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RJ Reynolds

Phyllis Small and Denise Fubini, Individually and on Behalf of Others Similarly Situated Against Lorillard Tobacco Company, Inc.. Arch, Et Al. -Vs- the American Tobacco Company, Et Al.. Deposition of Roger L Mozingo (Taken by Plaintiffs). Exhibits2

Date: 25 Sep 1997
Length: 870 pages
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Mozingo, R.L.
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ROGER MOZINGO, 9/25/9-1 PAGE 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 0 16 No ~ ~ 17 21 22 23 24 25 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA ARCH, et al. ) ) Plaintiffs, ) ) -VS- ) CIVIL NO. 96-5903-CN THE AMERICAN TOBACCO ) COMPANY, et al., ) ) Defendants. ) ) Deposition of ROGER L. MOZINGO (Taken by Plaintiffs) Winston-Salem, North Carolina Thursday, September 25, 1997 Reported in Stenotype by Lynn B. Gilliam Transcript produced by computer-aided transcription
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SUPREME COL^NT OF THE STATE OF NEW YORK ~~:;_"""TY OF NEW YORK x x 6 7 8 9 13 14 0 Q 15 O r n N N = 6 O O a ^ 20 21 22 23 24 25 =a':::=R:NE ZITO, PETER HOBERMAN, and x CECRGE ELISSEOU, individually, and on x -e_^.a?f of others similiarly situated, x x Plaintiffs, x x - against - x x THE AMERICAN TOBACCO COMPANY, INC., x Index : AG ~ 3 No. 110952/96 AMERICAN BRANDS, INC., COUNCIL'FOR x Judge Charles TOBACCO RESEARCH-USA, INC. (Successor x E. Ramos to Tobacco Industry Research x Committee, and TOBACCO INSTITUTE, x x Defendants. x x x i REPORTING, L D. 800-232-6878
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4 6 7 8 9 m ~ lo 0 ~ Y li U O _3 '; 4 20 21 22 23 24 25 i,~G= iYGZI NGO, 9/25/97 41 ':I Document, "Inside is an Important Vessage..." 179 42 1/10/79 TI Do cument, "Smoking and Health 1964-1979" 180 43 7/27/78 TI Staff/Craig Memorandum 182 44 Deposition Notice 184 B-00 -232 -MM
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XCZ7VGO, 9/25/97 Z liG -.+ . 9 ON 3EHALF OF DEFENDANT: z 5 6 7 a 9 m 1~ ~ ~ 0 LL ~ 1 1 0 H ~ _2 W y 5 :4 ° =5 . 0 ~ ~ N 16 S 119 a 17 D 0 Cr 16 Y m ¢ ~ 19 U W 20 21 22 23 24 25 Ti-:01MiAS D. SCciROEDER, ESQUIRE WOMBLE, CARLYLE, SANDRIDGE & RICE, P.L.L.C. 200 West Second Street Winston-Salem, North Carolina 27102 (910) 721-3600 JAMES A. GOOLD, ESQUIRE COVINGTON &~BURLING 1201 Pennsylvania Avenue, N.W. P. 0. Box 7566 Washington, D.C. 20044 (292) 662-5507 VIDEO DEPOSITION OF ROGER L. MOZINGO, a witness called by the Plaintiffs, before Lynn B. Gilliam, Notary Public, in and for the State of North Carolina, at the Law Offices of Womble, Carlyle, Sandridge and Rice, 200 W. Second Street, Winston-Salem, North Carolina, on Thursday, September 25, 1997, commencing at 9:00 a.m. INDEX OF EXAMINATIONS i , . - -
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===R M-CZ_NGO, 9/25/97 3 Y e 7 a 9 0 0 ~ 2 E " U O ~ z u Vf 5 0 0 n ~ ~ N 13 14 15 15 a 17 n 0 C Y ~3 ~ ~ c°U 19 W 20 21 22 23 24 25 ~•' ti!S. jAi..+Z:4AN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : AGr -4 BY MS. -ONDORF ..................................PA;~E 140 BY MR. GOOLD ....................................PRGE _85 BY ti:... HONDORF ..................................... PAGE -38 INDEX OF EXHIBITS NUMBER EXHIBIT MARKED IDENTIFIED Plaintiffs' Mozingo 1 Subpoena 14 2 8/3/79 Kloepfer/Mozingo Memorandum 107 3 8/3/79 Dryden/Kloepfer Memorandum 109 4 2/7/84 Kloepfer Memorandum 131 5 2/2/76 Holtzman/Mozingo Memorandum 134 6 1982 Document, "Cigarette Smoking and Cancer, A Scientific Perspective" 141 7 5/16/88 Press Release, "Claims that Cigarettes are Addictive Contradict Common Sense" 142 8 TI.Document, "Tobacco Smoke and the Nonsmoker" 143 9 1976 TI Document, "On Smoking" 146 10 TI Document, "Answers to the Most Asked i i REPORTING, . 800- -6 8
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,~5.. vCZINGO, 9i"25%77 L ..:'?R=ME C.^,UNT OF THE STA'T E CF NEW YORK 1 C.,.,-N'.Y OF NEW YORK x 4 =:i'_'ILIS SMALL and DENISE FUBINI, :::dividua=iy and on behalf of x x x D others similarly situated, x ~ 7 Plaintiffs, - against - x x x x ndex No. 8 LORILLARD TOBACCO COMPANY, INC.; LORILLARD, INC.; LOEWS CORPORATION; X x x 110949/96 Judge Charles 9 COUNCIL FOR TOBACCO RESEARCH-USA, x E. Ramos ~ INC. (Successor to Tobacco Industry x ~ 0 '_0 Research Committee); and TOBACCO x ~ 0 y W Q 2 INSTITUTE, INC., Defendants. x X ~ x y 3 ., STATE COURT OF THE STATE OF NEW YORK COL,ITY OF NEW YORK v ± , x , x S 10 -MA.RY ANN HOSKINS, Executrix of the x ~ Estate of Edwin Paul Hoskins, x 2 ~ =7 WALTINA BROWN, and DANTE x 0 AUBAIN, individually, and on behalf x y _3 of others similarly situated x ~ , z 0 x 19 Plaintiffs, x y ~ x 20 - against - x Index No. X 110951/96 21 R.J. REYNOLDS TOBACCO COMPANY, RJR x NABISCO, INC., COUNCIL FOR TOBACCO x Judge Charles 22 RESEARCH-USA, INC., (Successor to x E. Ramos Tobacco Industry Research Committee), x 23 AND TOBACCO INSTITUTE, INC., x 24 Defendants. x x 25 x NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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r :`^.CZ:NCO, 9/25/ 97 : A :,_ 3 Questions About Cigarettes 147 L 11 TI DOct:~T~e.^.t , nAnswe_ s to the MOst Asked Questions About Cigarettes 148 6 7 8 9 ~ z 0 LL ~ 11 .. ~ _2 13 9 14 16 a 17 ~ 0 ~ ¢ 18 > m z 0 U 19 W Z 20 21 22 23 24 25 TI Document, "A Statement About Tobacco and Health" 149 13 7/6/78 Dwyer Memorandum 150 14 Document, "Two Days in January" 150 15 Document, "TI Publications" 151 16 TIRC/TI Document, "Tobacco and Health Research" 151 17 Document, "Answers to the Most Asked Questions about Cigarettes" 152 i8 1979 TI Document, "Fact or Fancy?" 153 19 TI Document, "A Two-Way Street" 154 20 TI Speaker Program Document 154 21 TI Booklet, "Answers to the Most Asked Questions about Cigarettes" 157 22 1987-88 Document, "The Anti-Smoking Campaign: Enough is Enough" 158 23 1975 TI Document, "The answers We Seek" 158 24 Document, "The Cigarette Controversy, Eight Questions and Answers" 159 25 1984 TI Document, "The Cigarette Controversy: Why More Research is Needed" 160 00
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r V 3/25/ 37 =6 _962 TI Document, "Some Answers for ':'!,~e V'"ck_.^.Q 5 7 8 9 27 TI :.oc:Iment, "Some Answers for t~.e Smoking Public" .62 23 U. S. Tobacco Journal 12/4/69 Document 162 29 TI Document, "Some Frank Words About Smoking and Research" 163 30 1/81 TI Document, "The Cigarette Consumer Controversy 164 31 Backgrounder Document, "A Suggested 13 _4 > 9 Q U ~~ J 20 21 22 23 24 25 Response to the Charge of Addiction" 165 32 Backgrounder Document, "Health Effects of Smoking Low Tar Low Nicotine Filter Tipped Cigarettes" 166 33 Backgrounder Document, "General Background on Smoking and Health" 166 34 9/80 Kournegay magazine article, "The Cigarette Controversy" 167 35 1981 Toohey News Article, "More Research Needed on Tobacco Use" 169 36 1984 TI News Release 175 37 TI Document, "Women and Smoking" 175 38 TI Document "Tobacco Institute News" 177 39 TI Document, "Tobacco Institute News" 177 40 1984 Document, "Tobacco Institute News" 178 i _ , . - ~=6578
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2 .5 6 7 8 9 9 0 LL V 1 ~ 0 ~ ~ 12 w rn 5 13 14 1,7 ~ 0 e ~ 18 > a X c°U 19 W r 20 21 22 23 24 25 all objections are reserved expect as to form? MS • SALZMAN: We can stipulate to that, res. -^e New York matter is in State Court. MS. HONDORF: Yes, we'll stipulate to that. MR. SCHROEDER: Thank you. MS. SALZMAN: You're welcome. ROGER L. MOZINGO, having been first duly worn, was examined and did testify as follows: EXAMINATION BY MS. SALZMAN: Q. Mr. Mozingo, my name is Hollis Salzman. I'm going to be taking your deposition today; and I'll be asking you a series of questions. And if at any point you don't understand my question, or for any reason you don't hear me, please just ask me and I'll repeat my question. A. Okay. Q. And also, if you need a break at any time, just let me know and we can stop for a few minutes. You were subpoenaed here today; is that correct? A. Yes. MS. SALZMAN: Mark this, please.
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M--Z7NGO, 9/25/97 r:.G_: VIDEOGRAPHER: This is the videotape L D 5 7 3 9 _0 ;1 -2 13 15 1 6 17 1S 19 20 21 22 23 24 25 d___ csic'_on of Mr. Roger Mozingo, taken by the plai:,c'_ff :.^n t^e matters of the New York State tobacco litigation a::a 3arnes versus American Tobacco, et al. This deposition is being held in the law office of Womble, Carlyle, Sandridge and Rice, located at 200 West Second Street, Winston-Salem, North Carolina. Today's date is September 25th, 1997. The time is 9:41 a.m. The court reporter's name is Lynn GiI liam, representing Nationwide Court Reporters from New York City. The Videographer is Larry Schadle, also representing Nationwide Court Reporters. Will counsel now please introduce themselves? MS. SALZMAN: Hollis Salzman; Goodkind, Labaton, Rudoff & Sucharow, for the plaintiffs in the New York matter. MR. RASTOGI: Sameer Rastogi; Goodkind, Labaton, Rudoff & Sucharow, attorney for the New York action. MS. HONDORF: Sherrill Hondorf; Waite, Schneider, Bayless & Chesley, for the Barnes action pending in Pennsylvania. MR. EDWARDS: Craig Edwards for the plaintiffs; with Mellon, Webster & Mellon in the N, LTD. _ - m
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J_=Y MC'Z~:~IG C, 3/ 25 / 97 ; 2^.CZ T-\'GO EXH I3I': NL'y!BER .^vN= WAS 4 6 7 8 9 12 73 14 _6 17 18 20 21 22 23 24 25 :f,.A.=c:CED FOR IDEtiTI. ICATICN. ! S ALZ;~^31V . Ckay. Will you take a look at this document and tell me if you recognize this as the subpoena you were served with? A. Yes. Q. The subpoena requested that you bring certain documents with you to the deposition. Did you bring any documents with you today? A. I have no documents from the Tobacco Institute. Q. Do you have any documents in your possession, personal possession at home -- A. No. Q • -- that have anything to do with the Tobacco Institute or CTR? A. No, not at all. How about any documents dealing with smoking and ^ealth? A. None. Q. And you -- and just for the Record, you're leaving today to go out of town. Is that correct? A. I'm meeting a friend at the airport who's coming in from New York. Q. I see. So you're not leaving to go out of town? QA'I'I ONW 11 oUR POA 8 0-0--332-6
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, 6 7 8 9 ~ 11 N a 12 W N S 13 14 ` 20 21 22 23 24 25 :-'.GZ1NG0, 9/ 25/97 APPEARANCES GN SEHALF OF PLAINTIF FS : CRAIG T. EDWARDS, ESQUIRE MELLON, WEBSTER & MELLON 87 N. Broad Street Doylestown,-Pennsylvania 18901 (215) 348-7700 .Dn:::r 5 HOLLIS SALZMAN, ESQUIRE SAMEER RASTOGI, ESQUIRE GOODKIND, LABATON, RUDOFF & SUCHAROW. L.L.P. 100 Park Avenue New York, New York 10017-5563 SHERRILL HONDORF, ESQUIRE WAITE, SCHNEIDER, BAYLESS & CHESLEY CO., L.P.A. 1100 Poydras Street New Orleans, Louisiana 70163-3000 (504) 585-7920
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RC2ER :!CZINGO, 9%25% 97 rAGE 2 2 4 5 . ~ 7 8 3 ~ ~ 10 0 ~ U 1~ O ~ W 12 N 5 13 14 ° 0 ~ 15 In ~ 15 m a 17 n 0 ~ 19 > ~ cc 0 19 W x r 0 21 22 23 24 25 SUPREME COURT OF THE STATE CF NEW YORK COUNTY CF NEW YORK x x SHARLENE HOBERMAN and AUDREY HULSE, x as executrix, on behalf of the Estate x of Lewis Hulse, individually, and on x behalf of others similarly situated, x x Plaintiffs, x x - against - x Index No. x 110953/96 BROWN & WILLIAMSON TOBACCO x CORPORATION, B.A.T. INDUSTRIES, x Judge Charles P.L.C., BATUS, INC., BATUS HOLDINGS, x E. Ramos INC., COUNCIL FOR TOBACCO x RESEARCH-USA, INC. (Successor to x Tobacco Industry Research Committee), x and TOBACCO INSTITUTE, INC., x x Defendants. x SUPREME COUNT OF THE STATE OF NEW YORK COUNTY OF NEW YORK x x ROSA FROSINA, ELIZABETH COLAVITO and x ANILDA ROSS, individually, and on x behalf of others similarly situated, x x Plaintiffs, x x - against - x Index No. x 110950/96 PHILIP MORRIS, INC., PHILIP MORRIS x COMPANIES, INC., COUNCIL FOR TOBACCO x Judge Charles RESEARCH-USA, INC. (Successor to x E. Ramos Tobacco Industry Research Committee), x AND TOBACCO INSTITUTE, INC., x x Defendants. x x
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:'*.CZ=.;GO, :%25%77 2 : : 6 7 8 9 M Q _~ 0 LL Y 11 0 ~ y 2 12 y 5 13 14 15 _6 17 > ~ U 19 u 20 21 22 23 24 25 And schools today, mostly in our rural schocls, vocational agricu_?--ure is still a pre- `y ~~ p.:oular course Lor high schoolers. You have exposure pab_ic speaking, debating, parliamentary procedure, things of that sort. Q. So, have you taken any courses in the area of tobacco agriculture? to A. No. I grew up on a tobacco farm, so I guess I had a*_"irsthand knowledge of the crop, and how to grow the crop, and those aspects of tobacco farming. But in terms of taking a course on tobacco, per se, no. Q. Okay. How was it that you grew up on a tobacco farm? A. I grew up with my aunt and uncle, who were far.^,:e=s. They were tenant farmers. And as a result of, you {::ow, my family having difficulties, I went to live wit:^h my aunt and uncle. Went to high school there, and then to college. Q. Do your aunt and uncle still own a tobacco farm, or rent a tobacco farm? A. No, they never owned any. They are both retired now, and never owned any land. Q. Okay. Is any -- are there any other members of your family that either own or are tenants on tobacco producing property? , E , L D. 800-232-6878
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77 ?=_::nsylvan4a act;or., Barr.es. MR. SCHROEDER: Tom Schroeder, R. .;. =_•.rnc? ds Tobacco Company. MR. GOOLD: Jim Goold; Covington and 6 7 a 9 m I '_1.1; 9 LL N a _2 W N 5 13 14 > I ~°, 19 i .. 20 21 22 23 24 25 Burling, for the Tobacco Institute. MR. SCHROEDER: Before we begin, can i ;ust put on the record what we talked about before, and that was that Mr. Mozingo is being presented today on behalf of his employment with his former employer, the Tobacco Institute, and not on behalf of his present employer. MS. SALZMAN: That's correct. MR. SCHROEDER: And that goes with respect to the Notice of Deposition and the subpoena that accompanies the Notice. MS. SALZMAN: And I represent that for the New York case, although I stated before that I still would be inquiring into Mr. Mozingo's employment with RJR to the extent as to what he does and who he works for. I can't speak for the Pennsylvania case. MR. SCHROEDER: That's my understanding as well of what we said. Is that correct? MR. CRAIG: That's correct. MR. SCHROEDER: Okay. Thank you. And
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RC' _ER 'fOZ-1-NGO, y/25/97 6 7 8 9 ~ i tJ ~ .7. 1 ~ 11 c 13 14 Q 15 0 ~ ~ r No 16 ~ G 17 ~ 0 ~ 19 > ~ s 0 19 U W 20 21 22 23 24 25 A. Oh, some years? Q Yeah. If you want to start wit'r: the RJR blenui ~a acprcximateiy what years ycu were there? A. '61 to '63. Q. And then the 4-H program at North Carolina State? A. '63 to about '68. Q. And then the Department of'Agriculture, tobacco marketing? A. Excuse me. I think it was '67. Q. Okay. A. '67 to '70, 1970, with the Department of Agriculture. Q. And then Tobacco Associates? A. From '70 to '74. And then Tobacco Institute, '74 to '88. And then since '88, here in Winston-Salem. Q. Can you describe for me what the function of Tobacco Associates was? A. Sure. Tobacco Associates is an association of tobacco farmers, farmers from Virginia south through Florida. The role of Tobacco Associates is to entertain foreign delegations who want to see the tobacco industry in this country, and to assist importers of U.S. grown tobacco with their manufacturing, you know, brand operations. Essentially, that's what it is. Q. What was your position with Tobacco Associates? , I, . - -
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P:k:-:= _3 5 7 8 9 14 f ° 15 _5 ~ 17 ~ O > ~ x u 19 W 20 21 22 23 24 25 h. No. ~. OlCaV. :ave y0u ever `,3d your deDOsiti:..^n taken Ge_`C=e? a. Never. Q• Okay. Have you ever filed any affidavits on behalf of tae Tobacco Institute? A. None. Q. Have you ever testified at any trial? A. No, ma' a:n. Q. Can you describe for me your education since high school? A. I attended North Carolina State University in Raleigh, North Carolina; graduated with a BS degree in agriculture education. Later, during '78/`79, I attended a one-year nondegree business/government relations seminar at Cornell University. Q. And can you describe that course for me? A. As best I can remember. I was selected to represent -- at the time I was employed by the North Carolina Department of Agriculture, and I applied for and received the honor as the one North Carolina representative to participate in a national program which was sponsored by the National Association of Public Affairs. Government, federal government, state
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__= c .•?CZ=-NTG;D, 9%25%97 Y 6 7 a 9 a ~ 0 LL Y U -- O ~ N W 12 N g 13 _5 S ~ 20 21 22 23 24 25 a=so have a banker representative on their board, a r?ta=ler --°Dresentat-v°, wholesale r°_Dresentat_ve. The ::.ar3 of directors govern Tobacco Associates. 2~ -~ :1S . S AL ZMAN . Q. ls it a not-for-profit organization? A. Yes, it's not for profit. Q. Who -- where does the funding for Tobacco Associates derive? A. From the farmers directly. It's a check-off system. Q• And how does it work that the farmers are able to fund Tobacco Associates? A. Well, it's -- as with about every commodity in the coura ry that I'm familiar with, cotton, wheat, corn, all of these grower groups have an association. They contribute -- they call it a check-off. When you sell your crop, a very small amount of your proceeds go into supporting this effort. It's a pretty common practice, actually. Q. Okay. Is that the only financial contribution to Tobacco Associates was this check-off system from tobacco farmers? A. Yes, ma'am. Q. Was there any financial contribution from any tobacco company? i REPORTING, LTD. 800- 32-6878
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4 a. Never. w::at is your present position with RJR? =.. :' m~Iice President of State Government Reiations . ;~ . Ar.d what do you do as Vice President of State v nt Re ulati G ? ~ g o ernme ons 5 A. Administer our state regional director, and 7 lobbyist program. 3 Q. And what does that entail? 9 A. It means -- my specific job? a Y 0 Q. es. ~ Y U 0 11 A. Well, it entails keeping up with our regional ~ N a W N 12 directors, knowing where they are, knowing what issues 5 _3 they're dealing with, knowing what meetin gs they attend, =4 getting reports back from them, dealing with.personnel 0 matters; those sorts of things. 0 ~ ~ _5 Q. Do you have any contact with -- what was your -- S a 2 17 did you hold the same position since you went to work ~ 0 s for RJR in 1988? > ~ . U W 1 y 20 A. Yes, ma'am. Q. And who do you report to at RJR? 21 A. The head of external relations. 22 Q. What is that person's name? 23 A. Tom Griscombe. 24 Q. From 1988 to the present, through your employment 25 of RJR, have you had any dealings -- any business REPORTING, LTD. 800-232- 87
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~~ =Y :•'-Z:NGO, 9/25/97 : AGE 20 D A. Well, I was one of two individuals in the ,.as^:ngtcn o=:_ce, and I would do a lot of the entertaining of our foreign delegations, and I would T.ake some trips to international trade fairs, and things oL that sort. Q• what was your job title? 5 7 8 9 10 , , 12 ~ 31 3 -4 -. 5 , ` =7 _n ,g 20 21 22 23 24 25 A. When I left, I was Vice President of Tobacco Associates. Q. And when you started, what was your job title? A. I think I was Assistant to the President. Q. Did -- does Tobacco Associates have any affiliation with the Tobacco Institute? A. No. Did you have any dealings with the Tobacco 7nstitute while you were employed with Tobacco Associates? A. Well, our offices were located across the street. 7. knew some of the people; but in terms of having any working dealings, no. The two organizations really didn't represent the same interests. Q. who -- what entity or entities are in charge of Tobacco Associates? MR. SCHROEDER: Object to form. WITNESS: In charge, they have a board of directors which is comprised of tobacco farmers. They N, LTD. 8 0-23 -6 7
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__.. :r:,Z__tiTGO, 9/25/97 1 .3 7 8 9 ¢ 10 ~ ~ U -= 0 13 , 5 :5 20 21 22 23 24 :ea:_nas with the Tobacco Ir.stitute? ,.. Yes. 2iease describe them. 1 serve -- I represent R. J. Reynolds on the state act:vities -- the Tobacco Institute's State Activities Coordinating Committee. And the State Activities Committee is involved in the Tobacco Institute's state legislative program. Q And how much time do you devote to the State Ac*_ivities Committee? Q Q How much time over like -- Per year. Per year? Oh -- Or if you have an easier time frame to give it to me, if you want to say per month, that's fine also. A. Well, about every six weeks we have a meeting with the Tobacco Institute State Activities Committee, and those meetings will generally last three to four hours. And in-between those meetings, not on a daily basis, but periodically, I'm on the telephone with the gentleman who heads that department now. Q. Which department? A. The State Activities Department at the Tobacco Institute. What is that person's name? 25 Q ON= LTD. 800-232-6878
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RC==-• ~:CZINGC, 9/2:./97 4 5 5 7 9 ii _2 13 14 - 5 17 ,g 19 20 21 22 23 24 25 A. ?at Donoho. What is the goal of y. It provides a f:;rum --` the Tobacco Institute the State Activities Commit:~°_e? for a representative from each member companies to meet and receive reports on legislative activity, and discuss approaches to various, you know, pieces of legislation, and things of that sort. Pretty typical in the way trade associations operate, you know. We're members of the trade association. And any good trade association is going to keep its members informed and hold periodic meetings with them, which is pretty routine kinds of stuff. Q. Are you paid for you -- for your work with Tobacco inStitute? MR. SCHROEDER: Objection as to form. MR. GOOLD: Objection as to form. WITNESS: No, not specifically by the Tobacco Institute. I'm paid -- one of my functions is to deal with the Tobacco Institute, but I'm not paid specifically to deal with the Tobacco Institute. BY MS. SALZMAN: Q. So you receive a salary from RJR for your position; right? A. Yes. Q. And that salary covers the work that you do with , LTD. 800-232-68 8
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3/ 25/ 77 : A, 3 E 25 : 5 7 8 9 ~ ~ 10 0 LL U 1~ O ~ ~ 12 ~ 14 -5 20 21 22 23 24 25 _ e''-bacco :nsr-i:ute that you just described? MR. SC:iRCEDER: Object to form. WITNESS: It covers everything I do. _Y 7 S . SA L Z,`~'irr-~N . Q• well, do you receive additional -- what I'm asking is: Do you receive additional payment from any source for your work with the Tobacco Institute? A. No, ma'am, not at all. Q• So the only salary you receive -- or you've received from since 1988 through the present, is from Ru .'Z ? A. That's correct. Q. All right. Do you have any contact with the Ccunc=l for Tobacco Research? A. No. Q. What was your position when you began working for Tobacco Institute in 1974? A. well, the Tobacco Institute, I think the title was Manager or Director of State Activities. I think Manager. That's a long time ago. Q• How long did you hold that position? A. I think for about three years. I was promoted to Vice President. Q. And how did you get your job as Manager or Director of State Activities with Tobacco Institute? m , 1 RE OR I G, LTD. 800-232-6878
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9/25/97 -. . . i a!l -- these various t0bacco groups, would show up at a L ..f z.e same meetings; and we -- regardless of =::e asscc:ation, you know, we knew each other. So it wasn't just that they were across the street 9 ~ 10 0 ~ 0 11 N W 12 y 5 0 15 8 m ~ 17 0 ¢ ~' 13 r © ¢ c°~ 19 ~ from you, but also that you attended meetings wit:^- cther nersor:nel from Tobacco Institute? 6 A. Well, I can't say that I attended meetings with 7 them. They would be at the same meeting. I didn't, you 8 know, I didn't go with them to the meeting, you know. Q. They would be present? A. Yes. They would be present. Q. Besides their being across the street from you and attending the same conferences that you attended, is --here any other contact that you had with Tobacco Institute representatives or employees while you were worki^g with Tobacco Associates? A. Ch, I'd have lunch occasionally with some of the folks. 9 13 14 16 Q• Who would you have lunch with? A. People who are no longer there. I don't remember the names now. But, you know, for example, Frank Dryden, I got to know. Horace Kornegay, I would have lunch with Mr. Kornegay sometimes, but not on a regular basis. Q. What was your contact at Tobacco Institute that 20 21 22 23 24 25 NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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MOZ.NGO, 9/25i97 ?AGE 31 2 Q. And what do you smoke? A. _igarettes now. Wh at kind of cigarettes do you smoke? Winston, Winston Light. MS. HONDORF: You didn't have to say 6 7 8 9 _3 11 :2 13 14 _5 _5 17 18 ,_9 20 21 22 23 24 25 THE WITNESS: No, I do. MR. GOOLD: Surprised? BY :'^.S . SALZMAN : Q. How much do you smoke a day? A. I would say two packs, maybe. Q. And how long have you smoked two packs of cigarettes a day? A. Well, I can't tell you exactly how long. I know I've Deen -- I really started putting my pipe -- I lost my trusted pipe, you know, my pipe I loved. And I put my pipe aside and started smoking cigarettes after I lost my dear pipe. But I'd say ten years -- ten or so. Q. And during any point in time did you ever try to quit smoking? A. I have never tried to quit, no. Do you have any desire to quit smoking? A. No, ma'am. But I -- if I chose to quit, I don't think I'd have any problems with it, no. Q. Why is that? N F-~
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__ I'.OZ=NGO, ti/25/97 i gVver^ment, local government representatives were selected to participate in that program., and it was a :es of sem4:.ars conducted by professors at the c::s_ness school at Cornell. ~~d that course have anything to do with the area 8 7 8 9 ~ Q - ~ 0 ~ U ,~ 0 .. N W 12 N 5 13 _4 0 r r y ' rn m ~ -• ~ 0 ~ _8 > m ~ 0 U i 9 W I r 20 21 22 23 24 25 of tobacco? A. Not at all. is that your educational background? A. Since high school. Q. Okay. And your degree in agriculture that you received, your BS degree? A. No, agricultural education. Q. Education. Did that have anything to do with the tobacco industry? i. No. lt was teacher training, basically. Agricultural education qualifies a person to teach vocational agriculture in North Carolina high schools, basically. Q. Okay. So did you have any training during your college education on teaching about tobacco agriculture? A. No. My degree would have allowed me to teach on any agricultural subject. As you may or may not know, North Carolina is probably the most diversified state agriculturally, maybe with the exception of California, in the country.
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I 6 7 8 9 13 14 ~ J? In N N ~ i o -~ 0 m W 2 20 21 22 23 24 25 RC.._R `^.CZINGO, 9/25/97 ?AG:. 25 =:):d you of this position that was becom.ing ava'-.able? A. You know, I don't remember exactly how I found :.1.it. It could have been Frank Dryden, for examnle, but _.:on't know. I just don't remember how I really, you know. I don't remember how I found out. Q. Were.you interviewed for your position with Tobacco :r:stitute -- interviewed by Tobacco Institute employees or representatives? A. Yes. Q• Who interviewed you at Tobacco Institute? A. When Dr. Dryden -- excuse me, Dr. Welch -- when Dr. Welch announced his intentions to retire, a gentleman, Blucher Eringhaus. COURT REPORTER: What was the first name? THE WITNESS: Blucher, Blucher. Don't ask me how to spell it. Blucher Eringhaus was taking over the division. As I recall, I met with Mr. Eringhaus and I believe Mr. Kornegay -- I'm not absolutely certain about Mr. Kornegay -- but certainly Mr. Eringhaus. BY MS. SALZMAN: And how was the position of Manager/Director of State Activities described to you? A. As a person who would work in their State Activities Division representing the Institute at trade A I D CO T REPORTING, LTD. 800-232-6878
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XCZ:tiGO, 9-25/97 Z 0 7 8 9 10 11 12 , 1 Z 14 15 15 17 13 19 20 21 22 23 24 25 mee=_ngs, :racki.n.a legislat:or., reporting to member c^Tpanies, and as the trade associatior:s, largely gather _nfo_mati.,.n and ,.issem?nate •it to members; pretty _.,ine {inds of things in the government reiations area. What type of information would you gather? A. Status of legislation, where it might be in the process, things of that sort. Q. Did you distribute it -- who did you distribute it to? A. To our dues-paying members. Q. And who were your dues-paying members? A. Cigarette manufacturers, smokeless manufacturers, pipe tobacco manufacturers. It was manufacturing organizations. Q. What qualified you to act in the position of Director or Manager of State Activities? A. well, my background certainly -- you know, with an agriculture background, you know, I had a long interest in tobacco, and I had spent my career to that point in the tobacco industry. I had grown to know a lot of people in the industry, and even though I did not have a government relations background, per se, I guess it was determined that I could probably grow into or bring some i REPORTING, . - - lD
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R:'G_.:'~ .`•'.CZIti'GC, 9/25/97 J*...._ :c A. Well, I know that I could do it. You know, _r wanted to auit, I cou;d quiz. HCw do you know z:h3t? . Y 7 8 9 ~ ~ 10 ~ 0 LL 11 U O ~ y 5 _2 W N 5 13 14 A. I know myself. Q. Have you tried to quit any other activity in your life before? MR. SCHROEDER: Object to form. I don't think I understand that question. THE WITNESS: Well, I quit playing basketball after I got my nose broken three times. But that's not the kind of thing you're asking, I know, but BY MS. SALZMAN : Q. I'm just curious why you think that -- why you know you can quit. A. Well, I've changed my diet. You know, things like changing diet -- I just don't believe I'd have any .difficulty quitting. 4• ~ 20 Ismoking? 21 22 23 24 25 MR. SCHROEDER: Object to form. WITNESS: No, ma'am. BY MS. SALZMAN: Do you have any health problems as a result of When was the last time you went to a doctor? A. I had my annual physical three months ago. N N, D. 800-232-6878
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~.,_~~ ~ICZINGO, y/25/97 a: 6 7 8 9 ¢ 12 W a 13 14 Q• Arld d oes your doctor know that you smoke ciaarettes? -. :ies. Q. J_d :^e advise you to quit? A. He ciidn'= advise me to quit. He suggested : might want to, you know, scale back a little bit, you know. No, he didn't say quit. Q. And do you have any plans to scale back? A. No. Q. Did he tell you why you should scale back? A. well, he also told me I should probably watch my fatty food intake because my cholesterol was a bit f1;G^. Q. Is t::at why he told you should cut back on ciaarettes? MR. GOOLD: Objection calls for ~ 18 > m e 19 W r- 20 21 22 23 24 25 speculation. MR. SCHROEDER: Objection to form. WITNESS: I don't know why he told me to cut back. BY MS. SALZMAN: Q• Do you think smoking is bad for your health? A. I don't think smoking is necessarily good for my health. I think it's -- like a lot of other things we hear about in our daily lives, it's probably not a good NATI NWIDE CO T REPORTING, LTD. 800-232-6878
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. = Y:ZILGO, 9/25/97 4 ~ 6 7 3 9 m ~ l0 S ~ i U ~1 0 ~ :n ? _2 n a J ; 3 14 0 o --- ~ ~ N _5 o 0 m a i7 ~ 0 cr > m ~ c°U 19 W ~t 20 21 22 23 24 25 A. My wife's family -- my wife's mother sti1 i owr.s a s~-.=i i f arm _:~ eastern ~Jcrt:: CaYol-na, Nh_c:: t::ey iease . ~:;kay. Can you describe your .,~ J v a/ nist~ry s..._~ graduating from college? A. My first job was with R. J. Reynolds Tobacco Company here in Winston-Salem. I worked in the Blending Department. After a brief tenure here, I left RJR voluntarily to take a job with the North Carolina Agriculture Extension Service in this county, where I worked with the 4-H youth programs and with some tobacco farmer activity. Following that job -- it sounds like I can't keep a job -- I went to the North Carolina Department of Agriculture, where I worked in the Tobacco Marketing Division. It was while at North Carolina -- at the North Carolina Department of Agriculture, that I took the year at Cornell. Completing that year, I then joined Tobacco Associates in Washington, which is an organization that represents flue-cured tobacco farmers in a five-state region, and their export activity. After four years there, I joined the Tobacco Institute, also in Washington. And then nine years ago, I joined R. J. Reynolds. 4• If I could just get some years from you. about I IDE URT I2EP0 TING, LTD. 800-232-6878
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Z:~iGO, 3/25i 37 3-i t::_ng for me to do. L:1{e I probably should not love fried 0 7 8 y a x 0 ~ V ZZ 0 13 _4 ~ 20 21 22 23 24 25 -JVaas ,4 . .7. V well, but ; do, you know. So -- I missed your answer -- do you think that smc;cir:g is bad for your health? A. I thought I answered that. 4. And I apologize if you did. Could you answer it again? MR. GOOLD: Objection, asked and answered. THE WITNESS: I said I don't think it's is necessarily good for my health; but I don't -- I can't tell you that it's bad for my health. I enjoy smoki::g. BY MS. SALZMAN: Q. So you can't say one way or the other whether it's bad for your health? A. Well, you know, I think the point I made in answering the question was there are probably lots of things that we might not consider necessarily good for our health. I don't think smoking is necessarily good for my health. By the same token, I don't think it's I necessarily bad for my health either. You know, I enjoy smoking and it's a choice I made, and it is something I 1 , . - ~-~8'~8 0h
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~--=A ti.,-Z_~1Civ, 9/25/97 =.-,~VL G7 A. I told you that during my time with Tobacco 7 8 9 0 ~ U -- ~ r y ~ '_2 ta N 5 =3 -'D i6 ~ -7 ~ 0 > ~ T U l~ ~ 20 21 22 23 24 25 Associates, : was acquainted with -- met some of the 7:,6acco :nstizute people. And the gentleman who state activities operation at the time was retiring. headed I inquired about, interviewed for, and was given the job. Q. what is the name of the person whose position you replaced? A. Dr. Frank Dryden -- no, no, no; I'm sorry. Frank Welch, Dr. Frank Welch. Q. Previously you described that when you worked for Tobacco Associates, that -- that you came to know people rrem Tobacco Institute because their offices were across the street Trom you. A. Sure. And there were other tobacco groups in town, but our offices were closest together in terms of proximity. So how did it come to be that you were able to talk to Tobacco Institute personnel about getting a job with them? A. We would -- when I was with Tobacco Associates, I attended a lot of grower meetings. The Tobacco Institute would generally be represented. The wholesale association would be represented. Representatives from ~+ N ~ N F+ m m 1 1 , . - - p~
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.-~ `^CZ~VG~, 9/25% 97 : A:: =- » wr:at practically every other Washington assoc:at_or. 4 6 7 8 c m ~ 10 x 0 LL U 11 O ~ w 12 ~ g 13 : 15 0 N N N ~o 15 O m ~ 17 ~ 0 ~ 13 > ~ ~ 0 U 19 20 21 22 23 24 25 dces: ~t reports, compi~es inForrr:atior., produces, _:ou know, pacr.p'r.,ets, economic information, tax inforr,:at'_on, and shares that information with its members. Q• nlho told you that that was the function of Tobacco Ir.stitute? MR. SCHROEDER: Objection to the form. BY MS. SALZMAN: Q. Did anyone tell you that that was the function of Tobacco Institute? A. I witnessed it. I was there. I know what we did. Q. Was there any other function that you witnessed at Tobacco Institute? MR. SCHROEDER: Objection to form. THE WITNESS: Beyond representi::g the members in the tradition that a trade association would do, no. BY MS. SALZMAN: Q. What is the tradition that a trade association would do? A. Now, I know I answered that question. Q. Do you want to expound on your answer? A. Well, are you familiar with -- I'm not supposed to be asking you, but are you familiar with trade associations? , . - -
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, : 7 7 8 9 ~ ~ 12 N 5 13 ,4 i5 15 20 21 22 23 24 25 be.^.efi t to t^e position. But in terms of ^a•:: wod keci _rn the -:ilgreSS or worked 11 with an elected Of:~ciai, - C.:Q..' :. a•>> tha*_ background; no, ma'am. What did you know about smoking and health when _: ou came to work with Tobacco Institute? MR. SCHROEDER: Object to the form. WITNESS: Well, I knew for as long as 1 can remember, hearing my aunt and uncle say things like, you know, you shouldn't smoke. It's not good for you. You know, it's a coffin nail, you know, every cigarette you smoke is a coffin nail. And throughout, you know, my entire years growing up, I would hear, you know, different adults say t:,at, you know, you ought to think before you smoke. So I didn't -- in terms of the controversy, I knew, obviously -- I mean, I'd heard all my life that there was a controversy about, you know, the smoking issue. I heard that at a very early age. BY MS. SALZMAN: Q. Do you smoke? A. Yes, ma'am. \ How long have you smoked? A. I smoked a pipe when I was in college. I've smoked since the time I was in college. TI , LTD. 800-232-6878 G
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RCC==. MCZItiTGO, 9/25/97 PAGE 35 6 7 8 9 m Q 10 0 LL Y 11 U 0 N ffi 12 0 5 13 lY 20 21 22 23 24 25 choose to continue. Q. Does anyone else in your family smoke? A. My wife smokes. Q. How much does she smoke? A. You know, I really don't know. I would estimate about a pack a day. Q. Does she have any health problems from smoking? A. No. Q. Why do you choose to smoke light cigarettes as compared to a regular brand, full-strength brand? A. I just -- it's -- I like the taste. Q. You like the taste of a light cigarette better than a regular cigarette? A. Well, I don't know that I -- you know, since I started smoking cigarettes, I just started smoking one that'I liked the taste of. I did not consider -- it didn't occur to me, I didn't think about which one or ones may be better, or worse, or anything. I just chose to smoke one that I liked. And probably another reason is because when I first started smoking, I bummed a lot from a friend of mine who smoked that brand. I smoked a good while before I bought cigarettes, because I bummed cigarettes, and that was the brand he smoked. Q. So have you ever smoked anything but light NAT r , LTD. 800-232-6878
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,:_.. YC Z_.N, G0 9 %25/37 , (D-7SCUSSION OFF THE RECORD.) reauested answer was read by ::e court reporter.) 7 8 9 :3 _4 In ~ ,. g _o m a -7 ~ 0 > 9 S V i9 20 21 1 22 23 24 25 MS. SALZMAN: Thank you. 3Y MS. SALZMAN : Q. what did the tobacco -- thank you very much for doing that -- what did the Tobacco Institute do to =ulfill its function in making reports? A. I can speak to my area, state activities. We would track taxation legislation, as an example. If a state filed a piece of legislation to increase the tax, obviously our members needed to know that. we would provide weekly reports on what issues were being introduced in state legislatures around the country, and we would submit that information to our members. Another report that was updated every year was a report nationally on the tax situation in all 50 states, as well as the federal tax situation; and that information, information of that sort, was provided. Q- What was the source of that information? A. The staff, the field staff, and other staff people. We -- the Tobacco Institute had an economist, for example; and that person would do a lot of the tax ZN, LTD. - -
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M!--Z=NGO, 9/25, 97 42 5 6 7 8 - 9 a 5 10 0 LL Y ll U O r 13 14 15 16 20 21 22 23 24 Okay. Did there come a Fe_iod of time that you =eported to anyone else o=::er than Jack :Ce11y? A. Yes. After .:ac:c Ke? ly,* _ reported to Sam C:cote. ~. 'A^en was that? A. I think that was about '82, 1982. Q. What position did you hold in 1982 with Tobacco Institute? A. Senior Vice President of State Activities. I'm not exactly certain about this time frame, but that's pretty close. Q. When did you become Senior Vice President of State Activities? A. It would have been, I think, about 1982 or '83. Q. Did you hold any positions between the time you were regional director and the time you were Senior Vice President of State Activities? A. My entire career with the Tobacco Institute was in State Activities. I didn't work in any other division. Q. I understand you said in 1977 you were regional director, and in 1982 you were Senior Vice President? A. Well, I was promoted to Vice President in there somewhere. Do you want to go back over those dates? Started as -- Q• What was your first position -- your first position 25 was with TI, was -- NATIONWIDE LTD. 800-232-6878
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I m ZItiGO, 9/25%y7 vaT.Vl41 ~Jng . 'Nho did you report to in 1974 w^e.^n you began your =-.c-oy-nent with the Tobacco Institut°? 4 . 3lucher Eringhaus. Q. And who reported to you? A. Nobody. Q. No one? When did -- when in 1974 -- or did there come a time when you reported to someone else other than Blucher Enninghaus? A. Eringhaus. 6 7 3 y 1C Eringhaus. 11 A. Yes. When Mr. Eringhaus retired, I reported to a =2 gentleman by the name of Jack Kelly. 13 When was that? 14 e '_5 8 9 A. I would say '77 or '78. I'm not precise on that. Q. And what was your position or title in '77 or '78 whern you reported to Jack Kelly? A. I think it was regional director. Q. When did you become regional director? A. About that same time, '77 or '78. Q. Did you hold any other positions between the time that you were. a Manager or Director of State Activities to the time you were regional director with Tobacco Institute? A. No. 20 21 22 23 24 25 '
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:cCO=R MOZ=NGO, 9/25/ y7 ?A:; 7- 37 1 2 4 ~ 6 7 8 9 ~ = 10 0 ~ 0 x 12 N 5 13 14 ~ , 5 0 , ~ ., N 16 O 9 CL 17 D 0 ~ 18 > ~ ~ c°, 19 W Z 20 21 22 23 24 25 A. Well, as an officer in the company, I have the pr_vi?ece to choose :.o get cigarettes periodically -- we=:c,y as a matter of fact -- or I don'z: have to. You know, I smoke, I have the opportunity to get a carton a week, which I gladly accept. And I buy cigarettes as weil. Q• Does your wife smoke the same brand as you smoke? A. No. She smokes Salem. Q. So do you get unlimited cigarettes? A. No, I told you I get a carton a week. Q. You're limited -- this is through your employment at RJR? A. Yes. Q. And you're limited to one carton -- A. Yes, ma'am. Q. '-- a day? A. Per week. Q. Per week, I'm sorry. What is your understanding of the function of the Tobacco Institute? A. The Tobacco Institute is a Washington-based trade association, like hundreds of others up and down K Street. The Tobacco Institute membership comes from cigarette manufacturers. It_does for its members N, LTD. 800-232-68'18
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• _~=R `?CZ;1TG0, 9/25/ 97 F--r example, our state lobbyist in those states reported _ me. i was responsible for them. So was the designation of who should report to you i D 6 7 3 9 a ~ 10 a LL 0 ~ N ~ 12 ~ n 5 13 I4 i 5 N ~ ? 1 17 ~ 0 ~ > 0 ~ U ~~ W 20 21 22 23 24 25 hy geographical region? A. Yes, ma'am. Q. And you had the southeastern region? A. Yes. Q. Did you ever have any other region, other than the southeastern region? A. No. From there, my next -- no. The southeastern region was the only region that I worked directly. Q. what were you going to say? From there -- did your position change? A. when my position changed, I was Senior Vice :resident. I was responsible for all of our staff ~eople in the division, I mean. In terms of working a specific region of the country, I mean, it was the southeast. Q. Did you ever -- did your function ever include reporting on current research in the tobacco industry? MR. GOOLD: Objection. MR. SCHROEDER: Object to form. MS. SALZMAN: What is your objection? MR. GOOLD: What kind of research? MR. SCHROEDER: What kind of research? I LTD. 800-232-6878
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":C"~-R !^-Z_tiGO, 9./25i'7 =A2= z' 2 `! D 6 7 8 I-C you would ::ke w:T:vESS : The answer is ::o . all sorts of -esearc::. ~c t __ to scme type o~ -- BY M-S. SALZMAN: Q . Okay. No research whatsoever, of any type? A. Did you ask what my involvement was, if I had any involvement? Q. No, if one of your functions was -- or if one of the functions of your department was to report orn current research? A. No. MR. SCHROEDER: Same objection. 8 m 13 14 a 17 D 0 > ~ x ° 19 .. 20 21 22 23 24 25 WITNESS: No, ma'am. BY MS. SALZ^4AN : Q. During any of the time that you worked for TI in any position, did you have any involvement in the area of scientific research? A. No, ma'am. Q. Did you ever read any scientific research publications in your position with TI? A. I don't recall that I -- I don't recall that I did, summaries. I wouldn't labor through voluminous documents, no. Q. So when you were regional director, your position was to be the person that the representatives in the N , LTD. 800-232-6878
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RC '=~ `~^ :~iGO, 9/25/97 = . Z :,1i . ~ ~ 6 7 8 9 a ~ 10 ¢ 0 LL U O ~ W 12 ~ 5 13 20 21 22 23 24 25 A. As regional director, i was respcnsible for ad-n_ nistering -- you know, like most :rade associaticr.s, ~::e ='obacco Tr.stitute is forever undergoing _-es:_ucturing. So at different points in time, we would have dif-ferent numbers of people working in the states. So during that period of tiine, I was responsible for, you know, the daily activity of the people, their reporting, their travel, their involvement, you know, with legislative issues. Q. Which people? A. The regional -- the state people. We had people in Washington, and we had people in the states, regional people in the states. Q. And these people reported to you? A. Some of them did; not all of them. Q. What made some of them report to you and not all of them? A. There was another gentleman who was responsible for -- at one point in time, as a regional operative, as a representative of the Tobacco Institute, I had the southeastern states, the tobacco-producing, growing states. There were two other gentlemen -- three other gentlemen who had other parts of the country. And then at a different period of time, within those regions, we had people who reported to me. 800-232-6878 (J1
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_c t MCZI:vGO, 9/25i77 L 4 ~ 6 7 8 9 ~ ~ 10 0 ~ U 11 0 .. ~ ~ 12 y -n Q J 3 14 ~ s N 8 m i6 a 17 , U _1 9 20 21 22 23 24 25 ;~. And what was his posit:on at the ti^:e? ,. Ser.ior 'Iice Pres_denti State Act_v_ties. ~ And in 1982 when you reported to Sam ;.::__..ote -- h. Chilcote. Q. Chilcote; you were Senior Vice President, right? A. Yes, ma'am. Q. And what position did Mr. Chilcote hold? A. He was President of the Tobacco Institute. Q. And did anyone report to you when you were Senior Vice President? A. Regional vice presidents, staff members who were assigned a number of states to be responsible for, and a couple internal staff people. Q. And what were their names? What were the staff m,embers' names, regional vice presidents' names? I'm sorry. A. Oh, you're testing me now. Hearst Marshall. George Minchew, Ron Morris. I can't recall who the other people were. But the principal internal staffer who did a lot of writing, and reporting, and those kind of things was Bill Cannell. All these people have left the Tobacco Institute now, retired or changed jobs. Q. What were your -- what were your duties as regional director? NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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Z: V.CZ:NGO, 9/25/ 97 ?AGc 48 r N W 12 N Q J ~ 4 -~ ~ N N S `7 m a 17 ~ 0 z > ~ ~ 0 -y u r sout^eastern region would report to? A. Our lobbyists pri~:arily at that time. ti. Tell me, what would they report to you about? ,. Bill filings that we may have an interest in. For exampie, you know, tax legislation, other things that we felt of value to report to our members. Q. What would "other things" be? 5 6 7 A. A range of legislation, you know, tobacco-type legislation. Q. What else did you do besides receive information about tax legislation or other tobacco-related legislation from your lobbyists? A. We would work with them and suggest particular 0 9 ' 3 pieces of legislation that we would like them to work on, which is a function of the lobbyist, no matter who you represent. Q. Did you meet with them on a regular basis? A. Periodically; not regularly. Generally, it would be -- not as a group, individually. Q. And how many people reported to you during that time period that you were regional director? A. I would estimate ten, ten to fifteen. I forgot how 20 21 22 23 24 many states we had in that southeast somewhere in that neighborhood. region, but Q. And what did you do with the information that was 25 , LTD. - 32-68'7$
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RC'Z=P XOZ;NGO, 9/25/97 ?AGE 35 , c=aarettes? 3 A. Not routinely, no. No. ~ No ? A. No, ma' am. ~ Q. Okay. Are you aware of any -- are you aware of any 6 tobacco industry or scientific literature that describes 7 the nicotine delivery to the smoker in a light cigarette 8 _ to be higher than that of a regular cigarette? 9 MR. GOOLD: Objection. Could you read 0 ~ 10 hat b - k l ? 2 - ac , p ease ~ LL Y U O il (The preceding question was read y y 12 by the court reporter.) y 5 13 MR. GOOLD: Objection as to form. You 14 can answer it . 0 15 MR. SCHROEDER: Same objection. ~ r g 15 THE WITNESS: I'm not aware of any such m 1 17 liter atur e. I have not read any such literature on it; D 0 > no. ~ ~ 0 19 BY MS . SA LZMAN: w ~ 20 Q. Has anyone told you of any such literature? 21 A N ' . o, ma am. 22 Q. Do you pay for your cigarettes that you smoke? 23 A. I pay for some, and I get some without having to 24 pay. 25 Q. cn How do you get the ones you don't have to pay for? ~ ~ N 0 , LTD. -232=6878
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:'.CZ_NGO, 9/25/97 3 5 7 8 9 ~ Q iU 0 ~ U =~ 0 ~ 12 W 0 5 13 14 '_5 , .7. 9 a 17 ~ 20 21 22 23 24 25 reoor?--ed to you by these lobbyists? ~. We would ccmbine it with information from other :egions and put it in our reports to our members. ~ rrlho is "we"? Y • A. The other regional people -- the other three regional people I described. Q. So you would meet with the other three regional people and compile this information? A. I wouldn't meet with them. I mean, we had a person on staff who compiled the information. Q. So you -- how would the information get to the person on staff? Would each regional director give that information to the staff? A. Yes, ma'am. Q. And how is the staff comprised, how many people? A. I think ten to twelve total in Washington. Q. And how many staff were under your direction? A. well, when I became Senior Vice President, all of them. When I was regional director, one person, an administrative assistant, secretary. Q. And what was that person's name? A. I don't remember. Q. Did you have the same assistant during the entire time period that you were regional director? A. No. People, particularly in Washington, are rather ,N, LTD. - 2 3 Z---6TY8- l0
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X;ZywG0, 9/25/97 L 4 6 7 B 7 ~ I 12 t N 5 13 Q ° ?5 16 ~ 17 ~ 0 z ~ 13 > 9 ¢ 61 ;t 20 21 22 23 24 25 cf t:^.e companies. ti. And the tobacco industry companies' :°c_esentat'_ves? A. Yeah. The -- our member -- some of our member represer.tatives would occasionally, you know, be at meetings. Q• And what would take place at the meetings? A. Work. We would talk about a specific piece of legislation and what we could attempt to do to deal with it. Q. Did you ever -- was the -- were the meetings that were held in the various states fairly consistent? Was it the same type of meeting? A. Yes, ma'am. Q• So although the subject matter of each meeting might be different, the people -- the type of people that you met with were the same from state to state. that right? A. Yeah, generally the same. Q. Was there an exception to that? A. Not really, no. I mean it was generally the Is same -- I say "generally," I mean, it was the same group of people. It didn't matter what state it was. You still dealt with your lobbyist and any other company people who might be on the scene. i j REPORTING, LTD. 800-232-6878
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R:,.Z:i ti'.;ZINGO, 9/25/197 A. I wou'_d travel to any one of the ten to twelve to :__:.ee^, states in my reg=on. u• where, specifically, in these states did you go? A. _ would go, on occasion, to all of the states. Q. Where -- specifically, where in a particular state did you go? Did you go -- A. Oh, generally, the state capital. 5 7 a Q. What would you do at the state capital? A. I would meet with our contract lobbyist, or other 9 tobacco industry representatives. What is a contract lobbyist? N + i 8 m A. A contract lobbyist is a person in -- in our case, in the states -- it could be in the Congress -- generally who has background, maybe has served in office, or who has worked for a politician or a governor, for example, and who has gone into the business of representing clients. Most lobbyists represent multiple clients. And our lobbyists were contract. In addition to representing us, they would represent several other types of businesses. Q. So you met with contract lobbyists and other Tobacco Institute representatives? A. Tobacco Institute or -- generally, and then largely representatives from other trade associations, or some 13 _O 20 21 22 23 24 25 NTNG, . 800-232-6878
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~ -R `^.~Z_VGp, 9/25 / 9 7 3Y "S . SA7,ZIM.A,'V : Mr. Mozir.go, before we broke for a few minutes, we 4 5 6 7 8 9 ~ ~ 10 0 V y1 0 ~ n ¢ 12 y ~ 5 14 > s 5 0 19 20 21 22 23 24 25 were discussing your position as regional director. A. Yes, ma'am. And I was asking you what your function was as regional director. Can you describe for me what a typical day would be for you as a regional director? A. A lot of telephone work. I would deal with -- not all of our lobbyists every day -- but I would deal with our representatives in the states, determine what was pending, if anything, and report that to our members. And you would be on the phone all day doing that? A. No, not all day. Q. what else did you do during your day? A. You know, the routine office paperwork, expense accounts. But largely, my time was consumed with dealing with our people in the states. Q. And how would you deal with your people in the states that consumed your time? A. I did a lot of traveling. I didn't spend, you know, considerable time, probably 50 percent of my during this period of time I was regional director spent traveling. Q. And where would you travel? time was
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..__7-t .`EICZ_NGO, 9/25/97 c-."% ::: 3.' L j z 6 7 8 9 10 , t _2 13 14 i5 15 17 18 19 2 0 21 22 23 24 25 ~1 :y don' t you expiain to me what a ti acie associat'_on is? MR. GOOLD: 0a;ection, asked and answered. THE WITNESS: I think I was pretty comp'_et=_ on my answer. BY MS. SALZMAN: Q. ::ave you ever heard of the Tobacco Institute -- a function of the Tobacco Institute described that it should defend against attacks from whatever source pertaining to tobacco as a health hazard? A. No, no. Not in my experience or in my capacity, and in my area of responsibility,.no. Q. How about in any conversations you've had with other members of the Tobacco Institute? A. :Jo. Q. what did the Tobacco Institute do to fulfill the func:ion that you described? A. The overall trade association function? Q. Start with that, yes. A. I'm sorry. Would you repeat your question now? MS. SALZMAN: Can you read back his answer to what he described the function of the Tobacco Institute to be? I asked him what the function of the Tobacco Institute was. NATIONWIDE COURT REPORTING, LTD. 800-232-6878 N ~o
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Z n 5 7 3 9 13 r 20 2± 22 23 24 ?.; ~_~ `t=Z~tiGO, 9/25/97 A. PA G= 4 3 : was the lowest person on the totem pole. I think _ was manacer. ~. Ma:,ager of State Activities? ;. ':es, ma'am. Then I became a regional director. Q. k:.d what year was that? A. i think the title was regional director. Let's see -- Q. Was that in 1977? A. I think that would be pretty close; yes, ma'am. Q. Okay. What was the next position you held with Tobacco Ir.stitute? A. Vice President. Q. What year did you become Vice President? =,. I would have to say '79. Q. And what was your next position with Tobacco ;nstitute? A. Senior Vice President. Q. And that was in 1982? A. '82; I think that's correct, yeah. Q. Was that the last position you held with Tobacco Institute? A. Yes, ma'am. What -- who did you report to when you were Vice President? A. That would have been Jack Kelly. 25 , 0 , T . 800-232-6878
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.rJZ:;1G0, 9/25/97 } 5 8 9 ~ 5 13 14 0 15 ~ ~ ~ ~ 15 a 17 ~ 0 ¢ o > i3 a cc 0 19 LU ~ 20 21 22 23 24 25 Okay. Other than tax legislation, what were subjects of other tobacco l?gislation that were aiscussed at these meetings? A. Smoking bans was a big issue, big in that it appeared in a lot of states. The tax issue has been an issue for as long as I can remember. The sampling issue, at one point in time, was rather prominent; vending machine legislation. The fire safe issue was one that I think came along after my responsibility in the regional kind of job, you know, had ended. I was spending most of my time in DC at that time. But those are the general issues we dealt with. Q. Anything related to the health controversy associated with cigarettes? A. Only as it might relate to the smoking ban issue. Q• What was Tobacco Institute's position on smoking ban issues? A. Our position was that individual owners or managers of businesses should have the right to make the judgement as to whether or not they chose to allow smoking in their places of business, as opposed to having that decision dictated by government. Q. And were you able to -- was Tobacco Institute able to fulfill their desires as it relates to smoking bans? I-. ONWID COURT R PORTING, LTD. 800-232-6878
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. I .., ._._ V ~':1;G0, ~.7 L 4 6 7 8 9 ~ ~ ~ _2 ~ 11 8 9 13 15 20 a 17 ~ 0 s 0 =3 > ~ Q C~.) _9 -ji _ .. 21 22 23 24 25 business owners about the legislation. They woud d si:ow ~ and express their views; and in a lot of cases, their ._ews p_evai_ed. They presented their facts on the 7-,atter, their desires. Legislators considered all sides of r-he issue, and in some cases, either passed or rejected legislation. Q. How were you able to notify the business owners? A. Please keep in mind that businesses in states also have trade associations. Generally through their state trade association. Q. So what trade associations were affected by smoking ban issue? A. Restaurant associations, bar and tavern associations, and some -- in those days, some business and industry type groups had concern about that issue. Those are the primary ones that come to mind. Q. How were -- and how was Tobacco Institute able to communicate this information to these trade associations? A. As businesses -- keep in mind we're talking about a state setting. Q. Yes. A. There are state business organizations with their own associations. And in practically every state, there was a person who represented the wholesale candy and NATIONWIDE COURT REPORTING, LTD. 800-232-6878 ON
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VCZ_,NG0, 9/25iy7 =A. "I'° -Cbacco T:.5~`,1tLl~.e supported some of ~t1e ~::Qse associations, but not all of them, as Z recall. So did someone at the Tobacco Institute speak to ~ ~ 10 0 ~ J =1 0 ~ N ;, 12 N 5 ~ 15 9 a 2 17 ~ 0 _ ~ '_8 > ~ s ° 19 W r scMecne from the cigarette and candy vending asscciation? A. Yeah. I told you I spoke to some of the -- I spoke at some of their annual meetings. Q. So you would speak at the vending association meeting? A. I have spoken at the national vending meeting, yes, ma'am. AMOA, Amusement Machine Operators of America. Q. Okay. When did you speak at this annual meeting, during what year? A. well, the first year I joined the Tobacco Institute : spoke at about 14 wholesale association meetings, and these were weekend meetings all over the country. And that was a lot of work. Q. And how many of'those -- that was in the first year you were with Tobacco Institute? A. Yes, ma'am. 4 5 6 7 B 9 13 14 15 20 21 Q• And how many of these meetings did you discuss smoking bans? A. The smoking ban issue, during my first year at the Tobacco Institute, was an emerging issue. It was not considered by anybody then to be a major issue or 22 23 24 25 NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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RCG=R 9/25/97 -, L 3 4 6 7 8 9 U 11 V ~ y 12 N 5 13 14 ~ Q 15 ~ ~ n $ a ^ 17 ~ 0 s ~ 18 > ~ s 0 19 ~ A. Well, : would have to do some checking; but today : ~~~~eve it is sare to sa ?r te h y that ev__y sta as a law certainir.g to the subJect. Q What about when you were regional director with Tobacco Institute? A. Well, it was an emerging issue. And it was not an issue that states had focused a lot of time or effort on back in those days. What did the Tobacco Institute do to promote their position on smoking bans? MR. SCHROEDER: I object to the form. THE WITNESS: We would try to persuade legislators that it is an issue that should be left up to individual places of business or facilities. BY MS. SALZMAN: Q. And how did you persuade the legislatures to do that? MR. GOOLD: Objection. Say "tried to persuade." 0- 20 MS. SALZMAN: Tried to persuade. 21 22 23 24 25 THE WITNESS: I beg your pardon? BY MS. SALZMAN: Q. How did the Tobacco Institute try to persuade legislatures? A. We would alert restaurants owners and other E COURT REPORTING, LTD. 800-232-6878
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~~_~ ti~GZ7NG0, 9/25/97 ?;~= 5J 2 t_a::sient; they come and go. They move on and take :,t er jcbs. No, : d:d nct have the same person. How many assistants did you have during the time 4 5 6 7 8 y m ~ 10 13 14 0 15 N 6n N ~ 16 O m ~ 17 D 0 ~ 18 > 9 Q 0 U 19 W I H 20 21 22 23 24 25 period that you were regional director? A. Are you talking about administrative assistants, secretary? Yes. You said you only had one person that reported to you when you were regional director. A. Well, yeah -- two of us shared a secretary, which is, you know, pretty common. Q. Who did you share a secretary with? A. Well, one other individual. I don't remember. And you don't remember your secretary's name? A. Sharon Wall is the -- Sharon Wall worked, I think, for two of us, Hearst Marshall. Q. You and Chris Marshall shared Sharon Wall; is that correct? A. Yeah, Sharon Wall or somebody else. We -- I can't remember. THE WITNESS: Excuse me. Would you object if we took just a little break? Is that okay? MS. SALZMAN: Sure. Of course. VIDEOGRAPHER: Off the record at 10:42. (RECESS TAKEN.) VIDEOGRAPHER: We're back on record at i - -
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X'~'ZINGO, 9/25/97 J 5 o' 7 3 Q m 0 LL U iI 0 .. V) -3 =4 20 21 22 23 24 25 No, I don't. How afJOUt press re.eases? Did Tobacco i::St:clae =.er pubiish any press releases? A. - can' t say chat it did not, but I don' c remember soecifics. Q. So you didn't -- did you have any personal knowledge of any press releases being prepared at Tobacco Institute? Q No. What was your -- how did your job function change when you became vice president in 1979? A. Basically, I was responsible for administering some of the regional people, as opposed to being one of the regional persons. Q. And what does it mean to administer regional -- A. It's the care and feeding of people who work in the states. Q. What does "care and feeding" mean? A. That's taking care of the administrative duties, knowing where they are, what they're doing, those sorts of things. Routine things. Q Is that all you did was keep track of where the regional directors were? A. Well, we had other functions. We -- you know, providing, collecting information, as I described NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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`~CZ=%"GC, 9/25/97 _nstitute have while you were there? A. We:i, teleph:;ne, Xerox. yeu know, zn a te_e^r~ne and the mail, I guess, is la:gely what we used. Did they have a newsletter? ~ 18 > 9 ¢ c°~ 19 W S N A . No. -Q. Tobacco Institute did not have a newsletter? A. Not that I recall. 5 6 7 Q. Did it have any publications? A. Oh, yeah, of course. Q. What were the publications? A. Publications on the history. Q. History of what? A. The history of tobacco in America. Q. What was the name of that publication? A. I do not know. Q. Do you know where it was published? 8 13 14 '_5 A. It was published by the Tobacco Institute in 17 Washington. Q. And who was it provided to? A. Anyone who would write, call or request. It was 20 rather basic information that gave economic data on the 21 tobacco industry. Believe it or not, a lot of people 22 have an interest in that; and it was a service that the Tobacco Institute provided. Q. What other publications? 23 24 25 , LTD. 800-232-6878
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L 5 6 7 8 9 m ~ 10 0 ~ ~ 11 0 ~ 5 12 u ~ a J 13 _4 ~ 15 I 6 8 y a 17 ~ 0 " 18 > ~ U 19 u 0- 20 21 22 23 24 25 McZ.;iGG, 9/25/97 A. An annual tax summary report. and what was the annual tax summary report? ::%.::. -- =_. it was a compilation of all state tax laws, tax receipts, things of that sort. Q. And who would that publication be distributed to? A. Of course, the member companies would be on the mailing list, state tax administrators who were, you know, government employees, always requested copies of it. Beyond that, I don't recall. But it was available to anyone who requested it. Any other publications that the TI put out? A. None that really stand out in my mind. I mean, there were pamphlets, and different subjects were addressed. But those were the two that I remember most vividly, yes. Q. Have you ever heard of "The Tobacco Observer"? A. Yes. Q. What is "The Tobacco Observer"? A. Let's see. "The Tobacco Observer" -- I don't remember. I remember the name "Tobacco Observer." It was a publication that was done for a short period of time. I don't recall. I don't recall any specifics about it. Q. Do you recall who it was distributed to? NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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9/25/:7 0 LL 0 N ~ 12 y y 5 -~-''°-r getting that ::~forTation to our members, - , YJspcndir.g to =nvitations to be on a program, things of :::at sort. ~. ':''"gs of what sort? A. The sort of being on a program, responding to the Florida Tobacco and Candy Wholesale Distributors about appearing on their annual convention as a program- participant. You know, lots of invitations to appear at different groups. Q. To appear to speak? A. Sure; just be in attendance. Q. Just be in attendance, or to actually do a presentation? A. Sometimes both. 5 7 8 a 13 And when you received an invitation for a > a e 19 W 2 presentation, did you select the person who would present? A. No, it was pretty routine. If an individual had responsibility for a state or a given number of states, that person would generally be the one to attend the meeting. 20 2: 22 So it would be the regional director that would attend the meeting? A. Generally speaking, but sometimes it could be somebody else. But generally speaking, yes. 23 24 25 23 2 - 6 878 . , . -
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4 5 6 7 8 9 9 ~ 10 z 0 ~ U -1 0 4 13 21 22 23 24 25 R2 -R M-ZI:;GC, 9/25/97 -- =amiiiar with trade association meetir.gs - I'm t_yiag _., ..::derstand how the Tobacco Institute communicateci _::format;on to another trade association. Specifically, ::ow was =t done? Did someone from Tobacco Institute go and speak at trade association meetings? Did they mail -- A. I thought I covered that pretty well. Q. Did they mail something to the industries? What you stated to me, if I recall, is that word got around. And I want to know, how did word get around? A. Generally by telephone. I mean, that's the easiest and quickest way. You know, back during the period of time I was working in the states, we didn't have fax machines, and so generally by telephone. We had good relations with the state wholesale distributor associations. They knew.their counterparts in other associations. And a lot of times word was not even communicated by the Tobacco Institute. It would be somebody else. Q. Like who? A. Like the Executive Director of the Tobacco and Candy Wholesale Distributors Association, as the example, most states have such an association. Q. Is that an association that's related to Tobacco Institute? REPORTING, TD-$00-232-6878
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9) 5 6 7 3 9 21 22 23 24 25 K.v_E< ~::JZaNVC/ 9I25Jy7 ~- . Would t:.at be t::e President? =.. No, that' s the Senior Vice ?reside:.t. :7::o else is on :.here? A. A representative from the trade asso:.iaticn's member companies. For example, I represent RjR. I think I told you that earlier. Q. Yes. And that's it, ju st representatives from the tobacco companies and the vi ce president? A. Q. Yes. And what's the function of the State Activities C i ? omm ttee A. Are you sure we didn't cover this earlie r? I mean -- the State Activities Committee meets with the members periodically, about every six weeks or so. =t's not on a set schedule, but it meets generally every six weeks. We review legislation that's pending. The trade association reports to us, summarizing legislation. If a particular issue comes up that we need to discuss, we'll have a discussion about it. But -- and that's the nature of what we do. Q. What other committees were there at the Tobacco Institute? A. There was a Communications Committee -- we're talking about the time during I was there, of course. Q. That's right. REPORTING, L D. 800-232-6878
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'^CZ_XG0, 9/25/97 G Q• And those were the only memberships? Y 7 7 8 9 10 11 12 13 14 15 16 17 ,8 19 20 21 22 23 24 A. As far as I know. x. ~'ow, the Communications Committee and the State Act_vities Committee, when you said there were re:resentatives from the member tobacco companies, were chose CEOs, or other representatives from the member tobacco company? A. No. They would be, in the case of State Activities, their government relations representatives. Q. And how about in the Communications Committee? A. I don't know who those people were. I mean, I don't know what their titles were or anything of the sort. Q. what was the function of the Communications Co<<<mittee? A. Similar to the State Activities Committee, except in a different subject area that was a forum in which the member companies would meet to discuss ccmmunications activity. I was not a part of that committee. Q. Were you ever present at any Communications Committee meetings? A. I may have attended a few, but it was very few. Q• So which Senior Vice President served on the 25 Communications Committee? Was it a Senior Vice NATIONWIDE COURT REPORTING, LTD. 800-232-68~8
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9/25/97 5 6 7 8 9 ~ Q _0 0 ~ V 11 O ~ W 12 :A 5 13 :4 o _. ~ N a 17 D 0 ~ > 9 2 U =~ W r- 20 21 22 23 24 25 A. :'hat's the only other -- I don't think ti:ere was a '_~deral relations commitzee, oer se. X. Who served on the Communications Committee? ~. A representative from the member companies, but I don't recall any of the names. was there a senior representative of TI that served on the Communication Committee? A. It would generally be the head of the PR, the Public Relations Division. Would that be a Senior Vice President of Public Relations, or President of Public Relations? A. Senior VP. Q. And do you know of any other committees that were a part of TI when you were there? A. TI committees, per se, no. Q. How about an Executive Committee? Have you ever heard of an Executive Committee at Tobacco Institute? A. Well, I was thinking about the working committees. There was, of course, an Executive Committee. Every trade association has an Executive Committee or Board, and the Tobacco Institute is no exception. Q. And who served on the Executive Committee? A. Generally the CEO of the member companies. Q. And who from -- who else was -- A. The President of the Tobacco Institute. 1 , LTD. - 32- 878
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,..,::cern. 3 5 5 7 8 9 0 1, 1 ~ W 12 y 5 13 a 17 ~ 0 Q ~ 18 > a ~ 0 9 ( W S r 20 21 22 23 24 25 I -nea::, =°_gislators were just beginning :c: address the issue. I would address it in terms of an j^ergi:,g lssue. Did you prepare your own speeches for these meetings? A. Generally, no. I would use either staff or speeches that others had made; and I would plagiarize, .4f you will. Q. who on staff was responsible for writing speeches? A. I don't know that there was any one person. Bill Cannell in state activities, and I know that in -- I don't know about otherwise. I would generally get speeches from Mr. Kornegay, who was president of the Tobacco Institute, speeches that he made at other groups. Q. This was while you were regional director? A. Yes. Q. Did the number of speeches that you gave -- that you described 14 during the first year that you were regional director -- did they increase at any time during your position as regional director; or did they stay the same? A. They decreased. Q. Why?
