Tobacco Documents Online

HEALTH REPORT (9 Health Risks of Smoking Drawing Attention from Several Quarters The Surgeon General's latest report called smoking the biggest individual health danger, and Congress is considering tougher warning labels for cigarettes. BY JOHN K. IGLEHART T he federal government, demonstra[ ing an unusual willingness to con- front the tobacco lobby in an election year, is moving to underscore the dangers of smoking to health: The efforts include a new Surgeon General's report citing the risks of smoking, pending legislation that would require tougher warning labels on cigarette packages and advertising and the prospect of higher excise taxes on cigarettes. i hese steps, of course, will not elimi- nate the basic contradiction that has characterized the government's relation- ship with the tobacco industry for many years and has been particularly pro- nounced since the first Surgeon General's report was issued 20 years ago. The gov- ernment expresses concern about the health effects of smoking but continues price supports for tobacco growers. This contradiction stems from the eco- nomic importance of tobacco and the reluctance of Congress jo take funda- mentalisteps that could harm the indus- try Naturally, legislators who represent states where tobacco is grown-mainly North and South Carolina, l~entucky, Virginia, Tennsssee, Alabama,lGeorgia, Florida and A¢aryland--seek to protect their constituents. But the sale of tobacco products provides economic benefits such as increased tax revenues and jobs to every state. Over the years, the tobacco lobby has effectively employed the politics of regionalism to promote tax-financed sub- sidies for farmers and a benign govern- ment policy toward smoking. Legislators in states that grow tobacco traded votes for continued tobacco price supports with Members from states where milk, cotton, peanuts, wheat and other crops that bene- fit' from price supports are king. But that strategy is eroding because tobacco-state legislators no longer wield the power of their predecessors and accu- mulating scientific evidence links smok- ing with a range of devastating diseases. Surgeon General C. Everett Koop stated the case bluntly when be released his latest smoking report on May 23. "Cigarettes are the most important indi- vidual health risk in this country, respon- sible for more premature deaths and dis- ability than any other known agent," he said. Koop is not the only Reagan Adtninis- tration official to address the issue. In proclaiming April as Cancer Control Month, President Reagan said that "the single most important step which can be taken is to avoid smoking." On March 6, Health and Human Services (HHS) Sea retary Margaret M. Heckler, in announcg ing the department's new cancer preven- tion awareness program, cited seven steps that individuals could take to protect themselves against the likelihood of con- tracting the disease. The first step, she said, is "don't smoke or use tobacco in any form." Like most complicated issues, there is more than one dimension to the govern- ment's tobacco policy. The Administra- tion has demonstrated a sensitivity to the interests of the tobacco lobby and Sen. Jesse A. Helms, R-N:C., by moderating its stance onlegislatSpn requiring tougher warning labels on cigarettes and advertis- ing. In March 1982, the Administration withdrew its support for proposals that would have required cigarette manufao- turers to periodically rotate multiple la- bels citing specific health risks of smok- ing on their products and in their advertising. The policy change was dic. tated by the office of presidential coun- selor Edwin Meese tII, even though the Office of Management and Budget (OMB) had approved the multiple label approach, according to an OMB staff member who was involved in the process. But recently, House Democrats worked out a compromise bill that would require four rotating labels that the To- bacco Institute, which represents manu- facturers of tobacco products, said it would support. Orrin G, Hatch, R-Utah, chairman of the Senate Labor and Hu- man Resources Committee, quickly in- troduced the compromise measure in the Senate, and the Administration has not taken a position an the bill. The Administration also declined to take a position an a provision in the House version ot the tax bill that is now before a House and Senate conference committee that arould keep the excise tax on a pack of cigarettes at 12 cents, in- stead of allowing it to drop back