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c A', Remarks Prepared for Delivery by Dr. Julius B. Richmond Working Meeting: Research Needs on Low Yield Cigarettes June 9,,1980 This meeting has been called to help set new directions for Public Health Service research in the general area of smoking and health, and to bring into this area new scientific expertise. The need for this re-examination has risen primarily because of the recent C development of new kinds of cigarette products and, it would appear, the adoption by the public of new kinds of smoking behavior. Your deliberations this week and the recommendations and findings• of your work panels will fin&use in the Public Health Service's reponse to the Health Services and Centers Amendments of 1978, which direct our Department to study the health effects of varying levels of tar, nicotine, and cigarette additives. We expect they will also be a major contribution to the report on the health consequences of smoking which I am required under law to make to Congress each year. Although this marks a new direction for some smoking research it is just part of an overall program to expand our knowledge on the effects of smoking so that we can present the facts to the American people. This will not be the first time that directions have been changed in smoking and health research.. The earliest work in this field of smoking and health was by epidemiologists, looking into a sudden and alarming increase in the incidence of lung cancer. Gradually this research~was extended~to other disease states and was taken up by other branches of the biomedical and behavioral sciences. ~

2 < The first great change in the direction of smoking-related research came in the late 1950s and early 1960s. If there was a signal event to mark this change, it was the publication of Cornfield's paper on cigarette smoking and'~ lung cancer in the Journal of the National Cancer Institute in 1959. The distinguished authors of this paper, in addition to Cornfield, were Haenszel, Hammond, Lilienfeld, Shimkin, and our fellow-participant at this meeting, Ernst Wynder. With impeccable scholarship, the authors of this paper established beyond all reasonable doubt that a causal relationship exists between cigarette smoking and lung cancer. Additional evidence has accumulated since, and similar relationships have been established between cigarette smoking and other diseases. But the question on the hazards of cigarette smoking was answered. We in public health like to remind ourselves on~occasions like this of John Snow and his famous water pump in London. There is no proper analogy, however, between Snow's pump and the research of the epidemiologists in the 1950s. Snow was able to seal the polluted well; in a free society we can only try to persuade people to give up cigarette smoking -- or to show them, if this is possible, how to smoke with less hazard. We have made tremendous progress since 1959. There are proportionately fewer men smokers in our population today than at any time since perhaps the 1920s and 1930s. Women's smoking, which increased so quickly during and after World War II, now appears to be declining slowly. The uptake of smoking by boys is less than at any time in at least two generations and smoking by girls

. 3 ( may now at last be moving downward as well., Per capita consumption is less than it was when the Cornfield paper was published. And, as we are here to examine, the tar and nicotine yield of the cigarettes which Americans now smoke has been reduced by an astonishing extent. Every one of these trends in~smoking prevalence, in per capita consumption, and in lower tar and nicotine yields, is continuing. The Federal Government has encouraged this movement toward low yield cigarettes ( in a number of ways -- through the relaxing of Federal Trade Commission strictures against advertising tar and nicotine in the 1960s, the initiaton of the National Cancer Institute's tobacco program a short time later, and (not least) by the periodic testing of cigarettes by the FTC and the dissemination of these results through advertising and~through the educational efforts of the Public Health Service. In 1966 the Public Health Service and'the FTC issued a significant statement which I am sure will be examined at this meeting. Written by Cuyler Hammond and Dr. Wynder, and adopted by an ad hoc committee, it was that "the preponderance of scientific evidence strongly suggests that the lower the tar and nicotine content of cigarette smoke, the less harmful /will/ be the effect." Let me emphasize here, however, that this sentence has never been used by the Public Health Service without the corollary statement that the single most effective way for both men and women to reduce the hazards associated with cigarettes continues to be to quit smoking. ~~ C G 0 C The presence here this morning of representation from the National Institutes Ma of Health is a significant acknowledgement of our efforts in the Public Health ~' q CA

4 C C Service to~involve our scientific establisfim'ent with the determination of health i policy. Clearly, the direction and thrust of smoking research is changing and t must contin~e to change. But the need for knowledge is at least as great now as it was when the epidemiologists first began looking at the problem decades ago. 1