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February 18, 1964 SMOKING AND HEALTH' SIGNIFICANCE OF THE REPORT OF THE SURGEON GENERAL' S COMMIT T EE TO PHILIP MORRIS INCORPORATED Distribution: Mr. Hugh Cullrnan~ (10) Mr. H'. A. Atkins Mr. A. C. Britton Mr. J. E. Lincoln Mr. G. W. Macon, Jr. Dr. H. Wakeham (5)

SMOKING AND HEALTH (Significance of the Report of the Surgeon General-'s Advisory Committee to Philip Morris Incorporated) c INTJODUCTION AND SUMMARY s The Research Center has made an initial examination of the report of the Surgeon General's Advisory Committee on Smoking and Health with the view to its proper influence on Research Center program and formulation of technical advice to Philip Morris management. This statement summarizes those preliminary views. The onus of proof has been moved by the report from its usual position with the industry's accusers to the tobacco in- dustry itself. Meeting this challenge affords Philip Morris a spiendid opportunity to gain a competitive edge through effective technical activity. Positive programs to cure ills cited in this, ~ report, whether real or alleged, are recommended, as little basi Vs for disputing the findings at this time has appeared. Among those programs which~deserve increased corporate support are: 1. Expansion of Research Center knowledge through intelli- gence effort in epidemiology, bioassay, lung cancer research, etc., and liaison with a medical-school. 2. Increased laboratory study of: a. gas phase adsorption and selective filtration b. chemical carcinogenesis of smoke c. cigar and pipe smoke chemistry d. pulmonary clearance mechanisms e. other physiological effects of smoke, particularly on respiration characteristics and heart load. 3. Development by year end of a superior filter cigarette with acceptable taste having high gas-phase absorption and very low TPM - to be based on Series T microfiber polyethylene tow and adsorbents of surpassing adsorptive qualities. The hoped-for result of these efforts will be cigarettes with distinguishing new product properties which are biologically approved on all major health questions. Such products should be advertised vigorously on the basis of studies so conducted. I

SIGNIFICANCE OF REPORT'S FINDINGS TO TECHNICAL ACTIVITY The raising of so many bogey-man issues over the centuries concerning the allegedly unhealthful effects of tobacco has no doubt jaded the user's appetite for such rations. Consequently, ~ - th~a tobacco interests have successfully put their accusers in the position of proving their point, and as the latter failed, so the issue died. Now the findings of the ten man panel of impartial scientists seem to have been taken rather as a verdict against cigarette smoking. Adoption of the Smoking and Health Report as "policy" of the U. S. Public Health Service, press treatment of the news, various proposed legislation, quick folilow-up by the Federal Trade Commission and National Association of Broadcasters, and the beginning of negative actions in the Defense Department, all suggest a shift in the onus of proof from the accusers to the tobacco industry. The professional approach of the Advisory Committee furthermore may serve to force future arguments to a more scientific basis. The proposed FTC Rule 2 calling for more specific advertising claims backed up by "substantial and reliable evidence to prove the accuracy and significance (to health) of the claimi" is in this vein. These early reactions to the Smoking and Health Report under- score the increased importance of timely and effective R & D activity, unfettered by non-technical restrictions to its inquiry, to expand knowledge, upgrade present products, and introduce pertinent new ones. Health impact will surely be an important, perhaps the most important, basis for competition in the industry in the next few years. Competitive pressures suggest a break up of -2-

the common front approach of the industry through TI and~ TIRC. While R. J. Reynolds continues to advocate a joint fro7it, sit tight, status quo approach (it has the most to lose from any change in st T us quo), others like American and Liggett and N~yers, sanguine forimproved competitive positions, show signs of bolting and have capitalized with their new products on early reactions to the report. The greater the longer term market impact of the report, the more intense will there be health competition, which~is to say technical competition, among major tobacco companies. A special area of scientific activity receiving growing attention in the recent past and accorded emphasis in the report is that of pulmonary cleansing mechanisms, particularly cilia function. This, together with:respiratory effects of smoking in general, is due for increased scientific inquiry in the future. EXCEPTIONS TAKEN TO THE REPORT'S FINDINGS A careful review of the report has so far disclosed no "vitiating errors of commission. There are the following exceptions/ comments, however, that are constructive: 1. No epidemiological or other evidence directly concerning ( the possible ameliorating effect of filters on the association of health and smoking was available for consideration. This is an important omission, in virtue of the fact that modern filters cut cigarette tar and: nicotine deliveries up to one-half of their former values. The claim~that people haven't been smoking filters long enough to observe effects seem perfunctory treatment of a major industry effort to meet objections -~-

to its products. An unfortunate impression at the committee's press conference that "filters do no good" was at least subsequently rectified by Senator-.Cooper. 2. The report states (p. 143) that no evidenEe exists to indicate a smoking threshold, at rates below which no harmful effects occur. This conclusion is in the same situation as that relating to filters. Evidence does not prove the converse either, and, more importantly, the public at large has been left with the impression that it must eliminate, not moderate. If a threshold exists, the effect of filters must be cut by more than one-half (possibly eliminate) any harmful effects that may obtain in the long term future. Actually Tables 8 and 10 of Chapter 10 do not give great encouragement for a threshold. However, these total mortality data are dominated by deaths due to cardiovascular disease which may mask any threshold effect on lung cancer mortality. A tabulation of lung cancer mortality ratio versus smoking exposure would be more pertinent. 3. The report gives inadequate recognition (p. 61) to the selective adsorption of certain gas phase components from smoke which affect pulmonary cleansing mechanisms (viz., mucus flow, cilia activity). The statement that carbon filters previously employed do not have specific power to scrub the gas phase ignores pioneer work at American Tobacco reported in Tobacco Science, Vol. 3, pp. 52-56, 1959.

