hcmia prodace:l by Cobalt in the Duel:. Da~qu, yohn E.. &, W., and Rlgdon, R. H., Y. Lab.. & Olin, ~ed. "q .¢~7 73. &u~opsies with Limited pe~sona~l: Use of a Voicewrtter. Rlgdoo, E. H. and Schwander, Howard, ft. Assn. Am, Med. Colleges, July, 1945. 74. Effec~ of Rudtatioa on 5~alarla. Aa Experimental S~dY in the Clflck Duck. Eigdon, ~. H. and Radisell, Hi,yet, fir., Prac. See. Experl, :Biol. )Ied. 59:167, 75, Terminal Hypoglycemia ia Ducl:s wlth ~alarla. 5Iarvin, H. N. and R. H., -~. J. Hygiene 42j174, 1945. - --. ~ .... ~ Lab & Olin. 76. Anemia ~ ~Ialaria. Bostor~e~, H. H. ann m~aon, ~, ~., • • 30:860,1945. 77. Transfusions o~ ~ed ~ells in 5ialavia..kn Experimental Study ta Duck~. Rig. don, ~ H. end Va~adoe, Nove. B., £m. ~. Tro0. Meal. ~ : 40% 19~. 7~ plasmo~um L~hurae Infection of the Chick Embro. R~gdon, ~. H., Am. J. Hy~ene ~ :189, 1945. 79. Mala~ifil ~l~ent. ~ Consideration of the 5I~hanl~m of Ellml~ation ~e Duc~. Rtgdon, ~. H., Am. ft. Olin. Pa~. 15:489, 1945. 80. ~taneous Blastomycosis. Eigdon, R. H. and ~inkler, G. H., Jr, $. Ark. ~ed. Soc. 42:95, 81. Yeurologic Manifestations Associated with ~Iala~la in Dueka~ A pa~OlOglC Sa]dy. Fletcher, D. E. and Rigdon, R. H. Neurol, & 65:85, I~ 82. A Study of Ozygen ~rn~port ~ the Blo~d o~ Young and Adul~ Ducks. Ro~torfer, H. H. and ~igdon, R. H., Am. J. phy~:io. ~46:22~, 191~L &~. ~[ultiltle Argentaffin Tumors (Carcinold~) of the Rectum. ~tgdon, R. Fletcher, D. E., Am. J. Surg. 71:822, ~946. 84. A Consideration of Ano~a in tlm 5Iechmflsm of Death. ¢ in, Acute ~,~oofinn~ Riudon.~.~.,Ex9erl'5Ied'& Surg. 4:lo6, l[[*~,.. , ~ , ~*~}~i~i'" g~adY'nf ~e~mt,)poiesis in the Duck wlth 5lamrm, $5. H. ~. and ~i~don~ R. ~., ,~. ~. C~n. ~atl~. 16:518, 1946.
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1030 X~L Eltv,~t of Oxygen on I'. ~olfflura~ Infected Ducks. Itigdon, ~. ~. and lt~-,: fetter, H. If., Prec. ~oc. Exl,eri. Blel. & ~Ied. 63;165, 1946. hi. ]~th,,.r .f Vitamiu A Dcfi~.leney ,m Pras~odiu~ ~gpburac. Infection in Due~. I{ll~don, ~{. H., J. Infect. DI~.' -'t,} .'>",._~., 1946. ~;. Blo.d 0xyi~ea in Du¢.ka with Malaria. Rlgdon, R. H. and Rostorfer, H. ~., J. Nail Malaria See. ~ :253, 1946. ~'. A Phy-l,,1,,gh'al ~tudy of Erythrohla~ts in the D~s. Rflsto~er, H. H. and lt[,Ig.u, R. H., Blnml. The Z. of HematoL 1:75,1947. U0. Eff~'t o$ Oxygvll on Malaria. Rlgdon, R. H. and V~nadoe, None B., Y. Lab. & Cli~ Metl. 22 :aT, 91. ~)b~cr~ a~l,n~; ,m the Anemia in Dneks Infected with P. Lofl~urae. ~igdon, R. H. m,,l R,:~torfer. H. H., Blood, The ,l. of Hematol. 2:244, 1947. ll2. Tlw Itelatb:,n ,f BI,,,1 Oxygen Tr,msport to R~trtance to &m, xia in Chicks arM.,.,,.Dnekllllg~;. Ro~torfer, H. H. and R/gdon, R. ~., Biological Bull. tl;I ].ill ~dn¢,::',~ tn Daeka A~'eomp:myh~g Hypoglycemia. A Clinical mid Path- olt~gival St~uly. ~Ji:dolG R. ~ and ~letcher, ]). E.. Am. 3. Path, 23:227, tq. Effevt of In~ultn .n Pla,~modhon ~phurae Infection In Ducks. Rigdon, ~. H. a.d Marvin, tL V., Am. ft. tIyglene, ~3:19~. ~94L lib, Tr.rc,xor-e Myt,lltls Aeoomlmny~g TnberculosL~ MeMngitis. Rlgdon, 01L An h$ Vitro St~ldy of th~ M~hanism Producing Rapid Diminution in the I'ararlttmda ht Duek~ Infected with Plasmodho~ Loph~trae. Rigdon, R. ~., A~a, ft. IIyg. 4fi :254, 1947. ~7. ~mito Fuetol~ that Inflaem.e the Degree uf ParaMtemia in Ducks ~ffoeted ~lth P. L,vhurac. Rlgd,n, ~. H. and McCain, B. E., Am. ft. Trop. Med. 27 :t173.1U47, 113. Effe,~ o£ 3. 3'3Ie/hylcnebia (4 Hydr~xycoumarin) on Vitamin X Deficient Dn,.h.,. Rigdm~, R. IL and Varnad,~, Nora B., ft. I~tb. & C~. Med. 32 U~t. l,Sff~.t of 3, t'~[etlvlenebis (4 Hydroxyeoumarin} "Dicumarol" nn P. Lovhurav h~fection In ]}ttck~. Rlgdon. R. ~. and MeCain, B. E., ft. Natl. MMarla Sac. 7:38, 194S. m~L 'l'ahtreudu tn Arkan~a~. Rlgdan. R. H. and Chesnutt, C. R., fir.. 3. Ark. Mad. ~ov. ti :I~*L 10.t8. 101. ¢:hrmde Abycv:e:e5 ~eeantlary to Cholelitheiasis and Per~oratlon o~ the Gullbladder. Iiigdon, R. H.. Aln. J. Sllrg. 77:124, 1949. 10~ A I'om:i,l.ratl.u of Glolnornlar N*~phritis in Its Relatien to ~ll~fi Sensitivity. ~Jt:d-n, ~. H., Sial,h.n, ~V. H.. and b'leteher. D. ~...~ 3. Med. 6:177. 194fL 103, Neur,l,,~le 3lmdfes:hit~ou~ Associated wifli Vitamin .k Deficiency in Young Dat.k~. Fletvhel', D. E. and Ittgth,n, R. H., Arvh. Neurol. & Psych. 61:199. ~1. tqhdval Oh'~orvations on Vitamin A Defieleaey in Young Ducks. Rigdon. R. H.. Toxav Rep. Bl,l. & Med. 5:4. 4:l& ~ 947. 1l~5. i ~lfftl~'t, Arnyh~hl,,H~ of [1~ Skin Acvompanylng Primary Systemic AmylMdo- M~. Rlgdoa, R. tI., Am. Practitioner 2:423,194& 1oil A Coii~hh,rati,at of the UFe of Blood and Oxygen a~ Snpportlve Therapy in tim Trt,atrncnt ,f Malarht. Rlgdom R. ~., Am. g. Gila. ~ath. 18:4~, 1948. II}~. I'illart*r lfa. Rt~don, R. H., Texa:~ St. ft. Med. ~: 392. lt;~, Multiph, T.Ymldio~arvoma/on~ Ulcers in the ffejanum: Report o£ a Case. My,1. tl : 41.t. 1948. 1{19. l:ffi~'t ~,f Blood and Oxy~ou Oft P. KnowleM lnfeeti:n in 3Ionkers. Rigdon, R. IL, Aln. ft. Hy~eao 4S : ]47. 1919. I10. I'lhd--path,l,gh:, C,nferelwo. Rigdnn, R. H., Am. ft. Clin. Path. aS: 111, Ilem.glublmlrla (~ltlekw~for ~ver) In Monkeys. A Cr.~n~d~ra~on of the DI:. ~ast, In Man, Rlgdon. R, H.. Am. ft. Path. 25 : 195, 1~9. 112..~ho:r.gl.~:~4a Accompanying Primary Systemic Atnyloidosi~. Rigdon, umi N-blhi. l,'ralice~ E.. Aim. Otol., Rhiaol. & La ryngol., aS :470. ~949. i I:L lrlTq-q,,tley of Callevr IU 751~1 Routine Autop~ie~ Performed over a Peri~ of 42 Year:.: ~~t The University of Texas Medical Bram,h. Rigdon, R. H. and Khldt, r, L, A, Texa~ ~ept,, BiuL & Med.. 7:237,19t9. 1031 114. Effect of Antlhi.-tamim." on the Loou]ization of Trypan Blm~ in Xyh,nt, Treated Areas of 8kill, Rigdon, ~. ~., Pro,:. ~m~. Expcri. Biol. & 3I~,d,, Ti :~37, ~949. 115. 2~le Eleetr~c~diogram of Normal a~d 3Ialarial [Itfeeted Mot~eyFt. Ruskin, Arthur and Rigdoll, R. II,, ,L Lab. & Clin. ~Ied. 34: 1103, 11~. L~ffhal Effects and Eleclrocardlographh: Changes Produced hy Qulnhle l)ihydrochloriOe l#Malarlal Infected Monkeys. Rigdon, R. H, and ttuskht, Arthur, ft. ~ab. & Grin. M~. 34 : 1109, 2949. 117. Effee~ of Hmnan Blood on Plasmo~iltm Kn~wh'M Infctrtion In M.nkey~. Rlgdon, R. H. and Breslin, Dorothy, J. Nat'l Malarial 8oc. 8 : .,18, lXS. ~udden Dea~ During Pregnancy ia Sickle Cell Anemia. Rlgthm, R, IL. $outhern Med. ft. 42 : 1032, 1949. 119. Thrombosis of Cerebral Vessels with Xeerosls o£ th~ Basal Nuelt~l. Rlgdulh R. ~. and ~feber, Edward ft., .kuz Roy. The. 6~ : 247, 1950. 1~. Sudden Death during Chil~ood with Xanthoma Tubers*sam. Ridden, R. H, and Willeford, George, J.A.M.A, l~ : 12~8, 121. Pulmom~y Arterttis due to Acquired $yphilis;. ]Ie~tmartclk, Miltnu It,, ~radfield, James Y., an~ Rigdon, ~. H., Am. J. $yph,, 6onor. ~ Ven. Dis. ~ : ~6, 19~L 122. Chori~Eptthelioma Following Hysterectomy. Willeford, George and Rlgdon, ~. H., ~. ~. Surg. ~t: 933, 19~0, 123, A Consideration of the P~enomenon of "81udged ~lood" In DLuea~e, ~. ~I., Am. ~. Clin. Path. 20 : t~fi, 124. S~ad~n Death During Childhood ~ith Xanthomata. ~lgdon, It. H. J. Insurance MeO. 5 : #~, 1950. 125. Observations on the Effect of Certain of the Anthnalarlal Drugs on Erythr.- eytes. R~don~ ~. H. and Bresl~, Dorothy, 2"exas Itepts. Biol. & Metl. 37~, 1950, 126. Effect of Phenylhydrazlne Hydroehlorido on Plas~izodIul}~ K~lowlcsf tion in the Monkey. Rlgdon, R. ~., Mlcks, Don W., and Bre~lln, Dorothy, Am. Y. ~,~ene 52 : 808, 19~0. ~7. Primary Carcinoma of the Lung in Texa~. Rtgdon, R. H. and Paul, Texas St,. 3. Med. 4~: 885,1950. 12& Obs~'ations on ~e Mechanism of Blackwater Farter. An Study in ~e Monkey. Rigdon, R. H. aa~ QuatflebaImb ft. E., J, Nat'i Malaria Soc. 9 : 332, 1950. 129. IXeinz Body Phenomenon in 3Iankcy Erythr~yte~ : & Quantitative Method. Bigdon, R. H. mid Breslin, Doro~y, Pr¢~. Sot.. Exi~rL Biol. & Med. .4_, 130. Necrosis o£ the Banal Nuclei in Cases of Tuberculou~ Meningitia Treated with St~eptomyein. Rlgdon. R. H., Tabercnlolog~, March, 131. Frequency o£ Cahoot nf the Lung in all Malignancies Studied at Antop~y. ~igdon. R. H. and Kirch,ff, IIelen. Souther, Med. $. 44: 30fl, 195L 132. Accuracy of Death Certifieatvs for Establishing the Ft'equency nf Cam*er as ~hox~m by Autopsy. Rigdon, fL ~. and Klrt'hoff, Helen, Texas Biol. & 5Ied. 9 : ~52, 1951. l:t3. S(me Complications Observed it~ Easo~ of Tuberculous Menlugitls Treated xx5th Streptomycin. Med. Rec.& Ann. 45: 52~, 195L 1~4. An Anomalous Potency Ariery Arising from the ~flmnnary Artery. Croak, E. 8., Sinclair, ,~. G., and ~tgdon. g. H. Am. Heart J. 42: 1951. 135. Some Toxic lInnifo~tafions of Dn~g ~heragy from a Pa~ologie ~igdon. R. II. Pre~ente{l April 2, 19~1 to the Medical Service Offievr Basic Coupe. Army Medical ~ervlce Graduate Sch~l, Army hledical Center. Washington. D.C. 136. E~'t o£ Hy~rvitaminosis A and ~ovttaminnsL~ A on the Sla,h,tnn a Duck. ~gdon, R. ~. and ~nde, .1. O.. Arch. Petit, 52: 299. 137. Pathologic ~sions la the Nervm~s System of the D~u~k Fed ~ ~ation Deficient in Vitamin A. Rigdon. R. H., Arch, Path. 53: 239, 1952. 135. A Con~deratlon of Some of th~ ~'heorles Relath'e to the Eti,~lo~' Inciden~ of Lung Ganeer. Rl~don, R. II. and Kirchoff, ~elcn, Texan ~pt~. Biol. & ~Ied. 10: 76.1952. 139. ~Iyeottc Aneu~.sm (Cryptoco~o~:ls) of the Abdominal Antra. Rt,l,,~rt of Case with Autopsy. Ridgon. R. II. and Kirksey, O. T., ~. ~. Surg. 480, 1952. 1~. Pancreatic Fibrils in Due~ on a ~utrltional Basis. Mlllt, r, O. ~,al ~trtd ~igdon, R. ~., Pr0e. 8oe. Experi. BioL & Med. 80 : 165. 1952.
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I08~ 1,11. T,,xol~hl<mo,~<i~ in Texas: Report of a Ca~e with Autopsy. Corpening, T. .~hmd~rl,lgt,. I". A., and ~igdon, R. H.. Texas St. ,T. M~I. 4~: ~]9, 1052. 142, Path,do~le Charact,,rl,<tics of ~tlugu~ Disease as Observed at A~topsy. Rl~d,m. R. IL, Tcxa~ St. ~. 3ied. dS : ,1~0. 1952. 1,13. Frcq~lenc7 o£ Cancer in the White and Colored ~ces a:~ Observed at Aut,p:y b~4ween 19~0 ~nd 1919 at the Medical Drnn¢~. Rigdo~, R. ~., Klr~h~fff. Helen, and Walker, Mary Lee. Texas Rep. Biol. & 14L A Con 4d 'ration of ~ardiae Hypertrophy in Slekle Cell Anemia. Stembridge, V. A. and Itlgdon, R. H., Southern ~ied. J. 45 : 948, 1052. 115, T,hmr ~ P£odnct, d hy Methylch01anthrene in the Du~. Rigdon, R. H., Arch. l'ath. 54 : 4 9, 1952. lll$. Bl,,.~d V,lum*~,~ of Packs Uslng Human ~erum Album~ ~abeled with Radio- k, dln, 11~¢5~0. For~l, 0~car W., HcConnell, Kenneth P., and Rigdon, It. H., Prt~,. Stm. Ex~rl. Biol. & ~[ed. $1 : ~99,19~2. I~7. EfS,ct ~,£ Phenylhydrazir~e ~ydr~hlorlde on Pl~mod[~ Lophurae I~eefion luth, Duel;, Rigdoa, R. H., 3Iic~, Don W., and Breslin, Dorothy. Royal ~oc. Trop. Mcd. & Hyg. 47: 70, ~953. 14S. 310rph~dogie Changc~ In the Dog's Adrenal Gland ~ol[ow~g ~o~a (2~38). ~tigd~Jn, R. ~. and ~wann, ~. G., Proc. Soc. Expel. Biol. & Med. 82: 1 i9. Acute A~emia Pxodu~ by Ph~y~ydrazine ~ydroc~otide ~n ~e Duck : Ob- r~rvatkm~ on Nuclea~fl Ery~ro~ytes I~, V~vo. Rigdon, ~, ~, Texas BIoL & Med. ll : ~10, 1~0, ~ibrvma Arl~-;iag Item Feather ~ollicles of Ducks ~ollow~g ~cal cation ,ff Methyleholzm~rene to the Skin. Rigdon, R. ~, Proc. Soe. ~lmri. Bb)]. & Mcd. 83: 34, ~953. 15l. Inh'ata~culor IAfe Span of the Duck Red Blood ~lls as Determined by l~dh, Active ~cleni~ ~Ie~mnell, Kenneth P., Po~man, D. W., and Rl~d,~, R. H., Proc. ~oc. ExperL Biol. & M~. 83 : 240.19~3. 15~. A I¢~vt,w of th~ Effects of ~elenium on the Hemato~oiefic System. Walker~ ~I~ry Lee ,ud Rigdon, R. H., T~xa~ Rep. BioL & Me~ ]1 : ~7,1953. 153. A lt~ldb~-Transi)~rcnt Po~t-)Iortem Table. ltigdon, R. H. and Freund, A. Texa~ Rep. Biol. & Med. ~ : 512, 19~3. 1;4. Inhild~l.n ef ~Ia~utrlti~a of Duck Erythrocyt~ by So,urn Selenite. IL II., Cra~, O., and McConnell, Kenne~ P., Arch. Pa~. ~6: 374, ~9~. 1,5. Sm~l;i~ and Cancer of the Lung~Let's Review the Fac~. Rigdon, R. and Xirclmff, Helen., Texas Rep. Biol. & Med. Ii : 715,1953. 25~L Culdllary Permeability in Areas of Iuflammafion. Rigdoa, R. H., Revue Cauadien~e De Biologic 12 : ~7,1953. 15Z I'rha~r~ Di~,m<e Pm~ce~ea as Ohserved at Necropsy in 353 re~atHc Cases Examined between ]94~ and 1952 at ~e Medial B~an~ o£ the Universi~ ¢,~ T~xas. Thom~m, M. and Ridgon, R. H,, Texa~ Rep. Biol. & Med. 12: 15~. ~p,~t~I,~u~ tCegre~'sion of Neopla~m~. An Exper~ental Stu~ in ~e Duel I¢~g~mn, I¢. H., Southern Me& J. 47 : 303, 2954. 159. Tb~, Physician, Crime, ~d the Court. Rigdon, R, H., Texas Sa Y. M~ 3 : 5~ua~ 19Y~ l~ S[,mtuneou~ Occu~enee and Regression of Heman~omas in Chickens. R~- don, I~ H., ~,~ ~ou~wv~te~ Vet. 7: 311,1954. I~L SmokI~? Habi~ of College Students In T~. K~ehoff, H¢I~ an~ Rigdon, R. H., Te~w¢ ~ep. Biol. & Me~ 12: ~2,19~. ~i~2. A~mia Pr,:.]aeed by Chloramphenteol (Chloromy~fin) in ~e Due~ ~gdon, I¢. H., Cra~:~, G., and Mar~in, Norton., Arch. Path. 58: $6, 1954. 1~3. IIb-~.b,gic ~tudy of tl~e I-;one Marrc~w In Normal W~te Pekin Ducks, Crass, G. :rod Rigdon, R. H., Arch. Pa~ ~S : 159,1954. 1¢~& E~[,)rlm~:,ntal Production of Squ~ous-Cell Carc~omas in the S~n of Chlchen~. Itlgdon, R. H. and Brash~r, Doyle., Cancer ~es. 14: lt;~. ~cl,ntJfle Pr,,:,f of the Reaction of the Body to In~u~. ~gdon, R. H., Law arm Mcdlcln,, A Symposium, Journal of Public Law, 3: 61~, 1954. lt~$. l[.b~ .f Anoxia in the Pa~hogencsk~ of the Lesion in Acute ~Ialaria. Ri~r,b n, R. IL, Vmc~; Congress Internafionaux de Medectue Tropicalo ~.t d, Paludb~me~ II : 186, 1954. 1#~7. Ef~,,ct of Yihtmin B~ on Selenium Poisoning in the ~ Rigdon, R. H., O, ueh, J. R., Brashe~, Doyle, Qures~, R. Taher, Arch. Pa~. ~9 : 66, 1033 168. Consideration of the 5Ieehanism of the Anemia Produced by Chloramphenleol in the Duck. Rigdan. R. H., Martin, Norton. and Crass, G., Auttbiot, Chemother. 5 : 3.~, 1955. 169. Spontaneous Ro&~ession of Hemangiomag: An Exl~,rimental Study in the Duck and Chicken. Rigdon, R. H., Cancer Res. 15:77, 1955. 170. A Consideration of ~e Mechanism o~ Refieuloeyto~: An Ext~,rlmental Study in the Duck~ Rigdon, R. H., gmiley, David, Cra~:~, G., and Martin, Norton., Tex~ Rep. Biol. & Med. 13: 170, 1955. ]71. Where Cancer If ~e L~g Occurs in Texas. Rigdon, R. H., Kirchoff, Helen and Martin, Notma., Texas Rep. Biol. & Med. 13 : 1¢e2, 172. A~ypi~l Cirrhosis in ~e Duck Produced by Met~vlcholant~ene. R. ~., Am. J. Path. 31 : 461, 1955. 173. My~o~oridia in Fish in Waters Emptying into G~f of Mexico. Rl~d,n. R. ~. ~d Hen~cks, ~. W., 5. Parasitol. 41 : 511,1955. 174. ~iamine Deficiency in Sea Lions (Otaria, ~fornla) Fed only Frezen ~sh. Rigdon, R. H. and Dmger. G. A., 5. A. V. M. A. 127 : 453, 1955. 176. Neurogenic ~ors Produ~ by Methylcholan~ne in the White Pekin Duck. Rigdon, R. ~, C~cer S : ~, 19~5. 176. A Pa~olo~c Study of Vitamin B~ Deficient Chick Embryo~. Fer~mson, T. ~., Rigdon, R. ~., and Couch, 5. R. Ar~. P~th. ¢~ : 393,1955. 177. Cancer of the L~g before 19~0. A Hist~ca[ Review, Rigdon, R. ~., Texas Rots. Biol. & M~. lg: 993,1955. 178. A Comsideration of the Mechanism by which ~quamouu-Cell Carclnomat,id ~mors in ~e ~cken S~n~neou~ly Regress. Rigdon, R. H, and ~ooha, ZIurray D,, Cancer Res. 16 : 246,1936. 179. Ca~racts in Yi~m~ E Deficiency, ~ Ex~men~d 8~dy in the ~rkey Embed. ~erg~on, T. M,. Rigdon, R. IL, and ~uch, ft. R., Arch. Ophthal. 55 : 346,19~. 1~. Smoking HabI~ of 21, 612 Individuals in Texas. Klrchoff, Helen and Iflgdon, ~ H., I. Nat'l Cancer I~t. 16 : ~7, 1956. 181. Train and Cancer. An Ex~rimental "Study ~n ~e White P~kin Duck. ~gdon, ~ ~., Arch. Path. 61 : ~3,1956. 182. ~ibroela~osis in Adults. Guraieb, Sa~ra R. and Rlgdon, R. ~., He~t $. 52 : 13S, 183. Frequency of Caner in ~e White and Negro. A study Ba~ed u~n ~. K~ehoff, ~clen ~d Rlgdon, R. ~., Southe~ M~. Y. 49: [~34, 1956. 1~. Carlnogen~is in the ~tte P~in Duck. Rigdon, ~ H., Texas Biol. & M~. l&: 508, 195~. 1~. T~o~ Induced in Sk~ ~thout Pallicles. An ~perlmen~l Study- in ~o Duck. R~don, R. H., Caner Res. 16 : 8~, 19~. 186. ~emangiomas, ~ Ex~rlmental Study on ~e Duck. Rlgdon, R. ~,. Walker, ~ack, ~d Teddl[e. A. H. Cancer 9 : 1107, 18Z L~phoid hyl~rplasia Produ~d in the Skin of Chickvrm by Mcthylcholan. ~ene. Rigdon, R. ~., R. E. ~. 2 : 40,1956. l&% Th~oid in B-~ Defldent C~: ~bD, o~. Fer~gon, T. ~I., R. H., an~ ~ueh, J. ~, ~docrhmlogy 60:13,1957. 189. A Conslderagon of 'Smoking and Cancer of the Lung with a Review of ~terature. ~don, ~ H.. Sou~ern M~d. Y. ~ : 524, 1~. ~istologic Study of tho Skin of Hairless Ameri~m Deer Mice (Peromyscu~ Maniculatus gambell). Rigdou, R. H. an4 Packchanian, A. A., Arch. Path. CA : 210, 1957. 191. S~ophotome~le Exam~ation of Cirrhotic Liver~ for 3.Methylcholan- threne from ~Ite Pekin ~cks Treated with this Carcinogen. Rigdon, R. ~., Eason, Harold, and Neal, ~ack, Texas Repts. Biol. & Md. 15: 1~57. 192. Cancer of the Lung and ,Smoking. A Review of ~ome of ?he Data, R. ~., Pr~eedlngz of 1957 Seminar, Aug. pp. ~67, 1957, Nath, na[ clation of Coroners, Louisville, Kentucky. 1~. Effects of Gossypol ~n Young ~hickens with the Production of a Cerlod-ltke Pigment Rigdon, R. H,, Crass, G., Fergu,~n, T. 3I., and ~ouch, ~. Arch. Path. ~: 2~, 1958. 194. Smoking and Disease. A Study Eased upon 12,050 tndivldual~. Rlgdon, R. ~. and Klrchoff, Helem 'r~xas Repro. Biol. & Med. 16: ]]6, 1958. 195. Air Sacs in th~ Turkey. Rigdon, R. H.. F~rguo)n, T. M., Feldman, G. and Couch, Y. R. P~ultry ScL 37 : 53, 1958.
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1034 link Sl,-,nlaneom~ Hendas In the Axllb] of th~ Turkey. RJgdon, 1¢. H.. T. M., 1,'~ldman, O. L,, S~elza~*r~ H. l)., and Couvh, J. R., Poultry 37: 1~9, 1D~8. llU, 'Funmr~ Ind~lccd hy Methylcholanfl~rene in the ~rkey. Rigdon, R. ~., T.xa~ Rrpt~. Biol. & ~Ied. 16: ~2, 1958. J$~g, Cam:er of ~he Lm~g from l!~) to 19~40. Rigdoa, ~ IL and Kirehoff, Surg., Gy~h & Ob:~t. lr~7 : 105, 1~9. ~]ff~,,'¢ ,ff DJni~r.ldlemd on ?~ns of Chick Embryo. Feldman, G. L.. Ferguson, T. 5L, ltlgdon, R. H., Reid, B, L., Cro~s, 5L S., and Co~¢h, Y. R. Pr0c. ~o~'. EM:~rl. Bh~l & ~[ed 08: 6~6. 1958. 21~..~ S[lldy ~,f t]l~:~ Mt~eh~Hllslil 0f the Exl)erimen~lly Induced Pendulous Crap In Hm 'P~rkey. Rigdon, R. ~.. Fergusoa, T. 3L. Feldman, G. L.. Wheeler, II. O., tu~4 C,*~wh, $. R., Am, J. VeL Res. 19: 6SI. 1958. 2~1. Fungi in the Cr.l~ of th~ Turkey. Manfro. A. S.. Wheeler. H. O.. Feldmau, G. L. Rlgd~n, R. H, Ferguson, T. M., and Couch, ft. R., Am. $. Yet, • 2~r2 'l'nnlm:t and Cancer: A Review of the Problem. Rigdon, ~. II., Southern ~o3. 2r~ Viva P~)duedon of a C~roid-Itke Pigment in Chickens ~iven Gossyl.oL l~lgdoa, R. H., Fergustm, T. M., Mohau, V.S,, and Couch, J. R., Arch. Path 67 : ~, 204. Cataract:~ Produced by Di~li[rophenol, An Experimental Study. 2igdon, 2, It., Fcldmmh G. L., Ferguson, T. 5L, Reid, B. ~., and Ca,O~, J. Arch. Ophthal. 61 : 249, J959 2~3 Kerat,ac~(nthoma: E~rimentally Induced with 5Iethylcholnnfhrene in the Chlck~,n. Rlg,lem, R. tL, Arch. Demnat. 79; 189, 1959. 2(~k Cuncvr of the Lung-Svx Ratio. & Review of the Problem. Kirehoff. ~elen lind I~g,l~m. R. H., Te.xas Repts. Biol. & 5Ied. 17 : G~t. 1959. 2~Z Meehanl:~.i .f the Removal of Fluid and Paniculate Material from the R,'~-:plratotT Tr~.(et of ~e Duck. Rtgdon. R. ~.. Ar~. Path. 67: 21~. 1959. 2(*~ The R~,,plrate, ry Syst,~m In th¢~ Normal White Pekin Duck. Rigdon, R. II., L~.~I~, lt,~mgnlti.n of T~auma as a Cause ~f Cancer. Virginia Law Weeldy 11, 21*t Erythremic 5Iyelosl~. Bon~ch, Klaur. Rigdon, R. II., and Phillips, Charles. 'l'~,xa:.~ R~,piu. Biol. & Med. ~7 : ~$7, 1959. 211, Catarm+t~ in Chlcken~-~ with Lymphomat+.~sl~. Rigd,m, ~ ~. Am. J. Vet. Res. 20: ~17, 1959. 212. The i)harmar.logical Action of Autonomic Drngs on the Eye of Fowls. Cl,m:.~e. ~lehht E. and Rlgdon, R. IL Texas Repts. Biol. & 5fed. ~7: 305, ~¢m,q~..T.R. Am. ~. Yet. Res. 20: 96L 19~9. 21L Effvct *-~f 5fethylrholanfl~renv on ihe Respirato~ Tract of the White Pek~ Dm'h. Rlgdon. R. II,, Arch. 68 : 57& 1959. ~15 Effe~4 of Tol,:,~,o C.ndensaCe on Resl)lratory Tract of White Pel~ RI/,lem. R. H.. Arel). P:ith. 69 : ~. 211k Amyl,ddo~41;-Ext~rlnmntal Prcaluethm hJ Ducks with Methyleholm~threne. Rlgdon. R. H.. Texas ReDt~, BIr~L & ~Ied. 18 : 98, 21L Itl~t.lmthogeneMn of "Keratoaea~thonm" induced with methyleholauthre]~e. Rigd.n.R.H. Arch. of Derraatology. 81:381-a~l, 1960. 21,% tIl:::t,lmtlmlo~- of anima~I reaction to Dlgment compounds-chickens. The eh(,ml~4ry of go~ypol. Rigdon. R. H. Natl. Coltons~ed Prod~wt~ A~n. Ine. 211). rfhe vficet of nmthyh,holanthvene on the gastra-int~tinal tract of the duck. Rig,fern, R. H., T~x. Rep~. Biol. & 5led. 1,9:27~-2~% ~960. 22,. Ex~,~rlr, wntal t;tudics on vataraet formation. ~erguson. T. ~f.. A. A. ~m~, ,?. R, Cm~ch, G. L. Feldman and R. H Rigdam Am. J. of Ophthalmology. 4, : 79-Sl. 5fay 221. Bl,..l aml btme marrow differential e[~lmts on the rot. Rigdon. R. ~. d.lytl Crav;~ and L. R. Rtdmrdson, Texas Rots. Biol. & Med. 18: 4SG ~22. Cmwr,,tion,:; In the bladder of male rats. Rigdon. R. H. The Journal Urol,~gy, Si : ~07-310. }I.. T. 5I. F~,rguuc, n, 3. R. Couch..~ortc.an Z. of Veterinary Res. 21:97~ 1035 224, A long-term feeding study of Irradiated Iood_~ using rata as experimental animals. Richardsou, L, R.. S. d. Rltchcy and R. H. Rlgdou, P~u)(.eed~gs. Vol. 19 : 1023-102Z 225. Muscular dystrophy: Slmntaueous ,)coherence In ducks. Tex. Rt,~t:~, and Med. 19: 167-177, 1~]. RJgdor~, R. H. 226. ~ulmon~ry ~eoplasms producod by methyieholan~rene iu the white duck. ~lgdon, R. ~. Caner Re~. 21 : 571-574, 227. Tumors after ~planta of me~ylcholanthrone in ducks. Rlgdon, R. H. Yy~ Omer. A~ch of Path. 71 : ~1-¢~ 196L 228. S~0ntaneous muscula~ dystrophy in the white Pekin duel:, Rig,lea, American d. of Path. 39 : 27q0, ~;1. 229. Spontaneous oeem'ring m~srular n~'roscs and eneephalomalacla 1. tlte turkey. ~igdon, R. H., T. 5L Ferguson m~d J. R. ~oueh. Poultry Sol. 7~771, 1~1. 230. ~endulous crop in the ddeken--a pathologic :~tudy. Rigdon, R. H., Journal of Yeteri~ary Re,earth. 22 : 37~38L 23L Amyloidos~, slmnt~meous occurren~:e in white Pektn ducks. R, H. Rlgdon, 5I.D., American Journal ~-,f Pathology, 39: :~6~78,1~;1. 232. Cancer of the lung~193(~lgl]0. A Review. Rlgdon, ~. H. and Ktrch¢,ff, Helen. Texas Rept. Biol. & Med.. 19 : 465-513. 1~1. 233. ~sions in DueLs Given ~Iethyleholanthrene. Rlgtlo~, ~. H. antl S. M. Ar~. of Path.. 72 : 455~64. 196L 234. ~'ramaa and Cancer: A Helatlons~lp Based uptm Cell ~Iutatlon. Rig,Ion, ~ ~. 8auth. 51. J., 55: 341~, 1U62. 235. 81mntaneous Occurring 5Inseular Necrosis in the Chicken. Rlgdo~, R, Fergus~m, T. M. and Couch, ~. R. Paul. Sct. 41 : 39~t]fi, 236. Fatal Chickenpox: A Review of the Literature and a Rep.rt of a Ca~:e. Rigdon, R. H., Sho~aii, S. H. axtd Garber, E, P. Am. Prac,, 13: 292-302, 1~2. 237. 51uscular Dystrophy in the Chlcl:en. A Pathologic Study. Rigdon, R. Fergus(m, T. M., and Couch, J. R. Texas ReDt. Biol. &hied., 2t) 453. II~2. 23S. Spontaneuosly 0~nrrlng 5Iuscle Necrosis an4 Amyloidozls ta the White Pekin Duck. Rigdo~L R, H. Am. S. Vet, Res,, 23 : 1057-1~, 239. ~ect o£ Uzethane on Pulmonary Tumors Produced by 5Iethylch.hmfltrene. Rig(Ion, R. H. Texas Rep/s. Biol, & MeG, 21 : 07~73, 240. Pu~mmry Leuions In Dogs from 5Iethylcholanthrene. Rigdoa, R. tL and Corssen. Gunler. Arch. of Path., 75 : 3$~k~1, 1963. 241. Cflrclnos:trcoma of the Stomach. Argannra:~, Edwardo and Rlgdon, Gastroent,. ~ : 322-329, 242. Vital gtatistics ~d the Frequem'y of Disease. Rigdon, R. H. aml Klrchoff, Helen. Texas State J. Med.. 59 : ;::17~24, 248. Absorbing and Excretion of ~enzpyreae. Obserratlons in the Duck, Chlekvn. Mouse aud Dog. Rigdon, R. H. and Xcal, Jac., Texas ~epts. Biol. Med., 21 : ~47-261, 244, Cliulcopatlmlogic Conference. Ri~dan, R. H.; Harrison. Wll~-,n: ~leOlure: Chen. 3nlian: Oree~, Win. O.; and Mazuelos, D. 5I. Texas State S, ~Ied,, 59 : 707~11, 29~3. 24~. GalaeIose ~toxtcatiom Pathologic' Study tn the Chick. Rlgdt*n. R. H. Z. R., Croger, ~. R. and Ferguson, T. M. Ex~orlontla, 19:8~-357. 1963. 246. AbsmOtioa and Excreth,n of Benzpyrene in the ~ekroaeh kmerica~m) Rlgdon, R. H. and Neal, Sack. Ex[~rlentia, 19:474~1, 19~3, 247. Perosiu SoooBdsl'y to Naturally Ocvurrlng 5lusvle ~ecrt~sb~ ht Iht, Rig(ion, R. H. Am. Z. Vet ~e~.. 24 :~030-~057, ~963, 248. ~eet of Vi~in E on Spontane*)us-0ceurring Necroses In Striated of Duek~. ~gd(m. R. IL J. Camp. Path. & Theral-~,, 74 :S~S9, lfff~. 249. Flonr~scenee of Chieke~ sad Eggs Following the Fe~llng of C,TstaIs. Rigdon, R. H. a~d Neal, dock. Tpxn,~ Rept. Biol. & Med., 21 250. Effect of Carcinogenic Hydroearb.ns on Growth of 5Ilce, Rigdt,n, R. }L and Giannakos, XiO: J. Arch. of Path., 77:198-204, 251. Ahsar~tion and Excretion of Benzpyr~n~ wheat fed ¢o Mice, Rtgd.n, R. II, and Neal. Jack. Texas ReDt. Biol. & Med., 22 :]5¢~164, ~Sprlng, 1964. 252. Muscular Dystrophy in ~Ian and 1)uek, i C~mparatlve Study, Rlmhm. and 9roger, Glenn. ;~ci of Int. MeG, 113:5~¢.-597,
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1036 25~{. Radiob~gle Le~lon~ in white Pekin Ducks ~Yith 3Iu~eular Dystrophy. ~gflon. It. H. aml ~'~h~elL,% M. H. Jour. of Com~. Pa~. & Therap., 74(2) :20~204, 25 L llt:a.h)~b' Challg).'u of 5luscles of Chickens wt~ Malformed Fee~ and Le~ IU~d.~, R. H. Ara. $, Vet. Rc~..25:76S~73, 255. ]~tS:ct uf Feeding Be~pyr~e ~n Rct)roducflon in the ~at. Rigdon, ~ ~., aml Rvnnvl:~, E. G. E~verientia, 20:22~9. ~9~. 2:~1 Ruptur- .f Spleen In Ducks with Amyloidosis. Rigdon, R. ~. Arch. of Path., 2~7. bpontanoou~; Occurring Mu~:eular Dystrophy in ~e white Pekin Duck. Rig- d-~L I{. H. 'F~,x,~ Rept. Biol. & Meal., 22(1) :930-939, I~4. 25'4. ICifvc[~: oY F~:cdi~g ~cnco(a)pyrenc on Ferti~ty. Embryos, and Young Mice. Iti~*hm, R. II, and Neal, ,Turk. J. Natl. Cancer Inst., 34:297~0~, 1965. 2,~9. The Arthrogryp~sb~ Syndrome in Chickens, Clinical, Pathologic, and g~,t~:q:raphlc ~tudy. Rlgdon, R.~., Schreiber, 51.~., ~nd Levy~ Abe. Arch. Path., 21i0. Torticullis. Spon0meous 0c~rrence in Ducks with Consideration of Its I~elafloa [,~ ~mt in Man. Rlgdon, R.H., and Sch~eiber~ )LH. Arch. Pa~., 80: 2t11. Effvct .f In~atrucheal In$~.tion of Benze,(a)pyrene on Ducks. ~gdon, IL. and Nval, Jack. T~,xas Ropt. Biol. Meal., 23:49~06,196~. 2~;2, T~,,~II~, in the Sterile Hybrid Duel A Histologie and His~o~emi~l Study. R#(~d.n, R. H., and Mott, Charleu. Psi. vet.. 2:55g-565, 19~5. P~;:L Rlckctt";tal Infl,etlong in Texas, Ca~e Report of Spott~ Fever. Rigflon, ~.H., ]~**< Q. T, Ir.m~, J. V., and Waggcner. J. D. T~as S~. J. ~Ied., 62:43~9, ~:t. ~4I,(mttme~u~ ~fu'~cl~ Netted;is in Obielc~ Fed Adequate and Deficient Diets. RIgd,m, it. lI., Schrelber, BL H., and Richar~n~ L. R. Am. ~. Vet. Res., 27 : 2i~. *~u-:trle Carcinomas and Pulmonary Adenomas in Mice ~ed Booze (.a)Dyreue. ]Ugdoa, R, II., and Neal, Jack. Tex~ Rept. Biol. ~led., 24:19~207, 1~6. 2eL Tamor~ Produced by Methylcholanthrene tn the Respiratory ~net of Whih~ P~TAn Dark. ~igdon, R. ~. Lung 'l~mours in Animal~, Procoodings of tl,, Conf,,r¢,nee hehl at Perul~a, June 2~29, 1~, ~ited by L. SeverL ~e ~d~,~t rff C~eor Ib~:~,ar~, Perugia, I~qly, 2t$T. Horodlh]~ My(~pathy in the White Pekin Duck. Rigdon, R. H. Ann. Ac:td. SvL, 138:2~t8, 21~S Non-Natrltional Abnomnalities in rhe Fowl. ~igdon, R. H. Proceedings 21st Am~ual Tega~ Nutri~o~ ~afcrence, Oct. 1~21, Eollege ~afion, pp. ~6. 2~;#. lClfl,Pi eft F~,ding Bongo (a)pyrene on Growth of Young )Iice. Rigdon, R. and No:d, fftlC]L T~xnu Rept. Biol. 5[ed., 24:473~78, 1966. 270. Eff~*ct of ntacI~ ~-m the ~pontan~usly ~cc~ring myo~athy in ~e ducl:. Rfgdon, R, II. Texas RcO. Biol. 5Ied,. 2~ : 655~58,1966. 271, N~-~plw~mu in ~h~rile hybrid duck~--a melanoma and ~ teratomas. Rtgdon, 272. The mffrl~ve value of moldy grains and pro~in eoncen~ates for growth .f }-,,airy. Rtehurd~nn, L. R., S. Hayes and ~. H. Rlgdon. Po~flt~ Sei., 4~: 273. Amylold tn tim liver of dueL% Rigdon, ~ H. Poultry ScL, 46 : 69~705, 196Z 274, Gtmtld:¢ ta hermaphroditic dm:k~;: A pa~ologic study. ~igdon, ~. H. Am. 275, ~lyco~lde effe[,t upon membrane enzymo~ of erythrocytes and muscles duck ~O'*-*pathy. Brown, ~. D, ~. K. Chat¢opadhyay, A. Patel and R. Rtg*b,n. E~rlenfla, 23 : 52fi-5~% 1967. 27~t L~,ulw~-~ia iu mice fed benzo(a)pyrene. Rigdon, ~, ~, ~ack Neal and ~ohn Mae~;. Tcx~m R~:p, Biol. ~Ie.d., 25 : 422~31,1~7. 277. Aeub, myopathy in emb~T~s and newly hatched chicks. Rigdon, R. H., Arch. I-'~fl~., ~t : ~33~37, 1967. 27~ Pippit~g muscle of lhe chick. Clinical, pathological, and enz~a~c study. Rigd,m. I5 ~-L, H. D. Brown, S. K. Chattopadhyay and A. PateL Arch. Pafl~, ~ : 20~212,196S. 279. Ga:~tri,: tunmr:] in mice fed benzo(a)pyrene. A quan~atlve study. Neal. Jm'k ~md R. IL Rigd~)n. Texa~ Rep~ Biol. 5Ied., 25 : 553~57, 2967. 2:-ill N,,tqt]tt:;mq ill lalce nt'onatally inoculated with rat ~ymus antiserum and fl,d lwtt~, (a)pyre, no. ~igdon. ~ ~.. Jack Noal, D. &nig~tein and L. Xnig- ~ hqlt, Ccmccr Ro~:., 2T : 231~--2323,19t;7. 1037 2bl. Spontaneously oceurriug scolio~is in the white Pekin duck (A~t~:t rltynehos). Rig(ion, R. H., and John Mack. ~m. ft. Vet. Rc~., 29 : 10St-10ST, 1968. 2S2. Malformations o~ vertebrae ia ~terHe hybrid duehling~. ~igdun, ~, II. Dis., 12 : 202-207,196S. 283. Aggravation of cancer by trauma. Rigdon, ~ H. ~'rial Lawyer~ 2: 14, 2~ A~loid in ~e w~te Pekin duck: a fluorescence microscopic ~tudy. Rlgd,n, R. H. and Philip Schwartz. ft. ~. Geriat. See., l0: 285. Spontaneous occurrence of scoliost~ in the chicken. Rigdon, R. ~. and John Mack. Avian Dis., 12 : 53~543,19G8. 2S6. Necrosis in the "pip,lag" muscle of the chick. Rlgdon, R. H., T. M. F,~rgu. son, J. L. Trammel, J. R. Couch and H. L. Bermaa. Poultry Sol., 41 : 873- 877,1968. 287. Chromosomes of the sterile hybrid duck. 5Iott, C. L., Lillian L. Lochhart aml and R. H. R~don. Cytogenetics 7 : 403~12,1968, 2~. Rela~ons~p of leukemia ¢o l~g an~ stomach tumors In 5iice fed Benzo ( a ) pyrene. Rlgdon, R. ~. and Jack Neal. Prec. See. Ex~,r. Biok %h,d., 130 : 1969. ~. Effect o~ hormones on gonads o~ stetile hybH~ duck~. T~xas ~ept. BIuL Med., 26 : ~I, 19~. Rigdon, ~. ~. 2~. Ci~rette smoking and luag eancer~ a consideration of thia ~igdon, ~. ~. Southern Med. $, 62, 232,1969. h@. S~'~=~. ~an~ you~ Doctor. ~. Ec~rdt? hlr. ErKm~DT. On page 5~ D~:tor~ you refer to tlm Doll ~md Hill study. Couk~'t it bt~ said a littl~ bit easier that both those huvin~" luu~ c~cer and those aot h~ving lung cancer i~le at ]u~ about th~ same rate? .~bout a third of them with lung cancer did~ about two-thlrd~ ~em without, do no~? Dr. RIODON. Well~ I ~ess so but that is just what they ~tid and I am just gong by that. ~lr. Eo~Dr. What it z'eall) ~eans ~s flza~ thej, found that percen~ of t.lO.~e who did have ]no~ c~nc~r inhaled and of those with no lung cancer 66.6, so there is so l'i~le difference ther~ that h~g whht is inhaling and the indefiniteness o~ that you w,ulda'~, realh' gi~e ~ly sigmificauce one way or other to flint proposition, woMd Dr. Rro~-. Wcll~ I tlfink there is a lo~ uf difference betw,,en" and 66.6 myself. I am no statistician. ~ wouldn't know about thaL ~. EOK~rA~¢Dr. One thing thu.g bothers mc here is if in a group nf smokers found who had lui]g cancer there were 34.6 percent ,)~ who did no~ inhale, tha~ meaixs th',:tt there were 65.6 wl;o dicl inlmlo ~ your ~gure i~ says of those with no lung cancer 66.6 did inhale. ~ow, why not use comparable stati~.ics ~ There is only 1-percent ~fference actuull3,~ bet, ween those ~wo fi~res; is that no~ correct ~ Dr. ~ono~. OK. The thing i:~ that ~f we ~e going to conelm]~ that inhalation of cigare~es is the cause of cancer ~en we are to ~d u lot of ~ople that iMmle ~d don'~ lmve l~ cancer and me it is jus~ as im~o~ant to establish why people smok~ and doa'~. have lung cancer a~ it is the reverse so that welfare to think ab,,ut it ~rom both sides. There is no use to take one side and not take t]~e other side. ~. EC~.¢~DT. Doctor, I agree with evexTthing you say, but don't thit~ thee fi~.~res ~bow anytlfin~. Dr. RIODO~. Okay, okay.
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103S .~[1', ~;~ %TTI,:I{I"II';T,D. ]-)O yOU have any other questi,uus? 3I).'. :EcJ~l[.uu}r. ~o t[uo~tions. Mr. S.vrrr:mq~¢~,D. Mr. Brovldll? Mr. S vrr~,:nvu:LD. Mr. Preyer~ 3It. I'u~m~. I galht,r from that Sou do~Ft, put ~ lot of stock in ti~tieal ,:-::q,eiation as proving the eause-aud-effeet relationship be- Dr. llmuox. That is correct. Mr. P~¢~a'~m. Of what ~ignificance is it tha~ experimental attempt at :tldlmtl inhalations ]lave constantly and consistently faile4 to sup- i~.r/tlm ~'falis/icM assoeiation~ Dr. R~aoo~. Well~ we fi~q~re that, if we caa produce exl~rimenta] h':~iol~ th:tt will help us to(~-ar, d the possibility of something oeetu,r~g i~t man--it canlmt 1)e predicttd- that becauseqt ~ecurs ha a'mouse or a l':tl 0~ :t ~uinea pig, that it is going h~ take. place~ 19u~ it ~ just ;t ]ink in the t'h'ain lli;tl, helps us move ~ovward. That is all it. meatus. Me. Pm:rr:lt. But you have listed a number of possible eases of hmg v,n,:.~r, I g:ttlmr, to make i~ clear that you ~oel de~fitely tlla~ eig- ttlvtft~ :q,oldn~ ~ms not heen showu to ~¢ the cause of lm~g cancer. Dr. thooox. I hat is vorrect. Mr. I)lm~t. IIow about a cause~ ])r, I-~I(~DOS, It ha:qt't been proved to be a cause as far as I tim i'l II h'PFIII~d, Mr. lq~¥~a. So that auy expeeimental efforts would help us to e]imi- I h'. 1-htu,)x. ~t wouhl help u~ aml the reverse would be more sig- nili,::mt. I~ we could get these things~ d[m't you see~ then that woui'd ~iv(~ u-~ m.rc lea~:~ to work on in trying to establish t]x~e possibilities. ' Mr. ])~t. ~ Imnk ~'ou~ Doctor. Let me juse ask one more. Do you share. Dr. Fur~t?s ophfion that a~uming tha~ these problems are t~,ttled flint tha~ interferes s~,riously with pt,ogr~ ~th &e i~seareb /h:ttyou ~tt3- w(~ need. Dr. Itx,;~os. I do. Mr. I'm:r~.:m Thank you. Mr. S.Vm:~WmUD. Mr. Watson'~ Mr. WATSON. Thank you, ~£r. Chairman, and Omnk you, Dr. l.ligdon. . , . ., I was quite impres~:ed with th~ man) pages hsted o~ the various ]i.:ation~-flmt ydu either individuall~ br with others have prepared ,ml I uot,3 t, ht, r,~ are f:Olne 290 differen~ publications aad so ~orth in uhich you bav~ either authored ther~ ~r collaborated with o&ers, one a t~tudy of the frequency of cancer in ~,o00 routine autoi)sies per~ot:med ,r~:,r :t period of 43 years at the University of Texas )~edieal Branch. So~ it, i~ quite ob~,ious time through e~po~re alone that you h~ve ]m(( c :omitl~:.rable oxporieuc~ i~t this p:trficular field. D(~tor~ during the t.,rlicr pagc~ of your/eslimony, you ~ared me a lilt whea you po~/ed ,rot where the tb~gree of death ~d the attributable caus~ o~ de~th was u ron~ ht so many instances... I was beginning to wonder whether the lffc, lieal vcience was exact, enough really to accomplish its job. ~Vc are doin~ ~ l~)t better now today i~ dete~dniuff the cause dt,ath than we did back when you cited all these errors~ aren't we ? 1039 1),'. Rm~)ox'. Yes, w(~ are doing rt h)t better Intt it is still a diffi(:ult in.oblem to dia~n~ose clinically some of thes~ cases. It is no~ an uneom- mot~, firing,for us to find a. person that din icallv has been diagnosed to have can~er of the lung and really and ~rttl3; have cancer el~;cwhere h~ ~lae body thu t. sl,~a4 up there. ~he elihician (~d tl~. bes~ he could do iu diammsinff it but still I know that~ 1 have to be cautious. I reviewed a group o~ cm:es and found a fi0 percent error ia what was oa the death certificate and what we found at the autopsy. 3h'. W.v~'soN. And ~hat was as ]ate as ~ 963 tha~ you had that study and there was a 20 I~rCen~ error ~t tl~t fip~e; ...... , ........ Dr. Rmr~o~. Y~s, and at. was in ~t llOpSt~,l~l ~lla~ Spe~l~ilZ~S~ trout ~ ~ see. I wou't, name where i~ w~ but it was z hospital tha~ speeiahzw~ in cancer, I have to think about tbgse p~jfic tha~ g~e ~ick out ~a fiF batrk side of the county, tut4 don't, ha~'e X-rays. :~ ~octor just sign ~ death certificate as be~t he can~ and at ,tutops5 1 flint a difft.re~tt pathologic pr~ess. . , , , tak~ and our mistakes go to prison, x ou (toctor~ wlxell S u t . - takes they go to ~te cemcte~.. Mr ~'aTSOX. You bury yours, I was distre~,~M on the ~ame ~ ~o ~d i~ the fira~ paragraph theft officials of the New York State Health Department in 1955, and that wasn'~ too long ago~ fcmj~d ont that less than one-htd~ of the deaths attributed to lmeumonm in a group of cases they reviewed actually had pnemnoM~,t,, That is a pretty bio" oercentage of error there~ when you miss iL in h~Xter than one out o(~'o case~, ~snrt it~ Doctor ~ Dr, ~m~ox. I would th~kso. 5h'. ~r.~TSO~. I appreciate your testimony. I think it him been quite heloful here and shmfld alert, us to the cact ~hat there is as I m~ationcd •tre t~,dnnin¢¢ to diagnose the,.e cases ' [ ~ *~ ' . .,, - ;- " ~,,~--.~-----, somethin,, else. and there ~s no neect lot ¢~very~o~t) m,tkl, "'llff soBqe mist:tkes, m our am~. ,' s , • ' '.. .,~ , v,,,Fw-ulfl .robablv a~ree, wxth that gentleman~ ~ oul&~ t ~ ouL 2."~" ~ *~ ~, ~ , Y.a,~ ......... .e hut n~t only dl,t~to~in¢ but COdlnt$ ~ime ~Te have to be eautmus ]n mterl r, ~ .~ . ~}]~9"i~ trvin,r to evahtate flte frequency" ot lung ep.ncet. ~ "~r. W;('rs~'. And as • pathologist I a~ sure,~ ,dso ~ho is interested in the t~tth that we mtre ngures tmtt, are contradicted where, a~ you poia~ out~ the incklcnee of lung a,,,~],~ ht Enaland is ~gl per m~lion while ia America it i~ 112 and ~:.~.::,; .v , ;.E:~,,. -rot they come m) with no laboratory any other information to explain tirade grea~ a]Scl'epanele~ (.anvouexflamthem~ • • .. • • ~. e ..... ~ x'~, x can't The thin-'that bothers me is that ~t m ~?~'Jx.t.~',?~{,~,C.~-~.+~.. ~hat ~he ~-)~tieut lind ~hen lm died. So~S, w~ Cliff [o 0StaD,*~x ~f-~--., a ..* ...~..,~ ....... ,, SaVi)l*, when we say Ill'aFt talk abollg heart (tl~eases uut, uu,,..,~ ..... ~ ~
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1040 di-,~a~, .~ Ar~ wc talking about s~,philis of the _heart? _kre we talking ab,~ut rheumati,~ hear~ ,]~ea~e or arthr,~sclerosis? S~,, it is on~ thing to u~e a big term like heart d~{e~s~ ~-it~out speci- fying what you are talking about but I ha~e to do th~, • am sorry to say. Mr. ~V.xa~o~¢. i agree with n'ou m~d you just look ~t the fig~es that ~ mentioned ~:~ momen~ ago ~-here the consumption of cigarettes for ~tdult ma]c~ ]~ h~ghcr in the U~fite¢~ Statc~,than ~t is vet, tlm ]ncidem'~ of lung cancer is better umn ['h~:~ro than it i~ i~ th~ ~nited Somcb,~y ought to be concerned about find~g out why~ and it ought to xw~w~ t~ red flag in the mind of any unbiased indi~du~l as to whether .r no~ thcr~ i~-~ ~ causal relafions~p between or even ia my jud~eng I am bcghming to que~xioa th~ statistical relations~p at this point ~ x~,~~ Sound dirt th~ inconsistencies ~ the various reports and studies thab have been ms&~. C,rtainls" I am concerned and I appreciate your testimony as pathok*gi~., One final ~uestion:, What would be the perc~tage of ([e:ttlm in which there ~o~d be an autopsy performed~ Dr, I¢u.;~o~¢. That w~.tld vary in ~fferent hospitals. Ga]~t,:~.ttm w~ were doing ox'e~: 75 percent of cases that died fi~ the lm:.pital. Ther(~ arc some'hospitals tha~ ~vill do that now. I believe the AMA renuires for accreditation 95 percent. _ .... I could be wrong, a~,~ut that, bu~ you have to do tha~ many to mee~ the rc~quirem*:nts of an aece~tabl~ hospital ~.fr. W.:v~'sos. Tha~ is either with or without the consen~ of the ~;urv~vov. Dr. Rm~o~. Oh~ no. You have to have ~he permission ~rom the sur- vivin,:f one who i~; legally responsible for th~ b~ial of the person. Mr( W.~sox. Thank you very much. Mr. S.x~'c~rmnu. Any other questions? If no~ then I have one, Doctor. Do you h~ow (~f any new evidence relatinff to smol~g or the hazard of ~'~n-t,~kin~e that has developed sinc~ 196& ? Dr Rxc'~r,,,s There is this study o£ twins whid~ is somefldng fhat ha:. l~t,en ~t[,~¢glopin~ since that ¢~me and that is all si~nifi,:aat in this c~;~rall problem. a~, n ..... --~,~D Thank ~ou very much ...... Mr Ec~m-x~w Doctor~ do you recall of twins? Dr. Rxc~,:~. Oh~ fllere have been two or three. Mr. ~c~i~:xnt~. I mean the one y~u are talking a.bout. Dr. hm~,,',~-. Oh~ well~ I heard the man yesterday from Swed~ talk about, it and th~n fhere are s:ome others. I believe that Fisher refe~ red to thi~ n:mny years a~o, in ~9~.or la~er. Mr. Ec~lLx~:~. We are talxlngu~ou~ a~r wl~cther it has bcerr published or not but t~s o~: twin~ i~:: a piece of work tlmt ~s underway. Whether it ~s beea publi~h~d ] do not know. 1041 Mr. SA~SI~VI~.LD. I have be~n hi:refined, again in the interest of time, flm~ Dr. Broda D. Barnes, a pikvsician and medical researcher of ~t. Col~n~ ~lorado, has filed a StatemenL with the comraittco and w[tlmu~ objection tMs ~tatemcnt will be achnitted at this point.. It will b¢ iaclud~ ~ the record of fi~ese h~r~gs ~ this point. (Th~ sta~ment of D;. Ba~es ~ollows :) ~T~E~E~ OF D~ ~ROD& O. BA~ES~ ~o~r Co~, COLO, 3I~ name is Brads 0. Ba~es ; I practice medicine tn Fort Collin~, C,lerado, ~u~ devote over h~ or ~ tlme to medical re,;eareh. My uadergraduata work was done at the University of Denver where I began my career in ro:4oareh a~26, 48 years ago. I taught Biochemistry to medical students for two yearn Western Reserve U~versl~ wh~e I r~clved a Ma~ter'~ degree in that ~:ubJeet in 1~80. I taught P~siology to mescal students for five years at the Univer~;ity of Ohicago where I earned a Ph.D. In Physiology 1~ 103L 3Iy medic,tl degree, was completed at ~ush ~ledical C~liege in Ohleago in 193~ ~ hence, I have riced medle~e for over ~0 years. University upper.tents in the interim have indudeA the Univ~s~ty of Illinois S~ool of Medleine, the UnlverM~y of Denver, and Golora~ State University in ~o~ Collin~. Since I have been eng;tged herb resear~ and the ~rac~ce o£ m~icine, I belong to appropriate in bath fields and have contributed over 75 publica~ons to the medical literature. For many year~ Public ~calth officers and othe~ hav~ been trying to vfnce us that cigare~e smoking is very dangerous to ~ealth. 0n the other a numerica~g smMler but ~ually capable group ot scientists has been stating strongly ~at the evidence agains~ tobacco is gen~,ral and eigarette~: tn par. titular is inconchxsive. Whenever there t::~ m~ch strong disagreement among ~sts, ig usually means (1) that imperator and necessary evidence io lacld~g, o~ (2) ~a~ the evidence presented is nee consistent, o~ bo~. ~is statement relates to my versnnal attempt to resolve ~e que:~tloa,: iuvolved in the ~o-calletl c~garette cGntroversy so that I might decide what to tell my patients. No clear answer was i,reseated tu the medical literature. If were gong to learn about lung canter, it seemed necessary t0 know somethiug about the natural ~tstory of the disease. I went, therefore, to fl~e mcdlcM centers of Europe, especially to &ustria whets for 2~ years a law has requlretl an autopsy on each patient dying iu ~he hospital. My s~u~ were conducted in Graz, Austria, a etLv of 2~0,~0 lnhabltanht wi~ only ~ae m~or ho,pital whore all had to seek nmdleal attention. There one tan gel a cross-section of the popula~ior~ tenting to autopsy e.ch year, since a~ut 25% of all deaths occur In ~e hospital. These are all autop~ded the larg~ PatholoMeal Institute in the world. This figure far exe~ed~i the percentage of deaths coming to autopsy in the United States. I tan ~ot overemphasize the lm~rtance of autopsy dlagno..;e~. This bt t~ue regarding lung cancer, wMch can clozely resemble tuberculosis In location, onset, symptom, physical ~dings, ~inical course and terminal death. show tha~ b~ause of thee similari~ee; between tubereulo~L~ and lung eane.r. physiNans oftentimes are unoble to distinguish betweeo the two dlzcnse~ without autopsy. ~or exampl~ in 1913, Dr. ~eller, the pathoiogiat at the Univcreity Michigan, coll~t~ ~ ea~es which were known to have had lung cancer beeaut:c they ha~ ~een mi~oscopiealiy examtm~O. 0nly one case out of nine had been correctly diagno~l before autopsy. Observations ca~ied dug during t~e last ten year, s on the autop:de~, at have led to the conclusion that most, if not all, of the reported increa~e::t in lung cancer, h~r~ attacks and emphysema have n~t resulted from smoking clgarcttev. diet or other envimumental factors. Rather, they are the result of a decrea~u some diseases which thereby a~ow~ susceptible ~atients to live long enough to contract these diseases ~owing an increase. W~tle the erldence agaln~ the theory that cigarettes cause heart attacks is even stronger than the evidence against the ~ry that they cause l~g ca~eer, I shall limit my discaaslon today to lung cancer. &t Oraz eom~arlson was made ~tween the incidence of tuberoulost~ aml in,donee o~ lung cancer from 1930 flir~ugh a~0, Over 68.0~ autnWle:; occurred dur~g this interval. ~ere are ~r~ periods which deserve s~eial attention. first is 19g0 when 167 out of each I.~ deaths were duo to tuberculosis. ~fs t~t a very high fi~re, being at least twice as high as that seen ia either E~glnml or 29-230~69~p~. ~11
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I0~2 tlm L'aih,d ,~_~tatc~ at thut time. Tn eeutraM:, hmg ~u~e~ ~n lORO w~s qui~e low, ,.,r the United Stah*.~. It appear~ flJzz$ Ir~c~ tuberculosis deaths a~e numerou% Jb'~wcvll ~}:lo and 19~) ,ieath}; from tnhe~eulosis in Graz dropped dramatically t~',,n~ 1~;7 I,,,r 1,(}00 ill l~);{(} to [[(~ hi ]9~, nr Josg ~a~ ha~ the prerious level. During th., ~:nao bin,real, lung ealtcer wu~ rising stea~ly from e~ht per ~,~0 in t. ~0 In 1~41, Zqor¢ tha~ ~vlce a~ many. B~ thi,; time the war bad starh~d, and tubereu}osls jumped again, from 6~ in f,']l frmu U0 In I010 t,) 12 In I~, or almost half. ~ere it is seen that if deaths from I IlII~TPHI, I:-:I}~ rI~;,2, tho:~e from Ju~ eal}cer fall a~ once. ExaccIy the same observe. Ib,le~ Wore D~a)lo ia Germany daring World War I. One gels ~e ~}Dz'ession ).ah )l)~,,a~.~e~ ar~ compet~n~ for the Hfo of ~e same ~ndividuaL reheats su~i~2ng h~h.rv~l~,: h~ are Umlt;Ually ~m~c~-~tJble to lnng cancer. . l~.It)l.~ aatflu,)th.:) be,.ame available rod ~pe~c d~ a~alnse ~),~ ~,, Tho rcductl,m in tuberculosis leveled off tn 19~ at about 30 deaths ~e~ 1,~ aut,:,lC:~b,,. Lm~g ca]~ecr Mmwed no further rise during ~e next 11 Ye~s. Thl~ le~ olios-elf of lung ea[u~er is th~ most s"mifica • de;It]is are aill,~D~le,], and all lung c:~.eer cages are reported as sue~ l~ 1080 a~ GrIG~ ltl~lg e;HIcPr represented 17.1 percent of the total eance~s. The Public Health I:h,rvlco ,'}.tllnate,l that for lt)~7 lu~g eam,er would represent 16.4 ~rcent of all c~Hleor~:i 1}1 the Unlt,,d State~. With improved diagnoses I believe ~ba~ the number will ~;,,m level ,dr ~n the UnitedState~ 3u~t" as it ban ~ Oraz where no diagnoses are ~:, 1:¢:~,,,1. l'rv~;ent .vldcnee ~rom England, Cunada and the Unlt~ States indl- eat,,:, that tm~ ri~., in lmig cancer is ~lowing down as ~bereulosis is be/n~ conquered. 2~lc, probabIIify aeem~ goo~ that lung cancer is n~ri~ its pe~ and will take lt:~ place ~lth the other cancers depending neon patien~ suace I n~rim~ t~e I rmt 100 vear,~ th~ ~,.:a ........... . ~ ptibl~. ~ ~ , ~ ,~,u~.~c u~ ~ua~ ~nceI nag uep~nded upon ~U,~tUatlom~ In deatlv~ from ~bereulo~is. ~ seen ~ ~uberculosts Is e~mi~ted, l llPf i~ttln~Pp :dmuhl l'J~C parallel to o~er cance~ only as ~e population becomes nhl, w~. At the prc~,:~t time irradiation among the ur~ium miners seem~ to be the ~PJd~ ph,:'nola¢~n~ of a rJ~;e in lUDg caner simultaneously with a deel~e In t,lh,:x',:ub-c J~ J::; too exact t0 be m~re coincidence. There was a mark~ rise ~n ~e tuJ,'r,.~d,-~:4:{ rate d~wing both World Wars, and a simultaneous drop ~ the rate ,.i' l,mg cancer. ~hc ad~ eat of ~ew tr~atmea~ for tuberculosis ~ter World War II ,:an..d a draandic dv~.lhle In th~ Pate of this disease; an equally dramatic rise th,.. hwg cmvt, T rul~ ,:~ceurro~ RC ~e game time. ~d finally, when tuberc~osis d,,alh~{ l,,,a~,~, r,~lativoly negligible, lnng cancer ratez ceased ~o rise. enmpollhg, ~-,vIdf.nce iudlcates that there is a cer~in susceptible uhn qO,,r ,'.~'w~ ub e . ~ . -- g ~ of people • - . { er ulo~m early In ]~e or lung cancer later ~ life. When tnh,~renb ~1~ ]~ ~mdet, control, ~mre of these people lh'e to develop lung cancer. ~tl~,l when t~,,reub-,:-:I~ is not under control, very few lie ~,. .. .lher eolll~trje:,, In each country Jn which autops/~ have been ~olle, lung cancer by? n to ~q,I,:ar at a time t~bercu]nMs dea~ts fell t~low a critical level. England m~d flw Ihdted gtut~.~.; led Ibe woHd in red~eing tuberc~lo~is ; they ~ve 1~ the w.rld in Ibe rl;'c Jlx ]~n~ v;~ncer. Tubercul~M~ bew~ to fall In Germany 20 year~ ]},hT than Ill England ; lung cancer began to ri~e in Germany 20 years later than In )~,~:land. Ihh]ai~t had the lfighest death rate trom t~hercRlosis in the last v~}nlury, anti wa~ i]~o latest o£ oar major cI~es to cnnq~er the ~seaso~ lung ea~.c,,r r,:e,, Inter in Bu,]ape~t than elsewhere. :':,,me ~dght daba Ihat the rI~e in lung cancer has been due to cigaze~e ~Iau[,lllg', Had Ihe drop JI~ deMh~ from ttflwreuM~l~ ha, o~ly been coineiden~l. ~uvh an m'~m,ent i~ refuted b~ the time of occurrence. An ~pidem~e of lung n,-,,r we., ]-,r,~'..~ent In the autnp~le~ at Manchester Hospital In England during tl., ht:.t evnlury. A ~.lmilar epidemic was present in the autopsie~ at ~amburg, 12vr}:,~any, befor~ World War I. Lun~ cancer wm~ rising rapidly in the autopsies U,} Bo~ton City Ho~pitul in the Unit~ ~tates before the ciT~e~e era. It 1043 obviou~ that a high incidence of lung cancer preceded the popular u~e of tho cigarette. In fltct, it is po~Mble to have a h~h lncid~ce o~ lun~ ea~ce~ in modern times in the ~otal ab~ene~ ~£ ~garettes. From East Palfi~tan oome~ conclusive evidence that cigarette~ or oth~r em~ronmental faei'or¢, allegedly CtlUSlUg Illng cancer, are not nece~ary f,,r a ~gh D~cidence of this (~.a~e. From a r~ral ~r~a free 2rein tarred gaso}~e fumes, modent smog. eta, Ibrahim has reported au incidence of firmed lu~ c~ccr just a~high as In heavy smoker~. In hi~ ~'ories 70~ had never smoke~, and the oilier 30% bad smoked pipe.~ in which the smoke bubl,lcfl through water before being i~aled. Thi~{ is probably more efficient for ~emo~ lug nicotine and tars ~an any filter on the Ameriea,~ market. Yet, without asy of the on~onmental ~r, etor~ allegedly ean~i~g l~ng cancer, Ibrahlm reported rate as h~gh as ~at found ~ Ye United State~. Y2~r[her proof tha~ the rise in lung cancer t~ not a result of a vl~. in eigare~e consumption is Drovlde~ by a comparison ef the history o~ the rid'r, In lung cancer and the ri~e la cigarette consumption. The tr~lendous woalO~ o£ autopsy reports from England, Germ~y, Poland, La)v]a, Austria, ~ungary, Czechos]ovakia, RussZ% Switzerland, Holland. ~"a~- ada, Japan and ~e United State~ clearly indicates that a greater rl~o ~ hmg cancer occur~ca before the ~gatette er~ than has occurred Mace. And, in each o£ these countries, lung cancer began to appear at )he time tuberculo:d~ death~) fell below a ¢~ifical level. Autopsies from all over ~he world, including marry ~eports from ~uherruh):d~ sanatarlums in the United States, have proven that much of oar rl~o in lnng cancer in the last ~0 year~ has resulted from prnlon~ng the lhes of with tuberculosis. If certain people are ~usc~ptible to hofli tuberculosis and hmg cancer, it should follow tha~ tho:}e who co~tract tuberculosis an~ ~nrvlve wouM have a higher incidence of lung cancer In later 11£~ than those who had never had tuberculosis. This has been found to h~ true; the Incidence of lung cancer in tuberculosis sanata~ums may bo 20 t]mea~ greater than in the general pop~tion. Very strong evidence tn ~n~port of the assumption ~hat the ~ame people gee both lung cancer arid mberculo:dz is fouml ia reports from Meyv~ and his colleagues at Yale U~lver~l~, and from Wcutergrvn in ~weden. Both ve~tiga~or~ stupid eases of h~g cancer for lm~t evidence 0f tx~berc~ln~'l~ lnf~c- tiom A high percentage o~ patients surviving tubereulo:,i~ have perzIs~cat, posi- tive skin tests to i]~ecte~l ~ber~losls product~. ~omc ~h,,w evidence of healed scare on x-rays of their lungs. ~Ieyer found that 99% of ~e patients with proven luog caac~ had been i~ected at one time with tuber~nloMs. The ~eory ~hat cigarette smelting causes lung cancer i~ fo~ded on ~o a~sumpfion that lung cancer wa~ a rare disease~ tn the United Statc~ In It is true that in the dea~ ce~fieatos on~v 3,0~ oa~es were rein,fred at that ~me. However, ~mto~sy reports leave li~th~ doubt flint clinically about 1fl% of the eas~ of lung cancer were recognized at that timm If one multiplies 3.00} by 10, it is found that 30,~0 cas~s would have been a more reallstle fl~mre ~or the truc ~cid~nce i~ 19~0. An¢opsy ~dle~ leave no doubt that lung eano,~r was a disease in ~ United States in 19~0. I~ ts apparent that seine of the rlse ~ hmg cancer slnee 1930 1ms been due t~ ~tter dia~osOe methods resulting in recognition of lung cancer which had been mis~d ~ many eases pr~or lo .~at time. A second feeler In the rize has been additional new eases developing in the su~ivor~ of tubere~do~s l'e~ehing can~r age. Proof of ~e s~mnd factor i~: found in ~aHents m~fferlng frou~ both diseases in our tuberculosi~ sanntariums. Bolh source~ of now ea~:es of lung can- eer eov]d ~ecount far tlm rise ~ndlcated in the death eertificale~; h~L~ een 1930 and the present. There is no concrete evtde~.¢e that ~mokiug or ~ay other eI~virol~- mental factor has contributed ~ateriaIIy to ~is ri~e. WhM would ~p~n If we sl~0denly abolished all clgaret~e~ tomo~ow ? I would predic~ that ~he cessation of all ~garet~e smoking would have ~zo Mgnlfleant effect ou our death rates from lung cancer, heart ~ttacks, emphysema and m.:~t diseases a~egedly caused by cigarette smoking. The rates for the~e dir:ew:vs bare risen because premature deat~ fram ~any infectious diseases occurring at an early age have been sloped. People live longer, and lhere can be no doubt many o~ the eases of lung cancer have come from the ,~urvivom of s~c~ ~th dlsease~ are often present In ~e same pa~en~. It will be found that some of ~e o~er disap~a~ng diseases have contributed lo ~e rise in hear~ attacks and emphysema.
