Product Design
Smoking and Health Issues
Abstract
Overviews the smoking and health controversy. Discusses the scientific debate on smoking and health, reviews the concept of addiction, discusses Environmental Tobacco Smoke and restates the tobacco industry's stance on the smoking and health controversy.
Fields
- Hypothesis
- Women TargetingCigarettes designed to target women
- Health effects
Design changes which have measurably altered health effects of cigarette smoke, both for smokers and nonsmokers.- Perceptions of ETS
Design changes to reduce perception of environmental tobacco smoke among smokers and nonsmokers in response to public concerns about the dangers of ETS.- Toxicity and consumer intake
Development of scientifically valid procedures for measuring biological activity and neurological effects of nicotine and smoke constituents. - Health effects
- Keyword
- Carcinogenic (Cancer-causing)
- Cardiovascular system (Heart)
- Cotinine
- Lung cancer
- Smoking and Health Controversy
- Cardiovascular system (Heart)
- Smoke Constituent
- Benzo(a)pyrene
- Beta naphthylamine
- Carbon monoxide
- Hydrogen cyanide (HCN)
- Nicotine
- Nitric oxides
- Nitrosamines (N-nitrosamines)
- Total particulate matter
- Beta naphthylamine
- Design Component
- Reconstituted tobacco
- Expanded tobacco (Puffed tobacco, ET)
- Named Organization
- A.D. Little, Inc. (Performed biological research & testing for Liggett & Myers)Performed biological research and testing for Liggett on XA (Palladium) cigarette
- American Cancer Society
- American Heart Association (Voluntary health organization that focuses on cardiac health)
Voluntary health organization that focuses on cardiac health and stroke. AHA occasionally teams with tobacco retailers to engage in promotions/fund-raisers (see http://www.smokefree.net/doc-alert/messages/247136.html and http://www.rawbw.com/~jpk/stand/Pictures.html).- Barnes Hospital
- British Medical Association
- Brown & Williamson Tobacco Corporation (B&W)
Subsidiary of BAT U.S., located in Louisville, KY.- Columbia University
- Committee for Research on Tobacco and Health
- *Council for Tobacco Research-- U.S.A. Inc. CTR (Formerly Tobacco Industry Research Committee (TIRC))
Created and funded by the tobacco industry to award grants to study of the link between smoking and disease. Part of a four decade effort to cast doubt on the links between smoking and disease.- Creighton University
- Fox Chase Cancer Center
- Harvard University Medical School
- Health Education Council
- Hereditary Cancer Institute
- Industrial Technical Committee
- International Journal of Epidemiology
- Journal of Immunology
- Journal of Medical Sciences
- Journal of the American Medical Assocation JAMA
- Liggett & Myers Inc. (Pioneer in the generic cigarette business)
Cigarette manufacturer; Pioneer in the generic cigarette business; L&M is the manufacturer of Chesterfield, Decade, Dorado, Duke of Durham in 1958, Eagle, Eve, L&M, Lark, Pyramid and Stride cigarettes- Mayo Clinic (Located in Rochester, Minnesota)
Has a nicotine dependence center; runs the smoking cessation program at the Mayo Clinic- Michigan Cancer Foundation
- Microbiological Associates (Research lab in Bethesda, MD)
Research lab in Bethesda, MD. CTR contracted with this lab to do the world's largest inhalation study, involving more than 10,000 mice in 1973-1982.- Mount Sinai Medical School
- National Cancer Institute NCI
Division of Cancer Prevention and Control, National Cancer Institute located in Rockville, MD- National Institute on Drug Abuse (An addiction research center in Baltimore, MD)
An addiction research center located in Baltimore, MD- National Institutes of Health
- New Scientist
- New Zealand Medical Journal
- *Scientific Advisory Board (SAB) (Only use SAB with name of specific org.)
