Tobacco Documents Online

. rr 9 a d 2 ~ ~ r 3 ~ ~ 4 5 6 7 9 10 11 12 < a .~ 13. 0 K 3 14 15 16 17 18 19 ~ 20 ~ ~ 0 ~ 22 ~ ~ w 23 z 24 .~ x 2 [ I ; CHAYRMAN DIXON: I view that As.$aying that the Surgeon General is the only one that thinks that. Do you think that is so? If the Surgeon General says that, specifically says that; it does not say cigarette smoking, it says the Surgeon General is the one who thinks that. DR. STBtU:RT: That is grossly inadequate. C0144ISSIONBR BMAN: Do you think there is_ a pos::ible imhlication you are the-only one who has made that- de 4erjnir,ati on? DR. STDWART: . And• that-I. am the only Surgeon- _ General that ever existed? CI3AIRtrlAN DIaOh : All right. DR. STRWART: On the face of it, in a reasonable world, any product a:hich is both habit-forming and dangerous would be promoted with the greatest care and respunsibility, if it were promoted at all. Cigarettes are that kind of product. By any ordinary definition of the word, cigarettes are habit-forming to at least some persons and they are dangerous to health. It is to our mi.nd, i.ndefens-4.b].e that cigarettes should be ad-%Pertised as they are not•r being advertised, in a context -of happiness, v3.gor, , success and well-being, without evcn ~:- lt i r)t that the proc-luct may ul:;o a.had to 01."sc~ase arld aeaf.h. It soe:nls pc.rty_c:u2arl.y indefcnsibl.c t r f .r

lo ~ ~ ~ ~ I I 2 3 4 0 1]~ 12 Q . d .a 13 0 « 3 14 15 16 17 18 19 8 20 8 C~ ~ 21 O C g 22 ~ ~ w 23 z t 24 N 1• N LL when we realize that among the viewers of such advertisements . there are three particulnrly vulnerable classes of people. The first are young people, who may be encouraged to take up a dangerous habit which later on they may find agonizingly difficult to quit. The second are adults (a smaller but still substantial number) who are at the moment trying to give up smoking in response to their own good sense and in many cases at the direction of their physicians, who are being bombarded with the most enticing suggestions that they go back to cignrettes: And finally; there are those people who are ill, --- Buerger's disease and advanced -emphysema- come, to mine -- to whom cigarette smoking may_repreaent an almost immediate threat to life.- To my mind, we cannot defend the present state of affairs by saying that the public already knovis that smoking is hazardous, or that the-er.cellent anti-smoking messages on television and radio provide sufficient counter-effect, or that the warning on the label is adequate. The fact is that the cigarette advertiser is advertising a dangerous and habit- forming product as though it were perfectly innocent and perfectly ha-nmless. The adverse side of the story, though better told than before, can hardly be heard above the clamor. I will not comment here on what the practical effect', may be of requiring that a heaZth warning be placed in advei-tising. it has been said that. it would drive cigarette O W Ci^ ~ -4 CO OD v

11 J I advertising off the air. xf this is so -- if the truth about a product cannot be told -- then I thin}: it perfectly clear there should be no advertising. In testimony before the House Committee on Inter- 10 11 12 13 14 3.5 16 17 18 l9 0 20 O o . ~ 21 0 0 22 2 24 25 state and Foreign Commerce several weeks ago, I reviewed what has occurred in the five years since the publication of the Report of the Surgeon General's Advisory Committee on Smoking and Health. I di-sagree most strongly with the House Com- mittee's judgment that nothing new has been x3etermined since - the 1965 hearings with respect•-to the relationship between cigarette smoking and human health._ A great deal has been - learned, none of which discredits the-findings of the 1964 Report. We have summarized this new knowledge in ourr reports • - ~ to the Congress. I would present to you here, as I di d to the }Iouse Coinuaxttee on Interstate and Foreign Co-Yianerce: soime wceks ago, the summary statements which appeared in the 1967 and 1968 reports. .' , These reports, incidentally, are called for by the Federal Cigarette Labeling and Advertising Act of L965, which requires the Secretary of our Department each year to provide Congress with (a) current information on the health conse- I quences of smoking and (b) such recommendations for legislati.o,' as he may deem app~bpri.ate. i:n 1967, ue summarized the health consequences of 50380 7888

