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TOWA!ZDlS A LESS ILAIiM.I'UL CIGIIP,L°T'I'L - , Cha irmarr: Erne s ti L. Wynder, M. D. - Associr.te 1W,ember, Sloan-Kettering Institute for Cancer Research In 1SCI+, the Surgeon Ge ieral's Com.r.at:tee on Smoking and Health called fo-r ' > remed'al measures to. r•ec?ucc i:':e l~:e 3lth h+t::urrl associat:erl with cigaretLe smoking. One of these measures is the ostablistuient of a, lecs-hazardous cigarette. . _, , . _.,_. _ . ... , i The proceedings of t!1e workshop deeling wit;ti •l~.Lis area ndicai.:ed significant_ ' progress in the ide:ltification of factors iin cir;nrctte smoke that contribute to the iiea].th hazards as -we11 as rr.errns of theix reduc:tiori. - . . . ,. ` E, Encourage researclr into motivation leading to correct action, as well as the motivation bel~ind not taking Pc;;i on. F. Encourage researca into the immediute effects of smol:ing, and the practical use and effectiveness this Y_no!rledge miGht have in producing desiredd behavior cha4,es. G. Conduct .,tudiea m how chenf;es in t;ie environrnent (s+rch as resr:rict- ing nretis where srno}~i::itf. czuz t.rr,:r. Zar>cej m1~;11t lic!ve on smokir,E~, t~«~h^vior•. The event.ual goal here is"to c'ei.tz•1ni.nE: if srnoking can be ninde socially ~ uiincceptable. H. Conduct stud~:.es on the effects that increased cost of cigarettes y taVation or other ::,ea.ns ) i,:oulc: have on smc::i ng behavior. I. Conduct studies in•:olvir.g , whole ccrr rnu,tt ics in di: `ferent, countries :'tn t2C:lii isolate anC.l ulvlE_"r':;t,t1P:C1 rlii' 7oc1e:: al°a= (C'.,l.tura1 ilill(j :1ociP-'-1 1•F1Q:j.oi's have in smoki ng te.'~avior. EhcouragA more i'esea.rci, in t,he r re. of snioki.nl; and' accic',ents. III. Ces.:<<tion in ti~e Adult ..ho rntis'_ c{~:iit for reasons _ ~.'l0ti2'c'ttt' :;:AOl:er:: w;;G Jlll'F~r~l~ stla'('C'U~f2'c:rl clirGllic,reo(-/irntorl' diseZre,,,, .crillCer, ;1aCi h~:lJ.r~ C~_CC 15C' ShDliliu riC ~ivcn 5jPeC~1~.LC consideration as t1.tFiI'EC~ ,~ pGp~ilation for cifrzi'e tT.e GI nGkin(,r Cot'r,i-Col 1' O.ci:oI's 2':?lev f].'It to rriot.2vfi- , tion of t.~es^ patients for cess~rtion of sr cl._n~; ~,er:ci f`utther dclineation. - It is recor':mercied that el, ci! ic st-:rlics +iiized at tF:is trirget populaU.iorn t)e conducted to i;entir'y these fr.ctors anci to deterr,_i ne how tnese ptat:ients can better be helpec' in, their efforts to stop Jrrlo..ln,-. Acceptance of less hzzaa•:icus ;:ayF of c~o ~ing `'The research probLe:rn here is to netermine whether it is possible to pro- tice less;hazardouc Na; s of srmo}:in~ witiiout; interfering with programs designed ~to gepeople to _stop smol inc;: ~T..Y W.._' . . ... . .. ' -.. . . . . ...

