Tobacco Documents Online

21-DEC-1992 11:40 FROM I TO PM RYEBROOK P.002i009 PUBLIC SMQKING l . The industry and the campaign against E'l.'S in the CCC. Proposals for a 1ea.flet to be cleared by META companies and held in readiness by the META Secretary: A) Policy Aims B) Strategy C) Proposed content of the issue document: "Smokers and the Public - Separating Facts from Prejudice" D) Proposed next steps

21-DEC-1992 11:41 FROM TO PM RYEBROOK P.@H3i009 A) Policy Aims 1) Damage limitation including verbal overtures by individuals selected ;:_:J approved in advance by NIETA unanimouslv to reason with chosen public sceCir health and other officials to encourage these to consider industry arguments on merit rather than aping western authorities such as WHQ, the Environmental Protection Agency (EPA) in Washington, EC commission etc. 2) Take the sting out of official and private sector prejudice. 3) Stopping or at least delaying more - and more comprehensive - restrictions in the private sector. . n, 4) Change the mood among private sector managers from one of confrontation io one of "live and let live", or co-existcnce based on mutual courtesy between smoker and non-smoker.

21-DEC-1992 11:41 FROM TO PM RYEBROOK P.004/009 . $) StrF1teff 1) To demonstrate through scientific evidence that ETS is a minuscule element in "sick-building syndromes" compared with other well-documented factors: inadequate ventilation, inadequate filtration and contaminated ventilation systems as causes of sore eyes, dry throat, nose and chest irritation, fatigue, coughing, nausea etc. 2) To drive home the point that tobacco is a favoured target because tobacco srnoke is the most visible component of indoor air, leading to assume that it is the cause - of discomfort. 3) To advance the argument that smoking bans fail to achieve their desired ends :. - . of making places of work and pleasure less unhealthy, for reasons cited above. 4) TARGET principally a) private sector business owners, managers and employers. b) GCC health officials who are rational and reasonable where tobacco issues are concerned: i.e. - Dr. Abdul Wahab Al-Muhaideb ((1AE Assistant Under-Secretary for Preventive Health). Dr. Khalifah Al-Jaber, Director of Preventive Health, Qata:r Ministry of Health. Dr. Abdul Qader Al-Ghassany, Oman's Assistant Under-Secretary for Preventive Health. 5) To re-emphasise that smoking is part of the individual's that smoking is an adult habit deeply-rooted in people's behaviour in the GCC. 6) Question the efficacy and desirability of governments' regulating on personal tastes, and personal smoking habits, and question whether it is any more possible to regulate against tobacco than personal taste in scent or body odours. 7) Smokers have just as many rights as non smokers, and the right to smoke-free air is no more relevant than the right to have streets free from transport or industrial pollution. 8) Keep a campaign low key so that privatc sector managers, owners and employers are not antagonised. cn c) c3 0 cn w 4~- 0 4_11

21-DEC-1992 11:42 FROM TO PM RYEBROOK P.005i089 , C) Proposed Leaflet: /74--. SM(7KERS & THE PUBLIC SEPARATING FACTS FIiOR/I PREJUDICE Discriminatlon * In a number vI couiilries, ciisc:Atxtiuiation against smokers has increased substantially during the past several years. Much of this discrimination results from claims by anti-smoking activists, and some public health officials and scientists, that other people's tobacco smoke - known as 'environmental tobacco . smoke', or 'ETS' - causes disease in non-smokers. * Articles appearing in the popular press over the past ten years would convey the impression that there is little doubt about the purported health implications of exposure to ETS. Any study that can be construed, however unreasonably, to indict ETS tends to be covered extensively in the press. Meanwhile, studies reporting no association between ETS and nonsmoker health problems are generally ignored. ETS is not the same in chemical or physical properties as the mainstream tobacco smoke to which active smokers are exposed. Active smokers and ETS-exposed non-smokers also differ, not only in their level of exposure, but in their route and mariner of exposure. Consequently, conclusions concerning public health effects of ETS cannot be based on data or studies relating to active smoking - what is required are studies of non-smokers actually exposed to ETS. In terms of the actual levels of exposure of non-smokers to ETS, data show that a nonsmoker would have to spend more than 100 hours in a typical environment in which smoking is occurring before being exposed to a quantity of nicotine equivalent to that delivered in smoking a single cigarette. Health claims * The most publicised health claim about ETS is that it causes lung cancer in non- smokers. However, more than 30 epidemiologic studies of ETS and lung cancer among non-smokers have now been published. Of those, approximately 80 percent reported no statistically significant association with the primary index of ETS exposure. These studies compare lung cancer rates in nonsmoking spouses married to smokers, to lung cancer rates in nonsmoking spouses of non-smokers. Any differenco in lung cancer risk in the group of non-smokers married to smokers generally has been considered by the authors of these studies to be a result of their exposure to ETS, although other authors have challenged this assumption.