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104~ ~ Tit ~r. I~; comi~ellix~g autol~sy evidet~ce that the rise in lung cancer rates is n,lat~.'d to the rl~e In cigarette coR',~umpdo~. The rise iR lung eanee~ has a phe- mm.~nal ~.ot'rclatlon wlth the dccllne in tubcreulo~,i~ as is evidenced by re~able record:;. The rl',~e in lang cancer rater came long be£ore ~e rise in cigaret~ con. :;u~ptlon. ~he rl~e in lung cancer ha:~ been found in ar~s where ~ere Is no clgart<te t~moldng. And finally, the:re who advocate the theory that l~g ~ncer 1:~ rau;~cd by cigarette smoking have made the erroneous ~sump~on ~at lung c.mcr wa~ a rare disease in 1930 in the United 8tat~. At the present Hme there arc no solid fm:~s to lncrlminat~ tobacco as a factor in ~e rise o~ lung cancer, heart attaeH~ a~d emI~hyzema. ~RT1CL~ PUflLISHbS~ B~ ~RCDA O. BARNE3~ PH. D. ~. An Investigation o~ the Antagonizm of I~z~ by Posterior Pitui~y Extracts u~ Indicat~d by Changes In Ga~tro-intestinnl ~otl~ty. ~m. Jour. 1~3 : ~;s2, 1~30. { with t2u~ley) 2..kctK, n of In~:;ulin on lho Motility of the Oaztro-lnte~Hnal Tract. ¥I. ~go- nil,tic Action o~ Poztcrior Pltuitar~ Lobe Preparalions. ~m, 5our. Ph~siot. ~15 ; 7, 1~. (with Qu~ley) :¢. D~,',~ Im;ulln .~tagonlz~ ~e .kctlon o£ Atropine on ~e Cardiac Va~s End- h~l~i? Jour. Pha~. ~p~rtl. Thor. 41: 200, 1931. (with Barlow) ,1. 'l'~n, l'n~ductl~t o~ Hemogloblnemla and Polyeythemia In Normal by M~,:tn~ nf Inorgu~tc Eloments. Jo~n Blot. Chem. 94:~7, 1031. 5, ~4tudl~,~ on Thyroglobulln. I. The Dlge~tlblllty o~ ~hyroglobu~. ~m. Jest. l'h~,~fal. ~ : S~, 193L (wi~ A. J. Carlson and Riskin) tt Pr~,I~ar:ttlcn o~ Tbyroglobulln. Prec. See. ~ptl. Biol. and Meg. 29: ~8, 1931. 7. EIIml~:ttlon o~ Thyreglobulln ~rom tho Blood. Prec. See. E~pH. B~oL and Mc~I. 2~ : ~t~7, 1~31. (with La~rop and Mullin ) 8, The Feather Germ az Indicator for Thyroid Preparation. Am. Jonr. OS : ,IGOr, 10~. ( with ]uhn) 9. Th~ I,]x~-.rctton ,-~f Iodine In Experimental Hyperthyroidism. Ant. dour. ~tl, TI., I'byt, h~logh.a~ A~:llvlty of Iodine in Thyroglobul~. Am. ~our. Pl~aioloy~. 101 : 5~3, ~932. 11. The Fatt~ ~f Ihc Thyroid Hormone in ~xporlmentnl Hy~erthyroi~s~ Am. Jour. f'hltMol. 101 : 583, 1932 (with ~atldeu) 1~, The Influemx~ of F~cdlug Proteins, Amino Acids, and ~elnted Substances ul,m Crcatiu~_>creatlnlne ~Ietabolism. Jour. B~oL Chem. 04:49, 1932. (wlth D~,ard) 1;.t Varl:ttbmr~ in Blood Sugar Va~ue~ of Normal and Yagotomlzed Dogs Follow- ling Glu~'o~o Admtnlztra~on. Joker. NutriHon. 5 : ~7, 1932. (wi~ Q~gley and IIallaran) 1-L ~t,x ~thnulatln~ Principle In Extrac~ of Beef ~vpophy~s Effective in Female D*:~I~;. Prom t~OC. ~ptL ~ol. an~ ~c~. ~0: 1369, 1932. (wi~ Buono) 1~, R0atlon o~ the Hypophyals to Exporlmenta~ Diabetes. Science 1033 (with Itegan) lit Farth~;'r ~4tudh?~ on the Feather Germ ~est for Thyroid Hormone. Prec. ~tl. 17. Impr~'w~nt In Expcrlm~l Diabetes Following the A~inistmtion Amnlntln. A~n. ~led. ~s.~oc. Jour, 101 : 926, 1933. 18. ~hc Rchitlon o~ the Anterior Pltul~ to Carbohydrate Metabolism. erh~. 17: 522, 1933. (with Regnn) 19. IIypophy;'ccto~ed and Pancreatectomlzed dog. Am. #our. PiracieS. 10~: 4, '20, Is Thor~, a SI~cciflc Diuretic Hormone in the Ante~or Pi~ltary~ ~m. Jour. PhV,~tol. 105 : 559, 1933. (with ~egsn and Bueno) 21. Tim Eff,,ct of Calcium Gluconate on Parathyroid To,any in the Albino Rat. A ~. J,mr. PhU.vfoL 105 : l~ 19~3. fwith Bueno) 22, Tlm Eff~,rt cff Calcium Gluconatc on Parathyroid Tetany in the .Mblno Rat. Am. Jottr. PbVMoL 10~ : 3~. 1933. (wlt~ Fogolberg and Hanson) ~:l The, Tl~yroxlno Content of Thyroblobulim am. doum Phvs~oL 10~:~8, 1933. (with ~t. The Efft,,,t nf ~cclin and Thoolol In Latent Terry. Am. Jour. Phvsfol. 1 .I.~. 1~., 1.)~ ~. (with Mathl~n) '2~. The ~ffect of previous Itypophysectomy upon Diabetes resulting from Pan- cr~.atcctomy. Am. dou~. PliV~'ioL 103 : ~3, 1933. (with Xegan ~ 1045 26. The Excretion of Iodine in Experimental Hy!~erthyroldism. Am. Jour. Phlmiol. 103: 699, 1933. 27". Studies on Thyroglobnlin. IL Absorption of Thyroglnbulin and Related Sub. stances from the Alimen~ary Canal. Am. Jottr. P?tu~ioL 103: 570, 1933, (with 2S. ~ho Feather Germ Te~t for Thyroid H~one. ~m, Jeer. Ph~/.~tol. 10~ : :~, 29. ~rthe~ Studiies on ~e Excretion of Iodine in E~perlmental Hyperthyr.ld- ism. Xm. Jour. ~hysio[. 105 : 3,1933. (with Chnng~ 30. Para~yroid Tetany in the Albino Rat. Am. Jour. Physiol. ~05 : ~, 1933. 3L S~dies on Thyroglobulin. III. The ~£hyroglobulln Content o£ the Gland. Xm. Jour. Pfi~sioL 105 : 5~, 1~33. (with Jones) 32. Influence o~ ~hyro-parathyroideetomy and of Parathyroid H,rmom, llpon thv State of Calcium tn Serum of ~e Cat. Pro~. 8oe. E~ptl. Btol. a~d 32:253, 1932. 33. The Effec~ of the Endocrine Glandz ca Carbohydrate ~Ietabollsm. Am. ,~o,r Ph~Mol, I08 :~, 19~. 34. The Physlolo~eal Activity of the Thyroid Glsnd, A~. Jou~ Phy,~loL 10S : 19~£ (with Bueno and ~ones) 85. ~e Effects of Partial and Complete ~drenaleetomy on Experimental Dht- botts. A~. Jour. Ph~MoL 10S:35, 1934. (with Ferrill, Rogoff, and 8edit) 36. Fur~er Studies on the E~eets of Partial Adrenalectomy on Experimental D~tes. ~m. Jour. PItHs~oL 108:89, 19~. (with Rogoff, Scott, and Fcrrill) 37. Eff~t o~ Adrenalin on Ins~ Sersitlvtty og Partially Adronaleetomizcd and o~ ~othyseetomizea Dogs. Prec. gee. EzpIl. B~oL and ~f~;d. 31 193~ (with D~ and Rogoff) 38. Effects of Partiat Adrenaleetomy on Experlmenlal Dlabete~ and on tivi~ to Insulin. Prod. go~. Befit, Blot, aug ~ed. 31:524, 19~I. {with Scott, ~ill ~d 39. Implantation of Dog Pituitarle~ Into Immature Rats. Am. ~our. ]13, ]935. (wlth Fowler) 40. Diuresis o~ H~erth~ci~sm. Pro~. ~oc. ~tl. BtoL an~ Mcd. 32 :~16, 1935. (wi~ Roger) aL Experimental Diabetes Treated by X-ray Applled to the Pituitary and Adrenal ReCess. ~m~ Jour Physiol. 113, 193~. (wRh Culpepper and Hutton) 42. Influence of Thyroglobulin on Basal Metabolism. Rm, Jour. Phya~ol. 113, 19~. (wlt~ Bueno) 48. Some Ob~erva~ons ca Dogs Foll~w~g ~e Adm~lstratlon of Pregnoat ~[~es Ser~. ira. Jour. PI~.HMoL 113,1935. (wt~ Bueno) ~. The I~uenee of Posterior Pltulta~ Extracts on E~erlmentul Dlnbctcs. Am. Joun PANsioL 113, 45. ~rther S~dies on the Influence c,~ the Adrenal Glan~l~ on Diabetes. Am. Joker. PhHs~oL 113, 1935. (with Farrlll and Rogoff) 46. Study on Specific Dynamic Action FoUowin~ Removal o~ Varlous Emloerino Glands o~ Dog~ Am. Jeer. P~9~ol. 113, 1935. (w[~ Bueno a~d Rogoff) 47. The Re~tion of the P~a~yzold ~ormone to the State of Calcium In Blood, Am. ,Ionr. P~/s~oi 113, 141, 1935. (with Merman and 4S. The Sensi~vlty to ~sulin. Am, Jour. PhyMoL 10S: 95, 19~4. (with FerrM and Roger) 49. Bitteding 0viposRor-Lengthening Produced by Adrenal Extractz ~ : 2179, Oct. 2, 193~. (with Kanter nnd Kla~ans) ~0. On the 0rigln of the Substance in Urine Cauzlng Elongation o9 the ling Ovlposltor. Am. Jour. ODs. an~Z G~n~. 35 : 9M, ~6, Yune 51. Observations on the Adreno-Genital Syndrome. Prec. Am. l"hlts~ol, April. I939. 52. Rapid Recovery from Type XIII Lobar Pneumonia treated with Rrfl,blt Serum of a Patient with AddisoW~ Disease under Treatment wltl* co~ieosterone. J.tMA 113 : 1875, 19~:9. (with Ford K. Hiek~ 53. Ho~one~ and Aeno Yulga~s. Urinary Assay for the Th~r~wlmttc I've Androgens. A~eh. Do'm~t. and g!liQ~. 40: 249, 193f~. (with Cornhlo~,t } 54. Expe~mental 0b~ity. Pro~. An~. ~h~t.~loI. ~oc. 1~.10 (with ~. ~'. I£eohm~ ~5. ~drogenic Substance and SweAt Arch. Dcrm. anti gypldL 41:a~,l, 1910. (with ~. Co.blot) 56. ~actors in the Control 0£ the Human ~ppetlte. Proc. Am. PI~y:¢f.1. ~oc. (with Keeton) 57. Bas~ Temperature versus Basal Metabolism. #XMX 119:~072,
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1046 F,lr~mcnlo~It~--Etiology and Treatment. Joar. Olin. ~n~oeri,$. 3 : 2~, ]Ie~tdach~Etb~l~gy and Treatment. Fc~eratf~ Proeeedi~gs 6. No. 1, 1947. ~reatme~t ~r ~Ieustrual Disorders in Gener~ Practice..~zo~a ,Tan., Ol, The ~¢urly Diog~o~is and Treatment of Pertussis. Arlzo~m Medicine eel. 7, ~1 : ~.t-l-~, ,Tam 19~0, 62. Etiology and Treatment of Lowered Resistance to Upper P~)iratory f~,etion. ~YO~atto~, Proeucgfngs 12~ ~1, 19~3. l;[f. l'hy;-'l,logy and Clinical Mtmageme~t of Atherosclerosis and Coronary Heart DI: cm,,. ~cd~,r~d~e~. Proceedings 16, #1 :% 1957. (with RoberL W. Barnes) I~L li~*lt, ~f fht, Thyroid ia Coronary Artery Disease. Procecdi~es IF. I%~. A Next' Aplu'Oat.h to Hypertension axed Arterio~elero~is. Fegeratf~ Proceed- t~tg.~. 18, ~1, March ~]. ~"r~q,byl~xb~ ,,f I~chae~ic Heart Disease by Thyroid Tlterapy. The An ...... 19,.,,}. I)P 14, -..,_ ~]7. Arterk~:~clero'.~i~ in 10,~30 AutoD~ies and ~e Possible Role of Die~a~ Prefer. F~'d~ r~dl,~. Prcweedl~g, 19 #], Pt. 1, March 19~]0. (with B~ax Ratzenhofer i~d G. T:~ehorne} t.t~. t }m, l<t~,tuv hi Increace nf Broehial ~areinoma. JAM~ 174 :~29, Dec. 3~, 1960. twlth M. Ibtl~t,nltnfcr } t]++. Why Ihmrt Attack:+ Dccroamed in Europe darJDg the War: Pat vs. Protein. Pcderat+,+~< Proccedb+gs 20, #1, March xe+I. ~with ~I. Ratzenhofer) 7tl l'~'t+vt+)Jthm and Tre,~ttn~ of Coronary Ileart Disease. Part I. From a S~en- tiff, E~hibit t~t t]lt~ ~m. ~Ied. A~soe. Meeting, Denver. 0oloraflo, YI. C,:+ronary I+cart Disease: a Preven~ble ~Ie~bolic Disorder. t'rocecgPngs 21, #2, March-April, 19+2. 72. C+mm:Jry Heart Dk+ea~e: A 3IetaboBc Disorder Prevented by the Thyroid II, w~emo. 2~,rcc~Tta Jlcdica. ]nterna~onal Co,ross S~'ies #48, conta~g ~lb~tract:~ of Free CeJnmunleatlons read at the LXlI Interna~onal Congress of ~'hy,h'dr~gienl Sei(,nce,~. Lehlen { Holland), Sept. 10-17. !9~2. 23. )'rt,~enthm ~md Treatment tff C~,ronary ~eart D~ea~e, ~are II From a tHic Eshibit ~tt the XXII lntornational Congress of ~hysiological Sciences, Lehl,+~. H,dlund. Sept. ll.~IT. 1962. {t~gs 22. #2, 1~;3. (wi~ ~Iax 76. A I'rnctic:ll Dh,t ~r Weight ReducHom l,'ederatfo~ Procccdfngs 2~, ~2, 5Int.- Apr, 196~. 7L Exl.,rlmcl~tal Thyroid Deficiency in Swine. Presented :~t X~II In~erna~o~l C~,ns:re:-'~ ()f Phy~iolngical Sciences. Tokyo, ,Talmn. Sept. 1965. 79. Do U~ utnr~tcd Fat~ L,-nver Cholesterol by S~mulatiug the Thyroi4? ('rali,m Pr~,e(+cdb~as 25, ~2. 5Iar.-AVr.. 1966. 79. Su~cei, tlbllity t. Infection of C~ctia Swine. Fegeratlo~ Procee~lngs 26, 5htr.-,kla'., 19117. (with D. D. Cruea) 80, Why Emphy~em;~, Lung Cancer and Myocardinal Infarction? From a tiffs- Exhibit, American Acad~roy of General Practice, Dallas, Texas~ 1S-21. lflflT. :~1. t~m,~,l~ttldllt~" ~, Tuburculosi~ and the Rieing In,deuce of Lung Cancer. 52. Thyr++,hl Tht.rapy nm Pre+phylaxis agaim;~ Coronary Di+ease. Presented at XXIT International Ctmgre~ of Phy~+[olo+qcal Sciences. Was~ton, D.G. $3. EIghtccn-Xear ~'ollowup on Thyroid Therapy ia Prophyla~s ~d Trea~ent t~f Col'oil;tiT Di::ea~e. ~cderatfon Proecedi~gs 28, #2. ~Iar.-Aor., 1969. 5it. S.~wIE~.D. Our nex~ ~'itness is Dr. Irving Zeidman. Welcome {o the commi/[,~e. Dr. Z~idman. De you have a prepared s~atemeat ~ Dr. Z~)~.)~f.~m "Yes, sir. hit. Sxl~:Ia,~.:Ln. Is it ve~ long ~ Dr. Z)~I,)t.x~'. No, it is mm of the shorter ones Z thia~. Mr. SAvn.:m~.n. Fine. The only re,on I am mentioning it is ~hat ]mow ~,'m~e ,,f i],c membem have en gagem~ts this evening and the hour 1047 is getting late. I~ you care to present your statemen~ we will be glad to receive it. STATE1KENT O~F DX, ~VIN~ ZE~AN, PR0~flSOR OF PATHOLOGY, ~IVE~SITY O~ PE~SYLVANIA Dr. Z~. ~iy name is Irving Zeidman. I graduated ~rom University o2 2ennsylvani~ Schog] of Medicine ia 1941. ~kfh:~r an iate~ship and ~ years of serv]ce ia the Army, I returned to the 5[edical School anglo[ned ~e De~arhnent of Patholo~,. For over ~'ears ~ huve been here in aa academic position, teaching medical stu- dents ~bout c~us¢ and effects in discase~ and doing cancer rezearch. ......am now • ~ro2es~or o~ 2~thology. My chief .... r~~e~rch efforts_ have. concentrated on the wa), cancer spreads £rom zts rote of or~gm to ~erea~ ~r~s of th~ bo~v. Every year one of my lectures to students deals~ in pa~ wifl~ the relationship o~ tobacco to lung cancer. There- fore, I huve made ~r~ effo~s ¢o ke~p abrea~ o~ developments in thi~ field. Th~ ~act chat ~ am ~ smoker h~m also slmrpene4 my intcrcs~ the issue. I can summarize m~, opinion in the tobacco-cancer controvc~5~ by sa~in~ tha~ the evidence po~t~g ~ smo~ng as ~ cause o~ lun~ cancer is'in~mplete. However~ in expressing this option to ~edi~al stu- dents--t.h~ ~¢ure doctors of the ~'a~ioa--$ £e¢1 obllgated to do more thm~ present the purely scientiIic facts. I cannot le~w students ~ith old not to s~a~ smoking; there ma], be the h~ture d~m~er o~ lung can- cer: it is eas~ enough to avoid th~ start, hard to ~op:'And,}he o]~?r, habituM smoker ma~ be advised to stop or con~ue smoking weighing possib]~ toSacco hazards on ~e one side~ ~d--oa the other-- pos}}ble ~cholog]cal disturbance~, weigh~ gain, and other effects ]a~ed ~o ~i~hdra~'*d £rom tobacco. I~ short, i~ asked the ~ue~tioa: "~{ay heavv cigare~e smo~ng cause lung cancur~" I am l~e the m~ufious vrac~ic~ physician and I answer: "It may." Ho~ever, i~ a~ked ~ue~ion~"Dd¢~s heavy cigarette smoking ~ause hmg cancer?" ~he~} am ~accd with a more specific question and mu~ unsw~r as ~ The m~swcr is, "I canno~ te~. Th~ evidenc~ is suggestive, but sho~ o~ berg i~controvertlble and conclusive." ~," ~]1 ~his hed~n~ ~he~ fl~er~ is so much cuggest~vc that heavy mgarette smokmg causes lung cancer. (1) Extract~ of smoke certa~ly, p~oduce cancer o~ the skin of mice. (2) The incidenc~ of lung caner ~s mcreasing, and so is the cigarette consumption. (}l) People smoking two or more packs of cigarettes a da), haw a d(~cidedly hizher incidenc~ o~ lung cancer. The correlation i~ undeniable. V~en heavy cigarette smokers sb)p smoIdng, then their chances
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1048 ~ett.]ng lung eaneer are said to b~ decreased; so there seems to be a ,I~,l..,mh,~tc~.'-o~ do,~'~.~ and w~ km~w exp~rimentally th~ tlm production ,,t" ,:~mc~r dep~,nd-, in part~ on the dc~e o~ the carcinogenic age~. These ,d~:-:~,rvation:, ~:~em to ~ncriminate cigarette smoke as a causative agent i~ brag ,rancor, Why deny k. ? The denial is ba~ed on the fact that eacl~ ,d~:-,m:ation only s~gc~ts that smoki~g causes cancer. ~d each ,~rv~dio~ c:m b~ in~prctc4 in a nonincriminating way. Le~ us con. i,l~,r ~onm alterm~tivc interpretations o~ the~e obserrations--in the ( 1 ) The le:m~ useful ohzcrvati(m concerns tile eancer-produein~ fe,:t of tobacco lar on mou~e skin. Indeed, this work should uever ]a.,,n den~, recently, as similar work was done many decades ago and the ~t,: ~lt,~ u ere known already,. 5"ears ago it was sho~ tha~ coal ~ars pro- dw:, ~:kin cancer. The responsible chemicals ia the tars were isolated alid identified. It was aleo knowu that tobacco contained some o~ these ~:],,mic:t],~, hi ~;mall amounts. So, ouce agah~, hi the recent ~obacco t.ra,'t, exo:riment'~, known carcinoge~c c~emic~ls were applied to mouse ~l¢tn, and once again cancer deve]oped. Nothing new here. ~£ore impor- t~ml,, howe~-er~ i~ tlm diffic~t~ in ~terpretiag the reset. (.t)~ T~fi; ~t~me mous~ expe;iment has been repe~ted again and ag~n, inmiv~_~eatly, in man--as cig~r~yf.e smoke tars the ~gers tha~hol4 th~ ,:i,garettc during years of l~ea~3 smok~g. ~o cancer develops in the fing,,r:~. S,~ the mouse experiment~ for this and other reasons~ kas no t~pplication to (b) Many chemical carcinogens will produce cancer only in cer- . ~' ~ " . g~ ~. ~ ' . y ' ,mrcino~ n and then cancer begins; other orga~ do no~ r~pond to the ~'am,t earcinogen~ probably because such organs lack the che~cals ~,~.,h~d ~o 1,im] tl-Z~ carcinogen. And~ ~or similar reasons, chemical c,r.~ino~cn~ produce cancers in some animal speed,s an4 not in others. Th~ nm~v~e ~kin is chemically differen~ ~rom th~ mouse hmg or ~he lung of man. Hm~cc, the production of cancer i~ mouse s~in by ~obaeeo .,xtraer i~ no indication whatsoever that tobacco extract will produce (,~) Aud whe~(~he mom:e lung is exposed to ciga~e smoke, the ,alh d ~m.ki~g-r)pe cancer does not de.veloD. So the observatiou that tol.meco tar produces cancer of the mouse sldn then has little signifi- (~) At fir:~t,glance~ a bit. more respect ~eems due to the observation th:(t tlm incir]¢ ~cc of ]u a~ cancer is increasing, as is the cigarette con- ~.m:~pfion. One eouht di~n'-~ss this correla~o~bv sayin~ tl~'~ ~he iuei- d,.~nJt~ o'f u~inZ el(,ctrie shav~l's is aIso increasing. ~ut there is ~t more ~,:rious obj,cLion. Is ~he incidence o~ lung cancel- re~]]$ increasb~ If, i~ ve~e~,ffab]e fbat ~nany people con~ider the practi~ng ph~siei~ll infallibh in sp~eifving the disease o~ hand. He may have lhe best }:,r~thh fire l~e:~t(~cb~afi~n~ the bez~ laboratory and hospital ~es~s al,h,--~,t, his batting average is ~ar from 1.000. It is not the doctor's ~a~lf,. ,Sb~q~ly~ tht~ a~'ailab]e k~ow]edge and te~s are inadequate for 1(~0 l" ~ ~t accuracy~in diagnosis. It so happens that cancer of th~ b o~ i~ .n, .f fl~e nld~'~, difficul~ conditions to dia~ose~ as it is mimicked hv many olbcr condltlous. Even uuder the best hospital conditionz~ t~,. ~rr,%r ia ,]i~nn~ing primary cancer of the hmg is quite mar~ed. 1049 The ea,ror must be far ~reater for the many physicians practicing without adequate hospita['and laboratory .fae'ili~ies. Now~ it happe~s ~a%.the quoted incidence o~ hmg canc~r is obtained largely from ,hmih certificates~ speoi~ing a cau~ 8f death as determine~[ by the afteltd- ing physician. 5~any of such cases lmv~ not had chest X-rays or autopsy confirmation. Yet~ the ~aodem physician, aw~re of the presumed crea~ in lunz cancer. ~ ~robably raore likely to diagnose cancer in- ~e~ o~ another cohdit~%n ind~'stinguish~O~le from cam'er save by hospital and laboratory te~s. ~tt l)~rt of the increase in lung cancer is due ~o flfis~ ~1 a similar vein, our diagnostic ~acilltie~ haw~ im- proved ~emendously and more pati~))lts are using them Tweniv ve~trs a~o. the physxcl~ may hE~ve dmgnosed h~s cas~ as pneumom~t or l~ng abscess: Now, su~,ioio~fing lung cancer, he hospitalizes th(. t~ent and, w~th the al~ of X-rays and other te~s, the dragnet,s cancer ~ confirmed. ~ow much of the presumed increas~ in bulg cancer ~s attributable to these changm. c~rcun~taaccs, /hen. cancer is a disease of ~e aged ~d we are living longer. How much of the inerease in l~g cancer is related to an increased lifespan ~ How much is art ribu- table to our polluted atmosphere ? We t~lk gfibly about tlm incidence o~ lung caneer~ buL ~or man~ the only ce~ai~t.y ia this dla~osis comes wi~h an autopsy. o~fl~" about 10 p~rccnt of all deaths are ~ollowed by ~utops~.- The incidence o~ lung c~ncer may well be iacreaslng, but in view'of the above ~nsiderations I would certainly no~ specify tim degree o~ increa~. (3) ~ow~ ~s~ consider the strongest reason for im:rimimtti~g rette ~moking ~s the ca~e of lung c~ncer. Ther~ ~s an undcmabla correlation between he~ cig~re~ smoking and incidence of cancer. It should be emphasized that ~ correlation is not a proof or cause. ~ree possibilities exit. (a) The smok~g may~ indeed, cause the lung cancer. (b) Both hea~ smoking and lung cancer may be caused by an ass~cia~d third conditioa--~ch as ~ hormone dlsturbaace. (c) Finally, the correlation ~ay be sh'iefly coin~)dental. A scientist usuMly e~ablishes fl~e cause of an3 disease in the fol- lowing w~y. ~irst~ he notes that the ~¢~usativ~ agen~ and the diseas~ occur together. In the ~obacco controversy--the first step is, at least partially~ fulfified by the correlation b~tween smokh~g and lun~ can- eer. Secoadly~ he isolates the agent. ~hird, lm applies the ag~n~ experimental annals and reproduces the diseam. Her~ is ~.1~ fi]issing link in the tobacco cause-uad-effec~ relationship. Animals have been expend to tobacco smoke in a variety o~ ways over long pe~fiod~ant the vyoe o~ lung cancer said to be associated svlth smoking has nor developed. Indeed, in all but one experiment, no cancer oi any developed. M~ny e~cuses ~or these negative experiments hay6 been offered. I ~d all chest excuses lame. Until inhalation of cigarette cmoke reduce, ex,erimentallv, hm~ cancer as scent in man, the for &feet causatmnhas a m~ssmg hnk. So, tim scientist~ in establlshiiig the cause of dlseuse, pasze:~ flwough the abow .~re~ steps. To satis~s, the scientific community that a trm.~ cause bus been found, the re.sult~ must be positive in ~os~ fi~ rare situations. A~ter obtaining such positive results, the then removes the agent ~rom tlm population and watches thu diseast~
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10~0 tliall)]n'al:. This brings us to the fourth observation • dc,',reaa; nl incidence of lun~ ........ : .... ~uoted earher~ IlHll ~0 ~.}IG ffeheI'al D~,z~,,r- f] .......... - .. ~. , ~. ~ ra.e ........ ~ -- x~o near, as ~rom rdlably fli:tg~o::cd,lnng cancer over a 10-year period This numbe s, , lll:td[,]wd, to instil-, the ~ta ...... ,£ .... '. . _ r of ca.es is a rc .~ ~.d r~e of ]~g ~ncer. Even if~ in t.h~ long run, enough data accum~afe t tl~nd fl. re ls ~t~l no r . upport t.lm - , ~ ~ s p eel that smokm~ causes ] ~ho,~v who were able to ~h,e u ...... ~-: ..... ~ ... apt ~n~r. "m- , " ~'~' • ~ ~. ~....,~mg may ~e eonm~ut.~onallv or ~ m:¢aiw am.rend--ann so m~y belong to tim ~oup ~o~ fle~t~d d.velop c~neer, Or dkl ~ simJ]a~'elmnge in ano~er habi5 " " ;t vttrJtqv o2 crtr,~nI,x. ~ _ s ~,,,~u,g. ~ arzon~ nquors ~nfa~ , -;'~,. ----r-~ y-mponnd~ of u~mwn earemo " ' . and hr,-ah Pcrh~ .... n:~: :::~t ~-oa~ yne ~qy mrough the lung a):,r the d,'cre.t~,:,d rate o¢ ~ .......... • q or may uceount ~t er~,~t~ ea rat(~ l. real. Wffh t}~s tvl~e of o~de-~- ~ ..... ~r~g .~o ................ more da~a and to explore changesin other halfits coincident with the arrest, of smoking. T~2 fl~. final sifting of evidence for smo~ a.~ a cauee of un can x*l~ ~nd much snffgestive e~deneo ~l,;,-,~ ---'~-~ - -' : . ] g .cer pI way:. T]to lltaior nO~t n¢ +l.,~==~:~u~ ue lnterp~a m a varzety ~:/wa~ heavy ,ngarette smoldn~ and lun,- c ...... -,' "~la~.i~n , " , ..... arson IS equivalent, to calls a IiI :llt, ioncd above t%-~,. :,~ ~-- ~ . .. " . .e ~ nd effect As all I ~]-vt=eU • ~ ~ ~,~.o_~ gou~ c~rrela~lo~ ~etween J~vv dried al,',:,holi.=m is c,-m¢.a ~ ...... ,.:- ~i;~ r~xt a~lnd )vo~d ass~e that [.lttll.~ tire )rOD'LDI , r, rod (,f~ .~. .... t_, . , y 1. ~O~h COlldl- Likt,wi-~-, ~..-S ,--~:.- ~_u~.w .... e~Y~ny3°g~ea~ 2r comtltutional type. , ~.~ .u.g c[u~ger anti nea~w c~gare~te Smol~ffm~y b~ pro~uc~s a fldrd, as yet, tmdefined, situation. In view of th " " of alterna- ofli:ct prommuddmeut ob ~d.L~"%~-"'~ to a~c~p~ me a~reet cage-and: t.vrms o~ po~sibilit];. • .~ct~. xn my opinion, one ~n ta~ only in {Thu ateachmen~s ~ Dr. Zei~an~s ~tatemen~ ~ollow :) Born: Mar,:h 1% I918, Camden, N~w Jersey Married: 19~3 to Ellr~or Sleeper, ~o~ton, Children : U,H, Ar~; 1051 ~cfe~t~fle College ~ U. of P.. 3.934-~7~A.B. ~&ed~cal S~ool: U. o~ P., 1937~l~M.D. Inte~ship: Cooper Hospital ~mdcn, New Jer~ey~1941~ ~.8. Army: ~athologtst~194~ S~: :Department of ~a~holo~, U. of P. ~lcal 8chooI~lO4l?~l~re~e~t ~av~of-absenee: ~ Dr. Shields Wa~en, Cancer Researc.h In~tttute, ~ostou, Mass.~19~-~ 195~1~1 Associate Professor of PathoIo~ ~96~ Professor of Patholo~ Caneer Research. Problems in met~a~i~, par~eularly the ~pread cancer ~ ~e lymphatic ~st~. Board qua~ifieatio~ hIember of t~e Amerlc~ ~oard o~ Pathol~1947 ~ouie~y ~n~zbcr~-hfpa American Association for Ca~eer ]Research ~caa Association of Pa~ologis~ & Baeterlologists Fellow, American Az~iafion for Advancement of gelence _Mpha Omega .~pha Member, New ~ork Academy of Sciences _~e~lcan 8twlety for Cell ~iology 1. Che~cal Fa¢~ors i~ ~e ~utu~l Adhesiveness of Epithelial Cclk~, Cancer Research 7 : ~]~89,1947. 2. ~ailure of ~yaluro~dase to Increase the Invaslveness o£ Ncoplavms, au~o~Dale ~. Comas and Morton ~cCateheou. Caacez" Ite:;varch 3. A Simple Method o~ Measu~ng the S~ace Area o~ Small Objects of fur 8ha~. Science 108: 21~215,1948, 4. Effect o~ Temperature on the Mutua1 Adhe~vcne~ of Epithellal ~e~nee 109 : 596, 19~9, 6. Factors .~e~ing the ~ber o£ Tumor ~Ie~t~a~e~, Ex~erimeat~; with Transplantable 5Iouse ~mor. ~-au~or~--~lorton ~IeCuteheon ilutl Dalt~ R. Coman. Cancer Research 10 : 357-359, 6. The ~ignifieance of Low Calcium and ~igh Potassium Content la Tissue. Co-author~Robert ~. Do~ong and Dale R. ~oman, Cancer :~: 718-72l, 1950, Z Transpulraouary Passage or ~or Cell EmbolL Co-author~Jo.knne M. Cancer ~seareh 12 : ~g1-~33.1052. 8. Experimental Studie~ on the Spread or Cancer in the I~yitq)httfic I. Eff~ivenes~ of ~e Lymph ~le 0s a Barrier to the Pa~3age Embollc ~unmr Cells. Co-author--YoAnne M. Bu~,~. Cancer Re:-:earch 403~05, 105~. 9. Ex~eriment~ Studies on the Spread of Cancer iu the ~ymphatie IL ~bseaee of a Lymphatic Slopply in Ca~inoma. Co-author~--Bradh.y Col~eland and ~lfields Warren. Cancer 8 : ~3-127, 10. Ex~mental Studies on the Spread of Cancer in the Lymphatic System. III. Direct Passage of Tumor (Jell Embol[ f~om 2~oraeie Duct to Lymph Nodes. C~ancer Research 15 : 71~724, 29~5. 11. I~diate Passage of Tumor Cell Emboll ~hrough the Liv,,r and Ktdm~y, Co-author~--Walter ft. Gamble and Willtam L. Elovig, Cancer IU: 8!4~35.1956. 18, E~Ter~ental Stadies on ~e Spread of Cancer In ~e Lyml)hatie System. IV. Retr,~grado SpreaG Cancer R~earch 19 : 11~,1-1ll7, lt)59, 14. ~e Fa~e of Circulating Tumor Ceils. L Passage of Celia through Caplllarh,~. ~an~r ~eseareh 21 : 3~39,1961.
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1052 :1~. rfl.te Fat,.' o£ Circulating Tumor Cells. It. A ~rechantsm of Cortisone Action in Iucr*.a~lng 5Icta~ta~e~,. Cancer Re,earth 22 : 501-503,19~2. I*L R~qatlmt ,J~ Glucocortic~ld Activity of Steroids to Number ot DunM Albert and I~Ing Zeidm~. Gancer Research 2~: 1~7-1300. 1062. 17. Fah~ of Circulating Tamer Cells. III. Comparison o~ 5Ietastatle Profluccd hy T~mor Cell Emholi in ~'e~s and Lympha~es. C~cer Res~reh 1S. 5~,rum l'r.h,i~ Chu~ges in Neaplasl~. I. Studl~ on Mice with and Induced Cancers. Co.authors: J. W. Dempsey and Peter B. Shelley. Archiw ~:; of Paihology 85: ,181~S6,196S. 1,. Experl~mmtal 5I~ta~ta~iu Via Lymph and Blood S~eam. Irving Zeidman ,rod i,,aiah J. Fidlcr. Federation Proceedlug¢, 1~9 (abstract). T1,.~ C~r x~r.~x. Thank you very mush DeePen Mr. Ecldmrd~ ~ ~h'. E,ncHxn~. Thank you, Mn Chairman. Ooctor~ I congratulat~ you ~or a statement that ce~tMnly seems ob- j,','t iv,.~ and flfir. ~ would ~ike to ask about these exp~ime~s ~th :ow .l, to r tt~ and mice inhalhg or takh~g in smoke. Do ~ou thi~ thu~ ~t~ ~a',~ eve~' going ¢o get any valu~ out oi ¢~is ~nd o~¢e~ ¢onsidsring llu~ ~act that, I avsume that a rodent coaldnt be examined for too long a period of I would as~umc its li£~ span is not very great and we do find som~ r~,hdion~hip of cancer with a long period o~ t~e of development. don't know M-mr cause~ it but ~e do find that. it ~e~en¢l$ occurs middl~ age after the human bein~ has been subjected to some kind environmental fix over a long period of time. Would that be ~ consideration ~ith respect to these laboratory ex- lmrim~mt~; with mice ~ Dr. Z~m~y,~x. Well, sir, if you take a rodent~ a mo~se or a rat, and watch him a,, lw goea from bi},th to the end of a lifetime you find tha~ h~-~ too will spontaneousl~ develop tumors and he t~ will them in his middle ag~ d~en though his total ~Ie span is tufty, say year.& ~Ir;~E,n:~.xn~r. That is the qnest.ion I wanted to ask ~ou. Dr. Z*:*D~.~>'. And if we use cr~rcinogenic agents of a v~riety of ~ypes ,nd apply them to an animal, we find thab it takes about 25 percent of tht" lifc;".:;~)an of the antrum to dex~,,elop the cancer~that is, ~bouC 6 m,:,nfl,u. ~wn m',m has ~en accidentall~ exposed to carcinogen, the '. ,,-~ahm pcr,:cnhtgo'..,,, • o~ his li~ethn~ g~s b~'before c~cer appears--and tlm latent pe~od is about 15 ~ears. FrSm this t)Te o~ in~omation wonld .:ec~, r~: a~onable to expect lung cancer in rodents ~o~owing ex- lm:~nra to .;mok~ over a period o~ 6 ~onths or longer--i~ the rooks ir,ly :t earclno~en. Yet~ c~ncer ~ails to apoear. I 'don% think that the short life span of rodents and the consequen~ limited time for e~vo~ure t0 ~moke is the. answer as to why the smok~ ti.c~ no~ produce the lung cancer in rodents or other e~erlmental ~oin~ to a:~k and that is whefl~er or not ~odents sometimes develop cancer in a natural envimmaental situation. Dr. Zv~m~.xm Right. 5fn Ec~ ~.~n~. That has been observed and is lmown. D~: Z~:m~. Ye~. And in the ]aboratorv, where ]i~e span is pro- ]ong, 4 h), ideal environments, cancem a~e seen ~requently. Some ~,~rains of rodents may display ,~ cancer fi~cidence approximating 1053 100 percent. This appears ~ithout any known e~vironmental manip- ulation. hlr. Eo~m~. Well, is this different in various species ~ Dr. Z~m~Ax. I flxNk that different species do lmv~ different. ceotibi~ties to cancer, but to my knowledge calmer has bee~ ~om~d in e~ry anim~fl species ever examined ~'ith the possible exceptmu o~ cer- tMn wild on~ who don'~ live long enough to display it. ~r. EO~]~T. Tha~ you, mr. Th~ C~. Mr. Wat.son~ ~{r. W,u'sox. Thank you~ Mr. Chairman. I also appreciate your statement, Dr. Zeidman, tim obvious obOe,'five o~ it, and on peg6 1 near th6 bottom of the page you draw ou}" attention of th~ me~ical ar~ is concerne~ Dr. Z~m~a~'. Yes. sir~ that, is the ~av I feel about it Sir. W~Tso~. Tha't is the way you 15ok a~ it. I think it is a rather interesting obs~rvatiou that • lnan who smakes many clgarettc~ had had discolored his l~gers and so forth bu~ yet no c~nc~r hag developed oa tlm fingers. Is that oNy your conclusion or have you he~rd of any Dr. Z~m~fAx. No, I have never heard o~ a case o~ cancer of the ]~ers wher~ they are discolored in a heavy smoker and~ of course. you should he~tr of ~ oftcn~ ]nd~nng fi-om the way tobaeco producc~ cancer o~ the sl~ of the raouse. Mr. W~twso~. I haven't heard that point brought out ~)e-~ora and the Surgeon General didu% allud~ to it in his testimony but you know o~ no instance where we have had cancer of the fingers~ Dr. Z~m~xx. Never heard of it. Mr. WaTson'. I have seen some of them ~ust literally suppoTedly whit~ skin bu~ they ~cre almost, totally black there. You state on .... a "The mouse ~Nn i~ dtemicallv different from ~he mouse lun~ ~: ~: =~ ,v .... " so that you a~ach Ii~tle s~gnificance to the produc- tion of c~cer through the skta smear; ~s tl~a~ correcc~ Dr. Z~Dx,~x. Yes. sir. 5£r. Was'sex. Again von~ too~ ~e brave in admitting ~hat tim medi- cal science has not beeu ~'.; exact, as we would like it andI agree you are t,ha bes~ we ]mve and I really rely on you. Bug you po~t out~ too~ that h~ }lm past perhaps the diagnosis par- tictflar procedur~ have nob been adequate ~ougl} and as a conse- quence you ln~y have listed the cause as pneurnonm or lung whe~ a~l the ti~ao it, was lung cancer. Is flint about Dr. Z~rau. Yes, sir. h[r..' ~" r.<~so_., x.. On t~ag'e 6 ..~'ou .sort of fall into nay_ line of belief when you say, "Only about 10 percent of.all 4eath~ are fol~o~ed h.~ ~opsy." I have heard other% eveu the one wlm.prccctm~t ~-o~., ~2% m~W have some requ~emenI, that you must h~ve a,t antopsy on ~5 percent. First, I thi,fl: the doctors are more seem'ate than that am], ~econdly, I jus~ can% see ~ greater percentage than 10 percent as you indicate here.