~ i'$~'~"a,*.'^{.ra x ~5 ..... - ...-,-. . ...<.. ! ~ y ~ya Kr -.- . . . . .. - ! s r ( Since a definite dose-response relationship exists between the number of cigarettes smoked and diseases of the cerdiova.scular and pulmonary systems, :.:any-thinS that will reduce total smoke exposure is likely to be followed by a c o ' i il f ardi o l - r more ral, o y ra ~ -reductlon in , is.t, Such a rec?.uc•tlon ma~ hc e..pectec ~~,'' ` vascular then for neop3asti•c disease. 4inen considering rn,•ocExdial ini`erction, the Freponde.rance of evidence '; suggests that nicotine plays an essential role in its pathogenesis an&that its reduction would be associated with a rec.t_ictioni in deaths from this important ~, r ~ th rht t b y as disease. ~he eflect o~ nicotir.e on :,:rocarcial ~.xifaietlon was oud o e related to its possible effects on blood r.oagulatiorr, ae,d on mobilization of . free fatty acid. °_Thr:, pnrticu].atc matter •i ntobacco smoke is c.lenrly carcinogenic , ~c and co-carcinot;enic -com- c i:o the exc,,eramcntal anr.mal onc! specrif ir carcinoY;cn:~ Ponents have been I~lenIiif1c:d. 1 There .rus a borly of' api r,:iion that thr gaseous ~ pt,ase in cigarette smo.ce :uiZhl a.L,o c~.iicrt tY,e 7~^tY,ogenes._s of lun- cancei .and . chronic pulmonary disease and, tn-,t a rec:u,ction of' all potential toxic substances _ ~ should be accomplis;i!edl. Tl"ere was some ui saJreen,ent as to the relative import- ~ ance of various toxic s.Lbs'_ances in ci-arette smoke, particularly as to their ppp _ , _ yyy' f . r I_ .': _ .. effect or man. . . . .. . . ., ..: ,:. ', . ' _ - !1~- r. ,. .: ., .:: • ... .. .. .. .r" . . . . . . . . . ... .,• . ' .-.. . ~:. ..:~. . . . ........ .. ..,. . . .. . ..;.. . . Adequate means are already available for a practical lox'rering of "tar" and '< nicotine levels of cigarottes. In fact, tLere has been a tren& towards a r.: rec?,,rction of these v,~]!,.aes in American cig::.-ettes dirrinY; the past decade. aq; T are also available to reduce gasf~•o•,:: compor~e^ts. r Persuasive means r,eerl to be introdl.,.cec', for the tobacro i:ndlastry to mFZnu- ~' ~ facture less-har,nful cir;v~rette;;: ar.d for increasing their acceptability with rokinU. Such measures include: that poition of the publir thr t cannot give up sr _ . ~ 7~ LL ~: 1. Regulatory stande.rc:n _for a cigarette to be called a"1'ilter" cigarette. 2. : Regulatory stan.lardls i,rovldinC thzt a filter anr: t ie non smol<able verlap should be not less tiian 3C mn,: in length Y Re~~ulatory standards fiove ning the yield of" "tar" and nicotine and, possibl;i, other smoke comporlents, . : . _ : .. . . ..-. .. .'.~~ 1 t ... . . . . ' _ - . . - _ . . _ ., , r.:- - .. . . . . - ` ---4. ' Regulatory li.stinpg on 411 packa~ge:, oi the "tar" and nicotine ` content, nd perhaps in the future, of other deleterious substances. 0 ~ ' A suggestion was made, based on e:<tensive experimental data,, that increased nitrate levels of tobacco would reduce the formation of carcinogenic hydrocarbons. . . . ~ • . ., } :7 ~ ~- h .,. .. , ~.., .. .. at1} 'G. Y . .. . . . - ... . .. , . . ~~~~'.. r -; µ.' .N Q Enco uragement of the design of' cigf:rettes to reduce the practice . of i nhalation. '~ ad ~ '' The workshop rnembers ex.pre3sed u.dr_;;ire for close. coohcrr,tion with one , another. It wn ; rrnPos^d tac,i, ,a .rc,rl ~ rci rY, bF. i u i't i r' +~•rl con ~,t` rrri,c. t s t 1 . ~'r°, . .. . , . . s r r - ~ .r .~.. f "~- J. / ...ar'~ 4 .i. {- 1S. v s... c T~ .V! ~ 4