- Surgeon General of the United States Public Health Service (U.S. Federal government public health advocate)
The U.S. Surgeon General's office has found since 1964 that tobacco use causes disease in humans.- Tobacco Industry Research Committee (TIRC) (Renamed Council for Tobacco Research-USA (CTR))
Organized in 1954 as the Tobacco Industry Research Committee (TIRC), and renamed the Council for Tobacco Research-USA (CTR) in 1964.- Tobacco Working Group TWG (Federally funded project to create a safer cigarette)
A federally supported project launched by the National Cancer Institute, with the purpose of developing a less hazardous cigarette.- U.S. Air Pollution Control Association
- *United States Public Health Service (use United States Public Health Service)
- University of California Los Angeles (UCLA)
- University of Chicago
- University of Geneva
- University of Manitoba
- University of Minnesota
- University of Newcastle
- University of Reading (England)
- University of San Francisco Institute of Chemical Biology
- University of Southern California Medical Center
- University of Wisconsin
- W Alton Jones Cell Science Center
- Washington University in St. Louis
- Yale Medical School
- American Cancer Society
- Subject
- Addiction
- Cancer (Health Effects)
- Cardiovascular Effects (Health Effects)
- Effects—Smoking Behavior (Effects)
- health effects
- secondhand smoke/health effects
- Smoke Nicotine (Measures)
- Tar (Measures)
- Test/Animal Subject (Testing)
- Test/Smoke Condensate (Testing)
- Test/Smoke Constituents (Testing)
- Test/Toxicity (Testing)
- Cancer (Health Effects)
Document Images
SMOKING AND HEALTH ISSUES
AUGUST 21, 1989
CONFIDENTIAL ATTORNE¥-CLIENTMEMORANDUM
CONTAINING OPINION AND IMPRESSIONS
OF RETAINED COUNSEL
TABLF. OF CONTENTS
INTRODUCTION .........................
1
THE SCIENTIFIC DEBATE ON SMOKING AND HEALTH .........
5
SMOKING AND' ADDICTION .....................
60
THE NONSMOKER: ENVIRONMENTAL TOBACCO SMOKE ..........
76
PRIOR TOBACCO INDUSTRY POSITIONS ON SMOKING ANDHEALTH
9¸0
CONFIDENTIAL
10125996
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INTRODUCTION
The controversy over the claimed health effects of smoking
is as old as the practice of smoking itself. There is no publ~ic
health topic that has received as intense and prolonged scrutiny
by the Congress, various federal agencies, the medical profession,
and the press as has the issue of smoking and health. Smokers and
non-smokers alike have been inundated with information about the
health risks associated with smoking. The Surgeon General's Office,
for example, in addition to releasing its well-known annual report
dealing with health issues associated with. tobacco use, has for
the last several years been pursuing a highly publicized campaign
directed toward school-age children to achieve a "smoke free
society" by the year 2000. Every pack of cigarettes sold in this
country for the last 23. years has borne a Congressionally-mandated
warning label. For the last 17 years, this same warning has
appeared on all cigarette advertising.
Yet the scientific evidence that smoking cigarettes (and
other forms of tobacco use)~ causes cancer, heart disease, and other
chronic illnesses is not so one-sided as is often claimed.
Reputable independent scientists over the years have questioned
the validity of the various charges made against smoking. Brown &
Williamson. and the other major cigarette manufacturers have
consistently maintained, with. considerable support, that it has
CONF ]DENT IAL
not been proven that smoking causes any chronic disease. The
industry's position is often misunderstood to be that smoking has
been proved not to cause any disease. This is not the industry's
position. The ~ndustry believes that the question, is still
unanswered.
This is not to say that Congress has acted inappropriately
in continuing its scrutiny of the "public health" aspects o~
smoking. The "standard of proof" in a public health sense is quite
different -- and rightly so-- than that required by science, or
that mandated in. a courtroom. Particularly where the question is
whether the public has sufficient information about a particular
product, the government may decide to act before the scientific
"case" regarding the product is complete.
Many products carry with them claimed health risks--
butter, eggs, red meat, and milk are familiar examples. Many other
products carry known health risks -- automobiles, knives, and
whiskey are again familiar examples. The public awareness as to
the claimed risks of these products is much less than that with
regard to cigarettes. Moreover, with the possible exception, of
alcohol, no product other than cigarettes has been subj~ected to as
vehement and concerted an effort to restrict or deny its
availability to the adult consuming public. Thus, the use of
~ONF |'DENT |AL
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cigarettes in light of this awareness (and in the face of this
effort) is uniquely a ma£ter of personal and informed choice.
Brown & Williamson and other cigarette manufacturers
market their product for adults precisely because the question of
whether to smoke is one based on an informed personal choice. The
industry recognizes that the consumer has a great deal of negative
information through which he or she must sort in making the decision
to smoke. Because this topic has been so thoroughly and publicly
canvassed,. Brown & Williamson does not agree with those opponents
of smoking who wish to place greater restrictions on the
availability of cigarettes -- those who wish to make the adult
consumer's choice for the consumer, in the mistaken belief that
only the choice not to smoke can be "right" for any individual,
no matter how well informed he or she may be.