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10,54 Dr Z~m~ x~'. Sir, I think ~,our question to the previous witness was or at'h:ai-~t, ]~ia in~er~nce was ~hat~ercentago o~ ~utopsies are done in h,:,~;pitals. Mr. ~V.~T~O~. Y~:% sir. Dr. Z~.:n',~t.tx. )~qlen I ~ay ten percent I am talkin¢ about percenta~ nf tml qrA,,,~ done in all deaths in the country and m~hy of thee peopm ~vh,~ ,llc ,,~h;ide ,:,f the 1,3spiral of course dd not get. agy autopsy. Mr. ~.~,~o~. Thttt was the real fi~r¢ I was iaterSsted ~. ~at your fi~,urc and accordin~ to your statement o~y abou~ 10 percent of ~tll d,:~{h,~, ind~{inff boflx in and out of_the h~psita[s, }re fqllpwed by aa autoD:.y. ] ou certai~y mal=e i~ mighty clear here that while tir~<t hay,, th~ rclatmn~lnp or at least the fact that the a,ent and th~ di~;~,:t:-;,~ ¢,ecur tom~.her, th~ other factom are clearly missing and that i~3 t}m correl.ati~n bet@eea smoldng and lung cancer in the actual ex- l:,.,riment:ttion, and the proof of that and to me you have presented mighty compelling and conv~cing ar~ment " I x~d only note or tak~ exception to one statement on )our l~t p.ar~g~al-~h ou p~gc 6. Iu th~ scvond sentence yo? say, "F~rst~m ~o~ tlmt the cawmtive agent and tho disem~ occurring together, I think if yon ~wmld want to be totally objective about it you wou]d say hi:, notes ~.ht~t the ~u~pected co,afire agent. I~ you'Imow it is thg caus- allv~.~ sift n~ why proc~d to the next step ~ ~lr. W.~,sox. Thank you, ~Ir. Chairman. Mr, Pa-m~a. Just two bri~* quegions, Doctor. W~ hav~ had '~ discnsslo~ here earlier o~ experts on th~ subjec~ o~ wh~zthcr you can toll ~mokcrs ~om tho nonsmokers by examin~g the lung. g,-,u ar~ profeeeor of patholot~ at the Univ~'sity of Pemgl- Dr. ZEID~rA~'. ~'es~ sir. Mr. ~,~sma. I would be interested in geging ~our option ca that. Dr. Zx:m~r,xx. As I understand it, you%ave t~o lung~ in the hands ~m~ you look a~ them and by tlm p~ent and so ~orth you c~n say thi,~ bc}~n~a to a ~:mok~. and t~s does not. I also uncle.rotund l,'ol:,l,:~ .~aid t.h,~y could l:,e}l this. I would ~ti~mt~ that o~ ~ thousand pathologists in t~ country 998 w,,fld tay~ ~¢I cottl~} not te~," and the other two would say, "I cotfld tell," an,{ tha~ tho~ two who could tell either ~d aom~ diane tuition or were not teRlng the Me, P~m~m~. You say of a thousand ~athologists you would ~ess 99~ ~ ])r. ZEID~rA~. Yes, ~ir. Mr. l:',~.nm~. So thera is no discoloraeioa wlfich you saw, no tu~fing Dr. Z~:m~r~-. Di~co~oration ia not related to smokh~g~ but is related Mr P,:r~m 998 would say you can't {eIl~ and then you user some 1ti,~,, ~,ord~ to ~{li the other-t@o liar~. The oMv other ~uestion I had i~ lhat n~ tho bottom of pago I you state wh~t'ynu t~nk is proper to T~ouM you ~ay thi~ would ~e • precis~ labeling of a cigare~ pack- tt~zo or ad}crtisi~: "HeaxD' cigarette ~o~ m~y be a weak ~ncer l,r,adueing agent in a s,sceptible person. ' 1055 Is that your judm'nent of wha.t is the most exact, label to put on a warning~,~, ~/'o= quotg t his in your t~timony. Dr. Zrm~[.x>-. For waraingpurposes? Sir. P~mt. I do not mean that~ Dr. Z~m)~,~. We]l~ I think that is the fairest statement that can b~ made although you are ¢once~ed here only xvi~h cancer. Ycs~ ~[r. Psalm ~hat would bca ~air si::ttement ~ Dr. ZElum~'. Yes, sir. ~[r. Pue~=. All right. ~ank you~ Doctor. Th~ C~.~m~.~x. Tl]ank x ou very ~ndly~ Dr. Z~u)~a~-. Thank y~u~ ~r. The O,+a~m~.x~-. We appreciafe your coming and gi~ ing us the bene- fit of ~om' th~g. You know it h awful ~te hera tonight and w~ almos~ hare to apologiz~ for running so lat~ but we are trying ~o accommodate everyone that we can and we appreciate your tee~imony. Dr. Z~:m)~ax. I [tppreci~te your Wing me your time. The Cm~za~-. Thank you. At t~s time I would lik~ to place in the record a ~aiement [~ Dr. Lvman &. Brewer III, a thoradc surgeon and pro~essor at.~e ~[~dic~l S~hool of Loom Lh~da Univemity in ~s ~kngele.% He has provided a statemeat,~ to lhe committee on medical aspects of tar and nicotine. If there is no objection~ Dr. Brewer's st~vternent will bc lust.fred at tMs point in the record. I~ is so ordered. (The ~atement of Dr. Brewer £oUows :) T~ ~IC~ SCHOOL OF ~h ~IBDA UN~'~%ITY, LoS AN6ELE8, As a s~llst In disea=es of the chest, the writer has treated more than one ~ous~d cases of primary carcinoma of ~e lung. This ex~erlcnce has generated a great interest in the ~emenflous problem~ presented by bronchogenle careln.ma. B~ause man cabot be used as an experimental model for the lntrabru~eblal ~j~tion of various possible cure.ogees, ~ere has ~een a natural use nf tory anima~ to determine ~hether vr not lung cancer could be produced by tim introduction of various substances though~ to be ~rcin~genic. Early experiments utiliz~d "~moking mfiehines" to collect ~r~ and realdue~ from cigarette, These subs~nees were then a~plied to ~ s~n of e=~rimental animah; ~ high concentrations, mu~ higher than it is ew,r possible to attain ~ the lung of man by cigarette smo~g. After the applicathm o£ thence smoke co~eentrate:-~ un the skin of ex~mental an~al~, gkin cancers were obge~ed. Th~ obse~afion has been unduly emphasized, both In the United State~ abroad, as a demonstration of definite p~oof that the tars and residue:~ in cigar- ette smoke ~r~uce ~lmary bronchogemc carcinoma. It is obviotm to any get who l~ks at the~e cxperim~ta objectively that the only fact proved that very h~gh concentrations o~ cigarette smoke ~ra and re~ldue:~, tf placed on tb ~ ~lSn, may produce sk~ e~cer in experimental animals. FoRowlng this demonstration ~at sMn cancer could be produced in experl- mental anima~ by the exte~al application of tar~ an~ reaidue~ from cigarette smoke, fu~er experiments ~ere cabled out to attempt ~ prove ~;imllurly c~cinoma of the ~achebronchial trees could be produced in experimental ani- ma~ by instllRng these tars a~d residues dlr~tly into the tra*ehea, Despite ea~est and mreful ego.s, the re,eateR attempts by various investlgah,ra tu produce bronchogeulc carclno~ by ~e ins~llatkm ~f d~arette smoke tars aud residues into the ~acheobronch~l tree have been unsuccessful. Thus, experl- mental evidence Ig lacking ~a~ the t~atcaeheal admlnlstra[ton of ~]rs and dues from cigarette smoke will result In e~nslstent and definitive ~,rnduethm tracheobronch~al-pu~ona~Y cancer in ex~riment~tl anim~,l~, even wh~a doses of these substances a,e employed. Tl~ese results have t~een th~ ~:ame the substances have been instilled at ~torvals of ~vlce weekly over a period of
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lOb6 t~5 ~eektl (In! r~'porh,l by Dlcken,% gouc~, and Wynforth), or whether ~ single ~m:~ lye al*Plleatt.n ha'~ b~en ~de (a~ reported by Greenbe~ and HaDmann). Ia ~,harp coatm~ to the lack of ~ac~e~s in producing cancer of ~e lung cxt,'rl~ental anlmal~ with eiga~'et~e smoke Lars and residues is the definitive h~Jv,:tb.~ll of bctapropiolnetone, employing the same t~hnique. Also, numerou~ card~nmat;h lacludi~g tho~:e of the trachea, liver, kidney, and intestine, ha I~car, d in rat~ follawtng the iatratracheaI lusuffiatlon of aflatoxln. Thus, the c-qu,rlmel~tal teehnlque~ that har~, been employed appear to be satisfactory, th0 ahoy. t~v. ~;ub~ta}lce~ did produce cancer when apptied by the same methods a:, the:. ~xhlch Ddled to pr.duce cancer from cigarette smoke tars and residues. Farthernmr~,, ~,an:,or can be produced in the trachea of dogs ~g 9~10-dlmethyl, L2-1..nz~m0~rae~,ae ina colloidal gelatin suspension, ~stiliing it w~My into the riM]if: [e~ hrmu'hu-:, ttowcver, l~ was ltecet~ary t0 rever~e fl~e sequent of corot- .el l~n,hea tr~,a{ed ~or trcaeheal cancer to be produced with ~is chemical. w,,rl~ of St;tub, EFcn~:tein, Ha~,, and Beattie is mentioned to ~how tha~ certain ',nlv;t:o-~c~.~ can l.) made to produce tracheal cancer under s~cific conditions. Sll~lIarly, Dellnporta, Kolb, and ~huldk have produced malignant change~ h~ tt.., lr:tehc.hron,,hlal tt'ee o£ Syrian golden lmms~era by the p~iodic h'acheal adq~lnh,tr.fl.a of thit~ ~ame :~lb;~taace, Tht~s, it is clear ~at it Ls possible to l¢,.lu*'e ca~eer of the tracheobro~chkal tree experimentally wl~ certa~ ~ub- :t~m,,';~; It l:~ ~¢qnally evident that it has been imlmsslble :~ produce a shnllar ¢;lltce~ Cxt.~rlmea~dly with the ta~ and re~:ldues of cigarette smoke. The prol.m~_'n~ of certain restrictive legislation apparently h~ieve that it hag be*,n incontrovertibly proved experimentally that ~rs and residues from cigarette r,mohc produce tat, o~r of the: lower resplrato~ tract. As noted, such cancers have ~1o¢ beell l~ro,lueed :rod therefore, ~Zu bill I~ based oa a false praise. Present ~;ch*ntlllc hnoMe¢lge provldc~ uo valid reason for p~nti~g the quantity of tars ~nd tdeotim* or other "lncrimbmting agenff' on each pack of cigarettes. Further- }~or,,, :~ueh labeliug might set off eompetitlo~ between various tobacco companies, vacouragt~¢ daiam and counterclaims which, in our present state of ~owledge, xvouhl I). m,,aalu~de.~ and ,..nfu~ing to the public. TI01~ carr,,ntly m~bmitted legislation al~ough purport~ to be based ou scion. ~lllo leer, h&o gone beyond cstab~shed selentific knowl~ge tn its c~aclusions. Legb~latlon concerning health ~,hould have a firm ~ientific basis if it is to valid aml mcaldng£.l. When a bill goes beyond proved scientific knowledge, t;et~ a precedent for the introduction and paesage of further bills without valid Ia hum~-~ary, the facts are the~e : 1. Cano_,r of the traeheohronehlal tree ha~ been vrodueed In e~erhuen- tel a~hnal~, by the introduction of certain carcinogens (betapro~inlactone,. aflah,Mn, f410-dhoethyl, 1,2-benzanthracene in a colloidal gelat~ su~en- 2. U:~lng the ~ame teelmtques in o~erlmen~l animals, in~luetioa of tars and rr: 4dm,~t fwml cigarette ~moke has failed to produce cancer of the lower re~plratory tract. 3. ~]nee It h~l,~ not h~n proved exp¢~rimenKally ~at tang ~d residues from cigarette ;~mok~ l, reduce cancer of the respiratory tract, there is no valid r~,a~'on to lI~:t th,~ percent.ago of such tara and residues on p~ckages of lho ~qgar~ tt~.:: or in th,, advorttsi~g of the eigarette~, as reeammended ~ ~ome ,d th~ legb~latloa currently being considered. BIOGR.~PIIICA~ DAT.K rPho wrlt,,r'~ Intore-t hi earflllOlB~( of the In~ is the result of practicing medi- ~,lu- w~ a ~q.,,.i:~ll~t ill tl~.raeic surgery for more than 27 years. This ~peeialization follo~ed el~dht ye:~r:~ of 1.r.~I-graduate training in thoracic diseases, and genera[ al.l th,:raeie ~urg,,ry. follt~wing gr:tduation from file University of Mh.hignn ~[t tll,.~tl ~-ll~tol tn ~9Y¢2, Advanced doma~ include: M.K in surgery (UniverMty of 51b.ld,z'alll : fvllow~hilv.~ in file Anlm'iean College of Surgeons (F.A.C.A,), former Iz'~ crll-r lht..klaerh.all C~dh~ge ,~f (.'he~:t Phyaiei~ns (F.A.C.C.P), and the &mer- l,'au Coll,.;~,. of ~ar, llolo~" (F.5.C.O.). l,ieen~t~ are held in the stat~ of Michieau and Pallfornia ; and cerllfivation as Founder Member or the American Board qquq'avb" ~argcry. Past President of the g~wlety of Thoracic Surgeons, ~aeifie t',,a~t SuD~h'al A~sot.lalirm. California Char~ter af the American College of Che~t lqq,'*l.d~lw, Tt~de~ll 8.¢lely, and the Excelslor BUl'gi¢~l Society. President of the 1057 During World War II, the writer took l~art In setting up the first Che~t C(,nter in the United States Army Medical Corps, in Blzerte, Xorth Africa contributing to studies to improve the treatment o£ eltes~ wounds. This experlent~ w~t~ roe. orded in Volumes I (19~) and I1 (1[165) of ~urgcry tn Worm lVar II. Medical Department, United ~tatez Army: Thoracic ~urgery. Since World ~Yar II, efforts h~ve been dirtied between teaching, practice, and research ia thoracic dl~:e::tses. &t the present time, academic ap~o~tmen~t elude: ~'rofessor of $urg¢~y, Loma Linda University $ctlooI of 5Iedicim~; ~llnical Fro£e~sor o£ Surge~, U~verslty of 8outl~ern California School of Medicine, a~d University of Califomfia College of Medicine, ~s A~gelez. Additiona~ activlfle~ are: ch'ilian consultant to the Veteran:~' Admin~tration, U.$. Army hledical Co~s; coasuttan~ for various ho~pitals; founder member, American Thoracic SargenT, sere'lug six years as a~t active examiner and, for the l~a~t two years, as an emeritus member of ~e Board.* Membership is held in ~dx medical societies devoted exclusively to study of the problems or thoracic service as president ia ¢hr~ o~ those. Contributions to the medical literature In addt~oa to ~e ~o volumes mentioned, include one other hook and approximately 70 scientific a~cles related to problems of thorat.ic diseases. Premegica~ e$ucat~on: ~herst Colleg~B.A. 1928. Untv~e~ity of Michigan Medical Seho~d--~f,D. 1932. Unix~ty of Michigan ~ledtcal School--M.S. 1948. ln~ern,~M~ : 5Ie~cy Hospital, Toledo, Ohio--Surgety--1/1933--3/1933, Boston ~ Hospital, Boston, 5Iass.--Iaternat Medicine--Harvard 5[cdlcal g~oo~/1933--10/1934. B~levue Hospttgl, New ~ork City--Surgery--New York Univer~ity ~6~936. Barnes Hospital, St. Louis, Mo.--Sttgery--Washington University--f/1 to 6/1937. Resfdcn~cs : Universi~ of 5Ilchlgan ~ospRal--~athology--6/1932--1/1933. Bellevue Hospital, New York Clty--Thoracic--Culumbia --1/1936. ~avnes ~spi~l, ~t. ~uis, Mo.--Surgery--~'a~hlngtoa Univer~ity--tl/193~- 6/1938. University of ~ichigan ~ospital--Thoracic Surgery--6/193~6/1939. Boarg certifica~fon : Founder Member £merican Board of Thoracic ~u~e~ : 1948. Repres~tative of .~ericaa A~ociation fo~ Thoracic ~urgery 19~ Teaching appointments : Assistant in ~ediciae~ College oI Phystcianu aml Surgcoa~, Columtda Unt- vemity, 1/1936. Assistant in ~urgery, Washington University 5Iedical School, 6/1937-6/]938. Teaching Resident in Surgery, Unive~gity of Michigan, t~/193~6/1939. Instructor tn Surgery, University of Michigam 6/1939-/1940. Instructor ia 8m~e~, 1941, As~i~gant Clinical ~raf~ar, lf~6, A~ociate Pro~essor o£ Surgery, 1952 to 1961~ College of Medical Evangellt,ds, Lo,,t ~geles. Clinieat Prolonger of Surgery, Loma Linda University {)Mrraerly Colle:~, o£ ~Iedical Evangelists) Chief ~ection Thoracic and Cardiac Surgery, 1952-1964. Professo~ of Surgery, lf165. Visiting Professor, ~nerican University of Beirut, 1962. *Consultant for ~e State Depnrtment I"SAID Civilian ~ospital Vietnam 196~, 29- 23¢N--60--l,t, ~----12
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1058 t=.aatr~.n of Staff 195~IOG0, ~ai~an Depar~ent General Surgery 195~ 195~i, Lo~l Angclcu County General Chlc~ Conm~ltl~g ~horaclc Surgeon--Olive View Sanito~um ~d San ~era. ~¢ndo V,:terau~ C,*m~ul~g ~ur~onn--O~ho~dic ~o~i~al, Cl~ of ~o~ and U.S. Na~. Chie~ Thoracic Surgery, Ca~o~i~ ~os~ltul, ~hite ~emo~lal ~:taff Surgeon Ho}~pital of Good S~aritau ~nd S~ ~Incent's Hospl~al. ~irlli~n C~,~;uI~nt--~oracic Surge~U.S.~. ~ledieal Corps--Surgeon Am,,rl,'~n Surgical A~oclation Follo~ ~orie~m College of S~geons (Governor 1~59- ) A~,~rl~m A~ocl~ltion ~horacie Surgery (Co~l l-'~*:l~ic Coa:~L Surgical A.~on (Recorder 106~ ) ~,:,ci,.td, Internationale de Chirurgie l'au Pacl~c Surgical A~ociatio~ P:xccl~tor S~glc~l Club (President 19~) Lo~ ~gol,>;~ Surgical ~iety L~ A~gelc~ Trudcau ~odcty (~a~t pre~iden~) Lo~ Angolc~ Academy of Me~c~e }:ymI, o~t~ Society ,~cric,m College Ohe~t PhyMcla~ (pastpr~ldent, Calffor~a C~pter) C:d~o~a M,~ical A~ociatioa (Past Cha~m~, S~flon on GenerM S~ge~) ,~erlcan ~Icdical A~oclation A~oclation of ~e~k~ ~Ie~cM Col~eges Medical R,~earch A~oclation of Ca~or~a ~erlcan ~.~oclatlon of Univer~l~ Profe~ors Honora~ Mcmb~T: Society of Graduate S~geo~ of Los .~geles County General Editorial Board.~e~e~ Review o~ ~horacie Interua~o~mt Car~ovascu~r S~iety Am.rlc~n CoileD. of ~olo~ Nation:~] A'{~o~iatlon of St~mda~ ~Ie~cal Vocabul~y Fr~o~ek ~ Colh~r Surreal So~ety l-~cl,.~ty o£ ~ur~clc Surgeons Ita~k: Lieutenant Colonel. Active Duty: United Staten Army 3£e~cal Corp~ Over~ea~ Duty : 2727/43 to ~/X~/45, ~fe~terranean and ~uropean ~eater~ of }~rincl[,al A:}~i~mment: Secon~ Au~lia~ Surgical ~oup, Surges ~ Oha~e ~hora~c Sarge~, Team ~4. variou~ a~signmen~, including work ~ chesg cunt,}r::~ at Bizorte, Tunisia, 1943 and Mirecourt, France, 19~. ~so in fo~wtrd hospital~ In charge o~ ehe~t su~e~, 1943 to 194~. Bea~ head landlng:~ Salarno, Italy 1~43, ~zio, I~ly XP~, San Raphael, Sou~e~ Award~ and Clta[ioa~: Bronze Star Medal Campaign S~rs (Nor~ ~Ica, Sk~ly, ~outhern Italy, ~ome, Arno, Southern France, Rh~el~d, Cen~al EuroFc). Bronze Arrowhead. Unit Citation. 1, I~r~wor, Lym~m A., III~ ~he occurrence o~ parathyroid ~sue in, [hymus~ ~*,pnrt nf f, mr ea~;~, Endocrinology S : ~97, 1934. 2. ltr~,wvr, Lyman £., III: Routine practices o~ ~e Fonr~h ~cdical Service, llarvard ~Ie~.al School. Bo~on City Hospital, Edward .~hor. Michigan. 12~ pp. 19~Z ~¢. Doiloy, F. S. aml Brewer, L. X., III: Chest injuries. Ann Surg. 116 : 668. 1~2. .L D,.dlcy, F. S. and Brewer, L. A., IlI: Chc~t iuju~cs~A. Series of twelve 35 ram. ,,ob, r m,vlc~ u~ed at U.S. ,~my Teaching Centers, World War IL ~Iade at tim r~quc~t 0f National Re,each Cotmcll, 19~. 1059 5. Dolley, 1~. S. and Brewer, L. A., III: The diagnosis and treatment of primary intrathoracic tumorz, J.A.N.A. 121: 1130,1943. 6. Brewer, L. A., III : Portable hand driven sueUon machines. Bull. Med. Dept., U.S. Army, 75 : 119, 7. Saturn, P. 0., Brewer, L. A., III, ann Burbank, B.: Immediate care of the wounded ~orax. J.A.~L&. 129 : G07,1~16. 8. Burford, T. H., Samson, P. C., and Brewer, L. A., III : Recove~ f~om hemo~ticus s~phyl~o~us aureus bacteremla attributed to I~,nie~n therapy. JouL ~horac. Surg. 15: 1-30. ~. 9. Samson, P. C., Burford, T. H., Brewer, ~. ~,, III, and Burb~mk B.: The manag~t of war wonnds of the chest In a Ba~ Center. flour. Surg. 15: 1~0, 194~. 10. Brewer, ~. A., ~I, Samson, P. C., Burb~k, B, and S~Iff~ C. : ~e wet lung ~ war e~sual~. Anm Surg. ~3: ~3, 1~. 1Z Samsou, P. C. and Brewer, ~ ~ III: ~acheobronchial ~e~r aspirates In~cations ~d technique Med. Bull. U.S. A~y 52~ 228, 12. ~amson~ P. C, aud Brewer, ~. A., III: Principles of tmprovi~g ~adcquate ~aeheobronchial drayage ~ollo~g ~auma to ~e chest. Jo~. ~horac. Surg. 15 ~ 162-17~ I~6. 13. Brewer, L. ~ III~ Plombage in ~e treatment of ~ulmonn~ tubercule~:l~~. & prelimina~ repo~t of use following u~ucces~ thorac~p]as~. Ca~, Med. 65: 28, 1~6. 1~ Brewer~ L. A, IH, Dolley~ F. S, and Jones~ W. ~I. G. : Non-mali~ant in~ra- ~eracic lesions ~muIa~ng b~onchogenic ~cinoma. Re~ of ~} oi~rated cases, Jour.~ora,. Surg, 17: ~, 15. B~ewer, ~. A., IH, and Began, E. ~ Streptomycin in tuberculou~ bronchitis. Amer. Rev. ~ber. ~: ~, ~6. Brewer, L..~, III, Dolley, F. S., and Jones, ~. M. G. ~ Indication~ for pul- moua~ resec~en for tube~c~o~s b~th by lob~omy an~ Dis. of Chest 14 ~ 491, 17. Dolley, F. S. and Brewer, L. A., III; Chapter on P~mona~ ~esection~ ical ~uberculosls by Be~am~ Goldbe~, S~th Edition, F. &. Da~3 Co, Philadelphia, 18, Dolley~ F. S. an~ Brewer~ ~. A, III ~ D~o~ls and ~glcal trident patent duo~ arte~o~s. Re~ Pan~evI~-ma d~ ~e~c~a y Clrurgia del torox, 1 ~ 1, ~9. Brewer~ L. A., III ~d Dolley, F. S. ~ ~e surreal trea~ent of ca~ema of the thoracle e~opha~ The te~hnique of ~ns~orac~e thorac~lapar- otomy with esophageal resecfio~ and high esO~hagoga~ostomy. Your. S. G. and O. 5~: 61r-528,194~. 20. Brewer, ~. A., III and Bogen, E. ~ Streptomyc~ treatment of ~rc~ou~ ~acbeobronchitis, Calif. Me& ~: 1~ 2L Brewer, ~. A., III: Sur~l ~t of carcinoma of the cervical an~ upper thorn~c esophagi. West. $our. S. G. and O, 60: 1-12, 19~2. ~. Dol[ey, ~. S,, and B~ewer, L, ~, III: Conce~ion ~odc~a del ~ratam~to Me,Ice y Quiru~gico de Ia ~r~les~ t~monar, ContEbucion Extra- ord~arla. Se~ndo Cong~o ~entino de Tislolo~a, pp ~I02,1, Nov. 28, 1~9. 23. Brewer, L. A., ~II, and Doliey, F. S. ~ PlombaJe con Lucite, ~III Panic,cane ~Iemo~as de Tuberculos~ ULAST, ~p 517-52~, Mexico, 19~9. 2& Brewer~ D. A., III: One ~tage resection of cagc~oma of the cc~ical pha~ms was subpharyngeal esoph~goga~trostomy. Ann. S~g. 1~0: 25. Brewer, L. A., III and Dolley, ~. S~ : Carcinoma of the ~horaclc A discussion of early dieresis and ~ur~cal ~ea~ent. Cal~. ~lcd. 71: ~2, 1~9. 2~. Brewcr~ L. A., III ~d Dclley, F. S. ~ ~ors of the medlastimlm. A discus- sion of dia~mo~tie procedure and surreal t~ea~ent baged on with 44 operated cages..~er. Rev. ~ber. 60 ~4, 1~t9. 27. Brew~, L A., III, Do~ley, F. S. and Ev~s, B. H. : The surreal management o£ chronic '%pontaneous~ pneumothor~Reper~ on e~iologieal faetor~ and s~gical treatment employed ~n 15 ea~es. Jour, Thorac. Surg. 167-194, 28. Dolley, F. S. and Brewer, ~,. A., III: ~he ~iagnosis and treatment of chronic s~ntaneous ~neumothorax. WesL Jour, g.O. and G, 58: 463~171, 1950. 29. Brewer, L. A., III: The surgical treatment o~ pulmonary tuberculo~l~, County Tuberculosis Assn. Monogr~ph ~0, 0c[obe~,
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1060 ;¢0. Br~wer, L.. ~,, III, Klug, E., Killy, L. and Bal. A. : ~ronehial closure iu 1)ul- ~mnary rc':ecthm--& cll~tcal an~ exI~rlmen~l study using a predicled 1.,riv.rdtal fat graft reinforcement. J0ur. Thorae. Surg. 26: 507-532, i~;,r ~.~m~,rlta[ rc;;eeHon 1~ ~ulmonary Vaberculos~. &met. ~ev. ~uber. 69 : :;~, Br~:wvr, ~, A., III a;~d Bai, A. : Surgery o~ the bronchi and trachea--Expert. ,~nee with th,~ vvdieh~ perleardial fat graf~ reinfor~menh ~en :XL I~r.wcr, L. A., III: The s~rgical manag~mene of lesions of ~e thoracic thoracic duct to the hemla~ygos vein, &mer. ~ouL S~rg. 90: 21&227, :iL B~t, wer, I,. A. III. Bat, A. and Jones, W. ~I. O.: The development of idoxlral p:lrtltlon to prevent ovcr-ex~anMon og ~e lung fo~owlng partial hmg xo~,'ction : An experimcatal ~tudy wi~ e~nical appltoaflon. Jour. Thorav. S.rg, 31 : I~182~ 1956. ~rc';~h,~ I, ulmonary hi~toplasmosts wl~ bilateral ~eseetion and therapy, Anm InL ~Ied. ~: 9~, 19~6. 30, Br~wer~ L. A., III and Bat, A. F. : Tra~mtento Quirurgieo de la Tuber- vluo~i~ Pulmonav : La Imlmrtaneia de ~ Reseeeion ~lmonar. Contribueton Hxtx'a¢~rdinarial nl Quinto Cong~o A~gentino de Tisiolo~a. Nov. 2~30, 37, Xtr,~wor, Lyman A,, III: Operations on th~ ~rieardium : k ~eview of current :,ur;~ical 1,ro~edure.~'. Calif. Med. 8~ : 38~38~, :~. II,ml~,l, ~L tL mid Brewer, ~. A., ~I: Cardiac arrest one hoar followhg pneu- ~xom~eton~. ~uccc:~ft~l rosu~eltation and religation of right pulmonary artery. Arch. Sur~L 75: 277, 195~. :ltL Br~,wt, r, L~m:m A., IlI and Bat, k. F, : Chapter on: Surgery of ~ Bronchi ~md Tr;whea. Bronehopulmona~ Di.~eaacs. Emil A. Naclerio ; Editor. Hoe- lair II:trp,x, Now Yor~, 1957. q0. Brvwor, Lyman k. III and Bat, A. F,, Little, ~. N. and Rabago ~' Pardo. G. : Caroinaum ,~ the lung : A Practical elm~cation for early dia~osis and :;urgleal treatntont. J.A.M.A. 166 : aadO, ,11. Itrou-or, ~yman &.,III : PIeural partition procedure: & ~eelmiquo for tho tm- lm,dlab~ manngthlcnt of large lntra pleural dead space, following lobee- t,..y, lhtll,~tin d,~ la ~oeleto Internatlonnh~ de Chlrurgte, ~g : 305, 195~. 42. lCrower, Lyman A., IlI: Carcinoma of the e~ophagus: Surgical resection un- ,for hYl,~thoroJilt. Preliminary report. Bulletin de h Soeiete Intornatiotmle d*~ Chtr.r~ie, 5~] : 1, lf~dS. 4% Brewer, Lym.n A., III and F~lward ~. Kl~g: ~ypothermia in Thoracic anti Thora.a/,l¢~mhlal Surgery. American Journal of Surgery, 96: 137, 1958. 41. Br,,w~T. Lymau A., III, l¢ai. A., Kiug, E. L., Wareham, E. E., and ~arri~, .~. M. : The pathologic effcct~ ot umt~le forei~ boflie.u in the pulmonary t Irc~fl;dion. flour, of Thvr. a~d Ctlrdlovase. Surg.. 3S : 670, 4~. ]h',~w,~r. Lyman A.. III: Cr~ta and #a~tie ope~tlons a~ the ~aehea and hronchL Cor, ph.;-~ ~ondus XVIII e Co~grds de la Soeiatd ~ternationale dr, Chtrttr~h~ 1 : 7OS, 1959. 4tt. Cogghh C. ,L, Warcham. E. E., Brou'~r, Lyman A., III: Serum glutamhfic- oxa]aet'fle tra~alnina~'o activity ,~s a pro~ostie aid lo]lowing open heart t uegvrS wltll eardioplllmonary by ~as~. Bullets do la Soeiet6 Internaflon- ah, d,, Chlr~rglo, 19 : 4.10,1~0. .17. Itr,,w,,r, I,ynmn A.. IlI: Feank Rtephen Dolley I~SGI~I: .loire Thorao. m,l C,ivdtov,~v~Hur gurgt-ry, 42:4~1, 19(H. October. ,is. Itr,,wer. l,~man A. III, C~-nuthor: Meal. De~t. U.S. Army, SURGERY WORLD WAR II. Thoracic 8urgo~, Vol, I, Imge 394. U.S. Gov. Printing 4~L ]trower, Lynmu A., III: TRAUMATIC MEDICIXE AND SUROg;RY FOR TIlE A'~OltNEY. Page,~ ~71-287. Ch~q~ter o]~ Traehial lnjurie~ Dlr ,-*rt~',.:,. ttnft*,rworth lrw., lflO3. London. Euglaud. 50. Br,,wcr. l.yrta:tn A., III: ~eleetive deep hy~othermle eardio~Ivgia with extra- v,~rlu~rval elf*relation in ~e treatment of eongollital hom't disv~so. Sym- Ira: i~lm v.ne L'Bypotherm ~rofonde en Chlrargie Cardiaquo et Extra Cart~ae, Parl~, France, Aunalcz de Chlrurgio ~horaeiquo e~ Cardio-vaseulaire. l : 80 (Apz51) i~32. 1061 51. Brewer, ]byman A., llI: In Memorlum, Frank S. DolIey. Transactions Pacific Coas~ Surgical Assn. 33rd Annual Meeting. Page XVIL 1962. 52. Brewer, Lyman A., hi, C~gg~, Joan 0., Wareham, FAlswor~ and David: EI~vo Cardiac ~est In o~,~ hea~ surge~ with cardiopuh,,m- ary by pass. Bullet~ de la Soeiet6 IntemationaX do Chtrurgie. 2L t (Sept -- eL 1962. 53. Hinshaw~ David, S~her~ C. E., ~elkes, H. C., ~ggin, Joan C., and Brt~wer~ Lymau A. III: E~e~mental s~udies in coronary blood flow employin~ a square-wave electroma~e~c flowmeter. Bulletin do la Soeiet5 Interna- tionale Chlrur~e. Tome XXI, 1~2, 6 : 667-674. ~. Carter, Richard, Wareham, Ellsworth, Brewer, L~nan A. III. Rupture of ~o Bronchus foX,wing Clo~d C~es~ Trauma. ~erlcan Journal o~ Surgery~ 104:177, (Aug.) 1962. 55. Brewer, Lyman A. llI. Dlolo~eal Basis for advance~ in ~horactc Surgery, Surg. Gynee. & Obstet. In Press. 56. Carter, F R. and Brewer, ~. A. 111. Subphrenie &b~e~ In ~e .~ultbiotlc Era. .~. Y. Surg. 108 : 165,1964. 57. Brewer, L..M III, ~ggilL C. J., ~ff Warehnm, E. E. : Physlolaglcal probh,m~ ~ollowiug open opera~ons on the mi~l valve. ~ulletin do la Soot~td Inter- nafion~e de Chirur~e. In Press. 58. Brewer, L. ~. III: Chapter on Tul~reulesls Empyema and Bronehoploural ~s~a. Handbook on ~u~r~loMs. A~e~e~ College of Che~t Phyahdan~. In Pre~. 59. Drewer, Z. A. III, Co-author: ~Ied. Dept. U.S. A~y. Surgery in World War IL Thoracic Surety, YoL II, U.2. Governmen~ Printing 0~ee. In The ~a~)Ia~. Th~ comm[tte.e will s~ad adjourned. We woulcl like to go on and aeeo~odu~ bh~ ofl~r t.hr~ men wh~ aredn tod~ but I b~ove tMs is long enough fie mee~ ~t th~ moment, ~na we wm adjourn until tomo~ro~ mo~n~g a~ 9 :;~0 ~d t~ up ~here we lt~t off. So, the con~itt~ stands udjourned until ~mo~ow morning 9 :~0. (~Vh~r~upon, u~ 5:35 p.m. ~hu h~tlng ~4~o~rne4 ta reeonveno W~dn~day, April ~0~ 1969, a6 9:30 a.m.)
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CIGARETTE LAB~ELING AND ADVERTISING~19~;9 ~7~OE'~E OF ~EPF, ESEX-T~TIV~, CO~IITTE~ ON ~'~STATE A~D FO~G~ CO~I~ERCE~ ~he com~it~ met ~t 0:80 ~.m., pu~u~n~ to notice, ~n roo~ ~I~3, Raybu~ ~o~e ~ce Building, ~on. ~ar]ey O. Stngger~ (chah'ra~tn) presi~g. The Cm~.~. The committee ~ ill come ~o order. We ure ia a continuation of th~ public hearings oa all bills pending before the commit~e~ relating to glm l~bel~g and adve~ising re~. Our first witness tiffs mornh~g is Dr. Thomas Brem~ ~ter~dst, Los ~gdes, Calif. ~A~NT 0~ ~. TH0~AS H, B~, INT~BNIST, L0S " The C~. ~e welcome you to t, he committee~ Doctor. You may pro~ed a~ you s~e fit, Dr. B~m~. Thank ~ ou~ Mr. Chairman. Gentlemen, $ am ~r. Thomas H. Brem. a g~:adua~e o~ Johns Univer~[ty~chcol ~ Medicine in 19:~7. I h~(~ e been on the faculties St~ford (~niversitv School o~ ~Ied~ch~e, U~ver~i~ of Calfl'ornla at Los Angel~, and a~u currentIy profe ~or and chair~ian of ~hc ment ofmedicine ~ the University of Southern California Schovl Me,~ich~e and director of intc~a] ~c~clne o~ the ~s Aagele~ County- l~nlversit]~ o~ Southern C~li~ornia ~Iedical Center. I have 'been engaged ~ clinical medicine, research, medical educa- tlon, and a~ninistration in these ~elds ~or my wh~I~ professional life. My pr~cipal are~ of interest ha~ ~ ~een in d~easeg of the hearL and liver, and in neoplasia~ or canccc~ h~ general. ~ have w~hcd ~teres~ the con~.roversy over smoking and health and hare followed ~air]y comprehensively the scientific ]~terab~re and the report~ various concerned agencies and inst]tuti~n~. ,~]though I hav~ uo~, con- tribute~ to tlfis area of research, $ have had consid~rabl~ exuerience over the years in evaluating c~ical ~md experimental evidenc~ and in judging conclusions drawn from it as ~o their ju~tificatlon and logic. I%houId tell ~ou that ~ ~m here at ~m request o~ ~he ~ob~wco ill- dustLv, but I do want to eml~hasize t, hat, aux, opinions, idca~:, *hou~hts that. I express ar~ stri~h, my (nvn. ~hev,have been ~ormed long ~fore I ever had any idea $ wo~ld be t~sti~5 il~g before a. com- mittee of Congress.
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1064 I l|llt 3"t~V ]lill~l aware tha~ you have heard or re~d untold hours of t~%tiu~ony and dtbato on the relationship o~ smo~ng to cancer o~ g -:-~ ::~" t conflicting sets of argument. That of the ro- p,:,~,,at'~ of t/t~ cau~al relationship hypothesis involves ~sentially ~ur contt, ntion~: ~ 1. That~ thyr~ ha~ been a striking increas~ in ~he ineidene~ [~,-tc,,r ow~r.the pa~?,~ 40 t2 ~0 years coinciden~ with a similar increase -,~ l,'r caplt:t ,:onsump.tton o~ cig'xre~te~ . .: ~h~ eanc~r of ~he.lung ~s approxamate~y X0 ~es as ~re urn lit el~a~,~tte ~mot:ers as i~ Is in nonsmokers, q 3. ThaC tobacco smoke condensat~ contain materiMs tha~ have car- cino~e~e properties whe~ avp~ed to the ~n of e erim~ " ,L Fh,d, ml~:crov:eop~¢ changes which are regarded by some: a~ol. .I~i~;t:t m, "precancerous" are mueh moro frequen$ in smokers ~an Tim opponen~ o~ the hypothesis presen~ the ~ollowing set o~ ar~- 1, Tha~ there is serious doub~ tha~ the ~eat ~erea~ ~ reported lung rancher r~pre~entz in fae~ a true inorea~e in ~cidenee of tile dis. ,.~S' ~ t_~.lf t~#re m some de~e~ o~ increase an ~e ~cxd~e~ *her~ ~,r,., o,~ner equity, or oven more, ]~e~v eam~ for i~ than smo~g. ,J. That cancer of the bronchi and l~gs h~ ~ob Men produ~ exI"'rimt:ntal animals by the application o~ Mbaeeo ~oko or i~ con ,!._ "~'~a~ tim ~ierozeoplo changes seen in eke ~ronchial 1~ o~ +;eel+or++, and to 1v~+mor extent in nonsmo2ers, ha+a no~ b~n nro~d ~+ pr,:eal£c~rou:~, n~r arc the+- specific to smoking, and $hev d~o~ tm+~ :..am,_+ ,.tt~tr+butmn in the bronchial system +hak eanedm do. ;~. That an uncontrolled statistical correlaeion ca~oL prove n came- ttlttt-~q~et rclation~hin X trt meudous bod~ of literat~we relative to ~Ns problem h~ grown h~ }~l~ p~:~t j1,Fade 6r two, and massive aeeumulat,ions and analyses t~f .-~tatJ:/tjt.al data have been tier'eloped in effo~s to substan~iat~ or tli'.;l~ror~:~ tlm h.vpothosis. Virtually- all of these s~udies and retmrts ~2"J,)~ in r,,~}3.t~Tce to these pyilx3s. Each.side presents some hi-My U,.-':L,V-,I~f'~ COllHlCtlllg argumenrs, m~t neither can offer unequi~cdl ~.,:~.~.~t~fic ln?,.~f that vmokmg does or does not cause cancer of the lunu. ~, an~) crucia~ ~in~ tit the whole debate centers on whether or not rnol,~ ]lt~ mdeed been t true nlcreaso in Incidence m cancer of bm~,, f,u' 8, if bt fact there has not. it is hardly logical to aL~Hbute ,'~m,:er o£ the ]unX to the increased consumptibn of cigarettes over 10O~ From mort:-tlity tables it has been e,timated that the incldeace of cancer of tile lun'~, i~l white males increased ',2,6-fold between 1~)1-~ amt 1950~ or eighgfol4 between 1930 and 1960. '/he v~lidity of the~ ures o~ course depends on the eomplotet~oss and accuracy of dia~snozio of lung c~ncer over thi~ period The mortality tables ~ronl which the~ fi~res are dew, eloped ~OllSist of (~e accumu]atio~t of causes of death (~agnosis) li~ted on death certificates by mmxv thousands of indivld. ual practitioners of many Yarieties, frt~n wel]-t.rained, capabk, diag- nosticians through country general practitioner~, osteopalh~, home,- paths~ and others. They come in from all parts of the eountry--lar~t~ cities with excellent diaga~osttc facdtt~es to small hamlets ~h none.. A large proportion o~ the ¢~a~mosis rests on clinical impression,~ and relativdy few~ especi,dly in t~e past, will have been substauOated by pat.holo#e extmfination--biopsv or :mtopsv. The clinical entity of carclnSma of the iung in the early part of this centu~ was no~ wi'dely ~mwn amoaff the p~acticinff medical profc~;- sion. (~en such a con~on disorder as coronary oecl~lsion or myocar- dial h~farctioa w~s visually unknown to clinicians prior to the 1520's.) Other d~seases of the lungs~ particu]ttry tuht~rculosls and pnen~)aonia wero ~r moro prevtdent ks causes of ~eafla flxm~ they are no~v, and both of them can, and o~en do, resemble lung cancer ve~ closu]y. Even now sophisticated diagnostic techniques or pos~mortem'examin~t- tions are oftal r~uired to differentiate Betweeffthem, Fm, hcrmorc~ pneumo~a is ~e~uently present in the sea, eat of the lung t]~:tt is leered by ~ncer and only the effective therapy with mo&,rn anti- bio~ enables the patien~ to survi~'e re)ill the underlying cancer is suspee~d ~d speca~l dia~ostic procedures prove its pre~ence. A. G. Gi]liam t of the Biometrv and Epidemiology Branch o~ flw ~ational Cancer Institute has calculated that if onh;2 percent of deat~ in 1914 ascribed ¢o non-cancerous diseases 5f the resp~atou¢ system had indeed been duo to cancer of the ]un~ the increase in i~cideace of cancer o~ the lung between 191~ and 1955 would have been bu~ fourfold ~stead of the ~laimed 20-fold. Evidence that he relativ~ to the confusion or misdia~nosis of tubercu]osis for caucer in ches~ disease hospitals in recent ~ime~, mt~kes a 2-pemen~ error in 1914 enth'ely pl:msible. My judgment would be thae. considering flw lack of access to competen~ medioal care of a large pk'oportion of ,~ur pop~atio=~ the lacl.: of awareltess of the disease by the practieitig profession, and the imperfection of dlagno~:tic teclml}lue~, a 2-percent error in 1914 is a dis~inc~ underestimate. He goes on to sttttt~ that ~ the dia~ostic error wore 10 percent in 1914 and gradt~:ally diminished over t50 years as nacdica1 care became increasingl~ availabh~ and diagmo~.ic capabilities improved, to ~ percent, in 1950, t.her(~ wonhl l,c~ but a twofold ~crease in incidence. There is, of course~ nt) way of kuow- inz what the error has been over the vears~ but the eont(:nt.ion theft th~ error in diagnosis, and hence rel)ox:ting, was large 5, aud even decades a~o is h~rdiy assailable. Gilliam's conclusion is that "aIthough there appears to havebeeu u true increase in tlm incld~nce of carciuol~{a of the hmg, and that it is st~ill ixIcreasin~, that the ma~nitude of the increase is nowhere near as great as re6or(qcd mortaliLy shggests." t ~,illiam. A. ~.. '. "Trends el' ,'~lottallty Attt'lbllted *o Carcinoma of the 1,ung : l',~:~lbl0 195~.
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1066 (h,rtainly/'t~, tl> qttantity and qualitv of medierd care Jn nny p pu- ~, ~, • ' " o~ any I ~t/cukt~ d~,~..c, e~peemlh, rho~ diffieu]~ to diana mcr,,t-~e Thi~t." . - - . ~ o~e, ~s bound ~o ,. , ~ ~ " -" . [ ,*}~ ~ ~1~ ,~r_(~LIernllnlpg wltl~ an.y mwf, of accuracy or ~ertainty ,h,-,:v-,.~ is il*d,'e 'no,.L,o;..., :.. ~ ..... ~ h ...]t]~ c~e ~stem whether rr ,. ..... {d l7 ...... ~{"g '" ,w*qenee or whether ~ts race nit' " . • a.~9 % x~ e l't'any uo not know whether the true incidemce o}~ xon as /h ~ hll~ v is in f, " • " ' ancer of ..,.. Lg ' ,tet mc~:eusl[~g as mgarettes a.re increasin*l.- co l d"~ r,-. ~S.~,:q~,~ su!~ff~5~lrJll *rend the olda, ...... l ....... f]lell VOll~qllf.llIed .,l-mn~ fh~, ~ .-S ..... J ,. ~cer o~ the ltuz~ :. ~ _ ~;., ...... .,. ~ ..... :,m,~ l.,roporuon o~ cancer of all ~.t.. ,[,,,,,:::_now. xm~ ~,%ua su~g-e~e that there has b~n no ~ * va,-~. ~lt CttllCer o~ the lIl~,r l'ol;tti-~ + ........ :- . .,el .......... - h_~ report of the Advisor Oomm~tt th,, USPI~S ~,.,m..-~ .e ..... ~ :~. ..... ee to ~)~ Surgeon General . ,. ., . ~. h (1064)states on I lie ~tlltllor~ Of thi~ '~tion e~identl~'.~.;~ ~;L'Zi~~ ~a~e s~e~ ~.,, ta~J,)n of (Ydh~ml a In 19617 In t~s report entitle~ t?lit.v Atfrihuted to Cardnoma o~ .~.. r:~_. .. ~ :- Ih,mgfh th~ ~)fttl death rtte r ..... a_a ~ .... ;... , . sc~earthat, ~m:~ {ncr~a:::t,d throughout Lhe period (19a0 ~9~n~ ,~ ..... po~ula~on l)e rrttpha::lzm2 th,,refor- ~.-+ ~ ........ pccuyred, and, It mug tim r.t,., al, whM~ ~ ,~i~.,~,~"{?~.;'~.~*~ eo.~s{~em~g ~[erms in ,.u ~,,, }ncr~ ,tso oz ~eeroaso 1~ ae~ua/ ~,,~,~ T~ : ..... • ..... ~ ........... ~ ~ucar~ pomtma o£ cancer ,nmm,e rata of iner,:,.t~, T¢ fl~C~'~.~ t~efanL t~?~ea, as the de- a"~ ~{ F~ ..... , .. ~ -, .;~ .... ..... ~.u{ ~ o~ the trend connnues t " - ,-,'),, *~ *).u-.'k[9~J,ea~ among the wlute mala o ~atio " , ,~ L,.u~m Itlt~re (lJN;J} and then start.to decline.,,p p a m the fore- Th, fa,:,f that the rate of increase of cnncer of the . .,.: ",..". • .. •., . • L rtainl~ "a~ -mokin# ......... ~-;':- • s .~-, ner theory. ,?'wh na,~£i~t~: t~{.~r 2'ear'/og'~:fl. co~¢Merat~oa would diet.ate th~ with ..2_. _ ~, 2' ?¢,~ y~,~$nero wpu{a be a. greater increase in Inn " can ~. l~m oo::ervea aeelme ~n th~ rate of inerea~ o~ lu~ cancer ~xuetly wha~ o~ would expect, however, if tho re o~d in tyro (,:, con;:t:uttlr im~roviu,~ detectio.- ~.~ *~: .... P !rease ~re /op tl)at matt r "Th,-~ ~.a~., ~), ,~,.nzu ,nseas~or or any o~ner t ........ -_._ ,~-~,' ~.-*..:;~),.ht care has ~eeome inereasin~l " able .'-, :,,,} Uopm:tr.mn over trim n~nn ~.~ ,,..l~;.)J~ r., .. ,~ y.~vafl . p'cttnlqu,,..~ haw imnrovoa ~,~.&;,~aZ.2~?":'"~''~" ~,~e~e, amgnos~ie ~,p.omt ? nt,.r~::~mffly available to our no,)u).~; .... ~ .u ...... al.~e ~*~f O,ly mcr,.ase) but as the du~no~.a ..a .... ~e.lup~ ~ )tllllarn, A (% t "Trpnds of 3Iot'tallty Att~butvfl to Cnrelnoma of tha Lung." Canoes, 1067 preaches the true incidence, there will be a steady decline in the yearly increa~:e in reported incidence until a 1,.~vel st~t e is reached. - " Dr. Gilliam estimates this wo~d b~ in 1983 for the white m~le pop- al~tion. Th~ advocates o~ the capital relationship between cizaretto smoMng and l~g cancer cite as ~ ma~or ~ment in ~vor o~ their h~othesis the ~eat in, tease in cancer o~ the hag which has occu~ed c~ncomitant/y wi~h ~l~e ~ea~ increase ~#~he per capit~ ~nsumpti~n o~ cigarette~ over the pa~ 40 ye~. It is .enerally conceded~ howover~ and 5v tim proponents as wdl~ that it takes m~ny year% ~0~ 30 or 40 seara,~ff ~o~ng, to produce cancer o~ th~ lung. If riffs were the case, inoreases in the incidene~ of cancer should ~ol- low by 20 to 40 years the rise in con~mnp~ion of d~arettas. Th~ facts that {he greate~ increaze in the reported incidence in lung cancer carted between 1980 and 1995, before the rapid rise in ci~arett~ con. munption, and the yearly hacreas~ ha~,been falling ever m~e. I~ th~ ~eat incre~e in cohm~rni~tion of cigar~.ttes over the pas~ 40 3 ean~ wera ~deed a significant factor in the pr~,duction of lung eancer~ we should be seeing an increasing ris~ ht yearly rates today rather than the observed decline. One other point, the obsem~ed yearly increases in reported cancer of the lung beginning 40 years ago, at about the ~ime cigarette con:~ump- tion conspicbously beam its increas% affectd all age ~roups slmulta- neous~$. It does not provide for the necessaw thuo la~ ~or production el canber by smoMnff either. If smoking were m si~ificant, fact~r~ inqe:~ wdNd have-affected the older ages and left the younger unchanged. I would offer the speculation that in tlm next few years, now fha~ ~fedicare and 5[edicaid will make raedlcal care more accesziblo to rail. fiend of previously medically de ~rived dtizen% and mr ~ of {lu:,=e ob- wou¢Ix" ~nll be m the older a e ,~rou s th'xt there ma~ well be an m- crease for several yearn, rather than the current dechn% m the yes, fly rate of increase ~ reported cancer of the lung. Even if ~ pa~ of the increase in reporte~c~cer of the lung ~s real, and not simply apparenL to attribute it to srnokin~ is specu]ahive. Such thin~s as the nrbanization of oar populatimh rmd {~creasing industrial- izafi),n o~ our society. ~ocio-economic ]evds and other factors have been ~ati;dcallg relafed}o an increased risk of Iunff cancer. Also, t.he vagar- ies in the ihcidenc¢ of cancer of any organ o~<site are no~ at all stood. D~ing the period ~hat lung cancer has appeared to increase so dramatically, %he incidence of cancer of the stomach has decreased most equally. Thi~v years ago, ~hen cancer of the stomach wits of relatively high incidence, an eminent medical scientist attributed with conviction the ris~ ineidenca a[, the time to the inerea~a in home bar- beeuin~. ~e supp~cd the hypothesis by demonsfrat]n~ that charre~ fat of themeat conta]ndd e~cinoge~ic prope~ie~ when applb- ~ to the ~kin of mice. One would hardly conclude tha~. ~he subseqmmt declhm in s~omach cancer is ~ue ~o a ~ecrea~e in home barbecu]n~ ~hi~ emmt~. The ~act i~ th~f. we simply don't know ~hat causes ri~e~ an~ f~l~ in ~e~uenex, lmt there'i~ alwa~s the temptation, m comlmlsion~ to aserlbe the~ fn some sort of e~ en~ that ~e~.m~ at to he a~neiated with the change. The mos~ pervasive evidence in favor of the ~moldn~-canc,r hypnthesis ~s the repeated oboe,,arian that hm.~ ameer occurs ]n smok~
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1068 ~t ~uch more frequently than in nonsmokers, and that the incidence i ~ r,. luted to the amount smoked. (In other diseases attributed to smok- ira*, the difference is much les.~ ) This ratio is cited o~¢r and over in tl,~ protagomzt~ debate. ~hough ~t ~s ad~t~fl that other d~fferences ~n con~tltut]on~ temperament, pe~onality~ living habits~ economic level~ ,rod p:~,ehological attribu~s exis~ between smokers and uonsmokem, t ht~:~(dlff~rcn,:es ar~ considered as being of minor consequence, relative to th. difference in smok~g pa[t.erns.-This is~ of course, a judgment ha,~,,d on :~ti~Heal relation:~hips in which o~y one of many'variables i~-t oq~t, rolh d. Opponentz point o~t ~a~ despite fl~is high ratio, only u tel3, ~;mall proportion (probably less than ~ percent) o~ heavy smokers ovc'r many y,_~ars develops can~er o~ ~he lung. The ~ncidence is eveax mn,:h lower'for sm~kin~ women. If smoking were indeed an ~port~xnt ,:~tu~t~ of lung caner r~ it ]~ difficul~ to expl~ how 98 percent of smokers of l~m~ duration ~,~capo the Seethe. Ag~m~ logic ~ctates that taere n-,r-~t he ~:onwthin~ very different about these ~ perc~t~ other th~ their ~moking habit. This difference has~ of cour~ no~ been identifie~ m, to it:-~ nature, ~f,tim t~rt~tt "inereaso" in ~he incid~ce ot cancer over the pas~ ~o~r to, fi~,-~ dc;.adc',~ i~ indeed spurious, for which flmro ~ substantial e~i- den,% ~mokin~ can hardly be blame~ and other causes must be serf mm]v ,~on:~ldered for the d~fferenc~ m rates beL~.een ~okers ~nd now~mokcr~. Th~ro are ~ number of .other po~ts o~ debate between the believers ~md f.ho n,mb~qicvcn~ each with va~,ing degrees of merit. The inevi- htbl. conelusi.n that an ~bi~ed pemon of r~son would reach is that n(d~hor ~ide ~m~ conclusiw evidence ~or its position. ~ o~ ophfion ~:~ that tl~ evidenc~ in f~vor of the hypothesis possesses wea~esses~ and ttm proponenb~ h~)~,~ f~iled to answer satisfuctorily • n~ber of ,h;~rply c~mlficting ob~crvatio~ ~h~ mo~ si~ifi~nt one being the pe~J~tently d~'clining rat~ of ~crease o~ reported ~s~ of 1~ cancer ~n ~he fi~o~ of ]ncrc~ing per capita co~umptlon of cig~ettes. Mc, diea~ h]~ory ~s reple~ wi~ cherishe~ beli~ls based on uncon- h'olh d ob/om'ati~n:~,~,, and clinic~ impressions, which hsve subsequently been oomph rely demolished ~hen subjec[ed ~ properly con~ro~e~l clinical i~'e~i~tion. O~y r~ently~ ~or example~ medical gospel held th~xt fh~w~r, ~ptur~ of u peptio ulcer constituted the mo~ urgent indica- tion fo~ immediate emergancy ~urgery. We were taugh[.~ and virtuafiy ~w~r~,, ph~,~ichn fully believed, that ~he greater the number of hours that'~lap;:~.d betwm,n p~foration and the operation the less the chances of ~urvival of the patient. Approximately 20 years ago a British sur. l-~~m~ truanted t~ largo ~oup of ~uch pati~s ~ith consemmtive~ non. ~,urglcal mean~-: wifl~ resulting lower mortality rates than in compa- rabh_~ ~roup:~ treat,:~ surgically. This observation has led to ~ totally diff.r~at ~,proach to tlm muaagement of perforuted peptic ulcer. A few ~:um ago~ ~ wa.o of enthusia~a for ~ sur~cM procedure ~or angbl~.~ wctoH:.~ duo fo coronmT heart diseases swept the country. TI~s ~va~ :~ r,~lativdy s~n~le opera,ion involving the ligafion o~ ihe left int~x~al m~mma~" a~erv. The red,fits ]n ~]m relief of anginal pain wo~'. ~o imp~:~sive that ~Im operation gained wide pop~ari~ until a Bo~toa hc:~rt :mrgeon performed th~ cmdal controlled expedient in 1069 ." lml~ o~ his group o~ patients had the artery th~ operation q~Y mum, ~- ~b]ective soienfifie~u~Y: - ~ ..... 4~ion to the Surgeon ~roperly s~at~s ~p. x~vl "9%?_~::~(~lties in controlling environ- ~s rdatzv~y ....... ~ ........ ~s o~ ~oung peopl~ over ~ and not smoking readem a controlled expcrimen~ y~rs o~. s~. rezoreg" we ~r~--- told, we m~ raak~ a judh~ent on pr¢- imp2s~i~l°; Ti}e • _.,:3...~. *h~t has been so f~liblo on~o ~jmy dons ~a th~ p~t. ~[Y £ention ~ould ~ t~t onv saoula no~ . co~ ~ko ~ s~ientifi~ ]ud~ent if the under any compulsion, to ~vn of ~o ~,~t" ~c ~is~i~ pl~e wo~d.~vcr does not wa~n~ ~t. A.pe~ .... .~. ~he.r on the txD~ of ev,d~nc~ make ~ final ]~dgm~t one wa~ u~- ~,, .......... pres~. What is really neede~ is not a conclusion b~ed on xmcontrolled • • . . t rather ~ntinued and vigorous ~2:~m~ ~or star, still surv~$s, bu -~ ..... ..~ .f uman c~c~r kno~xledgemto t~ ...... ~ ...... ~d th~r~ is increasing ~kehhood omo of he snswers at ~ea~ w a ~ ' - ahea& Until t~s mine ~a~ ~v~ i~t abeyan~. Tha~ you.ve~ 9~ch~ follow :) (The attaclmaenm ~ 9r. Bmm~s ~atement CANCER OF ~£ Percent increase pnr per|od ClgarCtL~ White Nonwhite per I0. 2 ¢0, 8 1,355 7,9 B,2 3, 1~]9-41--194b.4] ................................................. ~z.~4-~7 ................................................. 1945-47--194~-50 ................................................. ~.s~-~gs*-s~ ..................................... ::'::::::::: ~.o 1~54-~6--1957-55 ..................................... z Gilliarn~ A. G, Cancer lk: 622. lcJ~l. , z "Sr~okzng a~d Health," Report el the AdvhorY Comml.slon to the Surgeon General el the Fublle BeaRh Sewi¢~, 10~4, p. 45.
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1070 C~I~J~c ULU ~ I..~m~m: Thoma~ l-lamilt~n ~rem S. Bu:~Ine~;~ uddre~ : ~25 Zonal Avenue, Lo~ Angele% Californi~ 3. lhm~ue-,~ phone : CA. ~-~511, Ext. ~0, 231 4. II,.,me ad,lre~:- : I~I0 MIlch, Sou~i Pasadena, Callfo~nia 91080 5, II,,me Dhuae: SY. 9-S091 I;. Date .f Idrth : Ot, tohe~, 3, 1910 7. Pla,.o .f birth : Cunal Zone, Panda ~. Citizel:~hiu : 9. Hvx : Male 10. Marital :~tatu,~: ~larried 11. Wife's n,ddon ll~nle: Elizabeth Bloss 12. Xuud._~r of children : Three 1. lIfgh S,:ho,,1 : Fairfax Hlah School, Los Angeles, graduated--192~ 2. College: Stanford Univer*ity, A.B.~1933 3. ~L_,dical ~chovl : Jnhns Hopk~s University, School of 5Ie~c~e, 1937 • 1. Inb,rn,~bip : John~ Hopkl~ Hospital~1937-1938 5. lh,:4dench, u: Re~idcnt in Pathology~ ~ta~ord U~versi~y--193,~1939 Re~;ldent In 51edieIn~U~O ~ervice, Los ~geles Coun~ tal--193tm1942 6. I,'~,llowzhips: None Z Hoaor:~ a~d awarda: Alpha Omega Alpha (Alpha Cha~ter ol Johu:~ lt~pkins Unive~4ty ~, ~Iot)llt;tlro: California, Maryland 9. I¢o~rd cettificatlou: American Board o~ ~te~nal 5Iedlc~l~6 ProIc,~shma~ ba~:groun~ 1. Academic nplmintmcnt~: A~btant in ~athology~g~nford UniverM~193~1939 In::tr~]ctor i~ 3Iedic~Univ. of Southe~ Calffo~ia--1931~X~9 A:~b~tant Clinical Profes~or o£ ~ic~U~A~194~195~ Av~:~ociate CBnieal Professor of ~Ie~cln~UCLA--1951-1953 Clinical Profc~:~or of Medicln~UCDA--195~ ~r~ffe~eor of Medicine and Director of Cfinfeal Tea~g~US~ ProS:;~:~or of Medicine and Co-Head of Dept. o~ Chairman, Interim A~ative Committee (Acting Dean) IJ~1956-1958 Ht~ad, Dcpar~ent of Medicine~ Univ. 0~ Son.era Califo~ia~ lO~prvsent 2. SD~eifle teaching respon~ibili~e~ : Daily rounds wifl~ undergraduate students and house staff Fnur rogtll~r clinical co~ere~ees ~er week 3. 8Fecllic adminb~tra~ve re~ponsibilitle~ : Ch:tirlnan of Inter~x AdmMis~adve Co~ittee~US~195~ Admls=:i,.,n.~ Comm itte~USC~195~195S Public Relations Committe~'SC~]95~1962 B-ard of Directors o£ L.A, County At~nding Staff Association-- ~Icdieal Education and Curriculum Committe~USC--191~- pr,.sent 4. ~fi~ary :~ervico: Medical Officer, A.~.S., in C.B.L Theater~eb. 19~-Dec. 1945 1071 D. ,.Society membersh{ps 1. Local : LOs Angeles Connty 3iedieal Associati.n California M~ical A~sociatio~ Los Angeles BoWery of Internal 5Iedich~Sevretary--195t; Vice l~re~ideat-1952 ; President--1953 Los Au~les Academy of Medielu~Board Of Oovernor::;~lO:~t: Prcsident--]9~l Los Angeles Hear~ ~sociation~B.ard of Dlrector~--lglT-1950 Long Beach Heart ksso,.lathm--B.ard of l}]rector~--1951-195t Pac~c Interurban Clinical Club 2. Na~onal: Amox'iean ~Iedit,:tl .~uerican C~llege of ~h y~[eians (~cllow) American Board of IDternnl 3lefliclnc--3lember Chairnmn 1963-1965 ~esideney Review C,nmMttee in Imernat Vice Chairman--19fi2-1963 Associati-n of Professor~, of M~c~e ~sociation of .~e~ean Physickms Western Association of physlclans--Vice PreL-ident--l[,15 Ad~ Board for the Hedical ~pe~alffe:~1963 d~t--196fi-l~S; ~re~:iden~--l~£~esent L ~cal : Area medical consultant ta Vetera~ Admiais~atlon, Editor- in.Chief, Audiodigest, 1959~renent 2. National: Member of SlmCi~t MeScal &dvisory Group to Admin~tra~o~]--196~1965; ~lee Chai~mR--1961-10t~4 ; Chair- maa--19~1965 C~ifornia: Membcx of State Advisory ~o~pi/al Conncil, 1961-1968 .... n, n..,-. Yo. have ~ well-prepare4 p~per w~ch ce~¢~dnly should be o~ great help reaching sons,ceSsion, h Dr. D~x. Thanl; you so muc~ • , The ~xm~ ~V~ have learned through fl~e years that usually there are two sides to every questioa a~d we are trying to get both sides. ~. Preyer~ h~ve ~ou any questionM Mr. P~:x~:~. ThaSk you, ~$r. Ch~iman. I h~ve ~u~t a ~ew. Doctor, i~ ~ understand your sta~meat corrcctly~ you ~r~ saying we do no~ know whether "tl~ere r~al]y Ires been ~his great increase lung c~cer incidence that we have beea hcari~ so ~uch about. Is ~at correct ~ Dr. ~. ~ es~ s r. Mr. P~m. This really gets at tlm corner~£oa~ o~ tim Pub]it I-Iealth ~ervic~s case. Dr. Bm¢~L It certainly does, yes. 5It. P~mv~. Until tt~t is es[ablished, that i% until it has been.., estab- lished th,~t tlmre is a grea~ inere~,se in lung e~neer, ~en that ~creasing constmK)t'ion oi cigarettes ~s the e~ume ox mug ctmct.r~ can you ~
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1072 1073 Dr'. Blm~r, This I believe is true. One of tim real problems is that it is .,,',,im~ to be utterly hnl,:,~sib]o. I think, ~o determine this because the b~d,~u'lation:~ arc b~cd on death certificates, as I mentioned. De~th cer- tlfit.at e~ arc notoriously inaccurate. Probably less ~an 10 percent~ and I tbin}~ o~,t~idcrably lees than that, of all deaths h~ e ~ c~u~e proven by po',-~t mort¢ m ex~:mfination. Without l-~n'.:~t mortem examination, or patholo~c study, cancer of the lung1 iz an ¢~xtraordlnarily difficult diagnosis to make. Wen now with all ~:,f tim ~pbistieated teclmiques tha~ we have fl~ere still is a large crr,,r in clinical diagnosis versus what is found at autopsy. Mr. Pn~x'ra. Doctor~ one thing that is hard ~or me to understand is that we hear testimony ~rom ou~ respected scientists l~e you~ and we h~w~ heard t~ ~reat d ~l earlier this week along the s~e ~ne you were m~. nt~onm~f, abou~ the unrehabfl~ty of mort~hty figure~we hear that, ,tnd tltc~,oa the ofl~er hand, fl~e ~ubli¢ Health Service, the American Can,:',,r Socicty~ the American ~eart Association, come i= and say thttl~,'tht~ the'ca~t~ has been proven aga~ cigarette smoking. H;uv do you account Yet that ? Dr. Bnt~. I can simply say that their,thr~hold for proo~ is very low dater a~ proving ans, thir~g,,* [~ one of our experimental la~ratories or ~ l,ur:~uin~,~ o~ the research projects that ~hey ~ance ~or Tb,.,y ~ouldn't ~nvmore accept, a protocol like this and finance it ~or a drm-~trJal, ~ay. ~l~e.y use an entirely different set o~ aandards. The~ r~,all~;]mvc del~trted ~rom strict scie£tific discipline. M~:. Pm.:~t: You would agree, then, I take it. with the recent state- m~,nt of Scerctary ~inch that there ar~ gaps in ~owledge about to- ha~,:,,, and tlmt a cuoperati~e re~eard~ ~ort between Governm~t ~d indu~t.~ iz h~ the public interest, to find an answer to these gaps ~ Dr. Br~r. I do. ~lr. P~n. You speak of the wave of enthusia~ aga~st smo~ng~ amt I thi~k we all some that. ~V~ had one witnes~ for example~ Banzhaf, that ten, tiffed that to smok~ • cigarette was, as I recall lilo~ l:~l~tyim~ ~u~zia~t roulette. Thcn'lu.,'we~ o~t to even stronger testimony, leavlng the imRression that to :~-mke waz almost certainly to contract a disease. Russian roul~.tt¢ x~-ould be ona chance in On pttg~, 7, you po~ted out somethin~ which is the first time I have :~mr~k,.rs ox ~r many ycam actually de~ elop c~ncer o~ the l~g. I~ that accurate~ Dr. Bm:~. I think i~ is a good deal l~s than that, Mr. Preyer, actu. tdl~,. I~ omz simply calculates on the basis of there being 70 minion ~',n~]~n~ h~ thi~ ~o~mtry~ which I think is tim figure that the Public Health Service ~tnd eveD'one el~ quotes and accept~ and each year there ar~ ~-omewhere near 40,000 deaths ~rom cancer of the lung, this mal~,~ th~:~ yearly death rate in ~luokers exceedingly low. ]t i~ a t~nv fraction o~ ~ percent per year. If you multiply tha~ by ~o or 3o v,,~(n~, it still ~s a small ~ractlon o£ 1 percent. If you get to :~ o~" ,~t~ ):,?~r~,'i~ comes somewhere perhaps nearer I percent who ~ill die in tt .10-year period. .~/a.. Pam'~_~. That is ~ good deal less than Russian roulette, :[ would say. Of course, we do not want anyonl~ to die from smoking if we can help it. Dr. Ba~r. Right. , , ~lr. P~a. Bug tt~ poin~ ~ou are nmking is not that ~e should callously disreeard the# percent or 1 percent tha~ ar~ dying~ but, as ~demt~n4 it,~our poi~tt is flint if it is that small a percentage b~Ang ~ffeeted by s~o~ng, and there are 9S t~ercent who are npt ~emg then ~hat shotfld r~iso very serious doub~ in our minas a~out smoking Dr. B~. I think it gmtfld focus attention for research on thi~ v~O, problem. ~at. is it that differs begween the 98 per'cent who do not get eal~cer o~ the l~g and the ~ percen~ th~tt do, who are hea~ smokers. the~e ~ro h~avy smokers, one to two packs ~ d~y over ~0 to 40 years. ~n~.~s ................ so~ly p ~ .... . , , vexT co~vincing that smoking can have very much to do wtth it only txvo out o~ a hundred over t~ long, long period llke this dewlol~ although, o~ course, it is possible. Ml'.)~m One other question ~dong t]mt lin% Doctor. I do not, thi~ Jt w~s ~ ~our testimony~ but as an aside y~u cited Dr, Gill Jam and sonic st~istIcs relating tu the white nml~ popuh~tion aml We save heard tes~imouy to the effect that smokir~ does not affect the ~emale smoker. I recall one doctor yesterday, I belier% te:~tified th~ it apparently did not affect Eslfimos. With tim ~act flint you said white male population, is there any indication that races df otlmr colors are no~ as seriously affected a~ ll~e white male population? Dr. B~. No, s~. One o~ the reasons they confine ~ good bit of their observations to white is that s~atistics ~or the nonwhite population '~ ~ and ~ years afro were even more unreliable than they were for white. The fac~ is that there h~s been an enomous mcrea.e m tlm reported ~tcidence o2 cancer of the lung iu the ~oawhim populatloa~ much greater than ~ the whir% in the hs~ 35 or 40 years, beginning in The reason w~ tlm£ at dmt date tim incidence of cance.r o~ the lung was diu~osed yoke, very rarely in the nonwhit~ popul~tion~ ~md clearly it was because they did no~ have access to medic~fl care, So as soon as gray began to get access to medical care, the incidence ~;mltiplied extremely rapidly so that today the incidenco among whi~s is jus~ abou~ t~e same as it is among ~vhites. ~r. ~s~. Th~nk you~ Doctor. 'ihe C~. Dr. C~rter ~ }[r. Ca~'~. Thank you~ Mr. Chairman. I certainly want to compliment ~he distin~ished gentleman on excellen~ presentation. I n%~ice you are pretender ,h~d c]u~rmau of the dep~rtment of medic~e, University of C~]ifornia School Medicine ! Dr. B~f. Southern California. Mr. C~. I was ve~ much impressed by your knowledg~ and your explanation of how we h~ve ~me, over the year% ~ di~o~:~ ~ancer of the lung.
