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AUG 171977 _ R B. SELiG1V1AN PHILIP MORRIS EUROPE MIDDLE EASTi AFRICA RESEARCHIAND DEVELOPMENT Dr. H. R. Wakeham, Vice-President, Science & Technology and' Dr. Raymond Fagan, Principal Scientist PHIiLIP'MORRIS INCORPORATED P.O. Box 26583 Richmond, Va. 23261 / USA Neuchatel, August 12, 11977/HGA/map Re : INTERNATIONAL COMMITTEE ON SMOKING ISSUES - WORKING PARTY ON MEDICAL RESEARCH As you all know, the meeting,took place on 27st/22nd'July at Shockerwick House near Bath. The participants were Dr. Bentley (chairman), Dr. Colby, Dr. Felton, Dr. Field, Mr. Matchett, Dr. Meloh and'myself. At the beginning of the meeting we almost came to a dead- lock. In discussing causality, a complete division of opinion occurred : Drs. Bentley, Field and Felton on the ane side and Dr. Colby and myself on the other with Dr. Meloh and'Mr. Matchett remaining indifferent. The reason was that ~'the three representatives of-the British companies accepted °that smoking was the direct cause of a number of diseases. .They shared the opinion held by the British medical esta- blishment that a consistent statistical association between one risk factor and a disease was sufficient to be able to assume causality. Dr. Colby and I emphasized, however, that the existence of a statistical association between a number of disease categories with a wide range of variables (risk markers or risk factors) - many of which have not even been recorded with sufficient accuracy - can, on principle, not serve to establish causality. ./. ` `~~IVH :~

--Drs. H.R. Wakeham and R. Fagan August 12, 1977/HGA/map Page 2 sophies differed so widely. Finding ourselves in this situation, it was very difficult to embark on a constructive discussion at all as the philo- animals which were so severe that they could'not be taken as representative of the human situation. He belongs to. the school of scientists who want to get "clear-cut end- points",„-,no matter what they mean. pecially Dr. Field tended to-bend over backwards in pro- posing smoking conditions to be imposed on experimental results which would be biased against the cigarette. Es- research ideas went out of the way to produce experimental In addition, I got the impression that some people really lived in "cloud-cuckoo land" because many of the proposed In the end we derived some consensus, the resulting paper was edited by Dr. Bentley. Although the whole thing is not very satisfactory, I wouldbe prepared to accept the paper if lines 29 to 33 were replaced by the following paragraph : co-variables.are : diet habits (e.g. vitamin intake), weight, with the same range of diseases - most of which are likely to have multi-factorial etiology. The most important of these "With very few exceptions, we found that deficiencies in know- ledge related to the lack of research concerning the many other co-variables besides smoking that are statistically associated occupation, income, family size, history of diseases within ,the family, hobbies, marriage/divorce." medications, drug abuse, personality score, ethnic background, height, sex, personal history of diseases, average amount of sleep, fitness (e.g. exercise, sports), alcohol consumption, Perhaps you could read through the draft prepared by Dr. Bentley and let me have additional comments that I might include with my answer to him. Perhaps you could do this by telex as I have to answer Dr. Bentley by 22nd August. Enclosure :'draft prepared by Dr. Bentley cc : Drs. R:B."Seligmar.4 M.'Hausermann Mr. P. Isenring