The road down which some anti-smoking advocates wish to
take American society is dangerous. Once the government begins to
ban "life-style choices," it is impossible to predict where it
will end. Who will draw the line dividing those products and
activities that are "healthful," and thus "permissible," from those
that are claimed to be "unhealthful," and thus "forbidden?'" More
fundamentally, what will happen to the quality of life for members
of such a society, under the heavy hand of such extraordinarily
intrusive government action?
CONFIDENT IAL
The following material outlines some potential topics for
discussion should Brown & Williamson. determine to pursue a program
of legislative contacts. This program would be designed to. provide
governmental decision-makers with an understandingand appreciation.
of Brown & Wi~liamson's position on smoking and health. At the
same time, Brown & Williamson would acknowledge its understanding
of positions Congress has taken.
CONF ];DENT IAL
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THE SCIENTIFIC DEBATE ON SMOKING AND HEALTH
CONFIDENTIAL
- 5 -
Although it is assumed by many people, and often asserted
by anti-smoking advocates, that the scientific community has long:
been unanimous in concluding that smoking "causes" various diseases,
the fact is that respected scientists have stated that the question
of whether cigarette smoking causes disease remains unanswered.
The passage of time has not diminished the flaws in the case for
causation; many of the reasons for skepticism that were cited by
scientists in. the 1950s and 1960s are sti~l valid concerns in the
1980s.
At the same time, Brown. & Williamson and the other
companies in the industry have behaved responsibly in funding
substantial research efforts by independent scientists into the
wide-ranging issues of "smoking and: health." Those efforts -- as
described below -- have not always resulted in findings favorable
to the industry. Much of that research -- favorable and unfavorable
-- has nonetheless been published.
CONFIDENT IAI.
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THE NATURE OF THE SCIENTIFIC EVIDENCE ON SMOKING
AND HEALTH.
A. Lunq Cancer
i. Epidemioloqical Data
The most important scientific part of the industry's
critics' case is the various epidemiological studies associating
cigarette smoking with certain chronic diseases.1 A number
independent scientists, however, have expressed concern about the
interpretation of such epidemiological data. These scientists
have been unimpressed by the numbers of such studies,, because of
concern about the underlying validity of the evidence.
For example, in the early ~980s, Dr. Laurence Kupper, in
criticizing many of these studies said:
i. These studies have two primary methods of approach:
retrospective and prospective. A retrospective study selects
a group of lung cancer patients, then tries to backtrack in
time to determine smoking histories. A prospective study
identifies a specific group, determines their smoking habits,
and then observes the disease patterns that develop. Both
types of studies then arrange the raw data into various
categories, and run statistical tests to determine if one
group (smokers) differs from another (nonsmokers) with respect
to a particular disease. These studies have generally shown
that smokers are more likely to get lung cancer than non-
smokers. Approximately 90% of lung cancer cases are smokers;
less than 5% of smokers, however, get lung: cancer.
CONF ],DEN] ],AL
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The main. prospective (i,.e., follow-up) studies
concerning smoking and its relationship to
mortality and morbidity from certain diseases
(as discussed in the latest Surgeon. Genera~
reports) d~o not address the issue of causality.
The claim that the conclusions reached are
'impressively uniform and consistent' does not
mean that a causal relationship has been
established, but only that approximately the
same observed associations keep appearing. I_~n
fact, the biases inherent in these studies
preclude the riqht to claim that causality has
been demonstrated. Actually, one could arque
that the same associations keep appearinq
because the same biases are present in each
study.
The fact that so: many studies have produced a
positive association between smoking and lung
cancer has led many people to make the false
conclusion that 'quantity means quality.' The
truth of the matter is that repeatability (!i.e.,
the ability to produce the same estimated
association) does not imply accuracy (i.e., the
ability to produce a valid estimate of the
true association). In this regard, one study
free from all bias and producing a valid
measure of the true smoking-lung cancer
association is worth more than a thousand biased
studies, all of which provide the same
distorted estimate of the true association.. (I)
And, a recent editorial in the International Journal of Epidemioloqy
suggested the following:
CONFIDENT ]AL
We trust that the global differences in cancer
incidence will finally be explained by the
interplay between the environment and our genes.
Thereby, it is certain that molecular biologists
will have to face the challenge to help explain
these variations in. incidence. A question
remains whether cancer epidemiology, and maybe
epidemiology in general, will have to fall to
the same leve~ of academic disrepute as miasma
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