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April 10, 1989 MEMORANDUM TO MR. RUPP Re: ETS Proiect Update This memorandum summarizes the meetings that George Leslie and I had on our most recent trek to Asia. It also outlines our ideas concerning the scope and format of the Bangkok meeting scheduled for June 22 and 23. I. CONSULTANT RECRUITING A. Korea 1. Dr. Yoon Shin KIM Associate Professor of Environmental Sciences College of Medicine Hanyang University Dr. ROH introduced us to his friend Dr. KIM, an expert on indoor air pollution in Korea. We have a copy of KIM's CV, which contains an impressive inventory of academic qualifications. KIM is fluent in both English and Japanese, and holds doctorates from the universities of Tokyo and Texas. KIM's professional interests correspond precisely with the consulting needs of our clients: environmental and occupational epidemiology, industrial health and occupational safety, and indoor air pollution and its health effects. We gave KIM the ETS literature packet and invited him to the Bangkok meeting, which he will attend. KIM is already familiar with much of the scientific literature on

2 ETS, and'even brought one of Repace and Lowrey"s articles (he evinced no affinity for their views). KIM is currently doing research on the various constituents of indoor air pollution in Korea, including oxides of nitrogen, carbon monoxide and radon. Recently, he submitted a paper on this subject for the Brussels Conference, although he did not attend that conference. He also informed us of a 1988 Tokyo conference at which he presented a paper. He is sending George copies of both these papers. It is our good fortune that KIM has already undertaken the kinds of research that we might wish to sponsor. To some extent, therefore, we can piggyback on the work KIM has already done. When KIM discusses the role of ETS in the Korean indoor environment, it will be measured against the other more threatening constituents that he has already identified. For the Bangkok meeting, KIM has agreed to make an informal presentation of his research on the sources of indoor air pollution in Korea. We would, of course, review this material in advance. After discussing what an appropriate consulting fee would be for Korea, ROH suggested the following rates: for KIM, $700 per day, and for ROH, $600 per day. ROH emphasized that KIM was the very best man in his field and could command this higher rate. Not wishing to haggle, we promptly agreed on these figures.

Finally, KIM recommended the names of one Taiwanese and three Japanese scientists for us to contact. 2. Dr. Jung Koo ROH Director, Toxicology Research Center KRICT Most of our session with KIM and ROH was devoted to explaining the nature of the project to KIM and securing his participation. From our brief discourse with ROH relating to the ETS literature packet that he reviewed, it was apparent that he needs educating on some of the issues, particularly the misclassification issue. ROH and KIM will likely perform different roles for us in Korea. ROH remains our entree into the Korean scientific community (and perhaps the political community as well -- he had lunch with the President a couple weeks ago). His connections should prove invaluable in successfully shepherding any Korean initiative from conception through execution. In addition, as head of the toxicology arm of KRICT, ROH can offer the facilities of his lab and the services of his team of scientists to perform toxicological and mutagenicity tests of various designs. With ROH and KIM, we believe that Korea is now well represented among our Asian consultants. Unless circumstances change, we should not need to recruit beyond these two. B. Taiwan George and I spent two days in Taiwan during which we spoke and met with five potential consultants. Unlike N ' Cn 0 0 0 *b- o:~ oN -P. 07

Korea and the Philippines, we suffered from the considerable handicap of not having a friendly contact in any branch of the Taiwanese scientific community. For this reason, we proceeded circumspectly from one phone call and meeting to the next. The Taiwanese made our task easier by their relentless hospitality and helpful dispositions. While we did not recruit a consultant on this trip, we did establish a friendly link with a pathologist, Dr. Donald HO. He should ensure that the next time we shake the Taiwanese scientific tree, one or two consultants will fall out. What follows is a summary of our meetings. 1. The Institute of Statistics On our list were two biostatisticians from this institute in Taipei. After considerable difficulty, we tracked them down on the phone, only to learn that they cannot possibly do outside consulting work. Their institute is government owned and their employer forbids any private moonlighting. 2. Dr. Chen-Yuan LEE Department of Pharmacology College of Medicine National Taiwan University To our disappointment, this LEE was not the author of the publications we reviewed from the Weinberg Group. To our relief, he was nonetheless gracious and cooperative. LEE is a retired professor and quite advanced in years. For this reason, we did not attempt to recruit him. According to George, LEE is a major figure in his field of pharmacology, having studied at Oxford with the leading

5 pharmacological lights. Unfortunately, he did not know of any pharmacologists doing work in indoor air pollution. Not having reviewed his publications, we declined to raise the issue of ETS. LEE will be attending the Brighton Toxicology Conference in July. In addition, George invited LEE to attend the Lisbon Conference next year and to circulate information on the conference in his department. George will see LEE in July to follow up. Although nothing tangible sprung from this encounter, LEE is worth staying in touch with for the future. 3. Dr. Donald Ming-Tak HO Department of Pathology Veterans Hospital This was our most fruitful meeting of the trip. HO is an atomic and neurological pathologist. We had an extensive conversation with him over lunch, during which the following points were made. First, we are unlikely to recruit anyone from a public hospital such as HO's. The government places severe restrictions on outside work, and travel opportunities to attend international conferences are limited. For these reasons, HO could not help us personally. Second, HO told us that in his field of pathology he did not believe a scientist would shrink from doing tobacco-sponsored research. After being accustomed to recruiting consultants in locations where the industry is a pariah, this was a great relief. George will send HO a