to 8 cents as scheduled on Oct. 1, 1985. The independent regulatory agencies have also spoken up about the smoking controversy. TU Federal Communica- tions Commissiaas, the Federal Trade Commission and the Civil Aeronautics Board (CAB) have all gotten involved in regulating tobacco products, and re- cently, the CAB voted to reverse a day- old policy banning all cigarette smoking on flights of two hours or less. SURGEON GENERALS REPORT wltilc the Administration at its highest levels may be dodging the controversial subject of smoking and health during an election year, Koop demonstrated no ra luctance to speak out when he issued the government's 17th Surgeon General's re- port on smoking. The report evaluaies the contribution that tobacco makes to morbidity and mortality attributable to chronic obstruc- tive lung diseascs The 1982 and 1983 reports examined smoking's relationship to cancer and heart disease. In a preface to the latest report, Koop, NATIONAL JOURNAL 6/9/84 1139

Surgeon General C. Everett Koop warned that ' cigarettes are the most important individual health risk in this country." But what worries the tobacco industry is his warning about passive smoking-the effect of cigarette smoking on nonsmokers. who is perhaps the most outspoken Sur- geon General ever on the dangers of smoking to health, said: "Cigarette smok- ing is causally related to chronic obstruc- tive lung disease, just as it is to cancer and coronary heart disease; severe em- physema would be rare were it not for cigarette smoking. The evidence pre- sented in this report supports my judg- ment and the judgment of five preceding Surgeons General that cigarette smoking is the chief, single, avoidable cause of death in our society and the most impor- tant public health issue of our time." Koop also noted that "in 1983, an esti- mated' 62,000 Americans died of chronic lung disease. We estimate that between 80 and 90 per cent of the chronic lung disease in this country is directly attribut- able to cigarette smoking, and thus over 50,000 of these deaths could have been prevented since these individuals would not have died of chronic lung disease if they had not smoked." Perhaps of greater concern to the to- bacco industry were the Surgeon Gener- al's comments on the phenomenon that has come to be known as "passive smok- ing"-the effect of cigarette smoking on nonsmokers. The report found'that "ciga- rette smoke can make a significant, mea- surable contribution to the level of indoor air pollution at levels of smoking and ventilation that are common in the indoor environment." On the implications of passive smoking for children, the report said: "The chil- dren of smoking parents have increased prevalence of reported respiratory symp- toms, and have increased frequency of bronchitis and pneumonia early in life. The children of smoking parents appear to have measurable but small differences in tests of pulmonary function when com- pared with children of nonsmoking par- ents."' The Tobacco Institute took exception to the Surgeon General's report, particu- larly its statements about passive smok- ing. An institute spokesman said that conclusions about the environmental ef- fects of tobacco smoke on nonsmokers do not match the findings of a workshop sponsored last year by the National Insti- tutes of Health (NIH). The workshop, the institute spokesman said, "concluded that the effects, if any, range from negli- gible to quite small." When asked at the news conference announcing the findings of the latest ro- port to account for this difference, Koop said that the workshop was based largely on a small number of community studies and that 80 other studies cited in the Surgeon General's report "run counter" to the NIH findings. Although previous reports of the Sur- geon General have referred to possible risks stemming from passive smoking, the new report discusses such hazards for nonsmokers in far greater detail. This development, plus Koop's contention in his news release that smoking has become "socially unacceptable," eould reinforce the objections raised by nonsmokers in recent years to smoking in public places. The tobacco industry long has been concerned about the growing nonsmok- ers' movement. The Roper Organization Inc. has conducted public opinion polis over the years to monitor attitudes toward cigarette smoking. In a new book pub- lished' in England, Smoke Ring: The Politics ojTobacco,,(The Bodley Head), author Peter Taylor discussed the find- ings of Roper's 1978 