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=v--~ ~f~^z:Nco, 9/25/97 .. .. _ . .,. < 6 7 8 13 14 -5 17 ~ 0 a 18 > W 20 21 22 23 24 25 Communications Comrnittee? A. As a routine, none, as a roucine matter. 3u:. 'r= .:Cyoep:eY, for example, would rece:ve conies ~: e.:r _egisiati•re reports. And I would assume that he shared t::a= within his department and with his committee. Did the Communications Committee ever share information with the State Activities Commission -- Committee -- excuse me? A. Through memos, yes. I was -- as department head, I was copied on memos from all the departments. Q. And what type of information would the Communications Committee be communicating to all the departments? A. I don't recall, offhand, specifics. A variety of things, but I can't recall, you know, a specific -- there was no set information, regular flow. I mean, I don't recall specifics at this point. Q. Was there ever a Scientific Committee at Tobacco Institute? A. No, not to my knowledge. Q. How about a Committee of Counsel? A. There was a Committee of Counsel, but I don't characterize that as a Tobacco Institute committee. They were not -- you know, they were not a part of the trade association. , ING, LTD. 800-232-6878
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, 6 7 8 9 ~ Q 10 0 ~ Y o ! ~ y .. W 12 yQ , 13 =4 0 o _5 ~ N N N ;6 8 a 17 a ~ 0 Q o 18 > m e 0 U 19 LU S 20 21 22 23 24 25 K-GZR ti:OZINGO, 9/25/97 ?A1132 73 Q. What were they? A • "t was a comm'_;.tee of member ccmpar.ies, comm:ttee ..= at--;,rneys. Q. ~,nd did you ever attend any Committee of Counsel meetings? A. Yes, I did. Q. And what was the function of the Committee of Counsel? A. Well, my function for being there was to update the committee on state legislation, the status of legislation, and if we needed advice or counsel, if we needed, you know, interpretation on some legal thing that we didn't have the wherewithal to comprehend, we would work through our attorneys to get that. Q. So was the Committee of Counsel a board of attorneys that you could consult for legal advice, for things that came up at the Tobacco Institute? A. Generally, no; we didn't go to the Committee of Counsel for legal advice. We had representation on interpreting legislation outside, you know, the Committee of Counsel. Q. How many Committee of Counsel meetings did you attend per year? A. I'd say four. Q• Was anyone else present during those meetings, E REPORTING, , 0 -232- 878
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~~ VOZ=NGO, 9/25/97 : ;2~ 7: -5 6 7 a Q 9 0 y U ~- O ~ 1 -~ 0 o =~ N N N Np ~ ~ O 1 1 7 ~ 0 ¢ n ¢ U i7 W 2 20 21 22 23 24 25 can't r=_call subjects, you know, today, what they rencr_e^d on. But, you know, it was a work setting and _t's a report to the head of whatever organization it is you're working for. I mean, it was pretty routine. Q• And there was no interaction between the Communications Committee and the State Activities Committee? A. There was interaction in that, you know, we would receive memos, and I would attend an occasional meeting with various individuals in the Public Affairs Department. I mean, you have to if you work, you know, in a small trade association. Q. So what was the interaction between the two committees? A. There was no formal interaction. If the State Activities Division had a position statement or a document, and if we felt that it was important to share t^at with our people, then I would meet with them and make sure we had enough copies to get out. It was that sort of thing. Q. And what type of information would be important enough to show the Communications Committee? A. Would you ask that again, please? Q. What type of information did you share with the N , L D. 800-232-6878
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... _=K "'.': Z_'qGO, 9%2~= i 97 ?.=.=5 ?4 6 7 e 9 13 14 O e 15 8 m 16 17 y _g 0 z c~i 19 W .: 20 21 22 23 24 25 ;;t~.er ti:a:, you and the counsel members? :.. 'ccasiona l_y t^e head of the federal ^perat_^n Nou:d be there for a report on federal legislat'_ve ac t_:? ~y. Beyond that, I don't recall who else attended-- I don't think anybody else from the TI -- it could be that Kloepfer attended occasionally; but I don' t recal l that. Q. Did you ever:hear Kloepfer ask for legal advice on- any communications that he was going to be releasing? A. No. Q. Did you ever attend any Executive Committee cr:e e t i ng s? A. Yes. And how many executive committee meetings did you attend per year? A. Three or four. Q. And did you -- what position -- did you attend Executive Committee meetings during all the years that you were employed at TI? A. No. Only during the period of time I was head of the department. Q. The Senior Vice President? A. Yes. Q. Not when you were the Vice President? . , LTD. 800- -68 S
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_~ .'r t...:... •*..:Z=N.r'i0, 9/25/97 A. Too many weekends away from home. And as we added a 'ew staff: People, others, vou know, attended some :,f =^~se rneetir_gs. were these people on your staff that attended t::e 5 7 8 9 0 ~ U -= 0 .- ~ ~ 72 ~ 5 13 ,4 N i6 ~ ~ m a 17 ~ 0 > ~ z °v 19 ~ 20 21 22 23 24 25 meetings on your behalf, or in your place? A. They were not necessarily people that I had direct control over, but they were Tobacco Institute staff people. Q. And who made the decision that they would go to these speeches? A. Well, it was a tradition that, = tw :. J 1 you know, you're invited. If you had anyone available to go, you would accept the invitation because they were a part of the tobacco industry, and we were accommodating to those people. Q. So after this information was communicated to the vending trade association, do you know how the trade association disseminated the information to, say, the restaurant association, or the other associations that you described would be interested in smoking bans? A. Not precisely. Trade associations have communication vehicles. They have newsletters. They do mailings to members. They do telephoning, and that's pretty traditional. Ln What communication vehicles does or did the Tobacco ~ N N , LTD. 800-232-6878
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RCG=- XCZ~IVGO, 9/25/97 paG = 70 0 h 7 8 9 ~ ~ 2.0 z 0 ~ U ~} 0 ~ N ¢ -2 W N 5 13 14 Q 15 8 m i 5 1 1.7 ~ 0 ~ 18 > ~ e U U l9 w r 20 21 22 23 24 25 ?r°_s'_dent of all of To:,acco -:,stitute? ei. ;~. No, of the Public Relations Division. And do you have any idea what type of publications ~ e Communications Committee discussed? A. No, I don't. Q• who was the Senior Vice President of Public Relations when you were working at TI? A. Bill Kloepfer f rom Q• were you friends with Bill Kloepfer? A. We were associates at work. I wouldn't -- I mean, sure we were friends, but we were not -- we didn't take vacations together, if that's the kind of friend you're aski :_g about. Q. And did you ever have any meetings with Bill K1oepTer during your tenure at Tobacco Institute? A. Bill Kloepfer was in charge of the PR Division. I was in charge of the State Activities, and the division heads would meet periodically; and the answer is yes. Q• And what would be discussed at the meetings, the periodic meetings? A. I would cover our activity. It was an activity report. It was a report to the president. Q. And so did you ever -- so what did you hear the Communications Committee report to the president? A. I don't recall. I was focused on my own report. I m
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( _=c "^Z -- . _ =~GG, 3,~~-/ y-7 A. He headed -- I reported to JacK Kelly. :ie was _'r.e 6 7 3 9 13 :4 1 5 g ~5 m a 17 ~ 0 ~ > m U ~7 W _ 20 22 23 24 25 c:ead of the decartment. ;~ So he was the PresidenL_ cf TI at the ..-.:e? :.. No, no. He was Senior vice President of State loverr.ment Relatio.^.s. So this was a time when you were Vice President? A. That's when the grass-roots program was started, yes. Q. Ar.d how were you selected to lead the organization? A. The Tobacco Action Network? It was a part of my function as head of the State Government Relations Department. Q. Did you head any other organizations as part of your functions? A. No. Q. So this began when you were Vice President -- when vou were Vice President of TI, you were also the director of Tobacco Action Network? A. No. I inherited the job as director when I was promoted to Senior Vice President. Q. Who did you inherit it from? A. Jack Kelly. Q. He held the position prior to you? A. Yes, ma'am. Q. And who were the members of the Tobacco Action REPORTING, LTD. 0 -2 2-6878
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YGZ,NGO, 9/25/97 7 9 5 6 7 8 9 m ~ 10 Q 0 :3 o _o 0 ~ 21 22 23 24 A. , presume that they were reporting, and tha:t they was responsible to see that they were doing their were w::ere they were supposed to be. ,~. So did you schedule where they were supposed to be? A. No. Q. They made their own schedules? A. Largely, yes. These were professional people who -- these were professionals. They did their own scheduling. Q. So you oversaw the regional directors and the vice president at the time you became Senior Vice President? A. Yes. The vice president's position, I think, had been eliminated at that time in one of our structures -- structural changes, as I recall. Q• Are you familiar with the film called "Smoking and Health, a Need to Know"? A. I don't recall it. Q. Do you know of any films that Tobacco Institute produced related to smoking? A. I don't recall a film. Q. Excuse me? A. I don't_recall a film on that subject. Q• Do you recall any films produced by the Tobacco Institute? 25 A. No, I don't. No. NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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9/25/97 =_ .. `357 =obacco distributors. These people were all, you know, par:t o= a little rraternity, iL you wi?! . So word ;ust'got around through the 8 m q T cbacco and Candy Distributors Association, or from our lobbyist. And that's pretty routine. Q. Well, but specifically, did someone from Tobacco Institute go and speak at these trade association : 7 8 9 13 14 '_5 meetings to communicate their position on smoking bans? A. I attended some myself. Q. What did you attend? A. Principally association meetings of groups that represent different facets of the industry. You know, we have a multi-segmented industry. The tobacco industry has many segments. Q. What are those segments? A. From top to bottom? You have manufacturing. :;h-huh. 20 21 22 23 24 25 Q. A. You have retailing, you have wholesaling, you have warehousing, you have exporting; and I probably left one out, but that's about it. So there's lots of segments to this industry. Q. Okay. A. For example, I mentioned vending. They have their own national association, okay, as an example. Q. So I'm trying to understand -- I'm not a person . C T REPORG, LTD. 800-232-6878
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4 5 0 6 7 8 9 .~ Q '-0 12 :3 15 17 18 _9 20 21 22 23 24 25 .:'Z:NGO, 9/25/?7 ? c~G: 7 7 1~• Did the izvitatior.s to present ever inciude a spec=fic topic for presentation? ?.. No. Topics were not designated, because, you kr.ow, _f we're invited -- we work in government relations, and the invitee, the person who extended the invitation knew what our business was and what we would talk about. So I mean, they didn't specify subjects, no. Q. So you were in the state government department; is that right? A. Now, I know I've told you that. Q. No, I know, I'm just -- what other departments exist at TI? A. Federal Relations and Public Affairs, and there was an Administration Department. And that's it. Q. So there were four departments at TI? A. Yes, ma'am. Q. How about were there any committees at TI? A. I've alluded to one, and that is the State Activities Committee. The name of that committee has changed for no good reason. It's now the State Activities Coordinating Committee.. But there has been a state committee for white a while. Q. And who makes up the State Activities Committee? A. The head of the division, present head of the division. n ~ ~ N r m NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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--..,ER '!:OZTNGO, 9/25/97 S o you nave no :cnowledge` therei o .C,er.g a 2eszarc^ 6 7 8 9 13 14 0 Q 15 0 ~ ~ , N . i ., 1 7 .7. ~ a '_7 ~ o_ T ~ 18 > ~ z ~ 19 ~ 20 21 22 23 24 25 Ccmmittee while ycu were at T;? A. :was only familiar with the name CTR that you've men t i o::ed . Q. What is CTR? A. Council for Tobacco Research. Q. And what is your understanding of CTR? A.. It's an organization that funds research. Q. What's the Tobacco Working Group? A. Tobacco Working Group, I don't know. Q. How about the Tobacco Action Network? A. The Tobacco Action Network was a grass-roots program the Tobacco Institute attempted to organize in the late '80s, mid -- late to early '80s. Q. And did you participate in that organization? A. Yes, I did. Q. In what capacity? A. After I was named Senior Vice President, I was the director of that program. It was one of -- it was within, you know, state government relations. Q. whose idea was it to form the Network? A. The idea largely came from Jack Kelly. Q. And who else? A. I don't recall who else. Q. Who was Jack Kelly at the time? COURT PORTING, LTD. 800-232-6878
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4 5 0 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 iCC=R .`;CZ:NCO, 7%?5% ti7 C':'R? y. Vct ;.?:at _ ;. Do you kno recai_ . w ar.yt:::ng about the work that CTR does? A. No, I don' t. Q. Have you e ver reviewed any scientific research that was funded by C TR? A. No, ma'am. Q• Have you e ver known the Tobacco Institute to publicize the research of CTR? A. vo. Q. Did the subject of CTR ever arise at any meeting that you attended at the Tobacco Institute? A. Not that I recall. Q. Did you ever speak on the subject of the CTR at any meetings at TI? A. : certainly don't remember if I did. I no do not, . You said when you arrived at the Tobacco Institute, that you reported to a Dr. Frank Welch. what kind of doctor was he? A. Ph.D. Q. Do you know what he had his Ph.D. in? A. Agriculture. Q. Were there any members of the Tobacco Institute ~ that had Ph.D.s in the area of science? ~ r J N h+ m -J ~ N : - , LTD. 800-232-6876
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tCG=cc '~'CZ_VGO y/25/97 :•: S..'- - ~ .i Y 1 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Institute? MR. SCHROEDER: Object, foundation. THE WITNESS:* I certainly -- I believe it =s, yes. BY MS. SALZMAN : Q. Did you ever communicate that belief to anyone? A. Not that I recall. Q. Did it ever come up in any of your trade association speeches? A. No. Q. Did you, did the Tobacco Institute ever promote that it was doing or spending money to research the smoking and health issue? A. I don't recall that being done, no. Q. Do you think the Tobacco Institute did anything to research the issue of smoking and health, in any capacity? A. The Tobacco Institute was a trade association; it was not a research organization. Q. Okay. I think we have three minutes on the video, so we need to break. MR. SCHROEDER: Okay. VIDEOGRAPHER: This concludes Tape Number One of the Roger Mozingo deposition. The time is 11:52. (DISCUSSION OFF THE RECORD.) REPORTING, TD. 800-232-6878
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.<.J-_"Z-R MCZINGO, 9/25/97 ?AGS 73 2 5 6 7 8 9 ° ~ 10 ¢ 0 ~ " 11 0 r N ¢ 12 W N 5 13 14 . ° i 5 15 21 22 23 24 25 Network? A. The members were individuals who came from the many seg,:•z::ts of the industry I described earlier, the w:.o-Asalers, the retailers, the venders, the growers, thcse people. Q. And what were the grass-root issues that Tobacco Action Network focused on? A. The number one issue, and the largest issue, was the excise tax issue. What other issues? A. Smoking bans, those were the two -- those were the two issues. Q. How about the Research Liaison Group; do you know what that is? A. Never heard of it. Q • When you became Senior Vice President, how did the function of your position change from that of Vice President? A. Well, it was a bit more confining. I had to stay in the office to take care of administrative matters. I became more of an administrator, personnel director than -- you know, than say direct involvement with the individual states. I was responsible for the people who work at the states. Q. And you were responsible in what way? . REPORTING, LTD. - 78 00
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c~0=~ ":CZ:tiGO, 9/25/97 ?A3E 33 7 3 7 m LL Y ~ W 12 V3 5 0 ~ ~ ~ N 8 a ~ 0 M „ a 18 > 0 5 0 U ~y W r- 20 21 22 23 24 25 A. There was a Ph.D. on staff -- I don't know what his ..-_.._p;ine was -- we did have a Ph.D. ; but I don't know w::a: hi s discioline was. ;~. Have you ever received any publications by the CTR? A. Not that I recall. Q. Who was on the Tobacco Institute mailing list? A. Well, I don't know that the Tobacco Institute maintained, you know, a mailing list. I can tell you who was on my mailing list in State Activities. I mean, our member companies and some of the associations I alluded to earlier. But in terms of there being a master TI mailing list, I'm not aware of any such list. Q. Did you ever request information or scientific i_:eYature from CTR? A. No, I have never made such a request. Q. Do you know who sits on the Board of Directors of CTR? A. I don't have a clue. Q. Do you know if the Tobacco Institute ever publicized CTR as an entity independent from the Tobacco Institute? A. No, I don't. Q. Did you ever discuss that CTR is a -- do you believe CTR is an entity independent from the Tobacco V ~ . ~ N N B T J NATIONWIDE COURT REPORTING, LTD. 800-232-6878 W
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.,,,,.__: `^CZ,~,'GC. 9/25/97 ?A:;E 35 1 -1 Y 5 7 8 9 (LUNCHEON RECESS TAKEN FROM 1'_ : 52 ':'0 12.55.) VIDEOGRAPHER: This is Tape Number t*-.e Roger Mozingo deposition. The time is 12:55. BY MS. SALZMAN: Q. Mr. Mozingo, I want to go back to trade TWo of associations and the functions of trade associations. Is it a trade association speak on behalf of its members? function to MR. SCHROEDER: Object to form. THE WITNESS: The -- I don't consider 13 14 20 21 22 23 24 25 that the Tobacco Institute spoke on behalf of its members. we spoke on behalf of our work and our responsibilities at the trade associations. BY MS. SALZMAN: Q. So are you saying it's not a traditional function of a trade association to speak on behalf of its members? A. I never considered that I was speaking for R. J. Reynolds, for example, at a trade association. Q. Well, I'm asking you in a general sense, because when I asked you before what TI -- you know, what the function of TI was, and you represented that it was -- you know, it performed basic trade association functions. REPORTING, LTD. 800-232-6878
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~~G=i `~'."Z:NGO, 9/25/97 ? = A~_ ,~ A. Not ti~at I recall, no. And did you ever attend any Communication .:cram=rzee D 6 7 8 9 13 1 4 0 15 0 ~ ~ ~ N 8 m 17 20 21 22 23 24 25 -•»t:^cs? A. Rarely, I promise you; rarely. But you have, in the past, attended Communicaticn Committee meetings? A. You know, I don't recall attending any, but it's not beyond the realm of possibility that I may have attended, you know, two or three. But it was not something that I was expected to do or required to do. And I had enough to say grace over as it was. I didn't look for meetings to go to, you know. Q. But you do recall attending at least one Communications meeting? A. I don't even recall that, but I'm there and it's not beyond the realm of possibility that I attended a meeting or two of the Communications Committee. Q. But you have no specific recollection of any? A. No. Q. Have you ever heard of the Special Lawyer Committee? A. No. Q. How about the Research Committee? Is there a Research Committee? A. No, ma'am; I had not heard of that. 0 NG, LTD. 800-232-6878
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2 z a D 6 7 8 9 .L1 13 14 H 20 21 22 23 24 25 'CG=R `/:CZ_~G:~. 3. 2= , : ~ ?3Cn 86 And I understand that you're saying specifically that Ti d'_,ad not speak on behalf o-r the tcbacco i:,dustry. =s that right? A. Repeat that one more time for me. I want to make sure I heard your question. Q. Well, my first question was: Is it a trade association function to speak on behalf of its members? A. No. The trade association speaks on behalf of the trade association. Q. So it's not a function to speak on behalf of its members? A. I've never -- in my experience, I didn't speak on behalf of any of the members. Q. Is it a trade association's -- I think you've answered my question -- but is it a trade associaticn function to speak to the public on behalf of the members? A. I don't view it that way. I think we spoke on behalf of the issues and the responsibilities we were dealing with. Q. And who determined what those issues would be? A. Well, in the case of the committee that I dealt with, it was a committee decision, legislative issues. Q. And you said -- and that would have been the committee on state activities? REPORTING, LTD. 800-232-6878
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1 3 4 6 7 a 9 © ~ 10 ~ 0 r ~ W .2 Ln 5 13 ;4 0 ~ ~ NY ~ N ~ m 17 0 ~ } ;a ~ ~ 0 19 20 21 22 23 24 25 z: C=~ XCZI;iGO, 9/25/97 Ztl-:7 33 d~scuss those items and generally agree. I don't recall a::v disagreement on the issu`s we addressed, because :'ney were issues that*we'd been dealing with for quite a neriod of time. Q what would happen if they did disagree? we would discuss it and almost always reach some agreement. Q. Would there be a vote? Not per se, no. It was just a general discussion and, you know, reaching agreement on pursuing the tax issue, for example. And there was very little disagreement on the issues, as I recall, any disagreement. Q. So there was never a vote by the committee on any activ=ti es? A. I don't recall, in our State Activities Committee, thac we voted. We would occasionally vote on -- discuss ac great length whether or not to get involved in a state initiative, for example. But we didn't vote on every issue because it was rather routine and repetitive year after year. And we, as a staff, knew what issues we would logically expect, and meet and talk about those issues. Q. So even if there was a new issue, there wouldn't be a vote? N1 , . - 32-687$
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;;,C=.~ ::OZI~;GO, 9 ' 25~ 37 ~ ; 5 6 7 8 I3 14 20 21 22 23 24 25 A. I don't recall a vote on new issues. We would cresent our recor;:^en.~'.aticz, you know, we had t*- .is issue, an emergi::g issue, whatever it might be, to the :ist.o: z,-Iings we were already dealing with. Q. So was the State Activities Committee more of a committee where information was reported to, rather than -- A. Well, for example, the name -- I told you the name of that committee has changed periodically now, and presently the name of it is the State Activities Coordinating Committee, which is -- more properly describes what the committee is. Q. Does the committee still function the same? A. Yeah, pretty much the same. It hasn't changed. Q. So it is not a decision-making committee? A. It's more in the nature of reporting, knowing what's out there so that the people on that committee can be informed and justify, you know, their activity. Q• Is it a -- does a traditional trade association function include reporting on current research, scientific research, for example, on a product? A. I don't remember that being a function in any department at the Tobacco Institute. Q. Okay. But what I'm asking is, is it a traditional trade association function? Not necessarily did the f NA`II NWID CO T REPORTING, LTD. 800-232-6878
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MCZINGO, 9/25/ 97 6 7 8 9 U 1~ 0 ~ N W 12 LO S 13 20 21 22 23 24 25 project, scientists reporting on their study. I don' c recall the subject cf _t at all_' but t:.at's the cr._y ~ ac..iv__y I recall with CTR. Y. Why did you attend that meeting? A. i was invited to go. Q. Who invited you? A. I don't recall. I don't recall where the invitation came from. It came from, you know, within the staff at the TI, just probably to help build attendance. Q. Did anyone else at Tobacco Institute attend with you? A. I don't recall who else was there. Q. Do you recall if you were the only Tobacco Izstitute representative there? A. No, I don't think I was the only one, but I don't recall who else attended. Q. And did you speak with any CTR members at the meeting? A. No. Q. Have you ever spoken to anyone who worked for the CTR? A. I've never known anyone who worked at CTR. It was not an organization I had any business dealing with. Q. Did you ever see any research that was produced by REPORTING, LTD. 80 -232-6878
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F~_:;ER XCZINGO, 9/25/97 :A1E 90 i 2 3 4 5 6 7 8 - 9 14 0 ~ ~ ~' 16 1 20 21 22 23 24 25 '='cbacco Institute implement such a function, but when vcu describe it for a traditional trade association -- A. I think probably you would find some trade associations that -- for example, the Pharmaceutical Research and Manufacturers Association, their role may be different. The name implies that they do involve themselves with research. But the Tobacco Institute, per se, did not have a research role in the medical area. Q. How about in the scientific area? A. In terms of research? No, not that I recall. Q. Do you have any knowledge of any scientific department of the Tobacco Institute? A. There was a gentleman whose name I mentioned a bit earlier, Dr. Kastenbaum, who headed a one-man -- I don't want -to misspeak the name of the organization, but I think it was a scientific division. That's one person who's a Ph.D., and as I said earlier, I don't recall what his discipline was. Q. How about Dr. Frank Dryden? What kind of doctor was he? A. Earlier I referred to Frank Dryden -- I recall earlier, I referred to Frank Dryden as a doctor. I misspoke. Dr. Frank Welch was the doctor. Frank Dryden is not a doctor. ~ ~ ~ N h-~ m O) 00 , . - - m
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I K.:.,=R MC~Z_NGO, 9/25/97 4 6 7 8 9 tA Cr ,_2 W N 2 Q• How about any videos that were produced by the :'cDacco :nstitute? A. There was -- no. I think there was a video cn the history cf tobacco in America; but I don't recall even whether that was Tobacco Institute or not. ~ think they may have had a hand in it. Q. Does the tobacco industry -- excuse me -- does the Tobacco Institute fund any research on smoking and health? A. Not to my knowledge. Do you think that the Tobacco Institute promotes 5 13 Q• smoking? A. No, I don't. How about the tobacco industry; do you think the 0 15 N ~ N N =5 8 a 17 3 0 ¢ ~ 18 > ~ z c°~ 19 W _ 0- 20 21 22 23 24 25 tobacco industry promotes smoking? A. No, I don't. MR. SCHROEDER: Object, form and scope. BY MS. SALZMAN: Q. Did you have any contact with any members of Council for Tobacco Research or CTR while you were with Tobacco Institute? A. It was an organization I had.no dealings with. Q. Did you ever attend any CTR meetings? A. I attended a meeting at the University of Washington in St. Louis that I believe was a CTR NATIONWIDE L D. 800-232-6878
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c~C=~ `,'CZ:VGO, 9/25/ 97 ?Ar.E 93 4 5 6 7 8 9 10 11 1,2 13 14 15 17 18 19 20 21 22 23 24 25 Q . Was that Executive Committee summaries? :. No, no. These were short summaries of t he Surgeon ..~neral's report. Xo who prepared thesee summaries? A. You know, I don't know. The people who prepared the Surgeon General's reports, as far as I know. Most reports have executive summaries. Q. I didn't know if you were saying that Tobacco Institute generated the executive summary. A. Not that I recall. Q. And who at the Tobacco Institute would distribute the Surgeon General's reports to members of the Tobacco Institute? A. That would be a public relations function. Q. Ar.d who, specifically, in Public Relations when you were at TI? A. Bill Kloepfer. Q. What other reports did you transmit, other than the Surgeon General report? A. I don't recall -- I don't recall specific reports. I mentioned the tax burden. That's one we would make sure we distributed every year. We would distribute reports we received from other types of tobacco organizations, the Smokeless Tobacco Council, for example. I , LTD-. 800-232-6878
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r :CG=:Z MCZ=VGO, 9/25/ 97 ?r.`E ?5 report, you know, to "the public." 2 . 0 7 8 9 13 '_4 3Y MS. SALZMAN: u• If I wanted to be on the mailing list of the -'obacco Ir.stitute as a nonaffiliate of the tobacco industry, is that possible? A. I would think so. Again, we talked about earlier, the Tobacco Institute maintaining a mailing list. I don't know if such a mailing list is maintained, but if you wanted to receive publications from the Tobacco T-nstitute, all you have to do is ask. You know, if you want or need that information, you certainly could get their publications. Q. Do you think it's a -- is it a traditional trade association function to advertise the activities of the members? A. No, no. How about the member-funded research organization? 20 21 22 23 24 25 A. I wouldn't see that as a trade association responsibility. Q. Do you think it's a traditional trade association function to speak to the public about industry controversies; for example, smoking and health? A. We did that in the context of dealing with legislation. But beyond -- you know, beyond my REPORTING, LTD. 800-232-6878
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=J=~ XCZ..NGC, 9j25i 97 J 9 7 a 0 ~ o ~ W ~ 5 o O 9 - 12 3 14 - _ J ~ ./7 ~ _.. m ^ 17 a n 0 > m x U W Z H 0 21 22 23 24 25 A, : '~n Ckay. I use the names interchangeabiy, and I' ;n just -- giad you reminded me of tZat because Frank Drvde.^n was head of the Administration Division. Dr. Wzi:.h was head of the State Activities Division when I joined t^e Tobacco Institute. Q. Okay. So the Tobacco Institute never reported o:n current research on tobacco products? A. No, not that I remember, no. Q. Okay. Is it a traditional trade association function to report to the public research conducted by other trade associations or trade organizations? A. I don't recall examples. I don't recall that the Tobacco Institute reported on anybody else's -- MR. GOOLD: Can we have that quest_on read black, please? (PRIOR QUESTION WAS READ BY THE COURT REPORTER.) THE WITNESS: We would circulate the Surgeon General's reports, for example, to those people who asked for it; but -- and reports of that type, but those are the ones that come to my mind. BY MS. SALZMAN: Q• Who would circulate Surgeon General's reports? A. Different staff people within the Tobacco ,
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G0, 9/25/97 ?A;:E ?2 .r.stitut?. For example, I would make sure that our 2 4 J 6 7 8 9 a Q 10 0 ~ x 11_ U O .- tA a 12 w 5 13 14 0 15 ~ ~ ~ 15 8 a 17 ~ 0 x i8 > a Cr ° U 19 W Z H 20 21 22 23 24 25 sta=f and our lobbyists had those repcrts or execut'-ve su,,maries of those reports,'short versions of those Yeccrts. I don't recall that I ever sent them, you know, reams of papers on those kinds of things. Q. So this is something that you would -- this is a duty you would perform? You would transmit this information, Surgeon General's excerpts, to people in the trade association, or to whom? A. We may well have sent it to some trade, you know, to other tobacco industry trade people. That was done, you know, by the individual -- our individual staff people who had responsibilities for different regions of the country. They would send that out generally over their signature. Or I might, on occasion, send it out. There was no set pattern in terms of that procedure. Q• Where did you get the information? A. Generally, from our Public Relations Division. We didn't generate -- we didn't generally -- I mean, we would receive summaries of reports, and the Surgeon General's report was issued, I don't recall how often, but there would be executive summaries of that report, and we would send out short versions of it. And I did some of that. 800- w N
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:•?CZTVGD, 9/25% 97 P:,G E 35 _::volvement, no, I didn't sneak to the general public about that subject. When you were Senior Vice President and you had z D 6 7 8 , 2 11 _2 13 14 l-) 17 _7 18 19 20 21 22 23 24 25 regional directors reporting to you, what states ir. the nation -- or what states in the nation were not covered by regional directors? A. All 50 states were covered. Q. All of the states were covered. What was Dr. Kastenbaum -- Kastenbaum? A. Kastenbaum. Q. ... Kastenbaum's function in the Scientific Division? A. I don't know what his total responsibility was. I know he would attend meetings, seminars. But you know, beyond that, I don't recall. ;. What meetings or seminars? A. I don't recall specifically. I had very limited dealings with Dr. Kastenbaum. Q. Do you know if Dr. Kastenbaum is living today? A. No, I don't. Q. Who would know about the Scientific Division if I wanted to find out about it? A. I'm not really certain. I'm not really certain who could describe or explain that function. Q. Does a Scientific Division exist today at TI? N, LTD. 80 -232-6878
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:R;. `R XCZ:NGO, 9/25/ 97 J 7 8 G 13 „ 21 22 23 24 25 A. I don't think so. Q• What meetings would the Scientific Division rart;cipate in? A. I don't recall the types of meetings Dr. Kastenbaum at:anded. Q. Did you ever attend a meeting where Dr. Kastenbaum was present? A. No. Q. Did you ever hear Dr. Kastenbaum speak? A. Not that I recall. Q. Did you ever have any conversations with Dr. Kastenbaum? A. Oh, yeah; I've had conversations with him. Q. What is his first fame? A. Marvin. Q. Do you know anyone who would know where Dr. Kastenbaum is? A. No, I don't. Q. When you were at the Tobacco Institute, how many people were employed? A. At which period of time? Q. How about when you started? A. I think about 15 to 20. Q. And when you left? A. Thirty-five, I would say. I'm estimating these QA'I'ZCTIQWII3E- C= POP 800-232-68-7-8
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t:._Z _. CZINGO, 9/ 2 5 / 9 7 I 2 z = 6 7 8 9 cYi 11 0 ~ tA ~ 12 W N 5 13 14 o ~5 20 21 22 23 24 25 nLmbers. That's in the ball park. ; understand. How about the r.u:nber of senior ,ffi~~rs at TI? A . l'oday? Q. When you started, and then when you left. A. I think that's remained pretty much constant. You have four division heads and the president. I would call those division heads the senior officers. Q• And is that true today, that.there are five senior' officers? A. I think it's still true today. Are you aware of any new divisions at the Tobacco Institute since you left their employment? A. No, ma'am. Q• :iow about -- are you aware of any new committees since you left Tobacco Institute employment? A. No, I'm not aware of any new committees. But committees are formed to work on specific issues; but I'm not aware of a committee that exists today that was not in existence when I left. Earlier I told you that the Committee of Counsel was not a Tobacco Institute committee. I was thinking line committees that staff persons like myself, the committee that we worked directly with. The Committee of Counsel was a Tobacco NATIONWIDE COURT REPORTING, LTD. 800-232-6878 00
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_ ~ ~~:.lZiNvO/ .9 /G.7% i / =1 : n'.dL 37 A. State Activities Committee. = 6 7 8 9 10 11 12 ;a _5 16 ;7 ,g 19 20 21 22 23 24 25 ~. And you said t^at `'^.e State Activities :.o„tmi;.tee -a::e ;:p of representatives of tobacco companies? A. T:at's true. But we didn't, we didn't speak for :.:.em. We spoke for our responsibility. actually a distinction there. Q• There's Can you explain the distinction to me? is A. Well, we had our responsibility to deal with tax legislation, for example. And when we addressed the tax issue, we were addressing the tax issue from a Tobacco Institute perspective. Q. Who determined what the issues would be? A. Those issues were reviewed by our State Activities Committee. Those issues, legislative-wise, that affected.the industry, it was the staff responsibility to deal with those issues. Q. Are you saying that the State Activities Committee selected the issues that the Tobacco Institute would work on? A. No. When we would meet with our committee, we would report on the issues pending out there. And there was never any disagreement about the -- I mean, we recommended -- you know, as a staff, we recommended those issues that we felt we needed to address. And the company representatives would REPORTING, L D. 800-232-6878 J 1i
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1 o i5 8 m a 17 ~ 0 e `~ 18 > m e c°~ 19 W r 20 ,., RCG=:; XCZIVGO, 9/25/97 _ What would that be? A. ~egi slat_'ve sur,i;r.aries on thei= issues, that k:::d :.* 2 Z Any cther scientific research that you would d distr:bute? A. Not that I recall. Q. would you consider the Surgeon General's reports to be scientific research? MR. SCHROEDER: Object to the form and lack of predicate. THE WITNESS: I'd have to characterize it as scientific research, yeah. BY MS. SALZMAN: D 6 7 8 9 13 And that's the only scientific research that you've 14 ever distributed? A. It's the one I recall, because it was the one that was so prominent, and it came out every couple of years, as I remember. Q. Okay. And would you say that that's a traditional trade association function, to report to the public this type of research, research involving the industry? MR. SCHROEDER: Objection to form. THE WITNESS: The public you're referring to, in my case, is the tobacco industry public. I mean, I didn't send reports, legislative reports or any other 16 21 22 23 24 25 NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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t-GZR :fCZ:'VG.7, 9%25/ 37 n*rt- _~~ _.. _ S A. Yes, ma'am. Do you know iJE any lawyers have ever served on the j 20 ~municatior.s Committee? A. No. It was -- no. To my recollection, no attorney served on the Communications Committee. What was the function of the Public Relations 7 P y :3 20 21 22 23 24 25 Division? A. To compile and disseminate information to its members, I would say was the largest -- if you had to bring it down, you know, to a nutshell, that would be 1 t . Q. Who was the person in charge of the Public Relations Division when you were there? A. Bill Kloepfer. Q. Bill Kloenfer? A. Yes, ma'am. Q. So is that the same division -- is the Communications Committee part of the Public Relations Division? A. It would be -- yes. Q. And Bill Kloepfer, was he the Senior Vice President? A. Yes, ma'am. Q• Who were the Vice Presidents of the Public Relations Division? . 1 1 , - -
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R:,G-R `^.OZINGv, 9/25/97 r'AGE 99 _'nstitute committee; we didn't have a person on staff w::o worked with that on a-- You didn't -- I'm sorry? W H d 7 8 9 13 _4 16 17 20 21 22 23 24 25 A. We didn't have a staff person who worked with that as I worked with the State Activities Committee. And my ~unction was to report and brief the committee on legislative issues. And when I needed some advice on a particular issue, I would ask for that advice. But I misspoke earlier when I told you that it was not a committee. It_was one of the committees of the Tobacco Institute. Traditionally, Committee of Counsel, Communications Committee, and the State Activities, those were the primary committees. And I'm not certain --he Communications Committee exists today. I'm just not certain of that. I have no depositions with it, if, in ~act, it does exist. Q. How about the Committee of Counsel? A. It still exists. Q. Okay. When was the last time you met with the Committee of Counsel? A. It would have been at some point in '88 when I left the Tobacco Institute. It's not a meeting that I attend -- Q• Why did you meet with them when you left the ~, LTD. 800-232-6878
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:^.CZItiGO, 9/25/97 6 7 3 9 0 ~ Y ~ . U 0 ~ N W -2 h 5 a Q - aesires of the tobacco industrv? MR. GCOLD: Objection as to form. THE WI TNESS : Well, I' m not sure I •-;::derstand your question on that one. BY IMS. SALZMAN : Q. Well, if the tobacco industry wanted TI to lobby on a particular issue for them, would TI do so? A. Generally it would work the other way around. As, I hope, good staff individuals, we were aware of the ;ssues in the states. And we would initiate action and report to our members what we're doing. It was one of those issues that we would ordinarily address. So I mean, the member companies didn't come to us and say, lobby this issue. Q. What if the tobacco industry wanted to, say, push teenage smoking? would the Tobacco Institute do that? MR. GOOLD: Objection, assumes facts not in evidence. MS. HONDORF: It was a good try. ~ 20 2I 22 23 24 THE WITNESS: Well, let me just tell you, at no point in my tenure with the Tobacco Institute, was it ever suggested to me that we push teenage smoking, ever. BY MS. SALZMAN: 25 Do you -- did the Tobacco Institute take any steps 4• NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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-?OZ_VGO, 9/25/97 ?AO£ _:4 m ¢ 10 0 ~ v 11 0 .. N ~ 12 W y 4 f A. Anne Duffin was there at the same time I was. 1 e Pete Spa:ber I _, ::cse are the two _ reca, _1. Y. ::ave you ever heard of the Roper study? A. I've heard of that study, but I don't know what it is. I don't know what it does or says, or what it surveys or studies, no. But I've heard that reference, yes. 2 3 4 6 7 Q. Do you know that it's a survey? 8 A. No, I don't know that it's a survey. Q. Are you aware of the Tobacco Institute performing 9 public polling on various topics? A. It wouldn't be beyond the realm of possibility, but I don't recall specific polls. I mean, it's not, it wouldn't be unusual for the Tobacco Institute to do that. Q. Why wouldn't it be unusual.? A. well, when you're dealing with legislative issues, it's '_mportant to know what public sentiment is on the issues you're concerned about. So it wouldn't be beyond the realm of possibility for the Tobacco Institute, as a part of the government relations function, to do some polling. 13 14 20 21 22 23 Q• well, what would happen if the tobacco industry came to TI and said, this is our position, for instance, 24 on smoking bans; would TI fulfill that, fulfill the 25 , LTD. - - 8
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MCZINGO, 3/25/97 =A- -~ ~ - - - L meet in New York, your fair city. 3Y MS . SALZiKAN : Where in New York would they meet? 8 7 8 9 13 14 ° +5 ~ ~ ~ N + i 8 ;o W ~ 20 21 22 23 24 25 A. Generally at one of the hotels, and 7. don't know that they ever met at the same hotel, but it would be - they would generally rotate meetings between Washington and New York, just for convenience' sake. Q. Did you attend any meetings in New York? A. A few, you know. Q. The meetings that you attended in New York, were they always at hotels? A. As I recall, yes. Q. And you said the Committee of Counsel meets four times per year; right? A. It may meet more than that. It was -- I don't know what their meeting schedule is. I didn't try to keep up with that schedule. It seems to me it was four times a year. It could be more. Q. Okay. Other than Dr. Kastenbaum, are you aware of any other scientists who were employed by Tobacco Institute? A. No, ma'am. Q• If I wanted to find out -- let me ask you this: Did the Communications Committee act independently of the State Activities Division? A IONWIDE COURT REPORTING, LTD. 800-232-6878 r
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...,_=R XCZI:vGO, 9/ 25/:7 PAG:. 1 "J7 6 7 0 ~ 0 U. U 0 ~ y ^f W y~' N 5 _3 14 0 1> C W~ 0 " N 1 g ~ ? 17 0 ~ > ~ cc iy 0 20 21 22 23 24 25 can't tell you how many states -- but I think if you wcu'_d check, vou' d=;::d t;:at well over half the states limit vending machines. And we support chat __aislation. BY :~S . SALZMAN : Q. And Mr. Mozingo, I'm going to show what's marked as Mozingo Two and ask if you can identify it. A. Yes, ma'am. (MOZINGO EXHIBIT NUMBER TWO WAS MARKED FOR IDENTIFICATION.) BY MS. SALZMAN: Q. What is it? A. It's a memo from myself to Bill Kloepfer addressing the subject pre-adult education. 4• Why were you addressing this to Bill Kloepfer? A. It appears that I was responding to a program, or an idea that had been submitted. That's my read of it. Q. Do you recall writing this memo? A. i don't recall writing it, but obviously I did. I mean, my name is on it. 4• What specifically -- what program were you specifically responding to? A. Unless it was the Helping Youth Decide Program, I can't imagine what else it would be. why were you participating in discussions on, if W a
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~CCER MCZINGO, 9/25/97 .3 6 7 8 9 10 ,1 12 13 14 , J 16 17 18 19 20 21 22 23 24 ccmmittee that was part of their division? A. Not a line committee like I would think of :.::e State Activities Committee as being; but the Finance and t'r.e Budget Committee, and they would get toget~.er once a year and discuss budgets and -- but it was not a committee that met regularly, no. Q. How about Jack Mills, what was his job position at the time? A. He was head of the federal lobbying program, the Congressional program. Q. How about Jack Kelly? A. He was head of the State Activities Division. Q. And J. C. B. Eringhaus? A. He was also -- Jack Kelly had come in at that time to replace Eringhaus. Q. So he was in the-- A. He was in the State Activities -- he was in the State Activities Division. Q. How about Fred Panzer? A. Fred was -- as I recall, he was in the Federal Relations Division, federal. Q. Do you know Fred Panzer today? A. I know Fred Panzer. I have not seen Fred Panzer in years. 25 1 Q. What role did he play at the Tobacco Institute? P RTING, LTD. 800-232-6878
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=~- CZ? ~OZI1NGO, 9/25/97 ?AGE _-2 < e ~5 ° J? ~ ^ N A. Yes, ma'am. 1. And did the Committee of Counsel act independently cf the State Activit'_es Division? A. These were independent committees, they were separate committees. L : 4 6 If I wanted to know, if I wanted to find out more information about the Communications Committee, who would I talk to? A. Bill Kloepfer. Q. And where is he today? A. I don't know. He's retired from the Tobacco Institute. I don't know -- the last I heard, he was living in Maryland, some north, just north of the D.C. line, but I can't name the community. Q. When was the last time you spoke to him? A. I don't recall. It's been years. Q. You haven't spoken to him in years? A. Years; it's been years since I've spoken to him. 7 8 9 13 14 16 Q. who else would know about the Communications Committee besides Bill Kloepfer? A. The President of the Tobacco Institute. Q. Who would that be? A. Sam Chilcote. We mentioned that one earlier, I think. Q. He's the present President? 20 21 22 23 24 25 i C T E OP R IT NG, LTD. 800-232-6878
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j D 5 7 3 y _2 ,4 lD „ 17 '9 20 21 22 23 24 25 R3ZER `f-Z.tiGO, 9/25/ 97 : a•-:_ _ _ zi t'r.is one if I hadn't seen, you know, i:it askir.c _; r-y ozinion. Y. H ave you read about that memo being quoted i:, ::ewspaper articles? A. No. What newspapers do you read on a regular basis, if any? A. I read the Wall Street Journal, and t^e Winston-Salem Journal, occasionally the New York Times. Q. Now, it says in here you're stating, "The message should be short, simple and to the point." Is that your opinion as to what the Public Relations Division should do? A. Well, not being a public relations expert, by a:.y means, I believe the opinion I was expressing was that any message in the proposed program should be directed to adults and not to kids. MS. SALZMAN: Can you mark that? (EXHIBIT NUMBER THREE WAS MARKED FOR IDENTIFICATION.) BY MS. SALZMAN: Q. I'm going to show you what's been marked as Mozingo Exhibit Three and ask if you can identify this? A. Yes. Q. What is it? REPORTING, . - - -a 0) ko tD
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.=~ '~!CZ=NGO, 9/25/97 ?A::= _~j 3 L 5 5 7 8 - 9 9 Q _0 0 ~ U O ~ W _2 y 5 :3 '4 _5 a =7 ~ 0 ¢ 18 > n s 0 19 W _ H 20 21 22 23 24 25 you recall correctly, relping Youth Program? A. T was -- if you look at the number of people who were copied here, i would gather .e t :.~i D e that I, in turn, copied people who were copied on the -- assuming there was a K';.oepfer memo asking for opinions, I gather that I would -- you `know, I copied back to the same people who were copied on the Kloepfer memo. Q• Was Kloepfer asking you about a public relations issue, your opinion on a public relations issue? A. It seems that he was, yeah. Q. Was this something that was done on a regular basis? A. I don't recall that it was. Q. Was it done on more than one occasion? A. I don't recall. Q. Do you know why Mr. Kloepfer would be asking someone -- he'd be asking someone who heads the State Activities Division about a public relations issue? A. Well, it appears that he asked a lot of people, according to the copies, to express an opinion. That wouldn't be beyond the realm of possibility, you know. Q. And this is the only instance that you recall that he ever looked for opinion on? A. I'm not going to tell you there couldn't have been others, but -- and I probably wouldn't have recalled 1 , LTD. - - 'T8
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=::G5R VOZINGO, 9/25/97 P1'1~G.:. !-I--- 2 5 6 7 8 9 M _0 x 0 ~ ~ 11 0 Q 12 ~ ~ .L. A. He did some federal lobbying, as I recall, and I ..:.ink he d_d some speech writing. Q. Who did he do speech writing for? A. I think Mr. Kornegay. Q. Do you know what his background is as far as writing? A. No, I really don't. Q. were any of speeches that you -- when you went to you 5 _3 14 a 15 0 ~ ~ In 15 0 0 9 a 17 ~ 0 M - _8 > 9 2 Q iy U 20 21 22 23 24 25 speak at trade associations, you stated before that used Mr. Kornegay's speeches. Were any of those speeches written by Fred Panzer? A. Could have been, but I can't say for certain. Mr. Kornegay wrote, you know, his own speeches sometimes. Q. How about Charles Waite, what department was he in? A. Charles Waite; boy, that's a name from the past. Charles Waite and Dr. Kastenbaum worked together, as I recall. Q• So he was in the Scientific Division? A. He would have been in the Scientific Division. But I had totally forgotten Charles Waite. But he and Kastenbaum did work together, as I recall, for a period of time. Q. Do you know if Charles Waite is a doctor? A. I'm not certain. I thought he was. I believe he . . -i3z=~
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R CG=R MCZ:NGO, 9 / 2 5 / 9 7 PAGE 117 Y il U O ~ y W 12 y 5 9 S 0 U 19 ~ r 22 23 wror:g -- is the Board of Directors of the Tobacco = st_tute? ,. ~he =xecu:.ive Committee, and then the Board. Q. The Executive Committee is above the Board of Directors? A. Yes. Q. How does membership in the Executive Committee 4 6 7 differ from Board of Directors? A. The Executive Committee members would also be members of the Board. You have Class A and Class B me*.nbers. 9 10 And as I recall, it's based on level of contribution. I think the cigarette manufacturers were the largest contributors, so they comprised the Class A membership. Q. And therefore, they were in the Executive Committee? A. Yes. 13 14 And were the Class B members in the Board of Directors only? A. As I recall, yes. Q. So the Board of Directors was larger than the Executive Committee? A. Yes, ma'am. 20 21 24 Was there a specific number of people in the 25 POA 8Oa
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RCG=R `^.GZ=NGO, 9/25/'7 ? r: ? 2 4 6 7 8 9 9 ~ _0 ~ 0 LL Y 11 U 0 r y W 12 ~ 5 13 14 > © ~ 0 19 W H 20 21 22 23 24 25 Tobacco Izstitute? A. It would have been one of the regularly scheduled meetings. I left the Tobacco Institute in '88, and whatever the last meeting was scheduled, that would have been the last time I attended when I was an employee of the Tobacco Institute. I don't attend those meetings, no. Q. Okay. And did you have any contact outside the Committee of Counsel meeting with.the Committee of Counsel members? A. Well, our in-house attorney at RJR is a gentleman that I have occasional contact with. He is our representative on the Committee of Counsel, yes. Q. Does each tobacco company have one representative i.^n the Committee of Counsel? A. I understand that to be the case, yeah. Q. Was that the case when you were working with TI? A. Yes. Q. Where does the Committee of Counsel meet at the tobacco industry offices? MR. SCHROEDER: Object to the form. I think you meant "the Tobacco Institute." MS. SALZMAN: Yes, I'm sorry. Thank you. THE WITNESS: When I was there, sometimes they would meet in Washington, and sometimes they would . REPORTING, . - - 78
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".,~ ~ ~ ~ ~ .., .NGO, R„ 9/25/97 , 6 7 8 9 on a -- since they were -- the committees consisted oi --~.embers of company representatives. ':hey were not :'obacco Institute staff people, so you'd have sort of a doz::ed li::e relationship, as I would describe it. Q. The committee was an arm of a division? A. That's a good way to put it. Q. Was the Tobacco -- is the Tobacco Institute fully funded by Class A and Class B members? A. Yes, ma'am. So if the tobacco industry came to the Tobacco 13 14 15 0 16 0 m 21 22 23 24 25 Institute and they had a position on the -- let me strike that. So the policies of the Tobacco Institute were formed by the Executive Committee, or by the Board of Directors? A. The Executive Committee, obviously, was the top committee. Q. Uh-huh. A. And as I stated earlier, the Executive Committee would meet much more frequently than the Board. As I recall, the Board met annually. The Executive Committee would meet three or four times a year, on a quarterly basis, I believe. Q. But as the division head, you attended the Board of Director meetings. Is that correct? R PORTING, LTD. 800-232-6878 m ~o
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2 4 5 6 7 8 9 13 14 0 15 ~ ~ , N ,5 0 0 a a 17 ~ 0 z ~ 18 > ~ Q 0 19 W _ .. 20 21 22 23 24 25 `~!OZ_:vGO, 9/25/97 =xecuti•re C;,mmittee? A. Five or six, as I recall. Q. ?aG= ~_3 Was it five or six tobacco industry CEOs and the ?resident of the Tobacco Institute? A. Yes, ma'am. And the Board of Directors was comprised of the President of TI, five CEOs, and some Class B CEOs? A. Yes, rna'am, or their representative. And who would a representative be? Would it be a president, would it be a corporate member? A. Generally the president or CEO, whatever the designation. Q. A high level -- A. Yes. Q. And was anyone else included in the Board of Directors? A. No, ma'am. Q. And then below the Board of Directors was whom? A. The Tobacco Institute President, division heads. Q. Okay. And the Executive Committee -- okay, I'm sorry. And then below the divisions were the committees? A. I can't say the committees were below the divisions. I would characterize the committees as being REPORTING, LTD. 800-232-68 8
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RC,__~ER YfCZ1NGC, 9/23/57 PAGE __6 1 z 5 6 7 8 9 © 0 LL ¢ E 0 ~ a W iN 5 13 14 0 0 15 ~ ~ ~ N 8 m 16 20 21 22 23 24 25 THE WITNESS: we, in talking about t^e s.;,cking and healt h=ssue, we called it a cOr.troversy, w:.'_: :^n i t certainly was in those days. And, you know, were not told to stay away from it, or it was not something that we deliberately addressed. BY MS. SALZMAN: Q• What was the the controversy in those days? we A. Well, the whole subject of smoking has been controversial for as long as I can remember. And there' was a whole controversy of-smoking and legislative bans, tax increases from our perspective, that was part of the controversy. Do you mind if we take a little quick break? MS. SALZMAN: No, of course. VIDEOGRAPHER: Off the Record at 1:49. (RECESS TAKEN.) VIDEOGRAPHER: We're back on the record at 2:09. BY MS. SALZMAN: Q. Mr. Mozingo, I want to go over the corporate structure of TI with you. I know we went over bits and pieces of it. I'd just like to get a clear picture. A. Right. Q• And at the top of the picture -- correct me if I'm N , LTD. 800-232-6878
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V.CZ1VCO, 9/25/97 =A0 E 12J 1 2 4 6 7 8 . 9 ~ 10 0 LL Y li ~ ~ ~ 12 W 5 13 14 21 22 23 24 25 A. That would be our annual meeting, yes. Q. And you also attended Executive Committee =~. I can't say I attended all of the them. I cer_a.nly attended some. meet:ngs, Q. So the answer to the question was yes, that the Executive Committee would form the policy for the Tobacco Institute? A. That was our top committee, and if we had questions about a policy -- which seldom came up -- then -- I don't recall that we ever had to go to the Executive Committee for a decision on -- at the state level, at least in my area of responsibility. I don't recall that we ever took an issue to the Executive Committee unless it -- a possible exception would be whether or not to deal in a state initiative, a ballot initiative. Q. And the Executive Committee had the final say on whether -- A. Our question generally was a financial question, you know, it's expensive to participate in ballot initiatives or referenda. Q. And who would bring the potential issues to the Executive Committee for consideration? A. The president. Q. And where would the president derive the issues to
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--=~ •`~Z:NGO, 9/25/97 :A::5 :I- Ad.:~i:.istration. If we had administration matters, or if ° scug;:,. our _::put on a subjec* , we would certainiy` rescond. What about to Tom Frankovic, what division, what was Tom Frankovic's - A. Frankovic. Q. Thank you. A. He was -- when Mr. Kornegay retired, and Mr. Dryden retired, Frankovic was brought as the, in the administration capacity, as I recall. Q. So in August of the 1979, was he in the Administrative Division? Because I see Mr. Kornegay's name is on here as well. A. Yeah. Well, Frankovic -- let me correct what I just said -- Frankovic joined the Tobacco Institute very shortly before Mr. Kornegay retired. I don't recall the sequence of all these ccmings and goings, okay; but -- and I'd really forgotten that Frankovic was there during the time, though I recall now that he was. And I think Frankovic preceded Mr. Chilcote, who is now president of the Tobacco Institute. I think that's the sequence. Q. But was he in the Administrative Division? A. As I recall he was, yes. Q. And did the Administrative Division have a - , LT . 800-232-6878
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~„__... ' = MGZT'VGO, 9/25/97 - J a. The Tobacco _nstitute -- in my capac:zy, we ..:ppc=ted 3egi s_ation t::at -- we have ac::•.:a~ly s~pper_ed 6 7 a 9 13 14 0 15 ~ ~ N 15 ~ 0 m a -7 D 0 ~ 0 18 > m x (Uj 1~ W H 20 21 22 23 24 25 6 :egisiation to -- that addresses the yout:: issue. And to this day we support legislation that addresses limiting youth access to tobacco products. For example, vending machine legislation. Our position was and is that a vending machine should not be placed where kids have access, for example. we have supported licensing legislation that requires wholesalers to be licensed and fined if they violate the license. So those are a couple examples that come to mind, yes. Q• c::=taii teenage smcking? Since when has the Tobacco Institute supported legislature to remove or ban vending machines from places where teenagers are present? A. Every year since the vending machine issue became an issue. Q. What year was that, approximately? A. I don't recall exactly. It was in the -- as I recall, it was the '80s, early '80s, mid'80s. Q. And has Tobacco Institute been successful in its lobbying efforts to ban vending machines where teenagers are Dresent? A. Yes, we've supported that. We've supported -- I i . . 800-232-6878
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R.,..=R `^.CZ_VGO, 9/25/97 :AG£ _22 m Q = 0 0 ~ ~ 11 0 ~ ~ ~ 12 W N 5 h. * :AIV no longer exists. It was a c:ass-r~cts crcyra :^at was attempted for a period of -- ::.ou_d have :.o 2 I say five or six years -- but that e:.tit_.~ no _--:.ger ex'-sts, to my knowledge, at the Tobacco _.^.stit.:te. Q. And your salary was paid by the Tobacco ir.stitute. ?s that right? A. Yes, ma'am, during the time I was at the TI. 5 6 7 And in your division, State Activities Division. 8 when decisions were to be made, you would bring them to the State Activities Committee for proposal? A. Yeah. We would make recommendations based on the issues we were facing. Q. And you would bring those proposals to the committee; right? A. More for information than -- as I mentioned earlier, for information purposes. Q. Who did you report your state activities to, the Executive Committee? A. When I attended the Executive Committee meetings, I would report on our activity, just a routine staff report. Q. Did you serve at the -- did your department serve at the direction of the Executive Committee? A. Well, the entire institute -- the entire trade association served at the pleasure of the Executive 9 13 14 20 21 22 23 24 25 I G, LTD. 800-232-6878
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RCGER XOZINGO, 9/25/97 ?~Gr .. _ ~_5 I 10 12 5 0 0 ~ N N N A. Number D? Q. Yes. A. I'm sorry. , G MR. SCHROEDER: I am going to object to the form. I'm not sure what you're asking him. THE WITNESS: I'm not certain what really programs -- I mentioned the -- I'm not really certain what the pre-adult education program -- if it ever became a program. So I can't speak to what Mr. Dryden may have thought or his opinion on the subject he was asked to give his opinion on. BY MS. SALZMAN: Q. Is it a tobacco industry policy to stay away from medical issues in communications? MR. SCHROEDER: Object as to "industry." BY MS. SALZMAN: Q. I'm sorry, Tobacco Institute. A. I don't recall it being a policy, no. Q. was it an informal policy? A. I don't recall it being an informal policy. Q. Was it ever discussed among -- did you ever discuss the issue that Tobacco Institute wanted to stay away from the medical issues in its communications with anyone else at the Tobacco Institute? MR. SCHROEDER: Objection as to form. 4 . 0 7 8 7 13 y5 15 20 21 22 23 24 25 0 E RTING, LTD. 800-232-6878
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-MOZ=VGO, 9/25/97 D 6 7 3 9 =J ,I 12 13 _5 17 lo 19 20 21 22 23 24 25 ~? brought to the Executive Committee? Through his se::-Lor staf:. Are you aware of the Tobacco Institute's C_Cs -- or _..~ ?xec:itive Committee CEOs ever bringing issues to the Tobacco Institute? A. Not specifically, no. I'm not aware of any. Q• Do you know what the Tobacco Institute Testing Lab is? A. I'm not real familiar with it, but it was a lab operated, I believe, in conjunction with -- or on contract with the FTC to test cigarettes. Q. What were they testing cigarettes for? A. I would assume, nicotine and tar. I can't tell you precisely what tests they contracted for, but I think it was an organization that did do contract work with the Federal Trade Commission. Q. Are you aware of any studies conducted by the Tobacco In$titute Testing Laboratory dealing with tar and nicotine? A. I don't recall -- no, I'm not aware of any. No. Q• Are you aware that tar and nicotine levels reported to the U.S. Government and placed in advertisements are prepared by the Tobacco Institute Testing Laboratory? A. No, I'm not. Q. Is -- which state does TAN lobby in? I G, LTD. 800-232-6878
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^ R: '_'z=< MCZ'_NGO, 9/25/97 ?,•.,:;'z _-_ 2 3 'i D 6 7 8 9 9 0 LL 11 U 0 .. y 13 ' 4 Q 15 8 m 16 ~ 17 ~ 0 ~ ~ 18 > ~ z 19 W 2 20 21 22 23 24 25 was a surgeon general of the Navy, a former surgeon in Navy, I be?ieve; so that would make him a doctor, would assume. I guess if you're going to be a surgeon general, it helps to be a doctor. Q. How about Mike Kerrigan? A. Mike Kerrigan was one of the -- he worked in State Activities. Q. In what position? A. About this time, Mike Kerrigan was one of the -- let's see, in '79 he would have been one of our regional people. He would have been my counterpart, basically, handling the northeastern states. Q. Do you know who Lorraine Policy is, or Police? A. No. Q. Do you recall receiving any other messages, other t::arn this one from Bill Kloepfer, as it relates to public relations issues at TI? A. I don't recall specific projects or programs I might have been asked my opinion on. I can't deny there may have been others, but I don't recall them. Q. Do you recall receiving the memo from Frank Dryden? A. No, I don't. I don't remember that. Q. What do you think of Mr. Dryden's statement that he suggests in Number D, "Stay entirely away from the medical side in our communications"? 1 : REPORTING, LTD. 80 -23 -6 78
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?3G`.R MOZI:vGO, 9/25/97 :AGi :24 z 4 5 6 7 8 9 13 1 `2 f ° 15 16 20 21 22 23 24 So, I mean, I've known for a long time t::a: it was risky :-- s:^oke. Q. So you're sayi::g a question still exists in your ... ir.d as to whether or not smoking causes cancer? A. I'm saying I don't know. Q• What would you need in order to make that decision? MR. SCHROEDER: Objection. THE WITNESS: I'm not certain. BY MS. SALZMAN: Q. what kind of proof would you like to see one way or the other before making a decision? MR. SCHROEDER: Same objection. WITNESS: It's not something I've thought about. Seriously, I don't know what it would take. BY MS. SALZMAN: Q. Do you know that the Surgeon General's position is tha~--- smoking causes cancer? A. Yes. Q• What knowledge do you have that's contrary to the Surgeon General's opinion that creates an issue in your mind as to whether or not smoking causes cancer? MR. SCHROEDER: For the record, same objection on the scope of this line of questioning. THE WITNESS: I don't take issue with the 25 Surgeon General. I'm not convinced that it has been NRF:P5R3`ING, LTD. 800-232-6878
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, Y 6 7 a 9 ~ ~ 13 0 ~ Y 11 O 1-3 14 ~ _5 ;6 8 9 s 17 ~ 0 cc 18 > 9 Z ~°, 2 9 20 2_ 22 23 24 25 K'oeDfer expressing an opinion on the same subject as -'-e T:emo we alluded to that I sent to :C=oepfer a moment VCZ71NG0, 9/25/97 A. It's a memorandum from Frank Dryden to Bill agv. 2. What was Frank Dryden's position? A. He was -- MR. SCHROEDER: Objection. I'm not sure he knows what Frank Dryden's knows. You're welcome to ask :^.is position. Object on the grounds of speculation. MS. SALZMAN: No, no, his job position. MR. SCHROEDER: Oh, his position? MS. SALZMAN: Yeah. THE WITNESS: He was the head of the Administration Division. As a senior officer, he would routinely be copied on memos. BY MS. SALZMAN: Q. So the Administrative Division is not -- or the Public Relations Division is not independent of the Administration Division, if he is copied on all the memos. Is that right? A. No, I don't see how you reached that conclusion. Q• Well, why was -- did your department regularly copy Frank Dryden on all your internal memos? A. Not on every internal memo. He was head of oN4G rJUR
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RC..ZR `^.CZ_NGO, 9/25/97 2 ~7 ~ 0 ~ ~ 18 > m ~ c°, 19 LU T H deposition. 2 0 So _f you're :nstructing him not :.o answer then, state so for the record. Otherwise, know, I just ask that you don't make speaking ob;ections. you MR. SCHROEDER: My objection goes to what r, ; understood was going to be the scope of the 7 deoosition, which is a predicate for this whole 8 deposition. 9 Now, I'm not going to instruct him not to answer right now; but if we're getting into a line of a_uestions that deal with -- in any way that you're going to contend at trial deal with some representation on behalf of R. J. Reynolds -- MS. SALZMAN: I already said I didn't. MR. SCHROEDER: Okay. So if you want to say that this is not with respect to anything with respect to Reynolds, then you can go forward. BY MS. SALZMAN: Q. why do you believe -- what do you know, other than through your employment at RJR, that creates a question 13 =^_ 15 =6 20 21 in your mind as to the issue of smoking and cancer? 22 MR. SCHROEDER: Okay. Wait -- can you read that back to me? (THE PRECEDING QUESTION WAS READ BY 23 24 25 , REPORTING, LTD. 8 0-232-6878
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XOZ1:'!G0, 9/25/97 ?AG= :33 MR. SCHROEDER: Object to the form. : z 5 6 7 8 9 10 11 12 _3 14 15 15 17 18 19 20 21 22 23 24 25 THE WITNESS: It speaks about i.^.depender.t : esea=c:^. on smoking. BY :•IS. SALZMAN : Q. Are they referring to CTR when they discuss independent research? A. That's my assumption, yeah, from reading the ad. So are you aware of -- is this the only -- strike that. So is it a function of the Tobacco Institute to advertise the amount of money it spent on research, or the amount of money that the CTR spent on researching the issue of smoking and health? MR. SCHROEDER: Object to the form. THE WITNESS: It was not a function of the Tobacco Institute to do that, but it was -- I gather that the illusion, the reference here is to the CTR, because the Tobacco Institute did not conduct research. BY MS. SALZMAN: Q. Did the Tobacco Institute periodically advertise, the Institute? A. I'm sorry? Q. This is an advertisement that was produced by the Tobacco Institute. Is that right? A. Yes. W
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, 2 z 6 7 8 9 ~ y Q 12 W 5 13 0 Q? ~ N , 5 8 m_ a 17 ~ 0 ¢ c~ 18 > m Q U -~ 20 21 22 23 24 25 -RCGZR XCZINGO, 9/25/97 Ccmmittee. ?AGE _23 But T_ guess I could say yes, because we were a part of the trade association. Y. And the president reports to the Executive Committee as well. Right? A. The Executive Committee. Q. Do you think that the tobacco industry is capable of manipulating the amount of nicotine in a cigarette? MR. SCHROEDER: Wait. Objection as to the "industry." That's beyond the scope of this deposition. THE WITNESS: I don't -- I'm not qualified to answer that. That's not something I know anything about. BY MS. SALZMAN : Q• Do you think that cigarette smoking causes cancer? A. I think it's a debate that's been raging for as far back as I can remember. I'm not certain that it does -- that they do -- and I'm not certain that they don't. I think smoking is risky. I think I said earlier that for as long as I've been in the tobacco industry, I've•heard various individuals in and outside the industry, or outside the industry growing up with my family, that, you know, you shouldn't smoke. , LTD. - _-"_78
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ROGER MOZINGO, 9/25/97 ?AG= _23 1 2 3 c 6 7 8 9 13 14 BY MS. SALZMAN: Do you -- based upon your background, do you have an opinion as to whether or not nicotine is addictive? MR. SCHROEDER: Other than his employment with R. J. Reynolds? MS. SALZMAN: Well, he's -- as far as I know, what he does at R. J. Reynolds wouldn't have an impact on whether he has an opinion whether nicotine was addictive, unless he's not disclosed something about what he does at RJR. MR. SCHROEDER: As long as it is a question about other than -- if you phrase it like you phrased your other question, I don't have any problem with it. MS. SALZMAN: I don't think I need to. 20 21 22 23 24 25 MR. SCHROEDER: Well, then I object to the extent that in any way it is attempted to related to his employment at R. J. Reynolds. THE WITNESS: I don't know the answer to that. I have -- again, let me give you a personal perspective: I have a lot of friends and acquaintances who have stopped smoking; and I have read and heard that there are millions who have done the same thing. From that perspective, the way I view addiction, if you can ONWIDE COURT REPORTING, LTD. 800-232-6878 %D
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MOZ:NGO, 9/25/97 :nGE _23 2 .5 4 D 6 7 8 9 ~ y ¢ 12 W N 5 13 14 15 16 a 17 n 0 S ~ 18 > D S c°~ 19 LU _ r 20 21 22 23 24 25 TriE COURT REPORTER.) THE WITNESS: Well, I'm not aualified to u_sagree with the Surgeon General, certainly. The S::rgeon General has stated an opinion. I have stated that : think smoking is a risk. But I'm not qualified to tell you whether or not I believe smoking causes various diseases. I'm just not -- I'm just not qualified to go any further on that subject. BY MS. SALZMAN: Q. Well, if the Attorney General tells -- excuse me, if the Surgeon General tells you that smoking causes car.cer, what is it in your mind that creates doubt? MR. GOOLD: Objection as to form. Objection, asked and answered. THE WITNESS: Well, I don't know that every smoker gets disease; okay? But I don't really want to go further into that question, because I'm not a scientist. I've not studied the subject. I have my personal view about, you know, how I feel personally. I do think that more conclusive evidence needs to be forthcoming. And I'm not certain in my mind that it's there yet. And that probably is in disagreement with the Surgeon General, as well as others. NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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. -, :A~;E _~i 1 L D 6 7 8 9 '~ 11 a 12 13 11 4 15 21 22 23 24 25 Are t:.ere -- does the Tobacco Institute regularly oroduce advertisements? A. Not regularly, no. Y. Are there other advertisements that you know of :nat Tobacco Institute produced? A. There have been other ads, but I don't recall -- I couldn't cite what they are. Q. Do you know of any other ads that discuss the CTR? A. No, I don't. (MOZINGO EXHIBIT NUMBER FIVE WAS MARKED FOR IDENTIFICATION.) BY MS. SALZMAN: Q. Do you recognize that? A. Okay. Q. Do you recognize this document? A. Yes, I recognize it. It's two documents. One, a memorandum from me to Mr. Holtzman; and the second memorandum is from -- letter -- is from Terry Pehler to me. Q. Okay. Who is Mr. Holtzman? A. I think Mr. Holtzman was a member of the Committee of Counsel, as I recall. Q. Do you know Mr. Holtzman's first name? A. No, ma'am. Q. Why were you forwarding these letters to someone on , . 0 -232-6878 iP
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6 7 8 9 ~ ~ 0 ~ 11 U O ~ N W _2 N g 13 o i5 ~ N ~ o _6 0 m > m x 0 U 19 20 21 22 23 24 25 : CGSR `^OZ=VG^v, 9/25/97 stcp somet :ing, then is that what you termi:.ate ;s; ,: i an adCict;o::? In my view, for me personaiiy, _ c;on't -r_ew my smoking as an addiction because I could tsuit smoking if wanted to. And I think that's where the distinction is, in my view. BY MS. SALZMAN: Q. where have you read that millions of people have been able to quit cigarette smoking? A. Newspapers. You said that you thought there was a risk in smoking? A. Sure. I mean, I don't see -- yeah, I said that. Q. As it relates to health problems? A. As it relates to one's overall health. But I also believe that there are lots of other things that I would consider risk factors. Q. In life, you mean? A. In life. Q. Did you ever hear that nicotine was addictive? A. Oh, I've heard -- oh, y es. I read it every week in the newspaper. Q. Have you ever seen studies that were funded by the CTR that said that nicotine is addictive? A. No, m a'am . : -LE , LTD. 800- 32-6878
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~~ -R XCZ,N„O, 9/25i. :7 _1,0E _25 s~icwn scientifically and conclusive that smoking causes u'_seases. SY MS . SALZ:KA~~I : Do you think that by-products of cigarettes cause 5 6 7 3 9 9 ~ 1 V ~ 0 LL Y ~1 J O r y W 12 Ch 5 13 14 0 Q 15 0 ~ ~ ~ N ~ I $ a _o ~ 17 x 0 13 } ~ co, 19 W 20 21 22 23 24 25 cancer? MR. SCHROEDER: Same objection. THE WITNESS: I don't know. BY MS. SALZMAN : Q. Why don't you know? A. Well, I've never -- I'm not a scientist. I think these are scientific questions that I'm not really qualified to answer. Q. well, what do you know that's contrary to the Surgeon General's opinion that smoking causes cancer? MR. SCHROEDER: Let me stop for just a mi.^.ute. Are we talking about what he knew -- are you asking questions about when he worked at the TI or are we now talking about -- MS. SALZMAN: I don't want to know about his employment with RJR. I just want to know why he -- MR. SCHROEDER: You're talking about his personal opinion? Nothing to do with -- MS. SALZMAN: No, his opinion based upon his experience in the tobacco industry since 1970s. MR. SCHROEDER: He's already testified REPORTING, LTD. 800-232-6878
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~tCZ7~NGO, 9/25/ 97 YA'53 Z :3 5 2 5 6 7 8 9 11 13 14 20 21 22 23 24 25 =^.e Ccmmittee of Counsel? 1~. ~ caz't recall why. :'m certain I don't remember =:-:e cc~rresncndence. I don't know why I would have sent Mr. Holtzman. But traditionally, the Committee of Counsel would have a chairman, chairperson. And it could have been that Mr. Holtzman was chairman at that particular time. Q. why would you be sending this information to the chairman of the Committee of Counsel? A. It addresses a subject that I knew nothing about. Terry Pehler certainly knew even less than I did, I would assume. But I think it was just general information that was worth passing on, for whatever anybody might decide to do with it, you know. Q. What other information did you pass on to the Committee of Counsel? A. Well, when I would meet with them, I would give an overview and brief them on our activity. But I don't recall routinely passing matters on to the Committee of Counsel. It.would be rare that I would do that. Q. Well, why -- A. I'm not even certain, by the way, about Mr. Holtzman. And I'm guessing. I recall the Holtzman NA D OURT REPORTING, LTD. 800-232-6878
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R'',3_R V"'ZrVGO, 9/25/97 . L Y 6 7 8 9 11 W 12 ~ 13 14 20 21 22 23 24 25 would suggest I do that, because there's no company me::tioi:AQ . ,e • :s that a -- is it a practice of yours, when you s=::d a letter to someone and you copy other people with a`opy of the letter -- to have reference to their names at the bottom of your either letter or memo? A. I didn't have a -- I don't recall that I had a standard practice. Q. Do you type your own letters? A. No. Q. Do you give them to your secretary to type? A. Yes. Q. Did you dictate them on a machine? A. No. Q. Who's SW? A. SW? Q. As the person who typed -- A. Sharon Wall was my secretary at the time. Q. So if you wanted this letter to go to someone else other than Mr. Holtzman, you would have told Sharon Wall? A. I would have told Sharon, or you know, written it out. Yes. Q. Now, why is Mr. Holtzman -- excuse me, why is -- who is Terry Pehler? E RTING, LTD. 800-232-6878 J
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'.~CZI~;CO, 9/25/97 ?Av . , - : --. ~~ ~ , L 6 7 8 9 13 20 21 22 23 24 25 :.~2. MS. SALZMAN: Mr. Mozingo, thank you very ....:z. THE WITNESS: Thank you. MS. SALZMAN: I'm finished asking you questions, and I'm going to pass the questioning over to the attorneys for the Barnes case. WITNESS: Thank you. VIDEOGRAPHER: Off the record at 3:02. (DISCUSSION OFF THE RECORD.) VIDEOGRAPHER: We're back on the record at 3:04. EXAMINATION BY MS. HONDORF: Q. Mr. Mozingo, my name is Sherrill Hondorf. I believe I introduced myself this morning. A. Yes, you did. Q. I'm here to represent the Barnes plaintiffs. And I just want to -- we've selected a group of documents from your tenure, from the time of your tenure at the Tobacco Institute. And we're in the nature of trying to authenticate these documents and ask you if you recognize them. And I'll identify them one by one. This says "Cigarette Smoking and Cancer, a Scientific REPORTING, LTD. 800-232-6878 a w m
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.`^.CZZNGC, 9/25/97 'ryG: :33 ; 2 3 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A. Well, you've got some words -- Terry Pehler was a _:,cbyist in the state of Indiana. ;~. Zo you know why he was writing to you about a:ve=zising issues? A. it would not have been in the realm of possibility (sic) for a lobbyist to write on any subject, those they know about and those they don't know about. You know, they were people who were not -- they represented tobacco and the Tobacco Institute; but they had multiple clients. So it's not like they were our sole representative in the states. A lot of lobbyists have multiple clients: Q. So you say in here, "advertising is far beyond the scope of the Institute's jurisdiction." A. In reading the Pehler document -- MR. SCHROEDER: Objection. Sorry, I don't think there's a question there. BY MS. SALZMAN: Q. what do you mean by that? A. The document is referring, not to Tobacco Institute advertising.. It's referring to other advertising over which the Tobacco Institute had no control. I mean, we didn't decide what companies, you know, did in the way of advertising. We had no involvement in that. N T NWIDE COURT REP RTING, LTD. 800-232-6878 00
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.•'GZ1NGO, -9/25/37 :ACC _~5 1 5 6 7 8 9 13 14 15 20 21 22 23 24 25 r.ame, Alexander Holtzman, that's here. Okay. I {r.ow in what capacity Mr. us` don't remember. u• Holtzman served at t;:e dor.' t t :;ne . :o you know if he worked for the Tobacco Institute? A. He was not a Tobacco Institute employee. Q. Co you know if he was employed by one of the tobacco companies? A. A. That is my belief, yes. Do you believe he's an attorney? I believe so. I believe he was a Committee of Counsel member, like I said. Q. Well, why, if you sent things to the Committee of Counsel on rare occasions, why would you send -- what about this document stood out that caused you to forward it? A. There could have been others, but this one stood out because he was talking about a company, a member company issue, that I had absolutely no involvement in. Q. Why wouldn't you have forwarded it to the president of TI? A. I probably did, but it's not reflected here. Q. Don't you usually have a copy list when you forward to numerous people? A. I don't recall why I sent this. If I sent it on to Mr. Holtzman, I don't recall the circumstances that NATIONWIDE COURT REPORTING, LTD. 800-232-6878 N Q~
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".CZItiGO, ?/25% 97 , L 4 D 6 7 8 - 9 13 14 0 15 6? 16 17 18 19 I 20 21 22 23 24 25 t::is is not his area. ae's in state government =elations l . ~^h;s whole line of questioning is beyond _-:z s~ope of what we were going'to be talking about today. MS. SALZMAN: I thought we said -- are you instructing him not to answer? MR. SCHROEDER: I'll object on this line of questioning and see how far we're going with it. But to the extent any of your questions are directed to anything relating to his employment at Reynolds, because they're in the present tense, I object, because that's well beyond the scope of what we were going to talk about. Now, if you want to ask -- if you could somehow limit it so that's not a problem, then I don't have any problem with that. MS. SALZMAN: Well, I thought we had stipulated that you were reserving your objections except as to form. MR. SCHROEDER: Right, with the understanding at the beginning of what the scope of this deposition was going to be about. I just don't want to get sidetracked on a bunch of issues that are not in his area. MS. SALZMAN: Well, I don't think what I'm asking violates the scope of our discovery
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1 2 3 4 5 6 7 9 10 11 13 20 21 22 23 24 25 ROGER MOZINGO, 9/25/97 '.-)AGE ,-32 BY MS. SALZMAN : Let me know when you're tinished reading it. A. Yes, ma'am. Q. Can you identify this document, please? A. Yes. it is a memorandum to Mssrs. Kornegay, Chilcote, Liebengood, Milway and Mozingo from Bill Kloepfer speaking to an ad that will be published in Phoenix and Tucson newspapers. Q. Who is Liebengood? A. Liebengood, at this period in time, headed the Federal Relations Division, Howard Liebengood. Q. And Milway? A. Milway was head of the Administration Division. Q. And what is the "Arizona Group"? A. The Arizona Group would have been a reference to the tobacco industry representatives in that state. Q. And did you look at the second page? A. Yes. Q. Is this an advertisement put out by the Tobacco Institute? A. It certainly appears to be. Q. Have you ever seen it before? A. I don't remember seeing it, but I obviously did. Q. Does this advertisement talk about -- speak to the issue of smoking and health? NATIONWIDE COURT REPORTING, LTD. 800-232-6878 I
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R=--R M^ZTvGO, 9/25/y7 ~~,C~ _,_ 5 6 7 a 9 " 11 ~ ~ y W . 12 ~ 13 14 I 20 21 22 23 24 ?erspective." it's from 1982. Have you ever seen t^is .ccu m e^ _? iPAUSE., MS. iiONDCRF: Sorry, gentlemen, I don't have ccpies, there were too many pages. MR. SCHROEDER: : All right. THE WITNESS: I don't recall seeing that specific document. Obviously it's a 1982 document. I was at the Tobacco Institute at that time, but I don't recall that specific document. BY MS. HONDORF: Q • Do you recognize it as a Tobacco Institute document? A. Well, from the cover it says "Tobacco Institute," barely legible; but I have to assume it is because the Tobacco Institute's name is on it. Yes, ma'am. MS. HONDORF: Okay. We'll mark this as Six. (MOZINGO EXHIBIT NUMBER SIX WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Your testimony is you don't recognize this document, Mozingo Six? Were you still with the Institute in May 25 of 1988? REPORTING, LTD. 800-232-6878
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`^.OZI:QGO, 9/25/97 ?AGE" .43 L 4 6 7 8 9 m 2 10 ~ ~ ~ 11 r N x 12 Wy , 13 14 0 i I - 5 15 a 17 ~. 0 x ~ 18 > m a v i9 W I r 20 21 22 23 24 25 Y. C Okay. MS.:iONDORF . Okay, tra* will be Moz:r.ac :;r.ber Seve.^.. (MOZINGO EXHIBIT NUMBER SEVEN WAS MARKED FOR IDENTIFICATION.). BY MS. HONDORF: Q. Here's a document dated -- oh, no, this would have been beyond your tenure. 1989 you were gone, correct? A. Yes, ma'am. Q. Here's a document that we can't date. It's entitled "Tobacco Smoke and the Non-smoker, Scientific Integrity at the Crossroads." This would be marked Mozingo Eight. (MOZINGO EXHIBIT NUMBER EIGHT WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. It's got the "Tobacco Institute" on the cover. Have you ever seen this document? A. Well, I can't deny having seen it, but it's not one I would have read. Q. But do you recognize it? A. No, I don't recognize it as being -- as a document I saw when I was at the Tobacco Institute. Q. When you were at the Institute during your tenure, would it have been the practice to copy you with , . - - 878
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`^.OZINCO, 9/25/97 Q• ? A.:'. _3 _ Do you know anyone who takes the position that smoking is ccod for one's health? 6 7 9 9 9 ~ 10 0 ~ U) ~ 12 w y 5 13 : 0 Q 15 0 19 ~ N N 0 0 m 16 20 21 22 23 24 25 A. I have never heard anyone say that smoking is good =or one's health. I have heard people say they enjoy smoking. I say that myself. But no one has ever told me that smoking is good for one's health, never. Q. And even though smoking is a risk, you still choose to smoke? A. Yes. I think it's -- I think it's a choice that adults should be able to make for themselves, yes. MS. SALZMAN: I just need a few minutes. Do you want to go off record for a few minutes? VIDEOGRAPHER: Off the record at 2:32. (DISCUSSION OFF THE RECORD.) VIDEOGRAPHER: We're back on the record at 2 :45 BY MS. SALZMAN: Q. Mr. Mozingo, I just want to show you this document -- I'm sorry, can you mark this document as the next exhibit? MR. SCHROEDER: What number will this one get? (MOZINGO EXHIBIT NUMBER FOUR WAS MARKED FOR IDENTIFICATION.) REPORTING, LTD. 800-232-6878
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L I I 4 6 7 8 13 14 15 16 a 17 ~ o. a ~. la > m g 19 W 2 H 20 21 22 . 23 24 25 ~~CZINGO. 9/25/97 :v PAGE 14 3 Number 10; this one will be marked Number 11.. ;MOZINGO EXHIBIT NUMBER "-1 WAS :`~':ARKED FOR IDENTIFICATION.) c:ONDORF : This one also says: "Answers to the Most Asked Questions About Cigarettes," and it appears to be the booklet that goes along with "Your Review," which was the previous exhibit. Do you recognize that document? A. Yes, ma'am. This is a Tobacco Institute pamphlet prepared by our Public Relations Division. Who, I do not know. Q. Who was that particular booklet directed to? A. I can't answer that. I don't know that it was directed to any given audience. It was probably available to anyone who asked. Q. Well, let me ask you this: Would the Tobacco Institute have just prepared a booklet and not have sent it to anyone? MR. GOOLD: Objection insofar as you're asking about activities outside his area. THE WITNESS: This is a document that I would have elected to send to the people me in state government relations, yes. BY MS. HONDORF: who worked with REPORTING, LTD. - 32-6878
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_-=- Z9/25/37 , cc:n~ry. I think ,'82 or '83, I think we moved. Ckay. Well, that's a side line. Have you ever Y 6 7 8 9 11 13 14 15 16 20 21 22 23 24 25 =e?n this document? This would be Mozingo Nine. (MOZINGO EXHIBIT NUMBER NINE WAS MARKED FOR IDENTIFICATION.) THE WITNESS: I recognize that as a TI document, but I don't remember reading that specific document. It's certainly is not beyond the realm of possibility that I did. BY MS. HONDORF: Q. And would it be your testimony that it was prepared by the Public Relations Division? A. Yes, ma'am. Q. would it have been prepared by a scientific person at Public Relations? A. That I cannot answer: Q. Do you know a person who could answer that question for me? A. The person whose name I alluded to earlier, Bill Kloepfer, headed that division; and he would know what assignments were made. Q. Okay. This one. A. Excuse me. Q. Sure. MR. GOOLD: Let's get a sticker on it `Fe~ & s .l Mal ndWsrZl i I!,& M -2 43 4 Tsi -]k A ± 800-232-6878 ON
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7 /27 % 77 :"tfV.~ ~ i.. , 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1,8 19 20 21 22 23 24 25 Do you have any reason to believe that it's not a _;cacco :nst;tute document? MR. GOOLL: Objection. He's testi-1ied he .c`s.. _ recognize it. THE WITNESS: The Tobacco Institute name is on the document. BY MS. HONDORF: Q. Thank you. This one was 12. Here's a document -- actually, it is a series of two documents -- the first one is dated July 6, 1978. The subject is "Action at Your Direction." It refers to a document entitled "Two Days in January." (MOZINGO EXHIBIT NUMBERS 13 AND 14 WERE MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q• Would you look at these documents and tell me whether you have any familiarity with them or not. We will mark these Mozingo 13 and 14. A. I don't recognize, or I don't have any familiarity with this document. Q. Do you recognize any discussion at the Tobacco Institute about the number given out by Attorney General Califano about how many deaths per year cigarette smoking causes? A. No, ma'am. , . 00-232-6878
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~CI~-R `~"'Z~'1G0, 9/25/97 ~ .:~aO_ _4Z :D 6 7 8 9 ~ 11 ~ N ¢ 12 N S 13 14 0 15 18 20 21 22 23 24 25 A. That would be about the time I 'Left the Instit•.:te. 1 think I left there on June 1st, '88. 1. Now, here's a document dated May 16th, 1998. Do ..c!, recail,ever seeing that document? That will be marked as Mozingo Seven. Let me read it: "Claims That Cigarettes are Addictive Contradict Common Sense." MR. GOOLD: Objection, mischaracterization only in that you've read the sort of capital part, not the full text of the document. MS. HONDORF: I'11 clarify that. It's a press release that says that very statement. MR. GOOLD: Objection, mischaracterization. (MOZINGO EXHIBIT NUMBER SEVEN WAS MARKED FOR IDENTIFICATION.) THE WITNESS: I don't recall, you know, reading that document. I can't deny that I received a copy of it; but I just don't remember it. BY MS. HONDORF: Q. In your tenure at the Tobacco Institute, was it common for you to get copies of news releases? A. Pretty much so, yes. Q. Do you recognize that as Tobacco Institute- generated document? A. Yes, ma'am. NATIONWIDE COURT REPORTING, LTD. 800-232-6878 w N
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R^Z_P MCZINGO, 9/25/97 ?Az= _=2 4 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 :::dustry Research Committee and *he ;obacco Institute. Have you ever seen this document? - No, ma'am. I worked at the Tobacco Institute for 14 years, and I never once heard the name "Tobacco -:,stitute Research Committee." Q• So is it fair to say that they had changed their name to the Council for Tobacco Research by the time you were there? A. I really -- I have no idea. Q. You don't know? A. I do not know. (MOZINGO EXHIBIT NUMBER 17 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Okay. Fair enough. Here's a document we will mark Mozingo 17 called "Answers to the Most Asked Questions About Cigarettes. How Many Questions Have You Asked About Cigarettes?" Do you recognize this document? A. It looks like a copy of a previous document. I recognize this as being a Tobacco Institute document. Q. Does it.look like one of the same ones, do you think? A. I think so. Maybe I didn't read them both that carefully, but it looks like a repeat. It's the one I
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RC'==R -yCZI-NGO, 9/25/97 PAGE 145 2 Y 6 7 8 9 11 13 14 15 16 20 21 22 23 24 25 y. Yes, ma'am. ,~ . :?ere' s a dccumer.t from 1976, titled "On Smoki ng. " ::'s "'rom the Tobacco Institute. It has a legend on the '-ac:c, the Tobacco Insti*_ute. Let me ask you a question just as a side thing about the address at the Institute. A. Uh-huh. Q. This one says 1776 K Street. Is that the address that the Institute was at the whole time you were there? A. Part of the time. The TI relocated to 1875 I Street later. I don't remember the year. Q. Would it have been in the late '70s? A. Late '70s or early '80s. Q. Well, the reason I'm asking this question is I believe it might be possible to date a document by the time that they changed addresses. A. I know we were at 1776 when we celebrated the big anniversary. Q. What number would that be? A. Well, it was the anniversary our country. Q. Oh, that anniversary, the 200th. I thought meant the TI anniversary. A. Oh, no. Q. Sorry. you A. I was speaking about the anniversary of our COURT REPORTING, LTD. 800-232-6878
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Fa== enough. Do you recall anything about 2 4 C 7 8 9 ,0 11 13 14 15 16 17 19 20 21 22 23 24 25 sc,r,et^,i::g called the Califano bumper sticker? ~ . :vc. :Do you have a copy? ":S. ::CNDCRF . Yeah. This document is dated 1979. This refers to t:e Califano bumper sticker. We'll call it Mozingo 15. (MOZINGO EXHIBIT NUMBER 15 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. It refers to the number of publications that TI put out in 1979, and it refers to something called the :.alifano bumper sticker, which I'm very curious about. MR. SCHROEDER: What's the question? MS. HONDORF: Does he know what that means. THE WITNESS: No, ma'am; I don't recall a Califano bumper sticker. MS. HONDORF: Fair enough. THE WITNESS: I don't recall what it is. (MOZINGO EXHIBIT NUMBER 16 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Here's a document that we will mark as Mozingo 16 entitled, "Background on Tobacco and Health Research." It is a joint document by the TIRC, which is the Tobacco , . - - 8
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9/25/97 1 L 4 D 5 7 8 9 ~ 11 ~ N W 12 N S 13 C i kh ~ N 14 15 I 20 21 22 23 24 25 t:^_ey' re 7-D 'ing the dialogue. MR. SCHROEDER: Okay. JY `,'.S . :?C:VDORF . Y. And it has a little cut-out on it. Are you ~am=yiar with that program in that document? Pardon me. We have three minutes on the video. Do you want to review that while we're changing tapes? WITNESS: Sure. Go right ahead. VIDEOGRAPHER: This concludes Tape Number Two of the Roger Mozingo deposition. The time is 3:27. (PAUSE.) VIDEOGRAPHER: This is Tape Number Three of the Mr. Roger Mozingo deposition. The time is 3:30. THE WITNESS: This is a Tobacco Institute document, and I do recall having seen that. BY MS. HONDORF: Q. Do you recall this particular program of speakers? A. These were employees in the Public Relations Division. Q. Did they -- are you familiar with the program that -- this is advertising, the speaking program? A. They responded to and solicited speaking engagements. That's the extent of what I remember about it. , LTD. 800-232-6878
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~.~_=R `f:Z:VGG, 9/25; 97 1 L z 6 7 9 m ~ 10 ~ LL 11 ZS ~ N a 12 W h S 3 14 15 16 a 17 ~ 0 c~s 18 > m ~ 19 W S 20 21 22 23 24 25 ^ocume:.ts or publications of that type? A. T th'_n;c so, yes. who would have preparedthose documents for the 7:-bacco Institute? A. The Public Affairs Division, Public Relations Division. Q. Public Affairs and Public Relations are the same thing? A. I'm sorry, Public Relations. Q. Is there a specific person that you can think of that had prepared those documents? A. No, ma'am. Q. Would it have been a scientific person? A. I really, I can't say, because I just, I don't know who might have prepared this document. Q. But it's your recollection that it Public Relations Division? came from the A. Documents generally were -- yeah, handled by, or came from, or circulated by the Public Relations Division. Yes, ma'acn. Q. So it's fair to say that publications dealing with science and health, such as this document and the document that I showed you earlier about cigarette smoking and cancer, would have been prepared by members of the Public Relations Division? • • ' - 'P
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K.~==~ .'~ZINGO, 9/25/ 97 _.. ` -.T , ; .' H ... , before we -- M S . HC:vDCRF . Ch, be_`^,re we get out of - :.:re. (MOZINGO EXHIBIT :VUMBER 10 WAS D 6 7 8 13 14 15 17 20 21 22 23 24 25 ~'.P.RKED FOR IDENTIFICATION. ) BY MS. HONDORF: Q. Sure. This one marked Mozingo 10 entitled "Answers to the Most Asked Questions About Cigarettes: Your Review of the 1982 Tobacco Institute Advertising. Program." A. I recognize -- yeah -- I recognize that, yes. Q. Do you recall seeing the document? A. I think I do remember seeing that, as a matter of fact. It's the kind of document I would have read. Some of the others were too lengthy. Q. When it says "your review," who does that refer to, "your°? Do you have any recollection? A. No, ma'am. I don't know why "your review" would be the nomenclature there. Q. Do you have any knowledge of who would have prepared this particular document? A. No, ma'am. Would it have come from the Public Relations Department? A. Absolutely.