21-DEC-1992 11:42 FROM TO PM RYEBROOK P.006i009 . , Inswfficient evidence .1:> 1986; qzm) b-W 4-b (r-~ U.S. Surgeon General, National Academy of Sciences and Austrulian ne Health and Medical Research Council Working Group all concluded that there was insufficient evidence of an association between ETS and cardiovascular disease. That conclusion was echoed by subsequent international reviewing bodies, culminating in the 1989 Proceedings of the International [ETS] Symposium at McGill University. * "Biases in observation and in the selection of subjects and the subjects' own expectations may account for the widely divergent results" that have been reported . in studies of ETS and asthmatics, according to the U.S. Surgeon G eneral f a 1986. * LLung Cancer Aitson g_ N,on-smokers Concern that ETS might be a cause of lung cancer among non-smokers was prompted by the publication of two studies in the early 1980s -- a study of Hiraya.m.a in Japan and a study by Trichopoulos and co-workers in Greece. Both were epidemiologic (or population-based) studies, comparing the incidence of lung cancer among nonsmoking women married to smokers and nonsmoking women married to non-smokers. Both reported a statistically significant increased incidence of lung cancer among the women married to smokers, a find that prompted some people to suggest that ETS might actually cause lung cancer among non-smokers. * From almost the moment of publication, the Hirayama and Trichopoulos studies prompted controversy. Part of the controversy involved doubts about the value of epidemiology as an investigatory tool for low-dose expesures and diseases (like lung cancer) having 30 to 40 year latency periods and a variety of causes. Many scientists pointed out at the time, and have continued to insist, that epidemiology is simply too blunt a tool to use in such circumstances. ~' Among the points that have been made in that connection are that the origin of lung cancer is Dot well understood, a host of factors have been linked to lung cancer (including diet, heredity and a number of high-dose chemical exposures) and it is virtually impossible to control for the effects of such confounding factors over a 30 to 40 year period. Without a degree of precision not possible in ann epidemiologic study, many scientists have emphasized, an investigator can never know whether a slight increase in the incidence of lung cancer among women married to smokers was caused by ETS or any number of other factors. A study of non-smokers ~ Personal exposure studies also have proven to be of value in placing E'I`S into perspective. One such study, conducted in the United Kingdozn, focused on a representative group of nonsmoking women. The women were asked to go about their normal business while wearing sampling "badges" that measured the level of various substances, including nicotine, to which the women were exposed. When the data from the study were tabulated, the investigators found that on average the women in the study would be exposed to an amount of nicotitte equivalent to that delivered by the smoking of a single cigarette only after a period of more than two years.

21-DEC-1992 11:44 FROM If ftsSiye Ginok211g - a convenient * TO PM RYEBROOK P.007/089 (C1 . The phrase itself - "passive srnoking" -- which often is used by antismoking activists when talking about nonsmoker exposure to ETS - is misleading. Products of combustion are found, at trace or higher levels, in almost every environment, and the chemicals produced in that manner also find their way into the air from many noncombustion sources. Yet, it would never occur to anyone to characterize someone walking along a street with passive automobiles or cooking dinner as a "passive smoker " Tndeed, it seems clear that the phrase "passive smoking" would never have been coined by the organized antismoking community were it not for the phrase's emotional content. "Sick builciin$s"• ~ If ETS is permitted to accumulate, it can of course be an annoyance -- to smokers as well as non-smokers. But so can other substances found indoors, including the carbon dioxide produced by human respiration, the formaldehyde emanating from carpets and waliboards and the ozone produced by office copying machines. ETS is not the same in chemical or physical properties as the mainstream tobacco smoke to which activee smokers are exposed. Almost all of the substances found in ETS have a variety of other sources indoors. In fact, literally hundreds of chemicals can reach excessive levels Indoors from myriad sources and activities if inadequate ventilation is provided and filtration is deficient. * Investigations have been conducted worldwide on so-called "sick buildings" -- buildings characterized by frequent complaints from occupants of symptoms ranging from scratchy eyes to dizziness and headaches. The fact is that the major components of ETS are water and carbon dioxide. But because ETS is one of the few substances that is both visible and can be smelled, many such complaints are initially attributed to smoking. Actual investigations however have overwhelmingly identified other causes -- with inadequate ventilation leading the list. * As a number of international standard setting organizations have concluded, smoking should not present a serious or widespread annoyance problem with adequate ventilation and appropriate filtration. Offices & restaur_ants: '~ Many fixed-site monitoring studies have measured levels of nicotine, particles and other substances in a variety of environments and many parts of the world. In offices, restaurants and public facilities where smoking is allowed, the level of nicotine in the air typically has ranged between 2 ug/m3 (micrograms per cubic meter) and 20 ug/m3. On commercial airliners, average airborne nicotine levels have been reported to range from 1 ug/m3 in nonsmoking sections to about 10 ug/m3 i.n the smoking sections.

