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HILL AND KNOWLTON, INC. Confidential for Members PR No. 25-64 INFORMATIONAL MEMORANDUM November 19, 1964 Subject: Second National Conference on Cardiovascular Diseases Sponsored jointly by the American Heart Association, the National Heart Institute and the Public Health Service, the conference is expected to attract about 600 physicians and laymen to Washington on November 22-24, Sunday through Tuesday. Ob3ectives of the conference are to clarify and perhaps reach a concensus on what is now known about cardiovascular disease and on future research needs. Conference findings will be considered carefully by the President's Commission on Heart Disease, Cancer and Stroke in making recommendations for action programs against heart disease. (See PR No. 20-64, October 21, 1964.) ' The conference is organized into some 50 divisions which will meet Sunday morning to evaluate preprinted reports on specialized areas. On Monday, the conclusions of the divisions will be evaluated in 12 discussion groups. On Tuesday, conclusions and recommendations will be presented to the conference in these areas: Education and Training, Community Service and Research. On Tuesday afternoon, the conference members will discuss and plan action programs. Surgeon General Luther Terry will address the conference on Sunday afternoon. The scope of the conference is indicated by the bulk of the preprinted reports, running several thousand pages in three offset volumes. Greatest emphasis on smoking in the preprinted volumes is in the report of the Division of Atherosclerosis Community Services under the chairmanship of Dr. Jeremiah Stamler of Chicago. Some excerpts: "There is considerable reason to believe...that...mortality rates for atherosclerotic coronary heart dicease...are continuing to rise slightly or have plateaued recently. (A footnote here says: "In noting the increase in certain diseases, one cannot fail to emphasize also the catastrophic increase in occurrence of certain cancers, particularly carcinoma of the lung...attributable mostly to the impact of twentieth century cigarette smoking habits. There is also reason to believe that an increase has occurred in...chronic bronchopulmonary disease, i.e. asthma, emphysema, bronchiecstasis, chronic bronchitis. These diseases - related first and foremost to smoking, particularly cigarette smoking and inhaling - are also on the increase in an absolute sense. They are already prime problems in Great Britain...") "It has been unequivocally demonstrated that such abnormalities as hypercholesteremia, hypertension, heavy cigarette smoking are associated with several fold increases in risk of occurrence of coronary disease in middle age." The report concludes with a discussion of prevention through education and environ- mental control, which includes these comments: (more) , C

2 "Similarly, the environment can be altered as part of the major effort necessary to effect a marked reduction in cigarette smoking (underlining in report in the present and next generation of adults... Attention to several aspects of the environment is very important, and should be actively pursued, while recognizing the futility and danger of any 'simple' prohibition approach. Thus the environment in respect to advertising on TV and radio, in magazines and newspapers, etc., can and should be significantly changed. The timing and content of cigarette advertising should be tightly controlled, and scientific facts on the health hazards of cigarette smoking should be presented in popular and sustained fashion. The environment in public buildings can and should be significantly changed through (the) institution and enforcement of no smoking provision at the local, county, state and national level. The environment with respect to cigarette vending machines can and should be changed,- to remove them from government buildings, hospitals, etc., and to enforce laws with respect to sale to minors. The environment with respect to the cigarette.package should be changed, by implementing proposals for labeling with respect to the health hazards. The environment should be changed by progressive increases in taxes on cigarettes. The social and psychological environment can and should be changed by large scale, imaginative, varied and above all sustained educational efforts to convince the public, young and middle aged, of the impropriety (in the fullest sense of the word) of smoking." Other division preprinted reports mention smoking with much less emphasis, and sometimes only in passing: . Education of the Lay Public - Division Chairman, Dr. George M. Wheatley, New York. Discusses position and program of the American Heart Association and the National Conference on Smoking and Youth. . School, College and Teacher Health Education - Division Chairman, Dr. Fred V. Hein, Chicago. Intensive study will be required to find out the best ways of influencing decisions about smoking. . Education of the Allied Health Professions - Division Chairman, Dr. Roslyn B. Alfin-Slater, Los Angeles. Includes smoking among several atherogenic factors, which, except for smoking and exercise, are largely uncontrollable. . Psychological and Social Factors in Cardiovascular Disease - Division Chairman, Dr. Stewart Wolf, Oklahoma City. Does not mention smoking; lengthy discussion of the effect of emotion and stress. . Pathology of Cardiovascular Disease - Division Chairman, Dr. Jesse E. Edwards, St. Paul, Minn. Epidemiologic studies have shown associations between ischemic heart disease and several factors, including smoking. . Pulmonary Vascular Disease and Cor Pulmonale - Division Chairman, Dr. Howard B. Burchell, Mayo Clinic. The management and prevention of cor pulmonale should include abstinence from smoking and removal of noxious gases in the atmosphere as aspects of community planning. Besides the division reports, a number of individual papers discuss smoking in varying degrees. + A paper by Dr. Joseph Doyle of Albany, "Tobacco and the Circulation Apparatus," ,-A 0 attributes the effect of tobacco on circulation entirely to nicotine, but adds: 0 0 (more)

3 "Present evidence suggests that tobacco usage in addition to its adverse effects on the circulatory apparatus in some unknown fashion accelerates the rate of dying from all causes. Coronary heart disease, far and away the commonest form of death, is proportionately increased in heavy cigarette smokers. The major research problem is to determine the manner in which tobacco aggravates ischemic heart disease..." Dr. S.L. Wilens, in "The Relation of Tobacco Smoking to Cardiovascular Disease," says: "Thromboangiitis obliterans, a disease that was believed to be related to tobacco smoking has declined in incidence to the point that its existence has been questioned during a period when cigarette smoking and the incidence of lung cancer have increased. It seems unlikely, therefore, that exposure to nicotine was a primary etiological factor in this condition. The only other cardiovascular lesion that has been linked to cigarette smoking by substantial evidence is 'coronary' or 'arteriosclerotic heart' disease... "It is surprising that no positive correlation between the incidence of myocardial infarction and cigarette smoking as found at necropsy has been reported... It can be questioned whether an accurate appraisal of the relationship of cigarette smoking to myocardial infarcts can be made if this large group of lesions are excluded. "There is little evidence from necropsy findings that the incidence of any other form of lesion related to arteriosclerosis is influenced by smoking habits." Dr. Irvine H. Page of Cleveland has prepared a "Commentary on a Decade and a Half of Study of Atheropoesis." Says Dr. Page: "Most investigators have come to accept the concept that atherosclerosis is a 'multifaceted disease.' They no longer look for a single cause... "It seems to me quite futile to prejudge the results of the study of diet, smoking, exercise and the like. Each of us is entitled to guess which among them, if any, are the more important. These guesses often give: clues about the guesser himself but I am not sure that the guesses are to be taken seriously..." In two review papers, "Thromboangiitis Obliterans (Buerger's Disease)" and "Arteriosclerosis Obliterans," Dr. Victor deWolfe discusses the current status of these diseases including the controversy on the role of smoking. Other papers mentioning smoking include: ."Aortic and Peripheral Atherosclerosis" - D.L. Sackett and W. Winkeistein. ."Current Status of Angina Pectoris" - Herrman L. Blumgart. • "Coronary Heart Disease" - F. Epstein. ."Contributions of Epidemiology to Community Programs in Cardiovascular Disease" - John Cassel. Hill and Knawlton, Inc. ..A 0 Public Relations Counsel 0 150 East 42nd Street 0 New York, N.Y. 10017 ~ cc: Members ~ Public Relations Representatives Legal Representatives r w