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~'9/25/97 =H:_ _~3 1 tc'd you I K jo i t thought I would have read. ~s a Tobacco ~.^.stltute document? You ~-ecog:::ze ;t? '.. 7es, ma' am. :o you have any idea who would have prepared this 6 7 8 9 10 11 H s 12 W S 13 14 ~ 15 N N 16 I 17 a Z O - ~ . 18 > m 5 c°~ 19 W F=~. 20 21 22 23 24 25 document? A. No. Q. There's a signature here by Samuel Chilcote. Would he have written it? If you don't know, you're perfectly within the purview of saying so. A. No, I don't know. Q. Okay. Here's a document from 1979 called IfFact or Fancy." It's the Tobacco Institute on the front. It's about women and smoking. Do you recognize this document which will be marked as Mozingo 18? (MOZINGO EXHIBIT NUMBER 18 WAS MARKED FOR IDENTIFICATION.) THE WITNESS: It is a Tobacco Institute document. I don't -- I don't recall having read that document. No, ma'am. BY MS. HONDORF: But do you recall -- you recognize it as a Tobacco Institute document, even though you didn't read it? A. Yes. W
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tC'==R `^.CZiNGO, 9/25/97 PAuE _,y Those were company decisions. it's not 2 someth_ng that the Tobacco :nstitute would have been engaged in. ~-o 4id you -- if letters -- if correspondence or 5 6 7 8 9 13 14 15 16 18 20 21 22 23 24 25 i:,for-.ation came to you that dealt with -- that dealt not with the Tobacco Institute, but with the tobacco industry -- is it your practice to forward those documents to an affiliate or representative of the tobacco industry? A. Not necessarily. Q. Under what circumstances do you forward that information, or did you forward that information? A. I don't recall. I don't recall the circumstances that prompted me to send this note. Q. So you have no recollection of this note? A. No, not until you showed it to me. Q. And you have no recollection of the previous exhibit, Mozingo Four? A. I would never have remembered that document if you hadn't shown it to me. MS. SALZMAN: Off the Record for a few minutes. VIDEOGRAPHER: Off the Record at 3:01. (DISCUSSION OFF THE RECORD.) VIDEOGRAPHER: Back on the record at NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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:'C L_- tiGO, 9/25i'97 ?=,:,? _~, i,o you recall whether they ever spoke to any of :^e Y 6 7 8 9 1V 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ~eop'_e :',:at you kr.ew _:n your various activities i^ =^e .,_a: es? T!:ey would, one or two of them would address, for exampie, meetings of wholesale distributors when they didn't have anybody else to send. Yeah, I mean, they would address industry groups. Q. Would they address a group like the Lions Club the Kiwanis Club if asked? A. If they were invited to do so. Q. would they be paid? A. Would they be paid? Q. Uh-huh. A. It was a part of their salary. I mean, they wouldn't be paid extra to do that. I mean, it was part of their regular salary. or a Q. What I'm driving at would be like would the Lions have to pay the Tobacco Institute, or would this be sort of a service? A. It was a service. Q. And it was not a charged service? A. No, ma'am. Q. Do you know of any states in particular off the top of your head where they went and gave presentations? A. I can't name, no. , . 800-232-6878
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:iC'3ER V'--ZiNGO, 9/25/97 ==ti*-~~ _-7 = = ...._s cr^gram? L :Vo, ma' am. iMOZINGO EXHIBIT NUMBER 21 WAS ~ 10 ~ ~ ~ 11 ~ ~ 12 9 (L 17 ~ ~ 18 > m Q ° U 19 W I 20 23 MARKED FOR IDENTIFICATION. ) BY MS. HONDORF: Q. Thank you. Mozingo Number 21, from the '80's, I can gather from the document. That's during your tenure. It's got "Answers" -- again, this is another booklet entitled, "Answers to the Most Asked Questions About Cigarettes." It's in a different form. A. we have already looked at this one, ma'am. . 0 7 8 9 13 14 is that they had many forms of the same thing. A. Yes. That's a Tobacco Institute document. booklet, I don't think. I believe -- and this is what I'm trying to get to with our document recognition -- 15 16 Q• Were any states, to your knowledge, excluded from we haven't looked at that particular form of that Q. Thank you. Do you have any knowledge as to who prepared this document? A. No, ma'am. 21 22 Q• Would it have come from the Public Relations Department? A. Yes, ma'am. 24 25 , . - - 8
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'^.CZ:VGO, 9/25/97 YA _C _:~ 1 L A • = d:.n' t know. (MOZINGO EXHIBIT NUMBER 25 WAS YA.=c:cED FOR IDENTIF ICATION. ) - - VS. ::C~,'DCRF : Here's a document from 1984 entitled "The Cigarette 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Controversy; Why More Research is Needed. A Review by the the Tobacco Institute of Recent Medical and Scientific Evidence Presented to the United States Congressional Committees." This.will be marked as Mozingo 25. A. Excuse me. Did you say you had a date on this one? Q. It's from 1984. I believe it's on the back of the document. A. Oh, I'm sorry. Q. But I can't be sure. I looked at them all. A. Yes, you're correct. I don't recall this one. I don't doubt that it's a Tobacco Institute document. Would the fact that it's prepared for a Congressional committee indicate it was from Public Affairs or from the Federal Relations Division? A. Public affairs. Q. Still from the Public Affairs? A. Yes, ma'am; Public Relations. We're using those names interchangeably, but Public Relations, Public I COURT REPORTING, LTD. 800-232-6878
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Q. Wou'_d a film prepared by the Tobacco Institute have 0 15 ~ ~ N hee^ . der _t:e aegis of :he Pub'__,. Re,ations Division? y. ies, ma' a;n. 4 6 7 8 9 13 14 16 20 21 22 23 24 25 (MOZINGO EXHIBIT NUMBER 24 WAS KARRED FOR IDENTIFICATION.) BY :`dS. 'rIONDORF : Q. Here's a document that we also can't date. It's got some handwriting on it. I do not know where it came from. It was on the document when we got it. It's called "The Cigarette Controversy, Eight Questions and Answers," once again, in another form. It will be marked as Mozingo Number 24. A. I don't recognize it. The other two or three that we looked at, I guess, addressed seventeen questions and answers, and this one addressed eight. I don't have any reason to believe it's not a Tobacco Institute document. Q. would this type of document have emanated from the Public Affairs Division, once again? A. Yes, ma'am. Q. Thanks. Seventeen questions? A. Right, or eighteen, or whatever it was, seventeen or eighteen. Q. I guess since time we went by there were more questions. , . 800-232-6878 ko
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RC0'-:'R XCZytiGO, 9/25/97 ?A2~ _:72 L 4 6 7 8 9 ~ 11 ~ N ¢ 12 W N S 13 14 15 16 20 21 22 23 24 25 BY MS. ::CNDCRF : Co you :ecollact t::is document? ~.. Well -- :.o, ma' am. (MOZINGO EXHIBIT NUMBER 29 WAS MARKE~ FOR IDENTIFICATION.) BY MS. HONDORF: Q. Okay. This is a page from the United States Tobacco Journal. It will be Mozingo Number 28. Would you give me a little background on your knowledge of what the United States Tobacco Journal was, if you know it? A. It's a trade publication that covers events, sales trends, selling, buying business, that sort of thing. And that covers the tobacco industry. It's just like Advertising Age covers the advertising industry. Q. Well, this appears to be a piece from Advertising Age reproduced in United States Tobacco Journal entitled, "The Truth Seems a Little Twisted," and then it is a report by the Tobacco Institute on something they apparently didn't like. Are you familiar with that document? A. No, ma'am; I am not. Q. Are you familiar with the subject, even, of the blurb in the middle of the page? A. Well, it appears the ad is calling for fairness in REPORTING, LTD. 800-232-6878 N
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uCZI-NTGO, '9/25/97 =A== -s- 1 7 8 9 ~ 11 ~ N W . 12 y S 13 14 15 20 21 22 23 24 25 s=fsirs• They're the same, basically. would have been Public Affairs who prepared ~::e document. Is that correct? Yes, ma' am. (MOZINGO EXHIBIT NUMBER 26 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Thank you. Here's a document entitled, "Some Answers for the Smoking Public. Today from the Industry Itself, Comes This 11-Point Report Contradictory Issues of Our Time." orl One of the Most There's a Tobacco Institute legend on the back. It will be Mozingo 26. Again, I have no date. A. I don't recognize -- I've never seen this before. Q. But you have no reason to doubt that it's from the Tobacco Institute? Well, there actually is a date on here. It says "Proposed ad Number Two, 1962," well previous to your tenure. Here's a document called -- this appears to be the same form, the same ad in a different form -- "Some Answers for the Smoking Public" with the same legend about the 11-point report, Mozingo 27. (MOZINGO EXHIBIT NUMBER 27 WAS MARKED FOR IDENTIFICATION. m -4 ~ 800-232-6878
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, , L 6 7 8 9 m ~ 10 LL ~ 11 ~ N a 12 13 14 15 16 a 17 Z) 0 } 1 m 9 19 W H 20 21 22 23 24 25 r Y^ZiNGO, 9/25/97 :ri..:= -~j terms of treatment of advertisers. I don't argue with ..::a:. . ~. But you don't know what it refers to? A. No, ma' am. Q. And what the issue is? A. No, ma'am. (MOZINGO EXHIBIT NUMBER 29 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Okay. Thank you. The next document, Mozingo 29, is from the tobacco industry, "Some Frank Words About Smoking and Research," bears the Tobacco Institute legend at the bottom. A. What year? Q. I don't have a year, but it's 808 17th Street. Is that an address you recognize? A. No, ma'am. Q• You don't even want to look at it? A. Oh, certainly I'll look at 'it. I've never seen this. Q. Thank you. These two are dated '69 and '63. Let me ask you this: Did you see any documents when you first came to the Tobacco Institute that may have pre-dated your tenure there? REPORTING, LTD. 800-232-6878
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`^.CZINGO, 9/25/97 :-,,^_ _,; 9 Would this document, to your knowledge, ever have ~ 5 5 7 8 9 m g 10 LL ~ 11 ~ N a 12 W N S 3 14 15 ~ ~ ~ N 16 17 a ~ 0 x ~ 18 > m ~ c°~ 19 z ~ 20 21 22 23 24 25 _eac::ed a public person or a consumer? , Y = can't answer that. Wcu'_d a consumer -- let me strike that. Would the Tobacco Institute advertise the availability of a booklet like this and ask the public to request it? t A. I don't know. I don't know whether there was a program of that sort or not. Q. Fair enough. Here's another document that I'm having trouble with a date. This is a joint document, which will be Plaintiff's Exhibit 12 -- or Mozingo 12, sorry. It's a joint document from the Tobacco Industry Research Committee and the Tobacco Institute entitled "A Statement About Tobacco and Health." (MOZINGO EXHIBIT NUMBER 12 WAS MARKED FOR IDENTIFICATION.) MS. HONDORF: I will represent to counsel that the little star on there was made by me on probably the tenth generation copy back. BY MS. HONDORF: Q. Do you recognize that document? A. No. No, ma'am. I don't know -- no, I don't recognize it. Excuse me. , . _
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K_yR ":~Z:NGO, 9/25/ 37 ?A::E :54 G ;~. Zo you have any recollection of who that docuTer.t was distributed to? No, ;,1a' am . r1hc :.hat document was prepared by? 6 7 8 9 13 14 15 16 20 21 22 23 24 25 A. tio, ma'am. (MOZINGO EXHIBIT NUMBER 19 WAS MARKED FOR IDENTIFICATION) BY MS. HONDORF: Q. Okay. - Mozingo Number 19, a document entitled "A Two-way Street,° bears the Tobacco Institute legend on the front. And I'll ask you if you have any recollection of this document? A. I don't remember this document, but it certainly appears to be a Tobacco Institute document; yes, ma'am. (MOZINGO EXHIBIT NUMBER 20 WAS MARKED FOR IDENTIFICATION) BY MS. HONDORF: Q. Thank you. The next document will be Mozingo 20. The first page bears the legend, "You've Seen Them on 'Good Morning America,' 'Today,' 'Tomorrow,' 'The MacNeil/Lehrer Report,' the 'David Susskind Show,' and the network news. Now hear them in person at your club, meeting or convention." MR. SCHROEDER: That's the title? MS. HONDORF: Well, that's the way
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-C~~R M'-ZINGO, 9/25/97 PAGE _67 T'.:ese documents were givern to us during discovery I 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 -=~m the Tobacco :nstit::te. A. I dcn't recall having seen these backgrounders or read them e"ven -- seen them or read them, even, that 1 remember. Did you receive any kind of backgrounders in your tenure at TI? A. You know, I can't deny that I -- I may ::ave received them, but I don't recall reading them. Do you have any recollection of who would have prepared a backgrounder? A. No, ma'am; I don't. Q. So it's your testimony that you can't tell me anything about these three documents? Is that correct? A. I can't tell you what I don't know. Okay. That's fair enough. I don't want you to speculate. A. All right. Thank you. (MOZINGO EXHIBIT NUMBER 34 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Here's a.document that appears to be a magazine article entitled, "The Cigarette Controversy," by Horace, Kornegay, dated September 1980. It will be Mozingo 34 if I can get the sicker off. 1 1 REPORTING, LTD. 800-232-6878
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!~CZINGO, 9/25/97 4 :1 6 7 8 9 10 11 12 13 14 0 15 16 17 ia 19 20 21 22 23 24 25 IMCZINGC EXHIBIT NL'MBER 22 WAS XARK,ED FOR TDENTIF:CATICN. ) VS. :iCNDCRF : Here's a document entitled "The Anti-Smoking Campaign, Enough is Enough." It's from 1987/'88, best I can gather. It will be marked Mozingo 22. Do you recollect this document? A. I don't recall this document. the (MOZINGO EXHIBIT NUMBER 23 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Okay, fair enough. This really isn't a memory test. We're trying to authenticate some of these documents. 1975, a document entitled "The Answers We Seek, a Tobacco Institute film" marked as Plaintiff's Mozingo Exhibit Number 23. A. I don't recall this one. Q. Do you have any reason to believe that it's not a Tobacco Institute document? A. No, ma'am. Q. But you.don't -- I think that Ms. Salzman asked you earlier if you are familiar with any films or anything prepared by the Tobacco Institute. A. Yeah, and I'm not familiar with this document. , LTD. - - pp
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RC=ZR MOZ1NG0, 9/25/97 PAGE 1--, Y ~ N L 4 5 6 7 9 10 11 a 12 ~ 13 14 1 15 20 21 22 23 24 25 smoking ban. The Tobacco Institute would know to take a pcsltion which was favorable to not legislating a .,-ncxi::g ban. A. cur position was that -- and we discussed this a bit earlier -- but our position was that owners and managers should dictate, you know, where their clientele could or could not smoke. I mean, that was one of our arguments. Q. So is it fair to say that on a given issue, the Tobacco Institute would take a policy position which was favorable to the industry's position? A. Well, I think you would have to -- I think that's a pretty broad comment. Q. You don't believe you can answer that as a yes or a no? A. I don't think so. Q. I think it's easy. It's either a yes or a no question, but if you don't agree with me, then I'm,not going to argue with you. A. No, no, no. It would depend on -- MR. GOOLD: Objection. Wait. Wait. Wait a minute. Objection, argumentive. BY MS. HONDORF: Q. Well, let's phrase it this way: Could the Tobacco REPORTING, LTD. 800-232-6878 00
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c~_= c tit'-Z=NGO, 9/25/97 PAGE _--Z4 L A. i don't recall any. I don't recall any specific uoc::Tents. No, ma'am. You didn't make ic a point to review files or Y 6 7 8 9 13 14 15 20 21 22 23 24 25 a^.r=:.ing of any sort? A. No, ma'am. (MOZINGO EXHIBIT NUMBER 30 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Here's a document. We will mark this as Mozingo 30. It bears the legend, "The Cigarette Consumer Controversy: A Lecture That Has Been Presented by Members of the Staff of the Tobacco Institute to Civic and Social Clubs and Professional Groups As Well As to Graduate and Undergraduate Students in Journalism, Business Administration, Communications, Health Education, Political Science, History, Sociology and Economics," dated January 1981 from the Tobacco Institute. The first question is: Do you recognize this document? A. Did you say this is a speech? Q. That's what it says on the front. I was reading verbatim. A. A rather long one. No, ma'am, I don't recognize -- I couldn't have sat through that. It's too long.
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j Y 11 ~ N ¢ 12 N S 13 W S r A. 1;c:.ow what a backgrounder is, but I don't ;c ncw w :e~ :er -- ,v:y don't you explain to me what a backgrounder _s? We' 11 go from there. A. It's a document that gives, in rather short version, top-line information on a subject. 6 Q. Did you say "top-line"? 7 A. You know, basic information on a subject. Q. Would it be the policy of the organization that prepared the backgrounder, contained in the 8 9 backgrounder? speculation. 14 MR. GOOLD: Objection; calls for THE WITNESS: Can you show me a backgrounder you're referring to? BY MS. HONDORF: Q. Well, that's one (indicating). Here's another one entitled, "Health Effects of Smoking Low Tar Low Nicotine Filter Tipped Cigarettes," which will be marked as Plaintiff's Mozingo 32. And here's another one marked Mozingo 33, "General Background on Smoking and Health.". (MO2INGO EXHIBIT NUMBERS 32 AND 33 WERE MARKED FOR IDENTIFICATION.) BY MS. HONDORF: 20 21 22 23 24 25 NA NWID COURT REPORTING, LTD. 800-232-6878
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~~_=K 'f^Z1N00, 9/25/97 ?~~E - - concern abcut that piece of legislation. Yz)u represented for the major part -- if I'm nct 7 8 9 ~ ~ 10 LL ~ 11 6 _.,_rec~: in this, tell me -- the major funding for =he -c'_-acco I:,stitute was from the tobacco manufacturers. :s t'-:at correct? A. That is absolutely correct, but that's not to say that other industry segments wouldn't be concerned about a piece of legislation. I understand that. But the Tobacco Institute was .. y W . 12 N S 13 14 15 16 ~ 17 0 a ~ 18 > m x c°~ 19 W 2 I- 20 21 22 23 24 25 Q. not in the business of taking their side on anything. Is that correct? It was only the major funding? Is that correct? I just asked you two questions, I'm sorry. MR. SCHROEDER: Yeah. I was going to object, compound. THE WITNESS: "Their side" meaning the other industry segment side? BY MS. HONDORF:. Q. Uh-huh. A. Our positions were parallel. Q. They could be in some respects on the same track; is that correct? A. Yes, ma'am. Q. They could also, in some respects, not always COURT REPORTING, LTD. 800-232-6878
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:r.CZ:NGO, 9/25/97 _ ~- --- =r. 0 4 ':MOZINGO EXHIBIT NUMBER 36 WAS `^.ARKED FOR I^EN'':'IFICATION. ? 3y MS. nCNDORF : ti. And I ask you if you recognize it. I should have t1:ree of these. I don't know what happened to them. A. I recognize it as a Tobacco Institute news release, 6 7 8 9 10 11 12 but I'm not -- I can't tell document. Q. you that I've seen that You would call it a news release, not a newsletter? A. No. I see that as a news release, or a news report, news release. I don't see that as a newsletter. what would be the distribution, if you're aware? 13 14 15 16 17 18 19 20 21 22 23 24 25 Q• A. I am in no way aware. Q• Would this document be prepared by Public Relations, Public Affairs? A. Yes, ma'am. (MOZINGO EXHIBIT NUMBER 37 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Thanks. Here's another document entitled "Women and Smoking.°. There's a paragraph that talks about the Tobacco Institute, third paragraph down, first page in, Mozingo Number 37. Do you recognize this document?
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.K_-_R Z1VGC, 9/ 2 5 /9l ?l'1JC. 17') A. I don't recall having read this document. It 4 5 6 7 9 10 ~ 11 .. N W 12 N S 13 14 ~ N NO 'y6 m 20 21 22 23 24 25 :.er,:ai::'_y appears to be a Tobacco Institute document. :.::d, again, it would be prepared in our Public Relations Q. Do you recall ever seeing it, as opposed to reading it? A. I don't recall -- I can't deny having seen it, but I don't recall, you know, reading that document. Q. Forgive me if I asked you this before; but was it a regular occurrence for you to be copied on the type of information that came from the Public Relations Division? A. Pamphlets and things of this sort, I would get in distribution, yes. Q. So would -- they would, as a general course, provide them to you so that if you wanted to send them around the country you could do so? A. Generally speaking. Q. We need to back -- what does "generally speaking" mean? You've got all, not all, some? A. I can't tell you that I got them all. I'm sure I got some. But I can't tell you I got every document they put out. We're talking about documents, pamphlets, think of that sort, sure REPORTING, LTD. 800-232-6878
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9/25/97 2 4 5 6 7 8 9 a ~ 10 ~ ~ 11 a 12 13 14 15 N 16 17 a D 0 cc 18 > m ~ 0 19 U W S 20 21 22 23 24 25 ~.^.sti~'ate take a position that was in opposition zo an ind•.:st:y position? A . Wei_, we formu?ated t'.:e position at the Tobacco you know, in cooperation with our State Aczivities Committee. We never got into the situation of having to make that choice. Is that helpful? Q. No. Could the Tobacco Institute take a position that was in opposition to an industry position? MR. GOOLD: Objection, calls for speculation. THE WITNESS: It don't recall -- you know, you can't put every piece of smoking restriction legislation -- for example, it's not a blanket. You'd have to look at a piece, a particular piece of legislation. MS. HONDORF: Uh-huh. THE WITNESS: If the legislation referred to banning smoking in youth centers, we certainly wouldn't oppose, you know, that.legislation, or that part of that -- if the legislation banned smoking in restaurants or places of business, we would oppose that. So it's not an either/or. BY MS. HONDORF: Q. Banning smoking in youth centers, being in favor of that would be an industry pro-position. Is that correct , . - - B'78
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3%25% 37 PAZ;B Y 5 6 7 8 9 13 14 15 16 17 a Z 0 Q 0 18 I ;MCZINGO EXHIBIT NUMBER 38 WAS MARKED FCR IDFNTIFICATION. ) 3Y `^•S . :GNDORF . ':ere's another document, Mozingo 38, entitled "':c'--acco Institute News." At the bottom it bears the legend -- I forgot this on the last one, this is Mozingo 38, "the Association of U.S. Cigarette Manufacturers." Do you recognize that? A. I can't tell you that I've ever seen it, but it certainly appears to be another press release. Q. Tobacco Institute release, we'll call it, press release? A. That's the way I see it. Q. Okay. Prepared by the Public Relations Division? A. Yes, ma'am. (MOZINGO EXHIBIT NUMBER 39 WAS MARKED FOR IDENTIFICATION.) > m ~ 0 19 W I ~ 20 21 22 23 24 25 BY MS. HONDORF: Q• Here's another "Tobacco Institute News." Do you recognize that one? What's the number? I forgot to read it for the Record, 39. A. Thirty-nine. Q. Same thing? A. It's another news release. REPORTING, LTD. 800-232-6878
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'sCZINGO, 9/25/97 ==%1E _33 L Y 5 7 6 8 9 ~ 11 ~ N W 12 ~ 13 I 14 15 16 A. No, ma'am; I do not. Okay. So you cannot answer my question whether ::is was the stated policy of TI or not? :Vo, I `an't answer that question. Okay. During your position with the Tobacco Institute, did you consider yourself part of the tobacco industry? A. well, certainly I was a part of the tobacco industry. The Tobacco Institute is a part of the tobacco industry. Q. Okay. These are the final mop-ups. What sort of preparation did you do for today's deposition? A. I had -- I met, on three occasions, with these two gentlemen. I had never been deposed before, and I had some awful serious questions about what it's all about. Q. well, it hasn't been so bad, has it? It's been long. MR. SCHROEDER: I didn't tell you 20 21 22 23 24 25 about -- you get to answer questions all day long.. MR. GOOLD: Yeah, objection, harassment. MS. HONDORF: Okay -- THE WITNESS: Would you like to trade chairs with me? MS. HONDORF: Sure. THE WITNESS: No; I'm kidding. REPORTING, LTD. 800-232-6878
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9i"25,37 =A~~ !:.-: BY MS. i-iCNOCRF : G D:d you review any documents in preparation LOr J =:~day's deposition? 4 D r1. No. Q. i:.ese two gentlemen didn't show you any documents? 6 A. (The witness shook his head negatively.) 7 Q. You have to say yes or no,. 8 A No . . 9 Q. Did they show you this particular deposition m g 10 notice, and this isn't a trick. I just want to attach ~ ~ 11 it as the last exhibit, the deposition notice for the ~ 0 s 12 Barnes case? W y S 13 MR. SCHROEDER: Barnes being t he same as 14 Arch? 0 15 MS. HONDORF: Yes. Some peopl e harassed ~ In N 16 Mr. Arch's family, and he dropped out. 1 a 17 WITNESS: Yeah I guess -- yes That's ~ , . 0 x ~ 18 all I can -- > m ~ c°~ 19 BY MS. HONDORF: W 2 H 20 Q. Okay. Thank you. 21 (MOZINGO EXHIBIT NUMBER 4 4 WAS 22 MARKED FOR IDENTIFICATION.) 23 BY MS. HONDORF: 24 Q. Did you review anybody's deposition testimony, or 25 anything, in preparation for today? , LTD. - - 78
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<C--:=R MOZ :tiGO, 9/25/97 ?A^z _-2 2 2 6 7 8 9 ~ 11 ~ N W 12 y S 13 14 15 16 20 21 22 23 24 25 A. So. "Sc," okay. n. Okay. 4 . Do you have any recollection that the Tobacco Ir.stitute had any outside consultants who might have prepared this type of scientific document? A. I'm not aware of who they would be. I'm not aware that the TI had outside consultants to prepare that document. Q. Thank you. (MOZINGO EXHIBIT NUMBER 43 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. This document is from 1978 to the TI staff from Mike Craig. Do you recognize that name? A. Mike Craig; yes, I do. Q. who is Mike Craig? A. He was a person who worked for a short period of time in Public Relations. As I recall, Public Relations; yes, ma'am. Q. This is Mozingo 43. It says: "The following is the official TI statement with regard to the 1977/'78 health consequences of smoking, the mandated annual report to Congress by HEW." Do you recognize this? , LTD. - 32- 8 8
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Rv":JR N^ZfNGO, 9/25%97 rAGE _~5 0 N O 1 6 7 8 13 14 15 16 20 21 22 23 24 25 No, ma'am. MS. HCNDORF: I think I'm finished. --:ea;emen, does anybody have any -- MR. GOOLD: Yeah, I have a few, Shirley. MS. HONDORF: Sure. Thank you, Mr. Mozingo. WITNESS: Thank you. EXAMINATION BY MR. GOOLD: Q Mr. Mozingo, during the questioning this morning, there was some mention of licensing legislation. And I believe in that connection, you've made reference to wholesalers. Do you recall that, generally? Do wholesalers need licenses to sell tobacco? No, retailers. If I said "wholesalers," I misspoke. It's retailers are licensed by the state. Q. Okay. Thank you. Do you know whether Mr. Kloepfer attended the Committee of Counsel meetings you attended? I don't recall being -- I don't recall being in a meeting at the same time as Mr. Kloepfer. It's not beyond the realm of possibility that he was there. I would expect he did attend some. I just don't recall being there at the same time. Q. Now, you received legal advice from the Committee
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r XCZINGO, 9/25/97 , - But you recall the campaign that's behind it ceing one that we spoke about before? It iocks to me . 5 6 7 8 9 ~ 11 ~ N W 12 N S 13 14 20 21 22 23 24 --:ce another form of the same campaign, or ar.other as year? ~ agree, yes; yes, ma am. The TI is offering this pamphlet through responding to -- by ordering the pamphlet. Q. And they're advertising the pamphlet in the national publications. That's what I get from the document. A. It certainly appears that way; yes, ma'am. Q. Thank you. We only have two more. (MONZINGO EXHIBIT NUMBER 42 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Now, we have a giant document from 1979 labeled -- entitled, pardon me, "Smoking and Health, 1964 through 1979: The Continuing Controversy." It bears the legend of the Tobacco Institute, January 10, 1979. This document was'prepared for distribution to news media on January 10, 1979, one day prior to receipt by the Tobacco Institute of the 1979 report of the_ Surgeon General on smoking and health. Do you recognize this monster document? I know you're going to tell me you didn't 25 read it. NATIONWIDE COURT REPORTING, LTD. 800-232-6878 co
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CZ1tiG0, 9/25/97 rAO-_S5 1 L cf Counsel, correct? a. Cn occasion. :,o you know whether Mr. Kloepfer also got legal 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 aa'v:ce from the Committee of Counsel? Do you kr.cw whe:her or not he did? A. I don't know whether or not he did, but if he asked them, I would assume he did. Q. Briefly, on a document which I believe was Exhibit Two this morning -- which I would ask the court reporter to pull just for a minute -- if you can -- it's the August 3, 1979 memorandum I believe you indicated you wrote referring to pre-adult education. Do you have that in front of you? A. Yes, I do. Q. At the bottom of the first page -- first paragraph, rather, you refer to -- and I'll read the sentence, quote, "To try to talk to kids through any medium will, in all probability, be misunderstood and create a backlash," close quote. Can you explain what your concern was? A. Well, I think I expressed my opinion about this pre-adult education program, that -- I do recall this morning saying that this could be referring to the Helping Youth Decide program. I'm not certain it was. I'm not certain NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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Y 5 6 7 8 9 m ~ 10 ~ ~ 11 ~ y ¢ 12 W y S 13 15 21 22 23 24 25 Y-="=R `/--Z=VGO, 9/25/97 :A.:7- _72 -- ~' .,, .:s-.^.g your own example -- the industry to take -::e pro-position on :.hat, t:^e same as the Institute. I; =::at correct? A. We would not oppose that legislation. Q. Was banning cigarettes -- strike that -- banning smoking in a restaurant, you would oppose that legislation? A. I'm sorry. would you say that one more time? Q. Okay, sure. I'm using your two examples. A. Okay. Q. We have the youth center, we have the restaurant. The issue of banning smoking in restaurants would be -- you would oppose that legislation? The Tobacco Institute would oppose it; is that correct? A. Yes. Q. Would the tobacco industry oppose it? A. The tobacco industry would oppose it. When you say "industry" now -- Q. I'm speaking of the members who fund the Tobacco Institute as the industry. A. Well, but the industry is much broader than the -- the industry is much broader than the manufacturers who fund the Tobacco Institute, their trade association. There are many more segments to this industry. There were other groups who would have a 800=232-6878 m
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, 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 :f~--ZINGO, 9/25/ 97 ?A::E : 3 ~. :t's from the Tobacco I.^.stitute? A. _es, ,,a' am. Y. Therj's no doubt in your mind? A. = dor.' t doubt it. Q. Okay. Thank you. Is it fair to say that this is a date for that? When it says 84-05, are you familiar enough with it to date it that.way? A. I'm not that familiar. Is the date not posted on the front? Q. No, it's not, which I find it odd. But it says "Contact: William D. Toohey." Do we know his years? Would he have been in the mid '80s? A. I think he would have been in the early '80s, early to mid '80s. But he was not there very long, as I recall. Q. Would Mr. Kloepfer be able to answer these questions, do you think, about a time frame for Mr. Toohey? A. I believe he would, yes. (MOZINGO EXHIBIT NUMBER 40 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Thanks. Plaintiffs' Exhibit 40, Mozingo 40, is another Tobacco Institute News. Again, I think it's from 1984, and it has Mr. Toohey's name on it. Do you , LTD. 800-232-6878
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RC,J=P YCZI.NGO, 9/25/97 PAGE 132 , L 4 D 6 7 8 9 10 11 12 13 14 ~ 15 vf N N 16 ~ 20 21 22 23 24 25 (DEPOSIT:ON WAS CONCLUDED AT 4:18 P.M.)
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YC=7? „vZ:vGO, 9%25i37 :A1-'7 _33 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 s~---rategy? Did he have any responsibility for iJr.^.ulating strategy, to your knowledge? A. Not ro my knowledge, no. ;~. ::ow about industry strategy or policy; did Mr. Panzer have any responsibility, to your knowledge, with respect to formulating either of those? A. No. Q. Did you, from time to time, receive copies of memoranda Mr. Panzer prepared? A. I don't remember receiving any. Q. Let me ask a more general question then: Did you find Mr. Panzer to be a reliable source of information about subjects like industry strategy or policy, in your experience with the Tobacco Institute? A. No, I didn't find Mr. Panzer to be someone I would seek for advice on any subject within my responsibility, no. MR. GOOLD: No further questions. MS. HONDORF: I just want to clean up a couple of things. REEXAMINATION BY MS. HONDORF: Q• Did TI, to your understanding, have its own counsel? 25 A. During a short period of time, there was an # LTD.
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~'.OZ1NG0, 9/25/ 97 ~:-: L 4 n 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 recognize this? A. :' d put it in t::e same category with the other :___ee or four we just iooked at; yes, ma'am. ,4 • It _s•a Tobacco Institute document, but you don't recall it? A. I don't recall it. Q. Thanks. MS. HONDORF: Do you want to see it, counselor? MR. SCHROEDER: No thanks. (MOZINGO EXHIBIT NUMBER 41 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Number Mozingo 41, the first page says, "Inside is an important Message from the Tobacco Institute That Continues to Reach Millions of Adults in These Publications." And it has a series of national publications on the front. It has an attachment about, once again, "Answers to the Most Asked Questions about Cigarettes." Do you recognize this? A. This appears to be one that we've covered in a different format already with a series of questions. recognize it as a TI document. Q. Do you recognize this front page here? A. No, ma'am; I don't recall seeing that. I NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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-_-- ~~CZI°dGO, 9/25/97 :aG_ E_5 7 4 6 7 8 9 ~ 11 ~ ~ ¢ 12 13 14 15 16 21 22 23 24 25 t~hat a pre-adult education program was ever conducted by zi'r.e Tobacco Institute. 3ut my opinion was that i f the Tobacco Institute, in any way, shape or form, tried to =aik to kids in any means, that we would be roundly criticized; and it would be something that we certainly didn't need. The message really ought to be addressed to parents and not kids. Q. Was the Helping Youth Decide program addressed to parents? A. Yes. Q. So when we look at this document, the August 1979 document referring 3, to pre-adult education, are we -- is it referring to any program that TI actually implemented? A. Not that I recall, no. Q. There was some brief mention of a Mr. Panzer who was at the Tobacco Institute part of the time while you were there. A. Yes. Q. Did Mr. Panzer, to your knowledge, have any responsibility for formulating Tobacco Institute in any area? A. No, not to my knowledge. How about with respect to Tobacco Institute policy REPORTING, . - - $
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-R YCZIVGO, 9/25/97 = ;^_ _ ;_ L ccincide? `~. :n some examp'_?s; yes, ma' am. -o you recall, in your tenure at the Tobacco m 6 7 8 9 10 11 a 12 13 0 14 15 16 17 a D 0 c~ 18 > m a ° U 19 20 21 22 23 24 25 _nstit::te, ever taking a position that was contrary to what the industry manufacturers' position was? A. In terms of a piece of legislation? Q. In terms of anything. But since you want to restrict it to legislation because that was your tenure, you can answer that question first. A. I don't recall taking an opposite position, because I don't recall that there were occasions that would warrant taking an opposite position. Q. So, is it fair to say that on any given issue, the Tobacco Institute would take a policy position which was favorable to the manufacturing arm of the industry? A. Yes. Q. Thank you. All right. We talked about this yesterday, or this morning, and this was not a trick question. There's these documents entitled "Tobacco Institute News." They're, from the best I can understand, by the legend on the back page, 84-03, from 1984, which would be in your tenure. Mark it as Mozingo 36 , . - - 8
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NOV- 1:38 PMy JOKESDAY CLEVELAHDa~ Cy~ ~~FAX x0~~ 2165790212 ~1~.r~10G1E .-9.,7 ., FRI.,, ROGER M02INaO, 9/25/97 PAGS 169 {MOZYNGQ EXHIgIT NvMBIt 35 WAS I 2 MARKED FOR II)ENTIFICATION. ) 3 BY MS. KONbOR6' s 4 0. Kare's a document from a newa article, 1981, from 5 Umaha, Nebraska. Yt's entitled, "More Research needed 6 on TobacCo,, Institute -- strike that. , '7 "More Research Needed on Tobacco Use." 8 The writer iv the Director of Media Relations Eor the 9 Tobaccb Institute in Washington. 10 My Question to you is: Who ie William 11 Toohey, T-O-O-H-H-Y? And I'll show the document, which 12 iQ going to be marked as Mo2ingo 35. ]3 A. William -, Bill Toohey was an employee in the ~. ~ 14 . Public Relations operation. I don't believe he was at 0 ~ 15 the TI very long. ~ 16 I don't recall his tenure there, but I do ~ 17 remember the name, and he was in Public Relations. ~ 18 Q. Do you reaa7.1 that he wrote articles for the ~ 19 Tobucco Ynstitute? 20 A. He waa one of their writers. 21 Q. Would it be eafe to say he #ormulated policy? 22 A. No. I wouldn't go that far with Bill 'roohey. 23 Q. Okay. Is it fair to eay that on any Wiven iesue, 24 that Tobacco xnst•itute would take a policy position 25 which was favorable to the industry? For example, a NATIONWIOE COURT REP't)RTZNO, LTD. 800-232-b878 7nTa P ul
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9/25/97 =h'=- - - 1 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Well, the question is: Did you ever give it? `~ • No, ~.a' am; not that I-- I certainly -- ~. W e:1, you certai:.ly wouldr.' t have cited all the _efe_er.ces, i'm sure. A. I certainly wouldn't have talked this long to anybody; no, ma'am. Q. And it's not a document that you recognize? A. No. I don't recognize it. Q. Do you have any reason to doubt it's from the Tobacco Institute? A. No, ma'am. Q. Now let me ask you a question. We have a series of documents here. We have three that we think the Tobacco Institute referred to as backgrounders. Is that a phrase that's familiar to you? A. I've certainly heard the term. (MOZINGO EXHIBIT NUMBER 31 WAS MARKED FOR IDENTIFICATION.) BY MS. HONDORF: Q. Well, then let me present you with one: Mozingo Exhibit 31, "A Suggested Response to the Charge of Addiction." A. I don't recall this document. Q. Does it refresh your memory as to what a backgrounder is? REPORTING, LTD. 800-232-6878
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RCGcR uCZiVGO, 9/25/97 1 1 E R R A T A S H E E T 2 J 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 RE: Tobacco Litigation PAG^c _34 DEPOSIT=CN OF: Roger L. Mozingo Please read this transcript with care, and if you find any corrections or.changes you wish made, list them by page and line number below. DO NOT WRITE IN THE TRANSCRIPT ITSELF. Return the Certificate and Errata Sheet to this office after it is signed. We would appreciate your prompt attention to this matter. To assist you in many any such corrections, please use the form below. If supplemental or additional pages are necessary, please furnish same and attach them to this errata sheet. Page Line should read: Page Line should read: Page Line should read: Page Line should read: Page Line should read: Page Line should REPORTING, LTD. 800-232-6878
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r_w -97 FRI 1'37 PM J4NES DAY CLEVELAND FAX N0. 2165790212 P. 2 i~ Iu -- r ' G 4 NU~,P-1A-lyY( 1d; 1'f PhKLU'I NHI IUINWIUC d1G -L( -- /.0O i . Do you recognize thie? 2 A. I recognize Horace Kornegay, obviously, but I don't 3 racognize the specific -- I mean I don't recall this 4 newspaper article. That's your questiitm, right? 5 6 7 0. Uh,huh. A. No, ma'am. I don't remember the article. Q, I'm sorry? . I don't remember that article. I know Horace 9 l0 11 12 13 14 15 16 17 18 19 20 21 22 23 24 a5 `. Kornegay. Q 0 1875 Y Street, that's the new addreas; correct? That would be the new address. Go ahead. I'm sorry I interrupted you. A. Y said I know Horace Kornegay, but I don't recall the document. Q. rio you recall Horace Kornegay to be a prolific writer on thie cigarette controversy? . No, ma' am. 0 Not one way or the other? I don't recall that he really wrote on the subject. I think he relied on hie Public Relatxons people to gupply him what he thought he needed. Q- him? So you think that Public Aifaxxs prepared thie for . That would be my guess. NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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`GZ1NG0, 9/25/97 _ - L { Y 5 6 7 A 9 Y 1 1 8 y W 12 N S 13 20 21 22 23 24 25 a. `Icu guessed my answer on that. Yeah, I remember because I thought it was the most __:icuious, weighted piece of paper I'd ever seen. Ncw, T'm going to have to ask you to explain what ..::at means. A. Well, it was just too much to read. Q. Too much for you to read,,or too much for the public to read? A. I wouldn't read that. Q. Do you know who prepared it? A. No, ma'am. Q. You don't believe it came from the Public Relations Division? A. I believe it did. I mean, the Public Relations Division was responsible for the kinds of things we've been looking at here today. Q. Do you have any recollection that a scientist prepared it? A. No, ma'am; I do not. Do you have any recollection that in 1979 there was a scientist on the staff of the Public Relations Division? A. '79, I don't remember. I mean, I can't remember the dates. Q. If you don't remember, say so. . REPORTING, LTD. 800- 32-6878
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D SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK x CATHERINE ZITO, PETER HOBERMAN, x and GEORGE ELISSEOU, individually, x and on behalf of others x similarly situated, x x Plaintiffs, x x Index No. - against - x 110952/96 x THE AMERICAN TOBACCO COMPANY, INC., x AMERICAN BRANDS, INC., COUNCIL FOR x TOBACCO RESEARCH-USA, INC. x Judge Charles (Successor to Tobacco Industry x E. Ramos Research Committee), AND TOBACCO x INSTITUTE, INC. x x Defendants. x x 141063.1 3
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RC-;ErZ XCZ1VG0, 9/25/ 97 -PaGE :90 2 4 did not think, or you did believe -- from Mr. Goold, the ?'.:°-stion from Mr. Goold, that Mr. Panzer was :nstru:;,er,tal in shaping Tobacco Institute policy or strategy. Do you recall that, about five minutes 0 N ~ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ago? A. Yes, ma'am. Q. Who did you understand had that responsibility if Mr. Panzer did not? A. The Tobacco Institute Executive Committee. Q. Did you understand anyone in the industry to have that responsibility to establish policy or strategy? A. No, ma'am. Just -- you're saying -- when you say "industry," may I ask you a question? Q. Sure. A. When you say "industry," you are referring to manufacturers; right? Q. I am. I'm assuming that's what Mr. Goold was, but I don't know because Mr. Goold didn't say. I'm just trying to back off the question that he asked you about Mr. Panzer. A. Okay. Did you understand Mr. Panzer to have any responsibility for making policy or strategy for the industry; and you said "No"? NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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ROGER MOZINGO, 9/25/97 PAGE 196 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 STATE OF NORTH CAROLINA COUNTY OF WAKE C 8 R T I F I C A T 8 I, Lynn B. Gilliam, a Notary Public in and for the State of North Carolina, do hereby certify that there came before me on Triursday, September 25, 1997, the person hereinbefore named, who was by me duly _ sworn to testify to the truth and nothing but the truth' of his knowledge concerning the matters in controversy in this cause; that the witness was thereupon examined under oath, the examination reduced to typewriting under my direction, and the deposition is a true record of the. testimony given by the witness. I further certify that I am neither attorney or counsel for, nor related to or employed by, any attorney or counsel employed by the parties hereto or financially interest in the action. IN 11IT=8S 11MZRZ0F, I have hereto set my. hand and affixed my official notarial seal, this the 3rd day of October, 1997. B. GILLIAM, Notary Public My Commission Expires 12/13/99 I NATIONWIDE COURT REPORTING, LTD. 800-232-6878
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SHARLENE HOBERMAN and AUDREY HULSE, ) on behalf of the Estate of Lewis Hulse, individually ) and on behalf of others similarly situated, ) ) Plaintiffs, ) ) - against - ) ) ) BROWN & WILLIAMSON TOBACCO ) CORPORATION, B.A. T. INDUSTRIES P. L. C., ) BATUS, INC., BATUS HOLDINGS, INC., COUNCIL ) FOR TOBACCO RESEARCH - USA, INC. ) (Successor to Tobacco Industry ) Research Committee), AND TOBACCO ) INSTITUTE, INC., ) ) Defendants. ) ) ROSE FROSINA, ELIZABETH COLAVITO ) and ANILDA ROSS, individually, and on ) behalf of others similarly situated, ) ) ) Plaintiffs, ) ) - against - ) ) PHILLIP MORRIS, INC., PHILIP MORRIS ) COMPANIES, INC., COUNCIL FOR TOBACCO ) RESEARCH - USA, INC. ) (Successor to Tobacco Industry ) Research Committee), AND TOBACCO ) INSTITUTE, INC., ) Defendants. ) ) )
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:iCG---R XCZI.VJO, 9/25/ 97 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A. That's exactly right. Okay. So did you have any understanding of any !parscr., :ther than Mr. Panzer, or any organization who •acu=d ::ave had that responsibility? A. Well, in the state government relations area, it was my staff, my division, in conjunction with our -- Q. It was your committee. A. ...our state committee. Q. I'm sorry. It was your committee. And did your committee report to any higher body? A. My committee did not report to the Executive Committee. I reported to the Executive Committee for my committee activity. Q. Okay. That's fair enough. A. Okay. MS. HONDORF: I think that's it, and we're five minutes over. WITNESS: Oh, thank you. MS. HONDORF: Thank you very much. MR. GOOLD: We'll read and sign. And thank you for your cooperation. MS. HONDORF: Why; did you expect not? VIDEOGRAPHER: This concludes the deposition of Mr. Roger Mozingo. The time is 4:18. REPORTING, LTD. _ _ 8 t0
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ROGER ti'.rJZ:NGO, 9/25/97 :AGE .33 C E R T i F I C A T E 2 z 5 6 7 8 9 I, Roger L. Mozingo, do hereby certify ~:hat I have read and understand the foregoing transcript and believe it to be a true, accurate, and complete transcript of my testimony, subject to the attached list of changes, if any. ROGER L. MOZINGO 0 11 13 14 15 20 21 22 23 24 25 This deposition was signed in my presence by Roger L. Mozingo, on the day of 1997. Notary Public My commission expires: REPORTING, LTD. 800-232-6878 1 J
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SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK x PHYLLIS SMALL and DENISE FUBINI, x individually, and on behalf of x others similarly situated, x x Plaintiffs, x x - against - x x LORILLARD TOBACCO COMPANY, INC., x Index No. LORILLARD, INC., LOEWS CORPORATION, x 110949/96 COUNCIL FOR TOBACCO RESEARCH-USA, INC. x (Successor to Tobacco Industry x Judge Charles Research Committee), AND TOBACCO x E. Ramos INSTITUTE, INC., x x Defendants. x x x SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK x MARY ANN HOSKINS, Executrix of the x Estate of Edwin Paul Hoskins, WALTINA x BROWN and DANTE AUBAIN, individually, x and on behalf of others similarly x situated, x x Plaintiffs, x x - against - X x R.J. REYNOLDS TOBACCO COMPANY, x Index No. RJR NABISCO, INC., COUNCIL FOR x 110951/96 TOBACCO RESEARCH-USA, INC. X (Successor to Tobacco Industry x Judge Charles Research Committee), AND TOBACCO x E. Ramos INSTITUTE, INC., x x Defendants. x x x 141063.1
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SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK Index Nos. (110949/96, 1 1 095 1 /96, 110953/96, 110950/96, 110952/96) PHYLLIS SMALL and DENISE FUBINI, ) individually, and on behalf of ) others similarly situated, ) ) Plaintiffs, ) ) - against - ) ) ) LORILLARD TOBACCO COMPANY, INC., ) LORRILLARD, INC., LOEWS CORPORATION,. ) COUNCIL FOR TOBACCO RESEARCH - USA, INC. ) (Successor to Tobacco Industry ) Research Committee), AND TOBACCO ) INSTITUTE, INC., ) ) Defendants. ) ) MARY ANN HOSKINS, Executrix of the ) Estate of Edwin Paul Hoskins, WALTINA ) BROWN and DANTE AUBAIN, individually, ) and on behalf of other similarly situated, ) ) Plaintiffs, ) ) - against - ) ) R. J. REYNOLDS TOBACCO CONiPANY, ) RJR NABISCO, INC., COUNCIL FOR TOBACCO ) RESEARCH - USA, INC. ) (Successor to Tobacco Industry ) Research Committee), AND TOBACCO ) INSTITUTE, INC., ) Defendants. ) ) ) A
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a ) SCHEDULE A PLEASE TAKE NOTICE, that deponent is required to produce at least five (5) days before such examination the following: all books, records, computer data and/or discs, correspondence, handwritten notes and other documents,. whether maintained on a personal basis or kept in the ordinary course of business, that in any way pertains to: (a) the claims and defenses of this action; (b) tobacco and health; (c) cigarette smoke and cancer; (d) research conducted by or funded by the Council for Tobacco Research-U.S.A., Inc., formerly known as the Tobacco Industry Research Committee; (e) the addictive nature of nicotine; (f) the relationship between the Council for Tobacco Research-U.S.A., Inc., formerly known as the Tobacco Industry Research Committee, and any Defendant listed in any of the above captioned matters; and (g) the relationship between the Tobacco Institute and any Defendant listed in any of the above captioned matters. iaizia.i
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SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK x SHARLENE HOBERMAN and AUDREY HULSE, x on behalf of the Estate x of Lewis Hulse, individually, x and on behalf of others x similarly situated, x x Plaintiffs, x x Index No. - against - x 110953/96 x BROWN & WILLIAMSON TOBACCO CORPORATION, x Judge Charles B.A.T. INDUSTRIES P.L.C., BATUS, INC., x E. Ramos BATUS HOLDINGS, INC., COUNCIL FOR x TOBACCO RESEARCH-USA, INC. x (Successor to Tobacco Industry x Research Committee), and TOBACCO x INSTITUTE, INC., x x Defendants. x x SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK x ROSE FROSINA, ELIZABETH COLAVITO x and ANILDA ROSS, individually, and on x behalf of others similarly situated, x x Plaintiffs, x x - against - x x PHILIP MORRIS, INC., PHILIP MORRIS x Index No. COMPANIES, INC., COUNCIL FOR x 110950/96 TOBACCO RESEARCH-USA, INC. x (Successor to Tobacco Industry x Judge Charles Research Committee), AND TOBACCO x E. Ramos INSTITUTE, INC., x x Defendants. x x x 141063.1 - 2
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R^==:c :fCZ1VG0, 9/25/97 1 2 4 6 7 8 9 m s~ 10 ~ ~ 11 ~ N Q 12 13 14 15 16 ~ 17 0 ~ ~ '18 } m Q c°, 19 W Z h- 20 21 22 23 24 25 attorney on staff, but we used outside counsel. ^^ean'_ng the Tobacco :nstitute uses outside counsel. ,~ . Ar:d that' s Covington and Buriir.g? A. Yes, ma'am. ;~. For the most part? A. Yes, ma'am. Q. Did you have any understanding that the Committee of Counsel represented, in a legal sense, the Tobacco Institute? MR. GOOLD: Objection. Calls for legal education that Mr. Mozingo has indicated he does not have. THE WITNESS: You know, from the standpoint of representing the TI in lawsuits, the Committee of Counsel didn't assume that responsibility. BY MS. HONDORF: Q. Did you ever understand the Committee of Counsel to represent you personally? A. No, ma'am. Q. What did you understand the Committee of Counsel's function to be? A. Was to receive reports from staff -- from the Tobacco Institute staff, give advice, give counsel, discuss industry issues. Q. All right. You just answered the question that you POF aoa 78
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r February 17, 1984 .`=ORANDUM TO: :XSSRS. RORNEGaY, CHILCOTE, LIEB&*1GOOD, MILWAY AND MOZINGO FROM: WILLIAM KLOEPFER, JR. The attached will be published in the Phoenix and Tucson newspapers on Monday and Tuesday at the request of our Arizona group. K CONFIDEN'i'IAL. NMNESOTA TOBACCO LTI'IGATION mss . Attachment Nff- -TIlVIN 0133719 ri KU 000018520 T1 1 3061
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8L89'Z£Z'008 *QZ'I lf)NTT.2IOd~w T.xno~ qQTMNc)T.T.dN pTnoys auiZ abea : plea.z ptnoqs auTZ absd : pie 9.1 pTnotis auiZ absd :peaz pZnoT4s autZ abad :plea.z pjnocis auiZ afiea : pie a.z pTnot4s auiZ ab'ed : p-ea.z ptnoqs aut7 ablea : pie 9.1 pTnotqs autZ absd :psa.z pTnoqs auzZ a6ied : paa.z pTnoqs auiZ absc! peaz pTnous aui7 a6-ed :peaz SZ 6Z EZ ZZ TZ oZ 61 8T LT 91 ST vZ ET 6 8 L 9 S t E Z L6/SZ/6 'O0I3IZOlri ~j?0;,E
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CATHERINE ZITO, PETER HOBERMAN ) and GEORGE ELISSEOU, individually, and on ) behalf of others similarly situated, ) ) ) Plaintiffs, ) ) - against - ) ) THE AMERICAN TOBACCO COMPANY, INC., ) AMERICAN BRANDS INC., COUNCIL FOR ) TOBACCO RESEARCH - USA, INC. ) (Successor to Tobacco Industry ) Research Committee), AND TOBACCO ) INSTITUTE, INC., ) Defendants. ) ) ORDER AND SUBPOENA An Amended Notice to Take Video Deposition, Open Conunission, and a Subpoena Duces Tecum addressed to Roger L. Mozingo having been presented to and examined by the undersigned Presiding Superior Court Judge of Forsyth County, North Carolina, and it appearing to the undersigned Judge pursuant to the provisions of Rule 28 of the North Carolina Rules of Civil Procedure, a North Carolina Order and Subpoena should be issued to Roger L. Mozingo, to appear at the Law Offices of Randolph James, One North Marshall Street, Winston-Salem, North Carolina on Thursday, September 25, 1997, at 9:00 a.m. NOW THEREFORE, IT IS ORDERED that the Sheriff of Forsyth County serve this Order, Subpoena Duces Tecum, Amended Notice to Take Video Deposition, and Open Commission upon Roger L. Mozingo, R. J. Reynolds Tobacco Company, 401 N. Main Street, Winston-Salem, North Carolina directing him to personally appear at the Law Offices of Randolph James, One North Marshall Street, Winston-Salem, North Carolina, on Thursday, September 25, 1997, at 9:00 a.m., for the purpose of taking testimony by videotaped deposition and to produce all documents indicated in Schedule A. -~ .5,P/- ~~t.bP~ This the ~f/li~ day of Xvgast, 1997.