12 s N 3. 2 4 1 1 J 4 5 7 8 10 11 12 ~ < d .~ 13 o - K 3 14 15 16 17 18 19 ~ 20 ~ N ~ 21 0 ~ : ~ 22 s ~ w 23 z ~ 24 N ~ n 25 9 In 3-1/2 years since the publication of the (1964) report, an unprecedented Amount of pertinent research has been completed, continued, or initiated in this country and abroad under the sponsorship of governments, universities, industry groups,.and other entities. Thio research has been reviewed and no evidence has been revealed which brings into question the conclusions of the 1964 report. On the contrary, the research studies published since 1964 have strengthened those conclusions and_have extended in some Important respects~our knowledge of_the health consequences of smoking. The present state of knowledge of these health con- sequences can, in the judgment of the Public Health Service be summarized-as follows: 1. Cigarette smoRers have substantially higher ra.tes of der;,th and di_saba.l_ity than their nonsmoking counter-• parts in the population. This means that cigarette smoliters tend to die at earlier ages and experience more days of dis- ability than comparable nonsmokers. - 2. A substantial portion of earlier deaths and excess disability would not have occurred if those affected had never smoked. 3. If it were not for cigarette smoking, practical ly none,of the earlier deaths .from lung cancer would have occurred, nor a substantial portion of the earlier deaths froI. chroyiic hroncho-pulmonaky di.scases (co1wrio:ily diagnosed as

$ 3 10 11 15 16 17 .18 19 20 27. 22 23 2 4 2 13 chronic bronchitis or pulmonary emphysema or both); nor a portion of the earlier deaths of cardiovascular origin. Excess disability from chronic pulmonary and cardiovascular diseases would also he less. 4. Cessation or appreciable reduction of cigarette smoking could delay or avert a substantial portion of deaths which occur from lung cancer, a substantial portion of the ll earlier deaths and excess disability from chronic broncho- pulmonary diseases, and a- portion of the earlier deaths-a»d excess da.sability of cardiovascular origin. In 196-8, our summary iaas as follows: Previous findings reported in 1967 indicate that cigarette smol:ing is associated with an increase in overall mortality and morbidity and leaels to subst:antial excess of deaths in those pcople %.rho :;raokc. In addition, evidence herein presented shows th'at life expectancy among young men is reduced by a average of 8 years in "heavy" cigarette smokers, those who smoke over two packs a day, and an average of 4 years in "light cigarette smokers, those who smoke less than on^--half pack per day. Current physiologicall evidence, in combination with additional epactemiological evidence confirms previous findings and suggests addit: onal bionlechanisms whereby cigarette SiCiUl, :l.11~3~ can contribute to coronary heart d~_sease. Cigarette :,,r,c)':3.Iin" adve7_sely affects the s.ntex°&c;,i.on be•tween the demand ~ ~ ~ ~ ~ r:a .-3 :. P t. . ~ 1.t c

14 A ~ ».. . . ~ ~ 2 N ~ ~ 4 5 6 8 F 10 1-1 12 a o. 0 cc 3 lA 15 16 17 18 19 N 0 20 ~ ~ ~ 21 ~ ~ 0 ~ 22 s ~ w 23 i ~ 24 ~ ~ ~ 25 of the heart for oxygen and other nutrients and their supply. Some of the ha.rmful cardiovascular effects appear to, be , reversible after cessation of cigarettes smoking. Because of the increasing convergence of epidemil- logical logical and physiological findings relating cigarette smoking to coronary heart disease, it is concluded that cigarette smoking can contribute to the development of cardiovascular disease and particularly to de-ath from coronary heart disease. Additional physiological and epidemiological evi- dence confirms- the--previous findings that. cigarette smoking is the most important cause of chronie nonneoplastic bron-- chopulmonary disease in the United States: Cigar_ette smoking can adversely affect pulmonary- fLUlction and disturb cardiopulmonary physiology. It is suggested that this can lc:ud to cardiopulmonary disease, notably pulmonary hypertension and corpulrnonale in those individuals who have severe chronic obstructive bronchitis. Additional evidence substantiates the previous findings that cigarette smoking is the main cause of lungg cancer in•men. Cigarette smoking is causally related to lung cancer in women but accounts for a smaller proportion of cases than in men. Smoking is-a significant factor in the causation of cancer of the larynx and in the development of . ~ ° l ~ t J ? d i ' :a ~ c ti em o og .cC_ Vity . Fu.rther. ep:1- cz"yzcer oi' t-l1e oral cu w OD a aC . r ~

15. 1 2. 3 4 5 6 9 10_ 11 12 15 16 17 18 19 20 21 22 23 2 5 strengthen the association of cigarotta smoking`with cancer o . , l the bladder and cancer of the pancreas. • In the five years since the publication of the Re- port of the Surgeon Generai'N Advisory Committee on Smoking and Health, per capita consumption of cigarettes has fallen by 3.4 percent; the rate of taking up of smoking by teenagers has dropped a little;.the number of adults who have given up -smoking hus increased. Thiss is progress, but it is slow- progress. S7e are faced today with a nation in which about half of all men and a. third of -all- women still smoke cigarette4~ ~- i . :~ and in which death rates from diseas-es associated with cigar e ettie smoking remain high. CO;4MISSIOI~BR- JONES: Dr. Stewart, has anybody made . , any analysi.s of the smoking ra-te since the anti.--cigar.et'r.e co~rrr!ierc3.al.s have been on the TV? DR. STEWART: I would have to ask Dr. Horn that question. Shoul_d he respond now or later? CHAIRMAN DIXON: Just wait unti7l you got up, Dr. ~ Ilorn, if you ccill. w J.1. 0 DR. ~RT: Deaths frc;-, : lung caric:e}° alolxc; <<ri_J.1. v aD number nearly 60,000 in 1969. . N The Surgeon General' s Advisory Corwina.ttee on Smoking 'aliC.2 IIC~:A-2:1h a31 3.{: c-~ 1 '[l,. rC:l).7'_{: t;hat is a hecr3.th havard a), suf:fi_c5 ent )_lrtpcJr'r.anC('e to vaz:Carit- r- _ U i~