6 fairly detailed letter outlining the specialty areas in which we still wish to recruit. We told HO that we are particularly interested in pathology, respiratory medicine, and cardiovascular medicine. The thrust of this solicitation letter will be indoor air pollution generally with an immediate emphasis on ETS. Potential consultants should come from private hospitals, which would not place prohibitive constraints on their outside work. 4. Dr. J. D. Wang Head, Graduate Institute of Public Health Director, International Commission on Occupational Health Dr. Wang expressed guarded interest in our project up until the moment he learned a group of tobacco companies were lurking in the background. He thereafter politely expressed his opinion that the American firms are unethically marketing their products in Asia, particularly to young people. Wang made vague references to his efforts against the tobacco industry, including the local monopoly. Wang was looking very promising up to this point. By self-admission, he is one of only three top-class epidemiologists in his country and appears to be a man of considerable, if not excessive, integrity. He prefers not to accept money from anyone for fear that his conclusions will appear preordained. We had already given Wang a copy of the literature packet when he expressed his reservations on consulting for the-industry. Instead of taking it back and leaving on a

sour note, we invited him to look at and give us his views. Whether he does so or not, we left on very amicable terms. He stated that he planned to attend the Brighton Conference but had not yet received an invitation. George then offered to make a phone call on his behalf. He will make sure that Wang receives an invitation to the Brighton Conference and will see him there in July. 4. Kaohsiung Kaohsiung is a city in the south of Taiwan, 40 minutes by plane from Taipei and serviced by an international airport. There are two scientists in Kaohsiung whom we may wish to see on our next visit to Taiwan in May. One of them is Dr. Hsin Lung WU of the Graduate School of Pharmaceutical Sciences, Kaohsiung Medical College. Wongphanich gave WU"s name to George, who phoned WU in connection with the Lisbon Conference. WU in turn gave George the names of Dr. Wang and a Dr. Y. C. KO, the Director of the Department of Public Health within the Medical School in Kaohsiung. We may want to meet with WU personally on our next visit to Taiwan in May. We have no idea whether he would be any more receptive than Wang to the prospect of working with us. C. The Philippines 1. Dr. B. Reverente Reverente is attending the Bangkok meeting and will discuss the application of the various epidemiologic studies to the Philippines. As Reverente noted, the

8 scarcity of air conditioners necessitates that windows stay open most of the time. ETS is therefore rarely trapped indoors. More importantly, outdoor air pollution in cities like Manila overwhelms the comparatively minuscule contribution to the indoor environment made by ETS. 2. Dr. Lina Somera Head, Department of Public Health University of the Philippines Reverente introduced us to Somera as a highly desirable consultant to have on board. We explained the nature of the project to her and answered the few questions she had. While Somera did not know for sure whether she would be able to attend the Bangkok meeting, I expect she will do so. George will ask for a CV and a list of her publications. We agreed to pay Reverente and Somera $600 per day for their consultancy work. 3. Dr. Marilyn Go Pediatrician Dr. Go was the first person we spoke with on our previous visit to the Philippines. After recruiting consultants as senior and high-ranking as Reverente and Somera, George and I felt that Go, who has only been practicing pediatrics for a few years, would look out of place. We therefore politely discouraged her from becoming a full-fledged consultant. Nevertheless, we believe Go can be of some use to us in identifying other more senior pediatricians for our panel. She indicated that there would be a pediatrics

conference in Manila later this month, which would be attended by pediatricians from across Asia. Go said that she will be attending that conference and will make discrete inquiries on our behalf. In addition, she will ask a professor at her medical school for the names of other possible consultants. We will follow up at the end of the month. D. Hong Kong 1. Dr. Sarah Liao George had lunch with Liao; Dr. Linda Koo and Dr. Francis Roe. Liao has agreed to join our group and will attend the Bangkok meeting. Dr. Koo also agreed to attend the Bangkok meeting, where she would discuss the epidemiology of lung cancer in Chinese women. Moreover, Liao suggested that she act as an intermediary and buffer between Koo and our group. Koo would invoice Liao for any work she does on our behalf, and Liao would in turn be paid by us. 2. Dr. Alun McIntyre We know from Dr. Liao that McIntyre is returning to England in approximately two months. For some inexplicable reason, McIntyre did not share this important information with us. Given his abbreviated tenure in Asia, we did not invite him to the Bangkok meeting. We told McIntyre that the recruitment phase of the project was not complete and that we would be in touch. We plan to

- 10 - establish contact with whomever replaces McIntyre as soon as possible. McIntyre attended the ACVA seminar on our behalf (we invited him prior to learning of his impending departure). He will invoice me for his time at an hourly rate of US $100. 3. Dr. Clive Ogle George and I met with Dr. Ogle in his office and convinced him to work with us on a trial basis. Ogle had some reservations about associating with us and questioned his contribution to the project. We assuaged his worries and prevailed upon him to have a go at the literature packet. He also tentatively agreed to attend the Bangkok meeting. Once he begins to relax a little and sees the caliber of the scientists he will be associating with, I believe Ogle can fulfill an important role as the only pharmacologist on our panel. 4. Dr. John Bacon-Shone Department of Statistics Hong Kong University Bacon-Shone is a biostatistician with an interest in environmental epidemiology. He has done consulting work in the past, which he generally does not share with the other members of his department. When informed of the tobacco connection, Bacon-Shone expressed no misgivings. He went on to say that MacKay had castigated him some time ago for the flimsiest of pretexts: consulting for.market research firms, which receive some of their revenues from