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a -•IT 9 -4 bl1 " PLEASE TAKE NOTICE, that deponent is required to produce at.least five (5) days before such examination the following: all books, records, computer data and/or discs, correspondence, handwritten notes and other documents, whether maintained on a personal basis or kept in the ordinary course of business, that in any way pertains to: (a) the claims and defenses of this action; (b) tobacco and health; (c) cigarette smoke and cancer; (d) research conducted by or funded by the Council for Tobacco Research-U.S.A., Inc., formerly known as the Tobacco Industry Research Committee; (e) the addictive nature of nicotine; (f) the relationship between the Council for Tobacco Research-U.S.A., Inc., formerly known as the Tobacco Industry Research Committee, and any Defendant listed in any of the above captioned matters; and (g) the relationship between the Tobacco Institute and any Defendant listed in any of the above captioned matters. 141218.1
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE OROEA 0 ! C i g aretto Smokinp and C a n c c r : A Sciontific Porspoctivo The Tobacco Institute la7S I Street, Northwost MashinSton, D.C. 20006 1 9 a 2 L~ ~ N r m OD m .. .- . '.-., .-~:.~.. ,~_........._ . N -
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4 . ~~ B((9-Subp«na duces ttcvmm blant coun. rtlb wtnaes'sUpulaUon • t*7a h' JN4Nf RuMK110. INC.. to remain sublea to attorney's rail. 9•91 /YSLtNtB11. NYC 1C01 3 SUPRr:ME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK IndesNo. 110949/96 against Plaintiff Calendar No. JUDICIAL SUBPOENA DUCES TECUM Defendant 114t 11xapir nf i#r l3tdt of Nrsa lork TO ROGER L. MOZINGO R.J. Reynolds Tobacco Company 401 N. Main Street, Winston-Salem, North Carolina GRyXTING: WE COMMAND YOU, That all usiness gnd excuses being laid aside, you and each of you appear and attend before a notar ~ub~ic. who is not an attorney or an employee of an attorne~ or any party herein, atthe Law Office~ of Randoff M Jam~~, 1 N. Marsha} ~St ~inston-Salem NC on the 25th day o Se d.~tember 97 at 9- 00 o c oc , ifi t e fore nobn, and at any recessed or ad journed te to give testimony in this action on the part of the and that you bring with you, and produce at the time and place aforesaid, a certain See Schedule A. Attached now in your custody, and all other deeds, evidences and writings, which you have in your custody or power, concerning the premises. Failure to comply with this subpoena is punishable as a contempt of Court and shall make you liable to the person on whose behalf this subpoena was issued for a penalty not to exceed fifty dollars and all dam- ages sustained by reason of your failure to comply. WITNESS, Honorable Charles E. Ramos one of the of said Court, at . 60 Centre Street tbe 29th day of August 19 97 Martis Ann Brachtl Goodkind Labaton Rudoff & Sucharow.LLP Attoraos(s)tor Plaintiffs oBice a.d Pon ofte allress 100 Park Avenue New York, New York 10017
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P200054048 . Zla TOBACCO. IitiSTITUTE, t,4 c... . t-sb w 'Stott, •OtrtwwtSt wwswivG•O% 0 C :0006 :0! :16N)a ova wtw C1%tAAt OnKt Nt/+wltR r3 702l47•y00 AORult :3; `19W: To: Bill 1Cloopfer From: Roger Notin=o ' Re: Pre•adult Education .oci.•.ouNIco ~"`' •1? 7 ;11~ If'•J~Iw ,;p~lOENTIuL It is sy opinion that the "message" should be directed to adults, zot kids. After all, kids don't vote parents do. Parents also serve as city councilmen, comsiss~srs, legislators, etc., kids don't. To try to talk to kids through any sedium will, in all probability be misunderstood and create a backlash. The message should be short, simple and to the point. A play on words would do nothing but arouse suspicion. Obviously, many productive uses could be sade of such a program. On. idea tDat cane to mind: . Conduct a sailing to every state legislator in the country with an explanation of why the program is being conducted. cc: Horace 1Corns=ay Tom Frankovic Jack Milis Jack Lelly •J.C.i. Ehringhaus Fred panser • Charles Waite Mike Rerridan i •{. t S F+
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46 asv UN_ RON BARKER - Sheriff ~ „ fi ~ Fors~~th Counh•,J~C.~ 2 ~1 (i~ TY OUT OF STATE OF NORTH CAROLINA AFFIDAVIT OF SERVICE STATE OF NORTH CAROLINA COUNTY OF FORSYTH COUNTY AFFIDAVIT OF SERVICE Deputy Sheriff of Forsyth County being duly sworn, do certify that on the 'E-5 day of Sc?7. , 19R-1, atQ~~ , o'clock k served the attached process(es) b~~? 'cA' by delivering to ~r37t- X N('san (Name of Person Served) copy of the process(es) at the following address: LA o r NZ-~r,, tit,a"-,, s-1-. STATE OF NORTH CAROLINA FORSYTH COUNTY q-C J't z rl RON~~RICER _ Sheri . >,fforsyth County Signa re of D ty S iff ~J~--,~c3l?., I, Chrystal B. Crosby, a Notary Public of Forsyth County, North Carolina do certify that ,~ ~ 4,"Lt4-, the maker, personally appeared before me this day and acknowledged the due execution of the foregoing instrument. W itness my, hand and notarial seal this 115`day of Signature of Notaiy Public - . " OFr=iCIAL SEAL' _~ "+0'yy Gi:DiiQ, North CaroGna ? ~ County ot Forsyttl 1/.f y PHYLLIS SMALL VS. LORILLARD TOBACCO COKPA]Wetal~ ROGER L. MOZINGO, RJ RE'INOLDS T08ACCO to be•served Cnrystcli S. Crosby ~ . •E.:, . . ?i?rh30 . P.O. 8OX 2t089 • Winston-Sa/em, North Carolina 27120-1089 • 919/727-2112 ,19'~7
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I PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTIVE ORDER This document, while not intended to be exhaustive, ii an attempt to provide a balanced perspective on somo of the issues in the smoking and cancer controversy. The discussions in the following chapters rely on scientific and medical literature to point out why no firm conclusions can be drawn. M Unknown Mechanism !or Carcinogenesis Even after many years of investigation and millions of research dollars, scientists still are unable to describe the mechanism by which normal cells are transformed into malig- nant, or cancerous, cells. A biomedical scientist noted this fact in the Journal of the National Cancer Institutel in August 19811 A fundamental unsolved problem in the field of cancet biology is the nature of the primary event leading to the production of abnormally proliferating transform*d cells. In particular, whether tobacco smoke plays any role in cancer causation is still undetermined. Even a scientist who accepts the conclusion that smoking is causally related to lung cancer wrote in 19791 •Indeed, no mechanism for human tobacco carcinogenesis has yet been successfully formulated and tested.•2 2 NA 0114 Vi _ ~_ . ~. _ . . , .-_...-..-
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PROTECTED 8Y MINNESOTA TOBACCO UT1CATION PROTECTIVE ORDER Animal Studies One of the most common approaches to the study of cancer causation is the exposure of laboratory ani:eals to pos- sible causative agents. Studies of animals exposed to tobacco smoke have produced inconclusive results. Despite considerable ettorts scientists essentially have failed to produce in animals the kind ot lung cancer most often associated with saoking. In summing up the experimental work in this area, a physician at Yale university said that "no well-designed and well-conducted experiments have shown that cigarette smoks causes lun cancer in animals."3 Epidemiological Studies Advocates of the theocy that smoking causes cancer claim substantial support from epidemiological studies. Epi- demiology is a statistical science -- the study of a group of people for both the occurrence of a disease and the detection ot factors that might be r+lated to it. Epidemiology deals with statistical relationships and comparisons. It cannot detscaine cause. As an Awrican Madical Association president once explained, •A statistic is a fact -- the result of a survey -- and that's all it is. Conjectures made on such a statistic ac• not tacts. They ace conjectures." 3 Ln ~ ~ N N m 00 m m ~ :'A 114
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PROIECTED 9Y MINNESOTA TOBACCO LRIt3AT1ON PROTECTIVE ORDER I . vill sucpass =100 Million. Only with such continued tes.aach ctn the pieces of the aancet •pussle• be put toqethsc. ! M.114 6
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PROTECTED 8Y MINNESOTA TOBACCO uncanON pROTECrvE oAOEA Cance[ of the Lung Foremost among ths chargss against eigacette smoking is the assertion that it causes bconchial carcinoma, or lung cancer. Few have not heard that allegation. An Aeaciean Cancer Socisty president even declared some time ago that •without smoking we would not have lung eancer.•1 That assertion bslies ths facts. Lung cancer appears in nonsmokers as well as smokers. Mocsover, thecs is an indication that lung cancer seems to- be Increasingly ocwrring in nonsmokers -- especially in males.2 in an April 1979 report on this phenosenon, a Cali- tocnia epidemiologist who belisves that smoking does cause lung cancer conceded that tactocs besides eigarstts smoking must have had a significant effect on the lung cancer moc- tality cate.2 Certainly, a higher proportion of the cases in lung cancer studies are smokecs. Bu t such lindings cannot estab- lish cause. They can only cais• questions -• ones that camain unanswered in the dilemma of smoking and cancsr. Animal Lxpeciments A aajoc question about lung cancsr is why •xp.ciuants cn ~ ; in which animals supposedly mimic human smoking repeatedly ~ m 11 00 ~ ~ A 114
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PROTECTED BY MINNESOTA TOBACCO LRIGAT10N PROTECTIVE ORDER .' . } yet a common mistake s,ade in the interpretation of epideniologieal data is the identification of a statistical association as a causal connection. Statistics ean never prove a cause and effect relationshipj as the AM official noted, •Statistics 0090 questions, they don't answer them.' What the statistical associations reported in epidaio• logical studies can do is suggest possible leads for further investigation. !or exampl., statistical associations have led to suggestions that diet, place of residence and personality characteristics may be related to eancer. So while epidemiology as a science has its role, it also has serious limitations. The shortcomings of cancer epidemiology in partieular were noted emphatically in a atate- ment by a prominent biostatisticians 'r know of no other scientific activity that's been so naive, so inappropriate, and so unscientific in its lack of attention to the basic data.•S Cancer Rate Patterns Tne Surgeon General's reports on a®oking and health have cited various prospective and retrospective population studies to support the claim that a causal link exists between cigarette smoking and cancers of the lun9, bladder, kidney, esophagus, lacynx, phacynx, pancreas and other sites. Close 4 M,A0011481
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PROTECTED BY MtNNCSOTA TOBACCO LITIGATION PROTECTiVE ORDEA The reliability of death certificates is a maior con- cern because they are the main soucc. for mortality data. A gcoup of scientists summacised the problem by saying that death certiticatss •ars sometimes materially inaccurate and research based on them alone may not be secvre.•9 a.ore detailed discussion of the r.liability and accuracy of mortality data app.ars in a subsequent chapter. Conclusion Questions about cancer causation are complex, as demon- strated by divergent theories and the uncertain meaning of research lindings. A director of the National Lnstitutss of Health alluded to the problem in a statement to Con9ress14 a short time agot in terms of the Ji9-saw pussl• analogy, medi- cal ressacehecs ao not know whether the blue piece they have found is part of the sky, the lake in the backgcound, the evening dress of the girl on the pocch or the body ot the stationwagon in the driveway. Md sometimes they manage to fit it very oonvineingly into what later turns out to be the wrong plac.. Independent scientific r.seareh, vhile not always pco- ductive, sust continue to be supported in ocdss to close the gaps in current knowledge. In January of 19'2, the tobacco industry's research commitment in the smoking and health area d M: A 114485
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER recently. Rtsearch reports suggesting that certain per- centages of cancers ac• attributable to oecupational exposures have stimulated considerable interest in th• midia. An edi- , tocial in a recent issue of the Journal ot the National Cancer Institute addressed the •nieed foc a systematic approach to environmental carcino9enesis in the wockplace.• The authors advocated a naw epideRiological method to study occupational exposures suspected of increasing the cisk of human cancer.7 In some discussions of workplace exposures and cancer, tobacco smoking, alcohol consumption, diet and other lifestyl• characteristics are dentioned as possibl• eo-factors. Some investigators have placed the majoc portion of the blame for the increased risk of cancer reported in soat industrial workers on smoking. However, other researchers have expressed concern that focusing on a worker's smoking habit may serve to divert attention away from the hazards of the wockplace.8 MoctalitY Data In order to study the possible relationship between factors, like smoking, and specific diseas., cesearch.cs generally use information on the causes of death in population groups. unfoctunately, such mortality data often contain ercocs and inaew raeies. This is ssp.eially true in eaneiec stu dies because of istakes in diagnosis and rscocd-ke.ping. v 1.4 ~ N F+ m 7 OD . a a I NA 001149
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PROTECTED BY MINNESOTA TOBACCO LJTIGATION PROTECTIVE OROEA erview I The soard of Lditocs welcomes suggestions foc future editorials that succinctly summacise current work toward a clearly defined hypothesis regarding the causes or cure of cancer. Journal of the National Cancer Institute Febcuary 1981 uUncertainty about the causes of cancer is strikingly reflected by the vast amount of public and private funds spent on basic cancer research, the scientific debate on theories of causation and the frequent suggestions that common things in our daily lives might cause cancer. Yet it is not surpris- ing that cancer receives so such attention because it is one of the most serious problems in biology. Unfortunately, solu- tions have not and will not come easily. Only well-conceived and objective scientific research can lead to the resolution of the problem. Despite the recognized limitations in our scientific understanding of cancer, claims often are made that smoking causes the disease. Foremost in the litany of charges against smoking is that it causes lung eancet. in cecent years, alle- gations also have included sites ranging fcoA the pancreas and bladder to the kidney and larynx. .A 0 114 73
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i7111,IJUUUUU ' • 0 Ag, That's how much the tobacco industry has already given for independent research on smoking i and health. That figure will grow by another S7,7 million before the year is over. And by "independent" we mean that scien• tists appl,ring these funds autonomously in more than 350 medical and research institutions. have - been encouraged to publish whatever they find. whatever the outcome. $111.000.000. More than the American Cancer Societ,r•, the American Heart Association and the American Lung Association combined. And yet legislation pending right now at the State Capital would increase cigarette taxes over • S3 million a year to fund cancer research. Just last month the Legislature increased taxes on cigarettes more than million over a fodr-year period to pay for additional cells for Arizona's burgeoning prison population. ' Is it fair to plaoe even mon tax burden on those who choose to smoke. in spite of the fact that cigarettes are already the single most heavily taxed consumer product? Is it fair to tax only one segment of the population to pay for a research <xnter which will be available to all the people including non-smokers? The estimated 740.000 smokers in Arizona last year paid over $41 million in cigarette exdse taxes. $9 million in sales taxes. to state and local treasuries to fund services that benefit all of the state's 2.7 million population. They also paid an additional $374 million in Federal taxes which now amount to 16 cents a pack. Think about it. Consider where the tobacco industry stands. ? It stands. as it has for thirty years. squarely ~ behind its rese"arch commitment. and firmly behind ~ its own responsibility to help find definitive answers m to the questions about~,~~,,,,1,,~~,,}~ smoking and health. 111C 1VLJ~tI:W listilututG o WO TnyQ10133720 tr Ku oooousti r, 13062
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PROTECTED 8Y MINNESOTA T09ACCO LlTIGATICN PROTECTIVE CROEA have failed to peodyee the type of lunq cancer for which smoking is most often blamed. The sucgeon Cenacal's report of 1968 admitted this deficiency. Using a variety of anii+als, larg.-scale inhala- tion stu dies have, it said, •essentially failed in pcodueinq squamous cell cancer of the lung.•3 Today, the situation remains basically unchanged4 -- despite wch-publieised efforts to promote findings reported from a beaqlt inhalation •xperimentS as laboratory proof that cigarettes cause lung cancer. =ndeed, on• of the in- vestigators in that experiment announced in the press that he and his colleagues had •closed th• circl• in linking cigarette smokinq and lung cancer.•4 Shortly aft.eward, the methodol- ogy and findings of the dog study were questi-onsd by other scientists, includinq members of a special National Academy of Sciences pinel.T-10 Further doubt vas cast on the pcojsct with subsequent reports that the dogs might havf been diseased before the experiment began.ll•12 Other animal experiments have been cited as proof that smoking causes ionq canear. These entailed daubing shaved animal skin with tobacco sAoke condensate (tac), which is the pacticv late matter collected in smoking machines by passing smok• through a cold trap at extremely low t.mp.ratur.s. 12 MNA 001149
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~ , PROTECTED BY IrAINNESOTA TOSACCO LITiGAT1ON PROTECTIVE ORDER cancer patients, and a group without lung cancer, then baek- tracks in tis<e to deteraine smoking Aistoriss. A prospective study identities a specific population group, supposedly free of disease, records their smoking habits and then observes the disease patterns that arise, Both kinds o6 studies arrange the raw data into various categories and run statistical tests to determine if one group (smokers) differs from another (non- smokers) in specific disease experience. Such statistical studies can provide a great deal of in tornation, but. it is impoctant to cenember, as one eminent statistician has said, that 'cancer is a biologic, not a statistical, pcoblee.'16 aasicslly, statistics gatheced in these ways can pcovs nothing. They can indicats the likeli- hood that any observed patterns acs not due to chance. But even •statistically signilicant' results siay have no biologi- cal cel.vanee. These epidemiological studies, aoreover, can always be affected by inherited tendencies to develop certain diseases, the undiscovered effects of occupational or other environ- nental exposures and many other behavioral and biological. unknowns. That is why this concession from the surgson Caneral's 1979 repoctlS is iAportanti 14 vA lia 1
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PAOTECTED 8Y MINNE50TA TOBACCO UTiGAT10N PROTECT1VtE ORDER Fipure 1 Ineld.na. Ratgs• per 100,000 Population from S.eond National Cancer Survey (SNCS) (19I749) and Third National Cancer Survey (TNCS) (1a09•71) 24 21 f C SNCS TNCS sNCS G~ CANCEA ORAL CAVITY SITE & PMARYNX I n U 9tJ1ooER Q- whit* male 0- nonwhite male ESOPh1AGtJS (3 - whlto /Nnale 0 - nonwhite iennalo •AQo adjusted to th.193E U.s. population standard Cd) 6 TNCS aNCS TNCS . A 0114
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PFiOTECT€D Bll MINNESOTA TOBACCO LITIGATION PROTECTIVE OROER ; F : .. i i . c t` r L r cancer rates around the world. Among the developed nations, the U.S. and Canada bav among the highest per capita eiga- rette consumption fijirss in the world. aut they rank ttA and 15th, respectively, in lung cancer mortality foc uales. Con- vers.ly, while the nnitsd lin9do., linland and the Netherlands have lower p.c capita consu.ption than the tT.S. and Canada, they have subatantiallf •'igher lung e:ancer death rates. These •xamples ace based on eigacette consumption and bronchopulmonary canaer rates in the middle 70's, the latest available foc eompacisoa internationally.2s-29 Evsn allow- ing for a lag period, tbe=trends in cigarette consumption going back to the 1930's ace inconsistent with national moc- tality rates. increased NoctalitY -- Real or Apparent? Recently, t!u ce have be.n ucies of 'epideaic' in those nations whecs sharp cises in lung cancer have been reported. Anti-saokers point to these repocted increases and the si.ui- taneous ciss in the prevalence of smoking as 'pcoor. that smoking causes cancer OR the lung. Such a simple explanation is no doubt appealing to thes, but is it right? The biggest pcoblee in the unquestioning acceptance of this simplisA is the kind of data on which the ecies of large-scaie 'epide.ics• ace based. Most of it is derived fcow 16 A 114
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I paOTECTTD BY tiA1NNESOTA TOBACCO LlT1GATION PROTECTIVE OROBR ~ . . . . 9. diagnosis. Tbis•m ive a false ie ression f the _3 ~p'nasa'ea)"- Changing Patberns Even if one ass7asel.foe the moment that part of the 'epidemic' is cea_lj_the:tr.nds in lung cancer death cates . .. still cannot be explainidsatisfactorily by sAokinq patt.cns. ; Zor examnle, a=atiitieians have suggested that the ate ~ of increase in lung canese moctality may be declining. Others ; have been quick to su99est that changes in cigarettes and ~ smoking habits have.tsused-:the decline. In 1975, a British ~ thoracic sur9eon asked whether such changes could explain the ~, . . ~ shifting lun9 cancer.pait.rns.' Be said that this explanation seemed 'likely' unt oee_esalised that the lung cancer ! .. changes actvally beqaa SO years ago, long before the altera- ~ tions in the ssokin9 habit. Be concluded that the observed patterns merely represented the 'natural history' of the M . . disessa.32 Lun9 Cancer in 1ioRen • Reports ot caoi'dly,inereasinq lung cancer death rates L foc wowen have sparked the claim that inereased smoking in women is responsible.'• " Lf1 m 00 ls N H.. a. . . A 0011499
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August 3, 1979 i I , AE: August 1"Pre-Adult Education" Memo TTO: Bill xloepfer FROM: Frank Dryden 0 1. 1 don't envy your assiSament. 2. Following the gist of the dfscussion wherein you received your marching orders, it seeos to ae our objective is (like EIlAt in the past) a "media event" which in itself proaises a lot but p ro duces little. Zhus, the opportnai ty to draw in the cats and dogs in ideas and parade theu quiekly, sublimation in short - (a) List our past efforts to discourage promotion directed towards youn= p.ople. (b) Exploit the fact that our spok.speople have, from coast to coast, consistently and repeatedly stated our positioa, aamely, that smoking is an adult custo', period. tions, regardless of the sedius ss.d. (c) lhat we recotaiz• the serious nature of the proble. and intend to launch a ser~es of aessapes to youth, parents, schools and through popular public figares-sskin=•thea td join in a.assive• effort to encourage youn=sters to forego snokinf until they reach aaturity and can mad. an adult decision on this controversial custom. Cd) Stay entirely away from the medical side in our communica- (e) Let the ad people tell us hov to do this most effectively. cc: Eioraos [orae=ay OeTos prsnkovic Jach Hills Jack 3ally J. C. 3. Earin:haus Fred Panzer Anni Ouffin Mike Kerri jan RoSer yozin;o Curles Waite ., T"6201 CCNFIDEKrIAL ---~ 702518 W TIlVIN 0004274
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r PROTECTED BY MINNESOTA TGBACCO L1TIGATION PROTECTIVE OADER That experiaents lik• this cannot be equated with the human smoking experience should be obvious, even to the lay uan, for at least three rsasons: • Rabbit •ars and the backs of mics are not the same as human lung tissue. • inhalation differa markedly from •paint- ing.• • The chemical properties of the so-called tar in such experiments say be quite dii- ferent from the smoke inhaled by smokers. i Then, too, tar quantities used in many of the •xperi- ments were completely unrealistic. The amount has been de- scribed as the equivalent of an individual smoking 100,000 cigarettes a day.13 One seseareher went so far as to say such experimental evidence was •claptrap.'14 Ev•n the 1979 surgeon General's report rather grudgingly conceded that •con- sid•rable criticism• has been directed at these studies.lS Statistical Studits Many of the reported findings used as •evidence• that cigarette smoking causes lung cancer coeo from epidemiologie studies. There ars two primary experimental methods used in these studies. A retrospective study selects a group of lung 13 [ M.N A 114 9
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. PROTECTED BY MINNESOTA TOBACCO LlTiGAT1ON PROTECTIVE ORDER examination of incidence and mortality eates, however, reveals many pattern s that are irreconcilable with the hypothesis that cigarette sAOkinq causes these diseases. t ' Under this hyoothesis, disease (or death) Cates would be related to smoking patterns or tobacco consumption in a specific way. toc example, after tobacco smoking increased (oc decreased) in a populatior,, a measurable increase (oc decrease) in disease Cates would be pcedicted some years later. This time interval is called the lag period. This relecs to the time from first exposure to an agent to the clinical appearance of the disease, tstimates o t lag periods published in some scientific papers !oe smoking and various cancers have canqed from appcoximately 20 to 40 years. or remain stable, depending on disease, gender and race. Zven if one considers the so-called lag period, the varied trends still could not be explained by the hypothesis that cigarette smoking is the causal agent. The causal theory cannot, !oe example, explain the varied patterns in bladder, ocal/phaeynqeal and esophageal cancer charted in fi9ure 1.6 Incidence Cates of these diseases seem to lack any coherent pattern. They rise, fall Cancer and the Vockplace The view that cancer may be related to environmental cn ~ '' hazards in the workplace has received ineeeasinq attention N r !'I 0 A 0114
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` . .~ • • PROTECTED 8Y M/.NN_ _ESa. _._TA.T08ACC0 LITiGAT10N PROTECTIVE OROER a roAen's eortality, there should be 'kinks' in the patterns. That is, tbe.femals lung cancer moctality patterns should not pacallel those of ..n~in time. They should instead be out of phase by a 30-year ps;tod. Is found no such kinks. This eeasoning from recocded secv lac tr.nds, perhaps diffiw it for the layman to follov, was presented to a meeting of fsllovs of the aoyal:'tatistical Society and published in the 8ociety's prestigiovs-jducnal.3i In the papsr, the researcher specifically coaarked about the escalation of lung cancer catfs fo! Momenl The•.ose'striking sustained rise in the in- ccements of poitality for both sexes covers the period 1915-1920 to 1931-)S, when ci4s• rstts saoki= n..h: ma~„wictus h3-c- ri uti on to tTi: ac s n=.asa. mphas s - ~ a Other lactocs The same type Of information that is cited about ciga- cetts smoking and lung cancer suggests that many factocs may be involved in tbe.developmant of lung cancsr. These include ocwpational:and enviconAental hasards, b.ba.iocal vaciables and •certaia psychological lactocs' mentioned in the 1979 suc9eon Censcal's celFovt.lS 20 Ln ~ J N F-~ m OD N W A 114 9
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r i PAOTECTED BY MINNESOTA TO6ACCO UTIGATION PROTECTIVE OADER physicist revisw d such oC the literaturs on snoking and lung cancer, studied tiss trends ol the sexes and concluded that lisber,s hypotbssis:is still valid.`0 ' Conclusion The clai. tbat-cigarstts saokin4 causes lung cancer has not been proven scientifically. The charge ignores basic unrssolvsd acisntilio,quistions concerning animal experiments, smoking patterns and lung canctc ratss, diagnostic variations and siany conlounding • factors. Lung cancer is.an extremely complex disease. A ons- sided attack on cigarette saoking as the causal agent doss nothing to advance the-seareh toc its cause -- and its aurs. 26 A 0011 003 .,..-- --_
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~ . Pr1OTECTEO 8Y MINNESOTA TOBACCO LmGAnON PROTECTivE ORDEA ~ ~' OCG'uDational LxQOsures_ F C ~ Occupational exposure has been strongly related sta- ~ tistically with increased lung cancer risk. ~ c • Exc•ssive rates have been found37 In workers in-petroli um and petroleum refining. • Navy rsonnel in oonstruction and d.clc vorkl~have been reported to have up to thr•• times the lung cancer ineidenee of other Navy enlisted men. • National Cancer ipstitute researc!»rs have found excessive lung eanc.r sortality rates in:eounties where paper, chesicai, petroleua anj9t#jns.poctation industries ac• loca'ted: Lxc.ssiv risk ot lung cancer has been found in such nonindustrial occupational 9roups aa dental technicians, decorators, •l.etricians; bar and restaurant managers and broadcasting employees.4l One authority on occupational cancer cautioned that har,rful industrial exposur.s zould continue ii pvblic atten- tion w•rs concentrated too itronqly on ei9arette saokin9.ls Ris concern ia shared by others, Including an expsrt on en- vironmental coata.inanta i~4= who wrote: A ceal question:ixists if cigarette smoking is not divertini'sttention from the effects of occupational •xposur• on industrial ~, wockers* r _i N N +A l1a
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PROTECTED 8Y M1NNESOTA TOBACCO LITIGATION PROTECTIVE ORDER . But some sei.ntists disaggee. Aa one Canadian re- searcher commented in the American Journal of Publie Health, 'Much more significant than changes ia vaten's smoking habits have been the changes in thrir employAent.'33 More women who develop lung cancer now are women who ++ork.34 supporting the b.lie! of the longtime director of the National Cancer institute's environmental cancer progras that not enough attention lias b.en paid to their on-the-job exposures. He has written that the adoption of smoking by women cannot explain their lung cancer patterns here or in . other countries.35 There also seems to be no explanation tor the statisti- cal findings of a sritish medical physicist who carefully exasined lung cancer mortality patterns of males and females in England and wales over the past century. Be reported a 'remarkable synehrony' in.the recorded changes ior males and females for the past 70 y.ars. Thus, although the lung cancer rates always have been higher toe males than tor teuales, the patterns of increase over time have been almost exactly the same. women's eonsusption of aigarettss, he argaed, increased markedly 30 years alter tbe striking rise in Mea's eonsuap- tion. Thus, he obsecwed,. ii.smoking caused an iacrease in 19 j A 114 . _ .... ..- _...-_.__... ~
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d . 0 P2oIDI)51 123 THE TOBACCO INSTITUTE '0 MEM011ANOiJM /ROM ROGER t_ MOZINGC e s February 2, 1976 Mr. Ho:tzman: Enclosed for your n=ormation are copies of letters from two c` our poeple •on the beat" _ who have commented on current advertising • appearinq throuqhc3t the country. Others have posed pretty luch the sasis question b during telephone c;ev!r~ouqrts in writinq. not, as yet, p " Advertisinq is fai beyond the scope of Institute jurisdictizn but I felt yott would like to know what scte peopl• are thinking - thus tbie enc:os:.:• t . . r"' % TtZ.. (;% r.. I V ED L. M• V fEa a 1976 WSJ Iw RLM: sw Enclosures ff.lti ~(~ .'~ ~~ lM., • ..3~t•f* i Z~ .lY 10410,2 ~if ~ ~•. .7.~ rd ~4S :. ' . Jr = , - A i' r . .• . CaNf7DENTiAL
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER i I i t i most large scale studies on smoking and health have tended to invsstigate the tole of smoking independently of othsr behavioral variables, such as alcohol consumption and other life style Lactors, occupational and environmental hasards and certain psyehologi• cal factors. These variables are known to be c.lated to health status. ph&srs addidl Thus, such statistical studi.s, no matter how large or covering how many years, •do not permit statements about causality. They can only ppint to differences between the observed groups.•17 irregulariti.s have been pointed outl8'=0 in the majoc •pid.miological studies21-26 that have been used to condemn cigarettes. Their preeise meaning may be unclear, bu t they show, obviously, that the case against cigarettes is not as simple as some would suggest. A recent comment on the subj.et=T would appear appco- priates Those epidemiologieal studies that purport to show a causal connection between cigarette smoking and various eancers, but particularly lung cancer, fail when examined critical~l to ' establish t=e cau_Tcla , a• s a~ddeal hoctalitr ltates vs. Consumption Levels one large dileasi 1or the cigarette causalists is the inconsistency of cigarstti,consumption patterns with lung 1S a , A 011499? ,_•..
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PROTECTED 9Y*MINNESOTA TOBACCO LITIGAT1pN PROTECTIVE ORDER The Esviconsent Industrial contasissants are not restricted to the wockec in the plant,-bowwer. Consider ttCl's identitieatioa of high lung cancer. d.a.th rates in counties with certain in- dustriss.39'40 lurtliic• suqqsstion that airborne industtial substances can affect area lung cancer death rates coees from two studies in tAe-saste issue of Archives of snvirons.ental Health in 1980.t3•11 Louisiana Gult Coast.parishes have betn found to have some of the highest i:cocdsd lung cancer death rates in the country.4s-4s A study of one such parish yielded a clue that rssid.ntial exposure to industrial effluents aay be a factor in the elevated lung cancer mortality rates in Louisiana.44 The rsbearehecs found excess risk with residential proximity to.soscs industcies (petroleum refining, lumber and metal manufacturing and canning) but not to others (soap and fucnituce 'sakinq), which led thest to eoeuaents This ottservation validstes the assumption that ldotocs'such as cigarette smoking are not cesponsibls for the observed residential cisks, and that.ia this urban area, cigarette smokin9 patxetas 4re sot related to distance tros iadnstrj/, and theretoce, not aonloundia9. Dietary Factors The newest development in lung cancer epidemiology sude headlines in 1981 --.the appearance of additional support for 22 1 A K114 ~
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I . I S . : . ~ : = : 1:• C 11 PROTE{TED 84 MINMEMU f08ACC0 LMGATION PROTECTiVE OROER a theory that earotsne, a autrient In dsrlc gceen and dacfc yellow vegetables and fruit'that is convertad In the liver to vitamin A, may ceduce'the risk of lung eaacer. Animal work in the 40's had sugg.sted that a vitamin A- enriched diet reduced the 4ncidehcs of cancer. Two small human studies in'the mid-70'a provided moce support. One, a prospective study of.men with known dietary habits,47 and the oth.r, a biochesicil investigation of serua A levels in patients and controls,48 had suqgssted that low.c levels of dietacy vitamin A may increase thi risk of lung caneec. So did a 1979 retrosp.ctive dietary and smoking study at Rosvell pack Hemocial'in'atitute in kulfalo, N.Y.49 and a pcelin+inary report ir 1986 of the investigation of serua A levels in British lung cancer.eaaes.SO The new evidence 4n 1loveslber 1951 was data from a large U.S. industrial health study.Sl Although it was based on only 33 lung cancer d.atha, the finding of an invecse rela- tionship of carotene with lung caneer•incidence in a popvla- nonsmolcers. tion of some 2,000 sid'd1e-ige•men suggests a protective quality In dietary vitamin-A. The risk generally decreased with increasing levels6! ths nutrient •- In ssokers and s.- 23 NA 11 00 ~. . .«;~~,~+. .r•.r~~..~..n•t. ... ~.~. ~~.~.t ~.~....w~~ ~•..,t... . .. ..; .~~~~. .....~,..~~.. .
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PROTECTED BWMUNNESbTI'T06ACC0 LtT1GATi0N PqOTECTIVE OADEA F F• L cancer.S6 This evidence has been aeaAulating since the 1960's, when a Scottisb resaarrher compared a group of lung cancer patients who ireis sliokers with a matched group of smokers clinically free of the disease and found the lung cancer patients significantly aore likely to deny and repress their emotions. Such interpersonal diffia lties, he wrote, could be important in the development of lung cancer.sS Further research in this area has iAdieated that psy- chological factors can-bi as sneb as twice as important as a history of smoking as a predictor that a patient with undiag- nossd chest disease will be found to have lung cancer.56 That finding supports the work of other investigators su ggest- ing that psychological factors precede the development of lung cancer.s7 Constitutional Factors William Oslsr, the Canadian-born physician, teacher and medical historian, once wrote: ••2t is'sweh more important to know what sort of patient has a disease than what sort of a disease a patient bas.•s= The tather of sodesn statistics, the late iir lbonald Tisher, suqgestsd in-tb• 1950.16 that constitutional factors might be far ewre ieportan'k than smoking or any other variable in lung cancer.s' Only recsntly', a prominent medical 0 25 ..1 - ~ ..~. . . ... , - .. . .~ . ~ .. ~ ... . .. ~ ~~~. . . .. ~~.~.~~ . .. . ..~~~~/.. . ..~~^~.. F . . . ..~.~ ~ .. ~ .~ ... .. . . .. .. l.... . . . . . . . - . a .. ... .5.: . . . ~ . - ... . . " .:
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PROTECTEO BY MINNESOTA TOBACCO UTiGA71ON PROTECTIVE OROEA F . V death certificatss, a l*s@ehan perfect soucce, to say the least. (ior a diseussion, se• the chapter on soctality data.) Another development •• improved medical technology -- also presents probleAs for Zliia atguAent. In the early part' of this century, doctors had limited capabiliti.s for diaqnos- ing lung cancer •in living patients. Not until after 1930 did the main clinical tools •• X eay, bronehoseopy and sputum cytology •- become available••to diagnostieians.j0 The •epi• demic,' then, may reflect nedical progress. eut medical pro9resa can becoAe a two•edqed swocdo Clinicians can overuse their asw tools. A Swedish medical team hinted as Auch in a report in 1975. The scientists, who believe that smoking is g.lated to lung canesr, discussed th* clinical and pathologic aspects of•aor• than 700 primary lung cancer cases autopsied in a university teaching hospital over 11 years. They said it is clear that until recently lung cancer was frequently not aiagnosed. They a ddsd that the increased interest in cancer in general and in bronchial cac• cinoma in particular• had• led to• a.ors frequent.recognition of it daring the patient's'life and, in some cases, even when it wasn't pcesent.31 In othat vocds, they saids ~ It is obvious that the froqataey figures based on clinical methods are too low ia earlier seci.p,:wberaas.in recent years the figures say bik too high because of over- 17 pLNA i W 114774 S
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PROTECTED dY MINNESOTA TOdACCO LITIGATION PROTECTIVE ORDER I Reterences tor Overvitw l. Straus, D.. •Somatic Mutation, Cellulac Di!lerentia- tion, and Cancer Causation,• J N, l Ca_n_ce_r, nat 67 (2) : 233-241, August, 1981e 2. Rnatrom, J., •Risinq Lung Cancec moctality Amon9 Non- s~eok.rs,' J 1~, atl ancec Inst 62(4): 7sS-'60, April, 1979. 3. !'.instein, A., Comments in •Discussion• of presentation by t. ducch, •Saoking and Lung Cancer: The tcoblem of Inferring Cause (With Discrsssion),- J R tat oc A 141 (Par t 4): 437-477, 197s. 4. Appel, J., •?he M1ab*rs Ca.e,• Address, liewsmakers Luncheon, Overseas Press Club, New Yock City, New York, Jun* 23, 1965. S. Anonymous, 'is Ca tpidomioloqy Kore Than M*rely Casing Into Entrails?,• n ernal M,,,d N_e_w:e 2, February 1S, 1911. 6. Devesa, S. and D. Silv*rman, "Cancsr Incidence and Kortality Trends in the United States: 1935-74," J N Cancer ner nat 60(3): S4S-S71, Macch, 1978. 7. Siemiatycki, J., et al., •Discov.riag Carcinogens in the Occupational Enviconuent: A Novsl EpidaAiologic hpproach,' J Na 1 Cancer nst 66(2)S 217-225, Yebruary, 16'8 . a. Stecling, T.. •Does Smokinq Kill Workers or Working Kill Smokers? or The 1lutual Relationship •.tween Smoking, Occupation, and Respiratory Disease,• i,_ J H*alth rv 8(3): 437-452, 197t. 9. Medical Services Study Group of the Royal College of Physicians of London, •ftath Certification and Epidemiological Reseaeeh,• Se t M_ Je 1063-1065, October 14, 1978. 10. Lamont-Bavecs, R., Statem.nt. O.S. Congress, Eouse, SubeoA.ittee of the CoNmitte• on AP4ropciations, Dspartmeats of Labor and Rsalth, tducatioa and Welfare Appropriations tor 1976, Bearing, 94th Cong., lat Seas., April !. 1975 (Maahin9ton# Government Printing Ottice. 197s), pp. 6-7. 10 YA OO 114987
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PROTECTED s$ IMtNh1jS°OTA TOBACCO LIT1GATlON PROTECTIVE ORDER Canc.c ot the Larynx Laryngeal cancer is*a.celatively rars disease -- representing less than 1.5 percent of the total annual cancer incidence rate in the Onited States.1 Thus, researchers . observe few laryngeal caacer, cases, even in larqe epidesio- logical studies. !or exaaplt. Hammond and itorn, in their study of 195,000 aale'a, 'recorded only 24 laryngeal cancer ..r . . deaths.= And Kahn's stu dy of approximately a quarter of a million U.S. :eterans.touni only 54 laryngeal cancer deaths.3 As a eonsequenci'ot such small numbers, the conclusions drawn from population stu dies aay be suspect. Nonetheless, the •Sui9eon G.neral's reports have used such studies as' a basis"tor conoluding that saoking is causally related to•lirynQeal cancer. yet an English spicialist in diseases of the larynx who reviewed several aajor epi'deAlological studies considered them inadequate to .stablish:such a causal celationship.l About the Hammond and 8orn'studx, he commented that the conclusions that can be drawn ar. _'aot qlear.• tte described Kahn's aor- tality ratios tor spokers'ai 'slightly lsss inpressive,• once they are •vi.wed in t!a llgbt'ot the nuwber of cases -- 54 in all, and usually in sin9li jigures in each smoking group.• And he contended tliat Doll and 8i11's 8ritisb physicians study •producsd no.tirs donciniioea about laryngeal carcinoaa.' Only Ln ~ . N 1., MNA 001150-15 .... .. - . . .~.. ~~... . ..~~.~•~•.w•r~w~s~s.....~..~.~•.~ -.... .. . ..•...~~.. .. , . ... • . . . . .. . .-. .. • . . . .. ......~~~.:'Y- . . .~ Y• ' ....~ .. . . . .. ~ ~ . . . . .
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PROTECTED 9Y MINNESOTA TOeACCO IRIGATiON PROTECTIVE ORDER 16 deaths dne to this disease wr• observed during a 10-y.ar iollov-up,s Ae also discvssed tbe contrast between cigarette smok- ing trends and the 'rearkably eoAstant• incidsnce rates ot laryngeal cancec. in•other vords, laryngeal cancer cates have been essentially the sau*-yiar after ysar even though tobacco consumption has indr.assd-drasatically. Cons.quently, he wrned that any datt'•sboving an association betwen cigarette smoking and lacynqeai carcinoma •mast be interpreted with caution.• Ovecall, therelore, he •tound •no irretatable evidencs• that smoking causes -laryngeal cancer. The contrasting smoking and diseast time trends gener- ated a comparable r:aeeion in another British scientist. He suggested that the stfikin9 dissimilarity 'vould seem to be incompatibl.• with th:•sypothesis that tobacco ts causally related to the diseasO A similar divergence in trends was noted in a report from 8cotland.y A1tho~9A the percentage of smcsrs in Scotland is high and ah'inareasin9 asount of tobacco is being consumed, th. au thocs did not find the higher death ratss in smok.rs that would bi prsdiated under the causal hypothesis. tios could th:y acoount for this same divergence in an as.a of 40 cn r i : I , A i15016 ._.~..-_. ..-....-----. ._ ... . _ . _ _.. _ . . __._ ._. _......_.._::. , • ..""_"":"'.. . .. . - - • • . . °
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t i M .~. -. . . .-'. - • . ' '-PROTECTED sY MINNESQTA TO8ACC0 I,ITiGATION PROTECTIVE ORCER The res.areh.es believe that eigarttte smoking in- cr.as.s the risk o l.dis.asa in addition to lung cancer an d wsrs cautious ot any'posiibls intsrprstation ot their data as showing that carotsno'protsets ssoksrs. One of thss conceded in an int.rvi.w tbati•tbb number of lung eanc.r cases was too small to draw any.conclusion other than that the soc• carotene i one eats, t.~• las~ s~atiatical risk there is of developing lung cane.r.s= . The rss.arch.r said that sci.ntists do not know how dietary vitauiA~71 sight protect the body against cancsr, and another sci.ntist, the director of turdu• tTniv.rsity's cancer center, told a repoctec: •What's really necessary is a good,. controlled study to provs that it's r.ally what ws think it is. i feel uncosiortabls with any of these things until we know the sicAanisn.•S1 All of the rsssstchsrs appsar to agcs• that these investigations of dietary factors warrant hurthsr study. Psychological lactors Iaer.asiagly, those who would t.rest out causes of disease aro, lookinq•to the sinds of patients as well as to their genetic sakaup.- The )onrnal Lancet cetsrred recently to •a small body of t.ssarch which w gg.sts that esrtain oeo- tional cAaractsristics• say enter into the dsv.lopsont of 24
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4 4 P20 4057125 ' • ~r4c= e•;A~M~tIMA 1 A G11i~A 1 ~ $TSas: CONF_7DENnAL ,,Gx~.MO~a .roQV , w~~~ A w RARRt SYOl~f} R~tO~ANT (19f~•1~1f1 TCAwI!•r ~f~t CC Y. PCIfLtR fttlllC t L, w,Lt v nu Nf Ywlo~ nlff~t fr~Ytwf w~ wOft>1 tt.awftttyl~ M lMDIAxApOLjA•latDj4XO fft ~OfO• ar;, 2 19-6 18u.new..86•,6.. Mr• Ro T 1Af. COes .Il . 1776 °e2nstitute ob 6 K • Zn Washin Street, N, W ~' 9ton, D. C. 20006 . Dear Roge ~ r; v - ~.. that tried to return ' . _ Should ou would be Your c ~ a nur,~ber°u wish toorea h~he ofti seYnreiidaY but waa iofo where you mi me ar ur late in the rmed ally return to my otf ght be reaer,d gent basis, kindl week. ~ to return such calls at e a~ter my in the evenfn Y leave N g ~ o that tim~ legisla:ive ~+ork ~s I usu. • • 1092 nd attempt I Cor~ittee of ls ncw are Se~at assigned •z the c01tinuthe e ar~d n do w is awi: : t in Gaver~en tal AI: airs r 9 to hat w g a hearin are goin °ger. ~ f t ses^~s e ca- :3 stoF i: there, paul and ask N g to negat:v , that ev •• whv Smoke? n e adv e.. t1e ci:arette do smoke • follow ertisem••n.s• ~aanufacturers ' you shou: tng wit.'s a admor fsm trovera}, abou ~ e brand t s..,oy,insmoke brand X ~e.zt s seeln to tha ti can vebads°ne to recommenjnd heal:h" isrer ads Cite thei+~ You 7 e legislati 0 da'~ag'n nYthi ost 'a = e i - • to ate the tugraus a ccp! OS 5hts o; ~., th:s lettes -• °' -u ~;s , as `--^"~~elY yc:.., y this matter, . , PPreei i n on g _3 e ' : - ngh 3ct rs ~ h u fur w ' =c rreve: e hanti uch neqa_ a re Dn a relate ~okin9 Peit the of m d sub,eCt Tobacco Tzonly sL`~ ~as have been t Ple peO . I wCouncil has its ,,an,°' tto: c! Do:N sl~ tA eenjure uP ositivs adv :onder if the -iLare:tes Do-9ans. yow tha«1 recte ert_sing camoai Znst::; _ ' t P=~otoY Taxes, `/. ~ Perhaer`1Menents go• M+ e m=~h _ or car.• Fsg?est: a sim~ _ Ps' E~.~ Smoy, W~the_,e' f'Sr; o~ ~s tha: cigalar~ ~cN W: t.ti Court y. / Z would I am sending t1r ~~ -~ Ot -ers~ es sf ^~ . a N'
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lb PROTECTED BY MINNBSOTA TO®ACCO t.ITIGATICN PROTECTIVE ORDER Fipure 1 . Inctdenc• Ra'l.s' Per 100,000 PopulaNon From Second Nattonal Canc.r Survey (SNCS, 1947-49) and Third NatlonavCancor Survey (TNCS, 19ao-71) : Orai Cancer WHITES . - NoNWHlTES Mal• FNnafi Mat. !<emat. 18.1 SNCS :TNCS: • 12% CJwe,o, Pharyn9eal Cancer --wHITES- Mat. " f.n+at. aNCS.:rNCa • tn cho,o, $NO11' TNCa • ZS% Clw4p SNCa TNCS -22% Cteeq. --NONwt"aTIR3- IlAal. !<anat. sNCa tNCS •6M G+.no. . * Age adluaed to th. 1950 u,S, populatlon stanAed (13) ' • - . 47 SNC3 TNCs ox c~,ano. I . . . _.. ..._._..--• ---. . . .. . e ~
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I I PROTECTED BY MINNESOTA TOBACCO UTiGAT1ON PROTECTIVE ORDER Summary of Contents Overvi w . . . . . . . . . . . . . . . . . . . . . . . . . pase 1 Cancer of the Lunp• • • . . • • • • • • . . . • . . • • • • paRe 11 The assertion that eitarette smoking is the oause of lung cancer isnores basic, unresolved questions about laboratory data, smoking patterns and mortality rates, diagnostic var• iations and other confounding faotors. Cancer of the Esophagus . . . . . . . . . . . . . . . . . .pape 33 Interpretation of a statistical relationship between smoking and esophageal cancer must involve considerable guesswork, because the association is inoonsistent on a worldwide basis and among Western nations.: Cancer of the Larynx . . . . . . . . . . . . . . . . . . .pate 39 Data do not warrant a eonelusion tAat smoking causes laryngeal cancer: Population studies provide insufficient informaation, and disease patterns and smoking trends do not fit a causal hypothesis. Cancers of the Oral Cavity and Pharynx. . . . . . . . . . .page Y) Suspected factors in the workplace, in the environment and in the diet have been statistically related to the development of oral and pharyngeal cancers. Causation has not been determined for these diseases. Cancer of the Pancreas. . . • . . • . • . • . • • . . . • .pa9e 53 Epidemiological research in the U.S. and abroad has suggested many possible risk factors, Including smokinR, but no specifio environmental factor has been consistently associated with the development of cancer of the pancreas. Cancers of the Urinary Tract. . . . . . . . . . . . . . . page 63 Inconsistencies in mortality trends in bladder and kidney oan- cers, associations with diet and occupation and suggestions of other factors requiring investisation leave unanswered aues- tions about reported links with smoking. Cancir of the Lung in Nonsmokers . . . . . . . . . . . . . pas• 75 Emotion must not be allowsd to obscure the fact that claims linking oigarette smoke to lung cancer in nonsmokers have not been proven. Mortality Vatas Now Reliablat Now Accurate? .......page 91 Extreme caution is warranted In evaluation of •pidsmiologieal studies based on mortality data -- such as those used to oon- demn seoking -- because errors resulting from clinical misdiagnoses and recording mistakes can affect the accuracy of the mortality data and any conclusions drawn from thee. 1 MANATOO 114977 I
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... PROTECTEO BY IMfNNESOTA- TOBACCO IRiGAT1ON PROTECTIVE ORDER Caneers of th.-0ea1 Cavity and PhaeYnx E .r An observation-tcoi a.Civi.v of recent aedical litera- .~ ture on ocal and pharynqial eancers characterises strikingly the need !or basic worlt'.dK !hs diseases. Said th. authors •tauch of the data aasi~lable on ocal and pharynqeal cancer is limited to case histor_iss that characterize ths clinical disease aspects and consist.ot ter nuabecs.,' According to the author, an epidenioloqiit:tcom the Oaiversity of Washington, the situation is compounded further by the tailure fully to analyse available data and by the existance of serious wak- nesses in aiccent aethodoloqy.l Discussing these waknesses, the researcher pointed to anothec pcoblesi. •pen thi most obvious confounding taetocs such as aqe, sax, race or.SIS (soeioeeono.ie statusl tr.- quently w.ee not controlled arhen other variables wc• ana- lyted," she said. The ceault of such shortcomings is that •th• literature often lacks eosparability and continuity,' she said, and this •ill•detin.d cesearch• allows !oc limited con- clusions. In bor visw,.tb.se! ltaitations certainly apply to con- clusions about.alcobol aAd tobaaaoe aven though she believes tb.y ari probably aajoc riik taetocs toc the two oaAcors, she conceded$ '- . i) . . ~....~ .- . ..-..~ .. .~. . ~.....~~» +....s.. 1"--t • ...Sr~1.~~~-.~r - .~.,.--~w. «. . .-. ... . . . . . . .. . ... .. . . .- ..sl..~..:~v+r..."~'"'.'.r...... . .-...-x.~~...-,._v:e.:c'.:~~:...~w+.~.-a~....~.; ..~.. . . .;~:r,•.. .~.
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t r. . s l I 1. 2. 3. 4. S. 6. 7. a. 9. PROTECTED 9Y MINNESbrA TOBACCO LtTiGAT10N PROTECTiVE ORDER R.terenee• !oc Wng Cancer pollard, E., intarviww, 'The John Scott show,• VOR-TV, Now York, 11.Y., tabruasy S, 1975. Enstroa, J., •iising Lung Cancer Moetality AAong lion- tmokers,• J li~a~t~ Ca, _r nst 62(4): 755-760, April. 1979. D.S. Public Health irrviee, M 8ealth Cons uence ~ Smokin . M8 ' nen .to ebi1907 tu~63 o ea .rvi ce Re_~v ew: epar ent or sealEwo 3d'ucatio 153 fi:Yfaii,~ub.liaat~a~ No: 16l6, 1966. Eurst, A., Statesen•t;:"O.i. Congcess, Senate, Cossiittee on Laboc an d 9u61io Nsl laee, lobeaa.ittse on Realth, C! a 2rette'Swok 'Mfase, 1976 Reacing, 94th con~g., n-d: ess., T.~tuacy ,/iaccb 34 and May 27, 197i (washinqtqns: Oovasnaant Printing O!lice, 1976), pp. 10i-11S. , " Auerbach, 0., •t al., •s!•leets of Cigarette Snokin on Dogs. IZ. 9ulaonary lieoplasms,• Arch Znv= Re 21(6)s 7S4•76a, Dicembe.r, 1970. Manb.r, N., •Dng amokiaq ?ests =.en Cancer Prool,• Ne~ ra X(N.J.) li,r, hbruary 6, 1970. drower, L., 'Smokidg and Cancsr,• aw, ock imes, lebcuary 1S, 1970. • Stecling, T., :Coomant On S4oking Doga,• Arch viron Health alth 22s 631-43Z, Nay, 1971. IV Comnittee on sio;o~ia.E!lscts o! At~nosphecie pollution, Particulat o o• c. ani tt e, Division of • ca c•nets,•. a ona •seaec ouncil (washing- ton: National•ACa syo! Sci.nc.s, 1l72). 10. Anony'ous, Environiint8 21, May, 1973. il. qirtb, R. and G.•8ottshdoei, •Ltsions teoduc.d by a N.W gi,• ee tho 10i 98S-407, 1973. Lungwora in Migle Do • I M • .. 12. Gsorgi, J.. • th ixcpsria.ntal Trams- Aisslon As+ong atage Lacvao,• g 194t r 9A ingostion of tirst 73l, 1tov.ob.e 12, 1976. : ... , 13. Giltoed-Jones, N., •'Cancecphobia's The Oniveesal a~ !(Toeonto: NcClalland i ~ Disease,• ~ atoe C ~ r ' Stawart, L Eao. r J N 27 V
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PROTECTED 8Y UiNNE3tiTX TOeAccO umcAnoN PROTECTIVE oAOaR western Scotland wbeee the- quality of data was high. Zven though the authors stated*there is scientific evidence su g- g.sting a causal relationship of smoking to laryngeal caneer', they are forced to reeognise that their own data presented an •anoaaly.• The causal hypothesis also is not supported by the work of an Argentinian who exawiAed.tbe seokin9 habits of cancer patients in three cities.$" lf• found that smoking did not have a statistically ii9n4ti.cint relationship to laryngeal cancsr. This finding was iaterpeeted as •not indicating a dependency between the ptis.nee o! the studied cancer and the smoking habit.• He concluded that •w can therefore hypo- th.tically assume that othsr lactors, besides the significance of the smoking habit, .ost logidally affect the etiology of these pathologies.• Thus, the data do not warrant a conclusion that smoking causes laryngeal canosr:liot only have the population studits provided insufficient ieitor.ation, but disease and smoking trends aee inconsistent"irith the causal hypothesis. Two British scisntists, altfiiouqh recognisin9 the considerable re- search intsrest in iwoking and laryngeal eane.c, nevertheless concluded that •a po'sitivi causal relationship has not been substantiated statistically.•9 41 B co W J M.tiA'I b0113017
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PROTECTED BY MINNESOTA TOBACCO L1TtGAT1ON Pf1OTECTIVE ORDER All of these findings suggat that vigorous scientilia inveatigation is needed. Claima of a causal =ole toc s.oking in the developsent of oral and pharyng.al cancecs ace without convincing scientitic foundation. cn . ~ ~ N F-+ m 49 A% tJ1 ~r~~
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i 4 PROTECTED BY MINNESOTAT09ACC0 LRIGAT10N PFiOTECTIVH OROER Changes in cancer rates Aight be explained by iwpeove- R.nts in the ability to diagnose diseases and the increased access of inoeity groups, especially blacfcs, to medical care lacilities. Wt these factors cannot explain the dscreased" oral cancer rates accompanying stable pharyngeal cancer rates among nonwhite woAen. Even when lag period is consideced, the observed disease trends are incodsistent with the causal theory, which predicts that disease rates will cise with incceased oiqaretta consumption. This has not occcrred in oral and pharyngeal cancer incidencet, which have decreased by almost 30 p.rcent ducing a period in which eigacette smoking was increasing. Differences in international eaneec eortality cates also challenge the validity of the causal theory. In 1975, tor instance, aale oral and phacyngeal cancer moctality cates in Bong Kong and Singapore were among the highest in the world. Dut the rates were such lover in the O.S., Denaack and Japan.14 L'ven though per capita cigarette consumption in Song xong and Singapore was such lower than in the O.S.,L5 mortality catss there were about touc times hi~ than in the v.S. Conversely, Japan, which had a reported per capita cigarette consumption rate similac to that of the O.Ss and the United Kingdo., ceported oral and pharynqeal cancer moctality rates raughly h l! those of the O.S., Lngland and Nalss and Scotland. 48
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PROTECTED BY MINNESOTA TOBACCO UTIGATIoN PROTECTIVE OROER Meanwhile, the sditor of a medieal magazine used the study and the publicity surrounding its publication to express his concernl about th. ray in vhich research dealing wieh cancer and suspected caneer-causing agents is reported to the public:. Too otten, both scientists and the press present the latest findings about a suspected carcinogen in incoepleta and misleading fashion. Csrtainly, the Barvard study reported finding •a strong association• with cottee consumption. fut the authors also emphasized "the need to dstarsine whether the association exists in other data and to evaluate its causal or noncausal natuc*.•2 According to the researchers, their study was planned to reevaluate the relationship between smoking and pancreatic cancer. eut they found only a•wak positive association• between pancreatic cancer and smoking. Gn the other hand, they were surprised at the •unexpeet.d association• with coffee drinking. A critical review of this article commended the investigators !or pursuing other suspects when •the original analysas showed nothing substantial to incri.inate• tobacco.$ 54 ~ ii ~
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PROTECTEO BY MINNESOTA•TOOACCO UTiGAT{ON PROTECTIVE ORDER w lower incidance of lip cancer than thoa• who used other me thods. 7 virusa also hive'bQen •xaainsd !or • possible role in these cancers. Althouqb the research is not conolusivo. ~ scientists have postulated that th. herpes sixplex virus may - be related to lip canc.rs.8 The ipstsin-iact virus has also been investigated toc its Oossibls etiologic role in naso- pharynq.al cancer t'tlCj ;!•11 Ons qrasp ot researchers described t1vis virus'as '1tbe only factor thus !ar linked to t+>PC in patients throughout the woeld,• but.it has not been d•tectad in all csss4.u Claims that smokinq causes oral and pharynqsal cancers are not supported brdissas• rats and cigarette consumption patterns. Logically, it both of the oancers are caused by cigarette sxekinq, their rats patterns should be fairly sixi- lar. Yet they do not appsae to be, according to data teo* two lar9e•scale national 'vaacsr surveys by the II.l* govern- oent.13 Th. surveys show-that over a 24-year period, pharynqeal cancer incid.nee role , by ls percent while cancer of the oral cavity dr~d,nearly 40 p.rosnt, oral and pharynqeal cancer ineidsnce cat.s by sox and raca, as eeportsd " these surveys, present another passla, as illustratsd in the acco.panyin9 cbart. . v, N F- . A 11
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PPIOTECTEO BY MINNESOTA TOBACCO t.lT1GATION PROTECTIVE OIiOEA ." . In addition, the Uarvard researchers noted that their observed association with coffee consumption seemed to be consistent with other findings. ipeeificially, they cosmsntsd on the apparent increase in pancreatic eane.r in recent decades in the tt.S. and on the low rates observed in Koraons and seventh-day Adventists, who advocat• abstaining froa tobacco, alcohol, tea and coffee. Although they speculated that this pattern could be.`cvspatible• with a causal role fos either coffee consumption oi cigarette smoking, they conceded that •the relatively small excess of men with the disease in proportion to women would seeA to be aore suggestive of a role for coffee rather than for cigarsttss.• Of course, this study neithsr proves nor disprov.s that pancreatic cancer is caused by coffee, tea, alcohol or amok- ing -- nor can any epideAiological study. And the lsad Harvard researcher appeared to address this point later that summer when he was quoted in a news story about research suq- gesting that green coffee beans may contain a powerful anti- cancer factor. He stated: 'we'r• not saying the association existed. we'ce just saying it existed in our data• and •there should be further rssearch.•7 I Unlike the sarvard study, two reports published in 3381 , from the International Mesting on Pancreatic Cancer made no I headlines.'-9 Perhaps that was because both of these ~ Ln ~ . N ~ A ll
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PROTECTBD 8P1MINNP.90TA TOBACCO ll11GAT10N PROTECTiVE ORDER Reler.nca !oc Esopha9eal Cancer 1• R.ys, •A.. •t al., 'The Diet and All-Caus,es Death ltato in the s.ven Countries Btudy,• ncet Il: Sa-61. July 11, 1941. 2. eti.is.n, N., et al., •Oesophaqeal Caneer in aceenland: sel.cted Epidseiologic;l and Clinical Aspeets,' J Cancer es Clin. O„nool 941 69-80, 1979. ~ f 3. Armatrong, r.,:"!ho spidemiology of Cancec in the People's R.pu biie o! China,• nt ~ dem o 9(4)1 30S•315, 1980. . e . 4. Lu. 8.. •t al.-'ttNCbgenicity of sxtraets of Pickled Vegstables-ColleOtid IA.Linbsien County, a aigh• ineidance Aria:.lbs EaopAageal Cancer iA Ilorthern Chiria,' JIt;~t1+Mcot' nst 66(1)t 33-36, January, 1981. S. Editorial, •Cancsr of the Oesophagus,' pr ftd j iI: 6. 7. : 8. F r- 9. 10. r 135-136, July 17, 1976. Day, H., '8ome Aspeces of the EpideAiology of Esopha- qeal Cancer,• Ca~ r_, 3S(11, part 2): 3304-3307, Novemb.r. i9iE* Chilvers, C., it al., 'Alcohol and Ossopha4eal Caneer: An Assessment ot.the Evidenee from Routinely Collected Dats.• 1 deaiol. oaa salth 33e 127•133. 1979. ttinlen. L., •Mortality in.ltelation to Abstinence from ruat in Certain"Qrdsrs of Rtligious Sisters in ecitain,' aAbu •. e c!.• anc. eid.nc Detined to n, . ~. r, e a. (old p~-Bar c, ev orki Cold Spring ltarbor Labora- tory, 1910),•pp."l3S•143. ueliec, A.; 'The *idemiology of Esophageal Cancer in the ttest,• cev Msd 9s -607•612, 1980. pottern L., et a1..•.'Esophag*al Cancer Amonq Black Men in 1~ash~ngton, •D.C.a 2. J1lcohol, ?obacco, and Other Risk Iaetoe1k•ca,_ s st 67 (4) e 777•783. . •. : Cctob.r. 19810 : . . . ; J II r lle del lta4ato,_J. diid •.,i0at •Nds.), •Cancer of the .at_ Diqestivs Traetrisopha s.' anc : ia osis, Tr ; ~ Aent, and ~rog osis, st •d. . Lou s: e C. . i _ ~ os y t~Paa~7f .~ pp 44~• •462. U, : • . _j N 00 ~ 38 W 'p U ~ A 11 14 ._._.. s_77--.•.`_~...._..~.~•.~:r •.. -77:77 " .. w-~.-~~ +.~..
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER It.tsi.re.s _!oe Laryngeal Cancer 1• G.t. D.pactasnt o! 8ea1tA and Susan 3.rvicss, surv.il- lanc., desiolo , and nd ~te_i,s,r incidsnl'i'3l~T roal,~ a ta ~ •~ y ~ one ra _, Nat ona inse tuus o e , ilt oa on o. 61-2330, June, 1981. • 2. 8a,uvond, _. [ad 0. gorn, •Seokinq and Death Rates -- Report on Focty-lour Nonths of rollovwOp of 197, 793 M.n. II. Death •Aates by Caus.,• ,w ~.d asoc 144(11)t 1296-13.09, 1lareb 13, 195~. 3. tahn, B., '?hs Dora Study of iwokinq and Mortality Aaong O.i. Vateranst RNport on ai qht and One-Ral! Years o! Observation,• deuie e ioal o e•s t the tvdy s Ca.ncss ~an,,~ ron seas.sj oA"-n~o ,,oeap_~ ~. anuary, , pp 4. etsll, r., •laokinq and Laryng.al Canc.r,• La~nest_ Is 617•61', Narch'li: 1972. S. Doll, R. and A: Rill, •Lnnq Cancer and Other Causes o t• Death in lt.latlon to ssokinge A Second Report on the Koctality of 3ititish Ooctors,• ! i~t M.d ~ II: 1071-10t1, tto~iilibsr 10, 1956. Doll, 1t. and A::1[ill, •Nortality in Relation to Saokinqi Tsn Yiirs' Observations of British Ooetors,• •rit M_, ~ ts ••ir399-1610, May 30, 1966. 6. surch, p., •Ari=lO• of Cancers lreventableT,• IR~CS, Med 8_ci 4s 333-3s6, 1970. 7. Boyle, P.: Ot-a1., •Canc.r ot the Larynx in acotland,• ee J Cancer 411 196•197, 2900. Ao lecrara, t., •Zdblb9ical Analysis ot Lung Cancer in the City of La tltti,• c os d n 0' 2• Intsrnational Cl.ans on: •iss, , • . 2Z!- 9. 8tall,.p' and•!. Mo0i11. •Zxposns0 to Asbestos and Laryngsal Caroinoma,• I La_ t ma s9(S)g sl3•517, 1975. r 42 cn ~ _j N ~ m OD w °D l E a 11 1 _~._......... .. _,._._ . .. , _ __...~ .. . . . ~. ; T,
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=. , PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER 26. Itihn, H., •Ths Oora dtudy of iaokinq and nostality Among p.S. V.t.ranss. Aspect an si At and on.-salf Years of Obsorvation,` d a olo oa J1 oacha e. th• Stu oi~ nea_ n o ason e s.aa s, M no ra I~, .. ~i.~asnsso , aewarY, , oo. •125. 27. eucch, t., ~h. iolo of aneare I sv'• coach (ealtiaor.s~fn v.ra ty~ar rfss 167i, 28. Lao, p., (od.) ; •b:eco onsua•ti in Vacious Countr i.s, Tobacgo ss.asc oun .'3ta .i'Trd1"tapss, o. , th •d.1 idinbus9bs T. and A. Constablt, Ltd., 1975). 29. l.qi, tl., at al., nc Mortalit _ Morbidity statisticsi Ja an in , Japan.s-Zanc.r ssoc at on, aoqra on ancss Rssoaroh No. 26 (Tokyo: JapanasR ioi~nti io Societies trss, M1). 30. Rosenblatt, M., itatoaint to Q.i. Coa9rsas. 31. d.rq.. To and il. Tor.mala, •lronchial Cancer -- A Clinical and tatholo9icai 3tudyl ii. trsqU•ncy According to Age and iax.Durinq•a 12•Year Psciod.• Sc d J 1ta~ tRLS S6 (2) t 120•126, 1Wqust, 1975. 32. s.lchar, J., •Ths Chtnqinq Pattern of sronchial Carcinoma,• •c'J. QI.-GhbSjt 691 267•258, 1975. 33. st.rlinq, T., •Additional Comments on the Critical Assessment of the Bridenea loarinq on 6aokin4 as the Causo of Lung Canc.r• ~I b o•a 66`2)s 1`1-i64, t.bruary, 1;76. 34. esaais, J., Jr., ot al., •Chanqin9 i9idsaioloqy of Lun9 Cancect incrsasinq ie MoAOn,• MsdicaCli i- t~o=b A.. 59(2)t 31S•325, March. _ 3S. Ku.per, M., •Wnq Cancer and 3aokinq in lerap.etivo,• La rs' Msdical C e o dia....~l s onal n uri*s and e . . tra'1i ceso o . , ar n an j Iise ~~Tbo Allen Smith Co.# 1972). 36. surch, t., •:aokin~~~ at~= ~ rs The Problem of inf.rrinq Causs,' tist lart 4. 141: 437•477, 1978: • 37. Gottliob,'N., •Lan9 CaAOOr and the Petroleum ind2stsy in Louisiana,• ~ Qg~ ~ 21(6)s 386•368. Jano. 19i0• 38. Hoibor9. A., •Canc.e./lsonq ltavy lersonnoll Occnps• tional Coaparisons,!_Mi_, lit Mid 146s SS6-S61, 7Wqust. 1981. 29 A 011506 . . . ,. ~... .-. . .. ._ •..• . ~..r.._ ._.,...+...._..~. _ ... ~~_..~.... ..~r...~_~~. . .~._ __ . . ..:. .~. . . . . . . .. . - . . . . . . ~ . . . "'~'~ •• .
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PROTECTED BY MINNESOTA T09ACC0 LRiGAT1ON PROTECTIVE OROEa uational Cancec Institn te studies stressed a such less drama- tic point -- that little is knc,rra about the cause or causes of cancer. Ons of these studies, which was authored by three ICI r.searchers, discussed several problems in analyzing data on pancreatie canesr. !or •xaAple,'the researchers noted that although pancreatic cancer mortality rates have increased in most countries, •it li*di!lieult to detsrmine how such of any increase• is actually ds• to a more frequent oceurr.nce of the disease and how much is due to other tactors. These could includs increased recognition of the disease because o t in- provemsnts in diagnostic procedures or increased accessibility to medical cars., Ths NCi researchers also cited a worldwide 1976 study by the international Agency tor Research on Cancsr10 vhich, . they said, demonstrated that •one of the persistent problems with descriptive epidemiology of pancreatic cancer is the fact that histologic confirmation of pancreatic cancer compared with other cancers is consistently low in .ost countries of the world.•a In otAer words, very few patients ace •xamin.d with suaA thoroughness that a portion of the suspected eancer is removed toc microscopic examination. In their own analysis of thousands of pancreatic cancer cases and deaths in the U.S. dating from the mid-19)0's, the s6 A O11 1
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PROTECTED BY MINNESOTA TOBACCO LlTiGAT1ON PROTECTIVE ORDER 12. Easton, J., •t al., "Nasophacynq0al Cateinos,a in the United States. A patlsoloqic Study of 177 O.S. and 30 loe.iqn Cas.s,' A~ OtolarYn4ol 106(2): e8-91, ?tbtuacy, 1980. 13. D.vesa, S. and D. Silve r.un, •CancsE Incidence and Moctality Trands in the United 8tatss: 1935-74,• J Na_tl_ Ca r nst 60(3)i $4S-571, March, 1978. 14. s.9i, M., et al.. Ws.l, Cane.r Moctalit and Mocbidit Statistim Ja w an e oc ,~panes• anc.r ssoc a . GI~NA~ e~o~Zpr'3n at Rlsaatch po. 26 (Tokyo8 Japanese Scientific Societies lt.ss, 1981). 15. Le., t. (.d.), Tobacco Consu.ption In Various Coun- tri.s, Tobacco •s.arc G-ouncLL;'Res.acch'-iapsi -IS. 6 TM-ed.l Edinburgho ?. and A. Constable Ltd., 1975). sl
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I PROTECTED BY MINNESOTA TOBACCO LRiGATtON PROTECTIVE ORDER 0 Caneer ot the Pancreas i Coffee Zs LinKed to Cancer of pancreas, Dut study Cautions Tie ia Only Statistical Nea dline The Wall Street Journal March 12, 1901 Just about every newspaper and newscast that day carried word of what one medical editor referred to as "the S latest entry in the careinogen-ol-the-week series.•1 Re- searchers tro. Harvard had just reported finding an associa- tion between America's favorite beverage, coffee, and pan- creatic cancer.2 But most of the headlines and news bulletins contained only half of the information in the Wall Street Journal's headlines They omitted the point that the Harvard study was purely statistical. As the Journal put it, the study •didn't show whether coffee caused pancreatic cancer, but said only that there is a statistical link between coffee consumption and the ailment.'3 iortunately for America's eoLtef drinkers, The New York Times and Medical Mtorid News later carried detailed criticisms from Yale, Columbia, Mt. Sinai Medical Center and even Nhit. River Junction, Vt., all of which suggested that the research was llawed." 33 A 11
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PROTECTED dY~AA1NNESOTA TOBACCO LR1GAT10N PROTECTiVE ORDER ~ .; 14. Rosanblatt, N., States•nt, tt.s. Con9ress, Bous•, ~ Coeeitts• an Interstate and toreiqn Couaeree ett : Lab•lin and Adver isiA •• 1 69, 8oarinq, 9ia ., s at ss.,-1'1pc , 39 an Nay 1, 1949 (lhshinqtods ~ Coverns•nt ptiptiAq 0ltioe, 19i9), pp. 12SS•1263. c 1S. o.s, Public Healtb"s4rviee, flakinq and Healtb. ~ a ~~u~3~ n•ca ,I~e~icFT•'eF ofA•alfb, • Rt e i i7ld ri Mi. blieation lfo. (pSi) 79-S006i, 1l7:. T 16• d.ckson, J., •sookinq and Lunq Cancers Sos• Obsarva- a ta A_ a 53 (261): tions.an ?wo llsoent 1t•ports,` . 28•36; Macoh;•11959. 17. D.t•eiaq, •[. and• s. RartsanA, •Nortaiity Associated La 61 IIi •1026. Novsb•r 12, 1977. with the pill,` . ls. v.S. Public 8•alth•iarvioe, k ~d E•a th. i neral R•porto o~ th• sor osis • eo ~i• r on C -- 3Fem , parttent o •ali, L&caFion ana ,. s aca, • ublieation so. 1303, 1961. 19, staclinq, ?., !?.p• tti•ots of s•lt•=•1•ction taotors in the Study of Wakinq and Lung Caneer,• pres•ntation, The 1lnnual Ke•.tifiq of the Aaeriean Statistical Assoola-. tion, Nontrial. lQu•b•e, August 16, 1972. 20. tt.s. publia*q•alth 3errice, DA a th con_~s.g{~lenC~es o smokiril 1 27- .::*a0arts•n ' ~ 3~'d1~ -a • acs,..D9!Ll . •fiu.bAI"tLo1 lLSla_lt~~) _7~-~OOiS, 3379. 21. Doll, R* and A. Yill, •Lunq Caneer and Other Causes of D•ath. in Relation to 3ookinq,• r e NZd J_ II: 1071-10f1, 1956:• 22. Namnond,,to arid D.'ttocn, •~eokinq and Death Rates •- Report on 44 Months of lollowup on 187083 Ken. part I. ?otalNostality. Pact I2. Death Rates by Cause," J 1N _ ,s og.166s 1159•1172, 1294•1308, 1958. 23. Docn, lt., *•Tht rloctality of Smok•rs and llon•3Aok•rs,• Proc Joe , 111„t .ct• Mi=c tat A,ssn, 36•71, 1959. 26, poll, N. ind l11 aill, 'Mortality iA Rolation to s.okinqs •?an Years'*0bserirations of British Doctors,• erLt Med is 1999•1910, 1944. --3 25. tlaasond, d.,. :9mokin9 in R:lation to the Death Rates of One Million Nin :ind troe•A,• idesio o ieal coaehes to ~he St~n o~arc• and~ • s . Fton3~aa~.~a• sn sel.• January. 1~• oP• - 28 ~. . . .. . .. . _~. , ........~~..r... .~.~~~....w•• ~..ws~w • •«+f+~~....~.•w.v at~ . . . . _ _ ~~ ^- . . .r . . . . . . ~,: .. .. .. . . ._ _ . . . . . ', •. .~
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PROTECTED BY MINNESOTA TOSACCO LPTiGAT1ON PROTECTIVE ORDER / into account an observation in the 1973 edition o t a medical t.xtl4 that is still celevanti The cause of pancreatic carcinoma remains unknovn, and ind.ed there is little eireus- stantial evidence troA either exp.cimental animals or epide.iolo9io studios on rhich to base even a tentative hypothesis. As the research indicat.s, little is known about the cause oc causes ot pancreatie cane.r, whieb represents abou t 3 percent of all cancers diaqnosed yearly in the O.s.1S Many possible risk factors have been suqqest.d, bu t no specific environmental factor has been consistently associated with the development o! panereatic cancer. The conclusions that have been c.ached, and even the data from which these conclusions have been drarn, are open to question. Certainly, much research remains to be done. 60 A 0011
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PROTECTEO 8Y MINNESOTA TOBACCO UTIGATION PROTECTtVE ORDER dietary factocs, decaffeinated coffee, oceupational exposures, stsroids and esrtain gyneeologic conditions and procsdnres. Although the researchers mentioned cigar.tts smokirq among the risk factors listed in other studies, th.ir = data shoved •abs.nce• of a relationship in mal.s and an ambiquity in females. They did not report finding a statistically siq- nificant relationship between smoking and pancrsatie cancec, but they did observe an increased risk among smoking women who drank d.caff.inat.d coffee or had c.rtain gynecologic problems. The authors had no explanation for this increassd risk and called for furth.r r.starch.12 Th• confusing and even conflicting findings in this area ar• illustrated in another article written by a group from the Univtrsity of South Carolina and Ouks M.dical Center. Unlike the investiqators from the University of Maryland, they were unable to find any association between smoking and pancreatic cancer in either sales _c females. But, also unlike the Maryland r.s*archers, they did find a statistically significant relationship between diabetes and pancreatic cancer in females.13 As these contradictory findings suqgsst, any consid.ra- tion of the possible causes of pancreatic cancer should take 59 . A O 11 4
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= PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTiVE ORDER . To date, no one type or amount of alcobolic or saokinq product bas been isplicated con- clu s ivily. • ' F1 Also coaplicatinq the atudy of oral cancer has been the -- r inability to detersine the aatural history of the disease in particular, whether a condition in the oral cavity called leukoplakia is a preoiirsor of canoer. Characterized by thickened, white patches on the tonque, gu• or clieek, leuko- plakia so.etises bas ti'een associated with the use o i tobacco. $owever, a study of iwkoplakia in patients lroa Denmark and qunqary found no statistically s4gniticant di!lereneas between snokers and nonsmokars:= W lindinqs troA Sv.Qen and Denmark indicate that the question of whether leukoplakia really is a precursor of oral cancer is unresolved. The Swedish study followed nearly 100 patients with leukoplakia tor up to 44 years and found that only 4 percent of the group had developed oral cancer after 20 years.j Abou t the sasa ircidence was observed in a group of 331 Danish patients who were followed !or periods of nore than a year.4 Interestinqly, in both studias, nonsmokers wrs much more likely to defelop oral cancer than smokers. Current epidesioio9ieal findings are of limited value. ContributiA9-to the dileAna ol oral aad pharynqaal cancers are occupational risk factors, possible involvesent of viruses, unusual patterns ia sortality ratas worldwide and negative N 1 t • - - - . ... _~. . .. ._..•. _r_•_..... _.__ .. , . .-.,._. _...- •
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PROTECTED BY MINNESOTA TOBACCO LfflGAT10N PROTEC"t1VE ORDER 14. No.rtsl, C., •Zxocrins tancrsas,- Cancsr Nsdicins (philadslphia: Lsa i lsbi9sr, 197 , pp•Zff3T-,N70. is. o.s. ospartmsnt of Health and Ruam sarvicss, survsi - lancs, id..iolo , and snltse incidsncs s us• o fisat . I8 ub cat on No. a~l-~2330, o~ ~ ~I ~ b.tAa,da, Md.. Juns, 1981, - , 62 I A 11
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PROTECTED BY MINNESOTA TOBACCO L1flGAT1pN PROTEC'nVE ORDER had disease rates approximating those of so-called low risk groups. Md they concluded: Despite this sost detailed description of the pattern of pancreas cancer occurrence in a large, diverae, contemporary population, there is no very credible biologic explana- tion for the pattern. In an attempt to explain the reported patterns of disease rates, other recent studies have looked at a variety of factors possibly related to pancreatic cancer. toc example, an ov.rrepresentation of metal workers among pan- creatic cancer deaths in one Minneapolis county was considered indicative of the need to examine occupational exposures. Tha study, which was co-authored by a researcher on assignment from the U.S. Center for Disease Control, identified and re- viewed records of all confirmed pancreatic cancer deaths in that county from 1995 to 1974. Although the researchers cited studies which have suggested that smoking is a cisk factor for pancreatic cancer, they could not examine this issue because they did not have smoking data available.ll A research team from the University of Maryland School of Medieine, publishing in the Journal of the American Medical Association, disaassed previous stodies and presented original data that linked pancriatie cancer with at least a dozen factors. These included chronic alcoholis., pancreatitis, allergies or dereatitis, gallstones, gallbladder removal, se , 115033 ~vA
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PAOTECTED BY MINNESOTA TOBACCO LITIGATION PAOTECTIVE OAOEA R*tsc*nees for Ocal and Ph_rYngeal Cancecs 1. Smith, s., 'Epidasioloqy ot Oral and Pharyngeal Cancfrs in the United Btatess Review of Recent Litscature,' J Ha 1 Cancer Inst 63(S)s 11t9-1198, November, 1979.. 2. Roed-Pstersen, 1., et ai., 'swokinq ![abits and aisto- lo9ical Charaeteci$tias of Oral Leukoplakias in Denmark and Kun9ary.' ~~ Cancer 28s S7S-S79, 1973. 3. Einhocn, J. and J. Weesall, 'Ineidenee of Oral Car- cinoma in Patients vith Leukoplakia of the Ocal ttucosa,' Cancer 20(12)s 2189-2193, December, 1967. 4. Roed-letersen, R.. 'Cancer Developuat in Oral Leuko- plakia rollow-tTp of 331 Aatients,' I nt es S0(3)s 711, riay/June, 1971. (Abstract) S. tJ.B. Public sealtb aervice, 'Chapter S. Canc.r,' ~Smok~inq and ttealth. Re r_t of th ~Sur ~s~on General, ' ' ~ ' ' 6. Oepr ~"ees { ro3~TsaTth, tducati'o ax.-Itaei, MwA - Publication No. (PitS) 79-S006i, 1979, pp. 39-42. Decoutle, P., •Caneer Risks 1lssociated with Laployment ' in the Leather and Leathec Pcoduets Zndustry.' Arch Invi on ealth 31( l) s 33•37, January/tebcuacy,=9. 7. Spitser, /t., et al., 'The Occupation of tishinq as a Risk lsctor in Cancer of the Lip,' N 7 f 11d 293(9)s 419-421, August 28, 1975. 8. Nollinshead, A. and C. Tarro, •=oluble Husibrane Antigens of Lip and Cervical Careino.ass Reactivity with Antibody~lor Berpesvicus ttonvirioa Antiqens,• Sci_ ., 179(4071)s i98-700, tebruacy, 1973. 9. Ranie, M., et al., 'Antibodies to Epsteia-Bacr Virus in Hasophacyn4eal Carcinoma, Other Bead and Neck Neo- piasns, assd Control acoups,' 3 at ano ns 44(1)s 22S•231, January, 1970. 10. 8uanq, 0., et ai., 'Demnstcatioa of spstaia-lars ! Virus-Associated liselear Antigen in Nasopharyaqeal Careinoaa Cells trom tcesh Biopsies,' j,U ~ Ca e 14s 11. - S80-S88, 1974. Cisser, 1t., et ai., 'suman, ltasophacynqeal Carcinomas Positive for tpstein-sarr Virus DNA in Horth JWeciea,' J Nat Ca_ r nst 61(i) s 1317•1319, June, 1980. so i
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PROTECTED BY MINNESOTA TDBACCO LJ?iGATtON PROTECTiVE ORDER NCi researchers concsded that imoking and diabetes, two risk tactocs commonly associated with pancr.atie canc.r, explained 'only a small proportion of the disease.' They concluded that 'much epid.miologic work remains to be don..'e The authors of the second study also emphasized the continuing need tor obtaining accurate intocmation about the incidence of tAis disease.$ They believed that their research, in contrast to other studies, achieved a•rathee complete ascertainA.nt• of cancer ineidsnce in Los Angeles County ov.r a six•year period. By using hospital and clinic pathology recocds as well as death certificates, they were able to analyze 3,6:4 pancreatic cancer cases and determine that this cancer 'still preferentially afflicts the old, the black and men, although the differences in risk with factors other than age ace modest.' lurthec, they found 'no eomp.l- ling evidenc.," they said, to support any specific tnviron- mfntal cause (such as oecvpational.sxposuce or sAokin9) . And they did find "substantial evidence which is ineonsist.nt' with •nvironA.ntal hypotheses. Although they noted that a causal interpr.tation of the association between smoking and pancreatic cancer described in some studies has 'credibility,' they also stated that 'a major etiologic rola toe •ith.e smoking or drinking is ineonsif tent' with certain disease rates. in other vords, groups thought to be at high risk becaus• of their smoking and drinking habits 57 I M A 0 11 03 . , . .