report. Taylor said that Roper concluded that the damage suffered by the tobacco in» dustry in the 1960s and 1970s because of health warnings on cigarette packages and advertisements had been successfully weathered because the warnings had all been directed against smokers and aware- ness of the health risk had nqt persuaded many smokers to quit. But now the issue was chanjing, Roper found, and non- smokers' rights were becoming a power- ful political force. Taylor quotes the Roper report as say- ing: "What the +smoker does to himself may be his business, but what the smoker does to the nonsmoker is quite a different matter. ... As the antismoking forces succeed in their efforts to convince non- smokers that their health is at stake, too, the pressure for segkgated facilities will change from a ripple to a tide, as we sa it." LABELING LEGISLATION Since 1964, when Congress first con- sidered health warning labels on cigarette packages and advertising, the issue has been controversial, but the move for tougher labeling now enjoys bipartisan support. The most infuential champions are Hatch, a conservative Republican who has tired of the Tobacco Institute's lobbying tactics, and Henry A. Waxman, D-Calif., chairman of the House Energy and Commerce Subcommittee on Health and the Environment. President Johnson signed legislation in 1965, which required every cigarette package to bear a conspicuous and legible label stating: "Caution: Cigarette Smok- ing May be Hazardous to Your Health." Five years later, Congress enacted a stronger warning label{ which is printed on cigarette packages and advertisements today: "The Surgeon General Has Deter- mined That Cigarette Smoking Is Dan, gerous to Your Health." Congress appears on the threshold of approving a far tougher set of labels worked out after prolonged negotiations between Tobacco Institute lobbyists and two House Democrats, Albert Gore Jr. of Tennessee and John D. Dingell of Michi- gan, chairman of the Energy and Com- merce Committee. (See box. p. 1142. )' The bill (HR 3979), reported unani- mously on May 17 by the Energy and Commerce Committee, would require four new health warnings that would ro- tate on all cigarette packages and ad- vertising. The warnings would be changed every three months. S E 1140 NATIONAL JOURNAL b/9/84

0 Hatch and Waxman also deserve credit for keeping pressure on the parties to continue the dialogue. For months, Hatch demonstrated a willingness to ac- commodate the interests of the tobacco lobby by striving to arrive at a compro- mise palatable to both the industry and Congress. He urged the tobacco industry to initiate discussions with Dn Edward N. Brandt, assistant HHS secretary for health. After weeks of negotiations between the Tobacco Institute and Brandt, the assistant secretary forwarded to Hatch's committee a proposed warning label that the industry was prepared to accept and the department was willing to endorse. It read: "Surgeon General's Warning Smoking increases your risk of cancer and heart, lung and~ other serious dis- eases." The Labor and Human Resources Committee rejected the proposed warn- ing, as too tepid, but it did syrve as a starting point for further talks with indus- try lobbyists. The committee eventually approved a stonger label, but not before Hatch ac- commodatcd the industry by allowing one of its lobbyists, Horace Kornegay, to make a presentation during the panel's markup session. The Senate bill, which Hatch has now abandoned for the tougher warning contained in the new compromise, would have required the fol- lowing language on cigarette packages an&advertisements: "WARNING! Ciga- rette smoking causes CANCER, EM- PHYSEMA AND HEART DISEASE, may complicate PREGNANCY and is Addictive." The Hatch bill also would have required disclosure of tar, nicotine and carbon monoxide levels. The bill never wcnt to the Senate floor because a number of tobacco-state Sena- tors placed holds on the measure, and, as Congress moved into the election year, the Republican leadership was hesitant to schedule a vote. , Another problem, according to staff members who were party to the negotia- tions in the House and Senate, was that the Tobacco Institute's lobbyi were un- able to deliver a commitmen~from the cigarette manufacturers to support, the Hatch bill. The institute began to lose credibility with legislators who were pushing for a compromise label. An aide to Hatch saidat the time, "The Senator is convinced that the Tobacco Institute did not negotiate