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1074 For instance, X-r,~ys were developed prior to the turn of the cen- tu,T but were not in common use, ma~y~ m~til perhaps the 19~0's, o~' ~,w,n th~q~. But there has been a greab proli~eration'h~ the use of X-r~3~;~ in the past, few ycars~ in the pas~ ~0 or 80 years, throughout all of cur comltry. - Prh~r to th~s, lun~ cancer would h~ve been very d~cult to dia~ose or to diffcrcr~tiate frora tuberculosis or o~her phlmonu~ con~tions, i~-~ that not Dr. B~. Yc~s, indeed~ it is. h,fr. ~;ua'~-~n. Even bronchozcopic examinations~ whid~ is nec~sa~ totb~y c~x cn when ~-t.~ haw~ films~ to actually make the ~al dia~nosis- broncho~copy was not developed until, I beheve~ ~t~l Dr. 5ac~on, one of tlm pier, cots in tha~ field. Dr. Bn~r~. Yc~,~eir~ in tim l%0rs. Mr: Cam-~::u,. Well~ the reason we ~ow there is more lung cancer day i,~ b~c~.m~:a our diagnostic proced~es have ~mproved so much t~vt,r lhe yvarz. ~ that no~ tru% Dr. Bm,~. Yes. Mr. C,~m~:. ~ cc~ai~y a~preciate your statements on this par- ticular fact~. I am a]zo itf~pre~.~ed by the fact that you have brought out th:t~ h-,~.~ them 2 percent of the 70 million smokers in our eo~- try ttctuMly d,wdop this condition. ~eally, if we bas~ it on the fi~res xvhiflt ttrt,'h~ our mortality tables--and I keep them here ~ith m~ c,m~tantl~,--it,would be less than 2 percent. Me. C~x~t. ~:~c is~ of the Squamous cell type~ which is t~:'oci~d:cd with smoking~ much less even Lh~ that. X a~ happy that you'brough~ out the statisticzl assodation which ~,:oa~:timc~ i~; u~cd for the basis of disease causafion~ p~rticularly such a~ the operation th~t was pertormed ca the hear~ to relieve angora and coromt~, distal% which was proved ~allacious~ although statistically it ~-:*~cmcd r~ght for • time. ,O~::our~% ~s l:~as been brought out so many times ~or many yearn, p~ll:~.~ in the South was a~ociated wi~h rogation of co~ meal. Malari~:~ w~,v~ :e:~oeiated with breathing miasmic air ~ mumhes, ~t.il ~.,:icnli:~t~; ~c~ to work out and ~ound out fl-mt, pe~agm ~vas due to ,li,,t~xw, d~Aieiency and ma]ari~ duo to the bite of the mosquito. I ar~:t happy to receive such an excellent presentation ~rom ~ ,ff ~:~:tt standing h~ the medical profession. q%t, nk you, M~. Chairman. Th~ Cn,uu~A~. ~Ir. Van Deeflin ? ~r. VA~ D~B~. ~o questions. "~ h ~ C~,~tatA~. Mr. Brotzm~m ? Mr. B~orz~r,x~r. ~o qu~:,~tions. Mr. Ecj~,~Dr. ~o questions. Th~.~ C~an~t,~m You say on ~e fim~ page~ "I h~ve been engazed ia clime'M" m~,dacJ.ne~" " re~earch~ medical, education~. , and a~igrai~on ia ~hct:o fields for my whole pro~essmnal hfe. ~d neoplasia~ or cancer m general. 1075 Do you notice any increase in heart, disease from smoking ~ Dr. B~m~. The reason, really, that I huve chosen cancer to talk about is that this is where the most s!~arp correlation occurs. In reg~rd to hear~ dise~t~, th~ ~rrdation is really so low ~th~t~ th~ Public ~lth Service doesn't ~si~ any causal relationship there. So cancer is tim tough o~. The C~.~.~x. Mr. Springer~ ~£r. S~m~n. Doctor~ this is ~usb one quest.ioa I would lik~ to pu~ to you which is not covered by your t.t~temm% but I would liko your obse~fion. ~v is there such ~ wide variance in tim testimony as to wlm~h~r or not sm-o~ng of ~bacco causes lung cancer ~ Dr. B~. Among do~tors ? ~. S~m. Amon~ r~a]ly eminent people. I t~e i~ you are eminent man in your field. We ha~,~ had ~wo or three o~ers ~his w~k who h~ve te,~ified s~lar to you~ and we h~ve had some who are equally K~ eminent who have testified to ~e opposite. ~y ~his grc~t variance ~ Dr,'B~. I think E~e fac~ that there is this die,cement iadicat¢~ ~a~ the c~e ~s not closed yet. There ~s on~ other ve~T important, thing. I am perfectly sur~ ~ you po~ the doctors of ~,his country you wo~ get u very stronff majority who bef~ves wh~t the Publio 'He~dth SerVice RepOrt time,here is substantial pr~ o~ fhe causally relatio~hip. Bu~ I there is o~y one in 10,000 floctom in this cougt~ who really, h~s read th~ papcm ~d evidence on th~ other side. . -- " ~ ~ Tht~t liOt.le book, "Smoking and I~eal~h~ ~hat t'hey p~f ou~ splendi4 d~umen~ for one s~de o~ the que~.ion~ but the~ hax ¢ con~dered~ se~ously enough ~ my judgment som~ of th~ ve~ sharply co~icfing and irr~oncihble observations. You just can~C make ou~ of thee two co~icting thinp. The high incidence of cancer of Vhe hmg ~ smokem versus non- smokers and the fact that it appears t.h~t there has been littl~ if h~cre~¢ ~ caner of the lung over all of t.l~ez~ years that smoking h~s increased so much--the two ~ don~ fi~. I ~y theft we oa~mot come .to an answer on this We cannot say that it do~ no~. ~e oa~o~ sa~y ~at it do~. " ~h'. Srm~arr. There is jus~ one other question ~ wo~d like to ask. :From the monalitv tables it has been ~fimatcd t],~ th~ incidence of cancer of the lung3n while males increased 2¢;-fold ~tween 1914 aud 1950, and eightfolfl between 1~30 and 1960. ~at ~used chat ~¢eat variation in rate of increase ~ Dr. Br~. Those are increases~ ~Ir. Sma~¢~. Th~ is the incideuce of cancer. Dr. B~. No~ i~ isn't ~¢ incide~. Y~ is ~h~ increase~ the yearly increase in incidence, the percentage increase. If one start~ at, tlm ~g point of 1914, there rztflly were ve~ few ~ of cancer of the l~g that were repo~e~ at that ~,rte~ very Mr. Srr~¢~. When ? Dr. B~. ~ 1914. There were ve~ few. So if you c~tYulah:~ the n~ber reported then as contrasted ~ the number reported in the increase has really been enormous,
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1076 But that ix bem~u~ the initial number reported in I914 was ~ im- p,.~:-4b]y and um'c~li~ically low. ~Vlmt tl,i~ hm~ ta mean i~ tlmt the v~t majority o~.people who died from c~ncer of (.}m lung a~und the country were m~ned out on the ch:tt~ c~¢r/.lhcate~ as tuber~ul~sm or pneumonm. I tlmdc on~ car say flint with c~j~s]d~r:~blc a:.~umncc. • ln~ m ~ dflhcult dm~m~tm problem. Cancer of the ]un~ still ~s In tt]nm:~b ~w~ry pat~en~ you ~ee~ pneumoma~ tuberculosis and other ~nds o~ Jnfecti,~t~ of tim lui~ have to be d}fferen~iated. I~ inn% easy Ia sume ~;tudie% as many as ~0 per~ent o~ the patiea~ who come t~ po~tmor[~:~ t~x~m~n~t,io~ with the clinicttl diagnos~ ot pneumonia~ of l~ ab:~ccss, of ~ube.rculos~s--turn oub at the autopsy t~ble to h~ve Cal-m,r of ~hc hung, even fed:t3'. Mr. SP~a ~=~. ~,me .of fh a-t is due, then~ to the fact that we are do~ Dr. Bm~. Thi:~ is one thing ~h~t h~m made bhe reco~zed go up~ ye:~. We do more. But stilI~ I suppo~ o~ all ~he people who die ia ~]xi~ country~ less d~n 10 p~rcent o~ ~hem have a po~mo~em uxamin;ttiol~. ~r. C.um~. Would the d~sdngu~shed gentleman ~'ie]d ? Mr. Srmx~m Yes. .~r. CA~WEn. The main reason why l~,- c~ncer has become increa~- ~nfdy evident ]~ because of our i~mrea~ed ~iagnostic capabilities at ths pr~,; ~cnt thne. I~l~aC not true~ sir ~ Dr. B~:ar. Ye~, in&~ed. £ m~ht e]te alt htstance in our own hosplt~l, not relative to cancer of th~.~ lu~ but of hyperpar~thyroid~m~ which is due to ~ ben~ t~or in tlm pa~'atl~'roi~ gland.,. A~ of i0 years ago, we virtually s~w none. The hlcrc:t:,e nt incidence of Efis dlse~se in our hospital population incrca:-:ed probably 100 times in these last 10 y~rs. ~,rm,,,i';m'i~im. ~V, now P[,ve rhea, au~nmtio machines and they can do l~ lot of chemical test~. I~ hype~parathy~oldlsm ~ calclum level is high. We have dis- covered them and tim incidence has increased almost 100 times. That d,~c:~a~t mean fl~a.t fl~ ~seaso has ]ncrea~d over the,~ 10 year% not a bit, bu.~vur ability to re~g~izo it has. ~r. ~n~o~m. Thank you. ~ lm CIIAn~A~. Tha~ you very ldndly~ Dr. Brem, for coming and ,,~dvin~ u~ fl~e benefit of your views. Dr. Bm..~. Thank you~ sir. The CH.~o~.~. ~t this tim~, I would like to present tot the record ~t ~t~t~m~:,nt of Dr. Doris L. Herman. ~ will b~ predated for the Without objection, it will he included in tim record direcgly after the, tc::~timonv bf Dr. Brem. (The ~:t at~mcat of Dr. Herman fo~o~ :) I ~lm Dorla L. ~erman, physician, a patholo~s~ tnterest~ In tl~ue dieresis ,)f tu~-i,)r;,. Ium pa~icularly interested in ~e biological ~h~%,lo~ of the speeifl~ c,~utar tyi~::~ of lung tumor. 1077 • My medical education was at Georgetown Unin, ersity and University of South- ern California. Since 1958 I have practiced ,and taught path~1ogy at the Los An- geles County-University of Southern California Medical Center (LAC-U~OMO), whor~ I am presently Assls/an~ Professor. D~lng ~e last decade of ~e 19~ century, when lung cancer was u rarely ~epoztcd human neoplasm, oath~logis~ (I) were ~ccuptc4 with a detailed of tumor type~ Lung carcinomas were ~requently associated wl~ chronic bronehi~s, ehron~ interstitial pneumonia, a~d atel~t~-~sls. Early report~ (2) du~ng the first and second decades ot ~c 20th century, al~ough ba~ed few cases, showed an increasing incidence that seemed to be reflected almo~;t exclusively In epidermoid (squamou~) and unflifferen~ated type~. h 19~ Dr. Kreyberg, who had been study~g lung turnoff: since 1930, a comprehensive and reproducible m~¢~d fez htstologlc clean.cations (3) that w~ later adopted by ~e World Health O~ganization (WHO) (4). Since al-~pro~i- merely 30 to 40% of l~ng tumors arc difficult to classify by routine methods. Kreyberg also developed a morn ~efined technique, by which a large portkm these tumors could be classified. In other work. Kreyberg divided lung tumors into two groups: Group I eluded epidermoid tumors; Group II included glandular tumors. In 1[t5~ 6;} and 1956 (6) he re~orted fln~n~ from his Nt,~e~an material which indicated a rela- tionship between cigarette smoking and a ~gher incidence of Group ] than of Group II tumors. In order to te~t his ~eory further, Kreyberg n'viewcd lung tumora iR o~er geo~a~hlcal sites. In 1957 (~), with Doll and ~lll, he toned s~ilar r~sulta in th~ Brlt~h stu~es. ~a concluded fr~,m ~ese ~o sO]dies clg~ette smoking was ~the m~n causative factor In ~ development of Group lung tumors, bu~ was not related to Group H ~r~. ~e 78 eases collected Venice, Italy, :from 1~ to 19~ by Ferrari wer~ reclassified by Kroyberg The ratio of G~oup I :Group II In men was 3.2:1. In 1~ Kreyberg and Saxen (9) revi,vwed 624 tumors collecte~ In Flnla.d for the years I957 to 1959. Finland was sel~ted because of the high fr~uency of l~g cancer despite lack of industrialization, The ratio of Group I to Group II tumors in men was ~.1 :L However, t~ere was no information on ~oking Several retrospective statistical studies (10, 11) tn ~e United Sta~e:~ indi- cated that the frequency of epldermoid ~mors ~as in.easing, while glandula~ ~mors remalned consent. Some Investigators {11, ~} ~ezcfoze amggcsted exogomou~ factor, such as cigarette s~o~ng, were causally related to epide~ mold but not to glandular t~ors. Methods of ~tudy and the criteria for histolog- ical classtfica~on varied considerably among ~ese studies. In 1958, Dr. Michael Sh~n. then of the National Ins~tutes of Health. gested that the LAC-USCSIC ~teocro~sy (autopsy) seres would be an .xc,,llent source of material to determine t~e differential trends of lung cancer by hl~tolog[e type. TMs material ~ad been kept over the years since 1927. I was the patholo~st sel~ted to make ~is ~tudy. All lung t~mors at necropsy at LA~USCMC ,from 1927 to 1957 were reviewed. All nt~opla~mt~ were reclas~fied according to ,two c~teria: a) a modification of method and b) Kreyberg's meth~ (WHO) by the use of speelal skdns, tlstical analyses were done by the N~tional ~ancer ~ltute (13)..Nine hundred ~ty-stx ~mors met the criteria for inch~sion in the study. Dr. Krcyb~,r#T ~dly consented to classify 1~ tumor~. ~ere was excellent agreement bctwe~,~ my dia~o~s and his, aceor~ng to the ~0 me~od. Results of this study differed significantly from other publi~hed JaVa. re~l~s in~eat~ that the pro~rtion of glandular tnmom in men woo ~g, while ~he proportion of epidermoid carcinoma wa~ decreasing. Our rntlo~ Group I to Group II ~mors in men were decreasing, whil~ the raflo~ by Kreyberg and others were lnerea~ng. Among ~s~ble explanations for our unanticipated finding~ wer~ 1) error.~ by the patholo~st tn histologic classification; 2) variations due to ant~p,y population and/or geo~tphtca] location. [n Ap~l 1~ I wa~ invited to attend ~he workshop for the elag~ifylng of ~mors that ~as s~nvor~ by the Subcommittee on C~]ncer of the Surgeon eral's Advisory Committee on Smoking and HealS. Tlam~es from 4(D or current LAC-~IO patients wiih pulmonary carc~ma wore ~ubmitted to the Commi~ee for classification by Dr. ~rey~rg {14). ~ere was
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1078 ~d,lo ~i~e,~m~)nt b~)tween Dr. Kreyberg's diagnoses and mine. confirming the InS .~ a l,w ratio el ~r~up I: Group It ~mors. ~hus, errors by the pathologist ~qu~llie~Itlon did not scc~ to be the explanation ~or our ~Ine,) ~e ~A~USO~IO material apl~eared to be d~erent ~rom that in the o_,mtric'.~ r~p~rtcd by Kreyberg and others, I ~dertook a ~ur*hez study .to see tt gerq~raIddeal explanation ~or the~ dl~erences e~sted. ~o study ~mS divldefl inb~ two l#hat~c:.~. Phase one was an analysis o~ ~e c~es o~ pr~ary lung ~'b~t~m~ ob~rrvcd a~ n¢c~,l~y from 1958 to 19~ to determine whether or not tr~,~td~i m-~te4 lu the l~e~ou~ study .stir existS. Phase two was a ~uzvey o~ dlff~ rent locations in the Unit~ .States to determine i~ a true varia~on ia the dl~,trlbutloa o~ Group I and Group II lung cancer occurred among ~ese area.s. Hlt,,~ ~;~h.c~ed were the Fran~s ~elaflel4 Hospital, New ~rk; ~ale U~versl~, N~w Haven, Connec~cut; Charity HospI~l, New 0rle~s. U~hIC. All )woIda~mu wer~ dc~i~ated on the ba~s o£ Kreyberg's ~teria anti ~,'th,,]~;. A ~eu~nt revision of the WHO classification (15) was not used, both h~'~:~w.;e o~ the ~cc4 ~o maintain eomparabili~, with the £~s ~geles study },'~'nu~:e ~ ~lm m~t convinet,d that the revision ~ helpful. 0~ course, ~e character- l,~th-; n£ Oh, lass tumo~ remain unchanged, regardless o~.the classification ]abels. Dl,;trlhutic,~ of the hi~tologlc types o~ lung tumors from the LAC-USCMU :end ~ho~e from Fr~,nci~ Dc-lafield and Yale-New Haven are compared in ~able Tuha,,r di~trihution of all major ty~es for LA~USCSIC ~ta and for Francis ~h,hdb~ld a~' ~dmilar, ~xcept f~r the sllghtly higher proportion o~ (::qn:tmo~0 carcinomas in the Francis Del~field material. Although the results fr.m New Orle:m~ are incomplote, preliminary tabulations indicate that the tu~,,~r db~iribution Is ~ir~lar to ihat oC L~u Angeles and Frnnciz Dolnfield. ew,r, dlffereucc~ uvr~ n~tcd ]n the proportions ~or both epidermoid and gl~dular groUI~:~ In the Y~h,-New Haven figures. ~he pzo~orGon e£ gl~dular tumors ~or Yal. w~; I0 to ~5~ lower than for ~e othe~ ~vo loca~ons, w~lo lhe epidermoid The ratio ~f Gr.up ~ to Group II tumors for ~rancis Delafl~Id and U:~05IC ~r~ ~hfdlar, i e. 1.7 : 1 and 1.3 : 1, respectively. As ~revi.usly noted, the date from LAC-USCMC ~how a decrease in the ratio with the ~assage o~ On the oih,~r h~md, ~he data Item Yale-New Haven revealed a 3.0:1 ratio, which ~4~U~lr t,) ~e~e ~,~ported by I~eybcrg ~or ~o~way (3) and Venice (8), but dlff,,r~ from GrPat Britain (7) and ~inland (9). Alfhm~gh :-moki~g habits were unknown ~ many individuals, histories o~ ,avy clgar,:,tto u~:o were ~,btained f*~r numerous patients in ea~ hlstologl~ ~o~p. hl:-~t,-*ry of n~m~moking was verifi~ in some patient. Data ~om ~,s Angeles aml kah,.New Haven indicate that, in noasmoklng women a~d men, although ~lamlular tumor~ pr~doml~ated, other cell ty~es--iucludiug epidermoid (SqUa- CONOLUSION The ~,~,ary oh:it cigarette smoking has eause~ a rlse in ~eldenee o~ epide~mol~ iu~r*r~ *~f the, lung (Group I) is no~ ~upp~rtcd by our studio. Since other are~ o~ llt~ Uldh~ Stab,~ ~how .the ~ame dh~Ibutlou o£ t~es o~ tumors as ~s Al~g~.b':~, ¢11o Lo~j Angeles data ea~not be di~mt~xed as merely fin unusual geograph- Ical rr~;~lt. On the other hand, there are areas in the ~ntted States and abroad whb'h ~how a di~;tribu~on of types of tumors very different ~om ~at of Los Apg,,l~. ~hvref.re, much more work is nece~ry befor~ we c~ ~derstand ~mY D~-~;~lblo relatk~u~hipa betw~n CyI~e~ o~ ~mors and passible causes. ~turo work should include resea~h in relation to host factors (16. 17). ~m~uuologlc~l (1,~}~ hereditary (1~ and endocrine (20) clmzac~er~tics may he ihq*0rta~t in determining why indtvldual~ get tung cancer. Extensive fur~er tll~ e:-rUga~vn In thc~e and o~er area~ t~ needed to establish ~e causes of lung cam~er, m~d ~o determine whether or not cignre~e smoking is one o~ them. 1079 TABLE 1.~COMPARISOH OF HISTOLO01O TYPES CF LUNB CAFICINOMA~ Oi]~ERVrD AT NECROPDY Center, 1958-.62 University, 1%~-59 Hospital, i.951~ How (:~81 ca~es) (82 ea,,es) (274 cases) Orte:~n~. Numbe~ Percent Number Percent fiumbcr Percent (~8 Type tumor Squamous ............................ Adeuacardaoma ...................... Mixe:i ............................... hnaplastie ............................ Bronchio zr ........................... Undifferentiated argo ................. Adenoma ............................ 0~her. ............................... Male-female ratio ..................... 81 28, 8 37 45.1 1(~0 36. 5 100 35.6 17 2~.7 87 31.7 5 1.8 3 l,i .......... s2 2z. i ....... ii ...... i~,;~" 54 t~. 7 .......... 5 1.8 2 2.5 6 2.2 .......... 20 7.1 5 ~.1 18 ~i,6 ~,4 .............. "'.=Z ........ ~ ....... 4,1:1 5.1~ 4,6:1 1. Adler, I. : primary ~Ialignani; Growths of ~e Lung and Bronchi; a Pathologic ~d Cl~i~ S~dy. New York, I~ans, Green and Co., 1912. 2. Wil~s, R. A, : Pa~ology of ~mours. I,oudon, Rutterworth and Co,, Lid, 3. ~yberg, ~. : ~he significance of histolo~c typing in the ~tudy o~ the epidomi. oIo~Y o~ primary epi~eR~ l~g turnouts. B~h d. Cancer, 8: 15t~208, d, Kreyb~g, L.; One hundred cons~utive primary epi~elial lung tumour~. Brit. J. C~cer 6: 112-119,1952. 5. ~eyberg, Z.: Lung c~cer and tobacco among in Norway. B~it, J. Cancer 9 49~569,1955. 6. Kreybe~, L. : Occurence an~ aettology o~ l~g cnncer tn Norway. Bri~, Prey. & SePal ~Icd. 10: Id~lSS, 7. Doll, R., ~11, A. B. an4 K~yberg, L. : The si~iflcance of ce~ tyI~) In rOut[on ¢o ~e e~ology o~ Drag cancer. Brit. ft. Cancer 11 : 4~4~, 1957. 8. Ferrari, E. and Kreyberg, L. : ~stologie t~es in a lung Cancer material Venice. Bri~ ft, Cancer, 14 : ~j~6~ 9,1~. 9. Kreyberg, L and Saxon, E. : A ¢om~rison of lung ~mor (~cs ~ ~lan4 and Nomray. B~t. J. Cancer, 15: 211-219. 10. Spa~, D. ~. : ~cent ch¢~gez ~ r¢latiw £r~u~cy of variou~ ~y~ez o~ b~on~ogeaic ca~i~oma. J. Nat. Cancer In~., 23 : ~7~t, ~959. 11. O'Neal, R. bL, Zee, K. T. and Edwa~d~ D. L. : Bronchogenlc carcinoma, Cancer, 10 : 1031-1036, ~. Wynder, E. L. : Tobacco ~ a cause o~ lung cancer, Penn. M, ~.: 57 : 19~. 13. Herman, O. ~. and ~ttenden, M.; Dist¢ib~on o~ p~ima~Y lung carclnoma:~ ~ relation to tlme as dotermin~ by histoehemical ~t~h~hl~. Cancer Inst., 27: ~7-12Y1. 14. U.S. Pubic Heal~ So,ice. Smoking an4 Health Repo~ of ~he ~mmitt~ to the Surgeon General of .th~ Pab~e Heal~ Service. ton, D.C., Dept. of Health, Education and Welfare, 1964. 1~, ~eyberg~ L. in coIIatmration with Liebow~ A. A. and Ueh~nger, ~. A. : ~s- tolo~eal ~ing of Lung ~umm~rs. £~¢nzattonaZ ~islologlca~ ~lass~ca, ~on o~ Tum~r~, No. I, Geneva, World Health Organization. 1~7, I6. %lacdon~d, L: B[olo~cnl pr~eterminism in human cancer. Surg. Gynee. Ob~., ~ : 44~52,1951. 17. Sommers, S. C. : Host factors in fa~l human lung cancer. Arch, Path., 65 : 10~111,19~8. 18. Krant, ~. J.. ~fanskopf, G., Breakup, C. S. and ~adoff, )I. A. : Immunolo~c alterations In br~uch~genic cancer, s~uenfiat study. Caiver, 21, 62~6U1~ 1~S. 19. Hosley, ~. F.: ~i-Protelns, Olasm:t~vtosis and cancer. Cancer, 20: 1~9. 20. Editorial Review: ~e end~rine and genetic fac¢ors In cancer .o~ the lung, ~owh, ~: 1-15.
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lOSO T]l~ Cmu~t.~n-. Our next witness is Dr. SheMon (3. Sommm.~, ~TATE~IENT 0~ DR. SHE~0N ~. S0~X~, ~W Y0~K, N.Y. 1 ht ~L~m~.. Welcom~ to the committee, Dr. So~ers. You nla. l:~r,,ox,,t :u~ you ~'.e~ fit. Y ~ r. Bomm~a~. Thank ~ou, Mr. ~hMrmam ~ am ~ppearin~ at r,'quc~-:t of rcprc::,mb.ttive~ of the tobacco industry My n'm~ ~s Sh,qdo- ~ ~ ...... " " - ......... .. ~,,mmers. i am a physician speciallzin~ in l:,filmlo~,and director o£ laboratories, LennOx ~]1 NospitM, ~[~,~12~?..:;.@meal i~r~fessor of pathlpgy, Columbia University Col- _ %; .)~. ~-a3~c~ans )}ha ~llrgeqns, New York, and cl nical professor of p; tt lt,,to~,, U lllversl ty of South ern Cali~orm~ School of Med~ tint, Los miui~-~tratitm ~hospitul consultant in ~atholo~-' I ,tin the e~' • ,. , - _ .... • • , htm of 1 ,t~,h,do~y Aroma], a. yearly scho]arJv pubheRhon comTmsed of easa ~vritt,,n by anal {or pathologists ~ I sei're on tlxe editorial hoar&s of t~ pmrnal% hwv,. about, ~0 medical publications, nnd nm the coauthor a ~ym:,eol,~gy textbook. My curriculum vitae and oub]ica*iol~ are ~tlacht,d. - _ .... For ~, ~vear~-, I have been on the Scientiflc...~dvisor -~ Boar. d, Council fat l .ba,_,.o I.tesearclb and am currently sen.rag on ~ts subcommittee to {,}evaluate re~arch pro~ams and planning in the field of tobacco and 1wrlth. Re,~cntly. ~ have been appointed re~earch director of the ' ~ n rn,~ scope aria sharpen the object, ires of tlm supporte~ re- ~-~'areh. The funds 5udgeted for these purpo~s have been c~siderably At thb; point, Bfr. Cbairmnn~ may I present ~or the record statements l-,~ D~. O]ar,,I/ee Coo~ Little, who is the scientific director, and Dr. Ilo].,rl~..~ C. H,d~ett, the acsociate~ .... ~eientific director o~ the Couicli ~,~ Fohaceo ~e~arch ~ ' Th~ CI-~,u~,tN. Witbou~ objection~ they will be inchded in .~e rec- ord followi~g your testimony D~: So~[~:rs. Consxderatmn has been g~ven e~ensi~elv in the cur- ~;,2~ hearmg:~ to tlm question of ~moldng and health. ~nest wide ~t~ffereno,~ of opiMon ,s to the importance of ~epoeted statistical ~'ociation~ between cigarette smokmz and verious diseases are held l~y pre~'r~ntly aetix:e workers in the p~iMnent fields of medical ~ieace. It :would ~h nnf~dr to deny the existence of evidence both favoring area oppr~::mg the belief that clffarettes may be or are associated ti~-;fie:t~]$ Mth various human di~ca~es E~ch indiridual workin~ ha this ~l~l is natnrallv iufluenced by his particular e'cien~iilc discipline, experience, and the'results of his'own ~,xp0rlmcntal projects. Z am a physician particularly interested ~un-~an di~:ea.:e~, their ~)~]ses, the stages off their development, ~nd too .~ont.~Lq~jt,n~ o[:portup~t~cs and strategies for their control and pre- }:,'arm~b.D{(~gno~:~ of d~sease, patient care, and disea~ prevention are me. Incdwally crucial 1081 Lung cancer has aroused the greatest public ~d gover~m~ental hi- retest. The mo.-:t common types affect, males fi~e or six times more often than females. No theoD" of cttusatio~t known has adequa%l~ explained this striking ~ different. ~ Women, whether they smoke or not, are le~3 susceptible. I~ is doubt- ~ul that notable benefl~could be anticipated iu preventing lung cancer amon~ women by any pre~nt p~hlic health program,, An'ibng men, who are relatively ~,ore likely to de~ ~lop lung cancer~ only a small n~ber of even h~a~y cigarette smoker~ are found have cancer. Tlfis association does not constitute causation. Of ~.he total population most heavily expe~ed only ~ small minority subg¢oup is affected~ and why is ~lmown. Lung cancer does not ~cur m the great majority of ~ither moderate or heavy smokers. Statistical cam- ~ar~sons betwe" en smokers and nonsmokers ~re difficult to make without introducing two serious types ot ~iemifie bias: (1) people ~:df-select whether to smoke or aot~ and the populations studmd thu~ art~ not random; (~) no mathematics exists ~or statistical comparisons o~ nonrandom or selected populations. Medically traNed pathologists would not employ death ceNificate dis,moses unconfirmed by ~ study of tissu,~s grossly and micro~pi. callv at. surge~ or autop~ m such mveshgatton~. The overall ratg in the United States is below 10 percent, ~md without supporting dat~ thee are too many death ce~ific~te errors ~ distinguishing between primary lung cancer and secondary spread to the lung of other cancers, a~ong a number of difficulties in the scientific us~=~ of death certificates. Lun~ cancer is o~ various types~ and several have no implied reht- tionshi]) to any environmental agent. It is a gro~s oversimpli~cation to lmnp together at least Nne different tumor types and ascribe them to any agent, including cig~ettes. After at leas~ 30 years of experimental ~ork~ and m~ny emolm inhalation experiment~ in nn}m~tl~, lung cancers o~ th~ mo~ ~ommon, squamous cell human tj pe ha~ e not been produced. It is usuallj difficult to prover negatire, lint zf cigarette smoke was a cause of lung cancer, is indeed sur~)rising that no ani~nal experiments have succeeded in production. Sl~ }~ainting sh~dies are scarcely relevant to th~ lung. kfore study is urge ntly ueede~l of what other fRotors~ such as x irus#~s, urbom air pollutants and degenerative chanffes contribute to lun~ cancer deve]opment in annul s and man. "" MedicM ~ashions clmngel for example, 30 yearn ago nut)critics con- sidered tuberculosis the most common cause of hmg cancer. It. is well to mention that understanding the formation of lung c~mcer~ one of the most complex and d~fficulg problen~ in cancer rc:~earch, not presently well undet(~tood and not yielding simple answers. .k ~econd even more serious medical probl~a is cardiovascular dis- ease, since it causes about lml~ the total deaths in the United Sh~tes and overall affects Im~gevity more than lung cancer. Again~ it middle:aged males"more often than females, {or unknown re~s~n~. ~ respect t0 smoking as a possiMe ~use or contributing factor, newer multifactori~l statistmal s~xdies also point to g family h]~.tory of •sease, ~e~ hl~d cholesterol~ t~dy weight and blood pr~:~auroas ~depeatdent predictive factors, whmh in various combination~ associated with increased rates of heart disease. :Each ~acto~ along
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1082 in,~ludi~,ff ~.nMdng i.~ not a cau;:e. A number of studies slmw no relation of ~mok~ng to hear~ disease and oaa'ht no~ be ignored Aging and c,r,ma'y m't,M,:,~clero~,is, of course, ~'ershadow other ~'oce~¢es that c,ad rilm~:~ le~ tl,~ mo~t c,~mmon type of heart disease. - "'" Am,ll,.r difficulty with coronary heart disease concerns how accu- rately, tlm dh~noMs ~s made. When tim most advanced c~ical te~s m:e ,;~qdoy~M, evidence ~or eoropa~ disease is found in Mmos~ ball ¢,~ ~m men .vet 40 year~. By tMs ago practicMly all the coronary art,.ric~ ~how ~ome i, atholo~c ]e~ions. Since both corona~. ~easo ~ttn~l ,:it?m~th.~ ~moki~z am sO common in the U.S. male pdptflation, ~ ~ ~ qmt~ dilllcul~ t. tind adequate numbers of people ~or comparison ~]le llax,,:t neith,r, or only one of the~ conditions ~k well-known 1 wal gallacy ~z lfl~ely tde~st, when groups of such unequal size are .1,:htphy;~ema has now been add~d to the li~t of di~eas~ blamed c~?ar~t~ zincking. The aeweet medical publications and governmental ~',I~Ort~ emphasize how difficult are the diagnosis, the classification~ and tl~,~ ~rading o£ ~'.¢verity of puhnonary emphysema~ even among uxp,rt~,. ~h,~ ,:;.tilde admitte~y ~s unknown. One common form de- ~,~,lop;; in every per¢on with age~ and l~ping zeveral ~ypes as if they ~:,mqM:.:,.,l ;m entity i~ unwarranted. Thu~. death certificate dia~oses ¢,r t~ r,-mtin~ p::ttholo~i¢ dieresis of emphy~a at pre~ent are ~'~tillcally practical@ useless~ except in a few specmlized research ~c.~[t~,r~. Xa th~ current er~ of relative ignorance con~g how dcln~,u~nd r,:cn£2~izc emphyeema and ether chronic lung ~seases~ no ~,wcq:,m~ g~,n,~ralizatlons as to causation can b~ just]fie~. ~ r~viewinff ah,we a few ~elec~cd dizcrepancies, ~fficulties, short- ~2mm~_~ and.t~n~olv,~d problems m the fieI~ of ~mok~g and health~ nict:~ ~ no w~zl~ to denigrate the concenfrated ¢ffor[s made by many work~ ~:~ to IbM an~wer~. It is simply that ~¢ field is ~o new~ ~e l~ehni,:(ucz t~ti~ being devdoped~ and the conclusive proofs ~ot Jtt. I~ m lc:~:~ than 40 years s~tce lung surge~ began: ~or example. ......A fi~w items ia the tear,may of others may ]'um~ comment. Th~ Surl~,"a General compared mahhty to demonstrate the formation of lunl~ canccm in experimental animals exposed to smoke with of o~pcrimenttd proffuctioa of lepton'. ~owever~ leprosy has be~ pm,tm',,d in ~mimals. S~nm c?~fusioa aroza through use of the word "ad~ction" in con- ~cct~o~t w~tlt ~obaceo use. By generMly accepted WHO critefi% smok- NtZ t~oacco is not considered aa addiction. Dr. Wil~ama of the Anterlc~n Cancer Societ] stated that a ~hysl- ~:ian looking a~ a a:llde of lung caner wi~hou~ mNrmatlon co~d te~. m ~.:omo detail about the pat~ent:s social ~fe, cigarette smoking for ~-',,-,m,~ 20 years, an~, so Nrgh. On the basis of my daily experhnce as t~ pathol~gi~;t~ when on~ loo~ at a s~de of l~g cancer neither pathr~hgi.,~g nor other physicians can tell whether it is from a man or waman~ and thu~ canno~ aceuratel.y d~cribe the social life. Fur- ttwr, it i~ not ~ssiblo ~rossly or m~croscopically~ or in any o~er w~y lmown to me, to ~tm~ish between N¢ lung of ~ smo-ker or ~ n'ms~uoker.~lackening of lungs is groin carbon pateieles~ and smok- 1~~ tobacco noes not introduce carbon panicles in~ the l~g. Ths educational value o~ tho various specimens sho~ tl~e co~ittea this :~i~uati,m escapes me. 1083 As to corona,r~y hear~ disease, a spokesman quoted the dean of Mount Sinai Medical School to the effect that the relation of cig~retta ~:mok- ~ is as firrNy e~ablished as the therapeutic use of anticoa~ulant~ for ~r~ating myoca.rdial infarcbion. ~ recent publication groin Yal~ cal School anMvzes t.he us~ of anticoa~lants an~ concludes that ~u~es are not ~vefi enough desired to drt~w any use~fl conclusions. I'heso are cited as over,students or misstatemeffis of medical ~owl- edge ~de by some Mtncss~. The 3.~be~pyrene is not proved to be responsible ~or human lung cancer~ had consequently its smelt or ~he removal of i~ can scarcely be considered at present crucial scientific matte~. Ci,,arette smoMn¢," is not a uninue h~lth hazard~ as claimed by Chairman Hyde of FCC. As D~: Kotm pointed ou.t~ no mystical prop- e~ies are attributabh to cigarettes. SdentifimHy~ cigarette ~znokhig h~ not been proved t~ be a health hazard at all. ~Iany fi~lres were cited concerning 30~000 or 50~000~ or 960~000 sons per year having or dying from' lung cancer or the other being considered. Since it is not known what ~a causes of lung canc~r~ coronazT heart disease, or bronchopu~onary disease are~ the mul~pli- cation of numbers does not contribute to unders~nding them ~my bettm'. One recent art.icle on the millio~ o~ pet~ons reported to have one of u long lis~ of dise:u~es concludes that there mu~ be s~trcely any healey people h~. ~ow to review briefly the specific ar~s of defieim~t knowledge trod ~he re,each needed for better uader~ding of the major claimed to be ~ocia~d with cigarette smoking. .~ ¢on~rns lung cancer, mul~ifae~rial s~i~fl techniques are now ia use epide~ologicMly, and they m~-@ b¢ expected to provide quanti~a~ve est.imates of the relative statistical impo~.anca o£ ~wban residence, occupation, lung infection, and inherited tendeneiez among o~her possiblo fa~o~, includ~g eigarettez. ~Xro ~zSve ~or a better agreement on ~lm da~ificatlon of ~-called precancerous lung coadi- tmns and c~cers, and ~h~ is slowly ~ing aC~eved, partly b~, inter- national cooperation through ~HO. Tech~ques to audy viruses, elud~g chronic virtls J~ections, are now beeo~ng more ~dely applicable. The predominance o~ mules with l~g cancer and the e~Sdence that men who h~tve lung cancer are endocrlnolo~oMly normM also desem.~ more s~udy. ~ anhnal exporting, ~ suiiabh lung bioassay model ~or ~nhalat, i~n studies ~s e~nestly .ough~ and teehnicM advances may be achieved within the next year. New tee~iques of ~stolo~c, histochemical and bioehe~cal study nee~ wider application~ and pa~holo~z Mll need hdp to apply these special methods more ~idely both to human trod animal matdriM. ExTosures to both the gas phase and particulate ph~ of eigaret~ smoke mus~ be designed so that ~ho chemical reac- tions at particular si~s in the hag may be undated. Do~s and luted respomes mu~ be evaluated. Although hith¢~o not ~ound, an~al model sys~m for producing l~g eaace~ like the common hu- m~ t~es ~ill needs ~ be sought,. In refemn~ to cardiovascular disea~e~, additionM multifacto~al sta~stical analyses and pathologic ~uehes are needed. We will ¢ndea~ or to dare,no accurately whether aaeriosclerosis of the coronary ~ries and ao~a differs in i~ devdopmene or qualitff or ~ quanti@
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108~ betw,:,cn t=mokers and nonsmokers. The effects of smoking on bloo~I ,"h~tting ttrtd ,:lot dissolution are high priority subjec~ for study Coronary blood flow can near be analyzed overall and the nutri~ion~i flow measured ~ts well. This nmk~ ~easibl¢ studies concerning ~ tl-m l~,r,:~dble acut~ and chronic effects of smokin~ ~ ~e~ons ~,nd without evidene~ of coroner, " . : " ~ , , . -. - ~ 3 d~sease. Myocardml a,:morm.a~ mus,~h~ proteins and carbon monoxide effec~ aH need ~-~udy. Va~-omotor activity and cardiac catecholamines like ar~ ~,f c.rrently greaterinterest. Cardiac reactions ~ffer with and thc:'c differences aec4 to be bet~r unders~od. Chrmdc pu.lmoaary disea::e~ such as bronchitis and emphy~ma. are rathu~ por~r]y undemff~o& Fu~her development o~ both th~ clini" c~d aml laboratory teclm]ques for their recognition is a oress~ lem, and a v, dd,~ e~ucafional program concer~ing ~he ~r&e~g ~ctho4~ av~dla~e should be undertaken. Only then can ti,:m .~ diagn~cs an~ ~:cientific analys~s be possible. The relations chronm lun;~ di:~eases to repeated or persistent bacterial and viral ~'ction~ aging~ particulars and aonpa~ic~ate inhaled chan~t,::~ in t]m-bronchi~d ~cretio~u and to imraune reactions of lung are a)! waiting exploration in detail. ~u~onary function studi~ over long p~riod~ ~rma adolescence oa ar~ badly needed. Vasomo~r e:~h~ch.lamine reac[ions o~ lung are of increasin~ impedance c)dglar di~e~ is an emerging entity o~ great intg~est ~nd com;le~, Atom ~1 models are urgently needed in these fields. - Thi,~ r~,view ]earle mamentioned many are~ where knowledge is ,',lually ]aclrinff~ and ~,other disease~ claimed to be associated with ~,-.~t,)l:in.~ tlmt ~re either rater or with an even more ~nuous relation. ~&ip. The nt~,l~ for research are greaL perhaps ex~eding the p~nt ~t~m}~:~ of qualified investigatom hod their available time. Cooperativ~ tdtort~ by tim Government~ private ~nda~ions ~d public charitable orzaniz~tions are hoped for and necessary in ~ important h~lth Wc all wan~ better health for the public. Chronic dieeas~ like di~,:u~>cd above develop over lon~ periods and they do not have the .*-ilUl~I,; c~tu~e-and-eff~et:.. .. relations, . P ........ ~'teur and others ~ound m" cet~' "n b:t,:terial d~ca~cz. Smiple solutions of these complex medical proble~ n~:ty b, h,)pcd for but they are scarcely to be expected. Tension is a ~laily ~r~ct of ~ife in the ~nited States: and reducing it is one of my ~¢qa-,~:mt dady profe~ional activities. Smoking~ like alcohol and tin, wing ~rt-~ or tobacco~ is widely u~d to relax t~nsion. P1D, sicia~ hart~ more wo~ when people have no release for tension. Con:~iderabk ti~.% eEoC, and money are be~g expended now and m,-*r,~ i~-~ b~qnff Imdgetcd for fl~turo inv~6gations hi the field of mno~n~ and ln~:dth~ by the A~[A-ERF and the Council for Tobacco ~eareh tul:.n'culo~:i:; is gong on rtow, as compared ~ years ago. ~}m OUght up::,urg~( of investigative projects and grant r~u~ts ~ the field o~ :~n-mkln1( and ],mdth is one good in.cater that at least among r~reh work,~g; tim answers we need ~ncer~ng the causes, developmentnl :-~tag,.,~, diagno~i% and control o2 these d~sem~es are no~ available. To 1085 claim there is now suttlcieat scientific evidence to establish theft ciga- rette smoking eallse8 disease is in my opinion unjustified. (The attachments Io D~ Sommers' statement, follow :) BO~ : Jllly 7, 1916, I~dl~na~olis, Indiana. M~rx'i~ : November 9,1~3, ~ith B~gg{, no children. S.B., ~rvard College, 1937, eum laude. M.D., ~a~'vard Medical School, 1~1, eum laude. Intern : Chicago University Clinics, 1941-1~2. A~}s~nt Resident and Re,dent in Pathology, New England Dcaeones's Boston, 194~8, A~isgant ~ident in ~atholo~, F~e ~ospHal for Women, Brooklhm, 19~. A~is~nt R~sid~*~ in Pathology, Boston Lying-In ~oupi~al, Boston, 294~9. Resident in Pagholo~,, ~enry Ford ~ospital, ~oit, ~edeaa Board Cere~cate in Pathology (Clinical Pathology--Pa~ologl¢ Aunt. omy), 1950. Associate Pat~logLut, Sew England ~acon~s ~pital, Boston, 197~-58. Assistant Pan,legist, ~arvard Oaacer Commission. Boston, Pathologlst, Massachusetts Memorial ~ospltals, Boston, 1953~L ~a~ologist, Serlpps Memorial ~ospltal, La 5o]la. California, Ass~te Dir~tor of Laboratories, Francis Delafield Hospl~l, New ~urk 67; Director 1967-68. Dir~to~ of ~bovatories, ~nox ~tll ~ospttal, New York, 19~. Assistant in Pathology, Harvard Medical School, 194~19, Instructor In thole&5', 1950-52, Aspirate in Patholo&~-, 1952-53, Lecturer" In ~athology, ~95t- Associate Professor of Pathology, Boston University School of M~ieirm, Boat,n, 195~61. Clinical P~of~sor of Pathology, University of Southern California Seho,4 of Medicine, Los Angeles, A~i~e Profe~or of Pa~ology, Columbia Untve~i~y, ~ollege of Phy~ffeiaa~ Surg~ns, N.Y. 1~5, Professor of Patholo~, 1~8, ~llnlcal of Pa~ology, 196~. Captain, ~iedical Corps, United States Army, 19~--16. Silver Star, Bronze S~r, Croix de Guerra ~d Pre~dent~l ~nit Citation. Bergen C~unty M~ieal Society, American Association of Path.logists and Baeterlologlsts. College of ~morl~n Pa~ologists. Amefie~m Soele~ of Cllnl~l Pathology. The Ilistochomieal Society. American S(~ety of Ex~rimental Pa, thology. New E~land C.anc~r Society. New England Society of ~a~loglsts ; Pre.qldont, 195~60. Intermttlonal Academy of Pathology. Society Exp. Biol. and Med. N.i'. Academy Mad. NX. Academy ~ci. Editor, Pathology Annual, Editorial Boards : Exeerpta 3[edica, .L Clio. Endoe,Snol. & Metab. Scientific Advisory Boa rd : C,,un¢il for Tobacco Research. College of .%merie~ Pathologists. Committee on Class & Nomenclature of American Society of EXl}erlmental Patholo~. Llalsmt Delegate n, Amerh.ao St~ciety uf Clllfleal P~ltlalio~v In Cancer. Seoretary-Elo't. New Ym'k Pathological SoclelY. Breast ('nnc~r Task Force, S.I.H., Ad Hoe Pathology Working Grot~p, Chalrm~m. PUBLISrlED ARTIC~S 1. ~aeohs, I. L and Sommers, S. C.: The specitity 0f formollzed proteln~. 1. lmmunol., 36 : 531-~1. 1937. 2. 5lenkln, V., Kadlsh, M. A. and .8ommers, S. C.: Leukocytosl~-prom,llog £aetor in t~ammatory exudates of mare Arch. Path., 33: lb~li,2. 1~2.