RECOMMENDATIONS FOR COMPANY POLICY _ Any important new situation in an industry presents a fresh opAortunity for the smaller companies to compete with the leaders on a new basis. Since the issue has been joined, Philip Morris should embrace the health area as such an opportunity with the same agressiveness that it has shown in packaging innovation. At the same time severely reduced reliance on TIRC and TI seems indicated by the impact of the report in spite of those activi- ties. To promulgate this shift, and for other purposes, the following recommendations are offered to Philip Morris management: 1. Adopt as internal policy for technical purposes the view that greater benefit will accrue from accepting the report's findings on face value and proceeding to the cure of ills, real and alleged as they may be, than from engaging in disputation and refutation of these claims. Research effort should include very little of the latter. 2. Recognize the accelerated technical competition developing in the industry through increased support of Research Center programs (details next section).' 3. Follow the prompt offering of a new dual carbon filter product (Philip Morris Multifilter - 2) by leap-frogging the competition with a better engineered one (see below) to be developed by Research Center before year end. 4. Move promptly and effectively toward establishment of suitable biological approval specifications for all new ' smoking products. It may be expected that in time the

c € i Government will force the adoption of such specifications, in which case Philip Morris would be able to influence the setting of the "uniform and reliable testing procedure" (p roposed FTC Rule 3) consistent with our own methodology. Apart from possible legal requirements, such apolicy would enhance advertising opportunities. Provide a substantive basis for vigorous health adver- tising by publication of suitable articles in the technical literature. IMPACT ON RESEARCH CENTER PROGbtAM Consideration of the report's findings has resulted in the following influences on the.Research Center program, to be acted on promptly: 1. A broad review of bioassay techniques, through both literature search and personal contact of recognized contributors, will b,e-undertaken~to define optimum criteria for use in physiological studies, both~at the Center and elsewhere. These criteria will include specifically a quick test for chemical carcinogenicity and best measures of pulmonary cleansing effectiveness (e.g. ciliastasis, mucus flow, phagocytosis, etc.), in addition to identification of appropriate respiratory parameters already under study. 2. A strong effort will be mounted to develop by year end a filter cigarette markedly better than any anticipated from the competition. This will combine very low TPM delivery (less than 10 mg./cigt.), adequate gas phase scrubbing to permit satisfactory functioning of pulmonary

to cleansing mechanisms, and flavor sufficient to attract a reasonable market. The development will be,=based,on Series T (new microfiber polyethylene tow) filter and _adsorbents having qualities surpassing those now on the market. Technical participation of Manufacturing Depart- ment is important to success of this venture if we are to manufacture by year end. 3. The chemistry of cigar and pipe smoke will be elucidated, and deliveries to smokers determined. Clues will be sought as to possible differences which might help explain the much lower mortality ratios of these smokers versus cigarette smokers. Pipe smokers, even those smoking (inhaling) more than 10 pipefuls per day for over 30 years, appear to have mortality ratios insignificantly different from non-smokers. 4. Present programs studying gas phase adsorption and tar fraction carcinogenicity will be emphasized, to improve com etiti~ve posture in these technical areas. ,~..,..-.._~_... _., ~ 5. Scientists will be assigned to expand the Center's knowledge of developments in epidemiology, cancer studies (clinical as well as animal), etc., by current interpretive review of literature and personal visits to centers of such knowledge, as an aid to research planning and competitive (technical) analysis. 6. Liaisoniwith a first class medical school should be established as a further expansion of sources of knowledge. -7

This relationship might be best initiated through a:grant to study possible effects of smoking on heart- load. INDUSTRY POSTURE VIS-A-VIS PUBLIC ~e The health value of filters is undersold in the report and is i the industry's best extant-answer to its problem. The Tobacco Institute obviously should foster the communication of the filter message by all effective means. At the same time TIRC can profitably sponsor development of those areas where exceptions to the report's treatment have been made (listed above). Specifically, a prospective survey of filter vs. non-filter smokers is appropriate. This study can be extended by correlation of filter smoking habits with examination of bronchial epithelium at autopsy (i.e. loss of ciliated columnar cells, presence of atypical cell nuclei), changes in which may occur some years before lung cancer, according to some (Scientific American, July 1962). An elucidation of the smoking threshold question by further analysis of present data and new work is also desirable. If it is true that the onus of proof in the Smoking and Health issue has shifted to the tobacco industry, then the industry must come forward with evidence to show that its products, present and prospective, are not harmful. N,edical research must be done for this purpose, as well as for judging the merit of work done outside the industry. The industry should~abandon its past reticence with respect to medical research. Indeed, failure to do such research could give rise to negligence charges. Further, it is not enough ~ to sponsor the work of third parties (e.g. ten million dollar gift -8-

.F& to AMA), though these moves are heartily to be desired. Individual companies must also do their own research if they expect to develop proprietary positions for the health competition. \