in good faith, even though Hatch bent over backwards to accommo- date the industry's interests." The Tobacco Institute improved its standing on Capitol Hill' when it hired Howard S. Liebengood, who left his post as the Senate's sergeant-at-arms last year. An aide to Hatch said, "Liebengood rec- ognized that unless the tobacco lobby A Study That's.Up, in Smoke : Until now, most of thc eflbrts being made to change the nation's smoking'habits , . have been undertaken' `by:federal,.state and some locai,goveriunents.;.But recently; Harvard University's John F. Kennedy School of.t'iovernment bas received a'sizablc private grant to establish an .Institute, for the Study ;nf Smoking Behavior and Eohry. The.S658,000 grant was awarded byt6e Carnegie Corp, a New-York based, foundation whose president; Dr: David :A. Hamburg, has long'maintained a strong interest'in reducing tobacoo~tse. . .• The inew institute wtU be dtrected'byTbotnas C. Schellmg,an econoaiut at; - ,_.. "Alihough [rmokutgjs~emalns~ ofahe most mtensivel~studted uiedtcal,:i :problems, Sclielling noted in a Harvar+a, news:nlcase, "re]attv`ely l't.ttle research :; has t~eennperformed concxriung the behavioral' aspects; ofl stiiokit~g.: Wlty,~or ~ .instanae;' have niiU~ons managed-3o qurt stoolong, while 35 on'ltion Anaencans~; iemain3ioolcsd'r' ~~-~t~`~"~~ i~ John M. I~Aney, ~vho scrved as a special asststant to'former~iealth; Educ~~ `t,on and~~Velfaic Secretary Josepbaiio Jr and~s ~ilirector~ot~be~ ;aepartinent'i Offtcevn Smokiiig artii~ieahh during the Carter'Adrnuust~tion;~~' will serve as cxecutive'director, of the tte.wr utstitnte. ~~~~~~A ~~~ ~~ - During thc instttute'i:fust five years, Schellin8 hopesahat rtrivill develop bctter iinderstandmg of`smoking behavwr and be able io adv~se;goveriiinents, ,, insuranoe cotnpanus, -phystcians,-schools andd corporations ~~ways to help .` people quit smoking and keep youngsters demonstrated some level of cooperation, the industry would lose the support it found on Capitol Hill that went beyond the tobacco states." But even Liebengood found it difficult to deliver a united indus- try, and recently, he announced his inten- tion to resign from the post he had held for only a few months. HOUSE ACTION Although the industry did not like the Senate bill, it disliked even more a mea- sure approved last fall by the House En- ergy and Commerce Subcommittee on Health and the EnvironmenL That legislation, which was introduced by Waxman, would have required three diftcrent warnings on cigarette packages and advertisements to be selected by the cigarette manufacturers on a random ba- sis. The warnings would have read as follows: "Warning: Cigarette smoking causes lung cancer and emphysema, is a major cause of heart discase, is addictive and may result in death ""Warning: Cig- arette smoking by pregnant women may result in miscarriage, premature births or low birth weight." 5mokers: No matter how long you have smoked, Quitting Now greatly reduces the risk to your health." Waxman's measure was never consid- ered by the full committee because Din- geU, sensitive to the concerns of the to- bacco industry, convened private discussions among the interested parties to negotiate a compromise. The discussions went on for several months, and while they continued, the tobacco lobby sought to find a member of the Energy Committee who, would be willing to sponsor a weaker alternative bill. The Tobacco Institute approached sev- eral members of the committee, includ- ing Democratic Reps. Dennis Eckart of Ohio and Gerry Sikorski of Minnesoja They floated a compromise proposal, but it ran into almost immediate opposition from the Coalition on Smoking or Health, an ocganization that includes the Ameri- can Cancer Society, the American Heart Association and the American Lung Association. Soon after the coalition ex- pressed its opposition, Eckart and Sikor- ski abandoned their compromise. While Dingell was searching for an- other compromise, Gore, a Member who had demonstrated concern about the in- dustry's interests and the dangers of smoking, entered the picture. "I saw a crunch coming and I thought perhaps there was some way I could help fashion a compromise," he said. A bargain eventually was struck but not before Dingell threatened to have the full committee take up Waxman's tougher measure unless the industry agreed to the compromise worked out by Gore and Dingell. The four health warnings that were approved by the En- ergy Committee read: • SURGEON GENERAL'S WARN- ING: Smoking Causes Lung Cancer, Heart Disease, Emphysema and May Complicate Pregnancy. • SURGEON GENERAL'S WARN- ING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health. • SURGEON' GENERAL'S WARN- ING: Smoking by Pregnant Women May NATIONAL JOURNAL 6/9/84 1141