i J.. ~Eh~T of the Department of Agriculture; ` Ros •ell Park t~err~orial Inctitute, New York . ~~ t-f ~`. ,:•Univeisity, the Uciiversity ef Kent~YCk,y and the Sloarc-Kett:eri.inC instittxte, to ~' meet..at three monthly interti=rls " It •is ho,-,ed,1,iiFt other interesfed i:.rivate ;;~~`~ research groups, as ~well as selentiFic di.rectors of the tebaccc, in.lustry, tizll th 4 join' this group and',that o^,enn channels of corrwunl:.aticn w,ll bA maintr-ined .ti ~ak tne Lung Cance, Task Force '„ Some concei n was exFressed about clalrls rcade fcr new filters or processes `~~ {<~- tc 'reduce' ttce he3lth risi_ of , cigarette mmo?tir•` in cn.se^ where s?:ch claiciis have ` ~.j•n'ot been accompanied by"ti:ell=f:ociur:enten' sc-entific datc:. 'It was surGested that .h =the Pi 1b1ic Health Service esta.bli.sh a nrxnel tl,r:t has t},e scientific al?t.ituc?n ~r° " 'trnd tha i.' i: rivcni, lcC J ,l .r,ui.hc~rii, to Frot^c t l~ rLc r.t rict ts ic~ orc!er to evaluci e y ~ - • ._ _ . . . ._ _ _ . .. .: :r- ~ 'i~. .. :_: ..-,_ . . ':.- , t ,.f.,.+ .. .....,. .•.. •.. . . ,.. . .. ,: •. . ..-• Eftorts must be conti nuea to develop clcer.licnl n.nd bioloGical methodoloSy to ~" establish the relative ic.:portac.ce of.i;o3:ic substances in tobacco smoke and pro-, vide Euid'elines for perrrissir]1e lcvels of these substarnces in cigalette smoke. :• 5 ,z, T= } - k,. . . . ; . -, . . . . - °. . .. . _ _: -: . . .. .. . . . . . : ~. - ' _ F~ F ftx The ultimate proof for a less-harmful cirarette must be the hunan exper ience. It was suggested'~ -- and it seems feasible -- to build a surveillai~ce ,sy stem in several major hospitals in the United States and abroaa where the scnoking habits of' individu als kith diseasec no~n i:no•.rn~ to be associated with ~ cigarette smo}ci_n gng would be recoruec?. Such recorais would includ'e the brand of cigarettes srno'..ed by each indiviclual. In this manner the relative health risk 4?: e of ci€. ~-nrette i;culd well be establislced. Nembers r4 associated ;«ith a given ta!•}- + v,~ ;~ t,a;-., of the workshop at;reed' to iiniti-ate s.~cir a system, hopefully with the support Fublic :ferrlth rigcncies. ' Spe-il:ing personally, ;uud us aomeonc A io hp. s :;henil nearly all of his ~ seienc•ific life i nvolve(i i~n cp,i r!ecr,ioloi;:ical nnc: Lhe b.1 si.c research aspects of , ~F7 he i,robic-m unclcr d}sr_iuc.:7ion :rt, t.liis confcrc nce nncJ o> :.omr;one who huc: watei.ced mr:11' ,.ji:parerit, difficult,y in (Livi nt; up cn,okint; rrnd j,revenLinv youth 1'rom stnrt- , ng,' it_ is evident that botir 'r'or l;ractical as well as acaolemic reasons work on V, ly.the less-hazardous smoking products must be continued and extended. It repre „ sents or.e cf_the logical measures called for by the Surgeon General's Report : #a ~Our workshop believed that if properly pursued and sv.pported, and if its sug ~ ~}r gestions -- many of which are practical today -- materialize, this remedial ~~. ~ easure will make its contribution to our common goal, the reduction, if not ~ r~xrelimination,'of all diseases linked'to cigarette smoking. It is towards this V=goa1 that our workshop hopes to have made a contribution. .~ ~.:.F '~L v•FS ~. 7. ~4. L~ ~;* {= 5, Sn' ~'f~w};k!'~~: v .• p.fl;w T . r ~~4 ..,- . - : C!