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTSCTIVE ORDER • in white sales bladder cancer ineidence is almost three ti,res that of kidney cancer. But in white females it is only halt again as high as kidney cancer. • Bladder cancer occurs twice as frequently in white sen as In black nen, but their kidney eancer rates are basically the same. • trhite femal• bladder cancer incidance is almost a third high•r than black wom•n's, but kidney cancer is equal in women of both races, Given these varying rates in aen and women of both races, these two cancers hardly can be blased on a single agent, such as cigarette smoking. Cancer of the Kidn•y An international review of cancer incidence published in 1976 reported sharply contrasting rates of kidney cancer worldwide. aigh catea oceaureed in Scandinavia and central i.vrope, while the lowest rates wete found in southern Durop•, most ot Asia and several parts of South Au•rica, interm•diate rates were repocted foc the tT.=o and Canada.4 8ow•ver, thes• rates and information on cigarette consumption do not fit the pattecas prsdieted by the causal theory wben an appropriate lag p•riod ia aonsidered. tor example, Sweden and Norway, which rsnk very high in kidney canc•r incidence, have shown consistently low per capita 64 A 0 11 39
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PROTECTED •Y MINNESOTA TOBACCG UTIGATION PROTECTIVE OROER animal work -- that is,,failed attempts to induce cancers vith cigarette sAOke. Experimental resiareA•on oral cancer has been hampered by the failure to find an:appropriata animal model. As tbe 1979 Snrgeon General's report concedsd, •An ideal animal model in which to study oral carcinoqenesis has not been found.• Of particular relevancr is this eoment from the same report: •Ciqar.tts ssok• and oiQiratts-ssoke condensates 9eneeally fail to prodice su liqnaneies when applied to the oral cavity of niice, rabbits, or na:sters.•s• Other investigators have examined the possible role of occupational factors.' A recent study at Itoswell park Memorial institute found that uale p4tients who had been employed in the leather industiy ba0 siqnificantly increased risks for these eancsrs, which the authors said, •coold not be explained by differences•in smoking habits.•d Another study investiqated lip cancer among commercial fishermen in Newfotindland. The authors found that the fishsr- en had a iS percent higher probability of dsvelopin9 lip cancer than men of•co.parable age and that eiqarettq smokinq was not i.poctant as a riak faetor* mat they ealled •unsx- pected• was the finding r:hat those fishermen who used the mouth as a third hand in hauling in the tar-coated nets had a 45 U1 ~ J F•+
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PROTECTEA 8Y MINNESOTA T09ACCO L1TiC,AT1ON PROTECTIVE OiiDER i r increased with duration Of 4splor.nt and resained elevated atter adjustment for smoking habits.•20 Researchers investiqatinq workers at a rubber manufac- turinq plant In Alcron, Ohio, pointed out that 'cancsc of the urinary bladder has long been recognized as a disease of rubber workers.•=1 Their study of 29087 sen and wooan employed in the plant between 1940 and 197• v.rified this association.== Additional evidence that the presence of industry aay account tor regional differences in bladder cancer rate comes from National Cancer Institute scientists. They studied data on pet dogs diagnosed foc cancer at 13 veterinary centers in the U.S. and Canada and found •a strong and statistically sig- nificant association• between bladder cancer and tbe presence of manufacturinq industries. They spse.y lated that this asso- ciation was related "to industrial carcinogens that have es- cap.d into the general environment.•=3 Regional differences In bladder cancer risk •ay also be influenced by local water sources, aecordin9 to some scien- tists. A recent liC2 study associated certain eheaical sub- stanees called tribaloswthanes (l3MS) In sose water supplies with increased risk of bladder canosr. Said the researchers: 70 A 11 S
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PROTECTED BY MINNESOTA TOBACCO LITiGATION PROTECTIVE ORDER high risk werej dyes, dye interAediates and organic pigAents, pharsaceutical prepatations and pecthses, cosoetics and other toilet preparations. • Indeed, the contribution of numerous industries to the risk o t bladder cancer has been studied since 18950 when German investigators reported a significant increase among aniline dye workers. Many subsequent studies have also examined the possible inlldence of cigarette smoking. : One large British study, which carefully assessed workers' histories, found excess bladder cancer risks in several occv pations. These included textile and clothing workers, tailors, electricians and electrical engineers, as well as:workers in the chemical dye industry. The authors lound, howevee, •no clear assoeiation• between eigarette smoking and the occurrence of bladder Mors.ls 2n another study of the chemical industry, researchers noted a striking increase in risk for workers manufacturing bensidine but found no correlation between smoking and bladder cancer.19 A iscent study of leather workers idsntitied •signiti- cantly high risks of bladder eaneer.• There were so few female cases that thsir smoking information was not analyzed. gowver, among males, the author said, •the eelative risk 69 A O11 ,.. _..., ...~_,~..-. . . :'_.._ •
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PPiOTECTEO 9Y MiNNESOTA TO6ACCO IJTiGAT1ON PROTECTiVE OROER possible in lluences of the analg.sie ph.nacetin,7 the flame retardant Trial and the synthetic estrogen DES.' atorkplace exposurss also have b.en investigated in connection with kidney cancer. aop retrospective studies have failed to establish oecupational associations with kidney cancer.6 Other researeh, however, has found elevated risks among workers in a number of industries, includiag petrochemi- cal and petroleuA retfners,10 laundry and dry eleaners,ll newspaper press workers12 and coke oven.workers.13 Another atu dy oi plant workers, the Western Electric Health S rjdy, proposed that high blood pressure and psycho- logical depression might be involvsd in kidney cancer.14-15 The study population of aore than 2,000 plant workers has been followed since the late 1950's. The investigators decided that a relationship between high blood pressure and cancer mortality observed in preliAinary data erited further study. A follow-up analysis, which controlled for a number of other iactors, ineludin9 smoking, found that elevated blood pressure "appeared to be related most stron4ly' to kidney cancer mor- tality.14 2A a separate artiel., the team reported that psycho- logical depression was assoeiatsd.witb a number of different cancers. Although the cancer deaths were too few for a i.ean- ingtul analysis by specific type. 60 percent of the kidney 66 - -- ---r- -- --.r. .--_...-- --. - .. ; - .. _. _. . .. ... .. . . ... .. •.. ~...... .. ...-....~.....~.nM-• . ~.y ..
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER Reasonably stron9 assooiations between bladder cancer and TEK levels in drinkinq water appear in both sexes after control tor differences in social class, ethnie•qroup, urban versus rural residence and overall county industrialisation. tvrthsr analyses indicated that the presence of specitic high-risk industries tor bladder cancer did not confound this association.=4 A researcher with the 0.9. =nvironaental Proteetion 1lqsncy, who reviewed this and other •pidesiioloqical studies, concluded that 'there is potentially an increased risk of bladder, colon and rectua cancer tros drinking waters con- taining trihalomethanea.'=B The controversy over bladder cancer is not limited to smoking. The debate surrounding saccharin and bladder cancer has received mueh attention in the hsadlines of maioc news- papers and needs no repetition here. Zt need only be noted that saccharin is one of many suspsets in the search toc the causes o ! bladder cancsr. The tentative nature of previous conclusions is illvs- trated by the reported ceeark of an NCI official in a disws- sion of saccharin and eaneero 'iladder cancer has, in taet, increased. we've 9enerally attributed this to s.oking, but perhaps we were vronq.'2` 71 M.rA 1104 i . ~.~ ~ .. •.,....~..~..~.:- .. .r ..~• .r.. ..~ ,~.,.r.~ ~ . ~ ~ . ~. ' ~ . .
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PROTECTED BY MiNNESOTA TOBACCO LiT1GAT10N PROTECTIVE ORDER 23. Kayas. u., •t al.. •sladds Canc*c in 'st Dogss A S.ntin.l for Environwntal Cancsr?,• W. 1. 3'g_, Ldeniol 114(2)s 229•233, wgast, 19s.1. 24. Cantoc, 1t.. •t al., •llssociations of Cancer moctality with 8alm.tbans in Dcinkicg wattc,• 1. uat_i Ca_ i, t 61(4): 979•9tS, OctoO.c. 1978. 2S.• williamson, 6.. 'spid..iological =tudi.s on Cancer and Ocganic Co.pounds in n.S. Drinking ltatscs.• 'UL ota Env~iro~: lti 1t7•203, 1981. 26. Gil1stts, -1l.. •11 Look at Tests, ?he• aan on Saccacin: How? Nhy?,• os t t lAts, March 20, 1977. r 7/ q 11 ..... . •"~:.7~`~ _ .. . R.. .. .~ .~_ .
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PROTECTED BY MINNESOTA TOBACCO LITiGAT10N PROTECTIVE ORDER cancer of the Guefa in Nonsaokors t claim that exposure to other people's cigarette smoke -- some- times reterred to as •passive' or •involuntary• smoking -- can cause lung cancer in nonsmokers. Among the more recent charges against ssroking is the Th.se assertions rely heavily on studies in Japanl and Gre.ce,2 which claimed nonssokers are at higher risk of developing lung cancer because of their exposure to cigarette smoke. Both studies have received extensive criticism in the scientific literature since their publication. Zn addition, findings from a recent American Cancer Society studyS con- tradict the Japanese and Gre.k research. Thus, these claims of increased cancer risks ate highly suspect and no proven. The Japanese study, by Or. Takeshi 8irayaaa, chief epidemiologist of Japan's National Cancer Centre Research Institute, reportedly found nonsmoking wives of heavy smokers to have a much greater risk of developing lung cancer than nonsmoking wives of nonseokers.i Shortly after the appearance of 8irayasa's study, questions were raised by other scientists about its design and the validity of its conelusions.4 Subsequeatly, a nuaber of 7s A 0115 .... ... ... , ~
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PROTECTED 9Y MINNESOTA TOBACCO llT1GAT10N PROTECTIVE ORDER different levels of tobacco smoke. !!e found that •non* of these differences were statistically signitieant' and concluded: Compared to nonsmoking women married to nonsmoking husbands, nonsmokers macried to smoking husbands shoved very little, it any, increased risk of lung cancer. in an intecview, Gartiakel emphasized his inability to detect an,~r increased risk in nonsmoking wives of hea smokers.13 He said, 'Ne could find no incrsased risk, no dose-response relationship.' And he added: Passive smoking may be a political matter but it is not a main issue in terms of health policy. Pollowing publication of the ACS study and criticisms of the Gceek and Japanese researeh, the managing director of the Alnecican Lung Association stated late in 1981: 'Whether or not passive smoking causes lung cancer is a subjeet !or more research.•14 79 A O1 4
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PROTECTED BY MINNESOTA TOBACCO UTiGATION PROTECTIVE ORDER Canc.rs of the nrinary_Tract Cancers of the kidney and bladd.r, which ace by far tlie most common urinary tract eancers, account respectively !or about 2 percent and 4•S percent of all cancer cases diagnosed in the U.S. y.arly.l Both of these cancers have been asso- ciated vith smoking in *some epidemiolo4ical studies.2 gov ever, as with the oth.r canc•rs discussed in this doaument, these urinary tract cancers have been related to numeeous other factors as vei1.2 Exposuces to various substances in the workpiace, the residential area and even the home have been suggested as possible suspects. Dietary taetors also have ceceived attsn- tion, and it has even been theorized that high blood pressure or psychological depression may place some people at increased risk. Not only must any attempt to study thes• diseases consider such tactors, it also must account for the curious anomalies in the ineid•nce data of bladder and kidney can- cers. An analysis of the most recent O.s. data from the National Cancer institutel brings to light some enigmatic patternsi • Overall, the incidence of bladder caneer is twice that of kidney caneer. 63
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PROTECTED BY MINNESOTA TOBACCO UTfGAT1ON PROTECTIVE ORDER ppA•l7 Both figures are vell below tAe limit of SO ppm recommended by various health agencies here and abroad Lor workers exposed over an eight-hour period. A New Jersey pharmacologist concludedla after ing the literature that: Znviroeu.ental studies suggest that tobacco smoke has little impact on the CO content of rooa air except under highly artificial conditions. ceview- Sowever, dependence upon measurements of Co to detsr- mine ambient smoke levels has been criticized repeatedly b.- cause carbon monoxide is produced by many sources other than tobacco smoke. In contrast, nicotine is considered a much more reliable indicator of the amount of tobacco smoke in the environment since it is produced almost exclusively by burning tobacco. Studies using nicotine as an indicator suggest the con- tribution of tobacco smoke to the atmosphere is siniaul. Ora. William Binds and Me1viA tirst of the Oarvard School of Public Sealtb, tor exasple, found only very small amounts of nicotine in the atmosphere of bars, bus and airline terminals, res- taurants and cocktail and student lounges.ip io a 1980 publication,20 binds further described their lindingat •1 A 0G11 QS~
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PROTECTED BY MINNESOTA TOBACCO I.ITIGATION PROTECTIVE ORDER cigaretts consumption over the last SO years. In eontrast, Japan and the united Kingdom, with relatively low kidney can- cer rates, have exhibited markedly higher cigarette consump- tion over this same period.s most epidemiological studies of kidney cancer have examined the possible significance of a variety of factors ia addition to smoking, with diet and occupation receiving the most attention. Tor exaspl., epidemiologists at the Mwrican 8ealth toundation review d international data on kidney cancer and presented findings from their own stu dy of 202 kidney cancer patients. lllthough they found 'a significant but moderate• association with cigarette smoking in their patient population, they concluded that •no eocrelation exists on a worldwide basis.•6 On the other hand, they did find significant associa- tions with consumption of sugar, .eat, silk, fats and oils. On the basis of these and other findings, they suggested •a working hypothesis that a dietary factor, most likely fat- cholesterol intake, contributes directly or indireetly to the development of kidney cancer. in a lengthy discussion of other suspected factocs, the same authors pointed out that kidney taaors had been pcodnced in animals by administsrin9 high estrogen doses, as well as by infection with viruses. Other animal work has suggested the 65 I , : .,,_,__ .,._ . ,; _ --~- ._..... .. . .. . -. . . . . . . • . . .. . . , _.. _ . .. . . . .. . - . . . . , .. _ _ . . ~ ~ ' . . . .
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PROTECTEO BY MINNESOTA TOBACCO LRiGAT{ON PROTECTIVE ORDER i highly critieal letters appeared in the British Medical Journal eephasisiAq several of thas d.Eicisnciss. I tor exaApl., an JUeerican cancer epidsAiologist questioned the maka-up of Eirayar+a's study population, sxplaininq that •certain bias.s• could have been introduced if the population wera not selected caretully.S The health districts includ.d in Birayama's study contained most of the heavy industri.s in Japan, she notsd, suggesting that occupational or •nviron- nental exposures could have affected the disease rates he reported. In anoth.c latter a mathematician called attention to •some apparent inconsistsncies• in tlirayasia's data.6 ltscal- culating from the published data, he dstsrmined that th• crude lung cancer death cate for u_roaarried _ moking women actually was higher than the rates for nonsmoking wives of both non- smok.rs and d smokers. Ke concluded it is •pcoblsmatie to relate the higher risk for lung cancer in nonsmoking women marri.d to smokers to passiv smoking.• in an editorial, the director of the Central.=nstitut• toc industrial Medicine in IIamburg, Nest O.rmany, revi.wsd these and other •pcobleas• in the Ilirayam study.7 heaas& of the high percentage of agricultural workers in tbe study population, he concluded that the sample was not reprasenta- tive ot the Japanese population as a whole. •• swwris.d: 76 I
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PROTECTED BY IMINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER 39. Aoover, 1le an d J. Praue•ni, •Cancer Mortality in U.S. Counties with Cbeaical industries,• vicon fs 9i 196-207, April; 1975. • 40. aiot. N. and J. trauaeni, •C*oqraphie Patterns ol,Lunq J iai_ eA_ 103: Cancfrr industrial Cocrflations,• P S39-SSO, • 1976: -- 41. Menck•, t: and f. Uenderson, •Ocaaipational Differences in Rates of 'Ginq Canefr,• J Oceu M d 1A (12): 797-801, Decesbfr; 1976: 42. Steclinq, T.. Voes Brokin4 xill tiorkers or Working Kill.Ssokres? or The Motuai Relationship Between Saokinq„Occdp7Ribe, and Respiratory Disfasf,• nt I He~ lgv t(3)i d37-4S2, 1978. 43. tord, A. and •O.'sialik, •Air Pollution and Urban Factors in-1lilation to Cancer Mortality,• l ch viron Realth 35(4)t 1S0•359, Noveaber/Deee.bfc,_19f0. I 1 r_ 44. Sh:ac, C., et al., •ividence for apace-Time Clustering of Lunq Cancer pfaths,• ,rcb lav~iro~n~ ltealeA 33(6)t 335-343, NOver+bfc/Deasobi~l3'8u': - 45. Kason, T., et al.',.. las 29 ancer o talit 1ot .S. Coun::•st 1950-196 . pac en o , 3uGa an • ace:Ml ru blication lto. (l/ig) 75-780, 1976. 46. riason, T:, •t al., Atlas 21 ancer Mortalit U.S. Hon-tmitess»~•d!0*33=3'-nfpareafnt o es th, s aaeon an f ar~, ~'u~bTioatiea No. (Htl) 76•1204, 1976. 47. Bifike, Z.; •Di.tary Vitasin A and Euaan Lung Cancer,• 2_ J Cancer 1514): S61-S6S, April, 1975. 48. sasu, T., et al.,••Plass~a Vitamin A in Patients with eronchial Carcino.a,• Be J Cancer 33: 119-121, January, 1976: ' 49. Mettlin, C.i •t.al., •Vitasin A and Lung Cancer,• J Natl Cancf nst 62A6)s 1435-143i, June, 1979. S0. Wald, N., et al.. •Low deron-Vitaain-A and BVbsfquent Risk of Canesr.' PrilisiAary Results of a Prospeetive itudy,• LaZZs 013-B1S, October 1S. 19io. Sl. 3hekelle, M.. •t al., •Dietary Vitamin A and Risk of Cancdc W the' M:itarn ilfctr'io =tndy,• naf ii: 11SS-1190, 1/oveeb.r 28, 1991. $20 sishop, J., •~un9 Caneer Risk May ff Cut by 1W trient in Ln aose yruitsP tibles, Btndy tinds,• ua1 treet I" Jou_ sal, Dfeeeber -.3, 1981. N , A 11 7 , ...-. •. .~~...~.~r r:...~.~.~-......~ •.... .n ....... .. .. . . .-~. :..a.. ' ~ . . . ..~ ._ •. ; ..j...1 ,....~... -.. _ . . -.. •.v:..~..~-........h.«_wr. ..:;?...•., .~t. :*r... ~_• .. •'~: . . . - ,
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PRO`rECTEO BY MINNESOTA TOBACCO LlTIGATION PROTECTIVE ORpER i I I Tobacco Smoke Comaonents Some investigators base their claims of increased' health hazards to nonssokers on repocted aeasurements of certain tobacco smoke eonponents In the atmospheee. Sovever, it must be noted that tbe methodologies tor measuring these substances in public places are still evolving. Moreover, simply because a component can be detected by highly sensitive instrueents, its presence does not necessarily imply any sig- nificance to human health: One widely studied component of environmental tobacco smoke has been carbon-monoxide (CO). Aeseacch has shown that the main sources of CO In the environment are motor vehicles and industrial pcocesses.1S Indoor levels of CO also ar• affected by activities such as cooking and heating, even the number of persons present, because CO is generated by body metabolism. Yet environmental tobacco smoke often is blamsd for contributing significant amounts of carbon monoxide to the environment. CO from tobacco smoke has been measured under realistic as well as unrealisti4 eonditionse tTnder realistic condi- tions, measurements indicate that CO levels indoors where smoking is allowed will rarely exceed 10 parts per illion (ppm),16 In public places with normal ventilation, the CO concentration would be expected to b* in the rang• of S eo ~ A 011 ..... . ...~ . .. . ... _~.~ ~r. . , ~ ~...~......+.a..~..+6~ .:.r.rt..e~..~..~ . . .. .v.• • ~~~. « ..._ . .~~ . . . .~ .... ~• .
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER Nevtrtheless, the typieal avtraqt airborne concentration of tobacco suoke in public rooos containing smokers provides the non- smoktr with an amount of inhaled tobacco smoke equivalent to ltss than 0.01 cigarettes per hour. Commenting on their findings, a physician at the Harvard Medical School said that under the most severe concsn- trations reported in the study, the nonsmokec would be exposed to •an amount of tobacco so small that the cisk of development of any adverse health effect would be nonexistent, on the basis of any available data in tht litecature today.•21 European researehtrs* using different methods to measure the presence of tobacco smoke in the atmosphere, found slightly higher concentrations of nicotine than 8inds and lirst.22 Yet basing thtic conclusion on their measurements, they, too, emphasized that •sAoking does not cepresent a risk to nonsmokers.• Studies of other tobacco smoke constituents indicate that their atmospheric ltvtls, too, are minimal.=3 One such study described the amount of volatile organie compounds added to the atmosphere by ei9acette smoking as •insigniticant.•24 1'hs claim has been made, based larqtly oa*repocts by American Health loundation scientists, that nitrosamines troa 12 i
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER it is not possible to show scientifically convincing proot that the risk of lung cancer is increased by so•called passive smoking. Other reviewecs noted the study's Eailure to cecord the histological types of the lung cancers found in the Japanese woment or to account for their exposure to indoor air pollu- tion from household heating and cooking equipment.9 One group of German scientistsla concludeds zn.view of so many open questions Dc. Hirayaea's eonclusions do not appear vecy well founded. Pinally, the cancer epldemiologist who had written earlier to the iournal about Birayama's study population vrote back to comment on his published reply.ll She stressed that Nirayama had not addressed 'most of the questions raised.' She noted that 8iraysma's extrapolations from the husbands' smoking habits did not quantify accurately the amount of smoke to which the wives actually had been exposed. Based on her review of the literature on the issue, she concluded that •on the strictly toxicological level there is no hazard !or non- smokers.' in the study of Creek women in tluse Athens hospitals, DiAitrios Triehopoulos and his colleagues concluded that a nonsmoking woman whose husband smokes has twice the risk of 77 , A 11 2
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. 4 PRCTECTED BY MINNESOTA TOBACCO UTiGAT1ON PROTECTIVE ORpER in a similar study, Canadian researchers exposed healthy nonsmokers to extremely high levels of tobacco amok• in a small, unventilated area under conditions which some sub- jects described as the worst they had ever experienced.jj Even under these extreme experimental conditions, only •sieii- mai",physiological responses wers reported. in evaluating these results, the researchors concluded that •tAe main argument !'or ssioke-lree air seems symptomatic rather than physiological.' I Statements made by more than a dozen scientists and physicians in oral testimony and written statements submittad to a subcoaunittee of the U.S. House ot Representatives in 1978 are still valid today.34 Dr. Edwin Fisher, a protessor of pathology, testified that 'thert is a lack of scientific in- toraation incriminating atmospheric tobacco sslok• as a health ha:ard.•3S Simiarly, Dr. 8iram Langston, past presidsnt of the American Association for Thoracic Surgery, concluded:3i The weight of evidence as it exists in the world literature does not support a olaia of adverse health effects for those exposed to 'passive smoking'. .Even critics of tobacco have acknowledged that smoking has not been established as a cause ot disease in nonssMOkers. Dr. srnst Wynder, president of the AmGCican 8ealtb Foundation, admitted that while he thought environmental tobacco smoke es [Inn
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PROTECTED BY tdINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER References for Paner.atie Cane.r 1. iditorial, •puttin9 suspected Careinogsns in Peespsc- tiv.,• ~l.d__ic•a__ Mo_;l N_.rs22(9): 7, April 27, 1981. 2. atacMahon, d.. •t al., •Cott.• and Cancer ot the Pancreas," N Engl J 2d 306(11)1 630-633,•Marcb 12. 1981. 3. Bishop, J., "Co!!e• Is Linked to Cancer of Pancreas, But Study Cautions Tie Is Only statistical,• wa11 se_ Jou1. Masch 12, 1981, p. 16. 4. Schseck, 8.. •Critics Sa Cotteo Study Was tlawd.• Ne_ York Ti_m,._s, June 30, 1981. S. Anonymous, "Stoca trew Over studY Tying Coffee to Pancreatic Canc.r,• M.d _ porl •w 22(8): 10-11, Apcil 13, 1981. 6. teinat.in, A., et al., •Cottss and Pancreatic Cancer. The Problems of Ztioloqic Science and Zpidsaiologic Case-Control Research,• J_ AN Med soe 216(9)i 957-961, August 28, 19a1. -' - 7. Cohn, V., "llap Percolates Over =tteets of Coffee 8sans,• Washi P_ t. August 29, 19i1. 8. Lsvin, D.. •t al., "Deaographio Charaet.ristics of Cancer of the Pancreas: Mortality , Ineidanee, and 3urvival." Ca 67(6)i 1656•1t68, 1981. 9. Mack, !. and A. taganini•ttill. •=pidswiology of tan- cr.as Cancer in Los Anqeles,• Cancer 47(6)t 1171•1183, 1981. 10. Wat.rhouse, J., •t al. (ads.)# ane Incidence in ive Continents, Vo . I -1976, IARC c ont C n ic •a ons, o. 1 on: International Agency toc Rss.arch on Cancer, 1976) . 11. Maruehi, u., at al., "Cancsr of the panereas in Olnsted County, Minn.sota,- 1936•1976,• a= n !-COO 541 215-249, 1979. 12. Lin, R, and i. Rsssl.r. •A Wilittactoriai Mod.l tot •ancr.atie Cancer in Mans spidt.iologie tVidenco,• J Al MLd 11sia~oc_ 243 (2) 1 167•152, January 9, 1981. 13. ahingleton, N., ot al.. •A Cas.-Control =tudy ot Cancer of the tancreas.• llst J toid.Aiol 110 (3) t 3S7•358, 1979. (Abstract) - - -~ 61 .....~~~. ... . ~-.~~.~ . . ..~~~.. .. ~ • , • . . ~• ,
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PROTECTEO BY MINNESOTA TOBACCO LRIGATION PROTECTIVE OROER . 0 35. tishec, 3.. SCateNnt, n.s. Conqress, Kouse, Committee on Aqciaultute, iubcom.ittee on ?obaceo,, !• t o! Sookin on NonsAOkers, tt.aring, 9Sth Conq., n~iss., epteseer 7_7197T(Washington: GovernAent Printinq 0!liee. 1978), pp. 2•=0• 36. Lanqston, a., Statesent, tJ.S. Conqress, House, Coausit- t.e on llqriculture, Subeo=itteo on ibbacco, Etlect ot Smokin _ 1lonsaok as, Searinq, 95th Conq., 2n ess-., Septesb.r 7;~I976 (W&ahinqtoal Gov.rnwent Printing Otlice, 1975), pp. 158-184. 37. Kynd.r, s., Quoted in •tTnter Vier Auq.n: Wenn Schon-dann lieb.r barsaos raucher (tace to Faee) • Schveiset Illuattierte, October 26, 1976. Trans~ation. 38. Wald •treathinq in Their Ssioks, • Ox_ Times, March 6, 1981. I 90 I A 011506
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PROTECTED 9Y MINNESOTA TOBACCO UTIGATION PROT8CTIVE ORDER 11• Kats, R. and 0. Jowtt, •re.wl. Laundry and Dcy Cleaning Workers in aisconsin: A Mortality Analysis,• ft J su~bli_g Heal h 71(3)t 305-307, Marcb, 1981. 12. Paqanini-Eill, A., et al., 'Caus.-8"cilie Nortality Aeonq -RtMspaper Mob •ress.fn,' J OcN M_e,d_ 22(1)o s42-544, August, 1900. 13: Redsond, C., tt al., 'Long•TecM Moctality Study of Steslvorkers. VT •• Mortality lros Malignant lstoplas.s Among Coke Oven Norkers,• J. Ccv lw gust, 1972 IN d 61(8)t 621•i2l, . 14. Raynoc, W., et al., 'Bigh Uood Pressure and 17-Year Cancer Mortality to the Mestern aiectrio lt.aitb Study,• 1_w I spi=_ 113.j.6) t 371-377, April, 1981. 13. shek.ll., R., •t al., •psyeholoqieal Depression and 17-Year Risk of Death Tro. Canasr,' psvc s Mf 43(2): 117-125, April, 1911. 16. S*qi, M., et al., (ods.), Cancee Mo _t~a~~~~ Morbidit Statistics~ J_~a ° ~ai,3 Ef~i~d"sla,~panese ancer ssoc a n, CAttlT~oqcapl-i onZ ncir Researeh No. 26 (Tokyo:- Japanese Scientific Societies tress, 1981). 17. 8lot, N, and J9 traum.ni, 'C.ographic Patterns of 9ladder Cancer in the United 8tates,• J Natl Cancer I_ns_t, 61(1): 1017-1023, October, 197t. ~-'- ! 18. Anthony, R. and•0. Thoaas, •1VRors of the Orinary Bladders An Analysis of the Occupations of 1,030 Patients in Leeds, inqland,` J t~Ll Cancer Ln„_ 6S(S): 879-895, Hoveab.r, 1970. 19. Horton, A. and E. dinghas, •Risk of dladder Zysors Among /Nnsidine Norkers and Their Serum •ropecdin Levels,• J Natl Ca-„ nce: ns S8(S)e 1225-1228, May. 1977. 20. o.coull.i p., 'Cancer Risks Associated with taploysent in the Leather and Ltather Yeoduets Indsstry,• Arch Environ iro_n Health 36 (W 33•37, Januaey/tebruary,-M!. 21. Monson, 1t, and L. lina, 'Caneee Moetality and Morbidity Aaonq ]iUbb.r Morkers • }~,~, eee ns 61(6): 1067•10l3, Oetobee, 197~. 22. Delsell, s. and R. Konson, •MortalitY Mong 1dbb.r uorkers. 111. Cause•Speeitie Mortality, 1940-1978,• J_ Ocaug s~d 23(10): 677•686, Cctober, 3361. 73 , A 0 .1 0~$ • ~,._.~__.... ....,.._...... . •~~._.-.. . _ -... ----• . _ . . .. . - ~ . _ • ,. ..)' . . . .`:• f. . - . • . ~ . ~ - . . • . , . . ..
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pAOTECTEO 8Y MtNNESOTA TOBACCO t„[TtGAnON PROTEGTIVE OROlR developing lung eane.r as a nonsmoking woman married to a non- smoker.= Yet even the authors of the Cre.k study conceded its •obvious• lisitations. Trichopoulos and his colleagues ad- mittsd that •th• number of cases are saall,• as the study consisted of only 51 women with lung cancec, 40 of theA non- smokers. A group of Cocsan researchers focused on this d.- ticiency, stating that the •ss+all aumber of inappropriately selected cases appears unable to yield convincing cesults.•10, In addition, the authors offered little intormation about the population from which the sample was selected, nor did they indicate that they considered tactors such as diet, family history or occupational exposure in reaching their conclusions. After reviewing problems such as these in both the Tricbopoulos and airayaua studies, a scientist from the Cecaan 8eart Center, Municb, concluded that •passive smoking may ean an annoyance toe healthy adults, but in all proba- bility it is not connected with dasuge to health.•12 Casting further doubt upon tAe conclusions reached by the two studies is a recently published repoct by Lawrence Carliakel. American Cancer 3oeiety vie* president ioc epidemiology and statLstics.I In a follow-up study of almost 1s0,000 American woma, Cartink.l compared lung cancer mortality rates of nonsmoking wives reportedly exposed to 78 1 . -....-_. - . , ... ...___.......... .. ,.~.~~-....:.. . . .-~+-.. -..•-~...~.~~" . . .
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PROTECTED 8Y MINNESOTA TOBACCO L1TiGAT1ON PROTECTIVE ORDER canc.c ,.octality bu t high in eigacetts consumption throughou t the relevant time period. Conversely, D.nmark, the Mether- lands and Dqlgiua rink quite low in cigarette consumption but have high bladder canctr rates.S,16 Analyses of U.:. bladder cancer rat.s on a cegional basis also show departures from causal-theory pcedictions. Two governa.nt epidemiologists found elevated .octality from bladder cancer in clusters of counties throaghont the U.a., especially in the Northeast. While accepting cigarette smoking as a bladder cancer risk laetor, they concluded that it •is not likely to be responsible ior the elevated .ortality in the Northeast, inasmuch as the available national surveys . show only small cegional diltsrene.s in smoking practices.'17: These same rsseacchers proposed that occupational ex- posures •ight explain the high ratss in csrtain areas. Their statistical analysis, they said, 'indicated that bladder ean- csr rates among males throughout the country were signifi- cantly higher in counties with chemical manufacturing plants,• with the highest tats recorded in sales County, N.J., wher• nearly one-lourth of the working population is eaployed_ iit chemical productioA. si.ilarly, the three parishes in Louisiana with the highest bladder cancer rates •had 'high' involvement' in the chemical indostry. The particular chemicals associated with . 6a _ FIN-A-M-11043 ...~~~.. - . . ~++.. • `S~~ ~~• .7 .. . .. ...~ ~ . .. ~~ . r
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PROTECTED BY MINNESOTA TOBACCO l1TiGATION PROTECTIVE OROEp tobacco smoke represent a cancse risk to nonsaokses.2S It is important to nots, how.v.r, that even these researchers have emphasized that there are at pessant •no epideAiolo9ical data linking human respiratory cancers to volatile nitro- saaina.'26 One of the saAt rOssarchers=7 reeently statsds There ar• no •pid.Aioloqic studies suggesting • a measurable increas.d risk tor tobacco- r.latsd diseases among nonsmokers and tor people working in'•s.ok.-pollutsd environments. A study by James Rfpacf and Alfred Lowrsy, who attempted to measure the concentration of particulat.s in 19 Washington, D.C., at.a establishments, often is cited to support the clai:a that cigarette smoke may be harmful to nonsmokers.le They reported that in buildings where smoking is permitted, levels of particulate matter ar• such greater than in places where smoking is not permitted. S.rious questions were raised about the study's sciOn- titic methodology when Repace presented additional data to a recent meeting of the American Society of Beatin9, 1t.trig.rat- ing and Uir-Conditioninq En9inws.29 A consulting snginetr asked 1l.pace whether be and Lowrsy had measured the quantity of outdoor air introduc.d by ventilation syst.ms.30 The answer was, •No.• 83 I 7 r . Aoii o
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~ PROTECTED BY MINNESOTA TOBACCO LtflGAT1ON PROTECTIVE ORDER •' Relersnc.s tor Urinary Tract Cancers 1. t1.S. DepactAent o! R,ealth and 11u.an Services, lurveil• lance, E id.wiolo , and e+d ltesul ~ ineidsna-emima" oA-Fuli Y ta, 3•~ ~Mono r ~ona~ Ins-ti u~te-s o ea , 3~t'~u~ cat on S: •1-2330, June, 1941, 2. U.S. Public Eeaith Oervice, eal h sonsme~ne,&s, gt ~SMok inj.law- han inq i a . ~r on Cenara ,I Otpaetsent o sealeb an~-Busia~t- v css, oication Ib. (p88) i1•S01S6, 1961. 3. National Cancer tnstitute, flational Institute of tnvironaental Bealtb leiences, uational 2nstitute !or occupational Safety and Oealtb, at sates e he rraction o~0 an et }n th ~nite [e te~tio, c~cu'gglonal ae ors, .'" Department of eat , ca on an e, September ls, 1971. 4. Waterhouse, J., at al., (eds.), C~anc~e incidence }n live Continents, Vol. 22i-1976, T70~Te~iMf&C " XMicae ons . Irm yon: nternational Agency tor Research on Caneer, 1976). S. Lee, P. (ed.), Tobacco Consu tion n Various C_oun- tries, Tobacco esearc oun , a~f-tAo. 6 T7ETi'ed.I Edinbuc9bs To and U. Constable Ltd., 1975). 6. Wynder, Z., et al., •Epidssiolo9Y of Jldanocareinosta of the Ridney,• ~ at ne r ns 53(6)s 1619-1636, Deeember, 1971. 7. isaka, X., •t al., •Tusors of apcaque=Davlay Rats induced by Lon9-Ten l,eedin9 of thenaeetin,• ann 70(l)i 29•36, lobeuary, 1979. 8. Reznik, C., et al., 'ltenal Careino9eaie and Nephrotoxie s!lects of the tla.e 1v tacdaAt Tris (2,3-dibcosopcopyl) Phosphate in Yl66 Rats and (Cl7sL/6N X C3H/1te1)ll Nia,• J 1_til Cancer Ln,:t 43(1)1 20s•212, Jsly, 19.79. 9. ltsznik-achaller, It.. •Caceino9eaie ittects of Disthylstilbatrol in Malo fycian Golden lta.atscs and suropean aaostscs,` J at Gjpjjr ins 62(6)s lOt3-10iS. Jlptil, 1979. 10. Thoeas, T., et al. lNortality 11Aonq Workers iseloyed in Petroleum ~talin;nq and tetroehemieal llants, J occu Ked 22(2)e 67-103, tebtuaty, 1960. 72 M A 11
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PROTECTED AY MINNESOTA TOBACCO LITIGATION PROTECTIVE ORDER 0 Mortality Datai _Nov Reliable? aow Aeaurate? ror many years, the n.s. and other countries have compiled •vital statistics• to monitor and study the health status of tAeir populations. Included In thes• vital statis- tics ar• numbers of deaths, usually classified by cause. Such mortality data can be useful in identifying and evaluating trends In specific dissases, In setting health research priorities, and, by way ot epidesiological studies, In sug- gesting factors that may be associated with certain diseases. It is obvious that tor valid conclusions to be drawn from these types of statistical studies, mortality data sust have a high degree of reliability. Sources of htortalitY Data$ Death Certificates Mortality data generally coa• from death certificates. As a result, scientists and statisticians have been concerned with the quality of this source of intoruation. 3ose comments from the medical and scientific literatur.l-4 indicate the depth of concerns It has become obvious that In many cases the diagnosis on a death certificate may have actually no bearing whatsoever oc any rsla- tion to the cause of death of a given patient. Disquiet exists about the aceuracy of the diagnostic intorsation contained io the medical certificate of cause of death even In cases when a full post-sortes examination is carried out. 91 , A 115066
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, PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTIVE ORDEA In addition, eritieisss of the research were submitted Lor inclusion in the printed record of the ineetinq.jl One coementator noted such.deticiencies as their failure to measure the particulate levels before swokinq be9an, their failure to pcesent intormation on actual ventilation cates and their failure to deternine th• specific contribution of tobacco smoke to particulate levels. In taet, his analysis of their earlier data suggested that partieulate lev.ls wer• far moce strongly related to the number of eo e present In the testinQ situation than to the percentage of those people who were smoking. He also expressed serious concern about the reliability of the testing instrument. He suggested that `the claim that smoking is responsible for indoor aic pollution is an oversimplification of a complex, multi•source pcoblem.• Other research has not supported claims of health effects associated with cigarette amoke components in the am- bi.nt air. IFor exaAple, Danish scientists exposed nonsmoking subjects to atmospheric tobacco smoke and measured levels of smoke components In the test coos.22 Their measurements of particulates indicated, they said, •the passive smoker will never inhal. nor• than what equals 1/2-1 cigarette par day.• They concluded that no data exist to support the contention that ambient tobacco ssaks would •bav a lasting adverse health effect In otherwise healthy individuals.• /4 ,A 0 11 S-9
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PROTECTED 0Y MINNESOTA Tp8ACC0 LITIGATION PROTECTIVE ORDER I A number of recent studies have used autopsy findings to evaluate the accuracy of elinical diagnoses. A 19A0 study in linland, !or exampla, compared clinical and autopsy diag%. noses in 377 cancer patients and found substantial disagree- ment. The inv.stiqators coneluded: •Our study indicatss that accurate clinical diagnosis r.mains a significant problem despite modern medical cesourees.•S Zven if the correet clinical diagnosis is made, it may not be recorded properly on the death certificate. Zn 1979, V.S. researchers compared the hospital diagnosis for 9,724 deaths with the underlying cause of death recorded on the death certificate and found agreement in only 72 percent of the cases.j Various reasons have been suggested for recording ecrors. One pathologist has comeented that many physicians •regard the death certificate as a document which simply declares that the death was due to natural causes and does not have medico-legal signilicance.• Ee noted also that "doctors certifying deaths often lail to realise that the iniormation they record is utilised by the statistician !or compiling data of epidemiologieal signiticance.•` Most recently, the whole question of death certificate accuracy and its effect on mortality statistics was addressed 93 M.vwooti . .. . . ~~.~ . . .. . . ' •
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTiVE ORDER i . "I M by a rea.arch team led by National Cancer instituto scien- tists.7 They compared the eaus: of death listed on the death certificate with what they eonsidered to be the •b*st estimation of the tsue cause of death' •• the cause •assigned by a physician based on autopsy findings in combination with pertinent clinical d.ta.• Oiaagresent.was found in 42 percent of their 2S7 cases. statistics. The scientists also considered the •eancellation et• tect• -- that losses and gsins toe a specific eause of d.ath, caused by misdiagnoses or recording ercors, might cancel each other out, resulting in valid overall reporting of mortality This possibility was rejected by the cesearchers, who concluded that their study •atticsu the need to assess the reliability of v.l. mortality statistics.•7 Cancec Moctality Data when researchers compare medical records and autopsy reports tor caneec of specific sites, they often find high rates of clinical••sisdiagnosis.• in this.eontext •isdia9• nosis s.ans un_,dssdiagnosis (cancec not detected by the attending physician but found at antopsy), $v_diagnosis (cancer clinically diagnosed but not found at autopsy) oc a 91 ~ _._._._ - , _-.~ .. _ ._,,,.~,_ ,•-... _ ..... . ti..._~....•. .._~_•..... ..._.. .. ... . . ..
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pAOTECTED BY MINNESOTA TOBACCO L1TiGAT/ON pqOTECTIVE ORDER . combination ot the two (cancer clinically diagnosed but as- si9ned to the wrong primary site). The view of one researcher that "there are many pittalls in the radioloqie and biopsy diagnosis of cancer, particularly, with regard to site of oriqin•, is w.ll supported. A study o t 1,000 consecutive autopsies at a New York City hospital concluded that •a considerable number of neoplasms were found at autopsy in which the site of origin had not been established durinq lite.•' For pancreatic cancer, 48 percent of ths cases found at autopsy had not been clinically diagnosed. In a study at Boston City Nospital, •incorrect clinical diagnoses of caneer appeared in 40 percent (1,094) of the 2,734 cancer patients."10 These errors involved either undiagnosed cancer or diagnosis of the wrong primary sits. Reports of cancer eisdiaqnosis have not been limited to the U.S. Finnish researchers found in an autopsy series of cancer patients that the clinically assigned site of the primary tumor was ineorreet in 20 percent of the cases.s Results of a Scottish study indicated that for the sare oommon sites of cancer, there was agreement betwen autopsy findings and clinical diagnosis in less than halt of the 327 cases.ll 95 KNA 0011 70 I ~ . ... , .. ....,~~......~~+.~~..s...,•w~„-,~~F..~a..,..r~7..~....-- -^ • . -...~ .. •• :.,......, . ... • .. ..
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e . References for LunQ Cancer in Nonsmokers I 1. PROTECTED BY MINNESOTA TO9ACCO l.IT1GATION PROTECTIVE OnOEA Virayasa, T., 'Non-Saokinq Wives of Reavy Smokers Have. a Higher Risk of Lung C'ancer: A Study from Japan,• Brit Hed J ts 183-185, January 17, 1981. 2. Trichopoulos, D., et al.. •Lun9 Cancer and Passive Smokinq,• i_ J aneec 27(1)s 1-4, 1981. 3. Gaclinekel, L.. •Tims Trends in Lung Cancer Moctality J1a+onq Nonsmokers and a Note on Passive Smokinq,• JNa_ Cancer nst 66(6)s 1061-1066, 1981: 4. Anonymous, •Japan Study Linking *assive Smoking with Strong Ca Risk Startles Exp.cts,' M_ 1to_ News, rebruacy 16, 1981. S. Macdonald, i.. •Non-Ssiokinq Wives of Heavy Smokecs Rave a Higher Risk ot Lunq Caneer,• 11it Me_d J iis 915-916, October 3, 1981. 6. Rutsch, H., •Non-Smokinq Wives of lieavy Smokers Eiave a Higher Risk ot Lung Cancer,• Brit M_ J i: 985, March 21, 1981. 7. Lehnert, G., •Xrank durch tassivcauchen? (I11 by Pas- sive Smoking?1,' Munch sied //schr 123(40)1 1485•1488, 1981. Translation - - 8. Schmahl, 0., Quoted in •Lunqenkrebs dutch passivrauchen? studie aus Japan bestatiqt Verdaeht/ widerspruch aus Deutschland (Lung Cancer from Passive Smoking? Study from Japan Confirms Suspicion/ Contradictory Opinion troe Gecsunyl,' Suddeutsche Zeitun , Macch 18, 1981. Translation. 9. Sterlinq, T., 'Ron-Snokinq Wives of Heavy Sarokers Have a Higher Risk of Lung Cancer,• rit Med J Is 1156, April 4, 1981. 10. Gcundesanng s., •t al., •Non•Ssokin4 Wives of Heavy Smokers Save a Higher Risk of Lunq Caneec.,' l= M_ J Ie 1156, April 4, 1981. 11. Macdonald, t., •tion•Sookinq Nives of Reavy S.okers bave a Higher Risk of Lun9 Cancer,• Brit Me_d J Iis 1465. November 21, 1981.' 12. Schievelb.in, B., •Lungenkarsinon bei tassivcauehecn (Lung Carcinoma in Passive Ssokecs).• un hned Ns= 123(17)t 668•669, 1981. Translation. 87 A 0 11 62
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PROTECTED 8Y MINNESOTA TOBACCO IITIGATION PROTECTIVE ORDER Comparison of death certificates with elini- cal and autopsy recocds has led to the con- ciusion that .octality statistics on eauss of death are of dubious acw racy. in 1979, the frequency of lung cancer in each county in the United States was repo rted by the Lpideaiology Branch of the National Cancer institute. These data ace nov used for our vital statistics, but I wonder how reliable such data can be it based on the kinds of death certificates that I have found. At first it sight sees surprising that the cause of death listed on a death certificate .ay not be accurate. Bow- ever, a closer look at how death certificate information is obtained reveals that errocs can occuc, chiefly from aisdiag- nosis and recording mistakes. The physician's diagnosis of the patient's fatal disease, usually found in the clinical or hospital cecord, often serves as the basis foc the cause of death listed on the death certificate.' Thus, the information entered on the death certificate will be inaccucate if the physician has failed to diagnose the patient's disease accurately and the •rcor is not corrected on the basis of laboratory or autopsy results. * The internationally a'ecopted death certificate fora ceires that a physieian indicate (a) the i.mediate cause of dq~ireseath, (b) the condition which led to the iaucediate cause of death and (o) the underlying disease or condition which led to the conditions listed in (a) and (b). It is the an in cause of death (c) t!u t is then aod.d and oou eventually cetl.eted in national and international moctality 'statistics. 92 NA 0011 06
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PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTIVE ORDER could be annoying, 'it has no intluence on the health.'37 And Dr. Nieholas Wald, a well-kRown British researcher with anti•smoking views, recently questioned the emphasis pla~ed on the health aspects ot involuntary sarokingi 'The most i.- portant issues regarding exposure to other people's saoke'in th. present state of knowledge are aesthetic and social rather than medical.•j, Conclusion Obviously, claims of increased health risk for non- smokers exposed to other people's cigarette smoke are not proven. But the considerable publicity received by studies purporting to show such risk have iesulted in insu!licient attention to the scientists who caution that emotion and fear must not be allowed to obscure scientific facts as they currently exist. The president of the German Society of Industrial Medicine in Berlin, in a recent reviev7 of studies on the public smoking issue, cautioneds One should remain conscious of tho fact that, especially in the case of an emotionally treated subject .atter such as passive saok- ing, unsubstantiated statements and premature requirements ior regulative measures or a reversal of burden of proof do not, in the final analysis, serve the cause of seientilie credibility nor taoilitate the search for truth. ii : r A O11 61 - ~-- ~- -. .,,..~~. ~_ .. . _...~...._~ . . ..,._,...~_,__ _ . . . . •.~.._._ _• . .. . . _ ...T; . . .
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PROTECTED BY MINNESOTA T08ACC01.lTIGATION PROTECTIVE OROER .r cancer deaths occurred in aeployMes with psyehologicaL depres- sion at the start of the study. The authors concluded that 'psychological depression in middle-aged son is associated with increased risk of death from a variety of cancers inde- pendently of age, cigarette smoking, alcohol consumption, family history of cancer and occupational status.015 Thus, it is clea: tr.aro are no easy answers for the questions regarding the causes of kidney cancer. Cigarette smoking has been associated with kidney cancer in some epi- demiological studies, but an analysis of worldwide data did not show a statistically significant association. Incon- sistencies in mortality trends, associations with diet and occupation, suggestions of possible influences by such factors as high blood pressure and depcession•-all require further investigation. So long as the issue remains elouded by these scien- tilic uncertainties, no answers ean be •xpected. Cancer at the gladder As with kidney.cancec, cospasisona of international bladder cancer rates with cigarette consumption figures cast doubt on the claimed causal link between the two. Zrsland, Finland and Japan all cank low or intermediate In bladder 67 MNATOO 115042
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PROTECTED BY MINNESOTA TOBACCO UTiGAT1ON PROTECTiVE ORDER men certified as dying Of pancreatie cancer •could possibly have had the dis.aso.•13 A11 mortality statistics, includinq those tos cancer of specilic sitas, may be affected by •rrors made in the cod~qin of the underlying cause of death listed on the death c.rtili- cats.* tor exanpla, when more than one cancer sit• is msn- tioned on the death eertilieate, coding of the underlyinq cause has always been difficult.15 It is also confusing when the word •mltastatic" appears, because this word is used ambiguously, sometimes to designate a primary sit• from which the cancer has spraad, and sometimes to designate a site to which cancer has sprsad.1S Lung Cancer MortalitY Data Of the cancer sitas, the lung frequently has received special attention from investiqators interested in questions of diagnostic accuracy. Their research tindinqs, while dit- ferent in some rssp.cts, have been consistent on one point: The rate of misdiagnosis of lung cancer has been high. Yet • Death certificates ac• collected by offices of vital statistics in each state and country and the intormation is •tzanslated• into an intsrnationally established code number denoting the •nndsrlyin9 caase-of dsatA.• The code numbers and corresponding diseases ars listed in the int.rnational Classification of oisoasos, atats, national and international mortality data tot specific diseases ar• compiled using the coded death certificates. 97 A 1 2 ' • . ~ • . .. ' . . . . . . - . . ~ .. • . ~~:. - .. . . ..
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PROTECTED eY MINNESOTA TOLACCO t.tTiGAT1ON PROTECTIVE ORDER data, have been analyzed in numerous studies and shown to have errors resulting from clinical sisdiaqnoses and recording mistakes. The reliability of cancer mortality statistics in partiaular has been questioned by researchers !or the same reasons. Tbus, extreme caution is warranted in the evaluation of epid.aioloqical studies using mortality data. 100 A 11 7 . . . . • • _ _. .«.. _ . -,.-..-. - . ..,~~..,. _.~~... _ ....~.,.~,......-,,_,~.~,r.~,. .........-_~ _..N. ~...•~- . - . ~ .. ' • ~ . . . . • ; . . . .. . • ~ . . •. r. . • ,' .. .. • . • . .
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PROTECTED BY MINNESOTA TOBACCO LITiGATION PROTECTIVE OROER there seea to be no consistent patterna or obvious explana• tions !or the discrepancies* in one study of 493 cancer cases In a 1i.w York City hospital, only 44 percent of the clinical diagnoses of lung cancer were conlirmed at autopsy.9 Also, the authors found that •carcinoAa of the lung vas the only sujor neoplasm In which no cases w re found at autopsy In addition to those diagnosed clinically.• I81Ohasis addsd] It was suggested further by the researchers that the overdiaqnosis probled observed In their stu dy aiqht be due to the similarity In appearance between primary cancer of the lung and other can- cers that had aetastasissd or spread to the lunq. Conv.rsely, a Boston hospital study found that lung cancer cases wer• missed clinically. Of lun9 cancers con• tirmed at autopsy, 27 percent had not been diagnosed in the hospital.l0 The Boston researchers did not address the question of clinical ovordia9nosis. t Oth.r studies, from Israei,12 tinland,s Scotlandil and ti.w York,li bavs found varying rates of overdiaqnosis and underdiaqnosis of lna9 cancer. i ~ Researchers from Yal6 1Ndical School bavO oiterod a possible explanation !or aisdiaqaoses of lnnq canc.r, bas.d on i i Ln : their patient data that includ.d suokin9 intoraation.l7 In ~ ~ ~ 90 . A O11 073 . ...-...-....•......-- . ~
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PaOTECTED BY MINNESOTA TOeACCO LITIGATION PROTECTIVE ORDER I 23. srunneAann. R.. •t al.. •Assesse.nt of Careinogenie Volatile N-NitrosaAines in Tobacco and in Mainatceaa and Sidestreaw Smoke from Cigar.tt.s,' Cancer Res 371 3218-3222, 1977. 26. erunnemann, Xe and D. HotlAann, •Chesieal Studies on Tobacco Smoke. LIX. Analysis of Volatile Nitrosasines in Tobacco Seok• and tollutad Indoor =nvironAents,' Environaental A_so.cts gj N-lfitroso om unds, ads, i. A. a csr, at al..-~Lyon: eient c ublica- tions, 1978)o pp. 343-3SS. 27. Etottmann, D., •t al., 'The Role of Volatile and Non- volatile li-Nitrosasina ir Tobacco Caccinogenesis,' aanbur Re rts A sal. i arett.t, *ds. C. Goci, et a.oldTpsings ar ci o Spcings Harbor Laboratory, 19a0), pp. 113-127. 28. Repace, J. and A. LowreY, 'Indoor Air tollution, Tobacco S~ooke, and Publie Health,• ci nce 208s 464-472, 1980. 29. Repace, J. and A. Lowrel, 'Tobacco Smoke, Ventilation, and Indoor Air Quality, Pr*sentation before The Sym- posium on Ventilation and Indoor Air Qnality , Semi- annual Ma.ting of AStlRAZ. 8ouston, January 2S, 1982. 30. Spielvogsl, L., Comments on J. Rspae• and A. Lovcay Presentation, 'Tobacco Ssok*, Ventilation, and Indoor Air Quality,• The SyAposiue on Ventilation and Indoor Air Quality, Semiannual Meeting of AS!!R#=, Houston. January 250 1982. 31. Sterling, T., Comments on J. Repae• and A. Lowrey Pcesentation, 'Tobacco Saoke, Ventilation, and Indoor Air Quality,• Th• Symposium on Ventilation and Indoor Air Quality, Seciannual Masting of USHRAs , Eouston, January 2S, 1982. 32. Eugod, C., •t al.. •Exposuce of Passive Smokers to Tobacco Smoke Constitu.nts,• i_ A_ h Occup En_ir_ Ne A 421 21-29, 1978. 33. pima, p., at al.. 'Pbysiological Effects of Acute Passive Exposure to Cigarette Ssrok.,' rch En= Health 33(4)s 201-213. 1978. 34. V.S. Congcess, Hous., Cosittee on Agciealture, Sub- committee on Tobacco, Et.et of ~Swoking ft Nonsaokecs, '- Hearing, 95th Cong., 2n~" t~is~ 3a CeuGir 7, 1975 (Washington: Government TcinUn9 S!lics, 1978). 89 . .. ...~ .... ~ ~ . .~ .: ~.. . .. • ..~ r.. , _ _ . `~ ~ . . .....~~~ J! . ~-....~~•~..~ . . .~~~ .. ' f~•
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PROTECTED BY MINNESOTA TOBACCO LITIGATION PpOTICTIVE ORDER Tobacco Smoke and The Nonsmoker: Scientific Integrity at The Crossroads 111e TobemD 1nSiittltC t87S I 9reet nenhwrst W3ShlflfitOfl. OC 20008 , A 114 1
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PROTECTED BY MINNESOTA TOBACCO llT1GATION PROTECTIYE ORDER 0 0 13. 14. Rolaes. •.P et al.. •1tor• on ueliability of Oeath Certitieates.• A nl J Mod 304(12)s 777, ltacch 19, 1981. Msson. To and !. Nexay, Q_.~s. Canasr Nor~taUtz by~~~ ou~nt..YY 1950-69, National Instit3i ''fi .t~i"'~ii6lrC'"Hea~' ~' a'! Ri •rvi ce, tJ.S. Department of Healtb. tdscatioa and aeliar., DRlN Psblication No. .(lilu) 74-615 (Nashin9- tons Government Printing o6tice, 1976). 15. teray, C. and h. polsan, •CoAparison of the Coding of DeatA Certificates 11sl.ted to Caneer in Seven Coon• tries,' lul_ 8e.e1,_tA Up 93(4)s 33S-3S0, July/August, 19780 16. Jimenes, r." et al., 'Caneer of the Lung in Males.' _ a cad ML S1(3) s 432-438* 1larch, 1975. 17. Zeinstein, A. and C. Mells. •Ciqarette Enokinq and W nq Cancers The Problems of 'Detection Bias' in E idssio- loqie ltates of Dis.ase,• ans As_soo- AM 9hys_ 87s 180-185, 1974. 102 A 11 .-....~....w.I~• ww..~.+.~.~..ww~~.....~+.. ~w w~ .,... . ..... • .v •. - •+..+...-nr ~ 7„7."'r~"t..av++....+w •s.a w.....~~..r• . ~ .
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r . . PROTECTED 9Y MINNESOTA TOBACCO LRiGATION PROTECTtVE ORDER / I I This dowASnt is publishod by the Tobacco iastitnte in the b.li.t that the controversy about sookind and health swst be resolved by scientific resoarob and iA the belief that la11, tree and intorsed disaussioa of the controversy is in the public intsrast. . 7777...^'. r...,..T~+.~...• ..~-..-}~....+~r. ...... , , . .. . .. . . • . • .
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• PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTtVE OROER a study of 6S4 cases in which primary lung cancer was found at autopsy, the investigators espocted that 16 p.rcent of these cases had not be.n clinically diagnosed. They hypothesized that physicians say use sore diagnostic tests foe lung cancer when a patient is a sAoker than when the patient is a non- smoker. They called this tendency •dstsction bias.• This could account foe the tailure to diagnose lung cancer in some nonsmoksrs. indsed, data lrom the Yale study •suggestsd that the mors patients smoked, ths.sore likely they wers to have their lung cancer detected d+tring liie.• lurthec, cytological examination of the spntua (a diagnostic procsdure foe lung cancer) had been ordered foe a significantly higher percentage of smokers than it had been foe nonsmokers. 2n iaet, it appeared that the rate of ordering such a test was related to the amount that the patient 910064. The authors concluded that •the rates of diagnosis may be affected by bias in the way that doctocs ordsr and deploy the available diagnostic teehnology.• Conclusion Kortality statistics ace often relied on by investiga• tors with little cecoqnition that such dita my contain inao- w raei.s. Death certiticates, the main source foe moctality 99 0 11 4
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pROTECTED BY MINNESOTA TOBACCO 11T1GAT10N pROTECT1yE ORDER I :; investigatocs in Israel condbeted a similar study and found that 23 percent of autopsied cancer cases were either '• clinically undiagnosed or assigned to the wrong primary sits.12 In addition, 19 percent of those cases with a clinical diagnosis of cancer were unconfirmed at autopsy. It also was noted that Aisdiagnosis rates did not occur with equal irequency within subgroups of the population but varied with the patient's etbnio oci9in, age and days hospitalized. These considerations led the authocs to cautions Our findings are of particular importance when related to the interpcetation of cancer incidence stvdies .... the fact that misdiagnosis does not occur rando.ly in the population has to be taken into account whenever inter•ethnie comparisons are made. Ovecceporting of certain types of cancer also occ.v rs, as evidenced by a 1941 lettsr to the editor of the 11ew Zngland Journal of Hedicine.13 The authors investigated the 'allegedly high mortality rates for cancer of the pancreas• in male residents of two counties in Kansas, which had been identified in a 1973 government cancer mortality atlas.14 All death certificates ooded to pancreatic cancer for these counties were obtained toc the appropciate time peciod, and all available hospital and medical reoocds were examined for the individuals concerned. The reseaccbecs found that, 'according to the .ost liberal critecia,• only 45 of the 63 9` L , . • '• - . . - • . _ _. . .. . ._. _.. ....:
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. PROTECTED BY MINNESOTA TOBACCO LlTiGATfCN PROTECTIVE ORDER . . Y E'TS in Context Cnrine tbe "Stdt BuidiaE 3yddronu" w..».»..w.......N...NN..w..w...w... IS Condusion .............».w..........N.....»....».w»Nw.......w.... w....... w.... w....... ......... »...N.....wN».. 47 Referenc,es ........ N...... w........»...w..»........»........w .............. w.......N............. »w»w...w...... .» 48 r, Conclusions and C2uDenEee ...»..w.w».....Nw.w ..........................N...N...N.....N.w........N.»»..N..». References .N...Nw...NMN.NN..N..».NNN.»w»NN.N.Nww.»w...Nw.N.N.wN..Nw..wNN..NNNNN»N..N Chapter Five: t0
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PROTECTEO dY MINNESOTA TOBACCO LITIGATION PROTECTri/E OROER Rsterences for MortalitY Data i ; : 1. eriqqs, R., •puality o! Death Certificate Diagnosis as Compsred to Autopsy tindinqs,• Aris M_ 32 (8): 617-619, August, 1975. 2. eusuttil, A.•. •t ai., 'Th• Accuracy of M.dical Certili- catos of Cause o t Death,' .alth s_ 1 39(3)r 11i-1s2, 1981. 3. Gittelsohn, A. and J. Senning, 'studies on th• Reli- ability o! Vital and sealth R.cords: t. Comparison of Cause of Death and tospital Record Diaqnos•s,' A ~ Public R•_ 69(7)k. 6t0-it9, July, 1979. 4. Riqdon, R., 'R.liability of Data from Death Certili- S. cates,' N EnqL J Mtd 303(26)* 1622, December 11. 1980. Stenbaclc, !- and N. taivariata, 'Rslation Betw•n Clinical and 1w topsy Diaqnoses, Lspecially as Regards Cancer,' cand j . o0 14d 8(2)1 67-72, 1980. 6. Gwynne, J.. 'Death Certitication in Dunedin liospitals,' NZ . li d J 86(S!2)s 77-81, Joly 27, 1977. 7. Enq•l, L.. •t al., '1lccuracy of Death Certification ir an Autopsied Population vith Specific Attention to Italiqnant lieoplasi.s and Vascular Dis•ases,' Am ~ tpi_ 111(1)s 9l-112, 1980. 8. Ros:nblatt, M., •t al., 'Diaqnostic Accuracy in Cancer as Determined by Post Mortaa taca.ination,' ro Clin Cancer Si 71-80, 1973. 9. Rosenblatt, M., •t al.. 'Causes of Death in 1,000 Consecutive Autopsi•s,' ta •J. M d 71(181: 2189-2193, September 1s9 . 10. 9auer, to and 3. Robbins, "An Autopsy Study ot Cancer Pati.ntso i. Accuracy of the Clinical-Diagnos•s (1935 to 1965) Boston City aospital,' ,~ ~Mad Assoc 221(13)t 1671•1676, September =3,-Il73: - 11. Ca.eson, Ke and S. MoGooqsn, 'l1 Prospective Study of 1152 rospital 1W topsi•ss i=. Analysis of inacouraci.s in Clinieal Diagnoses and sheit ii9nitieasas,' J. atho 133(4)s 285-300, 1981. 12. Ehrlich, D., •t al., 'iosw Factors Affecting the Accuracy of Canc•r Dia9nosis,• J. roni W 28(7/8)1 3S9•364, 1W9ust, 1975. 101 t M.'YA 01107 - . . ~. . . . • . . .. : . . . .. . .. . . ! ••.. . . . . . .. . .
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PROTECTED BY MINNE50TA TOBACCO IITIGATION PROTECTIVE ORDER ~I O~)"c1CC O Sl l1OE~(' < 11 1( 1 1 E 1(' N( )l 1c,1111( s (!u' I(dP.niultc.liltul• 1T4. .1ti1if i I\•utltx, ( -J \%,h; IRI);II~II I K _'(qRM. A 114 1
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PROTECTED 8Y UAINNEtOTA TOBACCO UTIGATION PROTECTIVE OROER -Caniec of the Esopha9us Pcevention:. ... Will be possible only when the setioldgy of 'the..disease has been un- ravelled. - ' tditotial Ths Iritish Medical Journal July 17,:1974 Esophageal cincsr.`studies sometimes have reported statistical associations with several factors, including alcohol, dlet and seokinq.' The :urgeon 6eneral's cepocts have int.rpretsd such studies as showing that smoking is a siqnili- cant cause of the-•dissass." My such conclusion, however, overlooks the basic'tsnet that epidemiological studies, espe• cially of chronic diseases, cannot prove cause and effect. A prominent epidemioloqist's warning that 'this limitation is sometimes forgottsn' seems relevant to the evaluation of claims that smoking ii*a cause,of esophageal cancsr.l While smoking and esophageal cancer have been statis• tically rslatsd in some studies, the link has not been ce- pocted woridwids. Inv.stigators who studied esophageal cancer pattsrrs:in Qreenland, fos-ixample, noted that •there would appear to be no, associaiion with the 1RfCe consumption of tobacco.•2 . ia northern China,.one area has had an extremely high esophageal cancer ctt.'for cintuciss. An Australian epidsmi- .. oloqist has notid that theocies about the disease occuerence - 33 A 11 l
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:~ . PROTECTED BY MINNBSOTA TOBACCO lIT1GAT10N PROTECTIVE ORDER reflected distary dsliei.noiss oe nutritional iabalane.s asso- I ciat.d with poarty.6 Some ess.arch.rs c9l0r only to rsports leom western countries in tAoit.discussions of poss4bls causes of asopha- g.al cancer. in thts., tobacco, and especially alcohol, art st.ntion.d frequently. Yet the •pidssiological studies do not consistently show even a statistical cisk associated with smoking. British •pidsAioloqists r.cently analys.d esophageal cancer mortality data'in sn9land and Wales for the p.ciod 1911•1975. Although alcohol was cspocted to be associatsd consistently with asophag.al canc.r, cigarett. smoking was not. -it tA.c.locs s..As s3nlik.ly,• the authocs concluded, •that cigar.tts smokiA4 ia an important taatoe In the aati• ology of o.sophag.al canoet In England aad Walas.•7 Another aritish r.ssacch.r stacttd out to study th• effect of abstin.ncs..lreA asat In Britain's V."tacian Society. tihfn hf found the r*cords insu !lici.nt toc study, he turned to six eont..plativ..csligious ocd.cs whose siatecs did not •at ssat. -1t• found an Gn.xpeots'dly high cats o! •.sopha- g.al cancer in the auns. Mots the aatAot of Ais tindiags: •Th.rs is an inttiguin9.oxcess ot .sopba9us cancer that cannot be attributed •ith.r to alcoboi oe tobaeco.•8 Ln ~ J N . F~ 1
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53. 54. S6. 57. St. S9. 60. .. ~....._..~~-...P•~w..~~+w•.T.!.~+...• PROTECTED SY MINNESOTA TOeACC01.IT1GAT10N PROTECTIVE OROER ttitschnet, s., 'Can a Catrot a Day lceep Cancer lwayt• uashno~ton oet. Oevambes 10, 1901. Aesonymous, •Mind and Caocer,' L_ ! t Is •706-707, March 31, 1979. xissen, 0., 'P.ychological tactots, Personality and Lung Cancer in MeA.Jlged SS-66,' fr tJ. M_ed_ ls~oi 40(patt I): 29-43. Narch, 1967. Horne, 1t., et al.. 'tsychosocial ltisk tactors tor Wnq Cancet,' tsyc_, h~os,o_ ~ 61(7) 1 S03-S16, 1lovember, 1979. Abse, D.0 et al., •fersonality and Behavioral Charac- teristics•ot Lung Cancer patients,• ~ s h ow •e lti 103-113, 1974. Osler, M., cited ip anc I: 1302, June 16, 1979. tisher,.R., m k n sh ncet Controvers , sose Attem t to ~!e ( n ur and'C3ndons Oliver anT,oy . 34) . eurcb, P., 'Smoking and Lung Cancer.' m 0D A 11
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I . PROTECTED 6Y I~ ESOTA T00ACC0 UTIGATION PROTECTIVE OROER . ierent trom those of the nonssiokers. thought might bo due to.tobacco were net siqnilicantly dit- Thus, the clais 1Ebat tobacco seokin9 is causally related to •sopha4eal.aanoor roceiv.s questionable support in the literature. And the evidence of a statistical association is inconsistent on both.a vorldwide basis and in Western countries. p.rhaps the beat suasary of the continuing dil.mma about esophageal caaber is pioiided by a recoqnised medical text, which notes that certain nutritional and •nvironmental factors are suspectsd, but 'tho cause or causes of cancer of the aophaqus'ase anknovn *11 KNA T0011SM ---~.. ..,~~. .... •.. ~.~.~..~~...o .-..--~+w-,..r.....-„1w~.•-:r.- ,~•,•~•~;......~.-~...;~... • . .,_ , . . .. ....,.. ..