16 appropriate remedial action. The remedial action to date, submit, has not been adequate. And one reason is cigarette advertising. Whatever else the tobacco industry did in 0 response to the 1964 report of the advisory committee, it increased its advertising_-- from $250 million in 1964, to $261 million-in 1965, to $263 million in.1966, to $297 million in 1967 and to $312 million in 1968. Q V nAMMTC.`CTf1fJVD VT.Ul11.T. 67~...1A ..w.u a.l...a. a.t,.. vva-u-sava~ava.asa~ a+a...-asaa~. WWVli/.a~i XVVI iiay LllQb Qs LiIC 10 evidence of the health dangers increased, the advertisin' expenditures increased? 11 DR.-STEWART: There seems to be a correlation 12 between those. .~ a .~ 13 Most of this money was spent in television advertisi g• ~ . , 3 14 The president of one of the leading cigarette manufacturers 15 was quoted several weeks ago as saying that the cigarette 16 labeling act had not hurt the sales of his brands or the 17 industry. This may be the reason why. 18 I would like to speak briefly, and in conclusion, o 19 .the attempts by the tobacco industry to discredit the 1964 20 Report of the Surgeon General's Advisory Committee on Smoking 9 O N 0 21 and Health and the medical and scientific consensus that ~ s ~ 22 cigarette smoking is, indeed, a health hazard. A more J ~ 23 complete statement..of my comments may be found in my letter Z 0 24 to the IIonor abl.e Ilarley 0. Staggers, Chairman of the House ~ Ln X 0 . ~ 25 Comtni.ttE.e on Interstate and 1'oreic;n Comri,,erce, dated hiay 20, ~ 0 . • .~ W f

4 5 10 12 4 0. .n - 13 0 d 15 16 17 18 19 20 v 2) .o ~- ° 22 ~ ~ 2 z . 14 2 17 , 1969 and appearing in the published report •of the Co:cunittee's ~ recent hearings, beginning on page 1407. , Let me review some of the points which the tobacco industry has brought forward in the past and which-they may be expected to bring forward in the future: . a.. The industry would have us believe that medical opinion is divided on, the relati_onship of smoking to health. Those individual scientists who sti].]l question the evidence represent a minority view. We know of no organized medical or scie3itific body in the world which states that cigarette -fsmoki ng is not a health hazard or has disagreed with the - major conclusions of the Surgeon.General's Advisory Com- raittee on Smoking and Health. 2. It charges that the epidemiological studies lin3 - ing cigarette smoking and disease. are based on unreliable data. 1,7e know of no epidemiological work anywhere which has been more careful in its use of data than the work of ~ researchers in the field of smoking and health. ~ w CD 0 3. Industry spokesmen suggest that some unknown ~ a factor or factors exist which account independently forr the c smoking-de«th re3.ationshipa. By this they mean that some inborn weakness or precde.li.ction for disease leads a person become a smoker and also leads him to an early death from «ny one of an assort),,icnt of such diseascs as lung Cancer, chroli?.C bronchitis a2',Ci hc?&-r% attack. `1'1]:3 Surgeon Gti21^rF°.l' c to r1l , r. I LA

18 2 4 . 5 6 7 8 10 Advisory Committee considered this hypothesis and rejected it, for reasons set forth in its report, beginning,on page 190. 4. The industry points to.a long list of what they consider inconsistencies in the relationship between cigarette smoking and disease. The list_is too long to be enumerated . here. For aa discussion-of them, I can refer the Commicsion to-my letter to Mr. Staggers, or better to an article written by Cornfield,-liaenszel,-Hammon, Lilienfield,.Shimkin and' Wynder and published by the National Cancer Institute in 1959. This paper ten years-ago anticipated every charge-of in- consistency which last month the tobacco industry brought before the House Comm3.ttee-.7 5. Finally, the statement.is made that the only 15 16 17 18 19 20 21 a ~ P ~ 22 : e s w 3 z ~ 24 ~ ~ 25 relationship between cigarette smoking and illness and death is statistical -- based on' "population studies, rnor tal:ity figures, and statistics." This charge overlooks the fact thatt the Surgeon General's Advisory Committee in 1964 and the scientists who'have prepared the succeeding reviews have based their judgment not*on population studies alone but on the convergence.of three kinds of evidence -- population studies, clinical and autopsy studies, and anAmal experiments. I would add one footnote at this point. There is good evidence of a continuing campaign to encourage and perpetuate the view that "the Surgeon General ha.s def:erz;i3_ncc1"