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1086 33. Somme~s, S. C. : Endocrine e]mnge~ after hemiadrena]ectomy and total body im'adiafion in parabiotic rats. J. Lab, & Clin. 3Ied., ~.: 396~07, 3~. Hol~, M. ~V., Sommer~, S. C. and Warren, S. : Intraanclear change~ requiting ~rom ~pos~re to i0ni~g radiation as detected ~ frozen-dried tJons. Lab. Invest., 2 : 40~8, I953. 3S. Somm~s, 8. C., Geye~, ~. 8. ~d Chute, R. N. : Auto~a~o~ap~ic Ionization in ~utt ~d emb~o~c eplthe~ an~ coanecttv, ti~sue, Prec. S~. ~ per. Riol. & Me&, ~: ~3~239, 3~. Sommers, S. G., Teloh, H. A. and Goldman, G.: Ovarian influence upon viral ~ breast canc~. ~. Surg., 67 : 91~919, 37. Sommers, S. C. and Lombard, O. M. : Cancer associated wl~h ovarian hy~erDl~la. Ar~. Path., ~6 : 462~6~, 1953. 38. Warrens, S. and Sommer~, S, C. : P,~holo~ of regional Ileitis and ulceratlv~ coli~is. ~. Am. Mcd. Ass~e., 154: 1~193,1954. ~9. ~damson, h'. E., Jr. and Sommor~', S. C. : Emlometr~d ossification, Am. Obst. and Gynee., 67 : 187-190, 40. Chute, R. N., Kenton, H. B. and Sommerz, S. C. : A laborato~ cpblemie human-~pe tuberculos~ ~ hamsters. ~, y. C/in. Pn~., 24: dL ~azcial-Rojas, R, A. and S0mmer~, S. C. : Dlfferenflatofl mucoe~tdcrmoid t~mozs o£ sallva~ glands. Arch. 0tolaryiag., 59: 13~140, 2954. ~. ~oltander, A., Sommers, ~. G. and G~wade, A, E. : ~istochcmical ~md ~]~'aviolet ~ogeopic sCadies of chronic dermato~e3 and th~ cozi~ membrane, ft. Invest. Dermat, 22: 33~3~8 4~. Strandp,.~., Sommers, S. G. ann P~:trak, ~I. ~'~}~onal enteroeolifi~ ~ cockez spame~ aog~. ~, Path., ~7 : 357-~62, ~. Sommers, S. C. and Mei~ner, %V. A. : Basement membrane ~ange~; in chronic thyro~difis and oth~ ~yroid d/senses, ~. ~. ~Iin. Pa~,, 2{ ; 19~ 45, Wood, I. S., Yr., He, eke, E. D, Clason, W. P. C., Sommers, S. C. and War. ten, S. : An exper~ental shady of ~e relationship between tumor ~]~ and number of lung met~ses Cancer, 7: 437~9,1954. 46. ~ddard, ~. W. u~d Sommers, S. C. ~e~od for th~oid ce~ ~apIdng. InvesL, ~ ~ ~97-210, 4~. Colcock, B. P. and Sommers, S. C. : Pr~osls tn Paget's ~sca~e of the breast. Surg. CI~. N. Am., ~: 77~7~, ~. Bu~t, A. S., Lauding. B. H. and ~ommers, S. C. : Amphophil tume, r~ of hypophysl~ induced In mice by I~'~ Cancer ~ea., 14: 497-502, ~954. 49. Sommcrs, S. C. and ~Ieissner~ ~L A. : Unusual ca~c~oma~ o2 ~e pancrea:¢, ~ch. Path., 53: 1~1-~1,19~. 50. Scrotums, S. C., Edwards, J. L. ~d Chute~ R, ~. : ~crea~e in gen~ty le~ions and parabiosis ~toxicaflon after adrenalc~tomy, Lab. and Cl~, ~Ied., ~: ~31-~43, 51. Sommers, S. C., Crozier, R. and Warren, ~.: Ultraviole~ mlcrozcopy of g[omerula~ diaeases. Am, y. Path., 30 ~ 9]f~939, 52. ~tner, D. D. and Sommers, S. C, ~ Medical intelligence, h'ew. Eng. Y. 251: 7~74~, 19~. ~. Paterson, W. B., Chu~, ~, N. and Sommerz, S, C. : Tran~lantatlon of human tumors into cor~aone-treated hamsters. Chaucer Res ]4~- ~C~59, ~i. Goddard. $. W, an~ ~0~er~, S. C. : ~y~old stimulation In dl~lbetea li~s. Diabetes, 3: ~%% ~5. Sommers, S. C., Mushy, S. A. aml Warren, S. : Pancreatic duet and cancer. Gas~xoenterolo~, 2~ : 62~0, ] ~4. Rohman, M. and $ommers, S. C. : k do~b]e Pt~a~ carcinoma o2 urinary bladder. J. Urol., ~2 : ~1~1177,1954. ST. S~mmers, S.C. : Some appllca~lorm ot ul~avlole~ microgcopy to PatlmI~gy. BMQ, 5: 105-]0S. ~954. ~S. ~mou, H, M. and Sommor~, ~. C. : Clint~opathologI~ ~onS, rence. Am. J. ~]in. Pa~., 24: 1402-1407, 1954. ~9. Sommers, S. C., Crozier, R. and Warren, S.~ ~ ~tudy ot the ul~ravl,lct microscopy of re~al vascular eHsease~. C~rculafio~, 2I: 3~3, 195~. ~. W~od, J. S.. ~r., Holyoke, E. D, Sommer~. S. C, and Wan'ca, S. : o~ pituitary growth hormone on ~owth and meh~sls forma~on tff transplantable mous~ sarcoma. Bull Johns Hop~ns Ho:~p., ~: t ,:,-I00, 1055. Bl. Sommerz, S. C. and Wa2~n, S. : Ulcerative eoH~ lesions in l~tdiated rat~. Am. J. Digest, Dis., t2 : 111,
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1088 t;2. Ho~ur~er~, R. 0.: Endocrine abnorma.lities in women with breast cancer, r,ab. Inve~4,, 4 ~ ~6~17d, 1fl55. ~l;I. Haloy, H. L,, Dcw~-~, G. H. and $ommers, S. C. : A h~t~hemical comparison ot' primary ~yroid hyl~rplasia and aflenomatous goiter. Ar~. F~th., 59: fl-L KrPfvr, G. ~. and ~¢~mmcrz, S. ~. : Clinico~atholo~c Coherence. &m. J. Clin, l'ath. 25 : 205~3-1057,19~5. *i5. S,~,~me~, ~. C., Gates, O. and ~odof, I. L : Late recurrence of granulosa ~'11 tum,~m, Obst. & Gynec., 6: 39~98, ~L S.mmers, t~. C.: DeveloI*ment of ~cs~azch at Massachusetts Memorial ~os- ~iL IIa~dlor, A. It. Duvk~, S. and ~omme~s, S. C. : IIeterotransplantation ex~ri- ~.~u, Park~,r. T. G. and Sommers, S. C. : Adtea~ ¢~rtical hype~lasia accompany- D*g ~'a~lc~,t. Arch. S~rg., 72 : 49~99. ~9~6. l}~l, Ho~.~or~, ~. O.: Testieuh~r ~I~rmatogenic cell hyper/ro~,y accompanying I,ro~tatle hYI~ertrophy and cancer. Am. J. Path., 32: 1~-199, 1951L 70. }~,,~,,mer~, ~, C. and ~aley, K. H. : Similarity of glomeralar ~b:~,rptlonn in dtabe/c:~ mellit~ and ~ftey eortison therapy. Pr~. See. E l~:r. BIuL & Me,l, 91 : 262-265, 1956. 71 Su],~u,er~, ~. C. a~d Chute, R. N. : Carcinogenesis and altered host reactions 1~ i~ardhio~c ~at~. A~eh. ~ath., 61 : 29~{01, 72. ;q,),,mcr~, S, C. : ]~truductl*m to patholo~ of neoplastic diseases. J. Student A.M.A, 21-25, April, 78. l~haM~a~.,hlr, T. and ~ommera, S. C. : Chronic mens~uaI endomet~ium. Obst. ~: Gylwc., 8 : 112-115,1956, 74. S,~u,r;~, ~, C.: Basement membranes, group substances and lymphoeytiC ~ggrPt~ttca in aging organ~. $. GeroatoI., 11: 251-260, i0~6. 75. Brh~, M. and Sommcrs, S, C. : A "b~ghte4" a~ites tumor. Transplant, Bull., 71]. 8oI,~mers, S. C. and Wadlaan, P. $. : ~athogenesis of polycystie ovaries. J. Ob~, & Gynee., 72 : 1ON169. 195it 7% lhmght~l~, G. A. sad $omme~. S. C.; Renal changes In ~h~'k trea~ed with levar~vren~l {L~,v.phed). Am. $. Clln. P~th., ~G: 2~-34, 1957. 7~, Burr, R. and ~ommers. ~. C,: Unusual causes of death after cardiac t,urgery, Am. lleart J. 53 : 232-~9, 1957. 7t~. Murle], A, arnl So~ner~, S. C. : End~rine eorrelatlons in m~mary ndeno. fil,ro:~l:~ and chrunic cystic mastitis. Ann. Surg., 145: 32~3, 1957. I:;0. ~,.,mmer~.~, S, O. : Endocrine chang~ with prostatic ~reinoma. Cancer. 10: 81. ~Uable, A. T., Burrow~, B. A., an4 ~ommers, S. C. : Ctinieot~thologi¢ Con- 5,rc~,. Refractory anemia, ~6amma~lobulinemia. and medlasthml tum,~r, Am. J. Cite. Path, 27 : di,~52, 1957. s2. M~'Nulty, ~. R. and ~ommc~, S. ~.: Keratcaean~oma as a surgical patho- b~glc ellllty. Surg., Gyn~. & Obst., 1~: 66~, 1957. 1~3. Jart~,~. It, G. and S~]oiun, rs. S. C. : Olomerular al'teratlon~ tn kidneys of rats ~,~at~'d with de~}xycurtivosterone. Arch. Path., 64: 5~62, 19~. a4~ l~altz, ~I, ~uhmwm=, ~, C., and S~thwlck, ~. ~.: Olinieopathologic tlou~ of fermi biopsies from ess~ntlal hyr~ensive p~tienK~. Ch.cularion, ~5, Merrhm~, $. C., Jr. and Sommers, S. C.: 5Ia~a~T ~rid~tal hyaliu diahuHe women. Lab. Inve~;t. 6 : 412~20, ]957. ~L M~:b?-~n~*r, W. A, Screener,s, S.C. and She~nmn, O. : Endometrial hyperplasia. Pmlom,,trlal carcinoma, and endometriosis produced extmrimeutaI~v by ,r~tr,g~,u. C~mc~r, 10: ~)~D, 1957. ,sT, ~-h,~:~rw,n~, S. C. a~d Mei::'~mer, W. A. : Host rslatJonsl~ips In experimental eud,,mutrlal car~,lnoma, Cane~r, 10: 5~15, 195Z SN, [~*l~lI~er;i, ~. C, amt Meb:-;ner, W. A.: Endocrine abnormalities accompany- Ing hunmu t, ndom.trial cancer. Cancer, 10 : 51~521. 195L ~, P,(~*ltter, L., Sommcr~, S. C., Relman, A. S. and Emer~nn, C. P.: Pr~idoms in ffm M~rglval management of th~ic ~umors Ann. Surg., l~i: 42~3S, I~t). Burr, I~. W, and ~ommer,s. S. e.: Endocrine nbnormali~ie.~ a~ompanying b~,patb: ctrrlm~ia and hepatoma. J. ~ltn. ~ndoeriuol., 17 : 1017-10~, 1957. IU. Ullrlck, W. G., L*~atiul, D..L a~d Sommer~, S .C. : Excitability and con- tr~.(e¢llffy of p~tmortem human heart muscle. Lab. I~vest., 6: 1089 92. Sommers, S. C.: Host factors in fatal human lung cancer. Arch. Path., 65 : 104-ill, 195S. 93. ~erriam, J'. C., Somme's, S. C. a~d gmithwiek~ It. H. : Cliaieopathological correlations of renal biopsies in hyI*ertensiou with pyelunephrltlu. Circu- lation, 17 : 243-248, 1955. 9~. Koefer, ~. D., B~vinton, N. W., Atkinson, R. P. and Sommers, S. C, : Panel discussion oR chro~c ulcexative coiitis. Am. ~f. Ga~troentcrol~ 2D: 35t~- 373,1958. 95. Azar, H. A. and Sommers, S, C. : Retroperitoneal ectolde seminal vc~lcle communicating with a contralaterai solitary l~idney, :Report of a J. Urol., 19: 94-~J8, 105S. 96. Sommers, S. 0., Relman, A. 8. and Smithwick, R. It. : Histologlc studies kidney biopsy specimens .from patients with hypertension. Am. ,L Path., 3,t : 6 ~rS5-715, 1958. 97. Sommers, S. C.: Constitutional aspects of gastrlc carcinoma. Arch. Path. 98. Ullriek, W. C., ~ntini, E. A. and So,mere, S. C. : Oygen consumptiua of ~s~ottem human heart muscle. Prec. See. Exl~r. Biol, & 3fed, 9~: 246- 247, 1~. 99. Shamma, A. ~., G~dard, J. W. and Somme~s, S. C. : A study o£ the adrenal s~tus ~ hypertension. J. Chron. Dis., S: 5S7-595, 1~58. ~. S~va~ ~. ~. and Sommer~, S. G. : Itenal biopsy chauges with tome, Am. $, Med. Sei., 236:7~7#~, 1958. 201. Keffier, R., Lenson, N. and Somraers, S. E.: Carcinoma arising in minor sa~v~ gland duct~ o£ ~e lower lip. Am. J. Surg., 97: 7~82, 1950, 102. Strong, S. M. and Somme~s, S. C. : Bzonchiogcnic carcinoma Arch, 0re- Ining. ~: 76~769, ~03. W~ins, ~. W, and Sommers, S. C. : Cllnicopa~ologlc ~oa£ereace. Enlazgc- merit o£ ~e heart, cardiac failure and loose, dry scaly skin. Am. J. Path., 3I : 6~72, I959. ~. Somm~s, S. C. : Pituitary cell relatiou~ to body states. Limb. Invest., ~: 62L 1959. 105. Co, an, J. D. and Somme~, S. C. : Famlllal pseudoxanthema ela~ttcum and valvular he~t discus. Circulation, 19:242-250, 1959. 106. 8ommers, S. C. : Pathology ~£ the Kidney and adrenal gland in telation. shiy to hypertension. In : "~ylmrtenslon" W. B. Saunders Co., 23, ~0L And~akis, G .D. and Sommers, S. C. : Criteria of tbymie cancer and clinic.el correla~ons of thymic tumors. J. Thoracic Surg., 37: ~W~2~, 1959. 10S. Androutsopoulos~ ~'. A. ~d Sommers, S. C. : Pos~menopau:~al Obstet. & Gynec., 14 : 24~248, 1959. ~. Ul~Ick, W. C., Len~i, E. A. and Sommers, S. O. : Summation and t~,taau~ ~ postmo~em human heart muscle. 5. Appl. Phyuiol., 14: ~67-~$, 1959. 110. Hollander. A. and Sommers, S. C.: Current case of lepromatous leprosy, acid-fast bacilli ~ epide~is. Conn. Med., 23 : 6~5:t~ 1959. 111. ~hayez, 0, L. and ~ommers, S. C. : Host factors in carcinoma of the uterine cervix. Am. J. 0bstet. & G~ec., 78:3S~95 1959. 112, Bloodworth, J. M. B. and Sommers, S. C. : "Cirrhotic glomerulo~clero~[~'. A neral lesion associated with helafic cirrhosis. Lab. Invest,~ 8:9(;2-978, 19~9. ~13. Fuller, C. H. and Sommers. S. O, : The ~yrotd status in relation to ar- terlo,~clerotic d~ease. B. MQ. 10:1-2, 1959 114. Sanchez, G. C. and Sommem, S. ~. : Peptic ulcer diathesis with a mixed adenocarcinoma of the pancreas : Case ~epo~t. Gastroenterology, ~ : 407- 470, 1960. 116. Sommers, S. ~. : ;Renal and adrenal [mthology In hy~ttension. Conn. 5Ied, 24: 24~2~, llt]. Kelly. 5. W. M.. Parsons, L., Friedell. G. H. and Sommers, S. C. : A pathah~gb~ study in ~ autopsies after radical sm~ery f~r cancer of the cervix. Gynec. and Obst., 110 : ~, 1~0. 117. He, under, A. and Sommers. 'S. C.: A histoeh~mical study of mu~.opMy. ~eeharides of leprosy o£ the skin. Acta. Dermat. l"enereol. Prec. llth Internat. Con~. De--at. 3: @7-411, llS. ,Buc~ngham, S. and ,Sommers, ~S. C. : Pulmonary hyaline membrane~, J. ~hild., ~: 21~T27, 1~. 119. ,Paten, R. 2. and .Sommers, ~, C. : The hlsopatholo~ of infection ~d other ul~rative disuses of the esophagus. Am. $. ~ln. Path,, ~ : 5~524,
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1090 ~20. llolland~,r, A. and ~oma~er~, S. O.: tlIstoebemical comparison o£ Boeok's ,~:trcold with oth~r eutam~u~ gr~ulom~..kreh. Dermal S~: 1~1. ~Tb~&ll, G. H,, Sh~an, ~, D. and $ommer~ $..C.: S~een and th~ an,,~[a o~ th~ tu~or-beariug hamster. Arch. P~tb. 70 : ~S71, 1960. 1~, Gr~v;~l, J. E. and ~ommer;~, S, C, : ~ ca~ of ear~oma of ~he b~east in a yo~f~ w,~m:m wi~h hamartomatous hy~o~alamic malformaNon. Am. J. 123. C,q,,rla, O. C., FrbM~l, G. H, and Sommers, S. C. : Raynaud's disease an~ I,rlm~try pulmomtry hypertension. Clrculatlon. 22: 105~1059, 1960. ~?1. rth,~'goo~,, C. and Somm,~r~, S. C.: ~uxtaglomerular cell coun~ and human bYl,ert.n~lon. ~. ~. Path., 38 : 227~241, 1~.~. ~ommer~, ~. O. and ~vgeon, C.: ~Iorphologlc studies on relationship py~lon,,phrl~ tn hypertension in: "Blolo~ o~ pyeloneI)hrltls" Brow~ an4 Comp:my, Boston, 1960. 12~. 5I,-Aub,y, ~. ~. and Sommer~, S. G. : ~Inst celia ia nons~ei~e ~eera~ve ,.ollti;~. A~. J. Dig~. DIg., 6: 233-~6,1961. 1~7, E]~,~mcr~, ~. C. a~d Ver~.,ndia, J. B. : ~n appraisal of laboratory determina- ~b~n:~ or cArogcn~. Am. J. Clio. ~;~thl, 35 : 31~327~ 1961. 12g. YI~, P-II a;~d ~mmera, $. ~.: Some ~atholo~c eorrelagons o~ ovarian ~romal hyperl~la~:la. J. Clin. Eadocrinol. & ~ietab., 21 : ~72~77, 196]. 12',). Patalano, V. J. a~d gommer~, ~. 0. ; Biopsy dhgnosis of ~rla~erl~s Arch. Path., 72;1-7, 1961, 1:',0. T~.,l~,'.~ehl, L. G. a~4 ~o~me~, S. G. : 0xytalan fibers ~ selerosing hema~o- i~1. Somm~r:~, S. '~. : Some pathologic conditions assoehted with renal and ad- r,~nal hyp:,rten~ion. ~. A. M. A., 178: 7]~717,1961. 1;~2. ~'h'd~H, G. ~, Sherman, Y. O. and Semmers, $. 0. : Growth eurv~ of ~an ,.aBcc, r tran~:ptant~ during experimen~l chemotherapy. 14: 111~- 1'121~ 1[~.~1. l~t~, ~h~rman, ]~ P., Gracchi, Y. E. and ~o~erz, S..O. : Hamartomatous ma~o~- matlo~, of the i~tlateral hypothalamu~. Lab. Invest., 11: 8~97, 1962. 1~]. ~Villh~:~, hi. Y. and Sommer~, S. ~, : Endocrine and cer~in o~er chants tn m~, wlth carcinoma of the hmg. Cancer, 15: 10~117, 18~, Goners, K., Frled~ql, G. H. and Bommers, S. O. : A ~dy of ovarian ~eeoma- ior~l~. California ~[edictne, 96 : 2~256, 1962. I::~L Tvdv~chl, L. G. aa,l Sommer~, ~. 0. : O~talan flbem~ermal flbromas and glant-mql t~ndon shea~ tumors. ~krch. Derm., 85: ~-5~, 1962. 137. '~t~vrgcl, K. ~. and Sommers, S. C.: ~e atveotar epi~eHal les~on of tdio- ~:~. ~h**,r~,,l, E H. and S~)mm~r~, S. C. : Idtopa~le pulmona~ hemoslderosts nml relat~d ~ymlromc~. Am. J. ~Iod., 32 : 49~511,1962. ~), ~omm~,r:~, ~. C., ~lcLa~hlin, R. J. and McAuley, R. L.: Patholo~ of dis- h,relic hypertension as a generalized vascular disease. ~. 5. Cardiol., 140. ~t~'evt~', G. and Somm~,r~, S. O.: Endometrlal hemosider~ as evidence metrorrh:.~gin. OBS and GYN., 19 : 79~7[*2, ~41. ~t,:,ynold,~, C. T. and Smithwlck, R. ~. and $omme~s, $. G. : adr~.nal nd,:n,ma and ~ym[~athectomy in the therapy of hypcrteasiom Am, ,~. Sur~t,ry, 103 : 69&701, 1962. 14~. M.re, B. M. aml ~,mnuer,. ~. 0.: ~tatn~ of th~ my~cardial arterioles ~i~h~a pcc[ori-~. Am~,r. ~r~ ~., 64: 32~33, 1962. !.13. ~¢t,ya*dd~, ~. T. and ~o~mer~, ~. C. : ~ympathectomy fo~ glomerulo-nephritts with hyW ~rh,~.b-,n. Arch. Surg., 85: 39&3~}3,1962. l'll. ~omm~,r:~, ~. C., Ib.~bbh, u, G. B,, Babin, D. $. and ~mack. O. T.: Chronic l,y~,iom'phrltls, renal tubular atr~p~ and h~c~tension. Arch. In~ Med., ].I~. Whba,;t:~lld. J. )I., I¢o~tns. D. and Sommers. S. C.: Some host factors in 11G. B,mght,:m, R. M. :l~d S,~mmer~. $. G. : & ~ew concept o~ ~enal hypertension. J. U~logy, $9 : 113-136, 1:~7. Rm~v~-, G., ~wcnutein, L. and $ommer.% $. C.: A suggested mechanism of ,,rythropot~-.tle control of j~tagtomerula~ ceils. ~. J. ~Ied. $ci., 245 : 1091 148. Hark, B. and Sommers, S. O.: Endomctrial curettage in dlagno~t~ and therapy. 0st. & Gynec., 21 : 631N-6~8. 149. Sommers, S. C., Weber, O. E. and Reeves, E. : A hcmagglutina[ion r~ctlon ~f mo~her$ and infants ¢f different ABe and Rh group~. Am. J. Clin. Pa~, 39 : 482~, 1963. 150. Russfield, A. B. and Sommers, S. C.: The effect of ma~utrition on ~opic hormone s~orage i~ the human hypophysls. ~krch. Path., 75: 564, 151. Beast, S. B., Sak, hi. and $ommers, S. C. : Influence of ~ulln theraIW and pyelonephritls upon dlabe~lc glomerulosclero~ls in hamstcr~. 5letab. 12 : 70~709, 1963. ' I52. Sommers, S. C.: Some endocrine 'aml immunolo~c a~pect~ of progno~l~ lu breast carcinoma, Acts Union Int. Centre Cancer 16: 95~t]0, 153. Reeves, G., ~iguerdo, A. and Sommer~, S. C.: k ease t)~ breast earolnr~ma wi~h hy~thalamic malformation. West. J. Surg. Obs. & Gyn. 71 : I86, 1963. 1~. Hurt, 5~. S. R. and Sommers, S. C. : k e~nicopathologte analy~i~: of hiop~y ~pe~mens in persistent glomeruloaephritis. Am. J. Path. 43: 45~-175~ 255. Bowden, D. H., Danis. P. G..and $ommer,~, S. ~. : Y. Neuropath & Exp. Neur. 22: ~5~3, 1963. 156. Beaser, S. B., Sak, M. F., Donaldson, G. W., McZaughlin, R. if. and ~,.,m- me~s. S. C. : Alloxan diabetes in th~ golden hamster, 5Iesocricctus Auratu~ lI. Glomeruloscl~rosis and its rela~on to diabetic ~egulatton. Dlabete:~, 23: ~-~, 1964. 157. Wi~i~s, ~., Barne~, ~I. D. and So~ers, S. C.: Hy~ona~emla, anti- diuretic homone s~etton and oat e~l carcinoma of the lung. Dis. of Chest, ~: ~99~ 1~. 155. %Iom'oe, L. $., Bough~n, G. &., and So~erS, S. C. : The association of gastric epithelhl hy~rplasia and cancer. Gastroeaterolo~ ~: 267-272, 159. Teel, P. and Sommers, S. C. : Vascular invasion a~ a prognostic factor In breast carcinoma. Surg. qynec, and 0bstet. llS : l~l(~S, i~. R~ves, G., I~)wenstcin~ D. and Soramers, S. C. : The renal maeul~ and ju~aglomerular body and cirrhosis. Arch. Int. M~. 112 : 7~715, 1963. 161. William, M. J. and $ommers, S. C.: Emphysema, Peptic ulcer aml lm~ carcinoma with pituitary Crooke's c~. Am. ft. Meal. S~. 247 : 196~ 162. So~urs, S. C. ~4 Dixon, F. J. : Seminar on untoward reacttonu to treat- men~ Am. Society of Clinical Pathologisb~, Chicago, 1~4, 67 1~. Breslau, k. ~I., Gonick, ~. C., Sommers, S. G. ~md Guzc, L. B. : Patho- genesis of ~onic pyeloncphritis. Am. J. Path., ~: (t7~705, 2~ Wright, C. F., MedenilIa, G. A. and Sommers, S. G.: Perinatal d~,~th: clinicopathologlcal analysi~ of 99 eases. Cali£ Med, 1~: 33~;9, 19~. 165. ~mmers, S. C.: Abnormalltle~ accompanying carcinomas o~ the large ce~tino. Dis. Colon and ~ectum 7: ~62-26~. 1964. 1~. Kennedy, 5. H., Williams, M. Y. and Sommers, S. C. : ~ushing's syndrome and cancer of the lung: Pituitary Crooke Cell hyper~lasla In pulmonary oat cell carcinoma, Ann. Surg. I~ :98~)4.19M. 167. Sommers, S. C, : Pathology of essential h~tenslon, Cycle. Med. 4:9-1U, 19~. 168. Buckingham, S. ~IcNary, W. F., 5r., and $ommers, $. C. : Pulmonar~ alveolar ceE inclm~ions : ~eir development in rat. Science, 145:1192-93, 1~4. 169. Russfield, Agnes, D., Fisher, Edwi[~, R. and Sommers, S. C. : Dl~::=a-,clatlon of h~ophyseM content and u~nary excretion (¢ gonadotropin ~ clrrho~,l~ Prec. $o~ Exp. & Med., 116 :~, 1022-1024, A~g-Sept. 170. So~ers, S. C.; P~monary emphy~cms, healed myocardial iufarctu and other disease correlations wi~ male b~east s~uc~re. AM. J. Mcd. SoL, 248 :Sept. 19~, 341-344. 171. Sommers, S. C., Gonick, H. C., Kalmanson, G. 5I. and Guze, ~. B.: Patho- genesis of e~onlc 9yelonephritis. ~I. J. Pa~., 45 :~5 729-Tt9, No. 172. Wri~ell, G., Betts, A. and Sommers, S. C. : The prognos~c valse r,f bloo~ vsesel lnva~on and l~cytic infll~ate~ in breast carcinoma. C~mccr~ 18 :~2, 16&66, Feb. 173. Ke~medY, Y. ~., Willlanms, ~. Y. and Sommers, S. C.: Pl~ita~ Crook~ Ceil hyp~rplasia in pulmonary carc~o~a, Acre U~o Contra Canc~um, 20:1523,196~
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1092 174. Gunick, IL 0., Rubinl, M. D., Gleason, L O., and Seminars, 8, C. : The renal l,'d,n In gout. Ann. Int. Mad., ~2 :~67.-674,19~5. 175. ~ommcrs, ~, C, : Hyi~rteuMon and Kidney Disease. Prog. in Cardiovascular Dleea~., 8:210-3~, Nov., 1965. 17~L Kal~a~non, G. hi., ~ommcm, ~. C. and Guze, L. B. : Pyelonephritis VII. Ex- l,'rimeatal a~ce~dlng in£ectlon with ~o~ezslon of lesions in the absence of bacteria. Arch. Path., ~ :50~516, 196~. 171. R,',v~, G. and ~rm~mer.~, S. C. : Sensitivity of the renal macula densa to urinary ~odlum. Prec. Soc. Exp. BIoL Mad., 120 :~26, 1965. 17~. F.,mmor:~, S. C.~ End¢~erlno pathology of pros~e hypertrophy and carci- ~m~l. Bull. N.Y. Aead. Zfed., 42 :~IS, March, 1966. (Abs~act). 17~, Bvrcovl~, Z. T. and 8ommers, S. G. : Altered inflammatory reacOon in l~I~'cl~e ulccratlv~ colitis. Arch. In~ ~Icd., ~17:334, April, 1ElL FfL'dcll, G. ~,, Sommer~, S. C., Chute, R. N. and Warren, S. : Ovarian tumori- g~'n~::~l~; in irradiated ~arabb)tic ra~s. Cancer Res. 26 :~7-4~, 66. lSl. Mcb~:'.ncr, W..~ and Sommer~ S. C.: Endometrial changes after proloage~ vrogc~b:ronc and testosterone administration to rabbits. (3ancer Res. 26 : 47~47,~, March, It, lL I~[E More, B. ~L, ~lcrdl~ger, ~'. F. and Summers, ~. C. : Cholecysitis and stenotic act e~b:e~eh:.zoMs, Am. $, Clio. Path. 45 :~67, lb~, k~.~mmer:~, ~. G, Frlc~ell, G. ~. and ~obinson, C, R. ; Chemotherapy of ~uman Cane,:r ~am~plant~ with ~ethotrexate (Amethopterin) and ~orse Serum. Cane,,r, lr~ :~¢ff6, laL l~vhindlvr, A. 3I and ~ommers, S G: Diabetic ~clerosis of the guxtaglomeru- lar A[~paratus. Lub. Inv~L, 15:877-884, May, 1966. lV.5. b~e~romer~, S. G. : Renal Factors In Hypertension. Henry ~ord ~osp. )Ied. Bull., 14 :,t7-54, h~arch, 19~6. lh~L Bu,,kin~ham, S., llelnemann. ~. O. Seminars, S. ~. and McNary, W. F.: Phm~pholipld Synthesi~ in the Large ~ulmonary Alveolar Gall : Its t[oa t¢~ Lung ~urfactants, Am. $. ~ath., 48:10~-1041, June, 1966. 1~7, ~.loway, H. ~. aml $ommer~, S. C.: Ead,~rin.~athy Associated with Pan- croatia Carvlnoma~Review of Host ~actors Including II~2mrl)la~ia Gonudotropic Activity. Annala 0£ Surgery, 1¢~ :30~304, 1~. Laragh, J. H., ~calcy, 5, E. and Seminars, S. C. : Patterns of Adrenal Seers- tiem and Urinary Excretion o~ Aldosterone and Plasma R~in Activity Nomual and Hy£~ztc~lvc ~ubj~.~t~. ~upplcment 1 to Circulation Research. V.l:~. XVIII and XIX, 1-158--1~74, ~une, 1966. lh~L Cann~:~, P. J. Stason, W. B., Demartinl, F. E., Sommers, S. C. and Laragh, J. II.; Hypcrarivcmta ia PrimatT and Renal Hypertension. New Eng. J. M~'d., 275 : 457~64, ~eptember, 1966. I~~:L b~**~]m~,n~, S. C. and Frlcdeli, ~. H. : Studies of Carcinogenesis in Parabiotic Ratr.~ Annal~ vf New ~ork Academy of Sciences, 125:9~932, January, 1~1. Kibitzer, S. J., ~anmers, S. C., Haagensen, C. D. and Cooley, E. : Re-evaluation of l¢l,ud Vessel Invm;l~n ~s a Prognostic Factor in Carci]mma nf ~h~ Brea::L Cruiser, 19:1213-1216, September, ]966. and LymldUmm Durl~g Antieonv~lsaut Thorapy. Blood, 28:41~427. llR~6. 1~}3. ~;umm,,r~, S. C. : 51a~;t Celb~ and Paneth Cells in Ulceragve Colitis. Gasrroen- ter, d,~gy, 51 :s41-8~% 1fl66. ]~4~ }~,unnmr,~, S. C.: Paflmlogy ef Cervical Carcinoma. II~ "New Concepts Gync~.olt,~ii,'al Olicob~gy" Hnln~elaann Symposium, 85-90, Coa,'vpt;~ In Gynecological On,:nlogy" Holmenmnn SymposiuuL 205-20P. 1}~*L ;~,anm,~rs, ~4. O. m~d Bcrcovitz. Z. T. : Inflammatory Responses in Ulcerative Colitis. N.Y. State J. Mad., Ca] ::F~]-3042, 1~7. Svol,:,da. A. C., Jr., Kuauer, C. 5I., Gamble, C. N., Seminars, ~. C. and Monroe. L. ~. Problems in the Early Diagnosis of Peptic Esophagiti~. Gastrointest. End,~neopy, Feb. 1~7. 19~. Carav~lc~, ~., Dl~ond, E. O., Seminars, S. C. aml Weak, R, : l'reeenti,,n nf Indmvd Ather~elero~h; by Perox~daue. Science, 155:128~1287. 5Iareb. I~:L ltlpI.~'y, J. IL a~nt 8ommer~, 8. C. : tlyvertr~phied ~las~na cells in reglona] cnterltlg. Am. J. Dig. Dbz, 12 :.~, ~967. 1093 200. Leon, ~\ and Seminars, 8. C, : Celk; of ma~cullnizing type in ovary of a lmttent with £eminine phenotype. AcLa Genelica et StaL l~Ied., 1967. 201. Goniek. H. C., Paul, W., Seminars, S. C. and Gaze, L. B. : Fnnetlonal in experimental pyelonephrltls. II. Correlation between acid exeretlng ability and enzyme hlstochemistry. Acid excretion and enzyme hlsto, chemistry in experimental pydoneI)hritis. Nephron, 4:75, 19~7. ~02. Goideuberg, V. E., Bf~ekingham, $. and Summers, S. C. : Pulmonary alveo- lar lesions in vagotomized rats. Lab. invest. : 16, 0~% 1967. 903. Seminars, S. C,, Reeves, O. and Reeves, E.: Immunologic and ahem,thera- peutic effects on human melanoma heterotransplants. Prec. Suc. Exp. Biol. and .Med., 123:740, 1967. 204. Bucldngham, S,, Sommers, S. C. and Bherwin, R. P. : Lesions o£ the dor:.~al vagal nuclatm in the res]piratory distress ~yndrome. Am, ft. (31in. Path. 48:269, 1967. 205. Scanners, S. C. : Sy.~tematized nomenclature of pathology. Pathologia Microbiologla, 30:826, 1967. 206. ~trauss, M. D., Seminars, S. C. : Medullary cystic disease and ftm~ilial ~uv~ nile nephronophthisis. Ne~v Eng. ft. ~led. 277:863, 207. Elahi, E. H., Long, M. E., Fxick. H. O., II and ~ommers. ~. C. : l_~ng-term survival in disseminated ovarian ~.mrcinoma. Am. Y. Obst. and Gym:e, 99 : 522, 1967. 208. ~enning, O. R., Seminars, S. C. and Qulgley, H. ~I. : Infertility In male l,a~lent!l with cystic fibrosis. Pediatrics, 41:7-~.7, 209. Harrington, J. T., Seminars, S. C. and Kas~rer, J. P. : Atheromatous embol! with progressive renal failure. Renal artcriograpby as the probable incit- ing factor..~amalg of Int. ]~Ied., 65 : 152-160, lI~68. 210. Cannon, P. J., teeming, J. 5i., Seminars, S. C., Winter~, R. W. and Laragh, J'. H. : J'uxtaglomerular cell hyperplasia and secondary hyperaldo~teron. ism (BattLer's Syndrome) : A reevaluation of the pathophyMology. ~Iedl- sine, 47:107-131. 1968, 211. Lnragh, ft. H., Ledingham. J. G. G, ~md Seminars, ~. C. : Secondary alde~;ter. onlsm and reduced 1,1a.~ma renin in hypertensive disease. Tennis. Am. Physicians, IXXX :16~%181, 1.06S. 212. 5Iarkewitz, St., Snmmer~., ~. C., Vet.heron, R. J. and Butler, ~I. D,: Tc~ticu. lar biopsy artifacts resulting fr.m improper tissue processing. J. Urol., 100: 44-49, 1968. 213. Seminars, S. C.: In. (J.SLB. Bloodworth, editor) "Textt,~ok of Endoerln~ Pathology" Thyrofg (TIang, ~Villlams and Wilkins Co., pp 133-1~0, 19C8. 214. Sommers, S. C.: In "Texlbook o~ Endocrine Pathology". J.I~I.B. Blo~d- worth, editor, ~ndoer{no .delivitt~s of Nonvndocrlnc Tissue Tumors, "Wil- liams and YVilkins Co., Baltimore. l~ld. 1968. 215. Altehek. A., Albright, ~'. b. and 8ommers, S. C. : The renal pathology of toxemia of pregnancy. Ob. and Gyn., 31:595-607, 1 216. Buckingham, S., Sommers. S. C. and 5IeNary, W. F. : Experimental re~plra- tory distress syndrome: I Central autonomic and humeral pathngenetie factors in pulmonary injury of rats induced with hyperbaric oxygen and the protective effects of bar.hiturates and Tru~ylol (~t Biol. NeenaL, 12:261-281, 1968. 217. Paley, W. B., Phancuf, O. J. and Bommers, S. C.: C,dncidental primary sarcoma and carcinoma o£ the cervix. Oh. and Gym 33:41-47. lt)69. 218. Ooldenberg, V, E., Buckingham, S. and Seminars, S. (3. : Pilocarplne stimu- lation of granular pneumoeyte '~ecrettou. Lab. Iuvest, 20:1-i7-158, 1f}69. 219. Kister. S. Z., Sommcrs, S. O.. Haagensen, D. C., Friedell, O. H. an,l CooL,y, E. : Nuclear grade and sinus histiocytosis in cancer o£ the bread;t. Cancer, 23:570-575, 1969. 220. Somaners, S. C.: Hls~ologlc changes in incipient carcinoma of the breast. Cancer, 23:822, 1969. The C~rAml~. Thank you~ Dr. Sommers, ~or giving us tlm :benefit o~ your views. ~h'. ~/,.w D~m~I~. Thank you, ~fr. Chairman. Dr. ~ommers, what is the Council for Tobacco l~esearch ? Dr. Soundings. The Council for Tobacco Research, sir, is now appr6xi- mutely 15 years, old. At tlm~ time, the various tobacco companies, the
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1094 re:tier l:mez in tl~¢ United State% got together and pro~ded ~unds t,:, }:, u ~,d f~r m~dical and biological research in the field relating to ~,~ ld~ and Tl,m~ wa~ ,h~veloped ~ scientific advieor~" board. The board is ]isted in on,, <,f th~ attaclm~e~t~ that I huve in~ert~d into the re~rd. These are imlividual ~:ek~ntist~ and physieia~ who act as a rex6ew bo~rd for any pro~ct~ requt~t for money to he]p r~earch in these fields. Tl,~r~ x~ a report of tim lo years aet~wtv by Dr. C. C. Little which h,..-~'l,'t~, l,ulfli'.~hed and is available. Dr. ~-,. D~:X~. Th~ American ~edlcal Association has an educational aml ~,,..,~az*ch fo~mdadon which ~as ~undcd by the tobacco industry. hI~ l,.,:rnory is not exaet~ but I believe ut firs~ they ~'ere given $10' r,filb,,~ and fl~cn ~ome years later $8 million more i~ order ~o under- tuh, b:tv,-~ti~ations in the field o~ smoking and health. Thi'-; n,onoy is ~administcreO and disl~en~ed 1-,v the A~L% through u,:i,:ntitb~ boai'd to invc~;tiffators interested ~ tKe projects in this Mr. V,x~ D~,~l~mN. Th~r,~ was criticism at the time, as I recall, of tim AMA, for acccptin~ money f~om this pardctflar source for particuhtr study. Holy lon]4 ago ~vas rids ? D~. Scalawags. I behtwe ~t goes back 7 or 8 years now. MI, VAN D~.:~I~LIN. Tlmnk yon~ Mr. Chah'man. Mr. Wh~,~,:,~. Mr. ChMnaan, I apolo~iz~ for behg ]a~e in ~rriving, but I was unavoidably detained. May I defer any oua~ionin~ until h~vo oo:a:aon to gin.nee over the wa~ess state.ment.$ Th~ Crra~e~za~. Dr. Ca~er 1 Mr,~ Cmdr. Thauk you, ~Ir. Chairman. Do,m~r, it ~eem~ that you are quffe a busy man. Director of labora- tor~t,.~, bmox Hill Hospital; chme~d professor of patholo~-, Colnmbm ~hfre~;jty Colle~ of Physicians and S~w~eons, h'ew ~'~rk med~caI p~fi':~: :,'*r of pafl~61o~ a~d University of S~uthern Californi~ SchooI of ~f,'~dlcine, ~ Anhe]e~; ),ou ~ach ,tt, the C4rnell ~Iedical SchooI M,~,:li,:al Cenh~r and New ~rn~k ~fed}~] Cell ege. Al~o, tlm V~tcran:~' Administration hospital consultant in pathology ~tmt editor of the Pathology ~ual. I t'.hink from tbc~c connections you must, be worth~- and we~ quali- fied. ~ further th~ you have given ~ very good p~e~entxtion. I read in tlm paper last Saturd~ that ~ecreta~ Finch of the De- p;trtm,:nt of Health, Eductttion, an~ Welittre bad annom~¢.ed that d,r~t, ry and Government wer~ engaging in cooperativ~ sffo~s to ex- pl,:,r,~, t.h,~ gap~ in knowledge on ~ Ruestion of smoking and health. Did ~ou r,,ad that? . Dr. So~r~r~:~. Ye~, sir; I sa~ that news release. ~at has happened h at tlm time of the ~erican Medical ~ociation Convention S~m F~anc~:::~ m ,lune la~ year, ~ comm~e~ ~as fomed comprising rtpre~q~ntati~c~ of tM ~ational Institut~ of ~eulth~ Dr. Endicott b,]n~ tlm chairman of t.ha~ meeting, and ~lao repr~en~a~ivea ~om the Am,rlcan ~.f~,dical &~ociation-~RF and ~ Co~cil ~or Tobacco. ~,~'arch Sctcnt.ifl¢ Adiv~o~ B~ard. Th~ wi~h was to ou.tline ~or all thre~ groups ~ lack of ~owl~dge or th~ ~lae~:~ where ~ledg~ was defici~t ~ re~rd ~ smo~ and ],:alttb and then to ~e~ ~p ~riori~ies for r~earch ~ ~h~ field. 1095 The subco ,r~mittee was appointed, of which I .~m a member. It me~ on severa~ occasions sillce then. We are hopeful that in a month o~ so we will have a single docu- ment that will reflect the combined ~eclings of the ~ational of ~eal~, tim National Cancer Institute, the A~ Research ~oun- darien and the Co~ci~ of Tobacco ~ese~reh S¢ientifi~ Board as ~ the deficiencms ~ knowledge in this field and ~ order priorities that one or ~or~ of these ~oups will I ve~ much hope we will get such a doc~ent. I thi~ i~ will helpfifi to all of ~ ~ the nex~ 5 yearn or so. ~Ir. C~. ~eallzation h~s dawned apoa m~ny of ~h~o people tha~ there ~re many gaps in ~e causation of lung eance~ Dr. So~z~rs. Ye% s~r. ~[r. Cx~a. Ar~ you acquainted with, and huve [o~ h~d any ciation ~ith~ ~n~ members of %hs Surgeon Scnora~s Adviso~ Corn- mittee wMch issued its reporh ~ ~964 ~ Dr. So~zs. Ye% sir. Pro~essor Fieser, org~nlc chemlst~T, ~ught me chemi~ i college. I Mve ~own ~ for over 30 ~ears. Dr. Emanuel ~rber and I ~r~ ~i~ds ~d bdong t6 a club together, ~ scientffio club. I ~orked for Dr. $~bob Furth as tds executive officer at Dolafield }Iospital for five years, so I saw him eveAy day. Dr. ~urth is ~ ~onder~ man. ~e and Dr. Father ~re experimental p~tho]ogis~. The~ iterest is ~ aninml e~eriment~l models of dif- feint dise~es. I was ve~ ~presse6 with ~he co~ai~tee ~d with the scientific por~ of the committee in ~964. &s ~ m:~er o2 ~ae% I hdped Dr. Fu~h to re~t~ pa~ o~ i~ because being ori~nMly Hung~riaa he had ~omo feel~g his~nglish wasa% as good as ~1; might be, bu% ia ~aet. it is vet good. . - Y So I was impr~sed. Then I read ~e report =d I r~lized what had h~ppened. They had s~ply don~ ~ se]ec~ive review o~ the li~erntu~. They had not ~vestigated ~ll aspects. Th~ ropo~ simply di~% cover tho entiro fidd, in my opinion. It was a disappoin~en~. Mr. Ona~ It was ~ dis~ppoin~men6~ Dr. So~. I~ w~ ~ ~s~ppo~ntm~t; y~. Mr. Oa~. I~ was no~ aee~a~ as you see it, and did not cover ~rets ~ . So~s. It is no% sir, ~ha~ i~ was inaccurate. It was aa~it,~o to sp~, wasa% qui~ equally weighed on both sides. ~,zr. wAma. Lt conta~ed many g~p% then ~ Dr. So~t~s. ~ s~; ~uny deficiencies. Mr. C~. I no~iced you mentioned pHmaD, ca. of the lung ~lso the secondary ca. of the lung. A~ording to the mo~Hty tables which I h~ve, ~1,000 peopl~ had pyim~ c~. of th~ lung last year, and seconda~ cu. of ~h~ lun~ about the s~me. S~ond~ c~. o~ the l~g m~y be due and often is due to problems ~rom other pa~ of th~ body, is *hat no~ Dr. So~I~mas. Y~, sir. In one study, ~5 percent of the cases though~ to be pr~ary l~g ~ncer at ~utopsy ~u~ed ou~ ~o ~ ~econd~ eure~omu.
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1096 ~[l', t:MCTt'.I¢. ,Ro many o{ tlte~e reported eases actually are me~a- ~-{a/ie and corer from l~sions in other places in the bod~'~ prostrato~ [tt~l']l [l~::~ or }Jono~ nr stomach ~ Dr. Soxt~lzrt~. "~a$ is correct; yes, sir, Mr. Ca~ma. Inhalation o* smoke, a~ain, in experimental animals ]ltts n,v~:,r produced hmg ca, is ¢ha¢ t~e~ Dr. $o~rm¢~. Tha~ i~ my undemtandinff Mr. Oaurzu, By the wt~};, do you kno~ i~ horses have emphysema Dr. So~,ts. 'Yea, ~ir.'Hor~ are aveW ~od exper~ental model for ,me form o~ emphysema. M~.'. Gu~m. Do ho}zes smoke ? Dr. So~rm,,r~s. ~o, sir. ~lv: Cawed. Thank you, s~. Th,. C~xnm, ax. Mr. ~ieklM 3ft. ~m++rm. Thank you, ~r. Chairman. Dr. So+emery, I have been impressed with $o~ testimony. You have ~-,=~e,:~, ~e~:, ai.h, but T ~till must s~y that, ~ou Mve made some very .~{r,:mg ~$ateraeats that ar~ in coatra~cti~n to *he m~joei~y of th~ peol.d, who h~tve testified here before this committee, Do you have any recommendations gor flds committee w]tlt respect ~o lh.* pr.bh,m la;:ing u~ so far as the course o~ our legislative ap- proadt is eoneerned ~ Dr. So~,n~as. I would answer you as a physician. I believe that the pr.,-.nt Ja}mlin~ on the cigaret{e package to the effec~ ~hat d~rette ~;m-king nmv be hazardou£-~to your hea]ff~ as {he sltua~]on now s~ands~ i~-~ ,uBi,,~:mf. 'It, is aboub as muc~ as I feel we know ia the field o~ smok- in~-~ and h.alth. I don't bdiev~ t,1~t }m-lixfiduals or the Governmen~ should go beyond wha~ is pruved in ~ampaigns o~ any ~nd ~ the health I ,om~what, re£~et~ as a citizen~ that that labefing became a 1~ be,:~n>~e it ~:~,emed {~ me somewhat d~scriminatory. I~ ro~, nw own experlene~ in reading, I would have thought p}:ivat~. ,tir~d~me:~ would ne~d {o b~ calle8 po~dbly hazardous to yot~ h),~dfiu I.r~ a,i of ~oung busine~smea and their ~amilles ~os~ every xu ~,I~ Id11¢d in sm~dl plane crashes. ~Iotorcycles-- M~'. ~w~aa~. Do~or, with all due r~sp~, T wa~ to challenge ~qhth.lm,nt. O¢ cotm'e they can be dangerous. But ~hat is no~ to the ~oint of m~r ]warhtg¢~ veally~ in my opinion. Dr. So~r:l~s, Pardon mo~ sir. Mr..~m~. Your test, imony ig that you think the presenb labdlng h' :qlllici~n/. ~his ie in strong ~pposition to the very heavy preponder- an,'o ,:,f cvi,k nc,:~ su]onitted to tfii~ committee. ~om~,finw~ T wonder if we on the committee are confused. Whom do we bclh:~ro? ~qdeh way do we ~o? I wonder if we should not have an bwc:wigatiou of th~ iAv~tiffat~m to try to ~d some fads o~ our OW]I, 3lpanwhile, we are fiwed with the proposition that we ~re either goiult to renew the law that we ]mve on tlm boo~s now~ and take no ac~ion~ let tlao FCC probably ban all adve~isement.~ or we ar~ going illereat~ ~,]m warning. . , ..... It ,-:,eros to mt~ that we huv~ mmh • heaxT amoun~ o~ evmence tlm ~~rmng should be recreated that ~hat x~ the proper npproa~ 1097 t~ little s~n" rised that you, r~presenting tim Tobacco .Coundl~ ~v~ut~mt recommend a stronger statement i~, ~ ~act, it can be shown that tl~t is u truthful statement. ]'ou question the ~atemen~, that i* we ~rengthen it, it would not be a t~mthgul statement. . " ~ ~as. Sir I am ~a individual. Imn not reMly ~ spoke~m~m ti~ato~ h~ medical scienc~ . .. ~ - -I do not believe it would be justifiable to go xurtaer, l, my.et~ could not~ ~th intellectual honesW~ make a statement that cigarette smoking is dangerous to xour he~kh~ ~nd that ie m~y cause cttncer and other ~seases. '" I thi~ ~at is mis~eading~ sir, and I do no~ believe it has been demon~rated. Mr. Pxcx~. Thank you~ Mr. Chairman. The C~A~)x~. ~[r. Sat~rfield ? , .. '. ~L~. Thank you, Mr. Chairman. , , ~I~.~.,~)_,: ..... a~e 4 of your statement you ~a~e ~oemr, ~ . • , _Y2 ~,~a oogce~in~ ~60,000 people nawng to figures ~aut. n~ve o~n ~ ............ ~ - - of hmg cancer and other diseases. .~re you f~lim" with the 809,0~0 excess de~ths figure theft the Sm'geon G~eml has u~d o~ oce~sK,a'~ .. ~.~ms Yes sir;I~veheard~hat. • p[ ~o~ "~2_ ~ ]~ ~,ou ~ow. or can ,on tall us, htwe you ~ny ~lr. ~A'UI~. ~ d Z~ 2 ' ,,, "~ ed at that ~m~re how the~ arrl " ~ " .~ _~ "~ ..... a.a~ ~ com~tm~ee I bolicve ie. i~aer~,*~ o'~'~inaliy *rote death ee}~e~t, es. . .... 7"s ~nd o£qn~o~a~tion d~s~'t lend ~tself to ye~?~r~o m under~,~nSng~ sm . . ' ' ~.. Sx~. I ~k the question because I am qu~t~ m~ " g e~ ~ uns~xer Over 2 weeks ago I asked the Surgeon in tDun to g • ," • " .n~t comeinyet. , th'~ m~ormahon to u~ It h~ . m~to su N ..... • • ,s not ~ene P~.. " • ., ~t~cm~ ~t orhe doe.' I ~,n~ he ~s_e,ther h~ng ~r~l~ ~e, egn~. ..... ~ ,r~ hearhw want it sub, coted to the se~tmy o~ tim w~tn~ ............. we~k. ~ks ~, y~2~ist', Doctor, you hlwe occasion eo examine hm~ ~x~top.~, 3 ... . .,~,a .,..a _,,, .... s-ec~aens almo~,t every ~r. ~o~l~lzns. k e.% sir; surgte,~. ,,attt ~-,~t,oa ~e Mr. S.~a~L~. C~ ~,ou tell the difference ~tweea the lung of smoker u~d a nonsmoker ;, Dr. So~,~s. ~o~ sir. Neither ~-ossly or mlero~coplc~y~ or any other way tint I know can I tell the ~r. S.~r~=zv. Do you know o~ n~y new f~etu~l evidence ~aat ha~; been devdoped sinee 1964 relating to the l~rd of smddng and health ? Dr. 8o~x~. I do not know of any truly new or cenvindng evidence beyon~ what w~s ~vailubl~ 5 years ago. ] K~ve read articles ~hich stat~ that there is nothing n~w einogen~s o~ tobacco, and tint very f~w people haw applied them- selv~ r~ently in the field, of the stntistic~l pr~f or dispr~.
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1098 So I think the information is about the ~ame oz where we stoo~l " ~[r. S.~nr~m~, Thank you, Doctor. ~ lm Cn.~zr~r.~ ~. Mr. Ec~ardt ~ 5It. Ec][~]:t~. Thank you, ~. ChaPman. Doctor~ I ~m~ic~ on pag,~ 4 o~ your ~tement you st~e t~u~ ~ number of studic:] showed no r~latioa of ~oking to heaz~ di~e, and Can ~ou give me ~n~, of flms¢ studie~ ~ r~r. So~m~. Yes~*~ir. ~ide ~'ro~ the general.understanding ,tidn't~ ,nd" be'could find no differenc~ attributable fo smoking and b~.liovcd t.hal~ constit~ional ~actors were more ~por~ant. Mr, Ec~,umr. ~ ith respect to coronary hear~ Dr. S,,~m.:r:s. ]~, sir. A E.tudy by Jolm~on~ ctal, American Journal of Publio ~eal~h, 19~is, ~o~md in ~rvivors of tim Hiroslfima atom bomb explosion that tlm prol:,orti,:m, of men who smoked was smaller h~ people with core- retry It,art di~.t~:e than ~lt~ nonsmokem. Ther~ w,~ more non~moker~ in Hiroshlma that had coronary hear~ Mr. ~.~m~. The~o were ~e~ons subjected to ~he bomb explosion Dr. ~o~m~. Yes, sir. They ar~ being" studied ia u variety of , A~t,~trtiele by Bruhn~ et al. Social 8eieace and ~'[edic~e~ ~968. .ludicd, the pOl~uhttioa o£ N'azarcth~ Pa. In the men ho could determ~e no ~,,ffcct of zm.kin~ on tim presenco o~ coronary disease. "ihen thert~ is a~"article by Brown, eta]. Journal American ttl ric:~ Soci~ty, 1~tt]7~ volume 1~. Th%- studied ~dividuuls nt th~ Ve~ ~,r,n:? A dn~ini~:tration Hospital in P~rtland~ Oreg. and they ~eluded b,:,th samktrz and nonzmokers. These people were chosen bec~us~ they had al,:~m,"c ofc~ronary disease. There werc.~uite a number of smoke~, with m~y years o~ smoking, mtd tltev ~;ho~ ed no evidenc~ of coronary disease. These are some of ~tmlk., "hi whi,:h there has been no correlation. Me. E~ u~r. :~tt flmre are ~ number o~ stu~ that do show curre]atita~ ~ is that not eo~,ect ~ D~. So~t~n.~. Yes, sir. Mr. ECKHa~tur. Do you have, ~hem eonvenien~ Dr. So,~trms. Ye~. ~'h¢ important ones are Hammond~ two s~udies~ f.r tlt~ ~kmeric,n Cancer Society; Doll and Hill, and their publica- Mr. Ec~u.ua~T. That was tim British ~IedicM Jou~al? Tlmu there is ~ Canadizm study on pensio~ reclpien~. Tha~ is Bess m; th~_~ ~,nior au0mr. That ~ in the Canadian ~1edical Association ,l.m~al in 1967~ volume 96. Thmt their,:, i~: a ~udy by AubD.~ and others~ in the Canadian Journal of Public Itealth~ Th~,n there ttr~ ~tudies of college students which h~ve been referred tu prcviou:dv in the hearings~ X'liorno et al, ~. J. ~pide~ol, 1968~ vohuno 87. ' 1099 Mr. :Ecrrr~nur. Then there is a study by ~Tenkins~ et ~1,, that was in- troduced here. .~, _.~ ,a.~, ~..~A-nta]l,, rather imnres~e~ m~ ~n that that ~tudy hrok~ ~o~ ~'~r~ous ~aetors that Sou referre~ to as being eontmbutory ~actor~ to heart disease. It used cholost~ol, beau Mph% cystolie BP, diastol~ B~ phy:dcal aeti~ty~ amount of exereise~ income level, all of tlm abo~ o ~ri~,lycerid~'~, and then ma¢l¢ a separate study ~ith x~sl)ec~ to som~ beSttvioral parterre ..... ~. ~u all of thes~ cases~ tho study came to ~,tm remark~bly.~Jn~llar cop- clusion~ particularly in the age groups of ,~9 and 49, that lwavy smok- ers had about three times the incidence oI coronary heart disea~;~ nonsmokers. Do you kno~ of any s~dies that shailar]y used clinical obzorva- tio~x~I gather this w~s ~om 1,000 personff you kmow o~ any study., that similarly, attempted to bre~ ~to~vn or to correct for ~ various contributory ~actors~ and e~tablished tht~ statistics on thebasis of that correction ~ Dr. So)~)~zns. I know of some in progrezs. I doWt lmow if yo~ ~t~:~ the B~it~ s~udy whist has been going on for years. O~te of th,~r reports is True~t~t a]., 5ourna] o~ Ci~ronie Disease. 19~7~ volume 20. They ~ound seven risk faetor~ for example. " , ~r.'Ec~o~. From ~]l o~ ~ our c~nsiderations o~ t,h~ se studie~-q do you no~ believe that there is at'least. ~ stati~ieal rolationship betw~'ort heavv smoking an~ coronary he~r~ di~e~se ? D~: So~z~mRs. ~c~, I believe there i~ ~ statistical rclat.ion~]til~ i~ several popul~tions. There are other populations ia which there . ' s to be a stati~ical relationship, some of which I cited. llo~e~ expl~,~tiou ~o,fle(be that, ~0. 1, cigar~t[e~ arc, tho cau~'~al ~actor ia the relationship. ~o ~ both the heart disease and tl~e smoking reflect .a third factor, ~,d. X~. 8, that the stat[s~c~ correlatio~ is act,ua~ ~ ,eh~:mee O~ thos~ ~ree~ ~rom rn~ own work I bcli~v~ tha~ fl~e, s~eon~ is l~ is ~h~ smokSng and coronaD~ dlscas~ are two r~fleet]o~ of ~ • . ~ _~_.~:~,v~.~.~ hn,rsonba~beeade~cribedin~'ariou~w~Y~' Type .& is one descrxpbon. A t~erson who nv ..................... . . H~etr mcl]naHons, both tho~e who seem su. cep " 1)~eat~o~. : .... :~ .........~i~1. s-emed to have hurl an eqtlal increa~:~ ~110 (tiff ~0~ seem ~u o~ ...... c~j, ...... , ,, . . _ wit.h respeeb to ~he ~neldenc~ of he~* d~se~se ~f they were smot{cr:;. I thi~ in both cases smoking beavilv resulted in about t.hre~ the incidence of heart dL~ease ~ both ~r~ups. _ _ Dr Soat~r~as. You see, wha~ is bothemome to me ~bout the tistica] relationships is that, in ~ sense, i( th~v coavewt~ they inft, r a causativ~ relatibns~p. But. statisti~ ca~ ~ver de~onstrah, causative relationship. , I woEc on kidney disease and we have ~ statist,teal ~,~,d~. M~" tistica] consultant sends me thi~ puper {rom Seienti~o Re~ ¢t;clh :xry ~, 1969, by Prof. William Feller, Higg~s ~rofes~:or o~ Mathc-
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1100 matle:~ at Princeton, ir~ which he agrees life scientists are over~wed I:,,; ;,ta, ti~;tics, "2 ~t ar w~ h~v~ all been influenced by statistical relationships where if we had ob:~ervational data we would discard them as not really ,:,_,f.~,nt. I fe:~r that. Mr. Eci~i~,u~tw. Let me ~sk you tMs question: Do you thNk it wotfld ]a~ ~ta ttccurMo ~;tatement to say ~hat N men under 50, heax~ cigarette :~m,da~r~ trove g higher incidence o~ heart ~sease than ndhsmbkers~ Dr, ~,::~t~. I would have to ask which men, because in a group ,d farrm m reposed by ~£orris (Caned. Med. Assoc. &~ 1967~ volume ,(b) It, appe:mt.d thai, 4he~r farming protected flmm from any effects that might ]t~a,,3 been due to eigaret.t~. In th,, Am,*rican Indian population it was not proved. So I would lmve to ~amw which ~population. . Mr. l,.c~n.~m~w. ~ nfight ~ay Japanese-Americans would be less hl,dy l~:',:au,.-:,~ of the .~tudy of Hir~Qtmaa. Dr. S~,~,~:~s. No~ sir. Tha.g doesn't apply ~ Japanese in Hawaii and ~m the. m~dnland af flat United States. Tim Jupaue~.:~ coronary disease study by Kimura (Acta Meal Stand. lttl~7~ Suppl. ,1t10) rumply showed that smokers had lower blood Mr. Ec~Ha~mT. But bpe,..m,_.e~ we find spec~c areas where a con- tr~3" rea~ult i~ discovered, does this mean that we cannot, make a state- m~,nt, Mth l'~,spe.et to the general male population m~der ~0 if our a:;:;ueiation ~:;tatlstically is a~ sharp as it appears to be in the Jenkins Rep.rt ~ 1 r. S,.,~m:~-~s. N% mr; I would not want to make one ~cause I fear it xwmld ~h,e an impr~sioa of ~rtainty where statistlas can never ?fiVt~ flm~. mTre~sion. I ,,rim~-ly mean this, sir. 'Ph,~ Cmxm~t.x~. Mr. Prey~y. Mr. Pim~'~.:n. 'rhanl~ you, Mr. Chairrnau. .IlL N~mlnel:<~ you have challen£'ed several stateraents made by other WltlW~;:-v:s ]mrp in a direct way. One of my colleaffues just me~tioned that the henry prep~mderan& of the evidence w~ had' heard showed ~hat ~-;m,,ldn~ ,:auses disease. ;k few day:-~ afro, mmther colleague commuted that almost e~'erv w~ln~,,.:~, witfi thr; exe,~ption of 1)orhaps one ~atholo~ist. testified that a phy~cmn could examine a hm~ and tell whefl~er the person was a ,-:molier or not. It ~eelns to m~ that idea h~ been lotally destroyed here. lm~ ~hat many of th,~ things ~hictt the gen~ra] punic feels are tn~e and which I fl~in); mpmh~rs of thi~ committee thoughg were true~ mav nob~ Wlml. ~v~ ar~ involved in is weighing the evidence, to ascribe a value t~ it, Your qualifications seem to b~ absolut~y impeccable. So soma of [.b~.~ t~. ttt T~ on which you challenge other witnesses are impor~n~. Fir:~t~ on the black ]un~ controversy, you ~ate flatly that you cammt ~,ll from a hla~ whetlm~n persou i:¢:( ~m~er or no~smoke~, an[~ you ,h:,dle~r,~ ~)'. Willbtt, s of the ~(rican Cancer S~ciet$ on'that.'He w~ nt :::~-~ fa~ a~: (o :~V you could deterge a person~s social life ~om ~xammm~r ~ lung. You,say you can't tell whether it is • man or a woman~ which is ~ dre~back in determNing their social life. 1101 You say flatly that you can't distinguish between the lung of smoker and a nonsmoker ? Dr. Seizure,s. That is correct. 1 cannot tell the differenc¢~. ~fr, ~R. IS th~t the general feeling o~ mo~ pathologi~ts~ Dr. ~o~z~s. Sir~ it is my ~lief that ths knowledga o£ wh~g the black pigment rep~sents, namely, car~t ptt~icles or coal dust, known to every, welI trained s~cond-year medical student, and that it is no~ possible~o equate blackening of the lung to exposure to tobacco products. I~. is siml~ly from the ~xposure to urban air in generM or, in thu of coal mh~ers~ in their- work they inhale the coal dus~ panicle. 5It. P~a. So that you flatly cha~enge Dr. Williams of the Ameri- can Cancer Society on tha~ statement? Dr. So~s. That~ in my opinion~ ~ misinformation~ sir--from lookin~ at a slid~ o~ lung c~ncer~ thag a pbysici~m~ he didn't say pathologtst~ can te~ somethm~ accurately abou~ the social li~e of the patient. One emmet tell anything beyond the fact that it is ~ cancer~ and believe you ca~t tell it is a human being. That is ~tboug as far as coNd go. 5[r."P~'~. You m~tioncd that fl~e Surgeon General te~t.ifie4 her~ tha$ he ~ave as an example of the inability to duplicate hum~m die:c~: h~ exper"imental aniraals the case of leprosy~ wMch ha said could not be in~roduced in ex~)er~ental animals. You say that it has been produced '~ Dr. So)~x~r~. Yes~ sir. Dr. Binford~ ~ho actually works for the Government, demonsgra~d it some 5 se~ra ago an~ he rcceiv¢~4 prize from the American Society of Chnical Pathologist~ for thi~:. I am surprised tha~ the Surggon General had not known of this. 5It. Prmwm. Generally spea~g~ is it true that you can duphcate most hnman diseases in cxperilneutal animMs or not ~ Dr. So~n~s~s. Well~ sir~ it varics. Ce~ain bacterial and viral di~cast,~: can be duplicated. Certaht dege~mratlw~ diseas~ can b~ duplicated. Other degenerative diseases are mor(~ diffienlt to duplicat% fol' axumple~ arteriosclerosis is mo::e diffienlt lo produce. There are some diseases which are~ I think~ not fouud in animals but only in hmnan beings. ~Ir. P~vEn. ~rbat I was getting at was how important is it as a scientist tha~ we had b~en unable t~) duplicate hmg cancer,'for example, in anilnals~ Dr. S~;~:us. To me it is ver~, important that we keep trying. Next, month there are three new smgNng machines going t~ bd examim, d and compared. We mus~ t~" to do our utmost t~ get un experimental model that corresponds to ~he common type of hmnan hmg cane~r. There are severM re~ous for that. elm is that we will'have a~'antage then toward bioassay. Until you have an adequate experi- mental model it is awfully hard to tal~e ~nt various components of mixture and demonstrate a change in the effect. Also, it is hard to a~lyze~the chemist~ that goes on in th~ where there is some damage, l'hose are two reasons. ~here are a ber of other reasons. If we had a hmg cancer model comparable to the human in animal~,, we could alter their hormone balance. We could alter their nutrition.