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PROTECfED 9* MINNESOTA TOBACCO l,fTIGAT{ON PROTECTIYE OROER tv.n in the O.d.r attar alcoAol coasuaptioa is taken into account, thes' is no eonsistsnt statistical association between smoking and esophaqeai cancer. ono analysis was based on data lrom over.1S0 Yitsrans Ad.inistration hospitals. The author concluded that.•dleoholio beveeagi consumption entails + a signiticantly hiqh eiik of :sophaqeal caneere which is ind.- pendent of smoked-tobaodo.gJ1ltbough he believes that smoking is involved in thi diseasi, be did not find a significantly high risk toe saokees whea alcohol consumption was eon- trolled. in tact, he calculated the relative risk of esopha- 9ea1 cancer tor s>eokers -to be only 11A. statistically, that is abou t the same as n_o; ncreased wak.g A similar conclusion was coacbed in a study of >tashing- ton, D.C., black .en; iihose esophageal cancse rates are among the highest in the n.l. Epid.uiolo9ists from the uational Cancer Institute eoiRudsd that their data •appeared adequate to identify alcoholic'b*v.ca4e consumption as the saJor lactor.•l0 They found •Ao significant risk associated with cigarette smoking and also no consistent enhancement of risk following exposure to•botb aleoholio b.veragei and cigarette ssoking.• I This tinding, peshape surprising to the ad thocs, pcospted t!N oo.eent thill'tAe ase ot a dittaceht control groop_ might show an iActsased ciik di• to'tobaoco. Wt; even with a. Ln different control gedUp; tbe newly calculated risks they _j N N . ~ I -~~~~ .~~ .....p.~...r~ .. .~ ...~.~. .~.~... ... Wr . .~ , , . ~ . . ~ . . .. • ' . .
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, _ . . ', . PROTECTED BY MINNESOTA TOBACCO LRIGATION PROTECTiVE ORDER r in the Chinese 'bot spot• cslate .ainly to diot.j A recent report of suspect ch..icals in the •xtracts of pickled ve4e- tabl.s, a eaison tesponant ot the diet of the area, support those thtoriss.4 seems to A British Medical Journal editocial, bowevsr, has argued that lgastronooy sax not explain evecytbiny since chickens in the acaa also see. to be particularly susceptible to •sophaqtal eaiicar. Nliitevse the sxplanation, th. dis.as., noted the editocs, •does not see. to be connected in this environment with alcohol and tobacco.•s As assessment ot worldwide patterns of tsophaqeal cancar, by an Znternational Agency for Research on Cancer researcher, provida lucther evidence ot the ineonsistent intarnational picture. The review mentioned a statistical relationship between tobacco and esophageal cancer that had been reported in several Nestern-eountri.s but noted its apparent absence in othecs. Although several factors have been linked with the diseas., the r wiewr noted, these have not been associated •stronqly enough or witb sufficient consistency between coun• tries for their •tiolo9iail role to b.-basio.• 1ts pointed out esophaqeal cancer's •peopiAsity' for iover sooioeaooo.ia groups iii many diltereist populations and suggested that this . . ; Ln . ~ . _j ' N , I . • . m - 34 %D ' _ . . _ _ w ~• .. . . ' . . . . ~ .. _ . ~ . . .. , . .
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PROTECTED BY MINNESOTA TOBACCO 11T1GATION PROTECTIVE ORDER . 13. Garfinkel. L.. Intecview, •vicht vow eiqantlichen Problem ablenken. (Let's Concentrate on the Main Issuel ,' Munch sed , Ws_,chr 123 (40) i 1483-1484, 1981. Translation. 14. Swomley, J.e Lettsr to Carol M. Thomas, 8ecretary, t*d.ral Trade Commission, Octob*r 19, 1981. 15. Stewart, lt., 'The sffects of Low Concentrations of Carbon Monoxide In Man,• irvironm.ntal bacco sm_ sttects on onsmo_k~e~c: e ce rom a or s o ed., . an~f:r, Denmar c~P. . '~Cm t; oo3~fC~; "I~4) , 56-62. 16. eridqe, D. and M. Cocn, 'Contribution to the Assessment of Exposure of Nonsmokers to 11ir Pollution lros Ciqa- rette and Ciqar sAOke In Oceupied Spaces,• E vr_ R_e_s 5(2): 192-209. 1972. 17. Anderson, Q* and T. Dal6amn. •![alsoriskerna vid passiv rokninq (The Risks to Sealth of 'assive Smokinql,• LakartidninQen 70: 2833-2836, 1973. Translation. 18. Rutchaon, D., 8tatement, State of New Jersey Public Nealth Couneil, Public 8sarinq on Regulation of Smoking in Certain Public Places,'Trenton, New Jersey, December 12, 1978. 19. Hinds, tt., and M. lirst, 'Concentrations of Nicotine and Tobacco Seoks In Public places,• 1! tntl I Me_,d 292(16): 844-815. 1975. 20. Ninds, N., •The Lung and the trsvironment.• eminacs In Rapi_ ra~ Medicine in: 1(3): 197-210, Januacy:~: - 21. Huber, G., •Smoke.and Beat,• N nl, J _ 293: 47-49, 1975. 22. eadre, lt., et al., "pollution Ataiosphecique par la tumee de Tabae (Atmospheric Pollution by Sookinq),• A_n_ Phar !r 36(9-10)i 443-452, 1978. Sranslation. 23. Xlosterkotter, Ne and t. Gono, •Zus Problem des Passivcauchens (On the Problem of tassive suokinql," =b akt liyg. L A-bt Oc 162i 51-69, 197i. sans a ion. 24. 8olser, 0., et al., •Qas Chroaatoqcaphie-Mass 8pectrometrie tvaluation of fxhaled Tobacco Smoke.• ~ Chromatogravhy 126: 771-785, 1976. ae i L 11 3
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PROTEC7fi0 OY MINNESOTA TOBACCO UTIGATION PROTECTiVE OROER 17 Coneiafon As a matter of xieatifia ixt„ espome to envi:onazuntel tobeooo smoke hu not been sbovm to csuse hina essnoa in nons3nokere. The increasin` poGtial preanre to deny tbst fact, or to rsaah a' contraeq oonciusion, diaarns both ieiena and the 9ublk inte»et. I V,AT114 8
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. i6l PFIOTEC T ED BY MINNESOTA TOBACCO LJTIGATION PROTECTIVE ORDER I Tobaeeo Smoke and The Noasmoker. Scientific Integrity at Tbe Croseroada 0 I ; Table of Contents Chapter One: Intzoduntion and Overview ....».N ....................».N.NN.N.......N.»w..................... «...».N...N....... Episode One ......N....N.........«»N..N..NN.N..»».»..N....w.......»»»...N...N........«..N....».N...N.. Episode Two .... «..N ................. .... N............N.N..NN...«..N..N....... «...... N........................... Episode Three ...................N.«....N............... ....»N.....N«.....N.N....... ...... «........ N...»....... Episode Four ...N» ............... N....N........w....w......NN..N.N»..w.......N...w.............»»...N»...... The Purpoae of This Repoet N...N.w..NNN..NN»N.«.,NN.wNwN.«».N...»..w«......w......NN...... Referencee .......NN.....N.....».Nw««.... N....»NN.»....w.......».«w...»...»».»«..N.NN...N..N.«...... Chapter Two: Lung Cancer in Nonunokere ........w...N..»»«.Nw...N«......N.w.«.N..N.....»«..«.»N....» ................ The H'irayama Study ..........N......».«N..N...»....N..N...»«..... »N........ N...N...... ».N..... N........ The American Cancer Society Seudy ....... ....»........ N««....N.N.....N» ............................... Understanding Epidemiology Nw..»......N».NN..»..N...N.N».».....N ...............«..................... Confounding and Misclassification ...... « ...................NNw.N..........N..w............................. Reaoepective Sdudtes: The Element of Bia: ......... N».w.Nw.» ...................... N................ Some Examples ........................................ N..N..N..»..«...»..»N..»..».....N..N................ Assessing the Literature ......N...».......N....... N.N.......... N.N...N»...... w...N........ w........... NN. Some Fundamental Observations N..w.N.......... N.... »N.»...w»N...N«..N.N.N.N .................. N. Conelusion ...............................NN..».N»................ wN......NN....... w..w...N.......... N.............. References .N.NNNN..NNNN.NNN.NN..NNNN..NN..NNN.N.N....NN.NNN..Nw..N.NN.N..NNN.NNNNN. Chapter Three: Environmentsl Tobacco Smoke and the Re:piratory Syeteen, Abergy, 8eart Disesse and Stroke .............................................. N..... N.N........ N............ N.wNN....N...N..NN......... »............ N. ETS and Pulmonary Function .N......»..... «N..w.N........ w..«...N...... .....N ........................... ETS and Asthma .............N......N..N.................NN.NN..w..N..N......... NN.N.............. N....... » ETS and Chronic Obitructive Polmonary Disease N.N.....»...»..N ............... N..N.......... ETS and the Health of Chs'tdren N..NN.».....N.......»N..w..w....N..N..N....... N........ »..».....N. ETS, HeaY Disease and SYVke N..w.NNNMMNN.NNNNN.NN.NNNNN.wN.NNNN.NNNN.NN.NN.. Hypersensitivity to Tobacco Senoks w.NNw«.«w.NN.w..NN.....w».....w.»....«...NN..N............ Conclusion N..w.N.w..NNN..N.N..N.M.NNN.NNN.NNN«N......NNwNww...M.M.w.N.N..NNN.N.w..NN.N •a.ereYMs w.wNN.wNN.ww..w..wwww.N«NN.NN...wNNN.N.NwNN..wNwN..NNN.NN.»..«..N.N..w.w Chapter Fonr: Toward a Sdenee of tlu Indoor EnvironmeAt w..N..«.«.Nw...N..N...«NNN.NNwN.NN..«N«N».... Wbat ETS Is-And Is Not .NNNN.MN.NMN...NN...w...NMw.wNNwN.N.NNN.NNN......NNNNNN.N Why Expoeure to ETS Is Not "Pasdw Sm.oking" N~..»»N...NN..N.w...N.....N.NNN..N.... "Exposure": Wbat Is Being Meaared? w.N M.N.N....N.N.IN.NN MN.N.Nw.. NN. NN. NN N.N.N.N Chemical and BIoioSiosl Markers ......Nw..w..N.Nw.wN.wN».wwN.NN.wNw.N.....NN.....NNw»N. wwNN.»...».NN».N......»...N.......NN.. Confounding Viriables ObatacJea end Opportonitift Pap 8 a 9 10 10 11 13 is 16 17 18 21 22 24 23 26 27 80 32 33 41 41 42 42 43 44 , A 114920
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PROTECTED BY MINNESOTA T08ACC0 L.ITIGATION PROTECTiVE OROER 0 TOBACCO SHOKE AND TBE NONSMOEER: SCIEN'TIFIC INTEGRITy AT THE CROSSROADS Cbapter Onss Introduction and Overview Increasing sttantion has been devot.d reea:tlyr to the suggestion that environmental tob.eoo nnoke (ETS) might constitute a health hanrd to nonsmokers. Although three major sdentiQc conferences, involving more than !ifly eminent edentists, have maduded within the and five years that there is no persuasive evidence that ETS presents a significant health risk, islatort io many ststes and in the U.S. Congress have tntroduced measures to rs:trict smokinS In public places and ia the workplace. Proponents of sueb aNawises typically have sought to juafjjr them by asserting that other people's tobacco smoke can adversely alleet the health oi oonanokesa, As this report will demonstrate in some dsta:l, the availsble ideaee does ti.ot support such an assertion. The report's purpose ia tpo-fold: to present the facta about public maft as clsarl and succinctly as the complex scientitic literature on the subject sllows, aAd to challenge iateierted readers to view those facts objectively. Although the report is addressed Dzin~arDy to a general audience, the research upon which it is based is sumn~arized in suffic~ent deta:7 to stimulate and educate the specialist as well. It is education, indeed, that is now the most pressint need. As this report makes elear, what is known about ETS is dwarfed by what is not known. Tbe tobaeoo industry is therefore devoti substantial resources to the investiEatton of indoor air quality pnerally and to ths ways in which' particular constituents of indoor air-includinQ tobaoao smoke-may affsot human beaaltb. That study necessarily has beQun with a detailed review of the aistiM scientific literature on theae subjecta. And it has yielded, to date, thres prelitninary eonelusiona. Two of the conclusions would not rurpriae any scientifically sophi:tiated person. The Am is that evidence relating ETS to health effects is seaaty, eoatradietory and often fkndamentaily flawed. The second is that more and better research needs to be done. In fact, the defidendes of the existiny literature suggest specific avenues for Improvement In methodoloor and study design. The third conclusion is less easy to understand. Despite the glaring deficiencies in the data and the absence of scientific proof that environmental tobaaoo imoke hareru nonsa:okers, certain otherwise principled Individuals and groupa have persistently advanced the contrary proposition, as if it were established fact. It is not an exaWration to say that such efforts have brought scientific integrity to a cow roads. Individual scientists and groups of aeieatists are~ asked kpusatly whether tobar~a ~ smoke in the environment presents a danger to the of oonoaoksrs. The isats ib not i whether some people ars wsoyed by the anoks of others. Nor is it whether prohibiting unoldnf in the vicinity of Aomnokers might indirectly "help" smokersb~ iordat them to sawke kfss often. It is a pnrely scientific questton, not a pol3cy qusstdoo. Tbs saawer L esnew aot only ~ because it may affect the attitude of Individuals and comanudtt.a towud smoking as a voh:ntary ~ activity but also because it tests the objeel3vity of the sdattifle prooass. Pressure from forces dedicated to the prohRbitiea of dEarette smoking ciareatly is iatenS.. Therefore It will be no ernall fest for scientists and health experts to dsaiu the ETS hsus with complete objectivity. Several recent epitodes iUutteate *A kiadt of pressura to which scientirts have been subjected on this Issue.
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER 6 brochures had been masYd to thoueands of phyiicfan,. The coderence orgudser thereafter decided to cancel the aonference rather than aonttnw with spropm tbat.was incomplete or tlNat might be peresivd by some as being nnbelanoed. In the months that have followed, ainu7a: epieodee of attsmptd intimidation have ooawed. For example, s tenured professor at a wa* ettte mdverdty was threaten.d with the loss of research fluWa by the etat.'e lualth commissioner bnt had *e atraiEth to aaeert his right to speak the truth as he eaw it and-wncad4lly so Lr-to uphold prineiples of acedernie freedom. Another scfentirt, a phyrdoan member of the Atnerioa Lung Adoelatlon, was the enNeet of gratuitous and defamatory personal atte+e3cs in a formal rmrmanduen ereulated at the Iart annual meeting of the association. ' Such incdents, 1iku those discussed ear:ies, raise eoctremely proublinE questions of eademio freedom and uientift objeetlvity. They aleo have prompted the butitate to redouble Its efforts to promote aientise debate and eeek to aontributs to It In sn objeeqve, accurate and responsible manner. This report is offerrd in that spirit. The Purpoee of This Report The science of environmental tobacco smoke fa emnplex, fauinatint and-perhaps above all- incomplete. The remainder of this report reviews what Is Ioiowo, and what Is unknown, about ETS and about the posubUity that It msy affect human health.l7se report addresses, In the next chapter, the question whether the seientise Steratu» has d.moastrated a esusal relationship between ETS and lung cancer in non:mokers. No subject Is more eontrowrsi.l e,nd vulnerable to distortion. The third c.bapter considers those studies that have explored the effects of ETS on the ret pirntory system in both adults and children. It also reviews the literawre on allergies to tobscoo smoke and the data on heart die.ase and stroke. The final chapter focuses upon problems of aeientisa metbodolopr, ep.dficelly uM such !hn- damental issues as how ezposare to ETS ean be measured »tlsbly and bow the eompoeition and dynamies of "environmental tobseco emoke" can be demted sdequatily. It then steps back to examine ETS in the context of Indoor sir pollution naerally. Examining the ETS issue from the mon general ve of mdoor eir quality may be useful not only for understanding the Importance of w~u~dentika call "confounding variables" but also for suggesting potentisllp buitlbl areas of additbnal raetreb aad pracsicsl solutions to the problem of contaminated Indoor air. Zbe evidence sttggests that It ie that problem (generally caused by inadequate ventilation), rather than t6ep of tob.eeo smoke, that poses a potential threat to the comfort and health of sinokers snd no ke» slDce. , The report's conclusion attempts to summarize the leas suodnetly, and to direct sltention once again to the ehallenEea poud by the e,ontroversy over tM purported health effects of environmental tobacco smoke. MVA 114927
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PROTECTED BY MINNE50TA TOBACCO UTIGATION PROTECTIVE OROER z ® arsinst ETS °(ilrom a oolitlal noittt view." the stud v_er:el ~111~~i tt: t ta 1"t ':- • 1 '1 ._1.-2 ll. ® liiiil 401111 ..-------.:.,, The study, from the Pulieonary S.edon of Yale Voiverdty's School of Medidne, esamiaed the response of nine young asthmatic robjects, ranging in age ion 19 to 30, to intwue levela of anachine•=aleratld cigarette smoke.' The subjects, who wen not amokers themselves, were ex• pOsed in an environmental chamber for one bonr to what the authors termed "a ievere simulation of passive unokina, beyond what normally ooems ia th. msf ority of tocW oe oeeapatioW oi• vironments." The exposure produced no wbeeeing and so cbaop ia expirstory Dow rates. In fact, the autbors reported, it "caused a dkbt ia uoiupaiBe bronchial raetivity" (em- phasis in originaiJ-that is, a iltgbt improveant ia e aboormal tendency of an asthmatic patient to react to a standard "brond~o-provoeitioa" tat by a aonstticdoa of beeathinj passages. The authors were properly cautious In Interpreting tb.ir results, noting that "(although our data show that pasiive smoking caused a atasu decrease In airway reactivity, the possibility that this could be associated with an amelioration of the underlyinf asthma cannot be determined from our study." Their dats did agg.st, howeva, "that pwive djar.tte smoking pra.nts no scute respiratory risk to young arymptotnatk astlunatfcs." , The author of an accompanying editorial evidently found this suggestion distressing. Even though the new study agreed with the condu:Wus of an svlier repW from another Voup of independent investigstors, and even though evidence to the contrary in the scientific literature was limited to a single experiment without proper controls to etware against biaa,' the editoflal caAed for "more rensitive" tests looking for "(dHiayed eflech ... after the passive senoldti` insult."N Why? Because of anecdotal reports and the notion that it ia "senerally appreciated that breathing tobacco smoke is not pleasant." The real reason for the editorial, thoutb, apparently bad little to do with skaeAca: "From a political point of view, " its author AoW, "the evrnnt movement for smoke•free environments would be strengthened If one were able to show objecli" laboratory dunges on acute erposure to 'second•hand' cigarette tmoke." It is precisely that sort of pressure-the pressure to `et the "right" results-that must be resisted if scientific integrity is to be protect.d. Episode Two ~~Z t.~ i IeL=? 1 C:'"--, [.T7. • »TL;I! a iT a'_:1LZr1E'--i LItL•1lL3'_?1'luili 1. UIJ rl 1 ri:.tl_l_.~lLlt~!~,i,l' W t . wo - - , o ~ v' - ' Ia faet, the report waa att~htfoeward and savrate: "Most aarrent research oood es that exposur. to eaviroamutal aAOke does oot eam pulmoniry dyshaction or respiratory disea.e. But the research methodolop and its findings an seriously flawed. UM speakers at the hearing, and should not be anade the bada for pnblie policy eLaates. The health effects of indoor tobaceo aaoke, they eoAdndad, are likely to be eomplex, multifactorial, aad weak."$ The report summuised the presentations of scientists who noted that adive smoking and pauive exposure to ETS invol.e toxdcologfeally dist3act phenoas,aa; that the effects of agins, ten+perature, I MA I`00114923
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, L PROTECTED BY MINNESOTA T08ACC0 UTIGATION PROTECTIVE ORDER 3 humidity. evaporation and diverse chemical interaetions make eutrspolation Nm active smoking data imposnble; that exposure to ETS ov.r kng periods is extriordinan7y dilScait to qusatity reliably; that dose is harder st;ll to mea.urK that aAy iAdoor ai*onment ooatairo an -array of particles and eAeanlcals Nm heatiaa and oooking mokL sad baeteris„ pets, household dusb and other sourees. In short, the report provided an aaeurate aod aetirs:t aooonat ot a eoeaplex seientiSc issne. Md•amokia8 partisans responded with lelters eritieidn8 the a:tide as "inaaeurate," '•mislad. in8'' and t•outiraEeovsly wront " A 1anS a=aodatioa spokesman eorxeded that the evidence was "inoompiete" but went on to oCer examples of .denttficaDy questionable-and in some aases repeatedly diuredited-•'kaowledpi" in support el hie demanelation of the artiele.' SirnBariys exautives of tbe Arneriean Caaar Sodety, Amerioaa LnnB Association and American Heart Assocation waroed the editor that "(Qt wontd be trdy uafoeeunaN if the AMA's efforts j'w oppootion to ETS) wers undermiaed by.th3s rapoet'" It waa, of ooures, to the credit of the ANAA o..rtpapes's editor and reporter that the account of the NAS meeting wat eceurate. What was mtbttnaat. wae the denunciations Out the oon. scientious reporting had provoked. It ir a tatt{e tlut bas become all too common sad, as the debate over E?S continues, threatt nw to make accuracy In both the seieace and the reporting of this issue the exception rather than the rule. Episode Three The incumbent Sureeon General recently haa AsehuSterizsd not only the xient3lie liter:tnr: - - - - b_ut also the conseruuto~three n Js~c d_ed that environfien m 1>t'1L' !!tt1_ilt' 'L1a't'.&!Y-`-: X'i! !2t! 1LL Lt'tP!tI,•i'ti W' V ! 4•i 1~ ~ Until recently, the evidence on ETS waa viewed ob3.ettvdy by tbe Su~eon CeAeral. The 1979 report of the Surgeon General, for example, aooe]nded tbat "Neahhy Aowmokers exposed to ei8arette smoke have little or Aoph ydolo8ie r.spoan to the smoke, a»d what response does oocur may be due to psychological laatoca.'I In 1N& tM conclusion was much the eawne, despite publication ir the intervenirg yeart of a hiShly aoatroreidsl Japanese study claiming to find an increased risk of lung cancer in the nonsnoking wives of smokia8 rnen.' By 1985, however, the current Surgeon General was teDint a Senw subcommittee that of lifteen studies examining a possible link between "passive smoking" and lung cancer, aD but three showed a"statisttaliy sigrAficaat positive eorrelatton."N That statement wss demonstsabJy incorr.ct. A review of the references ineluded in the Snrsen Gemeral's statement eho.va these were fifteen reports but that they represented only twelve etudia, of which three bad not beeA tated for etatisticai significance. Two others failed to find any sa*dcWly d t mrrelatioru. In three other studies, correlations wese d~il~t foe oae wc but not ~ otLer or for tbe group as a whoie. Thus, no more than tour of the studies abowed aondstst stSWral dpnilinna. In tesdbini again more recently, the Surgeon GeAaral modified bie eba~oa of tM evidence and said OOt'telatiOQa. only dfat "Mverar of the studiq ehowed significant While exaggerating the ananber and d8ailioaaa of studiea oA ETS aAd IuM caneer, the Surgeon Genenl atso sought unfairty to discredit the views Internationally prominent 01 seientis4 that an inoondstent with his ovm publicly stated views. The tsots an there: of nonsrnokeri. , 1 A 11a 2a I
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PROTECTED BY MINNESOTA TOBACCO LlT1GATtON PROTECTIVE ORDER 20 43. DoD, R. and Peto, R, "Cigarette aAokins and bronchial Caraaoma: doe. aod time rdaqoyhip= among regular smokerm and lifelong noo-naokexs," J EpW:n Coaaa XeauA 33: 303.13, 197a. 44. GreenberE, E.R., Roaur, B. and HenAekern, C.H., et ai., "An in.adgstioa cd biia In a'.tndy of nuclear shipyard workas," An J Ep+deenioi 123: 4i1-9, 1985. 45. IwreDen, m.LL and Samet, J.]L, "Aa aoewaeat of the vaNty of questioanaire responses by a eurvivinE tpovee," Am J 3'pidernW 123; 481-9, 19K 46. Gladen, B. and Rosan, W.J., "MieeJaadlfeatioa and the desp of aiviroatnental ttudtea," Arn. J Epidanioloyy 109(Sk 607•16, 1979. 47. Kraerner, H.C., "M robm4aeae of cmnvon auaaarer of W anoda" to biam dne to misclassiBeadont," dnin Sf4t 39(4X M90 (19ab). 48. Copeland, K.T., Cbedcowar, 8., MeMkbad, A.,T. and Hoibrook, R., "Btas dw to enierla;d• dation in the estimadon of rdalire ritk," Aw.. J ap+dtnMolopy 105(5)c 488-96. 49. Orkaynak, H. "Biaa dw to of personal euposures tn epideadokgic sWdiet of _ indoor and outdoor air poDutioa," Proc hei CW Indoor Air Qrality & Clinsats Z,377-84 (1984). 60. Lee, P.N., "Passive Smokint," In Satiok6y and the Lung, CumadnE, G. sAd BoudEnore, G. (edL), Plenum Publbhini Corp., 1984. 51. Lehnert, G., et al., "Round table ditanuion," Prev Dled 13: 730-46, 1984. 52. Kilpatrick, S.J., "btitclaesitication of ETS expoenre: Itt potential inBuenae on studiea' of environmental tobacco smoke and feerule lunE csneer," Paper presented at the Experimental To:dcoloEy Symposium on Paufire SmoldnE, Eseu, >s'RG, October 23-25, 1986. i ._...._ ~ . . __.._. ........_...... ,_
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PROTECTEO BY MINNESOTA TOBACCO Lff1GAT1ON PROTECTlVE OROER • Chapte= Two: Lans Cancer In Noasmoker. In all of the debate with respect to ETS, no inm has received as *mncls attentton s the daim that ETS might cause luni cancer smons nonsmokers. In 1981, Dr. Takeahi Hirsyama of Japan's National Cancer Centre Researeh Inttituts reportedly found nonsmoking wives of heavy anokers to have a greater risk of del" hm` eano.r than uonmakin5 wives of nonsmokers.s If tena, the campaign a6ainst ci8uettsr wodd be bolstered by trandormin5 th. decision to anoke from a pnrely personal cdoice to a ehaicm with a potentia0y eerions imput upon the health of family, friends, o¢workers and even perfeet etranters. It is not surprising, then, that 8iraysma's work has been so widely publicis.d and Its emotional Impact exploited to the maximum estent possible. Nor Is it mrprieinE, when tbe mstter is examined elosely, that the scentilic impact of Hiraysma's pape: has beea so adnimd. yVhea some IIfty scientists and physicians gathered In Yienna, Anserls, in 1984 to muid.e the evidena that environmental tobacco smoke might eauss lung cancer, all of thesn agreed, with ame exeeptbn, that proof of a causal relationship did not cdst. That exception was Takeshi Hiraysnu. A review of his rruthodoloBY, with Its obvious wesktmases and oppottunities for reveral types of tnisda& siacation, suggests why Hirayams stood alone. T3e Hirayaau Study Hirayama relied on qnestionnaires distributed to 265,118 adults residing In 29 health districts in Jspan over a 14•year period, from 1966 to 197l, to which more than 90 percent of tbe population responded. Questions were asked on a wide variety of eubjeets, most relating to nutrition and medical history. In analyzing his dats, Hiraytena found that for 72.3 percent of ma-rled eouples, data ex6sttd on the smoking behavior of both spouse:. Among 91,540 marrted women, 245 deaths from "lnnE cancer" Ners identilS.d; of tkw, 174 of the lnu5 cancer deaths (LCDs) were deaths of "nonsmokers." The words "lung cancer" and "nonamkers" are in quotation marks to highlight one of the most fundamental-and frequently critkbtd-s:pects of 8irayama'e work: its vulnerability to miselaWcation. For example, the "lun5 cancers" of which study eubjeets died was not confirmed histologically (i.e., by microscopic examination of tiuw). Similarly, there is every possibility that women classiAed as "nonsmokers" as a result of tke questionnaires were misclauifled as such. In sddition, Hinysma falled to Nke social and eultural considerations into aeeonnt. It is critical to keep these potential clsssisation errors In mind when reviewing Hirayama's conclusion, which was that nonsmoking wives of unoken had a stadstially significant increase In lung cancer risk when compared to the nonsmoking wlves of nonsmokers. It b also importsnt to note, on a more techninl but ao lea impartsnt level, that - - - It stely foUdwinS the pubUesdon of Hirayama's study his methods wers eritkir~.d br two ststbttaisnsei tor not using a wsvi.al or person•years approach. His aomputations of otistinl dSniliesnee also wete questioned." Commentinp upon the lIIraysma study .hertfy aRer Its pdbltadon, the 8urjeon Ceoeral's 1982 report noted that it had "stimuLt.d much discussion" and that "[eje=tain metiodoio8ia deta0s (e.g., th. de!lnition of an e:•smoksr hnsband, the method of age snd octapation standardirstion, and the teChniqlte or e7Rtnt of histologi0 OOnOrmation) wete not praeetld.'% 1'beie and other "limitstions In data and study deo8n" contributed to the Saet eon Genaal's conclusion that "the currently available evidence Is not iuftent to conclude that passive or involuatary smoking caa:es lun5 cinoer in nonsmokers ... .Two years ago, Hirayansa published an update of his 1981 artide.' Commenting apon the more recent publication, Dr. S. James X3lpatriek, Professor of Biostatisties at the Medical ColleBe of . A 11a ~
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PROTECTED BY MINNESOTA TOBACCO LITiGAT10N PROTECTiVE OAOER i , io That remains aa trne today aa it was tlua: the epideaaolopeal evidence that has accumulated in the five years dna 1981 is, taken togesha, essentially Imeharl8.d, pnly the wiD of some scientists and polieymakers to resist the increasins prea,ureas to teseh unsdentifk coachtdoat seems in danger of changing. Understanding Epidemiolop Before wmmari:iaf the epidemiolo8lc studies that have appeared since 1981 In an eNort to resolve some of the questions eelsed by the Sirsyaala end Garllakel reports, a few words about epdds- mioloQy-its utility and ita universally acknowledged limitations-are in order. Epidemiolopr Is a statistical ydeaoe: the ttady ad a poup of people for both the occurrence of a disease and the detection of factore that adght, be related to it. It aaaot deterratne cause. Yet a common mistake usade in iAteeprettnE epidemiologieal data ie the identification of a statistical associuloa aa a causal aoanectioa. What the statistical associations reported In epidemiolo8lc etud;a an do Io aaggaa poedbie leads for tl~rther iavestisstion.0 But e.ea that objective iI unattainable uAleu great can ia taken in study design and the interpretatioa of results. "I know of no other scientific activity," an expert in the Aeld told i "tbat'a beea so aaive, so inappropriate, and so ur>acieatilfc in its lack of attention to the ada data."W Nowhere are the limitations of the epidenniolo8ia method more evident, and asore importaat to keep in mind, than in the literature on the putative anodattoa between ETS aad lung cancer. The reports that exist are extraordinarily equivocal. The iaaoaei:teades both within and among studies and the abaence of statistical si8ailksnce in many ai the oluaparirotu all caution a8aitit the leap from aarociatloa to causality. This ie especially so wbere, ae in the Hirsyama .bsdy, mixlanifieatioa and "confounding variables" such as diet and occupation are all too likely to be present. And it is more so still where, as in .irtually an odfa Ildat ETS with health effects (not only cancer), exposure to ETS has not been measured with even adaimal reliability. Confounding and Mi.elassifioatioo As a paper presented to the Air Pollution Control Association recently aoted, the inauence of confounding variables on studies examining the relstloasbip between 8TS and lung cancer has received relatively little att.ntion.• The authors dted a 1985 atudy (discussed below) that reportad a doae•response relationship between the number of cigarettes reportedly smoked by the husband and lung cancer in the wife. Strifda8ly, no relationship was found between lung cancer and estimated total du7y exposure to ETS from all sourcea, including the husband. A"likdy expla nation" for the lSndiap, the authors concluded, "V that the aaalysb of lung cancer risk as a function of the huabaad'e reported smoking habits 4 highly eoufr.zdd by soome wideati&d factor or factors. Tbe husband'a nmoldaj habits wonld thea be acting ae a* marker or satrro8ste for the underlyinE, as yet aatdeaMed, eource." Reliable estimates of a aoanaaoker'a aposare to ET8 are notoriously di!llcult to develop. In all exdating epideasiolo8iCa1 etndiea, arb estimates hare been based npon r.s or perwaal bis~;~ interviews or both. A11 but oae ln.o atflisad, as the pelmary ls ~ of tbe reporting of sponaal smoking habits. They have eoaddered aelly expoauy ooeurriag the household, 18aoring-ss a recent editorial in the pointed out "the elGd of workplace axpoenre, di.ora and nau:riap, and exponure g ehildhood."n Only four hare attempted to consider expaare onWde the bome, umally In tbe workplaee. The importance of considering ET3 exposure outside tbe home was mdersoored ia 1983, when a report ta the American Journal of Public Health eoasrMed and qnaatiIIed the problems The M.4-931
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?'he TobC ^.CO I /ratttute 18TS A, Street. .Vorehaat ii asbin;tos, DC Z0006 18001434-9876 FOR RELEASE May 16, 1988 11:00 a.m. ~ CONTACT: : Bcaman Motan 202/417-4877 800/a24-9876 ( CLATMS THAT CIGARETTES ARE ADDIC'I'IVE , CONTRADICT CObMON SENSE wASHINGTON, D.C., - TYse Snr~eoa Geue:ai has repestadty stated tlat ! his BOaI Is a •smohe free soci:ty by the ynr 2000.• ~p.it shonld oaae as no wrpdse that this latest te/act marJcs yet aaotber earatadon In h~s sod-smolcing Mmpei8n, Smoking is huly s personsl dtoia a6ich wa be stopscd ~~ s~pe raon d.atdes to do so. 'Ihe S~.rBecxi General's own Public FIe:I~ 6gner iodiote tftat about 40 millioa Aamicaas an lo:met smokess and Os,t 95 paa-pt d dwin quit smokinF aritbout h p. Thm Bpt+es, sad common seaw conusdict soy dsfm tbat • • smol~n= is in uGUMoa. Todsy's teport js leagthy a~d a+i11 t~eqmte ~ rv.iew bdors suy spsdQc OOda~t sts C~a be m8de. HoiRSw, to~ PnwW Comosb an in Oidil. I I .Nf•_WS IlI•:I.FANE: This tlpOR 4tYfi1m ft sed0us dtYg prOblsa ~ by s0~lr. Z~N dtM dlit • ci8aecte smolcia8 i: adrn8 sd~elon ~ to coaiai or buvin ms. or aloohol sbuse. is tadoctuc,ue md tatware&nted. 'tlse mesaafe to tbe Mwieaapbld~at using ille~l druss. sudb ss asclt or heroin, lus an sre dtlc of sddi~n s;k Is ~ ~ Tbe claim that d}prette srrm~in__ s _au~m P~~ MP~ ~tl~~T m u~pt to IIad scme way to dt~a+t~tl:~ Mo1~n B+om otlMC taany ~ opaep ~ orw hs~m avul poanp ~fdesire~f ~sbou~id ~ted ~ however. tha s p to ~s lm~tsboy loas "a cla0 aa11 sts the ranida= ' sTmptarm rhe e1abas m.t haoioa: sn •addi=• defy oommoa xa;e aad aoaaadW e~. brx that people 9uk swoaaf emyday i f i! ®r 'TIl~T1P131438; ~
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER 4 I In March 1983, an internst3onal Workshop on Envi:+onmental Tobaooo Smokm was beld in Geneva, Switzerlaad, and its proceedings wen published in the Di sesse~. The workshop's orEanitsr, Dr. RaRner Ityynlder of the niversity of ~~w-8- den, speaidnE on behalf of the partidpanb, summarized the meedWs consensus as foDows: "An oversll evaiustion based upon tbe available seientiBo dsta 1486 to the conclusion that an inarea:ed (1unQ amoer] risk for nonsaakers fbaa (environmental tobaxo seaoke) exposure has not ban establisbed"" . ( ~ In May 1983, a Workshop on Plrpiratory Effeats of Involuntary Smoke Exposure was bel `d In Bethesda, Maryland, ander the auspioes of the National Heart, Lung snd Blood Institute, Depardnent of Health and Human Ser.k.es. The aaamsey report of tbe workshop concluded that ( "the effect of paa.ire smoktnE ce the retpiratory ryrt~etn ... varia l~+om neE1l~ble to qr3te sa~sA '. ,From this review, it was not posaibie to determine wbetber there is a spedBa group which Is at inrssased risk or what the mechanism of tlre effect of aay) nay be."n ~ ' In April 1984, an International Sympotlnm oa Passin SenokinE Eroin a M.dieal Point of View was he7d in Vienna, Austria. The sympodam was orEsniz.d by the American Health Foundation, Austrian Soeiety for Oaeupationtl Medtdne, Bs.aria» Society for OaaYpational and Social Medkine, and German Society for Occupational Medicine, in cooperation with the International Green Cross. Dr. Ernst Wynder, president of the Am.eian Health Foundation and oooegaiser of tbe sym- posium, rasde the following summary ststsment to the press at its aondnsion: "Should lawmakers wiah to take legislative measures with regard to passive smokins, they will, for the present, not be able to base their e!lorts on a demonstrstsd hazard from passive sawkinE."u When Lud with tbae three indicationr of consensus on the pest of the international sdent~tk community, the Surgeon General's response was to attack their validity and misrepresent their aonclusions. He told the Health and Environment Subeoaunittee of the House Committee an Energy and Commerce in June 1986 that "none of the stndist" exsmined at the Bethesda workshop '•wue designed to specifically lock at the e!leat of pasadw smoke ecposures and bealth.":• He quoted, out of eontext, eondusions r+arobed at the Geneva woeksbop to the egeet that health consequences from ETS "cannot be esdaded," and noted tbat it was ltimded in pert by Th. Tobamo Institute. As to the Vienna sympoeinm, be asserted that the conclusions quoted above were not from the conference but from "the press conferena that took plaee after the oonferenee." in fact, the Bethesda conference not only addressed the subject of ETS, as Its very title ("Workshop on Respiratory Effects of Involuntary Smoke Expoeure'l mska dear, but Its snm- mary report also noted rpeeilfcaDy that eseb of the principal studies examined provided a"aon• siderabJe amount of relevant data on the subj.et."ts Tbe Geneva workshop did indnde statementt by some participants to the effect that health consequences from ETS "eannot be excluded," and Tbe Tobaooo Institute did openly proNlde funding to the Univenity of Gene.a, wbich independently orSanised the proceedings and Invited distinguiahed researchers of uAimpearbable Integrity to naalcs tsNont.lbe Iaditute Is ps4~sd 1 of its sponsoi~ship and of the tast tlnt t>be wotktbop rlWl eaeste of s+e3sntiIIe opinia~ . in this atea. The .err 64 that dfrerre poinb of view were b.dT expressed snd op.ftIy debas.d ' strengthens rather than weakens the consensus arttcn4t.d by Dr. Rylander. that E1'$ bas not been shown to Increase the ri:k of lung cancer amonE nonsmokers. Aa -to the Vienna sympaainea, the Surgeon G.neral'e remarks wers particularly dt!'BcaUlt to ~ understand. It was Dr. Ernst Wlrnder himself who read the conclusion of the srnpodum to the ~ press. Wynder, a physician and president of the American Health Foundatlon, has vlewt regarding ~ cigarette tasokins that ate well known. Cons.quently, bts petional statement to the pr.as em phasizins that legislators proposing smoldns restrictions "wiU, foe the pre:ent, not be able to m ~ : A 114
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PROTECTED BY MINNE30'q TOBACCO UTIGATION PROTECTIVE ORDER 1! - 23. GarQnkel, L., Auabach, 0. and Jonber% L, "Iavohmtary unokin= and Img cancer: A eaae- control study," J N"7 Canar twat 7S(3k 46.4g, 1983. 24. Koo, L. C., Ho, J.H.C. and Saw, D.. "Is patiive smoking an added *risk fsdor for hmB nnaer . in Cl:inese womenY" I Zsp Clin Canar. Ra 3(Sk Z77-83, 1954. 23. Wu, A.H., Hendersoa, B.E., Piko, N.C. aod Yn, M.C., "Snaldns and othv risk taebon for lung cancer in women," J NstZ Cawer l" 74(4k 74741, 1985. 26. Kabat, G.C. and Wynda, B.L., Ltug cancer ia amemokers," Cancer 53: 1214•Z1, 1984. 27. Sandler, D.P., Everson, R.B. and W:7oox, A.J., "Passive aeroldnB in adulthood and esacer risk," A>< J Epid 121(1) $7-4a, 19tL 28. Sendi.r, D.P., Evwon, li.B., WGcox, A.J nd Browder. J.P., "Caaca risk in adulthood f:mn early life expomre to pareeata' oaoldnG" Am J Aiblie XeoitJl 75(Sx 48'1•92, 198b. 29. Ssndfer. D.P., Wilcox, AJ. and Ev.rioo, lt,B., 'Twxhd" elieaet of Bieetme pasdve smoking on cancer risk," Laaad 1: 31?r16, 1956. 30. Gillis, C.R., Hole, D.J., Hawthorne, V.M. and Boyk, P., "Tb. elled of eo.iroruneatal tobacco srnoke in two urban communities In the wsst of Soodaad," Eur J Resp Dia 63 (Supp 133): 121•26, 1984. 31. Miller, G.H., "Cancer, passive smoldnB and aoaemployed and employed wives," Wst J Med 140: 632•3s, 1984. 32. Knoth, A., Bohn, W. and Schmidt, F., "Ps;si.* smoking as a oausai factor for bronahial careinoma in femele aon•emokers," dlyd XZin 7!(2)c 66•69, 1988. 33. Offfce of Technolo=y As:essment, U.S. ConEress, Staff Paper, Passiw Seeoleieg in the Work- plaa: Selseted tawa 19-22, May 19ad. 34. Trichopoulos, D., Kalandidi, A., Sparroe, L and M.cMahon, B., "Lueg cancer and passive emoldn;," !nt J Caneer 27: 1-4, 1981. 35. Trtchopoulos, D., Kalandidi, A. and Spirros, L, "Leetier to tht Editor. LnM carcer and passive smokinE: Conclusions of a Greek study," Laaoet 2: 677•78, 1983. 36. Correa, P., Pickle, LW., Fontham, E., Lin, Y. and 8uastel, W., "Paivs smoking and lung cancer," Lanut 2: S9S•97, 19i3. 37. Lee, P.N., Chunberlair, J. and Aldasoa, M.R., "Rdatioeship of psaive smokint to risk of lung cancer and other efnokins•assoeiatad d;seates," Br J Canaer 64: 97•106, 1986. 38. Repace, J.LL and Lowrey, A.H., "A quantitative attmata of notianoke»' hinB cancer risk from passive srnoking," Lnrim hW 11: i-22, 1986. 39. Bnreh, P.R.J., "Healtb risks at pastiw anokia` Probleans of iAt.rpr.tatioa," anviro+e Int 1123•28, 19EB. 40. Aruadel, A.. Uwin. T. and SterEnB, T., "Nonuaaoker luW cancer risks !eo® tobacco smoke exposure: An evaluatbn of Repwe and Lowrey's pbenomtnoloBinl model," J Environ Sei XedtA 4(1): 99-118, 19lB. 41. Hugod, C., Hawkins, L.H. and Asen:p, P., "Exposm of pasdv. :iaokers to tobacco smoke c.oastituents," !nt Arrd Ooeap liinviron HesltJa 42: 81 Z9, 197a: 42. Jarvis, M.J., et oL, "Passi,re exposur. to tobaereo 11iakC tvira oottaiae aorsoeAtratiosu In a represen4tive population tiuaple of aoa-moldaB s+ebool eWldrea," Br Xod J 291: 9Z7•29, 1985. . A 114
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PROTECTED BY MINNESOTA T08ACC0 LITIGATION PROTECTIVE ORDER 11 . ,- study found that 47 percent of nonsmokinB wives of smoidnE butbandt In the United States reported U expoare to ETS In the bome. On the other hsnd, the ttudy disdowd, 40 pernAt of nonsmokin= women marrfd to nonsmokers reported exposure outdde the bome. Tlius, e1a& sif ation of exposure aetoedint to the smoking staqm of the husband Is likely to result In substantial rniselaasisation. Of the four epidemiolo8ieal studIeu that have eoneidsred ETS e:posure outside the hofn.,.tbne have attempted to combine a:posiae &om several sources into a single naamire of total saposnre.m a None found a statistically significant relatiooship between composite ETS exposure and hnft canur. A second major source of misclassification ooncerns "aoannrok.r'• status itselt As tbe Am~ Review of Rstiraton Di.esfe editorial pointed out, "beeanse spowes tend to hare siauhr amoirinS .tatva, nonunoidnf wives of aaokint husbands may bsn been a•anokan rsther tban nonsmokers, and this differential misclassification mi*t eterate the eLk adtnatee."u y[oreover. aeooediA~ to a recent study that took special we to va* tmoldns stetpn, hospital records vrere fo+md to be remarkably unreliable, with llilly 40 percent of wanen reported to be nonnnokers. aetually having smoked at some point In tbds Wn..s And aoeordin= to a third atudy of hun= aacer In nonsmokers, individuals with "anoking6related disea;u" tend to deny a smoking 1111017 more often than controls with diseases that have never been associated with aaokinE.• Finally there Is the third type of miad]aidtiatton, referred to In the discussion of Flirsysma's report: the failure to diiGrentiste between bms aaeerr that an primary bronei:o8enle areinomas- and those that are the result of inetaita* spread of anar ori8tnasinp In another organ. Several authoes have stressed the need for such histologic oonsrmation of tomotr." In summary, epidemtoloEia studies Iike those of 8irsyama and the American Cancer Society (Garfinkel I), which rely upon questionnaires and deatb eertiIIatea, tsnd to be ee.erely limited by confounding variables and a:ieeluMeation. Ar, rnoe, soe3oeeonomie ststos, marital statu:„ smoking ststu.. ETS exposure outside the bome and expoem to ebemiala from other sources all must be eonsidered when the results are iat.rpr.ted. Factoring in the deficiencies of~ponssl anokin` data and the tendeney of misclassification and oonfoandint to overatimste rLk, Eleanor Macdonald's 1981 response to Airayaeaa In tIu Iettere column of the British Medieal Journal remains accurate: Other people's tobaooo smoke presents, so far a current science it eAnarned, "no ha:ard for nonsrnoken."1• Retrospective Studies: The Element of Biaa As a general rule, epidemiolo83e stndies may be dasMed aa prospeeti.e longitudinal itndia or retrospective ase-eontrol nudiee. Eaeh has detined advsntas a tnd dlsadvantaEa. Proqudw studies follow a group of tubjeets forward over timt. Data are e.oUed.d, aod wbjeda Erouped, .e aaoldt~ etstns and sponav anold~ liabibj. according to the eharaetesistk onder smdy (nOch Tben sub jeeb an followed to e.M bow maW iA aeh pap de.e,op tbe disew In quatioa. TIe Hirayama and Amerian Cancer Society (GaelSnkd 1) eWet wen at this tya. Siaa prapeeNn studies assign patients to Eroupe before the diewe deniom dNy tend to bsw a deEre. of objectivity that retroepeettre .aidies do not. On tbe other baad, am d"! w atndies depeod upon the accuracy of Initial at wdl as wbeequent elasd&atiom. Jla we have soavary Is diffiaaIt to achieve when personal and epousai emoldeg status are the esiterta of Intered. R.troepective asa-aontrol eCudia, altbonih also enbJ.et to miuhsdliat~, can minbnise that problens if oonduated arefully. They can ut0ise much smaller Amnbers of swbjeets daa they involve selecting patients with the dieesee of interest ("atea") at the outset and emnparint them to iubjeats "matehed" in aD other rapeda but not auibriaS from that disease ("eontrob"). Caaa A 114032
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PROTECTED 9Y MINNESOTA TOeACCO l.IT1GATION PROTECTriIE 01010114 13 ! That said, what do the best of the eweontrol etudleu td1 usi Unfortunatsiy-ae wae the ae with the prospective studies-not wry murb. The rewlh are aonDieft and IhMSIMUt. Above all, they Roint to the naoaoty of more aoauate qaantilkadoa of exposure to ETS iz maningtnl results are to be achievd in the lbtare. That is so "b.nuse of the unotreainties in momuwMts of passive exposure to aigarette anoke, as wdd ae to other atpoeure(ej that might have eonttibutd to the development of lung esnoer."O In tbort, ae rev.re) internsttonv eoafwooq oa the wb,*eet have concluded, exisdn= studles-indudirg thoa published dnee the moet reant oonferena- have found no consistent aesoaiation between .xposure to ETS and Mns eanmer, mneh less any cause and effect relationship. Some Examples Nevertheless, beewse some individuale and 6roupa have recently aawted that '•taken to`etMr'• the literature aggests that some rLk may be "blansibl.," a emnmary of the most aot.wortby caseeontrol studies followe. The last ewo (GarEnlal II eAd Lee) ere dbeua.d at greatsr ten6th, not only beeause they .re the most reoent-one diowinE a"paitiv." aseoeistion and one showing none-but also becsuse they are among tlu tuoet asphiskated. Trichopoulos, gA," and Corree, "M bsve come doseet to reportto= consistent easodations between lung cancer incidence in women and batband's nnoldnt stotas. The former study oom- pared TT nonsmokin= cases identified at thr.e hospitale in Gre.ee with 225 oontrols Interviewed at a nearby orthopedic hospital. There was no attempt to ver* lung cancer diagnosis by Inde- pendent histologic eumiAation, and the eam. "uobHaded" interyieaer gathered eII dats, rewltin` in substaadaJ opporamitia for both miedassiliestton and biae. Although odde ratfoe tnereased significantly with estimated exposure, they did so only up to a point, with the highest snpoaue group showing an apparent deeline in r3sk. In other words, evidenee for a dowreaponee re1~ tionship was pufvoeal at best. Only 35 r.ses (10 male, 25 female) were included W the stdy by Correa,~~ and "nons- mokinE~• status was neither de!lned nor vetldated. Lung moa ~a were stolosidly. The only 9tstisdcally si`nitieaat relationrhip wes amont the nonanoldnE femala wboee husbands were reported to have smoked more than 42 peek•yeare. ("Paek yean" are derhred by multiplying the avera6e number of packs emokd per day by the number of yeed the ~t has emoked.) Again, a dose-response relationship was su~eeted but wss not elarly evidenced by the data. Koo. t~.,w verilied lung cancer Mstdot kalty In 200 easa and anatehed tban, by aEe and socioeconomic status, with 200 controls. Noannoldas cw and control Eroupa (consisting of 66 and 97 subjects, respectively) were interviewed and ests:orteed according to atimatea of home and workplaew exposure. No etstistteally significant nlationehip was found between either atimate, or a combined estimat. of ETS ~xpoem'e, and lanE nnoer iaddena. When analysed aooordtni to total hours or years of ET3 Upotare, no doeefts+potw rtlatiayhip wer ob:er.ed. Kabat and Wynderw analyzed Z9 male aAd 63 fwWe l.mg cancer cases aoerordini to three sehemea: airr=t ETS esporure oa a regdar beab at boemn r.Edea aarent espoetae at worlq and havint a spou.e who bad ...r tmoked. Of the dz ooatparboor, Jut oae ~d.d a et~ tieally ei~eant dentlon In rislc ibr sr~ala eupored at wadc, Dai the Sve aomparlsona ebowinE no elevation in riak. as well at tDe one that was podti.e, mnst be understood in context. NonsmokinE ~u waa det,r~n.d lrom tls.p~da% w1dM baa been tomd to be unreliable in such matters; important expoeure data werr not provided and exposure was not defined. The faet that miedaeeilSeat{on and biaa toward tabppodtlw taodationa may ooenr in such a setting makes the etudy's negative Mnlta apedally .irEdoE. Tbe two most recsat studla to be publl:hed in thia atea wRed tbst s~ome ot the deIIdsndee in previous epidemiolo6ia work eaa b4 remedted, wh6e the problem of quant*iW longtem I A 114
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. PROTECTED BY MINNESOTA TOBACCO lIT1GATION PiiOTECTiVE ORDER 12 and controls arn intv.iewed to esttmsta their exposure to the substance in question (aeh as ETS). With the exception of the two ptapecsive caes reported by B;irayam and Caellake! i, sIA of the epiderniologie studies of ETS and lung canar have been of the retratpectf ve, esse. control type. Cnforeinately, the advantages of the aw-control method have not always bao esploited, aad their validity otteu bas been uaderadrud by potentially serioas disadvantages. Some stndis of ETS and lung cancer bave utlized too few eaw and oaAtrols to give any mesnins to the rewilts ' from the staridpoint of statistical ~emoe.*m Some have failed to match nw and oontt+bls edequstely,My and some have taled to iAelude oontroia at ab.• Of most aoneern, bowever, is- peeially in the investlgation of ETS and hmg eaaoer, Is tbe fact ebat the rase•aontrol study, by its very nalure, is subj.et to biases of two tal types. The snt of these isW -- bias. lavesdgataes aoadnctins a aweontrol st- icsUy recuit dses and aontrob following an expiarstion of the parpost of the study. The indi- viduaJs may be eeleelad-aroee pr.dsely, mar sd.at tbe0neehea, by aEreeitK to be lntetvtewed in deptb-besad upon their exposure to ETS. As aam aotiaprebendre review of the litessttiao in this ares recently aoMd: "If a Aoa-anoldtg control with no ETS euponw is more ltkelr 'to participate tban one with ETS expaare, the small seleetion bias In the controls will be reflected in all subsequent odds ratios since this group of eontrds forms the baseline for such onu+pati- sons."~ . Case•control studies also ase subject to reA biss. When a woman Is diagnosed as bavta8. or has recently died of, lun8 cancer, for she, ba husband or ber elu7dreA or elm friends will be interviewed In an effort to detamine her Dusbattd's smoldnt babitt owr the pearfod of the marri.de and her exposn» to ETS bom otla soateas. Beeoue lnn8 oanee: Is a 411344160 that is "smoldaE-assoeiabd" in the popular imapinatioa (and perbaps, toor beeause of a mdrerial ~ human need to understand "why" an apparently raadom tragedy ba; oowrnd), the womsA's exposure to ETS is li3cely to be overestimated by those with strone aaotiotnl ties to her. Such I bias is much leu 1lkely to oorur whas, for atample, the drDdrea of a ooatrd who ha, been hoepitalised for orthopedic reasons we interviewed about their motber's exposure to ETS or their father's smoking habits. That Is, the bias Is sywmatte, consistently sksrved in the dlrectton of overestimating the ETS exposure of easem with disisaes presumed to be smokiAQ-usodat.d. The role that emotion and ntbf eetivity may plal as evai mw1 bi.ses an "smltiplied out" lo the statistfeal process ws,a Mnstnted by a r.eent aaecontrol study that wwasquite us In attemptine to estimate exposure (Garltnkel II).• 1Le study examined omeffically the elliet of respondent identity oA odds ntios. Wlun the amount oi ai smoking at bome was estimated by his wife (the .ubjed,), thd husband or a tsmilr 6144 no rehtfaa~ip was reported between the husbands' rmoldrg aAd lung eanaer In tbeir wives. T'he "odds rstios" we» less thaa 1.0. But when the subjeat's son or dewhter ns the "Ip)t, the odds ratlo was 3.1!-tbat is, the study suggested that aonsmoldM womw wl~oaalwsb~iAds emoked at kome were mon than three times as likdr to dMdop lmK rsnees as senaAOft wa1000 whose huwband; did Aot • smoke at hom.. (Wbst It may bave sbowo, Dowene, was tbat Aftea wbose aathers died of lung cancer wen mon likdy to elaim that tluir Ltlari auoked at lam..) Case•ooAtroi Kudies, tTe% tmlflc. proep.etiw stndiu ia wMeh dats are eAll.etsd before subjects have the diaeaae se quettioA. a» profoundly subject to systemstie bias as we0 as syst.rnatie ' miselasatlcatioa. The inability to document e:poan sdequately or to eoatroi for oonfouadiu8. variables such ass aEe, raee, aoeioaooAOmie ststvs, oceupstfotmi spoa- s to L'TS and various hazardous eherniesls complicates the pietare llsrtber. >ltiren when ea» i. W= to s;akh eawa and controls as closely as possible, to document 1tsa8 oaneWs IdrtdoEicaqy, and to supplement spousal unokinE data with total exposure dats, aucertaiAties "od. • . ! A 114
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PROTECTED 8Y MINNESOTA TOSACCO LITYGATION PROTECTIVE ORDER U Chapter Three: Environmental Tobacco Saake and tbe Ee.piratory Syttem. A11erQ, 8eart Dl.ea.e aad Stroke l.ate in January 1986, a special conwd#ee of the Nalion.i Research Conncil, National Academy of Scenus, convened a public meeting in Washington, D.C., as part of Its ongoins effort to evaluste the sdenoe of envirownentsl tobetxo amokt and to m.lce snaessdoas for llimre ree.at~d. Dr. Philip Witortch of the G.orBe WaebiaEton Uni.enity Medicat Ceatar enrnmsris.d at tlm meeting the results of his own entenahre rNrienw of the scleadfle literatore an ETS and the adult respiralcry rystem' as foDows: It hu'been suggested that data ia the literature daaonstrate that exposure to ETS ean cause or exacerbate chronic obstrutive pnlmonary disease b adults, lesd to aeai airways disease and dyslhnctlon. initiate or auecerbate aethma, ad adversely afiiat respiratory function and eymptomatology in IndividoaL wo preeadrda< ewpiratary 0In fact, a careful review of the pertinent sbadies reveals that eaeb p{Eutions an be accepted only if one Ii willing to Ignore acoepted eden0k aritaia and wahustion tedh- niQOes. Witoruh went on to identify what he termed "tbe moet wrioo., ad certainly t?u roost wide- spread, flaw in the epidemiologic etudies addressing ETS and adult pulmonary Amcttoa" It is a flaw shared, as Chapter Two has noted, by the studies al ETS and hmE caAOer. "tDe absence of appropriately verified estimates or measurements of espoenre and/W doea" And it is a flaev almost invariably found, as this and the following dUpter wfli waice desr, In both epidemiolo8io and experimental studies; studies of chronic dtseases like canoer, bronchitis and empbyesma as well as studies of acute a;thms, pulmonary llmctfon, Iafection and aDer=y; studies relating to adults and children: and studies focusing on eardiovauvlar ratber than respiratory health effeelt. In addition, as Witorach was careful to point ont; t!u abeenwe of ad.qnate exposure data Is far from the only problem with the research that bat bees done on ETS and adult respiratory function. The exiettn` literature Is replete with atodiee, both epidsadolotleil and experimental. that "ignore accepted scientific criteria aad evaluation teabniqu.e." For example, many studies include very ana11 anmbess of subjeeb, fig to Identify appropriate case and control groups. and pay insdequati attention, 9 any, to tbe.need for eliirdnatinE or at least minimizing selection and observer biu. Few studies take account of such confounding variables as Iifestyles, diet and nutrition, sod• oeconomic factors, preesdstSnE diseases, oocapational or other environmental exposnree to flun8i, bacteria, dusta, alleryens, industrial and household e>mieals, in:eet and rodent pevducts, oxides of nitrogen and sullt:r, forrnaldehyde, osone, aebeatot and other wbstsnea. Moreover, few if any of the e:dst{ng studies pay adequate atteation to lenels of rGAttlation, tanpasture or relative hunnidity, or to psychosenia and emotiotul feeton, wAirh can have considerable impaat upon cardiorespirstory physiology and health EenenDy. In some .tnd3ee, rdatbnsbipt between atndy II pe an not etaeLtieallbr d:nilkant. Soaastimes they are not InternaDy eonsistent or oonrist.at with data 6+om other thadis.la otisa eaea, s..ya where resulte seea+ to iwply an eifeet, no dokMponH1 rdadonehip b dearoaatssble. And 801214 authors report differences that are not pbysdoloBteaDy aod effideaDy dgWSmt or even biologicaDy plausible. Dr. Witorsnh, who ie Ctinical Professor of Medieine 1n the Diaidon of Pnhmiary Diaeasea and AUerpr at Georp washinjton Univesiqr, described theee desdendee, ad others, with epamdt~r He noted, in additton, that 'jwjhile It may eeem iattiittwiy reasonable to poetiulat. a posedbie adverse eifect' of ETS on respiratory lllnction, "Itpere are significant qaantitative aa w.ll as possible quaiitstive differences between ETS and the mainstream etnoke to which the active . ,A 1144
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PROTECTED 9Y MINNESOTA TO®ACCO llT1GATION PROTECTiVE ORDER Z3 and volao7e organic compounds, home and woelcplsee e:poeuces to Qrit.nt dueL and pw, diet and nutrition, elad .oeioeeonomie factora. • The authors made no sa.mpt to ediust their resulte for aP or body .ize, which even nonseientttb lmow intuitively (and medical edertitts lmow with considerable preeison) an aKeat lurtE espacity and function dramaliw'ly. • As one correspondent pointed out to the editor of the jounud that published tbe Wdy, the results were flawed even mors llwdamtatsDy beeeaie White and Froeb used a lmg fiaWott mea.urina device that falls short of the techninl standards raoommerd.d by the American Tbo- recic Sodety.1• • And even if the results of the eevdy were to be soapted .e eesentially aavrste, as they were by the authors of an accompanying edtorial, it remains tive now as It was then that "(tihae is no proof as yet that the reported e.duetlon In air.rayi lbuedon bae .ny physiological or clinical oonsequeneoe. In his presentation, Dr. Witondh, a eHrAdaA spedalWnt In the testing of pulmo®ary llmcdon and the diagnosis and treataunt~o~l~Wteonary dt...tee, piaeed epedv empbadt upon the htter two points. "Untortunately." be Oo~wOed, "the white am F!0!b eiiftera t'om very eeviouE flaws in. both dea`n and exewtion. Tb. study also Involves a a of highly questionable assumptioni, which undermine the study's validity and White and Froeb'a iaterpretatJoa of their dats." Witorsch also epeeillcslly questioned whether Its raua, even K accepted, Aad any clinical or phy.ioloafcai meaning. And although he sotad, ip his edlique of metbodolop, that "the same ' individual conducted the testinE and was raponeible for interpretatlon of the test realts, iatro. duciny serious questionr of investi`ator biae," eome of his moet telling methodoloElcal aritidem wes more technical, addre:dnE such ooaoerae as testing equipment and technique" and the limitations of epeeilie measurea of pnlmonary llmction.*'• "The dah reported by Wbite and Froeb," Dr. Witosuh aooduded, showed no siynisa;nt differences between sronpe In FVC oe FEV,. In taet, the only differences In pulmonary lbnction t~s repoeted by White and Froeb wen with respect to FEF", e~nd FEF,,,, (mia~ ter:e+inal Dow ratesj. As noted, thoa dillerenoes were quite arnil-in the ranEe of 6-15 percent. Fosthermors, the acAsel vahteo remained within the normal range, even iA the group with lower v.lues. As iadicsL.d previously. whether even abnormally reduced FEF,.» uWar FEFw* us inilkative of small airwe;,ya disease or dysknction ie open to ewions quadoo. To wggest that redue.d, bnt stiD normal, values for these parameters reseet clinically or phY11olot102111Y siPifk&At dYa' lunction oi the small airways ie aert.usly tsZJnstis.d. Tbe unrelisbility and clinieal insignitcsna of the paper by White and Froeb is underscored when one exssminea some of the moce r.oeat titerative. Retereaee has previously b.eo made to etudies by Comstocdc. ILS6• a,nd Keatner, "' neither of which IMd.np~ »latlomtdp between ETS er~d impsired pnla~onary AmetioA, nr.n to the aainim.l delr.e repoeted by White and Froeb. Although a 19W study by Kaufl~ann. L,l6" dsometimes interpreted, sis haft to the conclusions of White aAd thab, ia ieat tbe data it pr~o.idu .n biolo~ally hr~plsn~t and internavy inaorudstent- "more waseti.e," as Witotaeb put it, "oi rtad.dai artlhet tban bio- lo`inl fact." Cotuider, for eximple, the Kaaifmann tsoup'e finding that "20t pasdve eaakint" aaeD htd FEF,,,, nlues that we»~ Lo tlsNae of eronemoldas aNa, or tAst "intermediate" and `9ight" aetive emotiere h.d FEF.,, ~ralaa eaa le to those ad eotumolcao, or that FEF,,,, values wen euperior in older "p.ai.e emo ' women tban in yoW4er wofaea (who baw pruumably A 114
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PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTiVE ORDER ~ patienrs unveriQable, subjective report of "ehest psin." Was it psin, in i~ Or pressuret Or severs discomfort? Was it real or imssined? Whstsver it was,it eatainly ws. ,~ one tbint: an objeesive meisure upon which Aranow's conclusion could be seieAtiscally bssed. • Tfu error pu eompounded by the taot that the study was not doublo-bliaded TMt Is, the investigstor conducting the Nst-tellinS the sibjed bow nrch to "stre.." 6imself eaoonrs~~ the right amount at effort, elidtinS reports of pain or its absencs-lmew which subjeati had besn exposed to ETS and which had •oot beea. The opportunity to manipulate results-aonsdo+uly or llnConsdolisiy-wY onlIIiprlNZlt. Moreover, even ii anginal episoda had been determined objectively by using EKG changes rather than chest pain or prearurs as the end•polnt of int.rest, emotional and psyehoEenk factors warranted dose oans{deration. Strsa of all ldads-aot merely phydeal esadse-eaa devatt besrt rste, blood pres:ure and oxygen demand, and Its role In eaediorasealar disess., especially angiaa, is amply doenmented. Yet Aronow essentially iSnoeod t>,is etitlal parametes. Indeed. he Ignored important aspeet~i of the two paramehrt with which his own hypothesis was most lbndamentdly concerned: a.rbon aiano" snd slooe3A.. Althauo be measured blood levels of the former (iA the form of earbooqbeenoSlobin), he did not measure nieotine, and be did not measure CO levels In the atmosphers to wbi~L bis esperim.ntal subjeets were exposed. As Witorsch has explained: (T;he theoretical inereases In ambient carbon monoidde nader the conditions of (the Aronow) uudy would have been Insu#6dent to produce the reported inereasn In ear• boxyhemoSlobin that Aronow noted. In additton, the relationship between blood levels of earboxyhanoSiobin and impaired .rork performance were tnoon:istast with other data •: in the literature, including data p»vlously reported by Aronow.1UM In this reprd, it is pertinent to note that the general reliability and validity of data reported by Arnow, including data relative to carbon ®oaoodde and earboxyhemotlobin, bsve besn seriously questioned by two tederal aSenda.""*' With regard to Aronow's en-stions with respect to. ntoottne, It should be noted that levels of nicotine or nicotine metabolita we» not determined-and it Is not likely, on theoretical =rounds, that Aronow's subjects received suffident doses of niaotine to result in adverse cardiovascular eSeets. Other significant criticisms of Aronow's study indude inadequats controls and flawed and inappropriate statistical methodolo4y, as well as tai7ure to address a potential role of carbon dioxade build•up unda tbe conditions of his study. "In sum," Witorsch wrote, "the results of the Aronow study sre !!'ankly not credible and the conclusions of its author w not justilied." IAdeed, concerns about Aronow's credibility In other conteuts prompted two Investtptiow by federal sSenda Into his group's reportad falsification of arbon mono3dde da4 submitted to tbs Environmental Frotatloa Agency and of prescription drug tests submitted to tbe Food ad Drug Adm3nististtoa" In .ny event, Dr. Aronow's studies of L'TS and saStaa-wbirh oontSnne to be eited roadAely by opponents of pubSe anakinS-"anprwa tb be set atldo ad viewed u unrdisble."w `17ist is the view o! Dr. A.isdo, se It is of Dr. WitorerL, ad sa it onSht to be oi sny aoasdentlous medical scientist conorrned with the isau. As Aviado has noted: "The I9a9 Snrpon General'. Report in !ad does not mention the questioAable stndiss, althou=h *Ay wae dtseu.s.d in the earlier Surpon General Reports of 1872„ 1979, 1950 ad 19iI." The basa for rejeetlnE them are desr-and ought to bave beea clear much earlier to the Sageoa Geaersl. SWilarly Implausible and inetbodolopkally suspect, Witondh told ebe NAS committee, was a report by Husschmsn, "" that claimed to bave foad •"statietleally sk*Aant" ineseate ir t : s M A 00114 49
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PROTECTED sY AAINNESOTA T08ACC0 UTIGATtON PROTECTIVE OROER 27 oiQeetsaa smoked by the parents has no inaumce an rapiratory symptoms in t6eir, duldreh." A study by Camaeho and mworkers" of 13t2 dn7dzeA and dmdr parents focused on two dttiennt residentiaJ areas, one rnral and the otbae industtid,« The anNora reported a dpsiikat sstodadon between respiratory disfaae aod reddenoa In the indutMal aras, a/ weU Y a strong saaodst3oa bitween the respiratory sytnptomr of the ehddrro and thosn of their nathas. But they reported no asaociation between tmoking by the mathers; md the ehildrea's rsspiratatY stslut. This is not to say that oartiin podtire awodatlont ha.a not been reported. As both 1iVitorseh and Aviado adonowledded, they ha.e b.en. But iay dianE« aobd In lung lbtnetion or development have been extremely small, probably trivial and tend to disappear over tim.. Even th. best of the inveatiEations suggesting some atied (the "EasA 8oatoa" s#* of Tapr, lLM„IO and Larnittu, p,u:w) "sntbrs from a number of aiEnidnnt dalldeads," aa Wit4rteh put It, "that make interpretation of the dats quite dlldedt."' For =mpla, tlw exposure e,timata aied In that atudy reL'd on subjective, inadaqnatdy eerified adoinashft (As Ekwo, "" have noted, 'sliQht chanEa in the phrsdn; of eaa :adt In anbatantial diiis~eas ia the type of response one obtairu' ; dm~lar~r, 8~~"a ban fonM d snis ewt dilter.noa io qua- tionnsire resDons.s, depending upon whieb pa»nt oan~ths foem.) In addition, nsapy poten- tially crucial co- and eonfound~+s variables wan not by the East Boston iavestiQatom Thesm last two concerns-the abadute necessity of obtaiaft aoauste, qoandtstiw anasum rnents of exposure to ETS, and the poteAtiaXy powerhnl iaipad of ao- and confounding rarLbids. on the data gathered and the ooneisWona drawn-wiU beored a+on lWly ia the next ahapter. For the moment, the science w9th respect ETS and chadron an perhaps beat be Nmmariz~d by refer.inE to Avisdo's conclusion: "P1 study of the etiologl of childhood respiratory aryrmp- toms and disease is indicated in liEbt of the inaonsistent and oontrsdictory llndinEs reported thus tar."If ETS, Aeart Disease and Stroke In the 1970s, Dr. W. S. Aronow triggerad a onndderable medical controversy when htpubUshed a seriea of reports suggestdnt that exposum to tl»e earbon monoxide in wriromnaatal t.bao o smoke might adversely affect the eudiarsaculat health of nonsmokers, particularly thos. with proadstinE coronary pathology aanifeatitg Itself elininllr at atgina peotorls.•x An`im Is be• Geved to be caused by a nareowinE or spatm of the ooroAary arteriap that provide ouyEe&ddi blood to the heart muscle. When the supply of oxqEenated blood Is redueed, oe when exerd:P causes an inereased hart rate (thus inwassing the heart'a "denand" for oxygen In patients with coronary disease). pain and certain diatincthn dseteoc~dtofrsphie (EKG) changes ebarsete~dally result Aronow thought ETS might esnaa or "pot~tiate' aaEiad attaaks, and he dai;Ened an experiment to teat his hypothesis. The theory was tbic Tobacco smoke contains earbon monaadde (CO% which an be "rrdstaken" for oxygen by red blood oak the red blood esIIa may "earry" CO (in the toem ot earboxyhem• oEfobin) rather than 0, (ia the lonn of mrybsmoslobia) to ebe heart, thenby reducing that .itv muscle's supply of osypo. >ylor.o.er, tobaem swoln aontdw Moetlaa, whieh ean spad up heatt rate and thereby incrase oxygen dematd. Tba eonddn.d eifect, Aeorrow raaoned, mlht teiaar an anEinal attack in aue tible padents rspowd to ETS s~etimentaDy. Uniortunately, the experiments Aronow oonduetad to tot his bypotheds wen deepiy lfawed. The extraordnary subjectivity of the datl retied an bt Aronow's reports Is reason enough to dismias them as un.denti& Aronow dairnad that bb axpaiaatAts showed that "pasdw smoldng' reduced the durstion of aeedas neeeaasry toyeodtw "aA*s." Hawe~ra: rather than using the standard EKG change (abnormal ST•segmuat depusloW as the criterion ot an anginal episode- an objective m.aa~e widely accepted aa iodiattnt coronary 6u~nqr-Aronow osed adi , A 114 4