Albert Gore: The Man in the.Middle ,: The central role played by Rep Al- bert Gore Jr., D-Tenn,; in'negottating W ~ a compromise cigarette labeling bt71 says something about the status of the.•' tobacco industry's cause on Capitol `' Hill. The fact that Gore, who is favored ~ to replace Sen.'lHoward H. Baker 3r ~='~ whentlte MajorttyLeader retiresaext year, fel t •comfortable -negotiat'utg •a'r":' compromise'during an electiodyear';r suggests that legislators -are less ieti=;= . centthan in'xhe past :about takmg on~ this "controversial lssue. Tennesse~ tis.4 ~state, with ',I OO,fl00'~g was~? tobacco faraters;~nd Core, wb00 .a small tobacco.allotment"~etti,~has~:~ always beeii.4easttive'to the intercsti'X, '4alung .with ever greatcr frcquene ~`' ~~~=`~~ ~' i l of these votcrs.~ ~.: . , . Result in Fetal Injury, Premature Birth and Low Birth Weight. • SURGEON GENERAL'S WARN- ING: Cigarette Smoke Contains Carbon Monoxide. The bill, known as the Comprehensive Smoking Education Act also includes the Surgeon General?s findings that cigarette smoking is "associated with the unnec- essary deaths of over 300,000 Ameri- cans" and is the major cause of a range of serious diseases. The Tobacco Institute's lobbyists persuaded Gore and Dingell not to include the Surgeon General's opinion that cigarette smoking is addictive in their bills. The tobacco lobby also won several other concessions in the House, including the elimina- tion of any requirement that cigarette packages and ad- vertisements disclose the lev- els of tar, nicotine and carbon monoxide, as tested by HHS. Hatch introduced the bill (S 772) in the Senate as a substitute amendment to his measure. His swift action sur- prised industry lobbyists, who believed Congress would be reluctant to press the bill in an election year. The bill'could face a filibus- ter in the Senate by Helms, who is facing a tough reelec- tion fight against North Caro- lina Gov. James B. Hunt Jr. Helms is already smarting from Hunt's charges that the GOP Senator voted to double the excise tax on ciga- rettes, and he does not want to hand Hunt another issue that would incite tobacco farmers in North Carolina. Increased excise taxes are becoming 'more popular with legislators who are looking for ways to reduce the federal deficit, and the health risks of smoking make cigarettes an increasingly popular target. House Democrats are prepared to support the higher tax on tobacco, while Senate Republicans, at least in this elec- tion year, are resisting. (See NJ, S/S/84, p. 869.)' House Ways and Means Committee chairman Dan Rostenkowski of Illinois and other Democrats on the committee favor earmarking any additional revenues from the exise tax for the medicare hospi- tive in a wide range of health issues, and he said in an interview thathe has no doubt that smoking is.a health .`'T he precise mechanism that links smoking and disease is not known, but, the statistical evidenee_ is so •ovcr-. whelming that it makes further argu-, ` menttnoot;« Gore satd.^^;' ". But Caore' asakes a distinction be- tween the health and oconomic dimen-. sions of snfoking, particu.larly.as they _ apply.to tobaceofarmers.'Taldng the 7 3,r ~ ~=.rtght to grow tobacoo away from small : ~.farmen"V sviil "not have' aay uapact on' '` 'smolang," Gore ~aid,b~ ihe cig= W'-;aiette , mattufacturers7ivould ssmply ~ ~impori tobacoo,.a step'_t'6at_ihey::aro:. tal insurance trust fi6d, which faces de- pletion around 1990. Dick Chency of Wyoming, a Republi- can~ who wields an increasing amount of influence in the House, is also thinking of ways to reduce medicare's costs and raise additional revenue. Cheney said in an interview: "I think the evidence is over- whelming linking smoking and disease. I believe one can make a stong case for increasing the cost of medicare to people who smoke. It's almost like a user fee concept. I think Congress increasingly will assign some of the cost of our health care programs to the factors responsible. And smoking is clearly one of those fac- tors." O Sen. Orrin G. Hatch (left), a conservative Republican, and Rep. Henry A. Waxman, a liberal Democrat, have led the move in Congress for tougher warning labels on cigarette packages and advertising. • 1142 NATIONAL JOURNAL 6/9/84