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1102 Wtt coal,:[ ]calm about the fienetic component. There are many firings fhar, wouhl hvlp U~. Mr. t'~l,;~u. Jus~ o~e final ~uc~tion, Doctor, on some of ~he are~ wl)~'p~.you a~2" c~tall~nging our previous witnesses. u.9'.urn,u~ H~qh,.of th~ FC~ testified concerning the proposed bad oa c~t~ar,,~t~_~ adrertMng by the FCC that, i~ was justified bemuse ci~a- r, ttn :-;mol~l~g wtu-; a ~llIl]~u~~ health hazard ~ r:~oqnont~ "Bill, thi~ i~ only likely to occur hm~ because smoking . .. . ~ ~ ]~ ell, tl~e~e haw be~ stud~ m which smokin~ ci.'ars '.~ ~-~l:"':; ~;we~sno~yj~ ~t~tieal associations with various dis~e~ ~ ~, u~,~r,-~t,,od Dr.. Ko~6~ tos~i,n~ny co,re,fly, that qo.u, thai:, ~lwr~_~ ia notlfing mystical about the cigarett% but ia his rq:dnhm it, is ju~-~ ~other health problem. Mr, lhtl~m Thank you~ Doctor. The, CIIAII[~LIN, ~fr, Brotzman~ Mr, B~oTz,~t,~m Z have no questions. Th~ (hxAmz~. Mr, Watson? Mr. WnTao~. Think you, Mr. Chairman. ~',.~?~nmqrz~ Z arq zor~ ~ was not here to hear yo~ test~onv~ ~,~ ~ a,l,ha~fly read fi~rough yoqr prepared statement. 1~ [,:~, t~ ~tlIer:% am i~ a state of confusion with all of the co~ieting dot ,rely eon~p~,h,n~ but mttsa:mdlng medieval It, ju:-~t deft,::; my undersL:mding as ~ ]ayraaa as to how w~ could l~wn t~omvono a~ ~r. Williams com~ in ~d say even the eneral ~'t.' , ..... ,.. , .. ~ . _ , .g prac- .~..~,,~;~. ,t~ ],_;~,~ ~*at ~s tho.~s~Doa I got ~rom ~o~d toil lh,rn 3,t~t at., qn eminen~ pat]lo]ogi~t,~ and you say there is absolutely way of doi~ that. Dr. So~rzm~~. I canno~ do so, sir. I~ is doab~f~ ~ m~ how one .mid arrive, at that, conchmion. An experimen~ could be se~ up ~o tes~ ulFtl.,r ..n~ 9athologie,~ in t,ho eountr could do elfis T].tt k~ the only way Z ~ow of gett~n~ ~cientific ,,.~. ~ ~ .--,~ ~,, _ ~ ~ pz oo~ of whether _A w#n,::~s yc~t,e~y (Dr. Zeldman) ~a~d ho flmught tbae 998 out l#n0 pathologist., couM not tell, and the two who could had ~ome h~inn fvuida3ce or :qom,:thing else in their favor. nt ~;,~tn~ ~ fl~?~o early lun~ cancer changes reported by one worker, p[q,,.,t ot 12 other patho]oglst~ who were lmowledgeable in the field 4elM not contlrm hi.q ,.~,~t F~,~ ~a e~oe~imo~ apa.i~ eame ou~_le to 1 against the u.,~{~tj~ u, p~cJ~ up earJy cnang(~s tha~ are supposed to be smoke-re]areal tllt~ Mr. W,vrs,:,,~. Tb:~ Js a diz~ressing ~act, that we have the 'oplt~.wbo arn primarily being fed the o~her sido o~ bhe pic~uro. You ~,:,w thai. Taut vh3wpoin~ probably wouldn'~ get beyond the walls o$ th~ ,aring room, or not very f~r beyond that. 1103 You conclude ,that the blackening of lungs, or bla.~k lunge, as they call it, is the result of the inhalation of carbon particles, and you say ~a~ sntok~ tobacco does not introduce such eat'boa panicles. I believe i$ w~ ~e doc~or who gave us tim visual demonstration here, who h~ppened to practice in a co,el region of lllinois~ so perlmp~ tha~ might ]rove someflu%g to do wifl~ it. I behove there is on¢ thug that all doctors and everybody else ]s agreed on me~cally, flm~ you have. never produced lung cancer thrc~gh the.hflxulation of smoke in t~ lungs. ~ e all a~ree, the Suz'~eon General and everybody else. Dr. So~: Yes. Mr. WA~so~. Of course, the 9ubllc has u differ~t idea because o~ all of the reports that have gone ou& But you have never produced it. Dr. So~n~s. ~at is correct. ~'. WA~SOS. You trays spent how many millions vf dollars~ do you e~e, ~ ,~ry~g ~ produc~ lung c~ncer t~ongh ~e ~al,~ion of smoke ~ Dr. So~s. I personally could not answer tha~ qu~tion. ~ would guess it is ~omewhere ~ exce~ of $8 million or $10 afillion. ~. WAwso~. ~ea the ~erican Tobacco Council gave ehiz ~llion ~ the ~ ~or research in this particular field, were them any ~ings ~ttad~ed ~ i~, so far as you ~ow ? Dr. Sor~s. Not ~ my ~owledge. They were free to us~ the money as ~hey saw fie. . . Mr. WA~SOX. &s I stated ) es~rd~y~ ~ obse~ e4 that apparently ~ome had concluded on ~ very shay stutistlcal b~sis chad, we Imvo fo~d th~ panacea~ we have ~ou~d the c~e-ul] now. W~ have ~is dragon and we are gong ¢o stop it. Ther~ is gong to be a decrease in the research ~a this field. I ~ow one of the ]aborato~ scientism yesterday was ~pprehcnslw abou~ that. I ~ow the .Muericun Tobacco ~stitu~ has committed 610 ~l, ion to ~e ~A. They h~ve pledged ~other $8 million. Do y ?u happ?a to know 5ow much ~e Cancer Society is ~pcnding ~ ~is field, in this petticoat field of re, arch ~ Dr. So)~s. No~ sir~ I do not ]mow. Mr. WAtson. I think it might be ~tere~ing to find out, Cc~alnly, ~ ~ not fu~ting them. I h~ve served as • counky chairm~ ~or Cancer Society and I am vita~y concerned in thi~. But I am a.~rui4 now that ~erhups they are back~g up and trying to look for ~ answer. You po~ out again~ as I be]love Dr. ~i~don o~ the Universi~ of Texas ~£edical S~ool did, that there has been quite ~t discrepancy the medicM profession so ~ar as the diagno~s of the c~uses of de~th and such as that. You confirm flint statement. Dr. So~x)x~. Yes~ sir. Mr. WAtson. Do you re~]l that h~ pointed out ye~erday tha~ 1955, I believe in the State of New ~ork, they ~oun4 out~ when per- forming autopsies,.flmt the causes o~ de~th listed on the death certifi- ca~s ~ver~ wrong m more th~ S0 percent o~ the cases so f~r ~a~osis o~ pneumoni~ ~ Dr. So~ns. Yes, sir. )~r. WA~o~. It has been indicabzd earner here tha~ in the ~ta~o the art of ths medical profemion pcrh~ps~ now that we have a greater
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1104 incidcnc~ of hulgcancer it is because perhaps you have been diagnosing it a~d Ill, tin-~ it ~ ~omething else i~ e~u'lier years but ~11 ot a sudden ~ve Mv~ dce~ded now to accurately dmgnosm ~t as lung cancer. ~hank you very much. ~l Im C~.~n-~.~. Dr. Ca~er. Mr. C.tl~t. 5[r. Chairmtm~ ~',omcon¢ has mid someflfi~g~ I ~lieve~ ,tl,,ut tlm wltn~:~;~es who have testified tlm~ the cause of lung c~cer lm:~ n,~f b~'~,n proven,, a~tt the validity of the~¢ people. I w,,uM lik~ to re,view jus~ a tow of the~e,me~ who have t~ed t~mt their qualificatior~. For instance~ we ha~ e had this morning the ,t,~t~,nwnt ~d Dr Thom'~s H Brem, professor and chairman of the dq,trl,ment, ~-d medicine~ I:nlvers~tv o~South¢~ Cahform~ School of M,',li,'bw mid Director of Internal'$Iedicine Los Angeles Coa~tty-USC And Dr. Sommcm, who has so mt~ny~ ~any tead~iug conuy¢fio~s: dir,,,:lor of laboratories, ~nox Hill ~osp~ta], Columbm Un~ers~y~ clinical pr¢~fct~-,or of patholo~T~ University o~ Southc~ Cah~orma; Corncll Univcr~3ity Medical ~:hool: Tufts Medical Center~ ann ~ on. T]pyn wt~t-~ to'Dr. Dwayne Car~, professor thoracic starry, Uni- w~rt-:ity o~ ~'Cnnc~zte. Dr. Langaton, professor, of surg?~, ~f Ilbnoi~-~; pn~ident of ~he kmerlcaa Thoracm Association. Dr. ~g- don~ of tim Univer:~ity of Tex;~s~ who appeared here yesterday; ~r. Ro,'~,nnmn- a~;ietant cldef~ department, of medicine and associate t~i- r~c't'~r o~ t~~o~H't'~rob~ In~titt~te for Cardiovascular Diseases. Th~'-~ ar,~ a few, not all. But many, many eminent men throughout llm United St~,t,tes have ,testified contrary ~ wha~ has bee~t stated. Th~mk vou~ Mr. Chairman. TI.~ C~.m~t,tm ~kr¢ there any fu~her que~tions~ If m~t,, Do~,tor~ we want to'thank you ~or coming to give us the b~,nellt of ~,o.r vmw~. Dr. S.~m~m~. Tlrr~ you, sir. Th~t.C~,mt~rA~. At this time~ if I tlm~, r,:cord,, the e,~tement of Dr. Clareffhe Cook Little, and a ~e- m~ nt b~ Dr, Robert C. tIockett~ i~edia~ly following ~e ~es~ony Withou~ objection, tim statements pl.a,:,',l into tho (Tim ~atemen~ of Dr. Eigle ~ollows :) ~ TOBACCO I ah~ Clar~m-~ Cook Little of Ell~worth, DIaine. F,,r its flft~n years of existence I have ,~cen Scieut~c Dirtier of The Council f.r T,ba,.crt R~*~car~.h~U.S.A., and for twenty-seven years Dirtier and thirteen ycart~ DIr~'tor Emeritus of the $ackson Laboratory fvr ~esearch In ~ne~cs and Canc~,r. F~r ~ixtecn years (192~194~) I was ~Iana~ng D~or of the Am,,rl,~an t:~clety for the Control o~ Cancer. now the American Cancer Society. Itt lO:¢l I wa~ I're~ld.nt of th~ American As.~oclatton for Cancer Re,earth and was t. elccted f~r a :~econd time In ~. My active interest in ~neer research at~ u bh-,b~:~l:~t cover~ a s~an of aixty-~o years from 19~ to the present.* Thx-.ugh~tBt that D:,rIo*l I haw always been keenly aware of the complexity ~tf t,a~r ca~¢:Itlort :l~d have always advocated open-mind.hess, ~afien~ and *D~tallc~ ~:.rrlculum ~itae, tnvlu~ng ex~efleaee In university ~dmin~s~flon. ~ appended. 1105 humility in attempting to solve the problem of cancer ('allstltioa by re,~t, areh to fill the ~.xlsllng gal~S i~ oor lcuowledge. I still s~'ar~gly advocate, th~:~-~ pri~wipb,~,, Four years ago I had the privilege of giving to the members of Cor~ro~:t~ ~tatemeu~ of my interpretation of cancer as a disease. At tha~ time I pol]ttt,d out the extreme delicacy of i~ origin in an area of activity either wi~in a cule or between mol~ules. ~m danger t~f allowing the groz:~ and cruel manifestations of the diie~ in its adv~mce~ stt~ges to obscure Its extremely deIlgate and ~aute origin wa~ also e~,~phasized. ~iz situation rcmaim~ changed. In fact, research in the last four years ht~s definitely Indicated that the origin of cancer is a proce~ of ex~emely minute cellular biology and chemistry. Such an origin ia bound to be complictttcd ~or ,tim organization and rcla~0nship o£ cellular mol~ules can b~ modified by many agents to produce a single r~sult ~ueh as the o~igia of eanc:~r. ~m¢ of tho;~e agents alrcad~ nizea are genetic changes, gamma irradiation and certain I emphasize this si~atiou again because it ia an unassailable argument favor of ~ e~mfim~ed research which i~ e~aential to our ~dert, tandlng of the origin of cancer. Th8 Council's philo~o~hy in ,~tudying the possible effects of smoking an human health has b~n that ~e ques~on ~naot be ad~luatcly deflnt~ nor itt~ an~wer bdvea except by h~tensive study of the diseases themselves whleh have st~s~cally ~pHca~ed. Although emphasis ~ its progr~ of support of inde- pendent resem'ch has naturally evolved in the dlrec~on of certain fields research ~ which ~e greater amoun~ ~f promise for the ~u~re appcart~ e~st, the basic fact still holds--that it is cssen~al :to ca~y on fundamental res~rch in order to understand the complex mechani~g by which each of the ~ree groups of chronic disease (canc~:~r, cardiovascular dlsea~ an~ chronic respiratory disease) arc inifiat~ and encouraged. From the consideration both the notre of cancer m~d of ~e aitna.tioa a~ a whole, the om~ au~wer to tim questions w~ch face us all is much more research to give u~ much more needed knowledge. How ,true this Is is shown by ~he expenditures by bo~h govern~lental and private ageades ~unning into hundx~d~ of miHlons of dollart~ per year which are being matle to try to determ~e the various Cause3 of cancer, chroalc heart dlsea.se and chronic respiratory disease and, ~ possible, to delay or ¢ircumvvt~t their aPl~earance. These expcnaitures are increasing rather than and fl~is h~dtcates clearly that tha problems pre~entcd by ~ese dlsea~c~ arc unsolved and that their cauls are still an open que~tiom In the meantime a widespread, wgll-or~anized and aggre~:sive campaign c]ff~ette smokh~ff is being wag~l by both gove~mental nnd privah, agcm-ie~ ba~d ¢m the theory that tobacco smoke is either the major cat]~ or a~ htlportnnt vandal factor tn th~ three groups of dE~scs. The resl~onsibility ~or ~h~llng out a single agent as a causative factor i~ a grave one. Oversimplification, overstatement, oven.onfidence ht a~l prematurt, jadgmcnt,t of scientific reaear~h programs ¢aa delay or obstruct pro~ss tmvard the covexy and revelation o~ the whole truth which still el.dey~ The gaps in our Imowledge are still so ~cat t~at ~ose who do~atlcally at~scrt othc~3vis~whether they state that there Is or Is not ~mch a caugal relatlonsht~ are premature ia jud~eat. It anything, the pure biolo~cal evidence is away from, n,t toward, ~e causal hypothesis. With lids in mind, I should like to review brlefly three fields in which data arc being gathered and analyzed revealing gap~ in o~]r knowledge omcertdm~ pos~lblc effects o~ smoking oa hmm~ health. These ~ree fields are (l} ~lati~tic~, f2) ~:Htficat ohserratiot~% and (~) laboratory exuerlments. It t~ ~enerally agreed that while ~tatlsfieal association bm~d on t:tudy of ~iuffle [~Iil' 0f ~netors as, for example, smoking and lung cancer, m.y be tla~ re;mlt of a ~usfltive rdafion~hip, such s~di~s can never prov~ thi~ point The wtnt mnjorii5" of statistical studies on smoking haw b~n ~.~f this type. When statisti~l studies of many ~actors are made it I~ ~ound that there are man~ such factors that are sh-[tistiolly associated with lung (rancor, It i~; only this t)'pe of study of many facCors tha~ the proper perspective of tht, roles d~erent factors and of the~ ~eal meaning ~ the associative pro~t~t~ can be determined. __'29-236--69-DI. 3---15
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I~]~l:'~tilig ~tati~tleaL data ~hould be reexamined in view of the need of such raultlfaetorbd ar,.tly;&~, and futur~ e~r~ully eontruHed epide~ologleal stu~es :~bould be planned to tm.ludo tha~ analytical m~thod. CLI~ ICAL ~m,~,, 1-,a*h,d.g~t~ claim that Inhalation of tobacco smo~e roa~ l,e followed by ,~,rtalr~ ctutnge~ In the, tissue of th~ lung su~ace. These changes have been inte~- pret,,,l by t~om(, ~r~:.I bch~g sl~lfleant precursors to lung ~ancer. ~ere is, however, d~,iiull,, dt,~.)gre(.m,nt amon~ pathologists a~ to the significance of such e~anges. I~ t¢ l~olally eutlrel~ r~-,v.r:4ibte and thus d~ not lead to easter. Much more ~arefully t~ntrolled and extensive r~eareh ~ needed to detex~ine Iht~ to-tual t'ff~x.tt¢ of (obacco smoke and other ae~sols on lung ~ssue. The presen~ data 1, Anhaal ~xper/mentation provides the mo~t convenient and most rapid method of ~4udylng ,the effcet~ of tobacco on variou~ tissues and organ~. For years, the c**m~.,~u,,:,t and mo~t widespread ~ethod of te~;ting such eff~ts has been ~e use of tm t~rtlflcl;dly-~repared condensate of ~moke inaeeurate~, called "tar," which has bo~n palsied on ~e skin o~ mt~ and other rodent~ in variou~ concentrations. Whys this lu done the painHng 13 followed ~ some eases b~ abnormal ~owth of lh~' t~l.ln and, in ~ome of these eases, later by ~Mn ~neer. In this respect the eon- d,,ut,~te of tobacco e,moke joins more ~an ~00 other substances, many of which are l~tt.Yvtt to be cnHrely harml¢~ to man, ~ ~roduelng a more or less standardized ~,ff,~,~t .n ~nrm~,-~ vhlu. There ~ noting unusual or ~eeuliarly chazaeter~tle about i)w rv;teflnn of th~:~ animals to ~moke condensate. However, an important Iaet xvbleh haf~ born overlooked or ignored 13 that the relative eaneer-produe~g effects ,:~f col~d~.nt3ate:~ of cigarette ~moke, of ~IVe tobacco emoke and of eigar smoke do ~t~t follow the same order og aetlVl~ or co.clOt with ~e recorded degrees of t~tati~,tteal a,~:o~latton between cancer and these ~ree types of smoke e~osure in l~an. Thlr: ~v, erepancy Is b~le. It shnws that if ~e accept the statistics as a basis f.r ~t working hypotbe~ls we mu~t ~.1~'o admit that skin 9aln~ng ~lth coati.sates ,~f t,:d~at~o r.mol:o t~ not a ~l~lflca~t or valid method De tesOng ~e relative eaneer- £,~r~l~g potentI:HB o~ ~ueh smoke requirc~ b~ the working ~'~o~esLu. In o~er word~, the eml~loym,~nt o~ a different agent (condensate instead of smoke) on a dlffvr~nt larg,.t ,,rgan (~kln i~utead el lung) ann on a diffecent animal (mouse h~ :h';~d of ~an) t~ not a firm bn~Js on which to develop a broad nnd eomprehe~lve r,~;,';~rch l~rogra~ to determine the quantitative effects o£ smoke on man. Ev,,n more t~trlktng i8 tim negative evidence provided o~er years by seozes of exwrlmenl:~ in different laboratories involving ~e direct exposure of the lungs u~ cxperlm~.nb~l nnimalz to tobacco ~;moke lt~elt It ha~ ,been shown that such vxl,e:are to tob:~o smoke. It i~ reasonable therefore to expect flm~ if tobacco )a)~*)L~ t.au~c~ ~,uch cunce~, or greatly iuct'e~e~ or aeeelerate~ ~eir in.deuce, a t~l,~tdtlcaatly gn:ater number o~ such human type of lung cancer would occur for 1.wlttg exDu:mre of anlmal~ to tobacco smoke. This has not bees ~e e~e. ~h~ 1~; :~ of negative evtdcuee remains an a factor which certa~ly ra£ses the question tttg t*:t whether ihcre ts any eau~aHve action de tobacco smoke ia cancer ~ormatton. ¢-~ ETIO INFL~N C~ Itl~*l tyr, c ~*f natural cancer o~urring in laboratory animals. ~his has been ,,~qt..cla~y clvarly ~hown In mice where many inbred strains exist. ~ each ug which lhcre o~urz la generation after generation a eharaeter~fie re.arable m~d l*re,llctable Incidence of ~neer or different types, including l~g cancer. The truth of ~e principle of genetic influence has been established because h0,1J.todrt of tnlw~Mtug practical in mice ha~e demonstrated its validity. 0f course, rio ~**~eh elovt, labn~edMg occurs or will occur in man. Yet the human ~pulation is r,t~td, up of a myriad og different genetic t~s repres~ ~ereat degrees o~ fi).~cepllhlll~ or o~ re~lzt~ee to organ a~d tissue changes which 9recede and aeef,~,apany the aOI~arance of such dlsease~ us easter, chronic heart disease and ehro~le re}@iratoty disease. The study of ~uman twins has lndteat~ ~o lnfluen~ 1107 o£ genetic similarity in the incidenc~ oJ~ ehroaie hear~ dise:tse. Undoubtedly, future research will include much more study o£ human twin:~ and, a~: tb~ data ~rom such studies .acc~ulat¢. it will become ln~rcash~gly clear that lho genetic nat~e of the human indiviffual is the most Important factor In determini~t7 phy~eal and physiologleat reac~ons during his life ex~rienee. 0£ ~eat but as yet unanalyz~ significance in all three of the lmplieat,.4 dl~,ca~e grou~ in man is the difference in su:~¢eptibiIity betw~n the The determination of sex ts a generic phenomtmon defending upon the genetic composition of the male eex cell which is invMv¢~ in the £ertiltzatl.a of each hum~ ovum. In ~cldenee de lung cancer, chronic heart disease ann chronic res~lratn~. disease .an excess of males Is e~dently a universal ,biologleal 9h~llOml.non ring indo~endfinfly of o~vironmental factors laclu[~ng smoking. The que~tt0n ~ why? The answer may ~e profoundly important to our u~der~,tantllog e~ ea~atio~ D~FE~NOES BETWEEN Internatton~ da~ on c~ce~ incidence reveals ~idezvread and ~ge~nees begween nation~ in the zelatlve $~ueney o~ death I~m lung e~m~,er ~d from ~neer of other ~ttes. Such dl~erenee~ ea~ot be e~la~d by dl~erenee:~ ~ smo~ng~ablts. On the other hand, ~e ~ow .that ~pula~onz o~ dlEereng na~on~ have generic complexes and that ~ fact i~ coat,tent wi~ thB ~mtlar o~ occurrence of d~ereut rates and distributes o~ c~ce~ ~eldeneo In anlmul 9opulat~onn where diCerent genetic complexes are ~own to be the explanation, C0%~'OLUBION In the ~resent eontrovorsiaI situation as r~gards smoking and ht,~lth, and nnemo~onal campers to ~oint out the poL~ibility 0~ variou~ henl~ rl~;k:~ one ~in~ wKh which few can quarrel Repletions and prohibRions by decree or le~zlatlon to enforce or to limit of human behavior ~n relation t(, ~oking are quite another matter. They can cabby create a fal~e ~en~e of ae~evement, replace reason by emotion and age ~ear rather than knowledge a~ a ~otEve fur action. Th~,y are a da~:erou~; misleading substitute for the acquisition of scientific ~]~ by paHcnt and ~ese~ch, and they can never replace it. C~IC~,~ VITAE 0F DE. CL,~(~OB COOl: ~ITTI~ Dr. Clarence Cook L]ttl~, $eient~e Director og The C.uneil for Tobacco zeareh~U.$.A. 633 ThUd ~reaue, New Yorh, ~'ew York, ~17, an~ Dlreetu~ Emeritus, Roscoe B. Jack,on Memorla Lahoratory, Bar Harbor, ~Ia~e, wan bo~ in ~rooklze, Masza~u~et~, on October 6, 1888, A ~aduate of Harvard University, where he earned &.B.. S,~L, an~ D.~. degrees, Dr. IAttle holds honora~ degrees ~rom the Univer:~ity of Now Hamp~htr,, Mbiou College, ~e University ~ New ~Imxleo. Colby College. ~e Untversi~ Maine, the UniverslW o~ Chicago, Boron Unlven41y. Dlekin~:on ¢.llego and ~arietta College. He was Pro~ident of the University oI Main0 (1922-23) and of the UniversiW of Michigan (192~29). He 1~ former Prezldent of the Amcrle~m ~sociation ~or Cancer Re~eareh. In~ernation~ly ~ou~ in the field of cancer tnre:~tigation, Dr, Lttfle w~m Research ~eHow in GeneHe~ a~ Harvard, 191:~17 ~ a Ru:~careh A~:ochtte tn 9ara~ve Pa~ology, Hazard Medteal School, 1017-18; a Research A~;zoelat~t Horror5 ~Iedleal School, 191~21, and Asslst~t Director of ~e ~tatlon Experimen~l Evolution, Carnegie Inutitution nf Washiu~on. 1021~22. His cat.or includes :ecru'ice a~ an O~eer in the Army in ~orld ~V)~r I ; tug Dieter of the ~ericau Society for Control of Cancer, 192f~ (now American Cancer Society) ; mem~r of the EugeMe~ Go--liter, of the States since 1922; Dlr~tor og the Lm¢~eaa Bi~h Control l~a~o since Pr~id~t, 193~8; member o~ the Ex~uOve Commttt~ of ~o fir2~e Worl,1 Population Conference, Geneva, 1927; President of the Race Bett~.m~nt gress, ]9~29; Secretary General and ~alma~ or the Council of ~e SIx~ Iaternationat Congress of Genetics, Ithaca. I932; mem~r of ~ National ~drl-
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1108 ~.rY t'.tuj~.tl, ltt37-:i'~l; ttud l.'rc~ideut i t!t3i-33) of the Mount De~ert I:fland Mcdb.tll% the .Xlm,rb.~ln A~:,clatlon for the Ad~ancemen~ of ~ceince. and the l'ublit, lI~,altb &~ ~;~ri~lthut, the Polmlntion A~oeiatJou of A.mel'iell~ the American (Tlm ~hth~mt,rlt of Dr. Hoeket:~ follows:) My ~m.rm~ i;~ ~,-,bert Ca~ad Hoekef.L I am A~s¢~iate Scientific D~eetor of (?.aatdl an,l its; i,redece:~:~r, the Tobae~ Industry Re~:eareh Comalittee~ since ~,h.rtly rfftcr fiw~la/ion of the latter in 197~. l'~r rite I*;V~L fort3.fi~e yea~ I have ~I~eciallzed tn the fields of orga~e ehem- b~try trod blnch.emi~-try. ~vient.es that are greatly concerne~ with all life processes b./h n.rmnl aml ubm,rraal. I received the B;~chelor's. Master's and Doc~or of Phlhv, ;.phy D~'gr.,. tn the~e t~nbJeet~ from The Ohio State OniverM~y respectively II~ ]tl2h. ID2S and 19~9. After a year and a half as a ~mest scientist at ~he Nail.hal Int;titnb~ .f Health. D.S. Public ~ealth Se~ice. under a h~ational l{e~:carch Council Fellmv~hip. I became a member o£ file ~t~ there to ~gage in ]doclu,},deal ror;~,arch related to medical problemg. ]hq~v.,vu 1t,:¢4 and 1950. I was suceessivel~ Assistant Professor and Associate l'r¢]f,:,~,,r t~f Ch~,mi:-~try at th.~ M~]u~aehugetts I~stitute at T~hnoIogy~ conducting rt"~ '~.arch, traitdng graduate ~-:tudeaL~ f.r higher degrees and acting ~ a eon- .ulhtltt to pharmaeontical, chemical and food indu~ries. :~ui.,rvl~ing spow~orcd re,search in nutrition, food t~ology and Jn rel~te~ medical tleld~, t,uc~ a~ diab~tez and denM1 eerie. I have authored more th~n ;,Ixty ~c~;carch peppers public,heft in chemical ~ournals and ~avo also w~itten nniob,'r, of pa~cr~ for x~aedical ~ocieties and heal~ a~iatlons on problems of flmdam~,ntul rc~,'arch relat~ t,t~ healS. ill lllt]~ I hml 1he pt.ivileg,, of px'ese~ting to the Committee on Oonl~leree of the ~.:4. Scaat¢~ a r~,vlow of t~Amec~ and health research sponsored bY this Council ~,lu,'~, it~ in,:~thm, lit a coIatex~ of ~;elentiflc flndi~s ~ this flelfl from other vt,urev:g. ~hi,~ r~vlew xvns ~lhli~hed in the r~or~ {~. 807 if) where It can b~ con- mdtcd, genc~ my pr,~::ent ~:tatement propuses mainly to u~te ~a~ ~view by dorvrlblng ~;nrne ]ww ~nd~ngvt to expand certa~ sections, and partfcu]arly to lmint ant th- implb'ati,m~ ¢,f thee. findings, as I see them Der~na~, wi~ re~ct to b~},ae,:,~ u~;,, iu r~]~ don to human ~ealth. In 191]~, I dt,:'vribed iu c~.~or~lderable dentil the nature, organ~afion an~ moans .pcrmM£ of th*. Cour.d], anti thb~ description was included in ~a record. My oral ~tattq,t~llt WlLt¢ ,~ut,pl¢~lnente~d hy a complete baekgronnd d~ument outlining the CouacH'~ hh~t.ry, orguntzathm, selentlfle proeram and publications. This also alq.'ars tn tlm rev, e*rd and nccd not be repeated here. I t will su~c~ n.w to sum~ariz~ tho~:e s~atements as follows: L Tht~ r~:soarch program of the Council ~as always been conducted fhrough Cr~tr~t~ t. x~)~gntz,~d a~d ~steb~ffied inv¢~gators in medical schools, has. pltal~, mti~t,r:.itles and research institutes. 2. F~I]I rv~f~tmlblllty ~or the prepare is vesMd ~ a ~Mcntific Ad~sory ~inard eon~d~tht~ of independent scien~s~ of Mghese caliber who retain tht,lr In**tltnlnnal alIllb0lons an~ have no connection with the tobacco din,try. Tbi~; Ytoa~d eft, crates with t~mplete £reedom o£ action ~ ev~ respecL :t, In~ev, tlgator:~ who receive ~-in-aid have alwa~ ~en assured freedom in e.mduct off tee:earth an4 in the pre~ntatfon of resul~ at scientific ~m:eting~; and in seient~e publications. 1109 4. Since 1954, the Scientific Advisory ]=|oard has received mr.re than 717 applications £or re:search support. Research grants ~nd fellowv:hlp:.t lmw, totalled ~14,2t:0,00(}. Re.carch g~nt~ bare been nwm'ded to 2:11 ~;el,,ntl~t~t 213 medical schools, hospitals und laboratories flirougho~t this euuntry abrrmd. To date. grantees have Oublished nm~o than 717 1):]per~ ill ~elentiflc journals with ackuo~ ledgement of Council support. 5. Sevreal public Symlio~ia on Bvrtlnent topics have been SUplmr/ed by th., Council in whoJe ~ in part, as w*~ll aS a large number of smnlbr il~forlau] research I lanuing conferences. The stated Imrpo~e o~ ~e Council at the IhUe of f[~ fornlultitlon ~n~ "'to tthl and assist re,earth into tobacco x~e and [hmaan] health, aim Imre ntlttrlv h~t,~ the alleged rela~onship between the u~e oftobdeco' and ]tmg cancer." The ' t~e Adviso~ Board has considered from the bezimiing fh.~ this Pltgl.:~o eouhl best be achieved by concentrat~g study ~lpon the dLuea~e.u fltat htive bot,li reporh,d to be ass'~eiated statistically ~tlt tobacco u~e. It is still their policy to ~vesg~tlon of ~e factors, lnfluenee~ and agents, both internal and that may ~e involved M thu causation (that is etiology) or development ~-ff ,li~e~]ses. 0nly within su~2h a context can the p~*:~-~ihle effects of t-bltt, e[, IL-t' evt'r be evaluated realistic~flly. Moreover ~tlolu~eal ~tudics of rids kind are tho:.e mo'.~t ]ike/y to produce practicabie methods of preventing such maladie,~ or delaying flxeir The dlmasos so selected for principal s~dy include div:t,ave~ of the heart arte~'le~, etmcer, especially e~neer og the lung, chronic ret:piratory flif~it,lff~. peptic nlcer, as well a~ severed other~ of relatively le~t~,r im~01~alle~, ~t ~ t~Hl~e;q dis;~bility 0r death. S.mewhat later, tim Board undertook sponsor~bip of gati(m~ into the psyeho-pharmacologieM* effects of ~icotino Dnd um.kD~g, in thin Ihe Irerelict of smoking, the needs they :~cek to ~ati,fy by the lmwth:e. tim extent to which smoking actually meets such The constlt~tlonal di.~'casvs 'J~le l]l~tj0r dlsea~e~ that haw been mentioned ahor~ ~dl belong to the of I'¢~ts$1~ltio;tal dL~.rder~. By this: we ~leal] lhat they are brought n].mL nut hl~oetious mler.~org;mi~ms (Rke diph~erht or typhoid fevrr) or .o~ttt, p.tcnt gradttal change, break-down or dorange~uent of the ordinary I)udlly ltl0vhh~ery ~xp~n~ion ~n~ eOll~'~e~on, ~ow o~ bl~o~ ~o the v~ioU~ organ% d~Y~,~l.n ii~ evll~ ~ln4 the like. Tim Oon~tutioual d[~'ea~ occur ~1o~ O£(e~ in (drier pc,:qde, ~ w,)ubl /)t' i~: ~mually gradual ur~d is likely to produce verhdl~ dizabi]ily only h~tvr in llfe. hare [,t~n saved from early death fr,,m iufeHious ¢ll~ea~es and lntvc lived ]nova ~ldvaaced age. This relative irtcrett~e in Drev~flellee of e~rdb.~v~ctlhtl' year;,. The term "epidemic" has been apl)lled In thi~ lllere~s~ and. ~n the th(* coueeDt of an rptd~lie ilmrea-e hn~ hven q~e~tb,lled in each t,f tbt.~t, by reputable iuves~gat~re. diseases as I,he primary challenge to medic.el reeem'eh t~] oar $(ellvratiolh hlll to these problems ~rongh rezearoh. While ,~cw factors in Ihe eavh'olmmnt certify be studied~ many influences that brin% abou~ ehange~ I~l lhe l.-,dily neglected, the effects on the bra]a and ~ervous sy~era mleh as ~timulaflon, tr,-tt.lulllzatl.~q madifieatton of reflexe~, etc,
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1110 Of cm~r~c, ~dl thc~e ~onatitutio~l dit'ea,~ea f~ccurred and moat were well-known l.ng ],.far~. th,. u~c ,ff cigarctte~, becam~ prvvalenL They still occur among non- Epl,1,.ml,.duVlc~l ~tu,l~cs .[ ,x'mokb~g and comsti~utiom~l ~iscasc~ I~ ~a~ ~w~t ~uch cens~ituti.nal dls~ca~:e fl,at epidemiologlcal studies a few y,-~ar:~ ~*g,, r,~.rtcd to be more ~requent ame~lg ci%arette ~mokers thou among Ilt~ll-;¢laokt~r~, 'l'ht~ lisg o~ dt~:ea~es ~o m,soeitited extends to a score or more. 'rhc; e cpldctalollgleul 8tudi,:,~, have been and still are the subject o£ by ~4atbtieb,n>¢ with r~'nl.:,'t to their reliability on h~,flmical grounds, and ad~- tl,.atal rc:~,.~n-,.hv~, aimed at rcctifyin, ~,,me t,f flleir deficicneie~ a~d ~arifying • ,.me .f t]..' curh,lv, vontradlcti.ns ~]nd peculhu'ities have been recommended. If, l~ a i'~r.t. ,.,f hV~tor~', m~verthele~s, that Ihe~e el,idemioiogieal relmrls prmided Ille ilnl~ct~l~ l'or the abunda~tt re.'earth relalJn~ in o11;~ w.t~ or anoLher to "tobacco ;Ih~l he:dill" {ltal: ]l~l~ ~ut,.equendy I,eeu sponsored not oniy by Government Ill~lt;I£1DIOII['$ lair I~y :t aural:or nf voluntary health aszoeiallons nnd fouudagons. ln,.la,lt/~g The Cotmcil ft~r Tolsle~:9 Rezeard~ and the ~nerfean 3[edienl Assoc-ia- II,,ti'~J Edu,-ati.u and l-te.~varch Fomldathm. ~'Jli~ was a logical de~,elopment lllvo It l, vt,~g~dzed~illdeed, the majox~role of elfide~aiologieal research is to ldt}ltl ~[3' ~lr{~tr~ lit wl-dch more minute and extendt.d s~dies of other k[llds may he ~Ul,lde u,,~dary t~ta,]k,:~ :n'o necessary he,,au~e it is univer~ally recognized that a .tatl:~th.al a~r,,.clati,m can never, I, er ~e, e~,tab~sh a causal relaliom It cannot , le:,w ~ hctb,,r tl:~ : ttttlt-;tleally a~zotd~ ted factor is a major, minor or "lazt-straw" t'all:~ll fact,.,r or us cauval £netor ut all. For example, an association cannot :01.w wh~:lh~:r ci,:~rctte ~omldng huopens inertly to eteeom~any some pa~tern .r elu:~h,r t~f living hablt~; tha~ prcr~spt,.e to the dL'~ef~¢e or aggro~ate it, with- .lit lt~ ~lf bluing involved candidly. Nor can it show whether the k~d of people m,v,L lllo,ly to tlevclop the msease on account of congenital or constitutional ch;travterb',tlc,, aI~:t~ have a vpt~cial need or desire Is smoke. q'lw:;o qtlt,~tion'* have to be answered sep:tratcly for each disease time reT.:*rb:4 t. ,.,~,uz" nlur~ often J~ smokers thflll I~ non-~mokers. 3lar~y of thc~::c dl~caze~ have their ultimate origin ia the gradual ~i~ening .f the ve~,e! wall~ (artorlo:.:cleroMs) which teen.ally brings about ~ronie .r ~udd.u t~lmlrment of the blood supply to various organs. Str.kes, angina l,*','l,.a'ln trod heart attad~ (myocardial infarcthm)¢ are e.x~un~les of such ,ll:'.ma,a whl,~lx :trt- currently the .~t~atest t~anseS of n:or~lity in Ibis country. It l, untvcr, ally recognized that meny lTtetora may be .involved hi determining tit,. rat,., at which art,,rlo~clerod~ dt~vMop~ and also in influencing th~ preelpitatiou ,tf :t,'~lte dl*:vn~t, (,vont~. 0~ call readily li~t t~VeJlty such factor~ that have been ~lenxn t,, }rove ,.lth¢,r *t positive or lion, alive ~tatls?ical association with clinical ,lb,~';t,',~ ~ ,,f tl,o h.:trt nnd art~rie~. I think it is worth uhiI~ t,~ li~t them here ardor l,-~ flh:~:trate a principle : l. Heredity or genetic predisposition (family h~- fury), 2. ~hwah~l choler:torsi or choleeterol ovter< in the blood, ~. Elevated lipo- prn/ein:t bt the blond, 4. Hl~'h blood orca~urc, 5. High serum trlglyceridc~ when l'w tlw:, tt. I'l~yr;~,'*tl activity, 7. Stre:,s or poor ability to hnnd]e stre~, 8. Per- '.nmdlty f~tct,:*r~, 9. Pattern:~ of hormon~ vecrvtion or di,~position, 10. Bo~ build. ll. Obc:dty, 12, Cigarette :intuiting {hat nee cigar or pipe s~aol~g), 13. Use of c, tff,'e, Ie~l aml common drags, 14. Sex {malc~ berg more suscepHble), 15. High r.tl. ,,t' eh.b,-t,,r¢H to IdmH,holipin~ in the blued serum. 16. Foully eavlmhydrate I,tt,lah,,llsm. 17. C,~rtnht elvt.lrocardiographie imttern~. 18. Iligh uric acid in the bbmll, ltL IIIrfl~ rchttix v volume of red eorpuscle~ (hemato.rit). 20. Diet (es~cinlly ~-el'-~tut rll tern ,w a hl,~h proI~nrl io~ of ~aturated fats. It 1'~ p,,rf,.:fly clt,~r that these twenty ~actors are not aH alike in nature. Person- frilly and family t~,ndonule~ arc get,el,It end therefore reln/tv~y all.cult to change. I'hyr-~h.,al at,tlvlty t'¢ s:nmethtng mn';t of us can control Cholesterol In the blood /.~.vernod partly by heredity ~md partly by controllable factors like diet and Dr~:r~,.*; ~:*f ar*~oeh* lion in the t~tati~tte:~l rolMions betw~n those twenty factors ltlltl cardiuwt:eular dit~oa~:e~ vary widely and tn many eases are unclear. For ex- other thnn nrterh~vcler~slm vornn ~till qUitS myaterlous, seem to be Involved. but 1111 ample, though high blood cholesterol iz associated with increased danger of heart attacks, it i~ not really known whether the relation I~ castml. Hence If ch~de~torol is lowered by some ~~rtificial means, a~ by use t,f a drng, we ~tlll d~ not whe~er this will reduce the danger. Thi ~ k,ind of problem require~ stndle~t bt,yend discovery o~ an asso~ation between cholesterol and heart attaekz. When information en a grea~ number ~f such factors is collected upon a largo human population, the ~atisttelan i~ presented with a difficult h~sk of nnaly::l~. The first task is a imre~v ma~ematical o~]e. A technique called multivarbtt,-~ orally- sis mast be applied in order [o give relative weight~ to the fiaetore, ~Cl,arately ttn~l in ~'oups, as mathematical "predictors" of the re~ulL Sn,:h statistical though It cannot estab!i~h causation, can eliminate some factorz ac~ unlatpvrtant and sTmtllgBe others for further study by appropriate mcthod~, including expcrI. mental and c~nieal one~, The available :~tatistir~d methodz have be,:n ~low and laborious and ~lso ]nadeqmxte to handle so many variable~ simultaneously. The Coun¢~l lms boon assisting in the development of new computer melh,al:-; for h~tdling largo numbers of variablt.s simultaneously and rapidly l~t making these methods available to scientists gencra~y. A strong interest h~ts grown up t, eca~se ~ero are vast eolleetitms of data already existing which have re,vet been fully analyzed on account of tclmical problems. Appltca~on of the new methods was recently made, la a 9reltmtna~ way, to data from a current multlfactorial study o~ Iactors related to lon/~evity. wins found that cigarette smok~g was, raa~ematlcally speaking, a of a group of other factors which, without inclusion of smoking, were botb,r vredictom of length of Hfe. This mathematical analysi~ doe:~ not ~;how which fa~ors actually have a ~reet casual bear~g on length of life b~ they do flint others w~ch tend to "cluster" with smoking are as likely to be conically re~te~ ~ smoking per sv. The da~ use~ ~ tTds preliminary test w¢~re limited in character and extent, bat It ~ clear that method9 o£ ~t~ kind m'cd to applied to other and la~er bodies of information as a step in determinin~ which factom may ready ~ causal and the ,~xtent to which they actually contribute. In the same longe~y stud~, a sneularltV vffcet wa:~ discovered that could explain the whole statistical associatiem between cigarette satoking and length of l~e. ~here has I.,~n a change over the year~ in the dl~tHbuti,m of cigarette smoking in the general population, so that such smo~ng i~ heavier among of presently younger generations thnn among the older one~. Hence If ten thousand men were collected ~ a random sample of the current United male ~ulation and were lined up and executed uqth machine gum~, it would be found, statistically, that the heavier smokers had, by-and-large died at earlier ages than the Hght or non-smokers. Clearly their smoking could not, have been the cause of death, Afhcroscleros~ The ~duaHy thickening of the blood vessel walls has been mentbmed m~ an u~ded~ng factor ~ many di~ordexn of the he~r~ and arteries. A long-teria Count1 study of arteries, examined and measured after death, rep.rted mtn'e thi~ing {arteriosclerosis) ia the vezsds from persons who had a history cigarette zmo~g. ~IeanwhHe, two otb.cr similar studio8 involvln~ on.ly aeeldlqlt victims, showe~ the abs~ec of an~ relation betwee~ arterlo~eleroM~ and ing. ~lace there was little or no i~orma~on In an~ of the;~e studie~ on other factors that might h~ve been Involved, such as l:~ersmmllty, ahllity to lmadle stress and frustration, cholesterol level~ etc., which likely "'clu~ter" with 8mo~ag. no firm conclusions could be. drawn. Still another study dtd report a relation between arterial e~ndition and perzonality oi~ u kiud that may the n~l or desire to smoke. ~enee the question whether smoking aff~,ct:~ arh,rlu- sclerosis h~s not been segtled conclusively bat thi~ weight o~ evid~nce that it does Studies ~th animal models, so far, have been inconclusive. An effort t~ berg made to develop better animal m~el~, and new studie:~ on bo~ animals and human~ have been starte~ to determine whether nico~ne or ~moking will actually hafluence the incorporation of fatty materials from the bloodstream into the ~laques ~at line ~e arterial walls and may eventuall~ restrlet blood flow. ~eotfne pha~eolo#y & large number of studie:~ on the pha~aeolo~eat effects of nicotine and/t~r smoking have been ~onsore~. ~he~e have confirmed the transient nature of ~ffoets. While a great deal of i~fformatlon has been added to the ~toekpile, none
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1112 llw:~, :;lmlb,~ ha:~ e,~tubli>'hed nny eonlributiou hg nieoH~e or ~mokh~g to the ,.m~-~,tl,,a, ,~grava/l,:a, o~ precipitation of mlF eardi(n'a~eu~r disease tlmt J~ Nl,.,,tille lla~ beelt ~-:hnwn t~ have 9geet* simihlr to those o£ light exereiue ou lllld la the glrhq'ie::{ el: the heart itself ~mlosg these are too hardened by scl~rosis exp:~nd. ]Clew it~ the gldll may be reduced by nicotine in cold environments lint vxpaudmt ~lh,..ll ~,xterual temperature:~ are high. WitHe nicotine tends to l}ler~,,e ,., bh.,l flow h, the eormiary arterle~, it is lezs clear whether the extraction .f m.th'iflge ~alb; ',laa('~*~ fro~ the blood t:~ increased correspondingly. ~Jmwa that It Is rapidly converted iato a~er m~l,stanees of much lower plmrmaeo- logb'ul activity. A I~rge m~-~l:u~r of sttnlles have eontribnted to basic knowledge o£ henrt hmrH,m, l~hy~,b~l,.~,W, metabolism, biochemistry and respomse to d~gs, without dlr~,*'t $11i~ [Itlllll'dlll[l' relevance to tobacco or nicotine. Tim *art lhat plD~ and cigar smohers do not experleace heart and arter~ dlr:,,a~ o a~y Dl~l[o ~i~'~en th~n non-smoker~ ra]~ms ~e question xx~o~er nicotin~ ld~y~a m~y r,d. In tim development of the~a ailments, since pipe and cigar smokers ]lgl~ $, II~'l,n ~,hoxvn to ab~u~rb this alkaloid In substanHal amount. O.~CER Tla~ rhdm lha~ cigqrette .~m-~d~ing i~ ~ major causative factor in bureau lung ~me'e~" i:~ baned chb:,~y on epidemiological ~tudies. It is assertcdly buth'essed by v~,rlalu rrl.~rb~ uf patholeglcal changc~ observed in tim lungs o~ humal~ smokers aml :tmlh.;, wllh certain animal models, ~arttcular~v sk~ paining. }~pld,. Tim l~enel'al ~tah,luents that have been made about statistical associations, mullifael.rhd em~:,alb~n ~*f eon:~tituti.nal di:rea~es and the use of multivariai'e mmly:d;~ ~r,, j,:-t a:: applicable to cancer as to cax'diovascular t~seases. Ia the ..w~, .f c~m.:.,r w~, ~till have fewer leads with respect to contributo~T fael ors f,,r th,~ heart an,1 artery dl:.;ear.:es. I]elme in epidemiologieal slurries, it is 8till dllll,'~flt t- taqeef, thp a*l,Pr*,lwiate quesUens tu ask. k good example is ~rovided bY lbo ll('ll d~'~d, Rma'nfs in ul-udy of viruses as a cause of cancer. Very Illl~': IIoIIU ~xlth any bmu'~g on this ~ub.iect were asked in any o£ the well-kaowa The C,IIIlt 'I1 hW; ~al,}llVOD*d sewel'al epidemiologieal Stlldles In rite cancer field. tllld xvolllea llhd further slrongthelled the suspieh)u fllllt there is a real sex dJlrel't,llt,o, t[la+ llllsa, jhly Ill lnlrhlOlltll effects. Otl~er Council stt~dtes bare shown he l~llgtakel~ I'¢a" primary lul~g eal,eer. Statistics o£ lung e~ccr lneidpneu will be the bdal ur lho;:o n~,w whlely attributed to environmental expo:mre~. ~ ~n,, l~-*p,:~rtant ~llle:<tlon Is whether *q~eh changes are properly regarded ns "pre- (,~ exh,raad inihmnc(*~ comparable to the development of callouses on tbe feel ul lll.~o Wire walk barefoot. Iu a~flmal models they have not progressed to ~.m-w,,~, hut di~ul,r~mr when the external i~fluom,e i~ rmuoved, trhey may be ~o~rdv4 t~ carclll(~g~qlJe and the~ occur in C]llldre~ a~(l non-smokers. 1113 When tim statistical rcl)orts indicting cigarettes la cancer were Lrs;[ publb::hed. many iuve~tigalor~, undertook to mal:e animals inhale cigarette sm.ko in tlu, exp..teflon tba~ they would develop hmg eaneer,~ nnd that tim ~et~p.n~tlble ~:uh- ~tauces in smoke emthl lhen be isolated and e]imim~ted. But. over the St,lira the'. many experiments h~-tve all failed to produce human type hmg eanecr~=. The expe~e~tal method ~at did prodnce an ~bservablc remflt war~ the painting of smoke co~4(m,~alcs (generally but en'(meously called "~ra") the skins of mice. The mul~plication of such skin painting experiments hae~ chiefly respm~sible for the wide-spread and aPl~areutly confident idea that ~he reputed dangers of hum~ cigarette ~moklng ~th respect to lung cancer h~ve alrei~dy been traced to the amotmt o~ "tar" in the snmke. I feel th~tt thlu Is by any means correct and that a pause to consider some very Mini,Iv and b;mlc 1~t¢.t~ will slmw the tenuousness of the ease. My sl:~pfic~m of the relevmxee of the skin painting studies to the human cancer problem is based upon frye ver~- ftmdamental conshleratlon~ : inflations have been made indieat~g thag a man would have re* ~moke fr.m 30.000 to 1~0,000 cigarettes a day and inhale every puff to get ~ueh a of "~"' o~ an equivalen~ a~ca o~ his Su~ceptibili~ to em,eer-imhn:ing chemicals. ~Iediein:d ~alve~ used wlthmtt eb- scrvable harm by humun~ will readily produce ~ldn cancev~ in mh.~,. M~mla~y~ resist indefinitely the same ~kiu treatments that will produce ~kin eancer~ mlce in a few weeks. ~. D~f]¢rcnce~ bct~cc~ ~ldn ~n~ lm~. ~ouneil uupi~rted experlme~b~ shown these tissues to be far more resistaat thaa ~he skin. 8mok~ introduce~ directly into the lung have not producefi cancers. On fbo ,ther bnnd somc strong earc~ogen~e chemleals will do ~o if "pinned down" ~:o fhat ~hey remain in contact and are not quickly carried a~ay by the cleansing meehald~n~ o~ th~ 1ling (such as mucous ~ow and the scavenger whi~e cells). .~mo~e. Condensates of smoR~ collected by Das~g smoke throt~gh cold trap~ ~tl very lo~" temperatures are not ~ivale~lt either In ~hy~Ical or chemical prop- erties to wholo smoke. Bofl~ chemical and phy~leal ehange~ occur. ~om~ followh~g the formation of smoke in th~ ~urning zoom of a e~garette. eoutlnue to take 91ace ~ the condem:ate a~er eolleetion. Still f~ther, it ha~ been shown that eondengatog fro~ pi~o, ei~gtr uud else. rette ~ype tobaccos all exert a similar, ~ough feeble, activi~ oa the ~:kln~: mice. ~'et ~c s~ti~tical ~cidence of lung cancer ia very low even among ldpe a~d cigar smokers who report that they inhale. It seems clear fltat the effeet~ of chrome. ]~ng-term lnhalatioa of whole, ~re~h, no~al cigarette smoRe ~ever ~e realts2ically api,rai~d by means of smoke condensate ~Ludie~.~. ~. The ~ Doint coaceming the relevance of mouse sMn pahtting to the human lung cancer problem li~ in the im~icatlons of vlra~ agents such T]dr eomDlex subJe~ obvLougly crmnot be db~eussed lu any d-taiL here. should suffice to f~t]l attention to th~ fact 1hat many a~limal cancers are eertalnly o£ viral orlgln. Some DTes of ~rus~s muy exlst for a ions ttm~ hhhlen in the eels of the animal and re,reseed ~rom expressions fl~emselve:-:. Then may be released into activity by any one or more of a wide variety nf Internal or external inflnences. ~Iethod~ for detecting st~eh vi1'll*e~ hnx,* dev*.lolmd ral. idly in the la~ few years and it is now possible to measure tim degr~,e *o ~hleh ~hey h~ve become unleashed, long b~fore any oahvard manife~tati~m of eam.er n~ we lmmv it has ap~,ared. Difference~ h~ the apparent ~u~cevfibili~ of verb)us animal str~iu~ and ties fo enx~romnenfal influ~nce~ are Imi~g shown lo be due. in muny ca~¢e~, the relative concentration o~ mden~l~ed viru~ h~ ~hc~e animals. ~hun ~t m,w db mension is being added to animal bioas,.ay methmts in [lm field o~ cancer gene~b;. The state of the host ~imal is emerging as a prcdomlna~t factor In defermbd~I? how it responds to h-ea~men~ with chemical and ~tber ageu~. It ha~: long beam knows that great differences in sns~eptibility exist amon~ variou~ ~tratm~ speeds of animals, but now a new kind of control u~on this "lm~t ~a~:ceptibllity" lma b~.om~ ~osstble. Straln~ of anlmals with lmown level~ of th. poh,~tlal cancer.produelng viruses in the nnleashed state, promL~e to become Che animals of ~he fnture. Undeubtedly the interpretation of many carller
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1114 1115 mine whether smoking would affect any o£ the phy~Aologieal reactions that are believed by many clinicians to pla.y a par.t iu ulcer production, particularly oversecretion of acid by the stomach, lqo mgnifieant differences were found ~ any of ten measured responses between normal l~ersons and ulcer patienhJ, nor did smoking Just before or darbag measurements produce any conMstent pattern significant changes, On the other handel_ulcer is known to afflict chiefly person~ of a particular temperament, that is those susceptible to anxiety, tension and frustration. It reasonable to suppose that such persons would be esl~eclally likely to ,~eek relief from tension by smoking. Hence the weight of evldence suggests that the statlall- eal association between ulcer and smoking is non-causal and probably attributal,l~, to an increased tendency ot temperamentally ulcer-prone person~ to cigarettes. "~ne Council for Tobacco Research--U.S.A, has, in the last fifteen year~, scrod much research into the cause:~ of the d~seases with which 5rooking been statistically associated. But there still iz much to be learned befor~ tht~ complex questions involved can be answered and the cau~al factor:~ a~';certalned. Continuing Council work will be devoted to that end. THE ~IIL FOB TOBACCO RESEARcH~U.S.A, Kenneth ~Ierrill Lyn~, M.D., Sc.D., LL.D., Chairman, Chance]Jar and Profe~ Emeritus of Pathology, Medical ~dlege of South Carolina, Chafl¢~;4on, Carolina *~oward B. Andervont, ~c.D., Scientific :Editor, ~he ~oanaaI of the National Cancer Institute, Bethesd~ Ms.land ~iehard J. Blng, M.D., Professor and Ghairman, Depa~ent o~ Medicine, Waynv Stat~ University Collogo of Medic~, Oetrolt, ~Iiehiffan McKeen Cattoll, Ph.D., M.D., Prettier Emeritus of Pharmacology, Corm,ll vorsity MMie~ College, New ~ork, New ~bert J. Huebner, M.D., Chief, Virgil Careinogenesi~ Branch, National Instltute, ~ethesda, hlary~nd ~n 0. 3aeobson, ~I.D., De~ of ~e DlviMon of ~iologl~l Selence~, Regen~tt, ln ~fe~or of Blologlc~ ~enee~, Univerai~ of ~hieago, ~la~on G. Loosli, ~h.D., M.D., Has~ngs Professor of Medicine and Unlver~2ty of Southern ~l~o~ia School of M~icine, ~ Angele~, Callf~ht ~aren~ ~ok Little, Sc.D., L~D., Lftt.D., Scientific Director, The Council for Tobacco Research~U.S.A., Dirtier Emeritus, Roscoe B, Yaelmon ~aherato~, Bar Har~r, Maine William F. Ricnhoff Yr., M.D., ~rofe~sor Emerltua of gurgcry, ~ohns University School of ~IedJ~ne, Baltimore, Maryland Sheldon ~. ~mmem, ~I.D, ~rofc~so~ o£ Patholo~, Col~rahia UnlverMty of ~hysicians & SuSans, Dir~toc of Laboratories, I~nox ~ill Ho:~pital, Now York, New ~ork ~te C~a~r~ta~'. Our new witness is Dr. Ronald Okun~ a colo~ist ~om Los Angeles~ C~dif. Welcome to the committe% Doctor. STAtemENT 0~ DR. ROEALD 0KUI~, ~HAR~ACOL0~ST, LOS ~IG~S~ CAL~. The C~.~-. You may proceed. Dr. O~cx. Thank you. J: am aeneid Okmu M.D., direc~-r of elh~- icM rdm~mmcolo~y ~t Ceda~-S~nai BIed]c~l Center in I~:~ ~ali~. I ~ a gpa~dm~ of the Unh'ersity of O~lifo~h~, where I re,~eiv,,l degrees of ~.D, and BI.S ]] p~ trm~u,~loZy and Ioxicol%~,. havin~ completed a fe]lows}.p m c]m,:al pharmacolo~5~ at *Retired.
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1116 IIophh ,~. Z a;~-~ t ned my pr~:ent position. Imn an assistaut proft~sor m,',lici~, Und l~]mrl{m]'o]ngy at the University of California, I :~ttlmtit ~]ti~ ~atentent as :~ clinical pharrnacologis~ intereste~ in lmttill~z" flw question o1' cigarettes and their possible relationship ~.o vari, a~a ,li:-va~es, ~pceiallffhui~ cam.er, imo a scientific pe~pt~t, ive. Over 10 w,ars of researdh and t.rainin~ ~ftm" medical school, i,wlud- inl~ r,'se~rt:h on effects of era'iron.entail stra~s aud toxicolog)- hare ~',~l vinec,l ni~ thai, ;-'cientifie r~eareh, no~ emotions~ should se~ffe quea- gi,m;; of ,'au'-;ality ,ff diseasc.,a. T,,haccc, '.-~mokt~ ib extremeIg eomolex in eompoaitlnm ~ho '.~iti,-m ~-,t,l~~ to x'arv with the }ype n} *ohaeeo, the way in which it. has be.n ",-'m',:d" and }.he way in'which it is sinoked. ~he "nminst~ '.-,mr~k." c,f ,:igaro0es is f~infily acidl that of pipes m~y be acid or Ira,, whih, ci.-ar ~moke N n~naIIv atkaline. VeD, little, however, lmoun abont;-any medical imlm~nct~ of the~e varlet.ions. Skin cancer lma heen or-duced m lmce by appheatlOn o~ tar con- ,],'n-.',l Jrom tobacco .~n~oke h,,t the res, tl~s obtained by various in- ,,:-~li~ttt,:~r~ have u,t been u~iforln and exposure o~ a~Is to tobacco ~m,,k~ in inl~aled air has tidied to produce epidermoid lung cancer. Somv inve,~ti~atm'~ report flint the carcinogenic potential of cigarette -.m~-d~, ooluh,hsah~ as ~tpplied to mouse slda resfdes primarilyin the e:u'b,-m tvt,rtwhlovhle-zoluble material of the neutral fraction ~a~ con- ]ah,u'atnla-. Thla i-~'mneh differeng from measm'ing ee~a~ ehemieMs tl ,~ l-dv /su,"h a~ blood testa for dru~s) by laboratory solven~ It,terms t,,chui~u,~s. Those ehemmals are already p~sent in the body {rod th,:, h..4s d,'b:mdne their presence and the amount ~ound. Some "~;nvar" ]n,mlin mlght cause to be deposited in the body and removed fvola t],o bhmdatre~m because that is ,mlv a "tcsg tube" or "Iaborato~" an.:w,,r ~,ud do,-'.; not ,nvolvt~ the m,~st'import.ant fact of ~0 cas~ lit[ Vtl l'~' ~ll q d] fptl reg. Yoneth.eless, ~ome persons have t/then a ].,ia:t ,-ff rh.w and Lave overextended tim eonch~ons from lbnited debt. Fhev have thus lost their scientific posture and thought. They ],v~: l't't" to i rv to explain away the failure to induce epiderm3id cancer 1117 less than Amerlcan ~nokers, they nevertheless attempt, to explMn away such data. They chdm that. "the British smok¢~ more of ~ cb~a- jud~en~. . , One also is ~ruc~ b~ the almost, universal bias and ~erh.~ to find a positive relatio~M~ }~tween ci,mrettc cancer. It ~s ~ e~ d~fficult, indeed, for an investigator not to conscmu~ly or ~bconsciously wan~ to haw., nositive result a~ a,,a ........... effect relutmnshlp. Sclentmts, however, should not take a ~;.r h~g~at Jeas~ ~mporarily--but it should not be allowed fi:, our mepmess in the area of cancer re,arch. ~m:pholo~cM changes in the respirato~ tracts of mice and other annnais ~ssociated with~ a,nd clMmed to be caused by~ cigarette smoko have b~u descirbed Despite the pI'ec'mcerous inm]~c, f" :~ , ¢ mr . " ' ' ' , A_I( TIN , 0 ~ , - ~,ns lmve attached to these changes, flm ]esmns consa~ently "ions d L r%ress. -iney becom~ fifll-bloun m:flignancies. 3~y, then, did they recess in t.~is si~uation~ I IMi~w t, hev wort~ no~ ~,:~ eane~ous, Ot]mrwx.e, ammal Tntt]lgDailele~ ~eeonda~, ~o smoking wou]d lm easy to produeth no~ impossible Ono ~Mvesfigz~r noted in smokers an in~reas~d ineideneo o~ met;t. plasi~ ~,the ~arlies~ and lea~ ~ifferentiated form o{ wha~ is times de~et'ibed as precancerous ehanze) in the t~aehe~ ..... ~ +~ muinder o* the traeheobronehia: tree. B~It, Om extr'eme cancer is well ~own. ~u~her, ~.ho changes observ~ ere c~pahle of duNication by non- specific stimuli, for example, lack of ~i~min A~ viral pneumonlth:~ and so forth. Such e~erimml~fl m~d clinical s~udics cited s~ggo~ in the ~bsence of ottier factors, cigarette smoke does not suni~]v p~t.l~oeemc g~s needed ~or the dev~aopment of Nng cancer. It is ~r~g~g to hem thag in some of the studies thag claim have induced cancer in animals painted with tar, the animals in ~ crowded e~ronmen~. ~gork which I and other. ~ve~ei~ttors aid soveral yearn ago demon~rated that the toMei~ of many a~enN increased when annals are crowded in cages. A drowded di~oas fl:e data since the toxidty of varihus compounds may be increased. ~ I~ has been shown tha~ some carclnogen~ take longer to be eliminated from ~he body and bare ~ more dele}erious efi~c~ in the prvsenee of hver disease and ~erhaps kidney ~sease. These are only two factor~ tha g may ]rove a bearing on the et{~lo~- of cancer. It is "disturbing ~ hae, as ~ sde~i~s~ ~at w~th su~ ~ncomph,~ hfformation about how to de~, pl~ and car~, out @udies invoiw ing the proper e~osure of animals, some. investieators have fidt to make sweepm~ generahzatmns regardin~ their ~-*- ~.-~. *u,,-- -- awaro of the many vaz~ables which ~hov b~vo sos co.~.~l~.~ ~- experimental em, ironment~ In any experiment MN more than one variable or unKmown factor, one should bo e~r~ely cautious in ing generalizations. ' ,
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1118 Tl,:r~: are m~ny other ex:m~ples that could be cited to question claims ~f I~ can~-~ and effec~ relat.ion~hip between ~ig~rette ~mo~g and lung ~ancer. Sutlico it to ~ay~ at this time, that the gre~t amoun~ of bias, tim ,~m,:,ti,-,n-lad,~n question o~ brag cancer, the crusadh~g poin~ of ~ew of l,',:,ple ~ho want to remove ~~ ~cial practice frets our environment, the poorly controlled experiments, ¢tm ove~eneralization from incom- ph't,~ ,].at[~ all point out the need for the use of more caution. Care~l planning Mlh muti,:ulou:4 e~ientific inve~igatlon is necessa~ ¢o de- t,~rmim~ th,~ ¢ircum~tance'~ which lead ¢o lnn~ cancer. 1 ~,,fld like fo turn my attention, ne~ to the nicotine and "tar" cont,:nt of ~m,,,n ],,,in,,s d,, no~ ~moke "t::tr~' and no sig~ficanc} of laboyatqry J:~..cka,,wl~:'d,~4 by the 1964 8urgeon (iener~l s ~eport. no~ re pe m~ important health ~azard. Tlu~ remains true today. ~t~, then, the la'~'oceupat.~on with nicotine~ I know of no scientific ha;is for Different apecie:~ of tobacco may contain m~-ereng ampunu~ ~a ,:~,,ar,'tt~ :-,mokini~ to various ~tseases tends to pore al~.~m ~g d}t~ into on,:~ que;;thmabl,~ conclusion. Since ~he t~e of "Car" ~s qua~i- tativ,'ly m~d tmantitatively different, it follows that. we cannot "pool" all thi:~ iMorh~ation Nto one big pot and imply that a~ "tar" is the "am," If 't di~"~','-prodncing substance is presen~ in tim "tar," it may ,, ,, be ~ .......... ~ ~,~ ,, w.r- small na~ ~md the amount of total tar ]rr~.l~vant Pharmacolomeally active ehe~cals occurring m tobacco ,1,:, m~t. vary propo~,mnataly w~th the concentra~on_o~ tg • . ~lany ~-'~-called ermst]tnents in tobaccn smoke condensate may be ar- tlfacts'of the isolation a~nd put,cation techniques which are used in th~ laboratory. These Lola~ion ~na purification tectmi~ues have no narallel in tl}e human body. Nor example~ the human body does ],,~:,~ ~#ro~g organic solvents that chemisN use to trap a~d analyze cilmrctt~ :retake nor does it have any such high or low t?mperat~}s as ar,:~ used ]a is~,lation. The evidence for the pres~c~ o~ setup of :-;a-called harmful substances would be ~ lot more conv~emg smen- titically i~ the laboratory inveb~]gators used chemical syste~ which are duplicated in th~ human lung in their attempts to qu~ntitate ciga- r,'tt(~ ,~ok~ constituenN. ~ an attemp~ to h~n resNts, some seienti~s hav,~ taken sho~cuts and used techniques ~hieh leave their data open to question .... ll,,c,mtly, st,tat investigators who c~%~ed to )av?.~ola~d. one cal compound from smoke found that ~g was ae~uany a m~xture ox ~ral compaundt~. I que~;~ion whether or not ~e ~everal compoun~ ar~ not a~ifacts of ~lm chemi~ls used in isolation. Yet, here again~ claim are made that thesa compaun~ c~us2 di~ea~: ~$ ar~s?m~ inv~s~igato~ in such a hu~y to mako claims ~ase~ on msumc~eng info~on ~ They ~ould flint t~ to perfect ~chNqu~ of i~lation and purlficatlon of the~e compounds in a way wMch h~ sdenfifie bear- Ng in relationship to tha human body abso~tion and then ~udy compounds Mth carefally und~aken Nve~ga~ions. _ Not only arc ~em differences in the way the ~dy m~ts to the same m~t~rial when admini~ered in different ways (for exampl% inhalation 1119 versus oral), bu~ also there are great diff~re_nees in tl~ way tha body reacts to a material in fixed quantities but administe~.'ed over different amounts of time. For exmnple, ~ certain amount of cigarette smoke could conceivably have a different effect if it i~ slowly inhaled rather than rapidly inhaled. The n~te and amount ot~ absorption of cigarette smoke constituent~ probably depends upon the following factors: 1. The length of time the smoke remains in contact with the mucom, membranes. ~. The acidity of the body fluids with which the smoke comes contact. 8. The depth and degree of inhalation. I-Iow accustomed the person is to smoking. ~[ The chemical content of the tobacco smoked. 6. The moist~re content of tlm tobacco smoked. 7. The form in which the tobacco is smoked~ for example, finely cut tobaec% coarsely cut tobacco, and so forth. 8. The amount of cigarette remaining when the smoking i'~ 9. The use of a filter. 10. The acidity of the tobacco smoke. 11. The agglomeration of smoke particle~. 1~. The amount of moisture over which the smok~ travels. All these variables must be, carefully ~tudied and held constant before a scientist c.~a accuratel) ~sedlct absorption. There is great variance in ~scep,t,.ibility among laborator.,31 ~mim~d.~:. There are many potential factors ~lfich may affect their he:t]th. important tha~ other emdronmental factors be studied to set~, i[ produce similar results in identical situations as are used in the of cigarette smoke or condensate. The problem o~ our tot,~l environ- ment's effect on di.cea~ must be put in proper perspective, l~{any every~ ,lay materials may be dangerous. Meaninghd research leading to factq. then public dissemination of the facts is appropriate in a society ba~;ed on an educated freedom of choice. As a scientist, I fred no persuasive evidence that cigarette smoking causes lung cancer. Further, i~ cigarette ~moking wer~ made or if warn~mgs about smoking go beyond the true s~ate of sclentitlc knowledge or i£ certain ciga.rettes are eliminated from the marketplace on the basis of "t~r" and nicotine content~lnight the public turn else- where ~or satisfaction.~ Certainly there is reason to believe the con- smnption of alcoholic beverages and ~he illicit us~ o~ drugs, and ~o forth, would increase. These self-indulgence~ may be dangerous to the person and also to anyone with whom he comes in contact. In summary~ there is insufficient evidence to determine the etio.logy of lung cancer. There has been~ above all, a consistent failure to dem- onstrate a causat.ive relationship between cigarette smoking and lung cancer. Legislation which is directed at eauslng people to sm6kin_~ may sin=tvly encourage some persons to turn to practices which constitute a real danger to mnoe~mt third parties.