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PROTECTED BY MINNESOTA TOBACCO LITiGAT10N PROTECTIVE OROER 7 Rofsreeees: Inttodoesioo ao a O.a+iew 1. Viedeminn, H.. Mahler, D., Lotu, J.. YirQNto, J.. Snyder. P. and ltatthay, R., '•Acuw eilects of passive anokinE on lunQ ilwetlon and airway rmtivtty In aachmatio subjecLt," CAat a9(2k 18045, Febrnary, 1986. 2. Shephard, R., CoUin:, R. and Silverman, F., "Psssive exposure of asthmatic wbjeets to eiQarecte imoke,,• Lrnvim Ree W. 392402, 1979. 3. Dahma, T., Bolin J. and Slavin, L. "Psadve amoldnr. Tftect an bronchial astluna," C7kat 80: 530-U, 1981. 4. Lsfcoe, N., "Paasive amoldnS: Acnte eltoetr In asthma," CFeet 89(2k 161-62, February, 1986. 5. Kr'e8er, L. "Pauive smoke health eSeesa atiD odled ineondusive," Ameriean JUrdioal Neva 38, Febrna:y 14, 1986. 6. Munur, A., "Paaiive emok6 daaEera tdd," Amenieae; J[rdieal Now T. June 6, 1986. 7. Davis A., Ballin, S. and WeymueDss, L. "Seaitb effects of passive unokinE told," AnvriQan 3ledfeal News 6•7, Jtno 6, 1986. 8. U.S. Department of Health, Education and Welfare, Smokvig and IReaftli A Report of the Stiryeo+t General 11•28, 1979. 9. U.S. Department of Health and Human Servicea, TAe Xro1N Conaequencee of SmokiV. Co;neer: A Report of Ne Stirpeon Gnmra! 249, 1982. 10. Testimony of C. Everett Koop, M.D., SwBeoa General of the Unit*d Stata, before the U.B. Senate Subcommittee on Cirnl Service, Post OiSee and Geaeral Services, Committee on Gov, ernmental Affairs, October 1. 1985. 11. "ETS-Environmental Tobacco Saake-Repoet from a Workshop on Ellects and Exposure Levdi," Geneva, Switserland, Ew J Rap Dii 65 (Supp. 133x 1-152, 198t. 12. Workshop on Rupiratory Effects of Involuntary Smoke Exposure: Epidemiolo8lc Studks, May 1•3, 1983, National Institutes of HealtA, convened by the Division of LonE Diseases, National Hsart, Lung and Blood Institute, U.S. Public Hestta Serviee, Department of Health and Human Services. 13. "International Symposium on Medical Perspectives on Passive SmokinF," Prev lled 13(0 557•756, 1984. 14. Testimony of C. Everett Koop, M.D., Surgeon General of the United States, before the Subcommittee on Health and the Eavirona-ent, Committee on Enersy and Commers , U.S. House of Representstivea, June 12 and 27, 19E6. 15. Handler, J., PrefuM Proceedings of Sympoeinm on Passive Snaldnt from a Medical Point of View, Vienna, Awtrk 1981. Interaational Greea Croet, pp. A•B, 1986. .A o 11a
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PROTECTED BY MtNNESOTA TOBACCO UTIGATION PROTECTIVE ORDER lU Iteferesem Lan= Caeeet In Nonamoke:s 1. Hirsyanss, T., "Non•smokiat wives of heavy smokers have a higher risk of lung eaneer. A study 4min Japan," Br Mod J 282: 183-85, 1981. 2. Mantel, N., "Letter to the Editor," Br Mod J 283: 914•16, October 3, 1981. 3. Tsokos, C., "Lett.r to the Editor," Br Mod J Zs3: 146446, November 23, 1981. 4. "Miscalculation reported in seodlr on cancer In wives of smokers," Nsw York Tiffw, June 15, 1981, p. B•7. 5. "On pasave srnokinr. Cancer Society sAd Tobaseo inatitute in rare unity." JKediooi Wortd Neiot, July 6, 1981, pp. 80,91. 6. U.S. Department of Heattb and Human 3er.ka, TAe X.altJl Coaseqvena.e qrSwoleinp: Caaeer: A Report q fgr Swpron Genw+si Z46-61, 1982 7. Hirsyama, T.. "Cancer mort.lity In non~aldoi wonan with anokins bwbands based on a lar8e-snle cohort seudy in Japan," Pn. JI[id 13: EW90, 1984ti. 8. Upstridc, S.J., "Cbronie bealth e!leab of environnAstal tobaeoo smoke: A critique of the epidemioloEiesl literature," presented to the Committee on Passive Smoking, National Re- .earch Ccaac9, National Academy of Sdenqs„ Washington, D.C., Jannary !9, 1986. 9. Macdonald, E.J., "Letter to the Editor," Br Mod J 283: 915-18, October 3, 1981. 10. Macdonald, E.J., "Letter to the Editos," Br Mod J 283: 1465, November 28, 1981. 11. Sutton, G.C., "Iwtt.r to the Editot," Br Mod J Z82+ 735, February 28, 1981. 12. Burch, P.R.J., "Letter to the Editor." Br Mod J 282: 1393, Apefl 25, 1981. 13. Stalin8, T.D., "Iwttsr to the Editor," Br Mod 1282: 1156, Apeil 4, 1981. 14. GarSnkel, L., "Time trends ia lung aaeer mortality among nonsmokers and a note on passive smokin8," J Nail Cancer Iwt 66(6'k 104144, 1981. 15. Garlinkel. L., Interview, "Nkht vom, ei8entlidien Problem ablenken;" ("Let's concentrate on the main iiwe"J, MwwA *ud WieJ1r 1?940x 148M, 1981. 16. Rutach, M., "Letter to the Editor," Br Mod J 282: 986, March 21, 1981. 17. Lehnert, G., "Kraah dureh PatsivrsuehenP" (ID by Patsive Smokin8Y7 Mnndl eW Wedar 123(4oX 148a•88, 1981. '11anslation. 18. Conference Report, "Weak assocattass in epidemiology and tlair interpretation," Prev Med 11:464-76 (1982). 19. Artiele, "Is Ca epidemtology more than merely gazing into enqeiis?," lneernal Mod Neua, February 16, 1981, p. 2, 30, 81. 20. Balter, N.J., BDpatsiek, 8.1., Witosxb. P. and SebNarts, S.L. "Causal relatlonsAips between environawatal tobaano smoke and lun8 cancer In non-saaokas A critical revie.w of the lit• erature," Proe Air PoU Coetrol Aus, 1988. 21. Wetss, S.T» Editorial, "Paaive smoking and bw8 eanoer. What is the riskY' Am RUy Rsapir D+a 1S3(1k 1-3, 1986. 22. Friedman, G.D.. Petitd, D.B. and Bsrrdi, R.D., "Prevalenee and oorrelstes of paz dve smoldet" Mn J Pub ReaA 73(4X 401-06, 1983. ~ . A 114 3
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PROTECTED BY MINNESOTA TOBACCO LRIGATION PROTECTIVE OROER 6 base their efforts on a demonstrated health harird from pa.adve srnokinE," is entitled to mora credibility, not less. That point is underscored by the Internattonal Green Cro»' recent p"estdon, In a Gerttin language edition with an sooornpanyin` E traalation, of the proeeedin~ of the Vienna meeting, with a new preface writteA by Dr.A~h Hirdler, former director of the Worid Health Orpnisaaon. Handla asye that with one exeepttoA aamq eom Q!!y ecf.ntisb in att.ndance, ,all the participante agreed that so far tAae was no ddfaite proof of a amrl between passive smoking and the ridc of hmE meet. None of the epidemiolopic.t atudip sidered .atislfed the essential citeria of asientilie methodoloV."m Handler conduded that "the question as to whet6er the conceivable dieoatkd possibility of a risk ea11s for ofadal pre.ent3ve meaaum Is not a madial but ratber a polltioo-rodal oae. The response to it reflects the estent of palft regard Eee and rroopnition at pereonai freedom as opposed to non*fadal control Issaara in the IIdd et iaterbmm relationt.'• It is dear that the iAeunbent Su:zeon General has a.t:org opia3oa on the «pol3tloo-a3i1" question to which Handler refer.. It Is equally dear, however, that the Integrity of adenoe depends upon the extent to which individuv nieotbts a» able to reparat+e their politioasodil agendas from their purely .cienttse aeahitiee. By iaeteting that the "oonaivable eb.or.tial pouibiity of esk" mentioned by Dr. Haadler ib a demonetrated riik, the Surgeon General thratem the rapW. for reseon and objectivity upon whieb advaneentenN In real edentitb lawwledp depurd. Episode Four 119 WfF 5~1i~:I1Z3L1~j_II~ I_~'I=~I'FZLl?fTI~T'I'1 ~ L _y t lf t !n. ~~_~ 1 v !fl . _f.~~: _T~!r atte_ 0 Ca fi latio 0 =...1 • 7 ll !liii'1'1L.1~__. 1' -'<L:!l: The facts regarding the oonferena a» as toqowi It was organized by a faculty member at a leading medical school who alro is amanber of a group of asiaitins hoen a number of univeraidea that, at the request aW expetw of Tbe Tobaooo Wtitnte, lw eamiAed the scientific data on environmental tobacco miolce. Tl»a taaMrs ond reaaeeheri haw Independently .val- uated the science of ETS and Indoor air pollution from the standpoints ot taodeolopy, epidemiology, industrial hygiene, audtdne and pulmonary medidne. Tbey bs" ao4duded that public and profea- sional information on the mbjed has been Inedequate and aa oeaeion mWeadint. The conference organizer invited asdsnttsb witb varying viewpoints arA a»ae of expertise to make pre:astattons. Two tobaooo oamp.nta aAd a number of other orpnisaliaaa apwd to sponsor the event Tlsirtren proadoat aodemk rdeatbt4 with varyfog ereaw at expertia and vkwpoiAts, agreed to eerire ae aaferenoe 6rwlty. Shortly after the ooafwenoe was annoanoed, the university adminietrat3ou reaived a telegran from the lung aaodada& aad participating scientists raeived tsbplane calls from the aaodation and from the 0l8ee on Smoking aud 8ealth. The naiv.edtt, ta ib eredit, edneidered academic freedom to be paramoant and reNu.d to yield to the iAtimidatioa attempt:. A number of the eonfeunce faculty members ala relyued to Si+n in to the praw+e. But other speakers who had mnuniittad themselves to addressing tped& subjats before the conference and to participating In scheduled pand discusslona withdrew abruptly, after printed I i A i14926
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PROTECTEO BY MINNESOTA TOBACCO UTtGAT1ON PROTECTtvE OROER 9 Virginia, registered his diasatidaetion ia a praMtatJon to the Committa oo Paseiw Smokft of the National R.sov& Couaa'1, National Aademy of Sdaum' After noting that Hirayama had failed to answer aitidsms regarding his selection of a oabo:ts (a group of iAdividaaL rharin= a common experience or exposum) or source of health eare," and that Htrsyaaa had aoAttnwd to ignore questions about "aaortatire mating" (e.g., die tendency of smokers to masey srnok.rs and of nonsmokers to marry Aommokors) aad social elata aaadstioo with anoldM eookdaB methods and hatiay,'s•u KlpateieJc conduded: After reading his 1984 papa we ev11 ban Inadequate tntorirution about the ielecttaa of his ssmple, the validation of spousal responses a8tiast aseb other (they wers taken indeperrdently), the etsbility of the au"iaEe, the moi~ty ot the populatioo, the workplace exposure of nonsmoking rpoaee., the social cocrelata of onolda~ the accuracy and oompletsAeu of tbe death record or laa wooaa iA anatch~. Sinee Dr. ffisayama's study is the most quoted reference ia the Htermr., an Lndependeat assaanent of tb.ue questions should be aude. The American Cancer Society Study Ironially, only a fraetion of the press attention lavished upon Hiraysma's e.nsattonal report in 1981 was aeeorded an equally new.worthy-ii lw dramatk-report by Dr. Lawrence Gar!lnkel of the American Cancer Society that amm year (Garlfakd I).w Ia the course of a larSe scale prospective lonEitudinal study of almost 180,000 Amerian woawIt, Garlinkd compared lung cancer mortality rates of nonsmoking wiva reportedly exposed to different levels of environmental tobacco .moke. He found that "none of these ditierenaa wae statistically d=nilfnAt" aAd con. cluded: Compared to nonsmoking women marr,*ed to noaanoldnB husbands, nonsmokers married to smoking husbands ehoNed very little, if any, lacrewd risk of lnet cancer. In an interview, Garlinkel emphssised his Inability to detee! AU imeae.d risk In nonsmoking wives of even hsav-v smokers. More tpealkaAy, while his data analysis suggested a relative risk of 1.4 for nonsmoking wives of tnen reported to have nnoked las than 20 eiEatetta per day, the relative risk for wives of men smoking more than 20 a day was 1.0. That is„ the more their husbands smoked, the lew likely the spouses were to have latg cancer. "We could Sad no Increased risk. no dose-raponse relationship:" Garfinkel noted In aunmari:ia= the Qnd•inp of this study. And he added: "(P)ssrive smoking may be a political matta but It is not a maw t:sue In terms of health policy.'"" To the credit of the ecientilia comnunity. Hkayama'a suggestion ia 1981 of a d8nificant assoeiation between ETS sad lung cancer deatM was qnatioaed repeatedly by other seieatists in letters to seieatilk journals. AA American attces epideasioloSist aofad that the Dealth districts oeeupstioAat Hirayama itudied contained most of th. heavy indasbriea b Japaa, suggesting that or environmental could have affat.d the diasam rafe.lw ' A matheasddan, recalcalstin~ from~~~a ysms's published data, aoadnded that t>ba e~r~ asaosr d for ~msrried apnoidn[ women actually was hto.r than tbe ratea for aonanoftS wives of both nonsmokers and m+oker3.1• And linally, in what wae, or on8ht to 1uw bem, the go do mg for Hirayama'a sensational ooneludons, Oen was Gar!lnkd's 1991 sbudy for the American Cancer Society. "It is not posuble to show edeatilleaAy convincing proof," the daeetor of the Gnteal Institute for Industrial Medidne In Ftambur , Wett Gernnay. eoaelndsd In an editorial review of the evidence in 1981, "•tAat the risk of cancer is lnetessed by eo4llad pwtw sntokins."„ ~AT00114930
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PROTECTED 8Y MINNESOTA TOaACCO IITiGAT10N PROTECTiNE ORDER • ti reasona for the differenas in not aU lmoan. ... At bat, anm osa aondude that soms part of the difference betweeA tist two popalatlM may be dw to diSavroa lapad~e smoking ratea, but the awmptioA that Jt is rearonabie to attribute tbe eotire di~erenee to passive smoldns is a*utis.d. Tbe eSeet of tbess and other Bsws on the !laal estimates eilb into qneWaai the rollabIIity of either of tbeie numbers. But whs7e the OTA Staff Paper was sleat to the aumbees games tbat some attiora baw it fell prey to the seoond type of aiiaeharad.ris'~on. It concluded, in ~e¢t, tAat althou~'(a]U the lung cancer WAea have some m.diodolosia weakneasea," and although their results have been equivoeal, and although "aneertalntlsr in weaarement" reader eadi stvdy "oompaeible with either an iruseaae or an abseaae of exoesa riak," oe.vtb.l.sa when taken together di.y dispiay oonsistsnt~ an across iaa~aaed, rithat sic ..'7.ads weiSbt" to the trotion that "tbe t.rnlta are erslly language m~ests how uneasy its authors mwt w besa~b an~tbe wl~ a~o.d.n s that by adding together equivocal resnlts and aoatradiatoeY studlea the "total" oan some less equivocal, the "whole" more mdnin9K tlMS, Itt Individual partt. Yet it is precisely that trap Into which oee otber reomt sumsnary baa failea,p evea if more comprehensive review have not.L0a' And it is predsdy tAat trap that the epidemioloSy discussion by Lee, p,L&,., lays bare. Some Fundamental Observations Lee and his aoauthors identify four reasons why a slight positive assodatioo between expo=ure to ETS and lung cancer ia bert esplained not by any esuse-andeffiat relationship but by difler• ential atiiaclauiliestion and systematic bias. Fir:t, even under ectnma oonditioeu, a nonsmoker would need between 11 and 30 hou» to iehale the equivalent os otts d=aretta.„ When stattsticians have made calculations based on much higher "dsaretts equivaleat" esdmstu.p and have based their calculations on the assumption that aedve ~ does Increase lung cancer risk, they have concluded that any putadw rislc from ETS .rould be so much lower tlun 1.1 u to be virtually undetectable by even the most serupubus epddanioloSle stady.0 Second, Lee, et . point to the fact that "all the aludfa sutfer ftom weak exposure data, most studies only obtaining inforrnation on the"oum's snioldnB babits and none obtaining ob- jective data by messurement of ambient levds of smoke constituents In the atr of the home or workplaee "or of eoneentrations of eotueitwntt In body flnfds." These importaAt issues are discussed at greater length in Chapters Thra and Fonr of tlds nport. Third, the authors note, no studia adequately take into account the possibility of misdassi& cstion. The usn of qu.slioanaires and reliatKe upon the repoeuM of dost rnlstiva of cancer patients heighten tbe dangets of mladasdileatioo." Fourtb, "many of the studiea an opea to .pedQe eeitidRm," soeAe al which are disens.ed In this chapter. Tbe mo.t Important of these, of ooone, Is bist. As Lee, Iwlmert and othas have pointed out,"" lf mbdanillestioo and biaa resulted In )ust a IIve percent deviadoa from the truth about a subject poydat3on'a sposa~r" to tobtem tmoka, a.parlous rdsdvs risk of ap• pro3dmately 1.4 woWd rault In other .rords, it it nov be said tlut the positive arodatton found in some epidemiolosie studies Is "eo~dstsat" w1* ridc of lntK eanar in nonsmokers exposed to ETS, It i., In the oondudlAg words of L.e, ~,A„ "mon 11ke~y to be a result of bias in the study desiSn than of a tn~e egiat of passive seao" C , A 114 93 7
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E pROTECTED 8Y MINNESOTA TOBACCO LIT1GATION PROTECTIVE OROER E m Itstistirally dQniBcant dosFnsponst relationship betw.ea tliw number of aigaretta smoked by husbands and their wivos' death rat*, nor could they lSad sny signiQnnt diffarenceg among the thre. groups of wivea. When they combined the wives of "corrent anokees" with the wives of "former smokers" into a dn81e St+oop, ho.vrnr, they wers sble to report a stafttdly dpifinot • increaae in mortality Irorn iubemic beart disuss. AS Witorscb has stst.dt ne Garland study aiCas Qom a number of ms* potentially invalidalin8 Saors that render both Its Sndings and conclusions open to serious qnesdon, There are, for ownple, very seriow problems with tbe design sud tbs sbt~Uepidemiolo8ical eastbodolo8y used in the Garland study. These indude the isd that the subjects were volunteers who agreed to participate, that~~ the question ofpot~ntisl seli:sdeetSon bias, and 18 pereent o~t those sollcitd to parlleipste, pbidi mi8ht bsve been sniBcient to altsr the outcome and condodonsr The fact that two hetero8en.oos sronps, wives 01 "tormer smokers" and wives of "current smokers" was pooled is anoonlow wd io- appropriate. Twthermore, tb. aathors Choss to an.lyss mortslitq rather than the more conventional analysis of snrvival. In f.ct, it one analysea survival rather than nartality and treats the three groups separately, the results an oonftsry to those reported by the wthors. This suggests that wives of "cnrtent smokers" have longer survival rates than even wives of "former smokers" or "never stnokas." Thus, It Is quite probable that the results reported by Garland and his colleagues wers sienply an artifict ot the analyos. Having reviewed the work of Asonow and Hurschman and found it wanting, having considered the contribution of emironmentsl tobacco smoke to carbon aanoxdde and nicotine levels In the ambient air and fonnd It "insnlMent to prodace a pathophysblo;ic eltee%" and havias dismissed Garland's epidemiology aa "neither v.lid nor to the point," MarMb't wlysis was succinct. "In conclusion," he informed the NAS, "the available data fis7 to support eitba the actuality or the plambility of an adverse effect of environmental tobacco smoke on aardio.aeculat function In the nonsmoker." Hypersensitivity to Tobacco Smoke If science has consistently failed to demonstrate that such life•tbreatenin8 conditions as cancer, heart disease, emphysema and stroke ars caused or ezsaerbat.d by exposive to envirorrnental tobacco smoke, what about 1ta drastk Insults to health and bappinest, snch as aller=ia, hadsebe, scratchy throat, watery eyes? Here, at least, Is a set ot complaints and irritatioas that might be caused by relatively modest da.es of irritatin= or albr8wic pssa or partklss, among which ETS might plaumbly be counted. But here, too, the scientific evidence is scanty, and the potential impact of confounding variables and psychopnk factors is e..n aiore pronounced than in the csse of more substantial health eil.ev. Consider, for example, the theory that awspeop1• an "alleW to environmental tob.eeA smoke. In 1968, Spees evsluated 441 noatmolnrs who tsportad owalng and vasomotor rbWtis (runny nose) wbea eYpos.d to ETS."' Ha ooitdttdad that tkeit syenptoon were Ierritattn rather than allertk-that is, they .wrs not eumplea of what srJentyts eall "Iqrpsrwndthity'' ia which the expoee+d pason forms sp.cifie antibodies to a.p.dfie anti8sn Althongh there has been one ttndy to the cootrary,lu Its methodology snd oondushs have betu sp.dBcaDy criticized for their assumption that patients showin` a positive dda tsst to t.baeoa hd extract wen In fad allergic to tobacco smoke In the air.1" While Bedcer, t a1u ia 1976 did claim to lind tobacco antf`sn In smoke, aAd Indeed went .o far two years later as to suggest the possibility of some relationship between "tobacco aDerpr M.A 0114 1
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PROTECTED BY MINNESOTA TOBACCO L1TiGATION PR0T8CTIVE ORGSR ~ 1a and 54 husbands) whose eondition "was deIInitely or probably not relat.d to smoidAg.,• Detailed questions we» asked to characterw and qnaatily smoking (a) e:otrinty. (b) during the •y.at of I hospital admission and (c) mmciawa dutint LM whole of the marrian. In ab, th.» wen 47 ~ cases (15 maJe and 32 female) and 96 oanteola (30 mab and 66 female) for whom spauat mro data were available. Of the 143 aeea and oantrole~, apolu.l eetiohin< estia~abn were availablo b~ from the :pouse and the patient for 6! (61 peroeat), botA the spouse oaly for 55 (3i percent) and irom the patieat only tor 29 (20 pffoeat). Nine a6e•adjuat.d relativt risks of lunif cancer in relattod to spouaai smoking wern eak.~ulated (for males, females and combined cataEorta, tudaE patieat expown "tinsata, epowal atimatea, and atimatr based on both iourr.a), "Lo male patiaith, relative rieka wert Weresaed for tonte of the indiea," tae authors eoncluded, "bnt nambas of ea.es wan ana0 and aoot of the differences appro.eh.d statistical agnificanoe. In fenidN, where numbers of eaNS were larger, such trends aa e~cstsd teaded to be AeEative atd indead war+a adarEtnaily dsaiQrmtly negative (PtO5) for passive smoking during travel aad during loipua. For the combined atxa ao differences ~ or trends were atatiaically d`nilicant at the 95 paenit eonfid.aoe level; such trtnda as existed tending to be slightly negative." When Lee and colleaEues alculated the relative rLdc of developing lung eanoer in relation to estimates of spouaal smoking for the enti» period of the marria`s, it was 0.30 for th. sexes combined. In other words, the study suggestad that a nonsmoker anrried to a smoker was 20 percent less likely to develop lung- cancer, statiatiea]1y, than a nonsmoker married to a nonsmoker. "(P',auive smokin6," the authors oonc!udd, "was oot associated with risk of Inn` cancer among never smokers in our study." Assessing the Literature As valuable as the paper by Lee, " ia for the new, earelblly ooD.eted data It eoatains, it ia more noteworthy still for ita hldd, atentiIIally aphistioatad discussion of the litaratur» available through the summer of 1986. On the other hand, Dd.lity to the tdattlk method has not been uniform, and at lwt a few authors have, In varft deEreeq, a~ieeharacterisad the epidemiologle literature and the conclusions that an le=itiautely be drawn lRorn it The mischuacteriutiona generally biave been of two types. The llrst, and most egregious, involves using a study like Hirayaau't, Ignoring ita fatal vulnerability to misclasaifiation and bias, discounting the eriticism to which It has been wbjretad, and bestowing upon it a spurious validity beause of the large number of aubjeah surveyed. On one onwion, when this approach was csrried to extremea, and was combined with certain dmplistlc asmmpttoru, . it waa r.lied upon as support for a aontroversial "iatin+ats" to the tKiet that aome 6T00 hu~ aaneer dat?u per year among nonsmokers In t>se United Stater have been aus.d by anvi*ronm.ntal tobacco amoke.la This assertion has been vigorously and properly rebatt.d by atitiar who have concluded, aloag with Dr. P.R.J. Sareb of the University of Lseda„ that rneb admsta "amut be re~+d.d with the utmost euspidon."Ap The Ofiiee of Technology Aaaa~es~t of the U.S. Coa=rea, tae .xample, found the assumptions underlying the authors' oondusion that M annually eausa between 500 and 5000 daths "inappropriate."" An OTA Staff Paper eeitidsad the authors for, amon` other things, assuming- that the entire digerence between the lunE cancer death rate iA a group of nonwaokias Seventh Day Adventtds and in a group of nonsmoking (rm-3tveAth Dat Adventist) Southern Californians was attributable to panive aookft. Moetality rata for eaneers at other dtea are also lower In that Seventh Day Adventist populatioa, aad the exact V•. 11 .T,
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PROTECTED BY MINNESOTA T08ACC0 LtTIGATION PROTECTIVE ORDER , 40 Coaferenae an Oeenpatioaal Haalth ?tw" AlLetins Q.rieaUS.esetarld Peasan* At4ttta, Juty, 1981. 134. 3[eliua, J., et ai., "Indoor air qtulity-Z?a NIOSH ecpwienoe," Indoor Poqudol: Th. Ar• ehiteet'a Response, So Bmadtoo, No.amber, 1981. 135. Rhodes, W.W., "EpidewJoio8id ia.asdSseion: of ladoor air ooataminanN,'• Indoor Air Qual- ity Symposium, AlJanta, Odobee, 1986. 136. Robertion, C., "laveadistkts tise 'sdc ba3ldirg syndroau': ETS In eoatpct," Pra.a4tloa to the Committ.e on Paesive Smo13aS, Naeiorl Resfareh Cmmeil, Nattoeul Aeademy of Scieneea„ JanuarY 29, 198d. 137. Sterling, T.D. and Staft, E.M., "Ea.itoam.atal tobsm soaoke: Investigations on the di.ot of regulating enoldns on l.wla of Indoor popntion and oa the yareepdon ot health and eoinfort of olda warkers," 8'm I Rap Dit 66 (8aP81 188k 17•3Y„ 1984. 138. McFaddea, E.R Jr., Lnparello, T., L7om H.AL wd Bl..ek.r, Z., "T!u m.d~ oC adon of eautbn ia t6e iadnetton of sodte aetbma," PayrJlo.am Mod S1(Rx 134•43, 1969. 139. Aviado, D.M. and Selmidt. C.F., "Refiaea from .ereteb reeeptors ia blood wsels, beart and hings." PAysol R.n SS(2k ?.47•300, 1965. 140. Rwamel, R., et al., "?he phytiob8ial eti.ds of tnbalinS ahal.d d8arette anoke In :datioa to attitude of the aonemoka," J SeW Kia1fA 4S(9x 524•29, 1976. 141. Stone, J.D., Breidenbaeh, S.Z. and H.aitttra, N.W., "Anaoyane,e response of nonsmokers to cigarette :rnoke," Pn+upt Mot S1aZL 49: 907•16, 1979. 142. Sbor, RE. and WOGanu, D.C., "A bri.f enrvey of bdi.b abont t2u sfieeq of tobsao aeroke pollution on intdlecWal performance in college daveooms," Piyoiloi Rep 43: 1047•60, 1978. 143. Shor, R.E. and WiIIiama, D.C., "Reported phpiolo8ieal and piyebolo8ie.l symptoms of toa baoeo smoke poDution in nonanoldnt atndeats," PryeAot Rep 101: Z03•218, 1979. 144. Shor, RE., Williamt, D.C. aad Sbor, M.B., "An itnnstlSstion of reported symptoms and attitudes on tobaoco anoke pollution as a finet3oa of expositional eontuct, aaoldaB status, and gender," Addid Bdlav 6(4): 271•282, 1981. ' t .A 14 1
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER a u:~sitization to tobaao anoke e>ists'" ad that, on the otlur, p.yrholoEierl faeEora have been shown to play an important role in athnaw and it Orppdrstory phyaoloBy,M the peyehosocial aspects of "eensitivit/' to tobacco insol.ce mntt not be Ipnor.d. . Moreover, the intense eampaiEa by lhoae who would pzohibit stnoklns in public plaed-a eampeiEn eondueted in a hiEltily emotjonsl atanoaphere and replete with tmfonAded• alleSatloeui ehat, in the Nords of one, smokers an aomaaittint aot on1y "tlmmodoa tiiode" bnt "vo~r• modon murder"-fostan irrational teaes in otder to advanee a poStieal apndi With tbis esnipaip~ aa baekEr=d, it ia tapeaiaqy importaat to Invadgete the e+dationft between Aoe~anokas' attitudes toward and belieL about ETS and their phydoloBte reaction- to ETSexpo~u Whea Rnmrnel, ~,w did ju.t tbat, they fonud that college rtndents who "~" pnoke b d h!~ heart ratea aft.r eupornre thae~ those who wve daaified at "i~Ce~t." 8tooe, ~,~« 6sw oon!'.r:ned the Import;nae of pryc1tologicel !lactors in the "annoyaeee" enB.ndend afnonE e.eta;n nonamokers by ETS. And Shor, ",have pubUthed three papers nportint 1~ eorr.latlona between nonsmokers' aversion attttudes ind the inddenoe of thdr reported symptioou following exposure,1" "The focus on psychological fastors and their poeabli role In aendnB the environmental tobwoo smoke tymptom-complex does not i=nore the fiet," la- the opinion of Domingo Aviado, "that tobacco anoke under eatain extreme oondittons ew be offensive to the aormal nonsmoker."n Such "nonsmoker annoyana under theie eonditione," he notes, "doa not taean that anyone ia being harmed: rather, it means that tobaeoo smoke esn be a nuisana. Even given that such aondidons sometimes exist, It Is still dilQeuJt to explain edenttSeally why ee:saia nonsmokers react so violently to the prsaeaa of toba¢eo anokt." What c,a be concluded reienti!leaEy Is that the eomplaiMs voiced by some nonsmokers when exposd to tobacco smoke have not ban tborva to be based oa aIlerSie raettons, jnet as allegations that ETS can adversely atieet the health of nonamokers have not been proved. And what can be understood intnitively is that the eontinued proptSattoA of mftmded datmt that tobacco smoke oompromiua-even tliotly-the health of soamokas erfll only intooft the eusreAt cli- mate of emotionalism and impede the peoSrata of aeienttse inqniry. Conclusion Exposure to environmental tobaceo smoke hu not beea ahown to impair the respiratory or cardiovascular health of nonsmokiap adnlb or ehDdren, or to caarbate preexiMinS dissa:e in these groups, or to eause "aAergle" iymptoms on a phydoloSical basis. Studiea published to date in each of these areas are of widely varyini quality and tond to yt.ld inconsistent and oontradk:tory results, but two types of lbndamental delidendes an encountered with the Srtatest leequeney. The 5rst is the absence of adequate, qimtitfable, voeitlable mwaremenh of exporze and/or dose. The second Is the faffure adequatdy to take aoooant of ond to control for a wide variety of eo. and confounding .ariabies. ta parttalar, NAre reMareh must attend not only to diet and lifestyle, heredity and pryrholoEy but ala-and partlaiLrly-to the wide variety of eheminl, phy:ical and biolo`ieal eontamitMnta of the modan indoor eaviroament. A 0 ila9
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I PROTECTED BY MINNESOTA TOBACCO IITiGAT10N PROTECTtvE ORDER . 6/ 19. Snow. M., "Iastrtuneatatton," in CWauaen, J.L. (ed.a, Pv~ FwutioR Tatdnp G+ddetins. =d Controwreie• Equipnn; lilifAods end Nornml VaLuss; Acadernie Preas, pp. Z7-47, 1982. 20. Sarset, P.3L., at al., •,irlfect of maxdmal versus sobauvdaW e:piratory effort aa spirometsie values," RspinaNo+t 42: Z33-36, 1981. 21. Wler, ][.R, Grove, D.M. aad Pirwoclc, A.C., "Tfine domain spiroyram indiees: Their va:iaWty and reterenae vsluee in noeuoaohm" An Re. Rstpir Dv 182 1041-lS, 1985. 22. bfiller. M.R, Pinaoek, A.C. and Grove, DX„ "Pateiau. of epiroraas abnosmality iA individual smokers," Am Ra Rsapir D+6 182: 103440, 1985. 23. Fletshe:, C.M., at al., ?71e Noew+al X+itorlt of 1,hroide Brondt+tu end B+apJtysema, Oxford Uoivertity Pras, 1976. 24. Bnist, A.S. and Dueic, S., "Saaldne: Evaluda of sqdier whiob bave demmsbat.d puly mona:y lhaetton ehanBe.," la l[adlem, P.T. emd Permact, S. (eds.), T71. Lmp in tJte ?'ran- atim Bstwern RaltA o,nd Diara., Ma:od Deldces, 1979. 25. Bates, D.V., "Zbe tsts of the chronie beoncMtic A report of the ten•yest follow up ia the Canadian Departrr,ent of Vettraas Aitairs ooordinated study of chronic broncbitis," Am Rev Retpir Dit 108: 1043-6b, 1973. 26. Johnston, R.N., et al., "Chronic broaebitis: Mess,aeenenta and observations over 10 yean; • Thoras 31: 25-29, 1976. 27. McFadden, E.1i. arid Inyram, R.H., "Cliaieal application and interpretation of airway pbYsi- oloBY," in Nadel, J.A. (ed.), PJgttioloyy ad Paarrnaeobpy qj tJke Ai:+oayi, Marcel Dekker, pp. 297•325, 1980. 28. Berend. N. and TAuribeck, W.M., "Correlstions of maximum expiestory flow with small airway dimensions and patholoQr," J Appi PAyiioi S2: 346.51, 198Z. 29. Meadows, J.A., et al., "Density dependence of ma:dnW expiratory flow in chronic obstructive pulmonary disease," Am Rsn Rapis Die 121: 47•5S, 1980. 30. Mink, S.N. and Wood, L.D.H., "How does HeO, inereasa maximum expiratory flow In buman lunBsY" J Ctin Inroest 66: 720•29, 1980. 31. Beus, M.L., et s1., "Hssuds of asiny FEFs„ as Indicator of obstructive luny diseas.:" An Rev Reapir Dit 123(part 2r 102 (abst.), 1981. 32. Nagsi, A., et al., `Tbe National Innitutes of Heakb iutumittent po:itive•presare bresthin` , trial: PatholoBY studies, II: Correlation between morphologic liadin8s, clinical findings, and evidence of expiratory s,ir-flo.v obstruetion," An Rapsr Die 13Z: 94643, 1985. 33. Cosio, M.G., at aL, "The relations between stsvotursl changes In staall airways and pnlmoaaty i 19??. " N a'noi J Adid Z98: 1Z77411 function tesN , , i 34. Nemery, G., et al., "Signifiesnoe of ana11 airway tab In middle`aEed smokers," Am Rev Reepir D+a 124: 28?aA 1981. , : , 35. Tattess.ll„ S.F., at a1., "Tbe n.e of tew of peripberd luaE function for prediIinf lbtnre : disability frm airflow obstaruetion tu middltsBed saakan," Am Rev Raqir Die 118: I035• Ln i 50,19r8. W : ~ 36. Lebowits, M.D., Letter to Chairman, Suboommitt.e on Tobaem aod Pe.oate, Honse of Rep- resentatives, Congressional Record, pp. E52di3-54. December 16, 1982. ~ NA 114
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTiVE OROER U 37. KsuA~nann, F., et al., "Adult p.edw onoldnF in tM bofne anirown.nt A risk factor tot cbronia air!!ow limitadon," An 1 EpWOM+ot 117: 269•80, 1983. . 38. Brunekteef, B., et ai.. •'Indoor air pollution and itb elleet on pulmonary !lmctton of adult nonsmoldnE aromen: III. Pseeive anoldnE And puimoaary ftaion," Int+rnat J E ~~ 14: 227J0, 1985. P' 39. Remq"n, B., et s1., "Indoor eir pollution end its etl.et on puimonary llmclioa of adult aons- mokin8 women: I. Exposure atimates for nitro8ra diaodde and passive smokiaE," IstsrRat J Ep+demiol 14: 216-20, 1985. 40. Fiiher, P., et ai., "Indoor air pollution and Its eEed on pulmoniry hractioA of adult aons• mokinp women: II. Associations between aitrogn dioxide aad pulmonary functioo," Inerraat J Epidemiol 14: 221•2Q, 1985. 41. Lebowits, M.D., "The effects of ea.i:onmeAtd tobaeao tmoke e:poaure and gas stoves on daity peak flow rate3 In ssthtnatk and taoetedbmstie fanu1ie:,'• Etir 1 Reepir Dv 66 (SuppL 133k 90•97, 1984a. 42. Lebowit:, M.D., "Influence of passive smoking on pulmonary lhnction: A survey," Prw Med 13: 64S•5S, 1984b. , 43. Lebowits, M.D., et al., "Respiratory iymptoms and peak flow astoeiated with indoor and outdoor air pollutants in the Southwett," JAPCA 35: 1154•58, 1985. 44. Pimrn, P.E., et ai., "Physolot ic e8eeh of atut* pwdve exponut to dparette smoke," Arch Environ XattA 33: 201•13, 1978. 4S. Shepherd, R.J., et a1., "Passive expaure of asthmatic subjects to ai8atette smoke," Zrniran Rst 20: 392.i02, 1979. 46. Wiedemann, H., et al., "Acute effeett of psudve mnokdni on lung ibnetion and airway ewac• tivity in aatbmstic subjects," CAat Oft 1W85. 1986. 47. Dahms, T.E., et aL, "Passive smoldnr. Fffeata on bronchial esthtna," Akat 80: 63a34, 1981. 48. Knight, A. and Breslin, A.B., "Pwive cigarette smoking and patients with atthtns," 11fed J Arutrol 142: 194•95, 1985. 49. Godfrey, S. and Silverman, M., "DunonstratioR of pLeebo response in asthma by means of exercise testing," J Prydlosora Ree 17: 293•9T, 1973. 50. McFadden, E.R., et al., "The mechanism of action of wmstion in the induetion of acute asthma attacks," Piyrhosorn Med 31: 134•43; 1969. S1. Smith, M.M., et el., "Increase and d.creaee in pulmonary raistancr with bypootk suggestion in asttuna," Am Rn R.epir Dii 109: ts6-42, 1970. 52. Lefcoe, N., "Passivo tmoktnS: Aarto effeeto In saduW" CAre 3M 16142, febeovy, 1986• 53. Hininr, M., "Ctitial eoview of the relstioeubip between pwhe expoe~w to eiprett. anoke and cardiopnimonary diw..," In Gammage, LB., at al. (odt.j lsdoor Air and tTisom RealtA„ Lewis Publishers, pp. W•56, 1985. 54. Lee, P.N., Chansberlain, J. and Aldereon, M.R., "Relatlomblp of padw stnokinS to risk of lung cancer and other amokinE•aaaoeist.d diou " Br J Canar, 64: 9'f•105, 198d. 55. U.S. Public Health Service, Reportc WorlraAop on Retpir+atory E,Q'eete of InvobaMevy Smalr+ Espoeure: Epidnniolop+e Studies, U.S. Departna.nt of Hakb and 8uum Services, Deotmbes 1983. A 114
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PROTECTED BY IIAINNESOTA TOBACCO UMGATION PROTECTIVE ORDER S7 76. CoDey, J.RT., et e1., "Intluaia ot pmi.a w4okint and paMW pM%m an pneumonia and bronchitis in early du7dhood." Laut 2: 103134, 1974. • 77. Aulap, S. and Daviet, A.31., "Iaf.at OdIniNione to baepltd aad materaal anoldnt" Lmu~t . 1: 629032, 1974. 78. Weiee, S.T., et al., "Perasunt wbeese: Its relstbo to reepi" 91nese, dtarettt mokint end level ot pulaaoaaty Amcdon in a populatioa eaaApie of ch8dten," An Rev Rsepir Dis 122: 697•707, 1980. 79. i.eede:, S.R, et e1., "Influenee of taa* tasto» on tlu ioddeace of bwer eetpiratorry iUAees dwrint the llsst y.ar of Bie," Brit J Pm Soe M.d a0: Z0S.1Z, 19T6br 80. Leeder, S.R, et ai.. "Rapiratosy eymptm prvdenos In addde ?he aomp.rstiVe importsnce of eaoldnt and fwXy feat4rs," Aes J&pidmiot 105(6)c 5aW 19T1. 81. WanF, Y.C., Beard:more, C.S. aad $IIverinuo, Y., "Ptdmooety t.que]8e of aeonatal respi. ratory disQw in ve:y low birth weight iataate; A ebksi md pbydoio8ieal etudy," As& Dia G7lild 57: 418-24 (19M 82. Holma, B. eeid QVlndiny, 0., "8oudbM byglene, ead MeltA: A thuiy in old reeidential areas in Copenhs8ea," AreJl Snviron XealtA 32: 86-9$, 1977. 83. Mandi, A., et d., "Relationship between lmB lhtudon vsiw= and sir pollueion dats In Budapest tchool children," P'ntwnoaoloyie 160: Z17•25S (1974). 84. Cansaeho, E.J., Colomer, P.R. and Betorst, J.L.D., "Pulmoeury rytnptow and pdmonary " lSusctional tate awmE children iA relation to tbe ares of t+addence," Sur J Re:p Dia 63: 163•66, 1982. 85. Koeeo.e, D., et al., "Srnoke•lSlled rooiru and lorves re:piratoey dhaw in iniaAh,•• S Afr hfsd J 61: 621•24, 1982. 86. Fortrnsrker, S.L., et .1., "Parental aaokiat and the ridc od childhood a:thma," Ara J PVbl XealtA 72: 274•78, 1982. 87. Roncbetti, R., et d., "Wluenu di fattod tami8ari *' ambienteli euqa prevalensa dena sindrorru ismatica e della sindrome bronchitics del bambino (Sludio epidetalologlco eu 2600 seolari Romani)," Riv ltal Pod 8:166•66, 1982. 88. Kerrebijn, K.F., Hooaeveen-Schroot, &C.A. and nA de: Wil, M.C., "Chronic non:pecitic ; rapiratory diseaee In clL7dren: A llve year foDow•up study," Aeta Pordiat Sowsd 261: 149, j 1977. I 89. Scbenker, M.B., Saaut, J.Dd. and Spdees, F.E., "Risk iedoee for ddtd?ioad re:pirstory diteate: The effect oi host i.ators aAd boaae en*omm.ntd sqaew " An Rnr Rap Dis 128: 1038- 43, 1983. 90. Aronow, W.S., "Eltaet oi peaair" aaoldas on aMiaa ped+oeb," N iSyl J Yrd s99: Zl•24, i 1978. 91. Aronow, W.9A and LbeO, Y.W., "Carbon tnon"de effect oa eserdee•iAdnad en8ina pectorde," Ann tstsrn 1Krd 79: 892•96, 1975. 92. Aronow, W.3., et al., "Effect ot davette anoklA` wA beeathing carbon monoside on ear- dioveeeulae hemodynemia In w4itul patfenta„" COee;lation 601 a40-47, 1974. 93. Mintz, ll[., "FDA, citing phony eyidtnce, bens dV tsst by neearobet," TAe WQaJ,inpeon Poet, ldarch 23, 1983. 114935 XNAT
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER 0 36 94. Peter.oa, C., "EPA probe aitidw a nndy used to air qodty aUdard," TA. WaaAir4flon Post, June 7, 1983. 95. Budiansky, S., "Da4 bWQation: Food aad druB dsts lhd8.d," Natw+r 30Z: 560, 1983. .96. Aronow, W.S., st &L, "Efiect of freeway trs.t1 on an8ina peetorfr," Ann Iatem Aled 77: 699•706, 1972. 97. Sehierelbein, G. and Richtsr, F.. "Z9u bmuseum of passive ynt~em," Pr+e. adrd 13: 62644, 1984. smoking on the eard3avarcular 98. 8uracbman, L.G., st al., "The implioations of siddtrwn d8arette smoke for eatdio.aaaAar health," J Bneim Xea1N 41: 145d9, 1978. 99. BddB., D.P. aad Corn, M„ "Conbbatloa to the awssmene of exposnre of nonsmokers to air pollution irotn dpretsa .nd dZat anoka in ooeupi.d plaas," Z'rwiron Ra 5:192-209, 1971 100. U.S. Environmental Prot.d.ton Agency, Air Qvalft Criter+s fo. CarboR Monorids, EPA, - 1979. 101. Ryfander, R. and Vset.rlund, J., "Carbon monadde erlteria," Seend J Work Enviro+i lsteolth 7 Suppl, 1,-39, 198L 102. World Health Orpnitstion, and the UN EnvIronmsntal ProBrunme, Environmsntai lYatN Crsta,ia 1J: Carbon Mo~oside, 1979. 103. Nstional Academy of Soence. • National Reiearcb Comidl. Atedieal and Biolopie Sfats qf Enaronmsntal PollutanM: Carbo+i Afonaatida, waaMnEtoa, 1979. 104. Cole, P.V., "Comparatiw effects of aemo.pA.rk poDution and dgar.ttft smoldng on nrbox- yHemoslobiA levels !n me%" Naeurn 2$5: 699•701, 1976. 105. Srndowild, D., st al., "Body burden of earbon monwdds from pasdve smoking In o!lkes,'• Ind M.d 3: 310•13, 1976. 106. ObhaAsky, SJ., "Is anoker/nonsmoker segregation effie!{w In redudnE paesive itdalation among nonsmokers?" Am J Ptiblie Xeo1tA 72M 73739, 1982. 107. RusaeU, M.A.H. and Feyerabeed, C.. "Blood and urinary nieodne in nonsmokers," Laaut 1: 179•81, 1975. 108. Turino, G.M., "Effect of oarbon mono3dde on the c.edbrapiratory :ystem," Cir=ation 63: 253A•59A, 1981. 109. Garland, C., ec a1., "Efieata of passive unoldnt oee iechwnia l+.art ditwe aartelity of nonsmokers - A prospeethe .lndy," Ae# J apidowie! 1M 645•50, 1986. 110. SpNr, F., "Tobaeoo and tbe nonatuok.r;' ArrA Bleefran BesiN 16: d43-46, 1968. 111. Zusunan, B.3it., "ZbOaoeo anddritr itW dre a1lasEk paWnt," Ara AWrOY 2S: 371•77, 1910. 112. Taylor, G., "Tobsaoo imoke v1er8Y • Doa It ea3sCY' Seond J Rw Dis (Supp.) 91: 60•65, 1974. 113. Becker, C.G., Dnbin, T. and Wiedemann, H.P., "lirpaseneitivley to tobseoo anttpn," Proa Nat Aced U TS: 171Z16, 1976. 114. Becker, C.G., and Dubin, T., "Tobaooo aIlaBy and eadioraseular dlsast," Cardiowe 11[ed 3: 851•54, 1978. I
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PROTECTED 8Y M1NNE50TA TOBACCO LITIGATION PROTECTIVE ORDER 29 blood preseure and hesrt rate among aonsmolnrt expotad to ETS when compared to imokera, Tbe authors zuerted that the differences were "iiBMcant" at a"p" value of less than 10, which is meaninaless statistically. In addition. the dsirMd diL'erences, if real, wese diniaally hwiEnifIcsnt By contrast, well-ccaduc4d satdies reported by Schievelbein aod ItMte:" In 1934. iA which subjects were expoeed to ETS for much kW, and to hishes levels of arboa monwdde, showed no eKat on heart rate or blood pe~eaNr.. As poorly designed and exaaited as th. Aroaow and Ruruhmsn stydies were, they serve as good illustrstione of primitive attempts to quan* exposure to ETS by means of biological enarken. AhhouBh-sa the next chapter wQ1 i>butate-earbon monoxdde and oiwttne ers far from idesl in this re;ard (the foramr bocww It is not sad9e to ETS and tlu latter because It Is excreted from the body so rapid)y), the ideeiae of ETS, and proof of any health ei'leets i}+om exposure to it, cannot manin8ib11y advatien untit an aomsta quantitati.e marker of exposure Is found. With that in mind, it Is neverthdees uaN to review what IS lano•aa about CO arid nieotine, since it has been suggested that tbese substances may play some role In any ardovaeeular effects ETS r.-iy have. Federal ambient air qnvity standards for carbon moAoxide we 36 ppm(paM per million) for 1 hour and 9 ppm (wei8fit.d anrajs per hovr) for a bonrs. Bridge and Corn» . have demonstrated that CO concentrations generated by tmaidn; In occupied spaces we generally leea than 10 ppm and do not present a bazatd to Aon:mokers. Bastd upon miaul studies aad human observation, responsible authoritta have concluded that the general population should be protected from exposure to carbon monoxide that would nsult In blood carboxyhenao8lobin levels of 5 percent or mor..lm~m When levels of earboxrhemodobio wen meaaursd iu noaeaakinE offics personnel who worked ei8ht,houn eaeh day with ar~oldnE colleagues, concentrations averaged 1.12 percent in one iwdy,M+ and oonsartently le,es than 1 percent In another."6 SupplemendnE these results Is a nndy by Obhanslq,"I suggesting that In real 8fe sitnatiotu a three•hour expoaure to ETS incresas carboxyb.mo8lobin concentrations oo moro than 0.5 to 0.8 percent, and the work of Russell aAd Feyrrabend,w who noted that when aansnoken were exposed to ETS in an unventilated rom platma niaotlne Increased only modestly. (By contraat urinary niootine incraseed efaht•fold, the rapid excrelion probably aeeamtint for tbe. tran:ient and limited physiologic effects obeernd.) In short, the evidence eunsts strongly that the carbon monoxide and nieotin. In environmental tob:cco emoke do not give rise to substantially incressed levels of these substances In nonunokus' blood. When compared with the relatively dramatic Increase In wromokas' carboxyhemoslobia reported by Hurachman, ~(1.5 perant follo•ria; a 0.25 hou~ sxposurs to 20 ppm of earbon mono~dde, roughly ten ttmea the predictad bwseaw),w Huras9Jman's report Joina Arono+.'s In the realm of the utterly implandble and m.tbodoto8ially 09" . >ltirthermore, evew ii levels of carboxyhemo8lobin or suum nicodne wero elevated subatsat3ally fa 000umokas eheof1inDy eac posed to eiprette smok., It remains the eaM, a. Sddmnllbeia and Rtehtu hav. pointed oat, t6at animal etndiea hav. fatled to dea+oastrate that either of these subst>aaa cram caedbvasclar di3eaee." One recent epideraiolo8te study that lma received aotidd.rabte pabBdty stt11 mnst be oosuidered. Garland, "m exsmined death rates of aoArmoldtg women ~oen hehemk h.art dseaee, e1a& :ifyfnE them, according to their huebatfda' self•repoeted smoldtK statnt, as "never ainoked," "former anoker" and "current aAOkes." Expoaure was not v.rilfed, and ao dats ws» provided on the duration of spousal smoking or actaal anoldnE expoav. io the home. Crndal variablea relative to eardiovaacilar disswe such a; di.t, ltfestyl., mcerdse, Mcutrent diaeasa (sucb at diabetes) and 8enetic factors were not oaaaidaed The autbors were unable to demonstrste a A 11a
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I : PROTECTED BY MINNESOTA TOBACCO 11T1GATION PROTE=VB OROER 14 exposure continues to resist solution. They a!a aonam moeeover, that tbe epideaiclogic ineLhod has not definitively provea. or destitinly put to rest, the notion that ETS nat.r, or is- auooiat•ed with, lung canoer in nonsmokers. In fact, tbe results remain what tbey were in the beginning: canflietinE and inaonc]usive. T'u )steat "positive" study ia the aw-Notroi report of Gargak.1 (Garftkd II), the sawe Americsn Cancer 8aaety io.atl6stor whok prospeetirq study Sve yan a`o (Gerftkd I) a ettectively ntut.d HIrayarr& Having ideoti!!ed 134 Dooonoldg woenen with IunE esncer, CarQqkd took pains to avoid some mistakeu ot the past. Smoking status .vaa verified by "blinded" inter. viewen who did not know whether they we:. IziterviewiAg a eaim or a oontrd. Tumors w.re histologically eonfumed Independently at those eoodncsinE the stvdy. And efforts were made to ~ ver.fy ETS expomre through multiple iaterdews. 8aause of the an taken in GerQakd II we oow hsn aqUAtitative m.awre of tbe Imptet of miulaaiikation (of anokinE statna 'iad lnmor VW aad of respondent bi,t. We know, for example, thaat ETS axpoaure utimates by eaAaz rktifns' ddsdrea may result In a tAree•fold increase in odds ratios. We therefore eia eay, with more ea#ainty than befors, that !w riEoroua etudiea must be Interpreted with the utmost cautloo. Bnt for s11 bi: etiort, Garltaltd was powerless to eliminate completely the biases to which ctiaaoatrol andlet ars subject, or to coeitroi for all importint confounding factors, or to quaatifp exposure to EZ'3 with subst;ntialiy more precision than other epidernioloQie sadia have arbieved. • Not surprisingly, therefore, Garlfnk.l'e most reant report contains major inoonsiateada. -A statistically d"cant dose•responae relationship was noted when the data wen anslyzod eo• cording to the number of cigarettes anoksd per day by the hwband, whatber, tbat amber represented ci6arett.s smoked entirely at home or the total number tmokedp~s day. Many cstr6ory•by~ate6ory calculations of odds rstioo w.re gQ~ rtselattdly si6niQomt In addition, the study contained a cru¢ial lSadia` When the data were atvly:.d acoording to the total nwnber of hours per day of ETS expoaure, either over tbe Lat five years or over the la.t 2S years, there was no relationship at all between ETS exposure and bmt cancer. The most recent ease•eontrol study to be published, a report by Lee, jL,1.,M in the rm Journal of Caneer, shows a similar sensitivity to metbodolgical ooaeerns, upecialUr in the area of expo:ure aaseasenent. Lee and eoUe.tues intervlewed 12,693 patients orerall, of whom 3,832 were married cases and controls who completed a detaDedqws tionnain wbile iA the hospital. The details contained in that questionnaire coAtrs:ted aurludly with the erude I:utru:aent relied upon by Hirayaau and, Indeed, with many r.li.d upon eitw (Pjatienta wers.asked when the nuarriaEe started; ti and when it bad eaded; the awnnber of msnutacbAred cigarettes per day s;noked by the ipoute both during the last 12 months of marriage aAd also at tbe period of ouidmum anoldnE during the warriage; and whether the eponse ever regularly onoked ban&roD.d dsarettet, djart or a pipe during the marriai.. For second or wtbe.qwat aaaniagr, qneal-- t rdated to tAt lirit marrta`e to give the longest lateat inNrvv bitweea exporm+e and disw" owet. Tbe patients wtrs an a" to quaaft, aooor~ft to a foarloiat eeate (a lot, average, a little, aot at all), the extaAt to whirL they were regularly exposed to tobaoero smola bom other people prior to ¢oaJtg Into the boepibl in 4 dtustloes: at Aoae; at work; during dailyy travel; during leisuts ti.+e. In the m.in queKiomuire, detaDed questions were a:lced on urakio` habits and on a whole range of poUdble ooutonadin= rariabla. Follow-up interviews of the spouses of the 66 n+atr{ed bmE esnoer ea=et wbo were IdentiAed during their hospital stay as being lifelong twaano8en were attempeed. Suoea.thl inhorvl.ewo were obtained from spouses of 34 assea (10 wives anid 24 bwbands) and 30 controls (26 wiva A 114 I i
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PFiOTECTgD sY MINNESOTA TOBACCO UTIGATION PROTECTIYE OROER 10 38. Mdius, J., .t al., "Indoor Air Qnaitr-'Tbs NIOSH Experi.nn," Ann Am Cw Ca lud SPP 10: 30, 1984. . 37. Mo:ey, P., "Air poUution ia tb. ;rat tadoon," StaN LePiitotww, July/AagnA 1956, p. 3S, ..,.~.~~-.. ..........~..~~.. ~.-..-~r-•--~- -• - ~ . , . r
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PROTECTED SY MINNESOTA T06ACC0 lR1GAT10N PROTgCTIVE OROER so 115. Stedmm, R.L., "F.lliot of Smoking on Nomaokeri," 3tacemeat betore the Subooramitt,e oa Tobacco, Committee on Asricaltat, U.S. Home of R.preaeatsttva, Septembe:, 7, 1978. 116. McDougall, J.C. and Gleiek G.J., "Tob.coo eJ1aU-Fset or feacyY' J Allerplr Ctix h+aimol 57: 237, 1976. 117. Becker, C.B., Van 8al none, N wd W.Ener, yt., "Tobaoco, ooeos, coffee and ra6weed: Cro6.w reacting allergens tbst sctivste leetoaxll-depead.at paNwaye," Blood (S) 6a: a61-d7, 1981. 118. Salvaeo, J.E., Cavanau6hr J.J.A., Lo..eQ F.C. and L.dcoait:, s., "A oofnpexeon oi the immunolo6ic responses of normal and atopio individnale to intrenmBy edmWetwed ,eatigen,•" I ANrr9Y 35(1): 6249, 1964. - 119. Lebrer, 9.8., Barbsadt, F., Tyrbr, J.P. snd S:lvsgla, J.E., "Tob.o¢o anoke 'sensitivity- Ia th.re an ienasonoloEia beeist" J AU.rDy CKw hwmol ?3(Z): Z{0.46, 19a4. 120. Lehrer, S.B., McCants, ]L, Anb~:t, LL aud Silagglo, 7aM "Analyds of tobsew leai allergens by crowd re~ntauaatt~opborut," Qex Alier+yy 16: 8M1, 19Sb. 121. MeNaD, P.E., "Indoor air quaBt7: A s4tns report," A3NRAS Jownal, Jntu 1986, pp. 39- 48. 122. Yoasas, J.E., "Indoor-outdoor eir quality rdationsktpe: A critical revi..r," J A4r Pollution Contr Auoe 32(Sj: 500-2C, 1982. 123. Balter, N.J. and Cas/arsnovs, V., "Enviroamaital tobse:co smok~ The coAtributlon to indoor air poUution," Preeentation to the Coauntttee on Pasehre SmokiaE, National Rawcb Council, National Academy of Sdetues, January 29, 1936. 124. Iabowitz, M.D., "Health effects of indoor pollutants," Axn R.. Pubiie X.altk 4: 203-21, 1983. 125. U.S. Environmental Protection Agenry, ?7te Xfods qf flonv Yentilation Syetat on Indoor Radon-Da*Nr Leaeia, October, 1978. 126. Morey, P.R. and Ruadere, LE., Proaedino of W T1lird latereational CoWffeaer on indoor Air Quality and Ctimats, Stockkobn, Sweden, August 20•24, 1984, Volume 3, pp. Z47-S2. 127. Morey, P.R., "MIcroldal sources of indoor sir contaeninanta, " Indoor Air Quality Symposium, Atlanta. GeorEia, October, 1985. 128. Gupts, K.C., Ulsamer, A.G. and Preuts, P.W., "Formaldehyde In indoor air. Sources and to3dcity," Enviran lat 8(1-4849•6S, 198Z. 129. Morris, RH., "Indoor sir poltutton: Alrborae viruss and becte:is6" fleatir#?4piWAsr Con. ditioning, February, 1956, pp. W4i. 130. Mslis, et el., "Aesodatioa between Bas cooking and reepiratory disease in eldtdren," Br alod JZ149,197Z 131. Mouhandnue, D.J. and Reator, 8.a., "Indoor rsdoa coaaatrstbn.," ZxWm lat 6:77-s2, 1932. 132. Runders, R and Morey, P.R., "EVAC system operational panua.tert aCect airborae ltimEal levels In oacnpfed rpeas," ?7kird lataaatioaal Co+Vaena on hdoor Air Quality and Clinwts, Storlcbolm, Sweden, August ?3,, 19E4. 133. M.eeite, J. and Baka, D.B., "0cenpational beallth probleau In ofik.e-a ndand bac," and Keenlyiide, li.A., '•Rec.at NIOSH indoor air qadity, tn.eWEatia= An ov.rrlew," NIOSH A 0114960
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PROTECTEO BY IIAINNESOTATOBACCO UT1GATtON PROTECTIVE OROER control and anoke expoaure aould have fn~d the ruuits. Iemdeqnate inforrnstion n theu ststistial analysis also oontrsbut.a to largely uninterpretable rewltr.", In shaep E Shepherd's results (Ending no adverse eSeeta) are moet notable in .iew of bis iroup'a attention to random order of control and etperimental espaenree and the eWe e: tensi.e pulmonary function teWnf Despite the fact tbst tbe atudy in.olwd aqlddeat smoke exposure to asuae mfld oye irrk.doo In nine of 14 abjKh, and deapite the adstuue of a negsttve attitnde toward dt arette a:aldnt rer.abd prior to thA ttady by .e.eral subj.cts, no advesaa elfect of M on aatbma symptomology was demon- •trated Thoae comments apply with eren mare fora to the tnetladobgtesIIy arsupuloua etody by Wiedemsnn and his colleagues at Yale, .dhdeh was onarailab1, at the time Witoescb made his preaentuion to the National Aademy o` adeaoea. For e+r.n it jta sioaatioa that vcpoaue to E'PS might have cauaed a dight "am.lloebiadoa of the uadatyWg aSbnna" in tbe dndy'a mbJ.eta was prompted by a mere ttatiatied art3taet, the antbora' eonehWim "tbat dSarette smoldn` preaeriaedl no acute respiratory riak"18 to tboae s*eob war aud oatsnt with the beat data previoualy a.ailable. It waa inoondstent, oourae, as t6e a~ooompanyinS editorial in hQjW pointed out, with the "political point of Ke." ot th. "eur»nt mo~smsnt tor emoke•free environments."w ETS and Chronic Obstrnctl.e Pulmonm Disease Tbe facts about the role, it any, of environmental tobacco anoke in awdnE or exacerbaag' emphysema or chronic bronehitia are extraotdtnari]y few. Here again, of courae, aAecdotat npor4 on both sides of the iawe a» leoon. But the natural history of snrb disewa, collecl3vely referred to as chronic obstructive pulmonar7 dLeaae (COPD) or chronic obstructive IunE dirw (COLD), is so variable, their causes so multitactorial, and even tAdr patbophyeiology aad elininl diapoau sometimes so poorly desned, that much of the Ilterature on the eubj.ct Is alrmat hopelessly problematic In 1983, Higgtns" contributed a duapter to avolune on iAdoor air pollution In whic6 she reported that despite a diligent search ahe bad been uAable to identity a aingle reasonable ademtitk study directly addressing the issue of ETS and COPD. The 1906 eaw-oontrol atudy of Iwe, jj aV did, however, include chronic bronchitis amon< Its four "indeoc disgnaes," along with lung cancer, ischemic heart disase'and atroke. It attempted to oorrelate each Index diatno.i: with an estimate of exposure to ETS ae assessed by a detailed, rigorously applied atandatd! qu.s- tionruire that was validated whenever poaaible. For both was eoasbined, "the relative iisk In relation to the apouse amokin` during tbe whole of the marriage was 0.E3 for chronic bronchitis .." No significant relattonahip between aM of aerenl eat,1imatea at ETS exposure to rialc of chronic bronchitis was tound. Tbe atudy by Les,~,~, ~ta tM atndp ot Wiedenune,~~,, appeared aRer Iliijtacac>s bad preaeAted his crittque ot tbe pnbtbhed reMaseD oti bT3 aod the reepiratory tyst,ta to the NAS. If thoae reports bad beea ava~abie ia timr toe inrludan, it is poeaible tbat his remarb to the Academy would baw been e.ea .ftot4a tlua tbey wam In =a, carelul revisw and malydt of the pertineat adenttac lheratim lead to the conclusion that the availabb data do not support tbe oonteation that apoame to en- , vironmenhl tobaerx anoke ew.a oe exacerbatea pnlmonaep dyftwdo4 o: respirstory diaease in adulta, at least not on a pbydoloQie or toodeologic bads. Zbat eonduston ts aonsistent with the consensus of adwtiAe o aa ncpr.wd by a 1953 National Irutitutea of Health Workahop, which oonclu •"A rerlew of the data from atudies t ~ A 114
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1. PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTIVE OROER 31 and ardiovaswiar disease,"M it was not 104 betore the validity of such ooMUSIotm was uad dermined by other imrestiQators and, to an important dedree, by the Iater work ol8ecker hitnta Stedman, for example, aoted thst the authors had nMd a laboratory technique tbat had iatro- duced a"wbetantiai artifut" into materials that wera then used is biological t.ete.ul MeDonpll and Gleich,11• in tests of 30 subjeW wM histories ot aD o-~ o symptoms an w to tobacco smoke, failed to Snd ~ edda~ee of antlboiee ~breo wnolaD.r~~ ~( 'alto found no correlation between the results of dda te.t~ with tobaom antigen and tb. ooeorrake of syrnptoms.) And in some of their more r.orat work, Bedcer and his coworkers have reported that the tobacco giyaoprotaia tlut lbey wepect.d ef andns .ll.egie responses In ("atopie') subjects it present in many dtKirent .e~stabb pe~,In Their IIadi~ ~ possibility tbat "eensitivity" to tobacco saake is in 64 the resak of "erossrsetivity" to aatt~ found, for example, in aofiee, ooeos aAd ra~r..d. B.aow It i& w.II known that atopae tadi.idqals tend to develop antibodiea against a wide raotr at oo~nrnoa eavironmeatal ant3Eent,M the exirtetice of eliaieany relevant allergic reactions to tob.oeo smoke per se hse not been uhatifiatnyy eatab• lish.d. Two recently published reports by Lehrer, using eucb etate-of•tbe•art tnvqtigative tools as immunodiiIUsion, erossed imMUn oelectrophoeesie, and crossed radioimmuaodectropboresis, concluded that Immunologic reactivity to tobatm imoke and tobaooo lat antigens did not oorselats with clinica! "seasitivity" to nnoke. yi/heA atopic and oonatopie subjects ws» exposed to a number of tobaeco-related anttgene, there was no correlation between "smoke w»itivity" and either the incidence or the intensity of skin test respotws, antibody production or other eopList£ated mear ures of immunologic reactivity. In ehott, there was ia thas ttudia, tad there is in tke llterstEre as a whole, no evidence that genuine "allergy" Is a factor In the "sensitivity" to tobea~o smoke that some subjects report. In extraordinarily high eenoentntioru, perbape, such as might be acpected in seaatl, mveatilated or poorly ventilated spaces containing many emokes, tobaaoo s3oolu 1Dce my product of oora- bustion may csuee some irritation to sofne individuals. Bat to adca.owledp tbat Is to aclasowiedte the obvious, and is certainly not to ooeeJude that atqr Individual "tensithe" to smoke in sneb a circumstsna is, In the medical sense, "hyperseadtin" a.e., dergieYto tobaooo smoke. In fsct, it is usually the case that in poorly veatilated environmentt, tha tbreat to comfort-and sotnetinaes to health-ta not the tobacco anoke but the faadeqnate ventilation tbat has permitted not only smoke, but a host of more serious lAdoor pollutants, to aotnmulate. The crucial point is this: ETS Is but one of many potential sonraa of indoor air pobutioa.u" ~ Especially in today's enargy-efddent "tight" buildtngs„ poorly designed and operated ventilatton systems msy result in an areutnaiatioA of a.Mde vadety of plrieal, ebemical and biolodk contamirunts that may cause irritation or ltan mon serious balfk ooateqaenas.06-UP Among these contaminants are miesobes and.theh spores, dusts and aniaetd fibers, nrbon moaoadde, carbon dio3dde, oxides of edtrom4adoei, toetnaldeblyde atd abng ~_t ot Molatile or~anie ~em~ ic.1s: ~"= Indeed, tw.nl qstenude e~ina!loas of the "tl~6t battdi~ syadrome tn .arioya workplaces have d.monshsted that aomplaiat. o!!ea sttirlba0ed at ArR to L'TS-au]i aa b..darht6 nauw, coughing and eye frritatj.oa-ate in q*mdma* 03 percent of reported caees tbe result of eacposure to one or another of these otber, l.a vidbi., pollutants of Indoor air.*m Why, theA, do Aonenokerr' aomplaints, when they omnr, loQU so often on tobaoeo smoke? In part, no doubt, because iew oonetituents of iDdooe air an ss notlceable, and in paet for reasoaa that are psychological, social and political. As Iwluer,~~, ~ liaw pointed ont, "some raetioa to tobacco smoke may be due to the su~sstibikty of the rather than to a pharmaeolostk or an allergic resetion." In view of the faat tbat, on the oa "tbere ia ao proot that spwcift A 114 2
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PROTECTED BY MINNESOTA TOBACCO LRIGATION PROTECTIVE OROEA a smoker is espoaed." At best, be told the NAS, tbo ed.tEng itadl,q..on botb iidea of the iaaa. are inconcludve: I hasten to point out that the inralidatinS Sa.nt to wbiab I refer fnqaotly spply acta. the board-that i., to studtes purporft to ebow an adrerse efied of ETS oa adult pulmonary knetion as weD as to thoN not demo:utrattnS such an efrect, One cannot overemphasise the f.et that dSaiseanttr dawed ttndi.n do not permit one to reach .aSd •eientisc conclusions and aro ndtAer prs.e nor disprove a hypotbah. Siadiarly, anaoao- troUed anecdotal obeerrstlom wlme a eniteble be.k foe the hdtlatlon of etodlea and hypotbees, are by thenwl.ea not a.aBd bads upon which to reach tdentifie ooodmious. Unfortunstdy, lrowewr. iaoondiuhe needte, aneodotv npoete, and pe+ofotmdly Sa.red atudlet have been used by politicians aAd even am adwAIM to jtutliy egorts to retrict or dlmia94 smokint in public plaas. And if the ddaas In tbe oerdiarerpitatoty or .llet~ aras ase 1pa sensational than thorn about Imc emeer rLti, they are ao 1.n n~betiatiatrd. Coneequeatl7, they are no 1ea threatening to tb. iatepitp of edeeoe and to the denlopon.at of a rational public poliry besed on. meaain& e.ldeaoa rather tlun prejudloe ad VmWIw aawuaptiona. ETS and Pulmonary Fauctios Studies by Schilling ILA,,,8 In 19??. Coenstadc,"I In 1982, and ICeatnet, 2L4 In 1984 each faled to demonetrate an effect of emironmental tobaceo anoke on pdraoAaryon oe respiratory symptoms in nonanoidn` adalb. The autlsOra of tbe moet reerat of tLoee reporls emphasized that "only a few rtudiW" a the aubbet aW and that "an have the diadnant~. that there is a danger of ieleetton b1aL" Z'bey noted that the SchiZtinS sad Conutoelc 11(ijn common with ua ..., wae anabb to eatablisb aar etat4tiea1ly d~nt tedaotioet o[ pulmonary function in paaive onokas," wlwreat two otber studIft did ragp.t aa eflod ta eome categoriee. On balance, Mentaer. A.AL ooewinded, ••it sMau that tbe passi.e idWation of tobaeoo smoke at home or in tbe workpla-by healthy 3adMduala probably doet not Ised to any ewntirl impairment of pulmonary funcl3on." A eloae review of the two arQu.bly "positive" atndi.a lends et to l~tner's oondu:ion. For example, although tremendous pubiidty bat been aooorded 19t0 work of White and Froeb! "the only authors who unraervedy And that pwiva anotdn= leadr to sa Impairment of pulmonary function,"' their study eultera frm a aiultibide at defecte that render it, cal purposes, quite uaeleu. White and Froeb ueed que:tionnsirea and pulmonary ffmcda teeb (PlTa) to e.duate tho es propram~ :n~asked administer toT~tl~a• ~elres, witbont ~ aa ma~ titn nonstindardiz.d questioaadr.. It Is w.a r.eoPtud, of aourse, that ao11"ft data ia a~b s manner Is Inappropriate dnce It prowida tertlle VW1d Lor ad.daerjSestfos ai subj.ata." As discussed in Chapter 1Mo In connection with eptdea0ioloSia stvdia of lung aeooes, erea K oniy a tmall percentage of iub3eets ad tbenwl..r, tIM rardta tbst am obtdned 00 a{9" asroaations that are, f s fad, ianBd~ Metelazleas. Tbe me of .oluntwr .ab*ta by WWtr and SYoeb also raisw rerim que01om of aleetZon bias. More than one expert ]ut erltid:.d their study ea "improperly duipned dua thousands at subjects were excluded by White and P" without ad.qoste euplanatian."w" Ia addition, at least four other fuadaeantal Qawa mdermine tbe Valift of tlsdr ra,ultr • White and Froeb fafled not only to altmsteesp to ETS aacurately and wrisabiy,'e" but also to aooount for auh oo• and mnfomft tsriabi eavkoanent4l expoara to micr"s I . ~. _.. ...,,~~~... . _.. .. .... .
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PFIOTECTED 8Y MINNESOTA TOBACCO LITIGATiON PROTECTiVE OAOER 26 which address the effect of passive unoldn= on the rapirstory qdtm waeeta that the effea varies trorn negligible to qaite aaaD."u+ ETS and the Healtb of Child:eA Some have aasert.d that unokera may be injuring infants and children by samkins in their presence. When the "evidenee" for that awrlion is re.iewed, bowever, It is de.r that ao Ww ~onnuntv~ as.waation between onnuntv tobaeo onoke and pulmonary dydlmctfon or diaw in children has been demonstrated. Witorseh has identised twelve aiteria "pa:tiealarly appltc.ble to the pediat:ic age group"~ and applied them (w addition to thoa applkable to ~dia in adults) to oome two daan pabltahed reports.ukaw H'ii ooeulnsoni werN as foBowe • The "a.ailable data .re inoonsistat, and oantradiatory"; • In those studia measuring lang llmatton "wbere puport.dir paiti.e etfeets are ob:erned, they are invariably e:nall in mat nitnde, .ml witl& the normal ranp, and are of uncertain clinical or biological signifiaana or rdWranoe"; •"All of the published studies auller from the major potentially imralidating desdency of lack of verillcatioA of ETS ccpo.ure or doeap"; . • Despite the fact that they so obviously concern ehildren and their parents, "many of the studies fail adequatsiy to address familial or jeneeie aggregation of pulmonary f~netion param. •"EpidernioloQic studies focusing on symptoms and dlase an (Iike thoeu measuring pulmonary ltuudon) dnu7arly !lawd aAd dildwlt to interpret, as well aa oiten internaAy inoonsistent and contradictory"; • None of the studies took adequate account of possible lactstlonal e!lectt as opposed to ETS ellects; • None of the published studies "adequately addressed nutritional etsate, lifeetyle and familial health habits and attitudes." Other scientists reviewing the data generated by their own investigations, as well as those evaluating the literature as a whole, have reached s3wdlar ooreladont. In reporting an asaoeial3on between respiratory symptoms In eMdren and parental anokia`, for exsmple, Weiss, "" specifically noted a strong statistical aaodation between the ocaureaa of these symptoms in children and the prevalence of respiratory symptonM in their parentr. Needlas to esy, the poa. ab,'tia of croe.•infection and of genetically .aquireda~ap tFAty to inieetion hsd been om mented upon by scientists before Wdse and alt.r; e1•a' but these powibiUtia tend to be Ignored by those who maintain that ETS bat been ihown to epue respbatory ibdbadons ia ebDdren. In the course of a 19N evaluation of the pedlabk iltaatnre, a raeareb plpddaA and toemer professor otpharmaoolop at the Univerelty at Penaylrads Sdad at 1Ldietn., Dr. Doadngo A.iado, nat.d tbat "le"J14mr-AHIea claiming thst parental aao>ft eaaw rapiestoey qmptoms or fl1nas in ehl" tend to Ignore dudla from the United Stata, Biitaia, Zurom and Afriea. which do not find such wodatbna."'• In addition to dft as Witoesch did, the atndy by Schillins, et s• thst found no dgnUlcant relationship betw ~ anoidni and pubnoearY ~ detldts or respiratory tymptoaastology among S1e o[ S76 New England bm!Wa, Aviado pointed to ligh additional internaltonal elMdia, each reporting no saodatioa."• A clinical study by Karebljo, "' for example, toeAd that "(i)moldut and aonaAOkinE parents have sbout the eane proportion of ahildren with rapintay symptoms. The rntmber of ..A 1144 1_.__.. _..... ,.._....... ....~... . _.._.. _ . -_.._, .. _- ..