21-DEC-1992 11:44 FROM TO PM RYEBROOK P.008iH89 D) Proposed next steps ~ 1) META to comment, amend and/or approve the analysis, strategy and recommended action points of this proposal. 2) The META Secretary to draft an "Issue Document" based on this or other hIETA .- approved working paper to be used as the leaflet press kit to be printed and produced by Memac. Additional points to be used such as material from HORECA, to be provided by META companies using their experience from other countries. The META stamp to be used to sign the document on behalf of the industry, and to have it translated into Arabic - the Arabic rendition to be approved by t'xe chair company. 4) Memac to package leaflet which could also be used as a press kit for distribution to private sector employers, managers and owners particularly in the three private sector categories listed in Paragraph B above: a) Airlines & Public Transport i.e. taxis. b) .frTotels & Restaurants. c) Private sector working places i.e. off'.cces. 5) META companies and META company lawyers to assess and approve the MET.A drafted leaflet proposed in 2) above. 6) META to identify and to retain through MEMAC different individuals who can act as a'boice of reason" in writing by-lined articles in the regional & Pan-Arab press; these articles in English & Arabic to have been approved in advance by the META Secretary and chair company. 7) META company Field Managers to be provided with the Issue Document to use, when authorised by META but not before, as background in approaches to the private sector, particularly hotel GMs ad P&B managers with whom they are in contact during the course of normal company business. 8) META to approve in principle a separate budget for the costs of the Memac designing, printing and packaging of leaflets/brochures, as well as the cost of direct mail-shot campaign. 9) The META Secretary to hold the document until its release and/or use in any way ha been unanimously authorised by META principals. RRA

21-DEC-1992 11:45 FROM TO PM RYEBROOK P.009/009 Airlines: ~ • 7 * A number of scientists have pointed out that, at the levels described above, a nonsmoker would have to spend more than 100 hours in a typical office, restaurant or other public facility to be exposed to a quantity of nicotine equivalent to that delivered by the smoking of a single cigarette. The results for airline cabins are comparable and confirm the efficacy of airline policies establishing smoking and nonsmoking sections. One expert ha noted, for example, that a passenger would have to take 11 round trips between New York and Tokyo in smoking section of a Boeing 747 airliner before being exposed to the amount of nicotine delivered in smoking one • cigarette. In'ioroVeti yentilation: * Unless people are prepared to live in stainless steel enclosures without furniture or any of the other accoutrements of modern society -- thus being protected from motor vehicle exhausts, common household and office dusts, fumes from photocopiers, gases from processed woods and carpets, etc. -- improving in a meaningful way the quality of the air indoors typically requires enhanced ventilation and proper filtration. ~ A single-minded focus on ETS has proven repeatedly to be both short-sighted and ineffective. The key to a comfortable indoor environment is adequate ventilation, which can reduce the level of all substances that will accumulate if the air is not constantly replenished with appropriately filtered air or when a building's ventilation system has not been maintained in accordance with established standards. * Ventilation - coupled with appropriate filtration -- can reduce the overwhelming majority of substances found indoors to acceptable levels. Aans are not the sctlution: * Smoking bans strike at a symptom of a problem rather than the predominant causes -- inadequate or inadequately maintained ventilation systems coupled with deficient filtration. When a building's ventilation system is operating properly and an adequate amount of filtered air is being supplied to occupied spaces, smoking generally can occur without discomfort or annoyance. The same measures also will hold most other substances that can affect the quality of the air indoors to acceptable levels. Banning smoking will eliminate one of the few substances that can be seen and smelled but will not produce meaningful improvements in indoor air quality in the vast majority of cases. 0 © Courtesy and common se CA w -r~ ~ * Courtesy and common sense long have permitted smokers and non-smokers to %0 live and work together in harmony. The science of ETS provides no reason to abandon those fundamental principles. TOTAL P.009