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1120 (Tht: attaehm+.mls to I)r. Okun's statement follow :) CUI~ItIOLrLU~t ~'ITAE 0F ~OA'ALD 0KU~', M.D. Jftwit~l ,~t~tt~8: ~Vll'~ : Katherine G. ()Rum Un ~ ~, ~r~ity of Ca ~ffornia, Lo~ Angeles, ~lifor~ia--X~1fl~, B.A. Unlw~r~It$ of Calffo~nla, San Frane~eo, CaI~o~nin--1fl~ ~ ~,:ho.l de Medleln~19~8, M.D. Tcacllhlg A~d~mt, University of California, San ~h~nei~eo, lnt,,rn, Gt,at,ral Medical and Surgical Hospital, Yeterans Administration It.;q,ital, Lo~ .~gelc;,, California, 195~1i)59 Ite:dd,}~tt, $.terans Admiuistra~oa Hospital, Los Angeles, California, 1959- Fellow, (~l["lC,rtl Phax'macolo~y, ffohn8 ~opkJns Hospital ~al~more. lalvl--ll)61-1f~;3 Am,,rlcan Fedoratto]l for Clinical Resuarch--1961 AuB,rlean A:~:~,:~,~iatlon for Advancelaen~ of Scienc~1962 New Y.rR Academy ol+ Sclence:~--lt~.iS An,,rt,mn ~oelt,ty for Pharnlaeology & Experimental The~opeutic~--lg[~S Amorb:an Soel~y of Clinical (hnl:al Pharm~teology, Ce,~xr~:-Sinai Medical Center, Los Angeles, Ca]Ifru'~la--July A:r+i~-+lunt Profo:.,+~or of M+,dici~e and Pharmacelogy (in Residence). Untver- Mly .f CaKff~rnla, Lo~ Angeles, California--Sept 1963-Prescnt It,,~,varch I'harxi aeob:,gizt, Vvteramj Admini~.at/oa Hospital, Sepulreda. Callforlda~}et 19 ]4-Prvuont C,m:i~tuntiIt,alth_l~j0in Pharmacology, S~te of California, Department of Public Leg~:o Pr,'vcnthe Medicine A~,ard, University o£ Cd]ffornh, Medical Cen- ter--Fcb-Juu,~ 1958 Okun, R,, nlid Ell[oil, H. W.: Acute Pharmaeolngieal ~tudies o+ 8ohm X~w M rphlm, lh+rh, tltives. J. DharmcoL Exp. Ther. 12~: 25~259, 1958 (:lk~ll, IC, l,hldon, ~. 0., and Lasagn:t. L. : q'ho Effeet~ of AggrogM:i }n, ~l~:lric Sho,,k and Adrem+rglc Blnckh~g Drugs on Inhlbltio~ of the Writhing S~dron e. J. Pbttr~n,+,',L ~xl+, T)~cr. 193 ( 1 ) : 107-1~. Wll:+.n, W. It+, and Okun, It. : The Acute Hcmodynamic Effects of DJazoxide in ~Volh'. 1,'. W., Purmley, W. W., White, K., and Okun, ~. : Drug Induced Diabetes. JAMA ~,~ : 5f~-574, 11)1;3 WlLun, W. It., Okun. R+."getr_a,lt.o L., and FaHis, N. : Methyldopa and Hydro- +'Id,,r+:,thla~de in Primary HYlmrt+,nslon: Controlled Cl~ical Trial of Dn~gs Singly m.l In C,,mblnation..IAMA 1S3 : 81[~q25, W~t]l.,l', lV ~2- : Itonal Toxicity of 0ral Choleeys~ographIc Media. ,IAMA 186 : Ilk,Or. If., HII';~t,ll. R. P., and Wi]~<on. ~V. ~.: 12!~a Of Di:~zoxidc with Triehlor- l.,'thlazhh+ f,,r HyItortvn,;ion. ARcH INTERN. MED. 112: 88~8, 1~3. I71krllh H., Wib:on, W. ~,. and Gtdfalld, ~f. D.: The Hyperg~cemic Effect llyt,ott,l{.+tv,, Drug:+. I. f'.hro~. DI~. 17: 31-39, 196t, {'.rlhuq'. X. II., Seh{.lling. J.. Rus,~ell. R. P., Okun. ~., and Davi~. 5[.: Thiazide aml Phihdlrddlne In,hn~d Hyperglycemia in Hypertensive Pa~ents. JAMA 1121 Okun, R. : Principles o£ ClinicWl Drug Evaluation. Proceedings of the Pharmacology Society 8: 23-32, Winters, R. H., Levy, L., Thurtaan, W., and Okun, R. : Stu~es on the 3Ie~btdb;m and Distribution of Radioactive Amphetamine. Procecdlng~ de ~e We~torn Ok~, ~.. Re,h, S. B., Oct&re, A., a~ ~iaxwelI, M. ~. : ~he Long T~r~lt ne~s of Bie~yldo~ ia H~ertension. CALIF. 5IED, 16t : ,t~0, Kteeman, ~. R., andOkun, ~., and ~eller, ~. ~, : 2he Renal ~cgmlath,~'"'~ of an~ Pota~lma in Patleats wi~h Chroltic Renal Fallura aml flu, Dl~eties on the Excretion of These Ions. Ann. X.X'..kcad. Sel. 1;19: 1966. Sokol, A., Bashner, M. ~., Okun, R. : Nephrotlc Syndrome Caused hy Prob~}ut.cttL JAMA 1~): 43~, 1~7 Okun, ~. : Dhl~ties--Cse and Abuse. The Medical T~qevlaloa No,york, UCLA Cet~ter for the Health Sciences. 19f;T Okun, R., aad ~vem~, C. R. : Renal Disease Secondary to ~Ietab~llc or Physiological Deficiency States. Calif. Med. ~ : ~10.1967 Okun, R.: Development of New Drugs, In: A Textbook of Pharmacy}fogy. S~ of Depar~cnt of Pharmacology, UCLA, School of Medicine. Sectiun Chapter 4 In Press OMm. ~. : Pharmacology of Placebo:~. In : & ~cxtbook of Pharmac.logy, Ed. DeDL Phamacology, School of Medl~e, IICLA. Section I, Chaplet 5. In Prc:~ Okun, R, : Emergency Drug Toxic,:dogy. In: A Textbook o~ Plmrm~tc~flogy. Staff Dept, of Pharmacolo~-, School of Medicine, UCLA. ~ection I, Ohul,ter In Press eke, R. : Drug Dependence. In : A Textbook of Pharmacolo~. Ed. Staff merit of Pharmacology, School o£ Medicine. UCLA, ~ceflon I, ~haptvr 7. Okua, g.: Vsyehopharmae01og~. Ill: A Textbook of Pharmacoto;:y. Ed. Department of Pharmacology, School of Medicine UCL& Seetlml II, Chapter Ia Press Oktm, ~. :AIoohoI ( Ethanol ). In : A Texthool: of PharmaPology. Ed. S1 ~ ff Dt'F,t ment o£ Pharmacology, School af Medicine, UCLA Seethm III. In Press 0kun~ R, : ~tfiHldd Ag~u~. In: A Tex~l}ook of Plmrmaeology. Ed 6ta~ me~t of Pharmacology, School o~ Ble{llei~., UCL.X. Saetlo~ III, Cluti~t.r In Pros Get,rein, ~. R,, 0kun, ~., ~oniek, H. 0,, Wllner, II. L, Kle{,man, C. Maxwell, M. H. : Prolo~ed U:~e of ~Ieth{,namln~ ttippura**~ lu U~ary Trao~ Infection. ~. Urol. 1~ (~) : 7Bl, December 1~IS, 0klm, R. : Gen~ll Principles of Olinieal Phanimeology and and Early Clinical Drug EraluaHons. In: Br. G. Clark, K. 1}itlaan, C, and D. X. Freedman : Prinelples of Psyehopkarmaeology. N.~..kcademht IR Yres~ $ilwrmaa, ~ ~. and 0kun, R. : I~:o~roternol and Dolmmlne in th. Treatm.nt Meprobamate Ovcrdosage ~ Cats. ~r~ecdlngs of the Westvrn Phnrmacolo~y Society 11: ~98, 1958 Siegel, ~., E~Ison, T., Silverman, A. G., and 0kun, R.: Tissue Di~tribntl,n all-all-Amphetamine ~CI in Tol,,rant amI Nontolerant Cat~. Proct, vdln~.~ the Westo~ Pharmac{do~ See[ely 11: 9~)4. Elli~on, ~., ~iegel, M.. 811verman, A. G., and Ok~m, R. : {?mnlmrall~o of fll-~-Xmphetamine ~drochloride in ~ole~ant an~ Nontolerant {'at~. ~:cefliags of the We~tera PharmacnIogy ~oclety, 1~: Y~-gT. Ba]tes, B., Elli~on, T., ~evy, ~., and Okun, R. : The M{,tabolie Fatt, ,~ d-AmphPtn- min~ 8ulfote. The Ph~rmacologis~ 8 {2} : 220. 1966. 0kun, R. : Medical ~a~a RelleL ~L ~Io~ital Dental P~aetice. II{2~ ~ 32. :~. 0kuu, R. : U~e aud Abase of ~n~biofic~. ~l. Ito:~pi~al Dental ~rac~R,e. JL tal Dental Pra<,tiee. I[ (3) : ~-62, ~uB" Sllverman, A. G., Wilncr. H. K.. ~tnd 0kl~, ~. : Ca~ Report .f Ga~l eh, II,,nt-r- rha ge S~ondary to Tolzoline ~hera0y. ~ubllcatiou Pending. Silvermnn. ~ G., Wihmr, H. L, and Okun, ~. : ~a~e ~e~rt of Aceldel~h~l lion of ~yr~nium Pamo~te. ~ublicafion Pending. Karpman, H. L., and 0kun, ~.: The Place of Va~odilator Drug~ in ~,rlphPra[ Yase~ar Disease. ~ublicafioa Pending. 29-2~,6--6.')--p t. :]---16
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Mr. Va~¢ Dn~x~r (presiding). l~[r. Pickle? Mr. P~cx~. Mr. Ctmirm~n~ thank you. 0~ l~t:~ ~, Doct~r~ you make ~ho stutemeat, thut oa~ Mso is struck by th~ almo:~ uniw ~1 bi~ and perhzps need to find • positive rela- ti,:m~hip b~.t, weea cigaret~ smo~ng and lung c~cer. At, you zaying tha~ some of thee people who haw testified~ who r, l~.~.;mokin~ h~~vo ~ta~ed out to prove the need and tlmir r~ts ~ro concluded heior~ fl~ r~earch actually star[ed ~ Dr. O~v~, I t.hink in It sen~. that ]s correct. I feel that there is such aa emotion-laden question here~ them is so much bias~ ~h~t dUO is danger" o~ heists o~tracized by his colieagu~ in ~ sdeng~c co~u- nlt,y if hi~ datd docsa~ f~ll ia s~ep with precomdved opinions. ~Ir. P~c~. You make the fu~er statement on p~e 7, "I ~d no p,r;-a~asivo cvidcne~ that c~gar~t/~ smo~g c~uses lung can~rY Th*tt it~ t~ direct contradiction ag~ to ahea~ m~ber of witn~ses who h~vo come bcfora our cometic. I wonder if your word "per- ~a~,iw?~ i~_~ ~ proper choice of words, Would ~]-~o'ai~v~ ~videnc~" bo mor~ clearly d~crt~i~ or ~r~ you :- [~y h~ wifl~ your u~ of the word "persuasiw~ ~ -- Dr. O~-t~x. I am ahva~s willing ~ reconmder the use o~ the word~ :dr. What I merely meaKg to say was that ~ fo~4 no evidence which pcr~t~adc~:~ me that cigarette ~moking causes dise~e. Mr. ~mn~. Tha~]s all, Mr. Mr. V,~ D~am~. Dr, Carter. Mr. C,~¢;~. Thank you, hfr. Chairman. ~ D,,ctor~ a~ ~ stated prcviously~ o~ course gh~ people ~ho want to extend ~h,~ p,_~e~cnt la~l on cigarettes~ and the Federal tkm~ Con~mL~ion testified first. P,..oph:, who d,~:~ir~ labeling cigarettes in ~ much h~rsher ~y h~w ,ml~, t,~d~ week ~:~cmn to testiS. But I as~e you th~ they ~re nu- me~ou~ and com~. worthy and well qualified. YOU t:ay On pa~ ~ d~ your prepared statemen~ that tome persons ha~t~ taken t~ ert~sadmg point of ~ew and have overe~ded the eonelu~:ion~ from limited data." I~¢ tMt not true'~ Dr. 0~~. Yes, sir. Mr. C.~m~. Could you explain what you mean by this gatement ~ Dr, Oat*~: Ye.~: I think perhaps b~e~ on ~e need to ~d an mswer, .omcon~.~ at ~:omc.tim~ fel~ that perhaps cigarette smoking may rola~l~t.o il]nes~ many ye~m ago~ and a~mpted to prove his hy- poth¢ si.;and I ~hi~ ~a~ed miserably. Yet, I feel tha~ l,~eau~e u ston~ w~ sturte4 roll~g down a people have continued to ~ke up ~ds crusad~the word I chose to u~:~wi~,h rcMly no evidence~ but just the momen~m of a stone ~oH- ini, doxva a hill, wiflx no one pushing it~ with no more evidenc~ to push It it~ iu~ its inerfi;t. That is ~cuus~ of th~ lack of ideas~ p~rh~ps, l~ to what else might be respondbl~ Yet what I believe to ~ a figment o f :-~.~tk:ti.:d arithm~tic and o~her matters. I t~J~ wh::n one looks a~ the data in a cold, h~rd light, there is and remo~ ~ a ~odal habi~ from our env~ro~n~ which som~ 1123 find dista~eful, they choose a very emotion.laden illness to pin on it to make it easier to get thelr job done. Mr. Cam'~aL Certainly, I a~e~ with you. I ~eel that many of th~.~:~.~ people h~ve acted unnecessarily from ~ scientific busis an~ cool, c~lm, well-reasoned experimentation, Do you ~eel thak cigarette m~y he ~h~ un~o~unate victim o~ wi~h-hunt~gfor the ca~u~e o~ lun~c~cer a ~r. Ox~ ~ ve~ definitely do~ don't ~now of -n-'t w~ ~ms.cgme ~m~er such vigoro~ a~t~ek with so little ~u~;~ificatio~ no ~es~ ~er~moiogy ~ can us~ ~or this is witch-hunting. ~. C~m~. ~ ou m~itioned fl,~t you haw done animal flea work and you s~y oa page 6 that th~ ~xicity of an ageag may ~oreased by the crowded environment o~ tlm ~nimal darin~ the te~t. W~t Js the sig~ficance of this crowding of the animals during tests ? - Dr. 0~. Many e~eriments h~v~ beta ~one using ~ig~retto or condensate, or various material removed from cig~,re~tc smoke l~borious laboratory ~hn~ques ~d applied ~o anim~ who liw erM in a cage, ~or e~ample~ mice. It ~ now ~veH-kmown and well accepte~ ia tim scientific cor, m~uait4, flint animals ~ha~ arc stable~ with mor~ than one per oago had all • 'ugs~ medication~ chemic~ls~ what will you~ m ~ much fashion tha~ animals ~a~ Hvo ~rowded. T " he crowded ~mm~ls tend to respond more ad~e~ely to ,mu, a ~gs wer~ mcre~ea 1our or fiwfold by h~ving ~ahnah~ liv, so~or~l ~a ~ cage rather ~haa bY themselves. Humu~ don~ li~o crowde~ in a cage. ~ ~hink the w,,y the expt~rl. m~ta.~ioa was carri~ out and designed was ve~ faulty ~. C.~. ~ o~ unswer red, cures, then, tlu~ stress would something ~ do with the results. Dr. extol. Yes, very definitely. ~ C~. ~at you find i~, ~mals m~y be tru~ for humam, do~n ~i~ ? • . O~vx. I see no reason why i~ shouldn't be~ but E h~ve not c~trl'it~d dug tlm e~eriment~tion oa hum~s. ., ~.~ ~he mo~,, ~,.c~n'~ pub ~ay finger oa any dat~ to ~dicate ~ms ~s correct. ~ aoa ~ ~now evidence that it is ~ot ~orrecb I dealt believe it hue been ~ook~ ~r. C~. Do you feel that th~ print warning congMned on cig~re~ packages truly and accurately tells the public the ~ of our pr~ent so,entitle ~owl~go ubout ci~e~tes~ Dr. 0~vx. Well~ I am ~fm~d I am goia~ to t~ko u somewhat popular view. I think ig is ~ ligtl~ strong, B~s~ oa the ovidcac~ which I h~ve eva.luated, the scient~c literature, I death think that s~tement I thi~ it ~ends to imply tMt there m~$y b~ a health hazard, ~ that b~s is dist~cfly untie. M~'. C~. Tha~ you~ sir. Tha.nk you, Mr. C~im~n. Mr. V~x D~m. ~. Satterfield ~ Mr. S~~D. Th~nk you, Mr. Ch~m~n.
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1 h~d or~ I llotlci~ lln page, 3 you made ~ ~bxtemen~ or ~ suggestion that ln'~-~:~tllccr,~tlS implicatiol~$ a~e evid~n~ in ~e lung, trachea, brone~al hfl, ~ ,rid whatnot~ and actually produce lesiolm tlmt regress upon the ,',,: ~d ion of ~,moking. If ~ am correct., you have said that this is not indicative of pre- mtnc~trou9 ],::-~iol~, iu dmt correct ? Dr. ~ }~vm That i~ correct. Mr. SA~r:r.~. I was interested, a]~o~ two ~ara~aphs fu~her wh,,n y.u mention the fact that this same condttion can be duplicated by n.a~i,:dfic ~;timuli. * Dr. O~r~. Yt,:~, eir~ that is quite true. I feel thero has be~ relativeN liHlc work dono i~ this area, but what has como oat o~ some of work i~ that ~ome t, tber ~timuli can ~d~ic the~e ~ of ch~mges. Wc do not know tlm ~eat many other stim~i in ~ur environment whi~4~ y~n do the came thing, I am sure. This wofl~ remains undone. Mr. S~wnmm Are an~ of them related ~tatlstically or oflmrwisc ~,,, tim incid, mcc of l m~g cancer ~ Dr. O~¢t~. This is hnlmown. It h~m no~ been looked at, to the best ,f my lmowledge. Mr. Svx-nm,~mD. But i~ is there just as much as from cigaretto Dr, OKu~. Yes, ~ir. Mr. S.~n'l~m'n,;~.. But it has been ignored ] ~Ig. S.X't'I'J"iliFILLD. I think that [~ very, very interest~g. I wa~ htterc~,ted al~o on page 5 in your comments about tar and To your I~::wledge~ have any n~w ~acts been developed wifli respect to ta~: m~d nhotin~ as it might affec~ health and be c2~ec{ed with ~lllok~lll~ ~liC~ 1,964 ~ Dr. Cram. ~o, sir; I do not believe so. Mr. S;v,m~m~. Do you know of any evidence tha6 has been de- vclop,'d which,, would reflc,:t upon. the entire~ field ofn smoking" as it may relat~ to on~. ~ 1,mlth that we d~d not h~e in 196o when we ]a~ ha~ Dr. O~. I think there is ~ome~nff, and ~ think it is ~e fact tha~ ,.mainuing re,catch ha~ failed to show tlia~ ¢igaretb smoke causes ]1llI~ v::tllo~r in anilrm]s. By vlrtu,~ o~ th~ continued work being done and by virtu~ o~ the fw:t'llmt th~:,y hav~ l,~eu unable lo prove~ it starts to become app~en~ I]ml it ealmot l,,~ proved. Mr, SA~']'~Yn:~X~. And you consider tiffs u new ~ae~ not kno~m Dr. O~t-~. ~o, I {hinl~ it has just become more apparent, ~h'. Mr. S.v~n.:u.~n~. 2 hankvon verymuch. Mr. V.~ D~r:max. Mr. Ehkhardt. Mr. EC~H umr. Doctor, I notifi~ pn pag~ ~ o~ your report ~'ou say 1125 between various diseases and eigarette~, and exphdn that the;~e are not nece.~sarilv meaninghd becal~se, for in~tlull'e, you find l~ high de~]c9 of ~alle~r in a coimtry_in wl3ieh siimkillg is lfghter, lilu~ ~V]lft~ iS really wrong wlfll trying ~ i~xplaln ltway certain aPlmrent conclusmns from laboratolT or fl'om sbttisl~i~fl facts ~ Dr. OK~-. Let Rm start crib by s~lvin~ that I thhlk there i~ really nothing wron~ with doing it if She ,toc:(-i~ ,in ,u, occasion or two, hut when ~/h(~ m~t~rial contil{hes to come in with mm ~act after allothof appear~g to contradict the b~ic theory, it would seem t,, me thut ulibi~ed person would, afbr ~ reasonahk~ period of time, d,'cide that perhaps tim hypothesis should bt~ reque~tioned. Mr. ~c,~{.~h~. I agree. Bu~ it would ~eem to n-m that I~ mlmbt~r wimesses here at thoinstam~e of file ~,}meco industry m}Vh~ be~ to try lo expbdn uwas" the related ~ncidem~e o~ corom(ry lictor, and smoking ra~her t~mn to reexamine the v~flidit,y of t~mir concludon that cigarett~ mno~ng bus not beeu proved There certainly ~re ~ mm~b~r of stmlie~ ia whh.h rafl,,~r ,:aref,d corrections havt~ been made ~or oflter cause~ which h~dimtte It re]athm- ship between coronary hear~ di:~ea~o at leash in men beLwccn 39 and 49, which i~ significantly hi~her than the hlciden,..e of coron,~rv h~art d~sea~ m tho~c who are nonsraokers. _ Yet I h~vc ]}ear~ ilmumerable witnesses simply teatifv lien, that there are eel'tanl other causes tllu~ migh~ result in conhmrv dlsea~. - " ,Ienk~s and his assoclate~ attempt to analyze each group with rections ~or these factors and still como out wifl~ the samo Do you no~ feel .that win, who take the position dmt the. rt~kttion~hi1, has ndt been proven, should ~y to givo us some eXlflanation~ or perh~q,~, lm~ke your own s~udies o~ ~ay, 1,000 persons in tiffs c~ttegor~ ~md N~ow us how thee. t~ts are not accllrafe ~ " Dr. Ox~. I think that is ~ f0ir critici~n of what, I h~v~ ~;aid. I fc01 fhat at th~ same time Z submit that I am alw:~ys willing to reovaluatt, my posltioa wlfich each bit o~ information that appears in t.h¢~ soiem ti~c. literatm'e. I ~eel that in regard to the question of hcai* disease and cizarettt' mnoking, t.here is an abtmdance o~ data on both siden of the ~ue~.thm as to wheflmr or not there is a true caum-effect relationship, which is statistical argument. I dou't ]]kh to declE statistics. I use them in my work ~t, ffreaL But at the ~amo time, I like to respect tho ]hni'tadm~n whbh are t.]m~ one cannot prove ~ causal-effect re]tfl ionshiI,. One o~fly prove an association. :It. LcKmum'r. I *aft to ace ~lCh a ~harp di~inMion between d~tical data and c]hfical data fit this respect. In clinical dat~ you ~ttemptin~, to. al >pr°ximat~, th~ ....... ~anle ~ituation in ,'~ contlolled, t~: group winch ~s usually m the case of annals. ~n statistical clara, ~syou call it, you rtre attemptin~ fo tit to col rec~ away a number o£ factors which lnSF dilute a result. , But ix~ each case you are using statistical dat~ from ~ group that. ]ou a.ro trying ~o make :~ fair and reasonablo te~ on " So why ~his decxving of what you call statistical d~itt~ I~n't, that, ~us~ as ~c~entific as clinical data ~ -
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1126 D,' OKv~¢ ~e~, I think it is just as scieutifi% but the applieat_ion o.~ tlv-~ rc ~ult;~ I thi~ arc ~om~what d~fferent, When on~ demgns a chmca ,tuds:, one control~ th~ variable~ ~ best he can~ knowing what the varlable~ arc. The study should be designed ve~ tightly, very ficiently, ~:o th~ th~ v~iable% except ~or the one variable under TI~_~ ~tafi~ical c~ alua~ion~ o~ the ~orts ~h~t h~ve been made r~tr~:~pec~iw~ :~tud~.c~ all ~o o~n wher~ th~ stati~tlciun in retrospect tri~':~ #o control ~hc varable~ and al~, as ~e do o~en but more o~n~ un~o~:u~atcly~ f~ls to know wha~ a]l the v~riables are. Bc,~tu~-e o~,thc ~kimpine~s of dat~ relating to u pa~icular patient ho may not be able to control • variable in a particular patient because th,r, mt~y ]t~tv, het~n no data given on it. . ~ten a :::tudy i~ designeff before i~ is carries out, ~nen usu~tiy you can hold th,::t~ variable~ con~kmt. Wh~ you do ~ st~tis~ical retrospect :-,Lady, you can't, do thi~. You can only work with the dat~_th@ already available and you are limited by the goodness of the data Bfr. Ec~ln.~Im~. But in the cas~ of eliuical da~, you ~e limited by tlt~ 5,~t, tlt~tt 5on ,tre not able lo precisely reconstruct fl~c that votl are ex~mfininff. So in both c~ses ~,ou have certain You ]top~ to arriv,~ at'~he truth by utilizing both sources ~d coming to ~',o~t~t~thing like a~reement~ is tha~ correct ? Dr. O~lo~. I quite agree. ~fr. Ecxa ~,utdv. That is all I h~ve. Air. ~rA~; DI~RLI>L Mr. Preyer~ Aft. Pt~i~. 'l hank you~ B¢r. Cha~rm~n. I wa~ intcre:~ted in your use of words ]~e "the cn~sading poin~ of y~r¢~ ago~ about ~,~ejudice and b~as. He hsted a number of things ~:,cople thought th~_,y ~new tha~ w,~re not cor~ct. One ~f th~n wa~ that Ari~totl% one of the firs~ and greatest scien- ti~-:t~ w~ convluce,1 and promul~'a~ed tim doctrine that men had more H,. emil,1 lntv,~ eorr~,e~,l lhat ve~ simpl~ by h~ving ~Irs: .~i~tg~le ,1,~:n her ~tnu~h while he etmnte,1. But he d~dn't because he t~ougn, lcu, w, wh,, h~. did not know. I ~alhur that wha~ sometimes angers you~whag makers you make t...hd~mt~tt:~ t~ueh ~ts "witeh-hun¢iag"~is this business of people think- h~Is llt~v l;~t,~w wl,~,u flmy do not. . . On that I might ~u~t mentioua nonscientific bu~ personal survey li,m,,[ poe, pie flwre on Whether people's hmgs we~ ~scolorea ~y hm~.~'~-:." Tlmt b~ ,n ~xanaple ot people "knowln~ something flint u- n'm~~. I t~dc¢, it flaaf, your main thrust, is aga~s~ that. Me. Pm.:r~,a~. You state that you think fl~e presen~ label ~ too sh'ong. Dr. Ot~cr¢. Ye~, sir. ~Ir. ~t~mrt. ~ wouhl ~n~t mention your qu~lifieat~ou~ here a~ di- rve¢or of ,:lhfical phar:m,eolozy at Ce,lar-~.ma~ 3fedleal Center al; 1127 .~_agele~, having just le~t a fellowship in elinicul ph~rmacolo~, at dolms Hopkins. You are as.qistant professor of medicine and ph~mcolo~ at ~h~ U~fiversity of California now, also. With tho~e qua~fications, I would th~ your st~temeat is thing we would w~t to carefully consider. Dr. O~v~. Thank you. ~r. ~ST~oS. Z have no questions. Mr. V~ D~r~. The the.st of your t~.s~imony~ Doetor~ i~ that the legislation tha~ is now on th~ books should be ~tmended to remo~ o th~:~ wa~ing from cigarette packages and go back to where wo were be- fore 196~. That is about it ~ Dr. O~. Wel4 iu ~11 hones~q I haven't Wen that ~ ~cat de:tl o~ thought because this is u matter really out of my realn~ out o~ eont.rol. I would suggest that, if it is felt that there is some ~ort of lahcqing needed on cigarette packages~ I would amend the wordin~ ~o malw re]atmnsh~p between e~garette smoldng and d~eea~% which ~s ~mphed ~] fl~e s~atcment~ a weaker impl~:ation. h~. V.~x D~:~-. $~ now says that cigarette smoking amy be haz- ardous to he~flfl~ and that is about ~ll ]~ says. Dr. 0~. Yes. Something like "ma~ po~siblvl Or "coaceiv~blv." ~r. V~ DE~I,~. My. e~eemed c~ll~a.., ~.leS,'. _ Mr. Satterfleld~ ~:Ir ~rey~r, and others~ are ~ho ~uthors of le~sla¢ma to extend the w~rmng. I would not want. the suggesuon ]eft that they are unnecessarily hamh on the tobacco indust~. Thank you ~:ery mud~, DocMr. Dr. O~v~. thank you. Mr. Sa',~. Would flxe chairman yield ~or o~m question that point? Mr. VA~ DEluxe. Yes. ~1r. S.xv~. I th~k it m~gh~ be apropos here. The fllought occu~ to me tlmt oerhaos we could amend the to read ~hat gmoking may or may ndtbe g~od for you. That is MI, ~r. Chairman. - Mr. ~.x~ D~m~I~. At this poin~ in the record i~ is rc,p.tested tltat ~ statement by Dr. Yoshu~ Harold Burn, be included. That will be done. (~m statement of Dr. Burn follows :) T0 WASWINGTOS UN~'ERSITY~ ~T. LOUIS, ~ am Joshua Harold Burn, Doctor of Medicine in the Unlver~l¢y .f b~d.gc, England. From 193~ to 1959 I was ~ead of the Dopat'tlm,nt nf I-*h~rmtt- col0gy in the University of Oxford, England. Since 1959 to tht, l,r,~:~ent time have bee~ Vi~it~g Professor lu Ph~rmae~lo~ to Wa~hinghm Vn~ver~ity, ~o~is, MLssou~. I hold the honor~ry degree of Doctor ~u the Yale, ~fain~ ~nd P~ls. I have studle~ the a~on of nicotine ~ the human and animal body for m~ny years. I published capers on ~ls subject In the British ~1edlcal Jm~rmd in ~ 1958, in 1951 and in 1959. The nicotine absorb~ from a cig~~rette ts removed from the bitted fairly ra~,ld- ly, and there Is little et~mul~tive effect. By the time a elgare~e I~ finished, much of the nieo~ne absorbe~ when the smoker began is ~flready dc~troS'vd.
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1128 illlttulnt -f nhtdhle |n ~t ~.tgarettc cannot be stlid to be ham~rdous to health. 01~ the ,,,itte~lry thvrl~ i:~ tt ~ro~via;~ body n~ vvfdenee that nie.tin~ is siimnlating hvnelbqal acti.n t~; now known. A~ION OF NIC~INE I~ THE BODI" 'l']wrv are bye acclaim of nicotine whh'h ar~ often described by laymen. TB~ I/liP J~' that It ]ln:t A ~timuhmt action whl~ is evident when a cigarette is smoked d.rhtg a l,*.ri,,d ,,f m,:nttd t:onccntration, either in reading a long and comp~eatcd :~tat,,mt.nt, or in llstcnhtg to a detailed argument ~ in a lec~re. I have :-tad, qlt:~ In St. Lotlli~ attending three ~)r four locates during one morning who Th. ~vcOlld atqhtIl is a ~;edative action. During the Firs~ War it was common I. a.tb-~, th~ ~.ff~.*L of ~,l.qi-fire oa a party vf ~oldlers engaged ~n some task near Ih,, Frmd I,im,. If afb.r a verhM in whivh conditions were ~acfful, shells began t. fall mtt f~tr aw.y, ~.blicr.s wo~fld light cigarettes. This seemed ~o be done for Tin, r,~l~e~qdIol~ 'that nleo~m~ can ba~ stimulate and e~ also produce ~me ~'tl~ltho ~:v/b~lt st,eals at first r, lght difficult to acce~t, but evidence of hath effects Mare ~:tudh,*, of nicotine have been made with insu~cient regard to ~e dase~ n'ed. Thn. ht exgerlrm,~tal work rat~ have been given do~es far larger than Ih.,'t~ rvFeh,~,d hy amn In ~moMng, that is con~hlering the ranch smaller weight .f the, rat. Arm*r:~ge {19G5} has fom}d that the amount of nicotine entering the hb.~d of a ~molwr who Inhale~ is in the range of U0 to lYD mierog~mns of nl,,e~tln,, p.r DUff, which 1~ nhout 1 t~ 2 ~th,ogr~uls of nicotine ~er ~ogram bo~" w¢.ight. If tlw wlume of each puff is identical, the last p~ of a cigare~e con- 1~On:~ tw..r lhreo flme~; as ~l~cll nicotine as the first puff. It is also lnteres~ng lhat tht, t,ffe~.t tn rai,~lng ~]m hlootl pre3:~uro of a glngle puff of tobacco slnoke xer~, t~i.lilar to lho effect of the same amount of nicotine when given intrave- molvly. WhD'/~t~]y of the a~o~nt of nicotine taken in, is on~ o£ gr~at importance ~inc~ it l'~ o.xe fully ~ upportcd by detailed evidence than any previous study. 3"i,'.tll.~ action o~ cJfor~ Tile '-tln,lll:trlt :teflon ~f nleotln~ on tmneenrratefl effort has been de~nonstrate~ h~ ratq lo,pt without water for ~0 hmm~ to make them flflrsty. ~he rats are then lda,.ed in a box nne at a time. The box has a lever on one side which is near r.Ulld h.h* thr,m~h which the rat can put itg head. Wile rat ~on learn~ that pr~: ~ln~ llm h~vcr 1~-~ felhm'ed by the presentation of a drink of waler which It liml:~ In ~l t,up when it lmts its head through t~e hole. When the rat has learnt tMs, tl., water h~ not pro~'ented every time the rat presses the lever. ~ut onkv hdormlttently, nn uvora¢e once every ~ minnfe~. When i~ is trai~ed, a rat will prey: lho levtT at about the tame vale from day to day. Each pressure is recorded rat prv-:-'t,,~ Htv levvr daring tim eour:.c of la~ hours can then ~e determined and l~ ]lil~ h*'vll ~'¢llllld [lta[ certain rinsed increase the numher of time~. ~owever, ~e M, .I hi,, u It.-: ~h vii I~x ln.ieetiou int. a vien of the eon~rious rat without the animal I.qll': ;~Wilrl' IIn,f tim tllieethm was hein~ lllOdO. When a rat had heart trained. skill tit tilt' I,:a'k ,,f tit,' noel~ and tted In the jugolar vein. The rat then recovered brad I. llu+ lop r+f lhi+ oxgo where it was attached to a swh.el Joint. Tho rat i+tqlld then rqn :d+out the cage withont twistin~ tlm tube. At the ~wivel joint the ~:~dlllJt¢ll a~ It ~-/f':xdy rate Into the vein of the rat to 9revent a clot forming. rl*llt.l~ lhv rat w~lt: h':ted till Day I to v:eo how man~ times tt pros~d the lever for Wilier lit the ereu':e ¢*f 90 mlm~tes, q2te rat was tested on Day 2. bnt on this .ct a: l,,a It rt,cotvcd a ::nluthm eontainin~ nicotine of which it received 2 micro- ~ram,. at bmrvah, ef 30 sac for 1~ minutes. This ammmt was eqnivalent to a 1129 "smnldng" dose *.',',r a man. 't'hen ou [ilt[ ;:~ the exl~orinwnt varrlcd ,,ut on Day 1 was repealcal. It was found that iu many rats there was a ~reat ill, v~,tlt*e in thv number of times tl~e rat Dressed the lever on Day 2, Thus in tree rat thv were: 8aide--Day i : Lever prosged 53S times In 90 mhmte~. Nieatine~Day 2: Lever pressed 3.1:la times 1. till mlnute~;. ~ali~Day 3 : Le~er pressed 714 tim~ in 90 Thus when the rat ~eceived uieotlue, it~ tletermillati.n to ohtatn uater l,y pressing the lever wa~ ~eatly ioerea:~ed. These expcrlment~ were very to carry ou~ successfully, and ~eat credit is duo to tile worker~ eoneerned ( Arad- Cage, Hall and Morri~on, 19~;~ }. Experlmen~ of a different klnd have been pe~ormed by other wnrker~ which have shomI Chat the process of ]earning is lmstened by in]ection~ of nh,.tlne. ~us rata ~ve been placed in ~x ca~e with a metal grid a~ a rio.r, tln'..gh which an elee~ie shock can ~ passed, They eaa c:~cape the shock by Jumping from a compar~mnt on one side of the cage ~ver a barrier to a ~-:eeoml payment on ~e other side of the c~ge. & light is ~urn~ Fm 5 ~ccontl~2 the shock is applied. Ia fl~e course of a Sew days the rats~ learn t. :h~mp tim baxrier when they s~ ~e light, and thus e.~cape the shock. Each day tt rat is glven ~0 trials. On the first day ~e rat escapes the sltoclz enly tater twice. By the fourth day he may e~eapo the ~hoek a~ many as fo~y tiute:~ mlt 0f ~tY. Bevel (who received the Nobel prize) showed that rats injected with nicot~e le~ to escape the shock much more quickly. ~'icotln~ o~ the deetrocort~eogram Observations can be made of the el~rlcal changes whlc~ ocenr la the e.r~ex of the cat brnin by u~ing tim preparation RnOWlt as fine "encephale i~o167' ht ~ueh a cat which is sleeping, the ~Dlcal electrocortie.1 waves are what called s~lndles~ .the waves are of high volt~go an~ are slow. If th~ cat aroused ~e waves b~ome faster and the voltage Is medium ; fl~erc ar~ spindles to ~ s~n. ~i~ a further arousal of the cat th~ waves ar~ faue and low voltage. Finally If the eat ~ake~ up and 1~1;~ around, the low volta~:, fa.t waves continue. Experiments have been done tn which nicotine has been giv0n to the eat la one ~f two ways. Either by intravenou~ injeetlou or b~ a Imff nf el~aretW ~moke. In bo~h eases ~he amount of nicotine ~ven was e~luivalent to a do~e. Thus 7 micron'ares of nicotine ia cigarette smoke wa~ ~lven ~o a cat weighing 3 kilo~ams, whlch is equivalen~ to 140 mlc~ogranm for a mad of kilo~'am~, q?he effect of tl~e nicotine either intraveuoa~ly or in the eb~ar.tto was to produce a change from slow waves of hi~ vtdtage to faat waveq nf voltage tn the course of 8 minutes. When the nicotine was stopped, the waves of high voltng~ return~ aml ~e cat uas asleep agatn. The:~e obtained by £~itage and ~all {19~.;8). shr, w the stlrmdant effect on tl., brnh-~ wi~ great dari~y. Fol~nFtHo*b el She eubsLanee aeetvleBoHne In the hrain there are many ne~-e fibers, whteh like telephone wlre~ carry messages from one part of the brain ¢o another. When the mt:,~a~e re:tehv~ end .f the fiber it releases a chemical sulstance which exortv t,ertatn There are d~erent chemical substnnces released in flds way b~ diff,.rral~ fihor~, but one of the mo.gt impartaut of these substances i~ known pq neetyl- choline. This substance pro~uces the effect r~tulred and ts then raDidly desire v The nmonnt of peotyleholino liberated hy tho terminations o[ ~u.rve fih:l'~; considerable, nnd if its de~lrnotion ~ prevented, then dearth.hell,to h.al - ,ul the brMn on to its sa~ace, wh~re it en~ be e~lleeted~ Th~ when :] vat 1~ illtll~,r Hn nnestheUe it~ brain can he expO~:ed, alld a ~Inil][ cup fan be aFI'ItTLgPi[ tn wbh'h the flllid earning out of Ihe hrMn on to the sllrffloo iq f,¢dleetotl. In lhe Of the snbstance of lhr:,nsfimnine, the aeotyh.holino i~ ~at de~tl'~y*,d. ~tt~tl the When nicotine is elvon to the- eat in nn amannt eort'*,~Dondht~ la ~t Sltltd;ht~ dOSe. tha effect eomuimlly scou is flm~ the amount e~f :teety[elu~llap forllted 111 the cup in whioh tt ts collected i~ greatly increased, perhaps donldt.d. Tht~ again ~oints to nfeofine producing increased h~tin ttotivity. ~horo Is however n dtfforont effect, which tv~ also o~ great intore:~t. Tn eats iL is fonnd tlmt the farmatlrm nf aeetyloholtue g.e.~ on at o nX~lvh hi~.~h,-,v rate than n~ual, and re~lahlg nt thi~ height. When ale.tim, ia adntiat~¢er~l, ih~,
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1130 rat. ~f f.rnnition t~ not in.re:l~ed hut tg dimlnL~hed and remains diminished for ),,, dbatnl,~h.d hy nicotine. ~o that here is a b~si~ for a ~edatlve action shown ~lo.itln~,, Will,It hlJcnb-~ into a vein, or when Inllnled in ~ puff of cilirette ~moke hilit lilil, i~g th.' hidlow ~-ltaef,~4 ill the, hrahl lmo~m as ventricles, a d~erent effect lil,ll,,ltr~ t,i l.~, vauoe4 by the ~tqea~e of acetyehollne, for in the presenc~ of physo- 14[J#lDThle~ w]lil,]i llrOVOllt*~ the destruction of aeetyleholine, the fall of bloc6 pres- i,llro eltll, t~il ~ly lil,',,~thm l~i greater orl~ lno~e prolonged. The fall of bloo~ J,i lie[ ihb< to a ~ I¢~willg tit the heart rate. ..~, the l.ll,.~d l~r.:%urt~ i~i alway~ e:ven to ri~e. ~owever an effete of nicotine ~ brahi ljtliy dlmilii:.h the rl~e of blood Ilr~sure caused by nicotine acting on r~)mpath~,tlc ~anglla out~dde the brain. At present the contr~b~tion from such .,:tl.u .[ llb~.lluo wlihhi the brain on the overall effect on blood ~ressure du~ng I~Jglti'0itl, Nlll0klll~ t¢7 not known. However the occurrence of the depressing effect .it Ih*, hhl.i1 lllt.~v~l.lrc 1~ certain, and ~hows that the continued study of the action Lllmlblllli Ill bf~l ;:tndie~ of the effects o£ smoking on eo-t~v~s, one of whom ~as.,lo,d whlh, llm other did not, retold that "the smoking co-tw~ usually had a h,n,.r bb,od pro,;:,nre?' Thus be 2ound ~o evidence tha~ habitual amoking had the pttrt which 1,, converh,d In thi~; way ts of no use for carrying o~gen, though, if the ~ r, ttddnZ : tep'*, flx~:,re i:: a gradual zever~ion of the carboxy-haemoglob~ to the r~a~:.n to tltink that thi:~ reduction of tim haemoglobM is a factor of importance conoll~/~ ~a tltt' lft(l:~ Sur,fdomont to the 1937 U.S. Public ~ealth Service Review, with rcs;i.:ct to eardtora~:cular die, earle, on p. a3 it i~ stated that cigarette smoking raM. have a htgll~?r coronary heart did:ease death rate than non-smoking males, aml that thPi death rate ~ay be 70 ~r cent greater. In 1967 there were 667,710 tl,,a/h~; In the W.S.A., or ~1 per cent of the total of 1,D33,~ deaths. Clearly core- Ou tht~ f.llowluz page of the ~upplemen~ (p. 14) the coronary heart disease d~ath~ t~re given 5:~r the U~itcd State~ ~ 1~, from whi~ a simple calculation (h) under 55, the: coronary death~ were ~0.5~ of the total. (e) nmler 65, the, coronary deaths were 27.9~ of the /o~al. ~d} nmb,r 75, the corona~ deaths were ~6.2~o of the total. (.) under ,~5. th~ coronary death~ were 8~.2% of the total. Tho~e lig~r,:~ ~hnw tha~ 39 out or 40 coronary flea.s occur after the age of 45, althovigh lwaxT elgarctto star,king goe~ on between ~ ages of ~ and 45. Aga~ 7~.I per ccilt ttf the deaths, that is almost 3 out of e~ery 4, o~ur over t&e age of ~ ~ D out of 20 oee~lr after ~e ago of 75, and finals 1 in T occurs after the age a dl~;oa', e r~f the ~fld, that i~ to eay it t~ a disease which causes death at a wkea ~,'nplt, tile tn any ca~o, when, if they did ~o~ die or coronary disease, they The bald :~tatenwi~t that 31 per cent of the total of deaths are due to eorona~ ,II~oa~,., by lt~clf ~urge~a~ that there would be an ~ormous saving of Hie if ~ese ,1,aflr~ c~.~uld h~ pr~venied ; but that is not so, as ~ clear from ~e age at whic~ 1131 l~actors involved in coronary deaths The hear~ i~ the organ which must maintain its activity ~vlthout p~.ta':,e until dea~ All thugs which may hasten the time when It b~omea wore nat, will increase the deaths from corona~ disease. The hea~ will continue IL~ contrac- tions for a longer time in those who rake reeler ~xer~se than in ~o~,~ who da no~ take exerciue. The ~jea~ is weakened by alcohol because the output nt blond from ~e heaxt ~a~s wh~ ~cohol is pr~?sent in tho blood. The eontraefll, force the h~r~ is weak.cal. Those who dr~k alcohoI mu,~t therefore lncrcm~t, th¢~ rate of the heart beat h order to maintain the output. 'F~e strain on th. h~tr~ i~; creased by la~ of sleep since the work required of tim heart i~ at it~ lowo~,t fl~lng sleep. 'rhe strain on the heart i~ increased by overeating. ~ine~, a m~tput of blood is required to provide oxygen for the ~s~ue~; of a man wclghinf? 200 Ibs ~h~ for those o2 eat weighing 1.10 ~ then an attempt is to be m~ade to determine the po~:~iblo effect of cigarettes in causing deaths from coronary disease, it is necessary to a ~oup o£ nonsmokers with a group of smol:er~ who are identical wlth group of non-smokers In ~e amount of exercise ~ey take, in the amemnt alcohol Otey drink, in the amount of sleep they get, in flteir body weight, aml ia the stress to which their work sub~eeta them, Of eour;~e i~ is very di~cult if ~ot im~asib]e to make ~,ucb a comparl~0n, and su~ a comparison has never been made. For this reason the various pros~cttve studies which have been Dubl~ed ar~ or little value. !f the question of exercise ~ comddered it 1~ commoner to find tho,,-,e who take regular excrdse among non-smokers than among smokers. Slmilarly It 1~: co~oner to find those who do not drink alcohol am,~g those whu are non- smokers th~ among ~ose who are smokers. In general it can be said that non- smokers dtff~ from ~mokers not only In their smo~ng habits, but In the pri- ority they give to health. ~Iany non-~mokers ,are ~rsons who c.ntlnually take decisions mainly on the ~ound of health. Many smokers, ~rtlcularly hea~ ~mohers. are person~ who pay no attention to consldera~ons of health at all It ~ 0mrcfore not a ma~ter of surprise that e~okers have a high~,r ineidt~not~ of coronary disease than have noa-smoker~/, It is exactily what be predicted. But this greater incidence among ~okers may have no relation saloklllg Whatever: it may he due to the greater frequency with x~hleh they ~sregard considerations of healfl~ in all ~at they do. Ooro~le~W disease ~ identical twins 8o far ns the evidence concerning 3 relation between smokh~g aIid cor,,aary heart disease depends on the large prospective studies which have been it is inconclusive for the rea~c, ns given. There has however been a ~tudy, earrlvd oat by Lundman ca twin~, which is the nearest approach to avoiding tho~e mtmy O~erem'es between ~moker* and mm-smokcx~ which cannot be contr.lled. It is w~ll I~mwn that idenlical twin~ have ~;l~ilar habits and their attitude life and their choice of priorities is also similar. L~dman used a ~erles of [~t~ sf whom ~2 were ldonth.al twlus and 10~ were nomldenth,al twin.t, behtg like.sexed bairn aged ~S-~7 years. In e~ch pair one smoked m~d the ~ther did not, They il~l'eed iu re~eei.t 0~ their ei~i~'onment In that they had lived for rot.ire than hal ~ their life in n largo t~wn. Lundman'~ re~nlta were that~ "~ere was ~o e~e~.ss morhidl/y from overt coronary heart dh~.li~a in ~mokin¢ co-twlns. Th~ same *~ppltes to silent coronary h.art tlL~ea~e by means of post-exerci-'~, eler.trocardlog~nphy. The fre~lUenCy of ~'E tloDre~.¢ion~ (indicative of coronary ~easc). on ~e other hand. #awcr fnr ~m,,ker~. probably h~eau~o they did act achieve the ~ame of r~qa t~ve load a~ tlm non-smokers daring the exereI~ te~t. • 'The levels of the ~eram lipid'~ clmlesterol and trlglycerlde:,; were on ave~- age ?0wcr for fhe smoking monr~zygotic (identical) ell-twins, but the differ- ence was vet ~i~ifienut. Ti~e ~:moking di~ygotte Wins dial,layer1 a ]dghvr phospholtI)id ]eve] ; ~hi~ would suggest the pre~onee of it difference between smokers and ~,oa-smokers." ~lese result~ afford no supp<*rt whatever to th~ view that ~mohing increased coronary hear~ d~sease. They con~adiet i~ ~iga~ett~ s~oldng lg Is free that in the last sixty years there has h~n a great increase In retie smoking. ~i~ increase was noticed during th~ First Wnrld W~r, many soldiers, a~d the d~mger~, auxie¢ivs and boredom of trench warfare
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1132 ¢d~ ullm'l(:q in whh.h tla~ casualti*:~ were high, became ha:ivy smokars, aml eon- XVttr/hat tt~y :-,tt~ph.ion xvfl~ voiced that cigarctte~ word harl~ul, mid this arose as tuhvr, ul,.~ 1~. had ,]J~c~,tcd ltllleb olo~et' attention t~ the lung~. The eceur~uce of ];d.qJl~l~ arid udrcrlb lr~g in ~Iarch n/td AI~ril 1965 Dr. Duane Cart" said that the a re,w. inter,,: ted lind trained thor~eie ~urgeon. About 1950 file question was ral, ,d wbt~tla~y t:ig~ty~,ttc ~mt-,kln~ was a ~u~e of lung cancer, and studies h.tk In the U,ited 8tales and in Britain revealed that many patients with lun~ Th,~ It,,gi~;trar.t~e~cral publi~h~ annually a record of the number of deaths ~rom all km,wn eaw;.:~ xqd,:h bare ~cm'z~d in Engh~d and ~ales ~ the pr~.eding ~c~tr, ~dvip~ :el,~).rate ~igurc:~ for men and women. Table 1 shows the numbers reeler tht~ lwadiog Mall~mant Net.plasm of the Respirato~y Ssstem Ior the years ~r,mt l~G7 b} 19t;-L In each year the nun~er increased, both for men and for ~YIIleCII, ~t~ the pr~qu~itm of men to wo~es eh:l~ged very little, vmTh]g only ft',,It~ 5.11 In 1~t~I to ~.3 tn 1964. The rlse ear be exptalnc~ as due to increased care ta ]tlltltlll~ fl~r c;l~ L'N O~ lllllg eflllcer, ~xo~o of which were previously r~orded as Of th,, ea::~:-¢ r(~orded In Table 1, the cancer in the lung may not hate beam Ihvrt,, hut nlay l~ave ~pr~-ad to the lm~g from another organ. 'l'hus cancer may ]*vl;hl tit tho ~tomat.h oval titan ~pread to ~e lung. Unless a post mortem exnmina- tiun 13 made, anti tbl~; Is done only whcll the ~aUent dies In hospital, no decision t;t p.:-,Hhle whether tht, cancer begun In the lung or not, and if it did not bo#n in the ]IID~. It could not have been ,,aused by smoking. The ~ogisl~]~'-General has ll~th'd lit t]lO lunff. TId~ J~ headed "'Bremchus and Truehe:l and of lung art IWlwary." Tttkh}~ the year l~GS, tha total of t~tllCers in ~e hmg was 23.931. ~vhorea:~ for flio~e F,[t):)rllled :IS primary It was 15,4C~. Thus name or all of 7)863 ~'Jle u.tual invhbulea of the db'eave according to age is Mlown in Table 2 for the ~t*ar lll~tl, rY]l~ t.tal nmnber of men who died from lung cancer wa~ 20,289 and Taldc 2 :~ltttw~ fltat the nnmber who died under the age of 45 was 598. Thus the l.~r,,cnlage who died under 45 was 2.9t. Similarly the percentage who died under 6d ~a:~ 7.4, after which the number dyit~ was much larger. But even the men x~h. dlrd mnh~r tlm t~ge of fi5 were little more than half the total, being ~. lu 'l~dfle 3 arc giwm the percentages of men dying helow different ages for ~ht~ fbX,:c y~:a~':¢ lllUI, I~IU-I, 1966. The table ~hows that under the a~ of 45 deaths ul IUI, Ihe deaths are le~s than one-third of the total, from which it follows that t~~-lblrdtl of the death~ from lnng cancer are in men of 60 or more ~-ears ef ~tl.~,'..khont ¢fl~e half of the deaths occur over the age of 65, trod 30 per cent occur ~tv01' llt¢. ;~ffe of 711. It ~houhl he noted that each perc, vriLqge is lulling from 1961 Tllt'::o ~e:-3llt~ shttw llmt erlneer of the lung iS in ~e ]aai~ a ~fieas9 of the old. MIIII~" h~:: begin tit vliioke tit the ago of 15. ~ey continue to smoke slid reach lh,,Ip twentl*~tlt, tht~ir thirtieth and Hmir fortieth birthdays as heavy smokers. Set durhtg llu'*~;c 25 Scars they do not devolop lung cancer. It may be emphasized tqltlJ~ Jhat two-thirdt; o£ tile eat~es of llulg ean,'er occur over the age of I .ht,P f.rm, .f ranter have a very similar incidence In relation to age. In Table 4 al'l~ t~lv,,n l}~lro~ fi}r the l,~rc.n~tge~ of men an4 women dyBl~ under ~e age .f 15 :rod reeler the a~e of 65 from lung cancer, gastrointest~:d cancer, breast 1133 ilud genico-nrinavy etulct.r, aH well tts from canet~r ia all forms. The ll~ro~ are tar at~ and show flint there i~s no real difference l}et~ ('t'll lung (-an.at :rod Dtlalt.4 Of t-acute ,So ~Or its incidence at the~o ages i~ concerned, filial this agrcc- is,rot e:~sts grave doubt oa tho view lhttt cigarettes e;tuso lung caaeer~ l¢,r if they did so it would be expected that the age at ahich lung c~t~tver ~uld ~e related to the date at which smoMng began. Pas~ey publl~he~ a t~tudy iu 1Ufi2 whk.h shewe~ that there i~; no relatlem between the age of on~.;ct of easter and the first'at which ~mo~ng bering. He fle~:erlbed abe group whivh began to smoke between the ages o£ 6 and 14, in which the disea:~e develoi.2d at the average age of 58, and another group whieh began t0 ~moke betw~,en the agc;~ o£ 25 anff ~ ; in these the disease devdoped at the average of G2, that lt~ ut practica~y the same poinL Similarly he ~oun4 ~at the number of smoked per day had no r~lation to ~ y~ar of o~et of lung can~.er. Thu~ those who smoked from 1 to ~0 elgare~es a day, it began at an aw,rage a~o ~,f ~9, ~md ~ those who smoked ~rom ~ to 60 eigarettez a day it ~gau at average age of 57. ~e ralston of ~garette smo~ng to l~g ~ncer Is therefore very different ~at of reco~Iz~ carcinogenic ~bstances ac~ing in industfles where oc~rs, su~ as ~at due ~ B-naphthylam~e. ~hose exI~sed to Bmaphthyla*~dno ia ~ar]y manhood died of bladder cancer ~ ~lddle 'life, while th~:,s~ flrs~ ~osed in early middle life di~ ia ~e~ la~e ~fles. There wm~ a dcflnit~ b~v~n the ~st ex~sure ~4 ~e onset of lung caner. There i~ no ~,uch i~t~l be~ve~ ~e beginning of smoking and ~e onset of lung caneer. ~ese ~olnts in~cate tha~ cigarette ~oking doe~ not cauze l~g cancer. thca Is there a statistical relatiom:hip between smoking and l~g c~ce~'7 do not know, but o~e ca~ specxllate a~ to several po~:dbilltie~. For ~xam~le, the~ is a grea~ ~rence ~etweea ~ndividuals ~ ~e impvrtmwv they We to healS, and a~o ia ~e amount of se~-control ~ey po~;~u,~ In avtdd- ing excesse~ which lead ta ill-health. Th~ at one extreme ~ere are ~e smokers a~ong whom there a~e ~y who do not drink alcohol. Thc~',e men arc set.tamed to ~~k~ exegete a~d to avoid overea~ng. At the other there are the heavy smokers among whom there are many heavy drinkers ; they arc often men wh~ do not take exercise and who eat too much. BctwPcn two extremes fl~ere are ~ose who smoke, who drink, take some ~xer.l~e and llku good ~ood to va~g degrees. ~e,~ comparisons ar~ ~ade of ~mo~ng habits, care should be taken t. tha~ the ~mpar~ons ~e made be~een groups which diffe~ only in thoir habits, and not in their d~n~ng, tlwir eating and their exerci:~e. But thi~:; b; done. ~he ~es~ts of ~e compax~ons are ~id to show ~at thero 1~ a between cigarette smok~g and lung cancer, when they show only the cffect ef habits o~ life which are common among those who ~moko cigarette, aml ralston of these hahi~ to lung cancer. 7ABLE I.--REGIS]RAR-QE~ERhU~ STATISTIOAL ~EVlEW OF ENGLAND AND WALE~, D~ATHS FROM MALIGN~rIT NEOPLASM OF R~PIRA~O~Y S~ST£M MOll ).9s6 ............................................................. ).~ 45z ~.~,~ ~.~-t 1957 ............................................................. 1/',2).2 2 V~S~ ..................................................... ).~, s~ ~'. 1960 ............................................................. 19'759 S, 4~11 K 1-1 l~t ...................................... ~o:~8~ :~,~,~z ~.~-~ l~fi~ ............................................................ 22:236 4.1al
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1134 'r^tlLE 2.-TILE P~EGIST[tA[I-GEflE~AL'$ FIGURES FOR D~TH5 AT DIFFER~tT AGES F~OM LUN¢ CANCER ENCLOSED AHD WALES IN l~6I [D~aths are Irom m~l~g~a~t ncop~asm~ of [he respiratory 25 to ;~!} .......................................................... 21 6 27 51 18 63 1t0 to ~4 .......................................................... 1E8 67 225 ;t't to ~'1 .......................................................... 3~s 110 478 4~ to 44 .......................................................... 916 232 l, 148 4~ I,i 4~J .......................................................... LO 4 . .. 1,~97 323 2,320 'A In ','1 ..................................................... 3,331 400 3,731 4,122 550 4, 67Z (;~1 to (;4 .......................................................... 3,8E3 577 4 405 h~ I,~ t,q .................................................. 3:385 70 IO ~4 .......................................................... 2,872 513 ~, In "l'! ........................................................ l 7i4 403 2~ 117 ' 6~9 25¢ 943 ):i) Io I~ .......................................................... H~, an~ ~w~ ...................................................... 207 103 310 TABLE 3.--LUN~ CANCER IN MEN Ilho t~u~ d~w fh~u~.bcr ~ho died b~ ~w v=z~oua aE~ cxprc~cd o~ o percentage ofthe totalinthe 3 yea~ lg6l, Men dying ~r Under45 UcderSO Under60 Under65 Under2o ion| ............ 2.95 7,4 33.7 04.0 73.0 z~,~4 ............ ::::::::::::::::::::: ~.7 ~.3 ~0.~ sz.7 yz.~ 1~ ................................. 2,4 5,9 28.4 49.1 69.8 lAdlE 4--~E~I hI~ WOMEN DYING F~OM C~CER IN EI|GLAND AND WALES [H 13G4 Percentage dy|~g Under45 Under55 years yea~s 6.2 =3.0 ~II fimnm ~f cazicor .............................................................. 3. l 49. 0 ~n~ r~fl~r ................................................................... 3.0 33.0 I~w.~::ta dl~ to,~zi~ary¢~z~cr .................................................. 7.2 45,0 ,~,rmiI~;~,, A. ~. ;~n,] Hall, G, H, I!-IGS, Nicotine, ~mo~ag and Cortical Aetiva~on. Nat~]i',,, L,J~d,~u, vol. L"JP, ~p. 117~1180. Av~It,g,,, A. K., Hall, G. IL and Mo~i~on, C. ~., 1O0S. Pharmacological basis the tohacc. ~-~m~l~g habit Nature, London, vol. 217, pp. ~h~rr,~tt, $~t,ym,,x,d $,, 10¢J5, Hearln~ before the Com~ttee on Commerce, U.S. E,x~t~w, SPth C,m~rer~. Fir~:t Seae~ion on ~. 5~9 and S. 547, p~. ~700. Lund~an, T, 196~, Smoking in relation to corona~ he~ d~ease and lung tlua iu Twla~. Acta ~Iedica ~can~navlea, voL IS0, Supplement 455. lhu~r;ey, R, D., 1~2. Some problems of lu~ cancer. The ~ancet, ~p. 107-112. Itv~dth Con~:,~qz~em~e:~ of Sin,king, Public Health Service Review: 1967. H~,alth C,m~,~.qu~nce:~ of Emo~ng: l~S. Supplement to the 1967 Public H~I~ ~ervlce Review. 1~,92, DIareh 6, tn Barnard Castle, Coun~ Durham. ~,~,~ ~ )1 -~C'zmbridg~ Uaiver~ty, E~aauel Co~ege. fli:~, ~'~x~ua~,-Oct,.,be~X~lstant P~macologist to Burroughs ~eilcome ]f;l~, 0ctob~:r to 1918, 3a~ua~y--Lteutenaa~ Roy~ En~aeers, se~v~g 1135 1918, l~ebruary to 1020, 3une---Guy's Hospital, London. Completed studies. 1920, September--Pharmacologist to ~attonal Zn~tute for Medical ~earch, 192~19~DZre~or of ~harmacologZca~ ~abo£ato£le~, ~hacmuceuti~l ciety o~ G£eat 19~1937~ofessoc o~ ~ha~acolo~, Loaflon Unive£slty. 193~-19~zo~ssoc of ~harm:molo~, Oxford University. l~Jsi~ng ~rofessor ia Pharmacology to Washington U~dver~lty, Louis, Missouri. ~ellow o£ the ~oyal ~octety o~ ~ndoa Hoao~y ~ellow ~f the Natiomtl Institate of Sciences of Xudl~z. Member of ~e Deu~che AkademJe der N~tuz£or~cher Member of the Czechoslovak Medical SodeEy, J. E. Honora~ Member of the Deut~che PharmakologJ~ches Ge~,~ll~chafh Honora~ ~1~ber of the British ~barmacologtcal Society. LcoSurcships Abrah~ Flex~er Lecturer, Vanderbllt University, Nashville. Na~hanson Memorial Lecturer, University of Southern 3e3se Boot Foun~tion L~turcr, ~otti~gham, Eaghmd. 3oha Pur~er ~Iallett ~ct~rer, T~inity College, Dublin. Dixon Memorial Lecturer, ~oyal $odety o£ Medicine, ~ndon. Blolo~eal St~dardizatton. Oxford Univor~ity Pros~. Background to Thera~utZes. O~ord Universi~ Func~ons of Autonomic Trans~tter~. Williams & Wl]kin~. Principles of Therapeutics. Blackwell Scientific Publican, ms. L~ture Note~ on Pharmacology. ~lackweil Scientific PublicatJolz~. The Autonomic Nervous System. Blackwell Scientific Publicatlo}~. Drugs, Medicines and ~£an. Charles Scr]bner's Sons. Our ~Iost Intere~ng D[~easeu. Charle~ ~cribner'~ Sons. Galzdner International Award, 1959. (Six ~ho,sand dollar~). Sct~Zedeberg P~ke~te, 2967, awarded by the Deutsche Pharm~l~ologl~;chc, GeselLscha£t. The o~gen capacity of blood considered in relation to the ,~e,r**:'entr;,d0n haemoglobin, by 3. H. Burn, 3. Ph~siol. 1913, .~, 482. Dete~inagon of the constant of the differential blo~ gas apparatu~, wRh note on the specific oxygen ca~aci~ o£ bloo~, by J. Bancroft and 3. ~I. 3. Physiol. 1913, $5,493. The ac~on o£ coaesslne and ~nlarrhe, tae. the filkaloid~ of IIoZarrh~'~za gole~s, and also ~£ oxycozm:~bm, by 3. H. Bu£n, 3. Pharma~l. 1~)~, C, The ~c~n af ~r~zia qaate~avy ammonium bases, by 3. ~ Burn and ~ ~ Dab:, 3. Pharm~zcol. 1~15, 6, 417. The relation of nerv~supply and blood flow to swea~ng produced by piloca~Dlm,, by 3. H. Burn~ 3. Physiol. 1~22, 56, 232. Re~or~ on biolo~ca[ ~tandard~. L Pituitary extracts, by ~. H. Buzz and H. Dale, ~Ie~cal ~rch Council. ~is ~[aje:~y's S~Sone~ Office, The modification of ~he action o~ Zrzsu~n by pituitary e~ract an~ othc~ ~taaces, by 3. H. Bu~, 3. Physiol. 1~23, ~7, On the location ~d nature of the ac~ou o£ lnsull,, by 3. IL Burn awl H Dale, J. ~hysiol. 1924, ~0, Insulin and ~odi~ acet~acetate, by 3. ~. ~urn, ~. Phy~i~l. ~92~, 60, 26P. The z~lation o~ the thsroid gland to ~e action of ~uli,, by 3. H. Burn and H. ~. ~a£ks, ~. Physiol. 1925, 60,13L The ~ec~etion of s~eat and vasodilatation I¢oduced by pil~carpiae, by 3. Bu~, Y. PhysioL 192~, 60, ~e vaso-~ator ac~oa of histami~e, and iE~ physiological s]~caace, by J. ~u~ and ~. ~. Dale, J. Phys[ol. 1926, 61~ The biologic~ assay of the s~eciflc al~loid of ergot, by J. H. Bu£n and 3. ~fary EllD, Pha~. Y. 19~, 118, ~.
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1136 q'q~*' d-'-,v~o ~nd ,t~4h,u. of 1)ituitat'y ~,.xtrnet nnfi of the ergot allzaloids utt ~.n:4 ill ]/tbt/ilr~ ~lfh a llOte on tim m:tiou o£ adrenaline, by &. Bourne and J. H, ~tun,, J. Ob:~t~,L GynaeeoL 2927. 3,~, 249. Tht~ :.tan,bird for the bl,.,1,,gtc,d a~say of squH], by Z. ~ Burn, Pharm. Tim x,rhtti,n In the unit of fl~e ,~t~us-producing hormone, ~y Ka~arlne C,,t~ ard and J. H. Burn, 3. Physiol. 1927, ~3, 270. Tl,' l,harl.,~:t,:,l,.,~lcal a~Jay of digitalis by different me,otis, by Z. W. Ells, B~,~,cI¢, J. H. Burn and if. H. Gaddum, Quart. ,L ~harm. 19~, 1, Thv ,,ffveL ,,f iar~aliu on aevt,murla, by ft. H. Burn and H. W. ~ng, ft. Physiol, Tim ',y~tt'rHb~llc ~tetloll Of oe:~trln al, d pituitary extract on the i~olated uterus, by A. W. Rournr~ and J. IL Burn. Lanc'eg 1928 (it) 1090. Tim a,:tb,u of oxytc~eln aml va~opressia on ~e ute~s in labour, by k. W. lt,urm:~ and X. H. Burn, Lancet 192B (11) 694. O~'t.cln and va~:nl¢Cv~in: a further examination o~ the separated principles .f Idtllilary (p~.,:~terlor lobe) extract, by J. ~. B~n, Q~ Y. Phi. 1ff28, A v./apari¢'on of the oxy~oeie, pt~sor ~d ~tidiuret~c ac~vities of eo~ercial ; ~ntqdt~:t ot ldtuitary extract~ by U, G. Bijlsma, ft. B. Burn an~ ft. ~ Gaddum, quart, if. Pharia. 1928, 2, .t93. The vf/'~ct .f pltultt¢~ ex~ac~ and adrenaline on ketonuria and Uver g~cogen, 1,7 g. IL lturn and H. W. Ling. Q~a~ g. Pharm. 1929, 2, Z Tim ~,trei~gth uf Tinctures of B~ophaathm~ ~. P. and ~ples of r,,httt, d to 0it ~tcrnatkmal sMndard ouabain, by ft. ~. Bu~ and K. Singh I~,~val, Quart. J. Pharm. 1929, ~, 404. Tit,, rival a,lmhd~tratlvn of vowdered ergot, by Y. ~. Burn, Quar~. Y. Pha~. Th, ~,rr,r:; of hlnlo~deal a~ay, by Y. ~ Burn, Physiol. Rev. 1930,10, 186. I/t,t.'rturht In rat=; mt tt fat diet (a) after inje~ffions of tdt~tary (tm~rior lobe) vxtract. (b) daring prt~gnancy, by Y, H. Barn and H. W. L~;g, ft. PhysioL ll*",~l, 69, lP. 'D,, ,.:*ttnt~thm of d~gitalf,~ by pigeon nmesls and other methods, by J. H. Burn, J, lqlttr~mtv, d. 1930, 39, 221. Avli,li +:,n th+• huma~ ut,+ra:+ of anae~XheHcs and o~er drugs co--only used lu lab,mr, by A. W. ~ourno and J. H. Bun~, BrI£ Med. J. 1930 (it), q'ht, I,txlvJty of t]ifft~rent comniercial ::amples 0£ mereur0ehrome 220, by Burn imd G. K. Eli~lHek, QuavL ft. Pham. I'~armacol. XOJ0, B, 17~. TI,, ,.ardl,-vw:,:ular ~wtio~t of tyraml~e, by J. H. B~n, Quit. Y. l'harnu~:,l. 19:~0, 3. 1S7, All illia]y~l:¢ ~ lhc eff*2e~ of t-~-~eaine on the actions of adrenMiue anti ~ramine, h;, J. ]L Bunt and 5I. L. Tain/er. J. Phy~iol. 1931, 71,169. trite htt]~-rhtlwo ttf a :,tandttrd ,f reference in toxicity determina~ons of mercuro- tqn,~me, b~ J. H. Burn and G. D. Grevllle, J. PharmacoL 1931, 6S, 645, AhuMnhu~ a~d f,ml. A critical examination of the evidence available as to the t,d~qty ,Z abmdtdum, by J. H. B~a~ Rehash Be~r~, ~xternal S~ies~ I~i2. 1932. Tiw ;u'thm n£ t~TalMne ~ll~ e#edrine, by g. II. Bun~, g. PharmacoL 1932, ~6, 75. oa v~i-u-dihl~or ilbre~ ia the aympa~etic, a~d on ~e effect of circulating ml;,,nal~m' I]i augmenting ~tc vascular re~on~e to sympathetic ~imulafion, b$ J. It, l-alrlh J. PhyMol. 1932, 75,144. 2'h~ dt~tt,rnduathm of the antineu~tle vitamin, by Ka~ariae ~. Edward, l~ut'lt, II. XV. I,tng and Barbara G. E, Morgan, Biochem. Y. 3933, 27, 1719. A ltharlltit,:t,b.~h~II upI~roach tt~ the cause of ast~a. P~sidential Address, by J, IL Burro Pr~e. 12o~= S~e. 5led. 193S, 27, 1. 'flu, re,thin tff ~thor .u the sympathetic system, by B. B. Ghafia ~d ft. H. Btwn, 3, Phyvi.l. X~t:~3, ~,~, 157. qq.~ ,,mffr,,l -f bio*~d l¢C~<~ure. Presidential Address, by g. ~. Burn, Prec. Roy. Th,, ,~5~ml~tlwtk* dilator flbrc~ in the muscles o~ ~he cat and dog, by l~ulbri~r tin,1 J. ~ Burn, J. Phyuiol. ~935, 83,483. Tlu, o,.tlntatlon *ff ,:~c~tyin n~d of ~lale hormone in oily soluffon, by E~th Bffl- I~l~lZ nml J. It. l~u~, ft. Physiol. 2935. ~'~;, 320. S) n,pathvtic va~'o-dilatorv:~ by Edi~ B~:ilbring ~d ~. H. Burn, The Sechenov l'h.~:.lol. ,f the USSR, 21, No. 1137 ~Phe Sherrington phenomenon, by Edith Biilbrlng and J. H. Burn, J. PhyMoL 1986, g6. 61. .~ympat.heth. va~odilatation in the skin and the, intestine of the do~. hy l~dlth Biilbring and J. IL Burn, J. Physiol. 1~6, 87, 254. Sympathetic vase-dilator fibr~ in the hare and .tile moukey compared wl~ species, by Edith Bfilbrlng and J. H. Burn, J. Physiol. 1936, 88, 341. Die Anordnung biologi~eher Xuswer~.mgsmeth~en, by J. H. Burn, Arch. exp. Path. Pharmak. 193~ 184, ~7. The a~lon of tymmine an~ adrenaline on ~e denervated nictitating m~mbrane, hy Bdith BfilbrMg and J. H. Burns, J. PhyMoL ~38, 91, 4~9. A potency test for organic arsenic and antimony compound% by Edith Bfilbring and J. H. Burn, Quart. J. Pharm. ~harmacol. 1938, J£, 67. Hypophy~envo~leriapven und Fettstoffwechsel. by J. H. Btt~, Schwcizt,ri~ehen Med. Wocb~r. Itt;~;S. 6~L 932. Sympathetic vasudilator fibres, by J. IL Burn, PhyMoL Rev. 1938, 15', Btnod flow during muscle contraction and the Orbeli phenmuenoa itt the by Edith B(ilbring and ft. H. Burns, J. PhyMol, 1939, $5, 203. q'lle notion of drugs in muscular fatigue, by J. H. Burn, Brit. M~. J. 1939 ~1}, ~7. Va~.uhw ehmlges affecting ~o transmission of nervow~ Impulses, by ~lth Biilbring and .1. H. Burns, J. PhyMoL 1939. 97, ~0. .~,aleptics and sym~omi~c sub~tances, by J. H. B~, Brit. Med, J. (i) The eff~t of ~Tm~mimetic a~ other sub~nees on ~e contraction skete*al muscle, by Edith Biilhring and J. H. Burn. J. Pharmae.l. 19i0, 6~. A principle in rasp~rry leaves which relaxes uterine muscle, by J. H. Burn and E. ~ Withell, I~neet 1~ (it } L O~rv~ions ~ng on synapfle ~t~mi~ion by a£~tyleholine In the spinal cord, by Edith Bfllb~ng and J. H. Burn, ~. PhysioL 1941, 200, The interrela~on o~ p~tl~lne, adre~line a~d eph~ine in vkele~l mu~le, by Edith Biilbring and ~. H. Burn, if. PhyMol, 1942, 101, 24. ~ ac~on of adrenaline on t~nsmL~sion in sym~efle gamglia, ~rhi~ ~y lflaY a par~ in shock, by Edi~ Bfilbring and J. H. Burn, J. PhyMol, ltVt2, 101, The ~eta~ ~ntrol ~ ~ diabt~ in m~, by J. H. Bu~ ~.H,C. and F. D. KeLly, B~t. Meal. J. 1~1~ (it), 752. The anOdiureflc action of nico~ne and o£ smoking, by J. H. Burn, L. H. The rela~on of a~etmline to a~tylcholine in the nervou~ ~ystem, by ~, H. Bu~t, Phy~oL ~v. 1~, 25, Th~es ot a~the~c action, hy ~. H. Burn and H. G. E~, Brit. M~, The testing o£ local anatomies, by Y. H. Bu~. Brit. M~. Bull. ltVl6, ~. 95. The maintenance of blood pressure in anaestheMa, ~ J. H. Burn, Brit. Meal. Bull. 1946~ $, 95. Acetylcholine ~d 1~7 temperature, by J. ~. B~n m~d N. K. Dut~, Nature I~M8, 161. 18. ~'l~e s~retion of adrenaline from ~e ~rfused suprarenal gland, by Edith bring, J. H. Burn and F. J. de Elio, ~. Physiol. 1048, 107, ~2. The ae~on of a~l~oline ~d adrenaline on flexor and extem;~r movement ; evoked by simulation eft ~e d~cendtng motor ~ae~, by Edl~ ft. H. Bum and C. R. Skoglund, J. Physiol. 1948, 10~, 289. The standardi~fion of secre~n ~d pancrvozymin, by J. H, Bu~ mid Holton. ft. Physiol. 1948, ~07. ~9. The ln~blto~ a~ion of ~aludfine on the ~gon of gastric juice, by J. H. Bn~ and J. R. Yane, B~t. ft. Pharama~L 1~8, 3, The s~ion nf anmgoni~ of acety[chollne on the ve~ls of the rabbit's ~r, by Y. H. Burn and N. K. Duma, Brit. ft. Pharmacol. 1~8, 3, Fine chemicals in medicine. Inau~mra[ Ad~s to .~e Fine Ch£~mical~ G~mp • the S~iety of Clmmical Indus~y, by J. H. Burn, Chem, & Ind, lt~8, ~0, 787. Action of a~yleholi~ on ~abbit's aurlcl~ in relation ,to ace~leholinc by Edith B~lbring and J. H. Bum~, Natare ]~9, 1~13. 172. R~uetion in ~ronary flow by pttuita~ (~sterlor l~tm) extrac~ In relation the action of nicotine and to smoMng, by Edith Billbring, J. H. Burn and J. 3I. Walker, Quart. if. Med. (N.S.) 19i9, 1~, 73. 29-236~69--pt..q~lT
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Liberation o:~ noradrc~nall~e from the adrenal medulla by splanc~nic stimula- tion, by Edith Biilbring and J. H, Burn, Nature 1949, 168, 383. ~he r,.lattoa between the motor ~ l~lbitor aetio~ of aeetylch~e, 8ab;;~n~c~ tar ~e in the diagnosis ~d trident o~ vascular disease, by B,r~, I'o:~t-Grad. ~Z Z. 1~9, ~5,101. LfI,tratIoa of u,-~radre~ali~e ~rom the suprarenal gland, by Edith ~filbring and $. ~. Bur~, Brit. Z. Pha~macol. 1~9, 4, 202. Ac~on of ut,~tyh:hollnc oa rabbit auricles in relation to a~lcholine by Edith B~lbrlag and ]. H. Bur~, Y. Phy3iol. 1949, 108, 508. F,rmatIon at adr~l~e from noradren~tne in ~e ~rfa~d suprarenal glad, hy Edith I¢filbri~g and Y. H. Burn, Brit. J. Ph~macoL 1949, ~, 245. "Ch~ m~tb*]i ,f no~adrenalin~,, by ~. H. Burn and D. E. Hutehe~, Brit. ~. ~ha~ma- col l~.lO, $, 373. ]n~:~,,dteldc;:: and the poi:~0ni~g o~ crops, by ft. ~. BU~, Chem. ~ In~ ~9~9, ~1. E~:tlmaflon of ~tdrcnaline-noradrenaline mixture~, by Y. ~ B~n, D. E. ~uteheoa a~d 1¢. H. O. Parker, Brit. 5. P~rmacol. 1950, 5, • h~, ~ff~,et~ of dlgo~in and ouabain on the heart-l~g 9repara~on of ~e dog, J. M. Walker, E. hf. Laurie and $. ~. Burn, Brl~ J. Pharmacol. 19~0, 5, 3~. I~,lallon of motor a~d inhibitor effects of local hormones, by 5. ~. Burn, ~hysiol. l/ev. 1950, 80, lTL l'5~ymb~ 5w~atlon a~ ~oyadrenaliae in mammal/an tissue extracts, by Bcycr, H. Blu~:ehko, I. H. Burn and H. Lang~ann, Nature, 19~, 165, 926. Alloxmt dtaheW~, by ft. ~. Burn, II Cong~ International.de Th~rapeutique, Bc,x,.lh~, ltMg, a59. Editions Ar~'eia. A,IrcmflIlm ~md l~oradr~,ntllino In the sub,renal medu~ after insult, by B~lr~, D. l~] Hntclm,n and R. H. O. Parker~ Bri~ I. Yharmacol. 1950~ 5, 417. The, f¢~c~oation of mwadrel~aline from dlhydro~phemylserine, by ~. Blasehko, Z. H. l[uni and H, Lar~gemaoo, Brit. I. Pharmacol. i950, 5, 431. l-'harmaeologlcal aetion~; of ~mtihi~tamine coml~ouads, by J. ~. Bu~, Brit. .k dl~.cll~:.-lon on I]l[* lletI,~li ,)f ]OCa] hornlOlle~, IW 5. ~. Bllr~ a~ other~. Yroe. Roy. S~:~e. B 1050, 137, 2S1. Th~ dh~gm~i~; o£ diabetes iasipidu~. Action o~ nico~ne on diuresis, by N,,radr,~mlhu~ and adr~,,~altne in vessels of the rabbit ear ~ r~a~on to ~e action ,,f ~mfl~e ,xida~:e, by ~. H. B~lrn an~ Sudith ~ob~on~ Bri~ .L Pharmacol. R,~vcr:~d of the va~;eular re~l,on~e to aeetyleholine and adrenaline, by ft. ~. Burn real Judith Ihddm~-m, Brl~ J. P~armacoL 1951, 6,110. ~,m~d~ca~d~w, lu the whal~ ~uprarenal mo~ulla, by $. ~. Burn, ~. Langemana ~ud ~L H. O. Par]~er, ,L P~y~ioL ~951,118,123. The, habitation of adre,altne in the b~dy, by J. ~ Burn, Sir ~e~e Boot Founda- tloi~ Lvctr~ro, 10~0-51, The Univer~ity of Nott~gham. The, pre;* or amine~ la the adrenal medulla after irra~a~ion, by C. T. IL Bl:wC~ho, J. H. Burn and R, ~ ~ole, B~t. 3. Pha~maeol. 1951, 6, L-l~r~l~:t devarb*~xyla~a and pre~or am~e fomatioa ~ ~e adrenal medufia, by H. Bla,;chko, J. H. Burn and 0. W. Carter, .L Physiol. I951, 1~5, $7 ~. Ac~,tyleholl~,* lind ciliary movement, by Edith Bfilbrlng, ft. ~. Burn and ~amela Kordil¢, J. ~by:;lol. 1951, 2 ~5, 39 P. A~tldiuw~tie effect of nicotine and its imp~ea~ions, by ~. ~. ~n, B~t. ~fed. ~~51 (fl) 199. ~£I,~ imI*orta~ee of noradre~aline by J. ~. Burn, ~H~. 5. ~ed, gel. Sigh Series, No, 309, 2051, 34~. l'h~ucatatl.n ~f the zki,, by & It. B~n, Brit. ~. De~atol. 1051, 68, 431. '~h~ effect of X-irradiath:,a oa the reSl~Oa~O of O~e Intestine to ace~leholtne and .n i~:~ ,:ontc~t o~ "pseudo"-choli~v~terase, by $. H. Bu~, P~ela Kordik and l¢. H. Mo~e, Brit. J. Pha~acol. 1[152, 7. Clllary mow'meier and acetylehoDae, by Famela Kordtk, Edith B~lbring and IL IIm-n, I~iL J. Pharmac,-d. 1~152, 7, 6Z Tb~ ~',,hl aelivity aml amine oxida~e in the liver, by A. Sptnk$ au4 ,L ~ Burn, BrlL ,L Phar~neoL 195~, 7. 93. Effect of 5"-irmdiatian oa the choltnesterase ia rat inte~ine, by 5. l't~n,,la K,mllk and R. ~, ~Iole~ ~. ~hyvlol. 1952,116, 5 ~. Effect of d~,m,r~,aOon on amioa o~ida~ in the nictitating membrane, by ~;ur~t m.l .luflith Robin,on, J. Phy~-lol. 1952,116, 21 P. 1139 Thyroid he,mane and amine oxidase in the liver, by J, H, Burn and A. ~pluk;~, I. Physiol. 1952,116, 46 P. The enzyme at ~ympnthetlc ne~vo endir, g~, by ~. ~. Burn, Brit. 5fed, I. 19., (l), ~t o£ tlenervatlo~ on aml~e ~x~das~ In ~trnctu~e~ Innervated by the ~athetie, by ~. ~. ~lurn and 5udith Robinson, Brit. $. Pha~acol. ~052, 7, ~ies~iele fiir die zunehmende Verkafipfung van Plm~makologie uml Bloch~,mie, by J. ~. Bu~, Na[u~vis~e~cba~ten~ 1952,11, 243. The action of eseHne on the i~olated rabbit's :~uricle:;, by Edith B~lbrlng, J. II Burn and S. R. Kottegoda, J. Physiol. 1052, l 18, 3~ P. Augmentation aud diminution of sensitivity to sympathomimeH~~ amines] by denervation of the cat's nictitating membrane, by J. H. Bu~ and A. s~ein, J. Physiol. 1952, 118.34 P. ~he eff~ of dcnezvation on tlxe notion o£ sympa~omimetic amine:j on the ~ug membx'ane, by A. Fieckensteiu and J. ~- Burn, Brit. J. I'ha~acol. 8, 69. ~nsitivlty o~ the denorvated nictitating membrane a~d amlm~ oxiflm;~:, by J. ~. Burn and Judith Robinson, J. Physiol. 1953, 1~0, 224. ~ff~t of sympathetic denervation oR the chollne3terase ~ the nictltatlng mem- b£ane and the iri% J. ~. Burn and Flora $. Philpot, Brit. ,L Pharmaeol, 8, 248. ~kcetylcho~e and the heart beat, by J. H. Bu~, Lancet 1953 (i) 11~1. Acgoa of ~erine on lhe uuzicles of the rabbit heart, by J. ~. ~uru aml S. Kottegoda, J. PhysmL 19~3, 1~l. ~. The mechanism of the action of che~ca~ substances at nerve endings lllld pazt played by pcrlpheral ganglia, by J. H. Burn, Acta Physiol. Seaud. 29, 40. ~cetylcholine and cllt:~ry movemont in ~e gill plate~ o{ MyflIus cdulf~, by E~IRh Biilbring, J. II. Burn and ~eather ,~. ~helley, Prec. RoF. $o0. ~ 1953, 1~I. 445. Aceiylelmlin~ and the c~rdiac ~hythm, by Y. ~. Burn and J. ~I. Walker, XIX InternaHmml Physiological Control, s, Montreal, 1953~ p. 249. Qniuid!ea and nnti,-holine~terase:~ on rabbi~ atxrlele3 hy Sheila ~zCoe and .L Burn, Brit. J. Phar~uw~L 9. 42~ ]954. Acetylcholino as a local homone for ciliary movement and the heart, by J. Burn. Symposium on Neurohumo~al Transmission, Pharmacol, Roy. 6, 107, The hypertensi~vity of the denervated nicti~tlng membrane to various sub- stances, by .L H. Burn and U. ~endelenburg, Bzit. ,L Pharmacol. 9, 2ff2, Anficholincster~ses in the henrt-lun)$ pre~)ar~ttlon~ by $. H. Burn an4 3. Walker, Jr. Physiol. 12£ 4~9, 19~. Formaliou of acetyk.hollae-like subst~nce by rabbit heart, by S. Brlaco~ and Y. Burn. Z. PhysioL I~5. 3~ P. ~954. The pimrmacologY of chlorl~romazim~ and promethaztne, by ,L H. Burn, Roy. Sac. Med. 47. 617. !95 L Action of antlcholinesterases and of aeetylcholine on the oloct~eally driven lung ~ep~attan, by J. H. Burn, E. M. Vauglmn Williams and J. M. Walker, Physiol. 226, 43 P. 1954. L'ae6tylcholine et l~ nminti¢,n dn rythm~ eardlnque, by ~. H. Burn, Aetualds pharmacologique~ #. 1. 19~L . ..... The formation of au acetylcholinc-lll~a substar~c~ oy tho ~somtea raD~lt heart, by ShelI~ B~iseoe and 5. H. Buru. J. PhysioL 1~6, 181,1954. Effee~ of denervntinn on enzymes ia iris and blood vessel~, by ~. H, Burn, 5. philpot aml V. Treudel~vburg. Brlt. ft. pharmacoL 9 423, 195t. La s6,.r5tlne ot la p~uer~ozymi~e, by 5. H. Buni, &nn. Pharm. Frant~. 12, 476, 195~. La phnrmaco)oule do l~] eblnrpromr:zine et de la prom~thazixm, by ~, H, Cnhiers d'Anesth$~iologle 2. 309. 195 k A-~r block and cardiac output, by J. H. Burn, E. 5L Vaughan Wi~iams and Y. ~rnlker, Brit. ~Io~. 5. L r~T~. 1955 Vi~eernl functions of the ner~ons system, by .L H. Burn, Ann. Rev. Physiol. 17, 20~, 1005. Produetinn o£ anrh.ular flbr~latlnu by electrical stlm~lation of the heart-hl~g preparation in the i,rosence of antleholinesterase~, by Y. H. ~n~, E. Vaughaa Wil~iam~ and 2. M. ~Va~¢er, Y. Physlol. 128, 4 P, 195~. The effects o~ a(.etylcholine in the lwart-lung preparation inclmling the produc- tion of am'i~:ular fibrillation, by J. tI. B~rn, E. M. Vaughan Wl~iams and J. Walker. J. physiol. 198. 277,105~5.
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1140 ,~|r Ilenry Dale'~ c~Htrih~tl~m to therapeutice, by .~. H. Bum~ B~ M~. J. A,.,4ylclmli~e and the maintenance of ~rfliae rhythm, by a. H, Burn, ~eet~re~ on The prvduetion of block anti au~eu~r fibrillation in the hear~4~ng preparation by l~Jhlblt*~r:~ o[ eholino~etase, by ~. ~. Burn, ~. M. ~aughan Wllli~m~ and J. M. Walker, Brit. Heart. ~. ~7, ~, Ily~.~tImm~la, by J. ~. Burn, Oxfo~ M~ieal ~I Gase~te, 7, ~, ~5. Tb,, f,-,r~atioa o[ avetyleholine in the h~ar~ ; its effect on .~e sy~emic ou~u~ ),L M. Vau~h~n Williams and ~. M. W~k~r, J. Physiol. 131, 317, Tho uff,,ct of KG1 on auricular fibeiIIation ~r~u~d by el~.~l~l stlmulation in the I*re:~o~c,~ ,:,[ acetylcholine, by ~. H. Burn and J. M. W~ker, J. Physiol. The, ~.,ff~'~t of KG1 on atrl~ll fibrillation ea~us~ by aeetyleho~ne, by J. H. Burn, A. J. G~m-d~g a~d J. 3I. ~alker, Ci~ula[ion Res. 4, ~, Auricular fibrillation in the hea~-l~g preparation of ~e 4og, by J. H. Burn, A. J. Gunning, l& M. Vaughan ~illlams and J. M. Walker, XX International Phy~lolt~lval C~gre;:~, Brussels, July-Aug. 1956, Ab~ae~ o[ Comm~iea- tlon~, p, .146. I~l~l,,rimont~d atrial fibrillation, ~b~ ~, H. Burn, A. J. Gunning and J. M. Walker, J. ~ui~ ~, d*~ McJ. 86u ~nndp It~, supDl, an ~o. 87, p. ~O. Factvm~ afft~.t~g ventriculsr ~brillafion, by A. K, ~mi~ge, J. ~. Burn, and A. J. Gunning, $. Phy~iol. ~, O2P, 1O~J. Physiology o~ the) ~drenal gland, by .~. ~. Burn, Brit, ~. Anae~esla ~8, 459, Y~,ntrlcular fibrillation and ion ~ras~port, by A. K. Armitage, ~. H, Burn and A. ~. ~]nnn[ng, Clreulatb*n Res. 5, ~. 1957. Pr.duction .f fib~illstion in isolated atria o[ ~e r~bit h~r~ by W. C. Holland aod J. H. Burn, Brit, M~. J. I, I~1, 1957. Pr~ductiou .f auricular fibrilla~on by el~ttleal s~u~flon of ~la.~ rabbit uu~leles h~ ~he pre~enee of ac~tyleholin~, by W. C. Ho~aud, J. H. Burn and Eff~'t~ of ~.radrenaline and adrenaline on the atrial rhyt~ [n th~ heat~-lung [#rei,~tratiuu, by ,I. H. Burn, A, ~. ~unnlng and .I.M. Walker, ft. Physiol. I,~I, 1957, Eff~.'t ,¢ la~'k ,f gl~eo~;e aud of lack o~ oxygen on vent~ieular flbrlll~ion, by J. H. Burn and ~. J. Goo~fo~, ~. Phy~loL I~7, ~0~, ~7. lh',bb,mi di htanflardi~z~tzionv biologlea, by ~. H. Burn, ~ Farmaeo, E~ Prat. I2. 219, ~'~,ntricldlir flbrllbRio~ iu ~he £~olated rabbit heart, by ,~ K. Armi.tage, ~. BUrn and A. ~. Gunning. Brit. J. Pharma~L l& 215, 1957. The phy:~iolob~cal aethm of neuromuscular and ganglionic bloek~g ag~uts, by J. II. Burn, Brit. J. A~laesth. ~, 242, 1957. An i~xeltatory action of th~ vagina on rabbit a~ia, hy ~, H. Burn and M. J, Rand. J. Phy~lol. 137. 46P. A~,#,tyleholh~ a]ld t.ardl:le fibrillation, by ~. H, ~urn~ Brit. Me~ Bull 13, (3) Mevha~b~mu~ de~4 Herzflimme~ns, by J. ~. ~urn, Wets, klin, W~hsehr. 69, ]']Jar~m~lr~h.al and ~edi(.al ns~t~ of smo~ng, by J. H. Bu~, Pro~ Roy. goe. 1f4rdJat. FlbrlllaHo~, by J. H. Burn. II Farmnco, E& ~.~. 12. 610, 1957. ~perlall~illg at ~ehfml. ftxford survey, by J. H. Burn and Nesta Deau, The Tknen Educational Sup~lemen~ A~ag. 15, 1957. "l,'luuth;.~e": a rcp~,rt to the Medical ~es~areh ~neil by the Committ~ ou Non~xplo:~lve Anae:#hetlc Agents. Some pharmaeolo~c~ actions of ~u~hane, by J. II. Buru, H. G. Epstein, G. A. ~elgen and W. D. M. Paton, Brit. 3led. II, 470, 1957. l~xcltati,~ and Inhiblllon of rabbil atria by the va6ms ae~es, by ~. H. Burn a~ M. J. ~a~d, Phy~loL 1~8, 172, 1957. I,n m,,w.m~,nt and car,llae ~brllhtlon (Waiter E~est Dixou Memorial ~ctur~), by J. H~m-dd Burn, Pr~. ~oy. $oe. M~. 5~ 725, Be~'erphm aml nuradr~nallue in aztery wal~, by ~. ~. Burn a~ M. ~. Lan~.et i~, Ii~97, 1957. A,.th~a ~f Id~n~tlm, on the heart, by ~. H. Bern and ~I. ~. Rand, Bri& M~. 1141 Excitatory effee~ of vagal stimulatlgn on cooled atria and their relation to adrenaline, by ;l. H. Burn and 5i. 7. Rand, J. Physiol. 11~0, 45P, 1958. Eff~ts of cateehol amines pr~ent In l~rlpheral ti~ues, by ~, ~, Burn aa~ M, ~nd, J. Physiol. 150. 7P. 1958. A test for ~anquil~ing drugs, by J. II. Burn and Roneea ttobbu, Arch, i~t. Pha~macodyn. 118, 2~, 1958. Effect of reserpine on va~onstrlctten cau~ by sympathomimetic amine:., by d. H. Burn and M. J.~nd, Lancet ~, 673, ~oradrenalin9 in urt~ry walls and ira di~l hy rt,~er[dne by J. H. Bur~ and M. J. ~nd, Brit. ~I~. J. 1, 9~ 15~8. IIerzflimme~ uud Ionenver~hiebungen, by J. H. Burn, Trlangel ,% I~3, The action of tuboeurarine and aee~yleholine o~ eiIiar~ merriment, by J. H. B~rn and Margareg Day, .l. Phy~tul. I~I. 520, 1~58. Abuse o£ barbiturate& by J. ~. Bu~, Brik J. Addletio~ ~, 115, Excltatory action of the vagu~ in the siolat~ atria In relattnn t~ adm.nfillm,, by J. H. Bu~ and M. J. Rand, J. Phyniul. 14d, 17~, 193,% Vasomotor reversal and re~tne, by J. H. Bu~ aud M. J. Rand, J. Physl~t. ~ antihistamine comi_~mnds, by J. H. Bu~. Brit. 3Ied..l, iL ~5, Ves~rin and va~ular tone, by ~. H. Burn, Brit. J. Anae~th. ~0, ~;I, lf~& The cause of the su~ensitlvlty of organs after degeneration of sympathetic nerve~, by ~. H. Bu~ and M. J. ~nd, Lancet ii, I218, The action of sympathomlmetle amines in animal~ treated with re~,r[dn~,, by J. ~. Burn and M. J. ~nd, J. Physbd. I~, 314, The action of ~ym~thomimetie amines on heart vat~ in relation to the eff~.rt reserpine, by D. Bejrablaya, J. H. B~u'n and J. M. Walker, Brit, J. Pharmac,I. I~, ~61, 1958. The depressor action of da~min~ and adrenaline, by J. H. Bur~ and M, J. B~t. J. Pharmaeol. 1~, 471, 1958. • ~e action of sym~thomimetle amim~ on the hgart rate, hy J. H. Burn and J. ~I. Walker, J. PhysioL I~. 10P, 1959. Pharmacological testing t~f Anaesthetics, by J. ~. Burn, Proe. ~oy. S~. 32, ~$5, 1959. Some lmpo~ant phenolic cominmnd~ in pharma~lo~, by J. H. Burn. in ~rmaeology of Plan~ Phenoti~, Ed. Falrbalrn, London: Academic Pre~ L~., 1~9, p. 1. Pilo~et~on by nleo~lae and ehroma~n tissue, by J. H. Bu~, ~. H. ~,aeh M. J. Rand, .$. Physiol. 1~6.19P, Fall of blood pressure af[~r n nora~enaline infusion and it~ treatment by prc~or agents, by J, H. Bum and ~. J. ~nd, Brit. Me~ J. $, 3~, M~hanism of ~rterlal spasm ~ollowl~g intra-ar~erlal injection of ~hlo#entom*, by J. H. Burn and Roneen Hobbs, ~neet g, ~1~ 1~9. ~e caus~ of the sup~rs~nslttv~ ,f smooth muscle io aoradrenalin~ after im~etie degeneration, by J. H. Burn and ~. ~. Rand, J. Physiol. I~7, 1959, Peripheral effects of niet~tin~ and acetyleholine r~sembllng th~ o[ sym~thetle ~imulation by ,7. ~. Ru~, ~. H~ ~aeh, M. J. ~and and J. ~. J. Physiol I~8. ~2-57. 1959. The sympathetic adrenergie meeha~Hsm, by J. H. Burn and M. J. ~ad. (I~ondon) 18~, 1~13, 1959. Choline acetyIase activify in the atr['a, and Its ~ible relation to th~ ~aln- tenance of the memb~me ~tential, by J. H. ~u~ and A. S, Milton, Brit. Pharmac.L 1~, 4fl3~. 19~9. Th~ effect of preeu~o~ of noradte~m[lne oa the res~n~e to ~y~mlne and pa/l~etie stimulation, by J. H. Burn and M, J. ~and~ Brit. J. PharmaeoL 15, 47-~5. 1~0. Sympatheffe ~stgangltoni¢ cholmergie fibre, by J. ~. Bum and ~f. ,L Anoxia and ventrtenlar fibrillation ; with a summary of evidence on the eau~.e fibrillation, by J. H. Burn and S. Hukovi& BrlL J. PharmaeoL 16, 67-~0, ~e relation off circulating noradren~l~e to thu eff~t of ~;ympathetlc ~timulatlon, by ~. H. Bu~ and 3I. J. ~aml, J. Physiol. 1~0, ~C~3~, 1~, Why thiopeutone injured into an arlery may cause gangrene, by J. H. Burn, BrlL ~Ied. J., H, 41~, 1~0.
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1142 Th,~ effect of rc~r~lue on gangrene produced by thiol~ental in the mo~etall, ft. II, Burn and D. B. ~leDougal, J. ~harmacot. Exp. Then. 131. 167-70, 1961. The actl,m of ~icotine and tho pleasure of smo~ng, by Y. ~. Bu~, Advancement Th,, ~,ff,',,t of tcmp~ratnre on the re~pon~e to dru~, by J. ~ Bu~, Brit. ~led. Bu~. 17, fi{~, 1~1. • h,~ ca~,, ~f fibrillation, by J. H. B~rn, Canadian ~led. Assoc. Y., 8.~. 62~7, :1962. The, w~tlng of drug~ in meu. (Paget Memorial Lecture), b~ J. ~i. Burn, Conquest A u~w vb~w of adrcner~Ic nerve fibres expluini~g the ac~on of rese~ine, bretyN bml ~md graacthidine, by 3. ~. ~ura, ~t. ~Ied. Y., 4, 1623-7~ 2961. E~G,ct ~f noradr~allne on the action of nicotine and tyram~e ou isolated atria, I,y D. L. A~r~off anti ~. H. Burn, Brit. Z. Pharm~col, 16. ~g~B, Uptake o~ labelled noradrenallne by isolated atria, by G. P. B~n and Y. H. ~ura, Brlt Z. Pharm~coL I~L ~4~51,196L A,~tk,n ,~f ~t~b~tanc,~ which bloc~ sympathetic postgangl[oaic nerron$ trans~- ~4on, by Y, H. Durn and H. Free,e, Brl~ $. Pharmaeol, 20, 378-SZ Adn,rwr~lc m~ch:~n]~m In the nic[tl~ng membrane, br ~. ~. ~urn. ~I. Z. ~and nnd ~, Witch, Brit. $. Pharmaeol. 20, 8~94, 1~3. Eff~ct ¢~f ~,~;erlm~ ~n the r¢',~u~e of the vas defereas to hy~o~a~trle ~erve tt0U, by $. ~. Bu~ and D. F. Wc~tman, Brit. ~. Pharmaeol. $0. 7~82, R, q~'m~, ,,f aeetylcholim~ by ~ympathetic ne~e ~ulatio~l at different frequencies, hy ~. H. Burn~ J. J. Dromey aud B. J. Large, Brit. Y. Pharmaeol. $1, 97-103, Eff~,vt ~f ph,~noxybenm~mlue and of tolazollne on tl~e respons~ to sympathetic ~;tlmuI:t~on, by $. ~. Bum and W. R. Gibbons, B~t. ~$. Pharmacol, 92, $~7-39, P~r~ played by calcium in d~termtntng the regponse to stimulation of symlmthetic po~tg~,nglIo~c fibres, by ~. H. Bt~rn m~d W. ~. Gibbons. Brit. ft. Pharmacol, • h,~ :9~paflmfie DostgangHonle fibre and the block by lu'etylium. The block ~re- W. ~¢. ql~d.mu, Brla J. Pharmacol. ~2, 549--i7, ~fllonlc [ermianflan, by $ .H. Burn, K.~P. ~g, ~rit. 5. Pbarmacol.. ~$, 1905. Q,ab,rnlz,-,d sympa~omimctie amines, by ft. ~. Burn; ~I. F; Cuthbert and R. Na{~Ir,, (London), 200, 2~0,1963. l~uh~tan~v,~ 1.,locl, b~g sympathe~c p~tgang~onic fibres, by ft. H. B~n, and Tl:w l'~qea~c o~ aoradre~altne from symI~athede fibres in relation to caleh~m ~'am.eutratlon, by Y. ~. Burn, and %L ~. Glbhons, .~. Physiol ¢Lonflon) 18I, TI,, ~,ff¢ct of antlcholinesterases on tim increas~ in rate of the i~olated rabbit lwart In r,': Fon::e to atlmulatlon of t~o accelerator fibres, by ,~. H. Burn. and ~, ~ul;ovi6~ Y. Physiol. (London), 186, 32P. Pnrt ph~yed by calcium in determining the red, nee to ~t~m~lation of sympathetic I,~.~tc~*n~;lk*aie fibres, by Y. ~. Bnrn and W. ~ Gibbous. Brit. Y. PharmacoL The ~ympaflmtic Do~tga~gllonlc fibre and the block by bretyllum, ~e block 1,r,w~,nb'd by hexamethonlum and lml~ted by meeamylamln~, by 3. H. Burn V, ang]lr~rde t~,rminatlon, by Z. H. Burn, K.K.F. Ng, Brit. I. PlmrmacoI.~ Qunwrnlzed [~ympatbominmetic ~mines, by 3. H. ~,rn. ~I. F. Cuthber~ and Wh, n. Natur~ (~ndon), ~00, ~0, 19~3. ~nb<t~nce:~ blocking sympathe~c posManglionic fibres, by Y. ~. Burn, and V~qtzcr, J. Phy~lol {London) 179, 569, 19~. Th,~ r~,h,m~ +~ ne~radrcn~llne from sympa~etie fibres in ~e~ou to calcium con- ~.~,ntration, by Y. ~. Bur~, a~ W. ~ Gib~ns, 3. Physlol (~ndon) ~81, 1,~a~ in r~,~po~se to stimulation of the a~lerator fibre, by Y. ~. Bu~, ~. Hukovl~, J. Phy~lol {~on~on), 1~6, 33P, 1143 ~r. Y~ D~em~. Is Dr. 5gilliam B. Ober here~ Doctor~ you are aware that we ~re now on borrowed time. Tho bell has ~ung for th~ sees[ore We have not had a quorum call. If w~ sho~d have on% it ~ght reset in ~n interrup~iom If you ~ish to go we ~O~d lik~ ve~ ~ku~ to hear you. Dr. 0~. That ~ll b~ ~e. STAT~ O~ D~. W~ ~. 0BE~, pAT~O~0GIST, Dr. O~za. I ~m sor~ that Mr. S~t£sr$4~ l~ft because ~e ¢~h~ed the sugges~ion~ made in 196~, %h~b %.he only selmmt~oa]ly correct xx ord[n~ sho~d be dg~re~ smoking may or mu~ not ~ huzurdous to tour healbh." I ~ ~ppe~ring ~ th~ request of repre~entative~ o$ th~ ~h~tcco dust~ to present my vi~s on this subject. fm William B. O~r of Ten,fly, N.J., and Ne~ York, N.Y I ........... Kinekerboeker ~ospital and asociate professor oz p~mo,%~ ~v ~ ~w York Medical College. Furflmr details o( my cu~iculum vit~ as ~ li~ of my medical publications are attached to ~s statement. I ~m ~Dnearinff belore this committee because, it is. 1,o-islatio~eluti~ ~ cig~rette~. It hue been strong~Z pu~ ~Ryou ~[~cal Rcience h~ demonstrated that eigarehte smomng ~s ~s~ rail, acce )ted by phtsicians. I do not accept ~lsz and my ~l, atemen~ ~ill ~e~l ~th th~s6eiements in tim cas~ ~hich indic~ th~ the causo ~d effect relationsMp is not prov~. It is almost axiomatic that any scientific flxeo~ must cxplMa all cases f~llfixg ~to its general ttrea, With relation to ~o ttucstion ci~azette smo~ng and hmg cancer, i~ mush ezplMn not ~h]y why s~all proportion of smokers de.velop lung cancer but, ~hy q n~a hrger proportion of smokers never develop lung cancer~ or an~ {orm of cancer, ~t a~. ~ikewise a scientist theory must e~lMn the mechanism of om my own Dorsom%l exDerience~ the n~os~ sna~ um though interesting and sometimes help~u]~ do not explain how. ~ ~ ~y years ago it was noted statistically that people living in low, mar~;l y ~reas had a much hi~her incide~xce o~ mal~ri~ than p~bple who lived hi~her~ dry ~veas; iC~vas generMly uccepte~ that malaria was c~m~ed by th~ noxious wpo~ the had air (real + acre) urising from tim shes. I ti~ we know better tofi~y~ yet t]~e s~ti~tics, so ~ar as they went~ were ~ulte eo~ect. A scientific theory c~m~ot i~nore facts which run counter to i~; that, is a form o~ s~pp~vssio ve~ ~hi,:h is intolerable in either t.he hall~-~ of science of the courts of law. There are ee~a~ well-known d~xt~t which the ci~are~e-l~g cancer h~othesis doe~ not explain. For example~ in Gr~t Britain the per capita consumption of ~igarette~ iz much as in the United Stat~ bu1" the incidence of lung ~:mcer as much. In Australi% the per cupi~ consumption o~ cigarette3
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1144 :,.bt,ut th,:,~ sam,=~ as in Great Britain, yet Australians have Imlf as much lung cancer. In Holland, the per eapit~ consumption o~ eign~ttes is ].wet than in the United States~ but there is ~3 pereene more lun~ ,Tmce~; ~pl~ who tall you.t~at cigarette smoki~ caus~ 1~ eane~ ,m nc~ ~ig,, to ~J~ reminded el these data In fact, the, were no~ included llt tllt~ la.~ ~urgeou General s re~rt on "Smok~ .... a ~-~h ,, ,~:orry that theft publication presented only one-~de"~ prc~ent you with this in~ormatiOlt to show ~ou that one c~nnot rely upon ~n~id~nc~.fi~nares in ~t general population as a prooL ~ m]gh~ £uRher .go ~nto th~ ~act thug many o~ the statistical items were arawn from Oeath certifieates~ the lack el reliability ot which is lmtoriou~. Another point which the dgarette smoking there o~ oulmonary ,~ardnogens~s £ail~ to expl~ia is why epidermoid e~rei~om~ ~ha~ tvgu of cancer which is supposedly caused by smokin~)~whv ~ermoid e~relnoma rarely ~eea~ in the traehe~ ~hleh i~]ined ~y ~am,3 ~o~ of epithelium as the bronchus. The ~raehe~ almos~ never ~,~velop~ thiz ~orm of canee~. The tmehez (w~dpipe) is exposed the ~uH volume of inhaled smoke; ie reeeiven twice as much smoke as ~ither m~in ,bronchus. ~s n matter of tae~, the entire quieten o~ the distribution o¢ cancer in tim respiratory ~raet is no~ s~tis~aet~ril ~xpbdned by the eigarette smo~ng tbeo~y. Over fl~e p~ 15 ~o 20 ~r~s ha~ [~e5.,~ ~low b~) @ady decline in the ocem'rence of epidermoi~ c.n-emoma o~ the mourn, p~arynx, and nasophaz~nx, yet th~ tissues a~o as ~quch in contac~ with inhaled smoke as ~ hrynx sad ~raehe~. ~ et th~ recent studies by tho l~t~ Dr. K Henry ~aflan4 o~ San ci~ and by Aver~] A. Liebo% formerly o~ New H~ven, currently of.S~ Diego, h~w ~hown tha~ ~ much ~s*er number of lung c~nce~s ar~e ~ar out at tho periphery of the bronchial try, that is, t~os~ per t~o~ receiving tho least ex~osur~ to smoke. No[ only do the propon~ts ~f the cigarette theory ¢~ to ~xplaln how cigarette smo~ e~uses rang cancer; they f~il to taks into account thRt the anatomic ~tribu- ~ion o~ eanc~,r~ within the r~piratory tract milita~s agahxst th~ ' y cffort~ have been made to extract a cancer eaus~ substance frgnt c~garette ~oke, usi~ fhs t~m ~om 'the condensate. 8ome o~ ~-a.~b~tanee~ so isolated have produced tumors on the s~n o~ mice, bu~ ~:o ~ar no epidermoid lung tumors have ,~en produced ~ any animal. Th~n point ha~ b~n made several tim~ this morning. I~ one is inter- t':~tcd in ~okinn and skin cancer, ie is eommon~ 6bserved eh,t the index tlngcr and third finger of •eignrette smoker s hand are ex osed ~o hca~ conc~mtrations o~ cigarette smoke. Yet~ cancer o~ the s~n ,uch finger~ iz a greah great rarity. ~ h~vo never ~ a case. ~mst all tlm t~pidermoid carcinomas o~ the hand arise on the back o~ the hand which is hardly exposed to cigarette s~noko at all , ~isforlcally~ qur ~mw]ed~s o~ lung cancer h~ relaeion ~ txtorn~d causes de, ve]oped ~rom exposure to ~dustr~l inhsle~. T clas~ica,1 examph came from Central ~urope where it was noted t~ there ~ a~, a high incidenee ot lung cancer in the miners o¢ Schneeber~ and Joachlm~tlm]. It took ~t number o~ Tears to aseerta~ the ~ae~, but the con~;e~us of medical opinion now m tlm~ thee lu~ cancers w prpbabl~, due to inhaling ~dioactive dus~ ~rom *n~ ~ro ,~hleh ta~mff mined. I would emplmsizo that in this historical example a high 1145 proportion of the miners so exposed did develop lung cancer trod there- J~ore there seems to be a reasonable cause and effect relationship. This is quite unlike the low incidence with cigarette smokers. Not oven the most violent, opponent of cigr~rette smoking has claimed that anythlmr but a small percentage of cl-g~ret te smokers develop lung eance[,. In considering cigarette smoking as the chief cause of lung cancer there ~s great dang.er m overlooking or und(.rest~m~tmg the ~mpor. tance of other possible extermd causes~ chiefl$ exposure to industrial hazards and to polluted air. For example~ it ~s well known that is a h~h incidenc~ of lung cancer among men worldng in certaia part~; of the ehromate-pr~esslng indite. This matter ~vas inw,slig-at,~d carnally by the United States Public Health Sere, ice. Tim investiga- tors found ~hat • hizh prooo~ion of the men exposed developed hmg cancer; ~m~ animals similarly expend also developed hm~ cancer, This is more than the anti-cigarette faction has been able to ~o~er carcinogen is asbe~ a. su~tunce much more wi~ly u~cd than I had real~ed~ ~ substance to which we rag3, be expo:~ed Insidi- ously and ~thou¢ our knowledge. Once inhaled, ]he minuh~ ~be~tos bodies s~y in fl~e lung forever--that is~ u~ti] tim perzon die.,, Now that. asb~tosis has come to the fore as a earcinogen~ pathologists many places are examining lun$~ much more closely ~o-r tim pYezeneo of msbm~s bodies and~ ~ot surprisingly~ my colleagues ar~, finding them in much greater ~equeaey than was hitherto expected and, nut surprishgly, ~ the 1~ of many individuuls who had no lmown posm'~ to as~stos whatsoever. Somewhat more att~tion has been given to air pollution a:~ n or po~ible cause of l~g cancer. We all know thut thero is g higher inoideae~ of lung c~ncer in urb ~n populations titan in rural popula- tie,m--and this seems to hold up as true no matter which country the data comes from. A nuraber of studies have been done on the traction o£ possib]e carcinogen:.: from polluted ttir~ and these have ~en just about as successful as the cues nsing cigarette ~moke con- densate. Yet~ • p~son who ~okes g cih~rette does ~ as a ma~ter of delibernge choiee~ whereas, ~ person who is exposed to polluted air so ~posed willy-nilly. As • physician and ~m a citizen~ 1 thi~k t,hat whatever legislative e~ort is mffde should bo directed to protect tho~ who are un~ttingly or unwillingly expo~. The Just point, 1 sh~dl make i.~ a methodologic one. ~rariou~ inve~ti- gatom h~vo a~tempted to show what they co~der a sequential chan~e fix the bronchial epithelium, a progression of alterations in its mier~. seopie appearance from simple thickening to squamous mvtaplay~ia~ to atypical ~uamous metaplasia, to carcinoma in situ, and finally to involve carcinoma. It sounds ~eD. plausible~ aud it could actnally happen that ~y~ but when tla~..~o investigators ,present thi:~ idea se uential eh~es to a non-medical audience the] contrive t~ ,ire mapr~sma that th~s sequence ~s, gomg on wtthm the lung of a g~vett a~ gu~op~ and ~hero isn'~ an atom of proof that the altered bronchial opitheh%m they show you in the lung of ~fr. X is going to pm~t~. to the very at~ieal epithelium they show you in tho lun-g o~Mr. Y or to the ou~r~fit cancer m the lung of Mr. Z.
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1146 A~ :t matter of fact, it. had been reported to this conumittee, and it it-; ~d~;o ~n~ own observation, that m~ay of thez~ minor changes in the p~:u~doztra~ficd epithelium li~ng of the bronchial ~rae~ regre~s for r,z~on~4 tha~ are obscure. ~_, ¢htmge3 following influe~a are ~ ~ample, and there w~ri~.t~y of ofl~,:~r situations. It remahm aa ~erence~ha~engh~g, ]:,c :~ure, but an ~nferen~. ~ tM~ it may ht~resg fire committee to htow ~hat when the Con- ~r~ of the United Stat~ was debates the act which fo~de~ th~ ~:atioaal Cancer ~t~itute~ and this w~ about 1937~ there w~ A.rong and very v~al pressur~ group which was ve~T much concerned with tduminum ~ cookh~g ut~iis as a cause of cancer. Th~ appointed before boflx Houses o~ C0n~ess~ the d~y appointed comrmttcc~ and presented their ca~e ve~ vehemently. They were : tronffly convinced that aluminum ~used cancer. Not lung cancer~ but c:mc~,r her~ a~,~ there, all so~ of caner, They were so vociferous and ~;o ~ffcctivo that ~ally it was actuafiy written into the law fo~ng the National Cancer ~nsti~te tha~ i~ was obliged to ~vesigate alu- minum az a ca~e of lung cancer. Tlmy did that and it ~s~ the taxpayers a fair slug of money. ~ ig i~ a r~thcr amusing example in medical ~ory of the relation of medicine ~ law. $ f~ink t~ sor~ of historical pa~tem and relationship docz lmvo a tendency to recur from one g~era~ion to ~o~er. afraid we are in the ~d~eof it today. There am a number of prominent medical scientists who share my vicw~ either in whol~ or in part. One of the most notable amonff them J:~ Dr. ~lhelm C. Hueper, now retired from the ~tited Stat~ Public Itcalth Service~ one of the world~s lead~g exper~ on carc~og~esis. I nfft~r you to his detailed c~tique of the methods used by some ve~ti~a~rz to support the cigarette smoke theory~ the monograph titl~:~. "Envirorffaent'fi.~ : , and Occupational,. ~a~.plra~ry C~cinogens. . l~-~ ~ lu~l~ly techmcal document, but I tl~k ~t would be fair to say that Dr, Hueper comes to the same ver~ct as I; ~he ~a~liar Scotch ver- ,tict~Not proven ! In aummary~ I flfink that as o~ 1969, our knowledge of the ca~e ~r cau~-es oi lung cancer remains pr~i~ive. That cigare~e smokes ~m important cauz¢ remains an interestin~ hwothesis To date, the only evidence supporting fins hypo~esls ~s stat~stmal: and there ~ta~i~tic~ which fhil to suppor~ it. To dat¢~ no ~veatigator has demon- ~tra~od a satisfactory mechanism to explain how lung cancer develops iu smokers. As a zcient~st~ X wo~d urge you to be wa~ of witne~ who make dogmati~ statements. It ~ ve~tempt~g to t~nk one knows ~r ha~ proven more. than on~ actually ~ows or has proven. Given the i[npcrfcct ~tate of the art~ I th~k it unwise ~ develop legislative poli- clc~ and acts in fl~iz area. (Th~ attacl~ents to Dr. Cherts statement follow :) ~orn : ~ot~ton, ~Ia~chu~ett~--May 1~, 1920. 1941 G~m Laude. Boston University School of 5reticle, ~D~. Training: Intern in ~a~ology, Beth Israel ~¢spit~, ~oston, 194647. Re~Id~mt Putholog£st, Boston L~ng-~ Hospital, 1948. ~eseareh Fellow, No- tickled C~mcer ~tit~e, lPd~, A~sistant Pathologist, Arme~ Forces Of Pathe¢lo~, 19~0-52. 1147 Position.~: Chief, ]Division of ReSearch & Training, American Regl.~try of Path- elegy, Armed Forces Institute of Pathology, 1952-~;3. Pathologl~t, Bo~ton L~ng-in Hospital, 19~3-55. ~atholo~lst, ~ackcn~ack Honpihd~ 10~657, Director of Laboratories, Knickerbocker ~,spital, 19~ate. Diplomake: .~e~can Board of ~a~iology, 19~2, Tea~iug: Instructor In Pathology, ~oward Wniversi~, 19~2-~. I~ruetov IN Fa~ology, ~arvar~ Medical School, 19~-55. Instructor la Surgery (~urglctd Pa~ology), Colmm~a University College of Physi~an~ & ~urgeons, ~95G.62, A~istant Professor of Pa~ologyt Albert Einstein Collc~ of ~fedtclne, ~S7- date. £ssoclate Professor of Pathology, New ~ork Medical Eollege, 1901-date. ~o~ultant: Sloane ~ospital for ~omen, 1957-62. ~irst U.S. Army Medical Lab- oratory, 19#8-1~68. National Cancer Institute, 1960-date. Vetoran~ Admlal~- traflon Ho~it~ (Bronx), 1960-date. ~argaret Sanger Research Bureau, lt~6~ dat~ Lutheran Me~cal Center (Brooklyn), 2961-date. ~ew York Fertility In- s~tute~ 1902-flare. Licensen: New Tork. Xew Jersey, ~Iassachm~etts, California. So,cries : American Association of Pa~ologists & Bacte~ologts~s~ American ~o- eiety of Clinical Patholo~ts, International £cademy of Pathology, Patholog[. c~ Society of Great BrttMa & Ireland Fello~, Royal Socie~ of Mc~elne F~,I. low, Royal Microscopical Socie~ Fellow, New ~ork Academy of ~t.dlctne, New York Academy of Seience~, New York Cancer Society, New EngI~md Pathologi- cal Society Washington, D.C. Soclety of Pathologists, New Jeffrey Soclvty of Pathologists, New ~0rk Pathological Society, International Fertility A~*q~cla- fion T~e Harvey Soeiety, Sigma Xi. 1. Bans, ,N'. F., and 0bet, W. B.: Hereditary expothalmie golter: l~ePO~t eleren caso~ tn one family. J. Olin. ~ndocflnol., a: 57~G8~, ~ Ayres, W. W.. Ober, W. B., and ~amiltoa, P. K. : PosGtrau~atie neons granulomas associated with a crystalline materlal. Am. ft. P~ith., ~7: 808~515, 1951. 3. ~orrison, H., Mixter, ~. G., ~chles~ger, M. J., a=d Ober, W, B. : sis [ocaHzed ia the ~¢rmiform ap~dix, New ~ng. ~, ~ed, 2~g : 1952. 4 Blum~-,e~, Y. M., and Chef, W. B. : Carcinoma tn Mtu of ~he cervix: recur- rsnce In the vaginal vault, Am. Y. 0b~t, & Gyaec,, $6: 421-~5, 5. Ober, w. B.. and Jason, R. ~. : Sarcoma of endometrlal stroma. Arch. Path., 56: 301-311, 1955. 6. 0bet, W. B., Palmer, R. E., and Glassy, F. J.: Rhabdomyo~arcoma of the vulva and vub~na. Arch. Path., 56: 3¢~373, 1933. 7. 0bet, W. B.. and Edgcomb, $. H. : Sarco~ botryoldes ia the female trac~. C~cer 7: 7~91, 1954. 8. 0bet, W. B., and Rein~r, L. : Camcer of ~e cervix in Yewish women: England J. Meal., ~51 : 55~559, 19~4. (Reprinted as part of G~ ~eting Intl. See. Geog. Path. in Sehwel~ Ztschr. ~. ells. Path. Bakh. J8 : 77~7~0, 9. 0bet, W. B., and Black, M. B. : Neoplasm~ of the subcoelomie me~enehyna,~ Arch. Path., 59: 69~70~, 19~U. ~0. O~r, W.B., and Moore, T. E., St. : Comgenit~ cardiac malformatiom~ In neonatal period. Xew Engl~d 2. %Ied., ~58: 271~27U, 1955. 11. Chef, W. B., Yelardo, ~. T., Greene, ~. C., and Taylor, R. $. : Dcsmold tumor of the Ropllteal ~pace occurring during oregnaney : Report of a ea~;e wRh bioassnys. J. Nat. Cancer Irish, 16: 569-577, 12. Chef, ~5 B., and Be~steln, J. : Observances ca the endome~rlum and ovary of the newborn. Pediatrics, 16: 44~60, 1955. 15. 0bet, W. B., and LeComp[e, P. ~. : Acute fatty metamorphosl~ of the associated with prehmancy. Am. M. 5Ied., 10: 743-758, 14. Jewett. 3.F., and Ober, W. B.. : Primary p~mona~ hypertensitm as a o~ maternal death. Am. ft. Obst. & Gynee., 71; 133~1341, 15. ~oby, C. C., Ober, W. B., and Ororbaugh, J. ~. : Pregnauodlol oxercfloa ~e urine or newborn male infants. Pediatrics 17: 877~%~1, 19~G. 16. 0bet, W. ~., and Wh:~toa, ~. h'. : 0n the "Phry~an Gap," New England Med., ~ : 571~72~ 1956.
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1148 17. ttber, W. B., Reid, D. E., Romney, S. L., and Merrill, J. P. : Renal lesions and acute .xenal failure in pregnancy. Am. J. Med., 21: 781-810, 19~6. ]~. Ober, W. ]L, Grady, H. G., and Sehoenbucher, .L K. : Extopie ovarian de- ddaa wltkuut pregnancy. Am. J. Path., 33 : 1~-217, 1957. 19. Brown, D. E., and Ober, W. B. : Sickle-cell th~assomla (mlero~e~anocytie disea~?) in pregnancy. Am. J. 0b~t, & Gynee., 73: 773-7~, ~0. Ober, W. B., and Kaiser, G. A. : Hamarbma of the ~rathyrotd. Cancer, 2L Ober, W. B., Smith, J, A., and Rouillard, F. C. : Congeuitat sarcoma b~ty- rdde:-: of the vagina. Caner, 1l: 62~5,19~. 22. Oher, W. B.: Uterine sarcomas: Histogenesis and taxonomy. Ann. N.Y. Acad. SoL, 75: ~5~, 1050. 2:L Ol~v~, W. B, and Tovell, H. ~. M. : Mesenehymal sarcomas of the uteruu. Anh J. Oh~t. & Gyncc,, ~ ; 2~2~, 1959. 24. Ohor, W. B. : The Endocrine Patholo~ of the Female Reproduettve Tract. Ch. 10 in E~senHals of Human ~.profluetion, e& J. ~. Velarda, O~ord 25. Ohvr, W. B., Bruno, M. S., Simon, R. M., and W~ner, L. : Homoglob~ dlta:~t~t~ with fat embnlis~ Am. ft. Meal, a? : ~7~55, g6, Oh,r, W. B. : ~istorleal ~rs~e~ives on trophoblast and its tumor. ~. N.Y, Aead, SoL 80 : 3-~, 1959. 27, Ob~r, W, 1¢., and ~ovell, H. ~I. ~I. : Malignant lymphoma o~ the ureas. Bull, SI,ane Hasp. for Women, ~ : ~7fi. 1952. ~. Ober, W. B. : Solid ovarian teratoma wt~ st~a ovariL ~eca luteb~ ma~ fl~n, and tmdometrlal hy~lasla. ~. 0bst. & Gynem Bri~ Emp., 67: 4~- Lq). O~r, W. B., Berg, P., Tuehman, M., au~ Redner, W. ft, : Acute tflchinoM~ ~'ctsohrif Rudoll~lt Vlrehow See., pp. 32~2, 1~. 30, 0}mr, W. B., Bmmo, M. S., Jones, F. M., Jr., and Weiner, L: Fatal intra- va~(~l~ Wekllng in a patient with sickle.cell trMt. ~ew ~ngland ft. Med., B1. Bailey, O. T,. Ober. W. B.. a~d Bruno, ~L S. : Central ~nti~e myeltnolysist. ~2. ObtT, W. B. and Fa~'s, R. O. : The early histo~ of ehorloearcinomm J. ~st. Mad, & Alli,M $4,. ltl: 4~73, 196L S~ also; ~r~. Rtxfloff VireIlow ~led. ~q~. obt~v, W. B, and Kaiser. G. A.: Pz~anediol: Methods, limi~tions, and Idlcatl,n~. Am. ft. Clin. Path., 35 : ~7~18,19~L :~1. Nara~imhan. P. and Ober, W. B. : Sar~idv~Ig: Report at a fatal ~se with r~yo~utrdlt~l lnv,lvement. Indian Prac~, 1~ : 20~5~3, ~1. t~3. Ober, W. B. and ~rady, H. O. : SubinvoIutloa 0£ the placental site. Bull. Aead. Med. :t7 : 71~730, 1961. tiT. Ol,~r, W. B. : Seminar ,n Obstretleal and Oyn~lo#cal Patho]o~. ~med F,~re~ ~nstltute of Patho]o~. Washington, D.C., fiX. Janovukl, N. A., ~chuidenf~i, R~, aud O~r~ W. B. : Adenocar~noma of the cndotaetr[um : Re~rt of a ease developing uRer ~lvic i~adlatton asso- el:trod with ovarian hilus c~ll hy[~rplasia. Am. J, ObsL & eyries. ~ : ~t~L Cutler, A., Ot~er, W, B., Epstein, J. A.. and Kup~rman. ~ S. : ~e e~eet of 1-{IV24Iethylamin¢~thOXYl~enyl)-l-phenyl.2-anl~l e~anol u~n rat Idttti~ivy and uterine r~s~ses ta estrogen. Bnd~dnolo~, 69 : 47~82, 40. Obcr, W. B.: Goest EditoriM: Information for the Pathologist. GP 25: 41. O~-r, W. B. : Embryonal carcinoma of tesfieular ty~ ~lng in the ~nad -~ a t~t~ hemap~r~:~diM. Bull. ~ewish ~Iemo~l H~i~I, 6: ~1~, 1~. 42. B,~rg, I'. arid Ohor, W. B. : E~dfmazdlal flb~elastosls ~s~iat~ wi[h l~lusia of H'm right coronary art~ in an adult. New Eng. ~. 3Ied,, 48. SaR~,.~, ~t. I., N~raMmhan, P., B~uo, ~f. D. and O~r, W. B. : Renal ie'd,:m~ in essential hyertenslon: ~e problem of correlation ~tw~n renal hioVsy and clinical parameter. An#olo~, 13 : 21F~2~, 1~ 44. Buckingham, J. C., He~, H., and PIlL W. B. : Camlno~rcoma at the d~mvtdum, Am. g. Obst, & Gynec., 83 : 15~Gl:qe, 1149 Berg, P., rJ~uchman, M., l~dner, W. J., oud Ober, W. B. : Acute trlchll~osh¢. Bruno, M, S., Ober, W. B. and KUpl~'~an, H. S. : Coexistence o~ Addl- 1~2. { ter. W. B.. ~2tlak. a., Gerstmmm, K, ~L, and Ku~pe:man, IL ~.: Kru- )tken~rg turn& with androgenic ~tl proges~tlonal ege~. Am. a. & Oynec.. 85: 73~7~, 1~2. lomou. 3L I.. Bruno, M, S., an60ber, W. B. : percutaneow~ renal blop: SaI~ Im~r~nce In research and clinical medicine, N~w York S~t, J, Metl.. 62 : 32,~-325~, 1~2. 50. Baron, H. C. a~d Ober, W. B. : P:mttid gland atrophy. Xrch, ~n~g. ~ O~e~, W. B. : ~he endome~iat bioOsy i~ off~ce practice. GP 27 : ~ Ja~oTskL, ~. A.~ Weiaer, L., and 0her, W. B. : Soap intoxic~tOon ~g crinimal abo~on. New York S~te ~. Meal., 63 : 1~14~, ~3. Ba~e, J. A., Tchertkoff, V., &i:havan, T. H., ~nd Olaf, W. B. :Lcydig tumor ot t~s~s i~ a male pseudoher~y~it¢ ~qth testic~ar tcmiui- zation. New York State J. ~Icd., 63 : 225~2262, r. W B Endocrine, pa~alogy. Ch, 83 In Kup~an, H. S. : Hum~m ~. 0~ • -~ ........ ~ ~r~_n~t ~ A Dauis Co, Philadelphia, Endocrinology ; got. ~*a, pl. *a~*-~, ..... 1~. gS. ~oland, M. and O~r, W. B. : The enflo~tmpie eff~t of Prm'e~t in tory and anovulatory patients. Internat. a. Ferttl., 8:tRfl-¢¢14, 56. Bruno, M. S., Grief, W. R. N., and error, W. B. : Sponta~eou~t and rupture of ~phagus and stomach. Arch. Int. ~f~l, 112 : 1~. 57. Unsl~ed ~lto~at : ~te B~rhaavo syndrome, J.A.M.A. 187: 57, 58. Roland, M., Clyman, M, J., D~eker, A, and O~r, W. B. : Ottssiflcation endometrlal response to synthetic prt~gestagen-o~trege~x rompound~:, Fer- til.& Steril., 15 : 14~163, . . . : s Pro ¢~tagenos sintettcoa ca hl infertilid:td Fe~til. (M~xieo) pp. ~tt-3~¢, 1964. ~. O~r, W. B., Cl}~an, M. ~., D~ker, A., mid Itvlaml, M. : Endomctrhd ¢ff~ts of synthetic prog~t~lgens. ]Eternal. J. Fertil, 9: 597-f~8. ~ueh ~ 0bet, W. B. : Ove~t~ ~ laborato~ tesL~. I~ues 2 : 2-7, ~. 0bet. W. B. : Clinical an6 Fathttlo~icaI A~ets of AbnormM Dl~usslon, I~ The Early Coneeldu$, Nvrmal ~intl Abnor~tal, St,~hm pp. 141-t~. UnivorMtY of St, Andrew~, Dund~. ~. Ober, XV. B. : James Gralnger, ~LD. (1721-171~) : Po~t~ an3 Iropleal elne. ~'ew X'ork State J. ~letL, 6a : 1~57-12f~), ~X, ~. Olmr, W. B.: Pete~ Mark Ro~et, M,D,, F~S. (177~18~9) : Utilltarlalt lexicographer. Yew Y¢~ek State J. ~.. ~5: 1~I~, I~G. ~, 0her., W, B,, and Couway, A. ft.: Jo~ll XXI--Ophthalmolt~gi~t, ~7. Ober, W.B.: ~omaS Bowdler, M.D. (17~1~25) : Iro-VL'torlan and editor, N~" ~orR State .L M~., 6J : L~)2~2~0. 1963. 69. Ober, W. B.: Nicholas Ba~bon~ M.D. (71~1698) : Fire s~culative builder, and economist. New ~or~ State J. Mud., J3 69. 0her. W. B.: ~ohn Avms~(mg, )~;D. (179~1779) : A Sc~ t in ~ew York State J. Med.. 65 : 2711-2717, 19~15. (lb~ l. trod the 70. Ober, W. B.: Sir Richard Blaekmere, ALl). "5:N"~29) cartoons. New York State ft. 5Ied., aS: ~+51-~t~Sa. lt~5, 71. Roland, 5I., Aptdezwelg, N., Clyman. ~L 3., Decl~er, X., and Ober, W, )3. ~ro~es~gen "~he~py. Charles ~. ~homas, ~prh~/ield, IlL, 1~3. xv + 72 Ohm'. W.B, : ffohu &rbuthnot. 5LD., F.R,S., F,R.C.P. (lthW-17aS) : aud member of the Martittua 8erible~'us club, Sew X.rk ~lah, J. Mcd.,

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