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PROTECTED BY MINNESOTA TOBACCO LJTIGATION PROTECTIYE OROER ZI • been exposed for fearer yeare)r Tbt moet likely up{=dn for thas reailL ia that the Ranft. Study proves nothing at aU, one wiy or the otbei: Sab an Ianadon i.,, of aoutse, dl 04 more lacely siAOe the KauMMAM metbodoloEy wae, 9ke liiWs and'e, deeply Qawed. In $itap, , Kautlmann and her coworkers 0 uat ttandardir.d qnestionna,*res; but other envirarmealal .x- posurea and many ooniouadia8 varlabla adi as lbma bom N oookln8 were aot addsw>ed, nor were exposure eatiautea verified or vslidated ltoreom, aa was trw in tbg eaae of White and Froeb, evea• in tho.e Eroupe where ditlereaeea were ootad, PI+Ti nmained vritldn the ao ra a~.rmil a~. and therefore lacked el3niev dpmcanoe. The importa:+ae of such variables as expoeure to the nitVM dioidde PueraNd by pe rlovea and ovens ?us been well documented by Comrtoek, "s ~Lebmvitg ~r ~in, ~,• and Fisher, "N And in & eerirs of reeent results of a riso rou. study oipU1aaonary i~tJon reports ia 229 ~subjeela bom 11Z gamilla in 11u.oa, Asisons, thdr importinee was h~tad yet apiLoo The queetionAairss used by Iwbowits were oaootnmonly detalted, 6iEhly .tandardis.d, and eoo- sdentionsly applied. They were used to estimate e:paure aot otdy to tobaeoo smoke but also to a wide variety of indoor and outdoor air pollutants. More potential ooaf variabW were eontrolled for In the Arisona study than in aty otAa stIdy published to data. e iAvatiEstors were sble to examine not only healtby but aUo arthenatk abjeets, adults aa weA as ehitdren. In each group, they searched for any adverse effects of ETS oa pulmonary lbnelion or respiratory symptoms. They found aone. ETS and Asthma The pattern fonad in the few studie: of the e8aat of M exposure an asyunatie enbjeets it, now, a fa~ru'liar one: although aneadotal reporN aad wperDcaDy "plans~la" aaaunptioua sbonn% well done studies and scientific facts an uarea; aeleelioa bia. hat beeA a major prublem; smnple sizes have been small; results among and within stndia have be.a inoonddtat and ooaasdlexory; and the most eareful studies }uw ended without showing adverse elteett. In tbort, upoiure to environmental tobacco smoke has not beea ehma to nme or eaeetba4 atthmatk; attac]u or bronchoconstriction in subjects who-as anecdota would haw It-an prrtlealatly auceptibla Pimm, it 3,L,y in 1973 and Shepherd, ;,• In 1979 eaab l4ailed to demonstrate an adverse effect from ETS on asthmi Most reeendy, and ai the eridt of etawof-tlu-art measurements following "a severe (hour•lona) simulation of passive anoft beyond what normally occurs in the majority of social or occupational eaviroananN," Wiedemwi, "• eaxluded "that passive cigarette srnoidnE presents no awte rapiratory risk to yona8 aryasptomatie aathnatka." How, then, don one account for those Irolated etudia pnvoft8 a total of 16 aathmalie wbjeeN) purporting to demonMrate a decline io palenonary dmdaa valuea (n fewer t6aa balf of tote subjects) when compared to oontrols! The answer, in biti» It sel.etlon biat aad poor metbodolop. In one inatsnee, five of ba asthmada volunteers bad Lbned apedShcy aboot d=atetN omolu before they entered the sh*w In the second M0*el the dx 0b1.eta bad raported a history of aWuna att.dm that they belie.ed bad baa IodUad by expown to ambient dtarstte unoke." Siaw psy¢holosld iaetort are IcWwA to plar w Impoetint rola Ia the Iedtbtioa at tbe bronehoeonstrtos3on aad wh.eft ehan+ctertstk of aeate astamatie epiwda,+n tha InveattEstory could hardly have beaa surprised that those volunteers wbo eoaaplatned abont tob.eeo smoke or reported a history of sathmatie attaaks in response to ETS raxted to intense levela of mrehsnieaDy generated smoke as some of them apparently did. In commenting upon tbese ttudies to the NAS, Witors& pointed out tkat in th. Nooad aad smallest of the "positive" studies, by IWaht and Breslto,d "du eequeaee of teaft relative to w w XNA 1144
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WU PAOTECTBp BY yOfNESMA TOBACCO LfflQATiON p*OTZCTryE OROg Apswers to the must asked questions V- about cigarettes. 0 Your iE;YIE:r, ol k9,')L Mt.:; cO jm+Itlltf'. tl`ipfOtt',f.7(T1 0 ®
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, PROTECTEd BY MINNESOTA TOBACCO UTIGATION P/iOTECTIVE ORDER 34 66. Tager, LB., et al., "Egeet of parental eiEarette smoking on the pdmonary Asnclion of chWdren," Ain J Epide+nio! 110: 1&26, 1979. 57. Ryfander, R. (ed.), "ETS.ai.ironmentsl tobamo smoke: Report of a worksbop on elGsts and • exposure leveL,'• Etir J Rs+* Dis 65 (suppL M 1•16Z, 1984. 68. Ta6er, 1.8., .t al., "I,ongitudnal stndr of the esate of maternal .naldn; on pulmonsry ilnction In elildren," N ZPp J Xed 809: 699.703, 1983. 59. Lewitter, F.L, et al., "Genetie and envtromnsntd determinants of level of pulmonary Amo- don," Anur J Epidaw,o! 1z0: 6180, 1981. 60. Vedal. S., et al., "Risk factors for eln7dbood rapdratoey die.aee," An R.v Ra9ir D+t 130(21e 187•92, 1985. 61. Ware, J.E., et al., "Paafire eenoldas. i'es cooking and respiratory health In ehlldren living in ax ct9ei," An Rev Retpir Dv 129: S6&T4, 1984. 62. Ekwo, E.E., et al., "Reladonrhip of parwtal smoking and gas cooking to respiratory disease in clu7dren," Chut 84: 662468, 1983. 63. Taehldn, D.P., et a1., "The UCLA population tludiet of chronic obstivetive r.spiratory disease, VII. Relattonship between parental smoking and children's lung function," Asn Ra R.i)ir Die 129: 891•97, 1984. 64. DodEe, R., "The effects of indoor pollution on Arizona eb7dren," Ardl E+arir Jhith S7: 1S1• 55, 1982. 65. Has.elblad, V., et al., "Indoor environmental determinants of lunf function In r]uldren," An Ra Rerpir Dit 123: 47H5, 1981. . 66. Lebowits•. M.D., it al., "Fum7y sareEadon of.pulmonary Amatlon measurementa," An Rft Respir Dia 129: 8-11, 1984. 67. Lebowits, M.D., et al., "Tbe effect of pasdw smoking on pulmonary function in ohildren,'• Envirca Irternat & 371•7S, 1982b. 68. Gderlot, RL and Colley, J., "EpidemioloEieal investiptions on environmental tobacco srnoke," Searid J Re,tpir Dis Suppl. 91: 47-49, 1974. 69. Lebowit:, M.D. and Burrows, B., "Raspiatory symptoms related to smoking habits of family adults," Chat 69: 050, 1976. 70. Bland, M., it tl., "Efleat of children's and parent.' smoking on respiratory symptoau," Atd Dtir CAtildren 53: 100•6, 1975. 71. Bonhain, G.S. and WDson, LW., "Children'a health In tamn7ia with dprette senokers," Am J Ptiblie XraltA 71: 290•3, 1951. 72. FerEuuon, D.9d., et al., "Parentd anoldnE nd low.r respiratory IDnsw In the IIr.t three years of life," JSp+dessioi Conmmity Aeoltk 35: 180•i4, 1981. 73. Pedreira, F.AL et al., "Inrohmtsry smoking and inddeaa af respiratory Olnea darinf the first year of lifs," Pediatrut 75: 594•97, 1986. 74. Gortrnaker, S.L., it al., "Parental anoldnE and the eisk of childbood asthma," As J Pnblie XealtA 72: 574•79, 1982 . 75. Cameron, P., it al., "Etfeet of bome environment tobeooo anoke on family Leallth," J Appl Pkysol 67: 142•57, 1973. , ., A 114
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r w PAOTECTEC sY MtNNESCTA TpSACCO UTIGATION PROTECTN[ OROEA The Tobooos fnpllul* moeONiN IAU ftn vs d11fsfMICM 0/ OOiAi0n 00/1CMfMQ4 f010kft wd MiIfA. flW OOOkNt 1s Pro$~ M@N OMN tlu/ A/M. 1ra. WM MNO/md dba"on o/ tM Ne MW In 1M C0I1UIl110/1 ihM tlN M~/1o bOqfsy OMMt 0sf+mNI« bysilim"iC fv NM01~ it TM TN"" MWWAb 1m K stnM. Noro+w" WaqNnpron, O.C. Z000i N m 10 ~ t0
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r 51721 0973 ,t .. , . . .. .. ©
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I 0 0 EN ® THE TOBACCO INSTITUTE 8 ® I ® mw bAVATOM73M . ."., : . ._ ., .. .-•-•-.: • .. _. ~~~ ._ .. . . ~*-... ;..•r.. --+--•.~....~-... . •.. •, - .r~.~..,• . . .
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0 i PROTECTED 9Y MINNESOTA TOEACCO 1.1TiGAT1ON PROTECTIVE OROER ON SMOKING j 1 Mew manp si9arat.a a» .oN .eerNq N tM U.S.t ~ N.aqy ii0 Oihiai v9a.otta w.r. purchased in • 1st7i, about a oaelcand•a-hait a day by the ar..- .1 aqis pnekN. SaNa have Ittewd steadily upward in tM2 da0a" and aro OOntinui/lg tO inOraaia at a rato of about 1% P.e ritar. 2 M.w w,a",..,to m.k.t Ne" !0 TiOion adult Amlrieans-about 40% Of the adult popuiation. 3 At. tuttakaa dl0aant frotu een-miokarst Yai. aOMe doeton haw eonCiudad that iTOk.n have eaMaMiOr patterns different (rom n0A-smok- ar7. GMarNiy. ~arS taFld to Oe TOH atslr- tiw. titeo-eonseioua and anoorpatie than non- arnokars. 4 Old tho tiun.en G.n.nP. RpaA ..WMsh ahat tiino" aw" aanaa and Nba w..aaast No. The report of tha Advifory Coeimittao to tM SurO"n Gat.ral In 19" fail.d to ltitatfiiah a eausaand-Nhot roiatbn.hiP euw.an cigarette pnokin0 and Canear and olhor ditaasa. The tyOoR was essentially a"atu0y of nuna,.rs"-a sN00tiw Mriaw of pepilatien slYdiM whioh Com- Parnd diaaata• atq amon0 tmekNf% as-swnok.rs and eemsinek.rs. The nPon shew.d a aatia- tieal wodation eaw.«+ eiOanttft tiniokinS and Iwq esneu. Mow.+rp, thft noott uutad. -$taastkd ti>Nhods cannot astamsh Proof of a eaYad /WatleMhiP ia an snoeisden. The eauwM aipMAoanee of an a:aoetation is a natta N tudOtrWt whieri 9oa..yand antr aaeanont of abWtlCal 1110010461iGly." ~ Mfhd tiwtdMa were kt/t wi.nMMW by fM sur".a WnanPa R.Mef1 M.ny questions wor. IoR unresolved. Why. for aaaniON, d0 nat-aniOkM 10 vktim 10 MaA . A i
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PROTECTED BY MINNESOTA TOBACCO LITiGAnON PROTECTIVE ORDER 78 R.fereseee: >8wPisstw?, Cardietsuslas aad AUerp 1. 4Vitoneh, P.. "ETS .nd nrdiorespiratory ditordeA," presented to the Committee oa Psssare Smokiny. Natioael Zie«ateh COmo7, National Andsmy of 9eienoµ Weshinytan, D.C., Jan- . uary 29, 1986. 2. Sehs11in8, R.S.F., et 4: "Lurg llmetiaa, raspirstory dLeaat., sad emoldn8 In famVes," Ans J Epidsrniol 106: 274-d.1, 1977. • 3. Coft1SLAlk G.W., et iL, "Rtlpi?itory effeCts of bousehold exposures to tabfCCO smoke and yas ¢ookin8," An Ree Reapir Dtie 124(2k 143-48,, 1981. 4. Kentner, M., et el., "Z71e In e of peetlve pnokiaS on puhaonary timet;on-A study of 1351 otda workers," Pr.. Xed 18: 666-49, 193/. 5. White, J.RL and Frab, H.F, "SmtIl-air+Ryt dysfimetfoa In aaumokers eheonics<lly exposed to tobaeao smoke," N S'np1 J afid 302: 7T0•23, 1980. e. Shy, C.M., et a1., "Tbs effect af adseLwi&:doa of exposure sltaft In epidemiologW iUdies of >tir poilution health effects," M NY Aeod Y.d 64: 1156•66, 1978. 7. Stolwil'k, J.A.J., et el., "Experimental oonditioeu in the m.aaaeasent of exposures to sides- treaul aiprette smoke," In GemmaSe, R.B., et .i. (edt.), Iadoor Air and Xumn Ma1tA, Le*rie Pubiislleri, Dp. 20S•13, 19as. 8. Ozkaynak, H., et a1., "Bias due to eniSsIfication of pueon>al exposures in epidemioio8ie . studiea of indoor and outdoor air pollution," Proe Srd Internet Coy/ on Irdoor Air Qvality and Cli:nate, Stocidsolta, 1984. 9. Friedman, G.D., et a1., "Prevalence and correlates of passive smoldu8," Am J Pub Hrotek 73: 401-06, 1983. 10. Avlado, D.M., "Health issues rdattnS to 'paetive' tmolda8•• ia ToltlsoA, (ed.). Smokiv snd Soeiety, pp. 137•165, 1986. 11. Lebowits, M.D., cited by Fountain, L.A., "Wb{te•Froeb study diseedited by scientists," U.S. Congiesriana! Raeord, 97th Congress, 2nd Session, December 16, 1982. 12. Aviado, D.M., Letter to the Editor "StasII-e,irways dysflmetion iA passive aeakers," N Znp! J Msd 303(7k 393, 1980. iS. F:eedmsn, A., Letter to the EditPr, "Sm.D-airaays dyst4attion in pasAive smokers," N Essgi J Med. 303(7k 393, 1980. 14. Lenfaat, C. and Lia, B.M., "(Pasdre) smokers versuse (voluntary) ;mokea," N a„pt J al.d 302(13)c 742-43 (1980). 16. Ameriesn Tboeede Society, 'seyoet of Stawbdrd works<hop on staodardisattoo of .pirometrp," Am Rn lteor Dia 119: 831,18„ 1979. 16. Motrisf, A.H., et d. (eds.), OWW Ptibeo*ar7r FsMd+m Tirliw A Xe+oai of UnlonR Lab- oratory Proadhra, Intermountalk Thorxie Sodety, 1954. 17. Iwbowitt, M.D., et al., "Signifianoe of btrdndMdnal changes iA maxtalmn expiratory Dow voiulrle and peak eupiratory Bow oseuWaMMA." Ckat 81: 3070, 1982a. 18. Burrows, B., et a1., Rap6atory Disorde*e.• A PatllapAytiotoyie Approok Yearbook Medieal Publishers, 1983. A 114954
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t PROTECTED SY YINNESOTA TOBACCO LRK3AMlON PROTEC'T1VE OpOEA i ' Answers to the most asked questions about cigarettes. , ® 0
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PROTECTED BY MINNESOTA TOBACCO LITiGAT1ON PROTECTIVE OROEA 41 Chapter Foar. Towd a SeieaeM of the Iadoor EA.ltomeAt 'I'he !aalure of those individuals and Eroups dadieitad to proving epidemlotoEieaAy or esptlir~ttaAy that tobiow anolce harau the nonsmoker has Oot prevented tMm brom teyiaE a *M appr"Ch, one that might be terrnud rdeneo by awmptfon, ars;lop aad eJtiwed pLn6Otty. R/bap t6o arguments are analyzed dotely, hoNwer-at they hav. D.n by ra,nrel sclaintim and rrarehas- they fail to pessaade, becauam they an based upon everything but rel.rant, ve:isabie laets. This chapter reviewi-in abbreviat.d aad dmplified taem-the major aress of oontrov.rsy. In addition, it exaenines some of the technical problemu Involved in dellnins the predae natare of ETS and in deLrmininS the aaomt of It to wbkb noonookees dhroniosDy (oa»r man.y years) or scutely (over hours or days) tre expoe.d. F6uDy, )t aanta the loaportsaee of pladnE ETS in context, and of foauitg, as a autter both of eebaa aad of pdk bedtb policy, apon th.prob of which tobacco emoke Is only a atnall-aAd~~pr~obab~ a rvdy ~nnt-part: indoorta~ir pollution and the inad.qnate ventSation of enviranments. What ETS b-Md Ia Not As Professor Mark J. Reasor of the Deparbaent of Pbarmaoology and Toxieolopr of the Weat VirQinia University Medkal Center has Aoted,' eavironmeatal tobaooo anotn it a tum used to descn'be a complex mixture of exhaled mainstream emoke (EMS) and dd.Kteam anoke (SSJ. Tb. eompoaition of ETS is d)r.amie, beinj dependent upon the chemical and physical properties of SS (the mixture of eheadala released 'mto the air itan tbe burning tip of the dpreth) and EMS (as exhaled by different Individuals under different conditions) ova ttm.. 'Zu ehanS.a that' components of ETS undergo over time, both physical and elnmieal, an refated to a. "aft" The aging process includes dilution In room or ambi.at afr, reatlladon, Sltratioa, adherence to suriaaea, as well as physical and chemical ehantea resulting ban ehaegea In temperature, kuinidity and oxygenation. • None of these dynamie changes in the oomposition of ETS and its constituents, Reasor has concluded, has been istisfactors7y addressed by "y Investigator. Bvan the oontrjbvtion of SS to ETS, although it has been estimate+d,' remains nAdaterads.d, not oniy In qaantitstive but in qualitative terms. For this reason, although SS certainly ia a mafor oonttibntor to ETS, it is not a surrogate for it. Fresh SS, as it has been measurod In the laboratory, ia likely to be signrifieantly different in both its gaseous and partioulat* phasea, ban the a=ed. nnoko4erived material that is the real•world ETS to which human beings an expoeed. Accordingly, attempts to ebaraeterire the ebendn) composition of SS freshly generated In the laboratory,W and the relat.d assumption that It is oqnialent to ETS, an be wisleadin:. In partic+ilar, eines thft aoneentsatton of certain ebeniaL may be Mow In hetb SS than In MS (duo to th. much higher tsmperataew and ta& of !lltrstioa tbey ean aa at that to "ETS" is potentially mor. "toxdo» than to YS. Uworpeidn~r. oa s.t of data~~= that SS/!IS ratioa oi tiaQy hannlbl ebem~i~alt are oBs grater than 1.01ua been repeahd and unarit3aAy rqpmby those who would Indiet ZT3. But 53 bEd ETS, and 4eahly generated 3s Is oata* not the apd a'['S to.hm nonanokers may be exposed. Nor is hah ldS, obvionay, equivalent to M Tbae disdnetiooa Widerscore the taet that exposure to ETS Ia a toxicologically dia6et pb-I o~awas llcan active amokinE. And they highlight the fallaq of arguinents based on the labs saumpttoo that any health .lliett of expoenre to E"I'8 ean be artrapolated Eroen data on adivW wioft or km eb.ndal analysea of fresh, undiluted ddeatream anoke. 1lie latter analyaea bava been eritkised, as well, on meth• odoloyieal yrounds.' , 11
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PROTECTED BY MINNESOTA T08ACC0 UTIGATION PROTECTIVE OROER 44 Even wher. "aeote,» shot.tam pcpowr. Is being measured, the .videnet enccoste tbat doa individuals form aottairw by metabolisinE aiooelae at dUflorent rates, dna asaoutemeAt methods ars not standardir.d, aod eince aotiniAS doq not predictably aorrelate with other ETS ooeulltneute such ae partieulata enatta, eotiaiAe'e atility u a marker may be limited. pa soomt of tbese ind other phsrmaeolarutic eoAOaat ideatiEed by Sebwets, "it appeats undul optimistic to expect studiee relating aibjeat•report.d ETS e:cpoesn to body fPodd lhreb ot oie to bold mnah promise for vdidatiuE ootinine as a quantitative meaeurr ot ETS e:poaW..'w Confounding Yariablees Ob.taeles and Opportunities Efforts to in.eetiEate the poesibli health esfiete of ETS ere aomplictted by the need to take oo. and confounding variables Into ecoount Earlier eAep4rs hs" noted the difffiailpardwlarly with respect to lung cancer, eardio stor~r dieew in adults .nd ehfldrea, and a0erp. Although some of theee vuiabla may be ~~~+oEed tor-det aw Bfedyle, heredity aod psyeboioEid factore-many are irbvent In what Dr: Naney Beiter has taen.d, iA her NAS pre~ntatioA,~ "the eomple;,dty of the tadoor eaviroameat": The raurr,es of Indoor air pollutants, in addition to tob.ooo make, a» Aomerons. They indude pollutants entrsined trom outdoor air, poqataAte from mirobial eouroee, pollutants emitted !lroen components at the bnildtaE structure and eoinpounds rdeased from building mati riile, eontumer produen, tpptiaset, snd eambustioA deriees. Ex• amples of contaminants from thete eourees include: (1) nitrogen diosdde, a combustion product suodatd prtmwity with gas atove: and unventad kerosene beatsre; • (2) carbon monoxide, which can be emitted from aoweatad keroeene heaters or wood burning stoves or may ent*r the iedoor eavkonseent from automobile exbaust generated in attached garages; (3) volatile organic compounds, which are also present ta automobile exhaust or may be emitted from solvents, .dbeei.a, paintt, building materiait, plaetlm cleaning mate. cisls, spray propeUar:ts and dupiiator AWds; (4) formaldehyde, which can be released from p.rtkle board, plywood, pandinE, foam insulation, earpeft, upholstery, drsperies, fhrAitnre and other consumer products; (5) microorganiunt and spores, which can proliferate In sir spray systems, bntnidiAers and drain pans and become aeroeolised througb the duct work of beatios, ventilation and air conditioning systems; (6) mineral wod, IIbrow glass, aebesta and miiaDaneons dnyts, all of which may collect in duct work and beootom aeraolized; aad ('n radoa Ess, whieh nA eeespe foen tbe eo0 aAd eater bofldiO vSs erarb io the • foundation. Baiter noted, for exaopl., that radon gas has been wodated with loat e.aoes Is neaodum mineri,m and that "EPA e4tbtles suggest t6st redoo escpoe- +o Ie bddap may rewlt In 1,000. 20,000 cases el lung eanes pe:~v but tbat "aoae os tbe stteEee reported to data on environmental tobaooo sroke end lu~ eanaes control for this ob.iootlr i>nportant Latoe."M WIt1s refereooe to respiratory function aDd eymptomatoloq, abe redsn+ed, as C~jter TAree of this report lus dons, to etudies demonstrating tbat a wide .ariety od indooe is Ust.ats can r.dnee FEV, ..lu.e, esuse edsvut tightness, ooroEh, aneqe r.epoe:.e. .Ad lofadoau dwe.. The adst.noe of so many oa and ooatonndia= variables wifl, ol eomse, ooatinne to present formidable obstacles to the study of the health .lfectr, it any, of ET9. But t6elr ex3rterieoe also t Ln ~ _j N N m tn (A) .A 0;146
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PRQTSC'TEfl eY AIfNNESOTA TOSACCO U11GAT10N PROTECTIVE CROER a Seterae.a G.dtde.n ad CSaqea`a 1. "M.moraodam to Partidpano ia 190 ALA Aesml Yaf3a= S.oioa (DlJ 'Stst. Wd Loei1 ' srom 8bane Ye)ermot~ w Two Additiaaal Wododsop ~~ ~" ~~JJK 2. R.p.ea, J.L., "A rebutlai to ailidmu oi padt." afnolda3 research by toba= mdua&y eonanltanta," Am.rim Luas Arodsdaa, I[q 1986. 3. Oide, S., "Smokins Conterem Caeetled In D(spnte Ow! Sponsotshipy" ?'Jle WaAixon poe; June 12, 1986, p. A6. 4. Lefeoe, N., "Paahe imokinF Acute e6iedt In uthtna," CA.rt 89(Zx 161•6Z, Febrnary. 19a6. b. Wdla, AJ., Testimony Detosa tbe Snbeoeada.e a Natnral Raouraa„ Airtallan ReaarrL and the Earironmeat, Committa on Sd.na and Teelmoiop, U.S. Hoew of ~tstt.a, September 17, 1986. 6. Workshop on Rapiratory EHiele of Ia.olaatvy Smok. Expowre: Epidaniolodo SAudia, May 1•3, 1983, National leutitata of Health, aonvenedby the Di.iLion of Lon3 Diaa.ee, Nacional Heart, Lnn3 and Blood Jnstlbut., V.3. Pnbib Haitb Service, Deparem.nt of Healtb and Human Servka. 7. "ETS-Environmental Tobacco Smoke-Report from a Workshop on Effects and Expoeur. Levele,'• Geneva, Switserland, Sw J Rap Db 66 (Supp. 138): 1•152, 1984. 8. "Interaational Symposium on ldedinl Paspectiva on Psf:iw Sraoldng," Ppev 1Ued 13(6k S57•756, 1984. 9. National R,aeareb Council, National Acadeoly of 9denas, TAe Ab4ine. Cobin E=irwaeet• Air Quality and Sg/ity, National AeadM Prat, 1986. 10. 0ldaker, G.B. and Coorad, F.W., "Eitimsdon of the elfest of environmental tob.em smoke (ETS) on the a1r quality arithia siersstt abim," Snbada.d to BairoM SW Tedl, Juy 1986. 11. "Pasaive smokins dati How wiipyt" Xedie+ot Worid Noo., Februarp Z4, 1986, pp. 103-106. cn ' ~ N N . ~ . ~p N 1 A 114 4
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PROTECTED BY MINNESOTA TOBACCO UTIGATION PROTECTIVE ORDER 42 Wh7 ExPons to ET3 Ia Not "Ps.dv. BmoWaE" In addition to the taet that E'!'8 is duaiieaDy distinct from MS and SS, ditfapiop ia. p6ysicv properties and modes of eacpowre wQrt that active sttoldtK and eomAsd "paissive semoidhW• ere to:de,olo4ica11y distinct ia other resp.ats. Although all tobaooo anoke aoen~t of Isass and partdea, it is well establithsd that tbe pa:tG3es characteristic of ILS6 a;e larger than t6oen of SS, or ETS., Several rcentists, including Dr. Cuater Ob.rdoriNr, a pulmonary tadooloEist and Assodtte Professor at the Uniwrdty of Roeh.gw Medical Center w6o prasated a to the NAS "On the Do.imetry of Environmental Tob.ooo 8a:oke,"9 bavs noted that pir paper s of difleraat dzes an deposited to different d.Erea and at diftst+eat dt.. In the respiratory tract,K+s and Mat particles of different dzet trs lOcdy to 6ave different dmmdW oompoeitiooa a. w.U.u Simllar diKaenees are likely to exist with r.isr.oa to dre di!lerent EaNoua oooaeitasntt of 4ob 1K3, dn`` on the one 1:aod. and aged ETS on the otJwr,%=+W aa~ any between and exposure to ET3 (.o~s~ltsd "p.riv" smoMn~') aa~I o~aW ~e~s. emol Any effort to extrapolats from aettve mtoldnE data to tondudaos about ETS eapowr.-ia terms, for e:ampie, of "aiEarette squivaleats"-lr aclandfically insp.et for other rsaeons as well. As Ressor and others have eoted.expoa» to ETS Involves relatively tbaUow, regular breathing patterns, during which highly dIIute ETS oonstibmts are iduted ~imattly through the nose. By contrast, an active unoker Inhales (pritnarily DdS) by mouth, often with a much deeper inbalatioA followed by a prolonged respiratory pause. This incr.aeu ths nddenae time of particles and gues in the lung. "Consequently," Dr. Nancy Balter of Georgetown University and ber ooanthors concluded th a paper published in the ssaeistio "atimstioo sponirt ia tume of 'dprettesqui eats' Is unjuetilied on asdentisc bada. Sued on a oonsideration at thae diilres.ese ~(regarding bres pattsr:u and physical and chemieat eharaetwrirtla) In the exposure at the active smoker to D and exposure of the ean-unok.r to ETS, It ib logical to ootN2ude that the two represent toxi- coloyically distinct pheramena.'"" "Exposure": What I. Being Measured? Quite apart from the to:deoloEical uncertainties associated with the emerEing scienee of ETS, tAere is the problem of how expoars to ETS, once it Is properly desned, can be wrisably measured or quantified. As previous chapttrs have aotsd, the abs.aoe of aoairate maairtmaits of this kind oon.tituta the most fundamental law In the Btsrstar» oa hukb eltah. Reeogni:i- thit, the NAS eoenmitta's publu notJee speeiIIraUy eoniht e:pert opinion on this itms. If tbe comments received did not provide encouragement about the poseibEity at prseias qnaodlfeation of exposure, at least tbsy helped olarilyt the dimfmdotr of tbs yeobbm. For wrample, Dr. 3aivators R. DtNardi, As:odW Peosissor at publle $alth at the Univs:dty of Ma:.uhu.etta and Cbairmaa at the 8nbeonamittae oa CbemiaoL Is ths IAdooe Enviiroment of the American Itidmtsiei Hsahb Anodstias, observed that mauy Investigators bav. bwd atitnates of swpaa» ts ETS npon .stImSta at espowe to tb.:apirible wp.aded_ p.rttdss (RSP) it aoata~.n He Aotsd, however, tit.t dna any iftdooe eavironment contains RSP from many other sources, it is nsase.ry not only to quantiiy totel RSp aaaaratdy but also to msawrs background concentrations with pr.deion. DiNardi went on to examiae two of the mo.t widely dted stnd3es dat bsv" attanto quantity the contribution at L'TS to RSP ia varioat indooe en.ironm.Att. Ths bi 4bghly field work of Repass and Lowrey,u be concluded, atiliesd a dearly iiDAPpe!optists baekiroutW Ln r v N r m ko 1-n r A 0114 ~3
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PaGTECTED 9Y MINNESOTA TOBACCO lIT1GAT10N PRpTICTyE ORDER 4/ Beiaeac.as Indoor lla.leoA.eaW Selsaes 1. Reae.or, MJ.. "Tb. compodtion and~~~r~naa0iea of en.troomeota! 'tob.ooo aolc.," Pre.eatstbn to the Committr on Pasaiw 3 , Nadoeul R4=nh Coondl, National Andanr oZ . Saenas, January 29, 1986. 2. First, M.W., "Constituents ot sideet:eaia snd wda:ream tobcooo aoolcb and markas to quantily espsaas to than," Ia Gaouaep and I4ys (eda.) ladoor Air sad 8unsis BatrJk, Lewi• Publishers, 1984, pp. 19&203. 3. Brunnemann, K.D., at a1., "The inIIuence of tobaao ennoks on indoor ateno.pbsr:s II. Volatile and tobeeoo specific aitrna.ndna In maia- and eidsrtr.aei onok. and t6etr contribution to indoor poUntion," in Prroaediapr, 46 JeW Cok4raa es $ewiwp */~,'%risomwxtaf Po&ta,ts, Amsrian Chemica! Sorlety, 19?7, ppr i'J6-880. 4. Brnnnsmann, g-D. and Hol6h+.nn, D:, "Cbwke1 dvdles oa Oob.ow eeaolu, LEL Mvy* of .olable nitro.amines In Oobaooo aeoke aAd po0nted Indoor eo.hvdnNnts," IARC 19: 341-66, 1978. 5. StshlOc, G., Richter, 0., AJtmann, H., "Concentraeloa of diaieehlrlydtrosamia. In the air cf anoke-!lllsd rooma," EeofoaW Environ Sgrety 6: 496-600, 2982. 6. Hnber, G.L., at al., "A morphologic and phydolo`ic bioawy for quantifying altorations in the lung following euperimentv chronic inhslation of tobacco smoke," Btilt awop Pjiyaiapau R" 17: 269-527, 1981. 7. Kelth. C.H. and Derrfck, J.C.. "Measurement of the partiels dze dirtabndoa and conceA- tration of dtsretts anoks by the 'Caifige,` I Co(i Soie#er 18: 340-66, 1960. 8. Inrebrsthsen, B.J. and Sears. S., Presentation to the Tobasao Chemists Research Conference, Montreal, Cansda, October 2-6, 1985. 9. Oberdorstsr, G., "On the Dodmetrp of Environrneatal Tobacco Sniok.," PtaaitstEon to the Committee on Passive SmokinB, Natlonal Research CwuncII, National Academy of Seietuea. January 29, .1986: 10. Ii7ler, C.F., at al., "Deposition of eideeeram d8arette smoke in tbe human respiratory tract," An Rev Reipir Du 125: 406-08, 1982. 11. Yeh. H.C. and Sdrom, G.M., "Modele of human lanB ainvs,lrs and their appl;cstion to inhaled particle deposition," Bvlt JMatA Biolopy 42: 46140, 1980. 12. Jenkins, LW., at sl., "Chemia! .ariabDttr of aainstream diaestte saoke as a llwct3on of aerodynamie diameter," J A.ra Sr;esae 10: 333.36t, 1979. 13. M:71er, F.J:, at a1., 'Tlaeoo-ph.ryn:rd removal at osone in rabbita and Ntnen pip," TowieolopY 14: 27341, 19?9. 14. Wer, FJ., at al., "Paimonary dodmetrp of aitropo dioWd. in antmsL and m.n," in Schnsi- der, T. and Grant, L. (ede.), Air PoDWNon 6y N'~tropex Ga+dw, Bbevier Co., 19811, pp. 377. 86. 15. Morle, G.P. and Baggett, M.3., "Obserndeos aa the dietefbuBoA of ceitain mb.ooo smoke components with rapeet to parttclt du," Beitr TabaV9: 7l-7% 19?7. 16. Balter, N.J., st al., "Cawal relationship between en.troneMntel tobseoo anokt and Wn< cancer in non•anaksn: A critieal review of the Iiteralute," Proe Ai. PW Coatrol Aaoe, 1986. i , c 114 _ . _ . , .. . . _ . . _ , .__ . ~ . _ ~.. . __ ..._ _ - . . . . . .:.. . . '.-
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pROrECTED BY MiNNESOTA TOBACCO LlTIGATION PROTECTIVE OROER u (outside air) for comparieon, did not ineluds msazatwah of ventilation rata or relative lnmidity, and aQitered hom IIaws in instrna~entatloa~ aad technical ®edadolop. Moat esitlailr, their eorw clusions were onderntined by their aonmptloa that otber iadoor sources of RSP-tieh as beaft air conditioning and ventiiatioa systaot, eooldaiir dusts, Sbes, microbial aoasteminaote, buaam arid animal activity, outdoor air ebarscter3stin, automobile traft and tho like-are aonaxiitent or unimportant. A ainular fai7ure to control for non-ETS sourc.s ot R3P, DiNsrdi aot.d, also diawM.d tho value of a study by 3penEler, ~ as did Its small asaipl* siu, on. apparently distort~.d aAd distorting measurement, and an erence to actual nookitg behavior as opposed to the mere fact that a"anoker" rarided ia tbe home. In tla lhtnre, DiNardi -ated totbe NAS aomadttse, ,•caretbl evaluatlon of biekEround .xpowra to indooe air pollutants is aveial, esp.eiaDy for measuring RSP, when eotapeeinE soore.. bndooei will alwqe be pr.teat." Chemical aad Biological Markers Tobaooo indusby scientists are in the forelrOnt of research aim.d at dbeovain= rhemie~l markers of tobaooo smoke in the atmosphere, In an attempt to solve tbe problew o! "mspedtidtlr.'• But the problem has proved elusive, espeddly as ret ardB pareieuiate aaat;er. Rerarch.:s at R.J. Reymolds, for example, have demonstrated that whereas tdootia. In mainstream smoke is associated almost exclusively (more than 96 percent).vitb particles, niaotine In sidestream smoke ia associated to an equal extent (more than 93 percent) with the .apo: phw.• The complexity of the problem Increases when research attention dum-at It Increasingly has- to the search for "biolosical" markers of tobacco uaolce In an exposed individual's body nuid; .uah as blood, nrine or salivL Although savrrsl imnstis stors have used carbon moAo4de (CO) levels by measuring carboxyhemo6lobin, the Lct that there an so many sources of CO other than ETS severely limita its useihlaess."s 8imiiarly, the hydrogen cyanide In tobstco smoke can elevate thiocyanate levels-but so can other "eyaaof w" found In food, indudie~ those produced by the normal breakdown of protein as It iB me4bolised.• At bat, asxoedinE to the NAS prea entadon of Dr. Sorell L. Schvuta, Proi'emr of P1armacoloWr at the Georgetown University Schools of Medicine and Dentistry, plasma and salivary thiocyanate levels may serve as indicators of relatively heavy active smoking, eincs they ars not sensitive enough to quantify chronic exposure to ETS.y Most specitic and promising to date, Schwart:. Obeedorster and Ressor agreed, have been nicotine and ita metabolite (breakdowa product) ootiAine. But each scientist pointed to epaitic limitations. Reasor notid. for example, that'becsuse It Is likely tbat:dcotine decays at a different rate than other ETS chemids, it rnsy be difficult to relate nicotine values to other constituents of smoke. Thus its utslbinass as an ETS4ped& marker may be 13oiit.d.'" Oberdortter obe.rved that biological "(bWltlma for nicotine In the blood oomparqneat ... a» rather tboet-oa the order of hours. This det posa another diffienity fa iattepe. Ienb messured some time atter e~rposnre.'~ Sehwart:, in a highly t.e?miad pewa~tadaa,w e phosized not only tbe rapidity with which nicotine ib deand trom the bodP, but the fad that e.ve:ai studies baw demo~sted wide variations amons Individuals In the ehanidl'a distribution dwoa~hont the body and In Its elearanee by the kidney and other olons, which may depend eot only upon the Individual but the klio- syncrsda of asid•base b.lanc..•• Cotiaine Is las subject to variations of mrinary pH aad has a greater La1f-Nfe than eico- tine.wim-0 Measurable levels may reiaain In the body kom 11 to 30 bourrM tlms„ as Oberdorster noted, "ootiniAe may be a better predictor of ETS espoeue than aiootine, although the balttime Is not long enough to permit an adnat4 of cumuhtl.e past eocpotura."g In the eaa of chronic health effects, of course, such atmulatiw expo.are is the critical rartable. A 114 4
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PROTECTEpt1f AAIN1+1Eg0TA TOBACCO t,l11t3A71ON PROTEGwE ORGER Wld do rn lW bo aoW"? W. want.dult Am.elaaa b MMqh both slda b.iois thn ';. tak. dd...bout th. Nnm perr.Md in th..dnrW.amab. W. vr...nt tWa eampabn fa 1l~* b.~i.t tbet tull.ad lr.e dt.. cusm v tn th. pnbito lee.e..t And th.t ia mstaes od ad.lt aodal c.v.bmA th..art msloritr .:: _af idrmt.d.d Am.eiew hoaor ".du.l &+..dom at choic.. Nar.rn ~M w.dMs sriodWi • 1N.:.cd.e iamwom 6om miaab.es of th. vr.am vovea- ea.At ot9kdaL snd thl.QWMal publlc aa aA mqaim; basi.. :" ?h.ab Mstnisd thb lcldv anawf dGvW ~m.r many o d• av•um we hm mat Sr.Qwmth. Who w tlw~ ~r~ ~rM:a!? W. wo.rit to mmawatcslft with Amwk=.4 23 Y.ara of .Qe snd otds NoRn1T d.c~aaulc.es oidaL~by~ .a l.ad.es and thw pm., but.II d"banv~ 1hi-SWIMsaa -~.. AL T Onrvr...onie~q: th... tM~.. ~.. b..a d.b.td,~.~~ od• ha.. ~ouqh5oa th. ~ibj.ct ' 90F'~W: wUh b aoenm~toat~ b . ~ *0Tbe sdNttIdD.eb wIII.ppmm ds m...udl.ao. dospa• N.~wew..k P.opla SP" IDnsWt.d, TM TV tsutdo and N.i.s a iNaew ~~ . . • .* . - ..;W . _~• Tb. mw~.p.. w~l ala bip~..L.M.d.in tba. pe~o~t ~Ob.ooo~ ~lw ~r.d Tob~oo Fa~i++~ ~ ~. .. Farm.h .A f.rm.~ T~.ooo larraaboe~.L Th. Tobacoo Ob.i~wr.md3JS'~bb.ooo JaL . M..elhm.ats ~.Pp.~e svnOblY anoi. mae~ fa..eh o~ ~~~ . ' . . ._ . ~ 2r W..wioom. Yoarswyoet of thts_.8oet to..h An.tles:u loe 4ff -BEFORE -Y4U TAKE SIDES. . THE rOBaMursr1rurE
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Jsly 1, 1978 ~ xsxo A TO: Yessrs. Ave, llalak, levliss, liskstt, ?vs.est, iebissis, tliss as• Tssksr 3 T10a: ViLLIAk ip. Df!=1 z sGeJtCT: ACTION AT ToOM Oit=CTSOM 7 ~ In #assoit el cYe diresties we received ises you at yees last ssetis$ the 2saticsts sailed Wh• sselesed desnsesc, 'Tve Days is Jassaty," asd soar ~ M h seserasdss ts the 2,221 sass sstia rspsssatati.as vste vties ess speksssas •aa bad es.tact. ~ Z tte already ka.e 1a• rsspssae te the slisr iot tyrtDer islersatiss= several sslia estlst• 1aa called for broadcast istat.ievs. ~ w p r lb cc: ys. kevdsll MT: Teske ' Ms. Lorselay Mr. Teti Mr. teOplss Mr. Tsar=is Ms. Rsaeb Ms. taks 2.11 a3oor -CTR-ARCH
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PROTECTED BY MINNESOTA T09ACCO IRIWTION PROTECTIVE ORDER 43 ! ; provides two important opporeunitfes, one sdentise, the oder prac![eal. Itf former is Ns op- portunity to broaden the saops of the iaquiry bm the $denae of ETS to the saenea of Indoor envirorunents. The latter is to undrrstaed that when tobacco smok. .oaunWatn in sn• indoor environment, it is a symptom of a mor. important-aad potentially morm darsrrout-probiern; inadequate ventilation. ETS ia Contest: Carirf the "Siek Bsildius Sjadtoss." One of the most impresave and intriEuias of tbe prpmtstkonw made when the NAS committee met in Washin`ton on January 29, 1986 was aude by Gray Robertaon, President of ACVA Atlantir, Inc.. a¢ompany sp.dali:inS In the atsessmeat and resolution of indoor air pollution probiems.• "Over the past Sve years," Rob.edoo said, "ACVA has atndNd the air quality In 125 major ofQos buildings with owr 27 million squars feet of operm oewpdd by over 135 thousand people ... as well as numaous small oommatidal buildings aod rsddeue.e. ... ACVA's pritaary lindinE-thst environmeatal tobacco emoke'rar* is the esmm of the indoor sir poDutioa problems found in thesf baildinp-is Important to this Committp's woelc.V "On many occasions," Robertson noted, "iuttisl eomplaiats sss tl,ou to be related to tlu presence of ETS, when symptoms In o~Qa workers s~ub as so» and ~stery eyu, hudaches, nausea, coughing and general respiratory problems ats report.d.... The reason Is obvious- environmental tobacco smok. often is the only visible iudoar air pollutant." Robatsoo went on to point out, however, that "the prasncs of hiEh aoaeeatrations of tobsoeo uAOks indiestq a much more serious problem of poorly desiEned aod bnproperir msintaiA.d ventilation *y:tem. In this ca'e ETS, as well ae a number of other more st`niseant indoor contaminants, arm permitted to se+curaulste in the indoor ipaee.•" Of 125 buildings invatitated by ACVA sinea 1981, hhigh l..ob of environmental tobsooo anoke have been detsrmined to be the immsdiate cansa of indoor sir probiaro In only Sw, or 4p.reent. In a eimilar study of 203 buildings from 19T&1888, the Natiotul IostttuN for Oxupstionsl Safety and Health found that only four of the buildings stndird (2 peiaoy had Indoor sir quality problems attributable to high oonoentrstione of ETS." 83=nilieaae;y, where >d:h accumulations of sTS have been found, ACVA also has discovered an .xeas of llag! and bsetiaria In the bstinF, renti4tion and air conditioning ystem. These mktoorganim baw bm idmti6.d by ACVA as tM primsry causes of the complaints and aeute adverse bsslth eli.cts reported by buildinE xcupawts. Among the bacteria discovered by ACVA to be major contaminants of oldoe HVAC system:: Staphylococcus aureus„ Staphylococcus .pidermidis, Coliform sp.eiee, Diphtheroid builli, Pseu• domonas speciee and Serratia spedes. Nine percent of buildings inrsrtipated, according to Rob- ertson, "•ezhibited high l.vels of potentially pathogenic or sAerpeandnE bsoteria." Among the 27 differeAt spedee of W oontUninaft air bandliaS systanc Peulcil.13mn, Muaor, AsperEibue, Alternszia, Rhitopue, Rbodotorola, Caudlds, QsdosporhuA, fiaw73s, Fusarium and Cepbalosporium. . Of the over 125 buildings stodisd by ACVA siaa 1953, Roboteoa report.d, 39. or 31 petant, have been "found to contain high levels of potentislllr patlro90de or aperp esnsiai AmSl...: In some instaaces, colony ooants of airborn. W bsrs rna iats d. 1boasuds pa enbk met.r of air." In revaal buiIdinp ebarseteriaad by soasive stsB oompiaiob, fbs Spoers of tb~e isolited !1m were used to test "aU affeot.d ~etaff' and "sewrs sD.rsie r..elioas was aonsrmed." WheeI ih oHending FIVAC .yRemt wers cleaned, a"oompl4Ite abataamt oI aoMpWnts renWlt.d." The experience was rspeated, according to Roberbon, '9n arh of tbe fi.e buildings fouad by ACVA to contain high levels of environoaentsl tAbaoeo snwha In eaeb of tbae bnl3dinp, oaee the 81IAC 14~p ('001149bb
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..0.61M1•339"1 mm r. .. . i ~ 0 I I ; : P~o n0340t)
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• S ZIN/= RZFEWMESC ourMna 0 ORM ie , most asked questions about cigarettes. . "Advertisinq certainly is not the cvlprlt" That's how a Director of the U.S. Office on Smoking & Health answered the questi.an. If advertising doe.n't cause kids b smoke, whet doa? Thero are no pat answers. Aesearch by experts Indicates peer pressure is important as well aa many o&w complex perchcloqi. caL cultural. and socio.oonomic facbrs. There eaaY be as many reasons why as tha» are kids who do. While ciqar.tDe tndustry sales are incnasinq, tewer t.eaeqers are smoking. For esample, the American Canoee Sodetr tepoets that among younq waasa maktnq has decr.aeed 17 p.wnu since 1974. We think that't good because we don't think kids should smoke. Smoking is an adult custom based on mature and inforaed iudqment That's right adults, not children. If you d like more information, write for cur booklet "Answers to the most asked questions about ciqarettes," Address: The Tobacco Institute, Sulte 831.1875 Eye Str.et, North- west Washinqton, D.G 20006. We offer it in the belief that full and fr.e dis- cussion of these important public b:ues Is in the public Interest And that in matters of adult sodal custDms, the vast maiority of lair•eainded Americans honor individual freedom of choice. WEIGH BOTH SIDES BEFORE YOU TAKE SIDES. Ln ~ ~ N ~ A 4 ~ ~ ~
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t T PROTECTED sY YWNESOTj ~ONtCCC Mus. _ a1~ TRCT7vs ~ADE~~~~. Ma•antinw. hkve undresund that eira.ater ad. ~. % rel•anryt i. rwit t1a*qgOtnsI as intluee Invp1r N1 .tan VnfllnlKm ki{h IK a1n'hYSh• r4r. hut to divicle tha al.radk ratinC naikat iw• petwmninA hraiK) nk•ntiri.~tkn n.~tk.n and Mw.k. amonr i+nsldr w•his aie wnrdu•n.1•hat ath a~twinr tira. e.r initiate.~ot~k~nK w.olw•icaaa •. Nna.. an'et'al F'•unqs7n e+alntrita that alhw.• nn ad.eRianR hut.ce inet~.•inK.dr.. •1•hat it dtnsn't eau.r 4tah ta.medce a inditatrd in tlN dnqs in tas•n >atx+kinq in thi+ tountry w hilr riranqte nnkrn eantieuie t..l.n>rttnee thei. Mstnh -tea adult .nK ALCa. 4 Neuld yw, aa a teb.eev ledeistry ~.~~~.'t youm t..n.go aon er M..r intkatn• etnple,r.as weuhl tdl reu thev'd I•rrk. their ehiwtett did na .ntek.. =tnok,n;t ia an adult eusotn. Kke.oeial drinkinEW us,rinR u/p latr. making otte: oM tt clwtiee of M•hat movis w TV sfwws to.rateho latttR /At.dd he utaeal .~w to aeake until they hsve enou raan. knwv and erre.ienee in Iife tu ma ~ttattua and in detiainns. 5 Oe.a ai&rotto neaico.nd.nser non- . anteh.rsii N1t.t'a tla 1ot.at raasroh! . ~ lan. sivork who M•ant .mokinR b.nntd w.et ariet in puhiit idaees.ae that attokr in the .en>a{+henr e.n ewte dieaie In nonnxdurn. '1'hr.r elaims de tat. he•.e.en ttand up hrforrr arientiRe scrutiny. Recentk. br examl+lt. a a/+atteu Mud~• inx that notwnoki~ w•iraa seroken hae e s li • risk af /unR e.neer Rot a lot of ruhiieit,r. lfut the y alidh ef tM awl.• w•aa aerioudy yuest ionrd in the medical titrnwee h! a.•.rirey o/ esrert. , around the world. Within /ix mm mis an Antericsn Cancer Society aude tove.i 1 T}•ean and 200.1NK! Ptopie ron- tr.dieted thp a{unrae study. The new ft.eanrh. M• the society a ttuiaieal d eeetor. indieatal that •ierond•hand•.nwke haa inaiEnifieaet stroet on IunR cancer nta In notrnakers MN11T00668190
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© Z1i0 DAYS Zp JANUARY On two days in January 1978 a public official and a larse, private, medieall7•related organization each issued statemeats vtiich vere sdelsadin=, inaccurata and vhich both sbould have bovn vere tnsuppoitable: In 1977 alone, wri than 300,000 people died froa cancer, heart disease, and lon= disuse attributable to sasldnt. ' Joseph A. Califano, :eeretar~ of Haalth, idncation, and ti.ldar. (1) Last year, smoking vas a aajor factor in 220,000 deaths from heart disease; 78,000 luas cancer deaths, and 22,000 deaths from other eaacers, including eanear of the aoath, eancei of the ssopha=us, cancer of the panerus, cancer of the kidney and cancer of tha blsdder. Joseph A. Califano, Secretary of aealth, tdvtation, and tialfara (2) Ciiarette swkini vas related in 1977 to: • more than 320,000 daaths; Anericaa Cancer Society (3) This contention of "eaeeaa deaths" has been pivotal to the rmokini and health eontroversy for,aore than 13 ysars. Although the figures vary depending on vho is giving thm_aod AsS, and how much shock impact the "authority" vishes to ereata, they have been quoted, repeated and sltsundarstood so such that asap paople accept th.o umeritieally. iIN 229?'9 CTR-ARCH
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0 3 PROTECTED BY MINNESOTA TOBACCO lJT1GAT{ON PROTECTIVE OROER social and et:onoe+io raenifieations, it is unrealis- tie for us to suggest a tobacco prohibition as a feasible snort•taree goa1, and that campaign would bring Into question our own credibility. p Is there that we are on our weakest Oround, While prohibiung use of cigarettes In publio places would pleaso non-sntokers, it would not necessarily reduce owrall cigarette t;anwmption or reduee the health eonsaptlaneos. We hsrf done tiette resqrch on the hasards, q any, of other people's eigarottes." 14 Are non.satekera aubjeeled to 1 heaNh hazard when they breathe o1Mr /eopN'a smoke? Public smoking in a normal environment has no known assooistion with diseaae. Dr. Reuel =tal• tones. who was a eonsuusnt to the Surgeon 3.n- eral's Advisory Comnlittae, stated, "1n very direct terrns, there's no medical Oroof that non•seakers exposed to eigarette se+oke in ordinary ratations with sn+okers suffer any d.nrage." A study eom ducted by two scientiatf from Narvard UnhrV- sity': School of Public Mpalth also failed le dNn• Onstrate any health hazard to the non-smoker. Th~ scientists took a special ait sampling device into several Boston area public places (rataw rants, wailing reonrs. Coektail lounqas) to thoatwf the smoke eoneentratiem. Their figures ehow that in order to inhsle the equivalent of a s"N filte/ cigarette, ahe non•sR1okN would have 10 sit in a Crowdad cocktail lounge for n1ore then 100 consecutive hours. I5 1Nhat abow the aaeged "righr M breathe srnoke•hee airt St,tod In terms of a "right" the isa1N beOonMs more fundamental then just thw question• of whether or not people shoYld be a1bwod a smoke in public platoa. Aeaotdirp 1o Federal District Judge Jack AA. Qorden, the issw really involved personal Irs edOn. Tha/ was t11L niaw espress.d by Judgo Gordon In hie dedaion dia rrrissing a tawaA Mat would hnr. Prohibitad • . on" and the sale of al4pata N tM N" Orteans Supadonto: "For the CONSpA1on 10 be nad to protaet nematnekors frow UNpNn4 10• boees tarnoke would be a broadan t/N rtOhtt of aN ConaNMtkA a ib1Wt haMlofOr~ YMNfd of ... This r.ourt Is of tM epMren tMt IM $".t.*. Oortt- aiw attito0b lew.fd ttthokYp In Me Lou- iNMa &tpordotftb atl.quNNr pfMNwb iM dNl- eale bdanp of Indhridwl AqMo rriqtobt yiMdMq 1o the tanptatten te NMenrsrtb In purely private I - r 16 Who is s..esomm.lom «t...ee., The tob.eoe Ihdowy htM a tw.W rhO.a at tA. aoate a00;~000./ ~a d Is /A~e b11hN IarEoot eaah eroP bMWtd eedt, sP~MrtA whar! Nd aeqeR uM „M OYNOIIqr apdAAp/1t1/ 1W 10bah0 oroa+en .w.4e.e 011baea. The U.S. a.a4 the N.anIf apaar .a ub.e.e «d atft third Isegpt tob.oee itnportota TM noult 1. s post- Mvo nu eenbl0utlen of Kam tl+fan IIt blMton Por rw to the U.iA bd«toe of paynn«w. 17 •A.1's the .Reet N tobaeeo t.,naT FoOard, W!b and IoCd OO~wnMMMb rttafto ttom.'1 buqen afwwdyr In rlraU tws an ta baoeo poduast. TAM loraM» haw Prwldb aChoets, roada, hOapNMa an0 Olher 1dW dOtl'ertiF rttaM atwidos. Tottyoob tac eelNttNra wb bs- a.d" eaMy by IAON bao MoehoNe OrvNpM atd OatseMnb. Since 1dp wMn tM F~nl Qev- onrbont bpae Wln0 bbseoe, ntae than $107 baml,hn bbel eoNboMd. 18 Oa assokora g.y theilr fak aharo N taxes? They eataNUy do. LaM ywr. Uor osawrl% 1fW gINW aaah.rs pid owM t110 mllMt+ In dntbM»d foOuM, ttea" bM Ned tWOM, In FetR=. CeuMr 1n vHgNis (wMr" a rsarretlw OuWN sntekln0 OrdiAin" wat r@OM1Mr a1ladtedl tlnlokM PMd 87.8 wklftt tnore then nenoantolarst In IoeM. tpato and MONN oatobe ltsa. tAA01QRS PAY 7 ,.A .._6 ~' ~1
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9 i PaOTECTED By AAtNNESOTA TOBACt:O UTIGATtON PROTEC?1vE OROEA the 1964 Surgeon General's Report on Smoking and Health .epor:ed tnat it is present in tobacco Smoke only in insignificant amounts. 10 Does ei9arette advertiaing cause young people to tlsM seaitirNt A number ol independent studies have examined reaions why individuals choese to snloke. NO study has demonstrated that advertising Is rr sponsible. Dr. Ernst Wynder. President of the American Health Foundation has said. "1 d0 110111 believe tnat advertising has much in/kaneo." In a recent editorial about its eiqarette adverfit- I+q poUcy, The Columbia JournNla,n /Nview, ro• markad: "What about the solid research (which indicated) that cigarette advertising rarely in- Iluenees decisions to smoke or not to smoke. but (rather) that its effect and purpose is to influence the choice of brands?" Advertising creates brand loyalties: it appah enfly doCa not create new smokers. Tobacco companies do not encourage young people to srtake. They regard smoking as an adult custom based on a mature individual's freedom of choice. 11 What orqonisations oppoq smoking and tobacce? Some are the voluntary health atseciationa (American Cancer Society; American Lung As- sociation; American HearS Association) which existed long before the I96S Surgeon 3anorat's Ropon. Other organizations have aprung vp since then, mostly during tM Iast three to iive years. Most are acronyms: ASH (Action on Smoking and Health): fAPIS (Fresh Air for Nor+- Smokers): GASP (Group A9ainat 'Jnrokers Poi- luuon) and SHAME (Society to Humiliate. Aqgrt vate. Moniy and Embarrass Smokers). 12 what eathNes the .MI-smotsinE /llovement? oospite the ix.seneo ef wirNnq notices on aN cigarette packages sold In tNs etouMrr. then aro 4 i i tltlp these weo believe that it is their duty to "proteq us tront ourselves." Ffty years ago it was the consunlption of ateeholic beverages which aroused the passion of such crusaders. Prohibition was supposed to save the nation.. bu1, as ws now lurow. it croatad more problems than It aew.r. The oppotitlort 10 ft penonat enjoyrnent of tobacco began soon after Sir Watta Raleigh brought 1M tirsf csrqo of leaf to Erpland in ft NlqotintA csntury. As early as 104. antWobacoo patntpNsts such as "A COtrtttublpto to Tobacco" atAhorod by it7eq lameM I of Enqtand were eirew ~ tated. Today. with tebaeeo woN into its bfth century of use. ft controversy continues. N the 1lb0a and lOs, fM attack against tobacco was aimed at the produet-eqsretts-and ted to the paetaEo warning IabN, the broadcast adver- tiairq ban and higher taxes. NeverthNess. ci0ar- ette silea continued to riM RecNftty, the attack hat ahtfted to the users of the produt:t-lmokors -by attanltrts to make them socially ueaccept- ablo. ATSrican Lung Asaedatim pasaprosid.Mt Jack Hofbean has tuid, "Probabty the only way we ean win a substantial reduction of smokinq is if we oae soQOhow make It non-acceotabte so- eieny. We thought tAO soaN of medical statistics and opinioes would prodree a ntaj*or reduebon. It dlde't." TAsre aro so/no who would go furtMr. ca)linq (or an atMOYt prohibieieR of tobaCCO. Dr. BenjanNn eyr0, a fiast-preaident of the American Cancer Society said rec.ath. "1 ahink we would be better oH a thsro wen ne eigantles in the tJ.l, f would tik. to no theln baensd by Conaross." t 13 W1.ft Mt~,Nis - I- i n anaetif AeemdY+O a Dr. Peter Bourne. Special Assistant to ft Prosidtant for Hoapil isawa, such propos- tls an nett r+atisqio. In rrmarka to tM Ad-HOe Conrrnittto on Tobeeee and :nrokin4 Research of ao ALalean aane«:oeietr on Novun00r 10. 10T7. Or. /outne euid, ""eavso of ft p0titlosl. E NINA OOS.: :{ ~ ~.~
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., , PAOTECTED BY w11NNESOTA TOBACCO UITIGATION ppOTECT1Vt OpDEq \1wh 10.0. lu•/•n m:wlr It.• aoll..nxtkerstds IIMI l. «. (:.+IrG•rnia rlaititinic t...iNwv tlut r!ti%*uR 1V.rt.•tll• .//ILI.• In 11tr wlrrkltIare R{hltlA t11r lunl! IIHU"/u.l/,•i INNN/I1114M. •1•1NOewhnttlNlte tl r• •uul. .n g-/a•I. htw...•rr. fail in talte i/ttn t. ,..,ttu ,.11.41 •.tr td thr 6«v.•rninrnt: ehief ,•%{wrt. .% nNa• itn a Lnp-t ldinwisi in 1hr.anK .....,.i . . ~'11.c c% i.ICtwY• ltht.r tsom..itr on..klnlt rn .t t:.It. ral J•uMwldla•rr Ila. havltit rA-cm, w•tvte 1 r1 (:1.otJ.• I xni:utl td thr Xaliunal I ksrt. I.un1, , ru I I11...1 1 n•1 il ut r. 'renlain. a~.arnr, inercntplele • 10.1 •.rr.n.•lirna% un.'.mvinc•ing." 1•Wu Wean 16ter. tt .u11 ,-. \n..lla•r •nuly c.nnnNrrdv lnual in.n/l{vrt o1e110k• fT1L ra.irK1Mnn i1N•ItlooedtIN' rtleNQrlnlelK of vnwul.u• /tcotter in I,moQ>aie huildittRs around J.hiul,nno. 1).C . hr lw•e rt+wearehets who then , I:IU1rt.I that />,N"Kt{cers srr ex/+aed to -sixniG•~ .•aot ,ir Irdluti/at l+unlent. from indoorsntokitl~. ~t, .ladinltivr Ilic•ce hrre. eithrr. llresa.e the Irr. l~t it;atl /n. /na•swn•ll no suhusnee speeit'ie to c• •1•:u-1a .nN.kr-like nicntine. ktr itwseee. Nor .lt.l tha•v takr ony rraclil>k+.k,An• the introduction r.l 1tt1.:NYM11•Itxtkr. Tlleir IIR'i1Vlrenletlth therefore. m+. •,tnl,h rc•Met the smlwlnt of duft in the sir attll f/nw r tittlr rrlevaner.n far ta toh.eeo anake t• rrnaa rnt•tl. \.r h~r.l clmclu.icna can he drawn aMltt the e/• (.•. t.. if unv. of rnvinmrnrnul eiRarrtte smoke on tht• h.althv nun.nK+krr. The i+utte is sn emotional ..nc. And i•na+tinn rual• elnud the peree{xiotu and luwmuns ttl tluwe who ii:dike ciRarette elnoke. tia•irnlific• t•lutlic+% on the narNCrMkcr, questiort con- tinur. a. Iltly .IxwJd. 6 • 1s it true that sideatre.m smoke that a drifts oRtheendoftheoi&lrettoootttsins . trr 3reater quantities of smoke eotl/tltuMts then ntsinstresm smoke draw•n from the eia.retter by the smoker! All ceNl.titucnta af ciprrtte smoke-ineludinR tsr. ni.4KirK anti esrhnn monnride-sre immadistely ddutrti 1+.• the xlrmundinR sir. N Iro.uremrnts of atmoq.heriecie rette smoke t.krn unclrr .nr/i~iir nw/iriem ind•tcste that the ennt r1>,u inn of tnh.ero uooke to the tk w•e brsathe i• minimal. C)ne study st I larrsrd found only 3 lSNAT00668191
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-2- /Jnw. ..Fin «..• •1.. Rtw....• ,..w •s. •wp......iw .+*..e f/4a orisiaated. Oae health official quotas a public relations practi:ioaer as the source vhile the latter claias they ease froa "the =overameat." Media occasionally attribute them to their nevest source but iretessinelv nrovide no attribution at all. This papsr rill att.mpt to trace the origin of the "excess death" figuaes, shm how they baw been "marked np" (or dom) aad, fiaally, vill shov bov vulnerable such statistics are to misuse. 'Whare did the figures come from vhich Secretar7 Califaoo cited on Januar7 llth, and thi Amerieaa Cancer Society parroted three weeks later? The "excess deaths" concept =rev primarily iro. various pr.•1966 studies comparia= smokers and aoosmokers by two Britons, Richard Doll and A. B. Bill, aad those of Daniel Boss and Z. Cuyler Baaond of the Ooited States. Much of their data vss naad, in oae form or another, in the preparation of the 1964 Smoking and • Health report by the Advisory Co=ittes to the II. i. Surgeon General. Rovever, at w rill see, that report visely warned against the concept. • ta her book, Smoke Sc, 2ob_ ej Lbl Public iis1=, published a year b.foi-s the Surjeoo Caaeral's sepost, Naatos Maurine l. l/euber=sr quoted Dr. 8osn as saying it roold be his "bast Suess" to blame smoking fer "300,000 to 500,000...duths I dip 22980 CTR-ARCH ., . . _...~.. .,. _. _ . n ~ A
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0 c pqOTECTED RY MINNESOTA TOEACCO UT{GATION PROTECTIVE ORDER 74 .# tM blood rapidly and there is liltle etFeu/atiw aff.Cf, sy the time tM eiqaretta is Oni{heC much . of tM niooune is already matabotiiad. As was , pointed tlut In the 1l6a SWqaotl QaNarat•s Ad- visary Contntittae RapoA an Smoking and M.atth. . "MtAtlM in qtlantiffN abaorlsad tro111 >tfnokin9 atta atN+a methods of tobacco use is vary low 0 probablr eo.s not raprnant a aiqnircant i~ an 0 haaNh problant." 'Tar' is tM pafttevlaN twaltu eaa.etad by allpa/~C001U1s and condensing tobaCeo smoke tlMw apaeiat labaatory eoneitiona. This method N pre0uern4 'tar" has Uttla to do with the war we arnoka elqantt.s. Conean about "tar' is P~ly due to aryr experiments which involvad paitlWlo tM aAifieialty-pro0uaa substanea on LbR!a" anie+ats• skin. Other eonHnon sub- ata11CN such as taa have also b.an appli.0 in much tM ea" way, produeinq skin eanear on 1fN baCks of teyt aAinlals. =ueh e=pNimMfs ara of tltty scientific vak+a tnnea the skin of test aMtttay doaa not approximate the lin+no of a hWRatl kMp, and baOauM tM quantities of "tar" used Aivt• baan aMi111atae to apWl a mart's atnekift0 t00.000 etqsrattq a day. WAro gps contained in el0ar.llo setoke Aart7lhd to the MIOka1? 1t is CIURIaO that cigarette a/D01t@ contains harnl- IW Quaetities of oarbon tttonoai0.. nitroptn di• attN. a+td hydrogen eyaniea. Nowaver. such oaM! CCCNr oNy in low tAnCa/ltrati0ns and antal) t a eoetpareC te tM Iwqn eonwnlralions Ciparettes havo n.wr bean prewn.te be taaato. ouan Many varieties of low 'IaP'•+ttaeaka aiprMNs W4 IN" atnouma eaeassary to fuo0uoe =iqe are now on ttu.marttat In raapontsa b eettsu~ar ~~ ~~ preterenee traaCt Salas of Ci9arMNa wilh 1an0, •• ~"'PWRIevatio^ proam prodticats carbon ot "tar" or ~» tnerassM y ti0~1. b tl7f aate e.~~~ on a Na n^Oe• auto a- COmprised more than 25% of Iba ata.lcat at 15». hooft PrIls" du^O arm am Dr. MNmut wakNunt, said h+ an arttate published In IrN- .:.• ;. ~ M.dlobr.. o.eMrtba. tfn. -Ciqarette $ A.. "w- aw rv.kwlm} itiM!~lt:: ~neklrt! a an tnai4nilipnt source of asreott dansereln~' ~-•: ...• ~•, tltonOatMa in tM owraM aprqaplNra at aanpar.Q Ctaims Mat"tas" and w/81 O/ttal nalurat and Atan~/11a0e IOUrCatt,~ nlf~iilbbt dONW.i'KanA y ~A a~,. ~ a~" Is prasant In the smoker aro noft strp0end by adatutl ~' huD rdqaratta snaka, As for hydrogen eyani0a, The niCOtiM Ir~l a Oioafatbtila ~11it1a 40 a sease. lung cancer and oltW aisaasn tra Quently associated with t/nokarst It, as SOaOa ano.smokin9 proups daint, eiparatla smoking Is tre major eauso of turq aaneu, why is lI Utat the vast maiority of tM "h.ay' sraokars nawr develop the disease? Why t+qe't Indopandant sc,enune rsearah bNn able to tdaelifr anr onN or eombination of tM thouart0s of eompett.rtta as found in oiqanettft smoM M the aauao of aMr particular disease? WAfr in nren tMn Iorly years 01 res.aroh hasn't anyata been abN te npta euea the typo of hrrts taneor aaoeiata0 witlM s'noking-thrOUph totlaC00 talloka IflhalaflafM~ in laboratory anunalal 6 Have esNnlWs AN.nMeaN what causes eanaart No. Seientists are eotttinaieq thaareh to Oa lermine what causes eanear in huntana• In at• tempts to learn iM eawa of iwq eanea. lor e:ample, some rqeareAartt an itwasti9athq the ertects of envirenmenlal agents iMla air snatt as vapors. dust and other polkAanta. OtMr seien- tists ar. studptq the posaibtTiqr tttat t:aruin iWP viCuals may htlve a 9eneli6 Oradilp0lllbo/l to cancer. Sorne stOdl.s of the t/1a10ar16a af IaMt4 cancer by geographic ana.0o not show eorr.ls- tiont with tevats Of arnOkiaF 7 Are eiqsr.ftes iqt •ttV "W atn/ nieotine "Mfaf" for titlNt;.nt7 • ~.~~ .. . . . 2 •~ . 3 .Mt.NM:9_i
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, -3- , per year." (4) Eorn himself apparently eas@ to repard that as an exaggeration, and wbseqwatlp hs confined his "excess deaths" estimtis to 300,000 or iiwr. The Sur=eon Ceaeral's report itself raj.eted the theory of "excess deaths": "Shs total nvmebsr of swsss deaths causally related to cigarette seokie* ia the 0. i. population eaaaot by aaciaately estimated." (3) Why did the Ad.isor7 Cammittst take this position? ihe Assistant Surieoa Ceaeral, who was ric• ehaiiua o=.tbs ddvisoty Cosmittes, gave the reason at a news aoalsrmes at the tiaa the report vas relsise'd: "The Co®ittes considered the possibility of trying to aaks sueh calculations but it ia.olvss sakiig so maay aistssptions that the Comittee felt that it should hot att.mpt this..." (6) Eut others i=aorsd this restraint. On Jaanarp 11, 1l6S, the first anniversary of the Surgeou General's report, 3yrrtoa Footi, an advertising executive and ehairmaa of an organization eall.d the National Interagency Cotimail on 3.okiaj•aud l.alth, basas a aev rosmd of "aueass deaths" speculation ia a osvs . relsase: "Estimatss aad@ by scientists who has spent rars s tvdyini the probis, vaary d.peadins upon the way that the data are iatarpreted." rs..rth.less, be wat on to ass.rt, "It np be said with .nr.asss that aisarette nokia= is today responsible for at least 125,000 deaths saeh year ia tbs Vait.d =tates. Cijarett• ssokias .ay b• responsible for as .mJ as 100,000, deaths p.r year tb this aovatrr." (7) hIN 22981 CTR-ARCH
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0 a PROTECTED BY MINNESOTA TOBACCO LRiGATION PROTECTIVE ORDER . . . - 1 r F i t 1. Aro ntore or less people snwking ewws lia%'alNr /!f iiliKllati{n1 KNMIh. the MN/MAjy11f iKkall Amavitsna whu clx..we iu snKdte : al+/+srentl. (areter than a%rr. Mit the inrick-».v~~I,mr.kiuq- ehe ratr /K Lrra~onta~r-is kwvrr. Xrariv ert mi1li.Nt .inveritvn...x slnwu a thirnl .o/ ilw adult Lrrt+ulatNon. .nMske. l'he l'.5. 1'uhlie I Iralth Sen•ia: rrryKUu atmdcinR incidrnre anwma mrn in I'eetI ae k,.I prravnt and amunK wYmien. 24.11 lwft'rnt. '!'eenaRe.mokinx ham heen deelininR snwaetg ixMh h" and Riris. Asavrdinq to the Amrrfcan C•aneerSorietv. the ineidenet tef smukinK smnnR termRers i dewn : s pertttnt. ee the kM we level since 1 W.i. An>tteK eeenaRe Rirls, the snwkinK tote hss daere.sed 17 pereent sutev 1974. in lrr.ti =3 i+rraene. 2 How enan~ ef jsrettes are soid .nnwlly . fn th. u.S.r . Aiq+rnaimstelv hti billion eiRarettes ..•rre iKir• ehased in 1991. an iner.aee d 17 i.erernt in the last deeade. Governtnent sun•ews indicate the s.•eragev smoker sn.okea about s pack a dkv. nMu svrraRina a Iittle mnre tlwn wotnrn. 3 De.s efpr.cte advertising eause kids to . start smoking? IU not, what doest There ee no pt answers. A dir.etor of the Rovernment i Offiee on SmokinR and I kskh ha4 said thn frof+le ehoase to senoke fer a vsrietv of rea.om6 l+ut eiRareete adveRisinR is not wfist he esifed'the eulprii ' A recent SurReon General's report said that nsiwnses from teenaKrrs tiwtn• se1.•es indieate that p.e. p~.+wre en..• be one of the msjor inQuenea& ils.esreh M• es f•rrtP indiesteo that the l+ressure of f+et+es is imfvoresne. btu so are msnr eomfdfae!c et i+wYhekssiesi. cultural and soeioeeeitamie as. '1'een smoking is ds.s a. ehouRh, and wr're KIaJ ie 7s. lieeswe we don't think kids should stnoke. as you11 see in the next question. !lNAT00668189
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0 a -7- Lxc.ss Deaths Amoai Male CiSssette Smoksss Age 1` and Over. n.,4«.A A..p... IM A ~ A Lxeess Deaths A.eei= Total Deaths 3 Cause of Death C s. s Seokeg - Malas li i Oves 2 o. esasnt e A Lung Caacez 29,472 13.5 35;304 0 Z arocehitis 4 bephy. 10.002 76.0 13, iSa ~ Caaeer of Lasyas 1,564 72.0 2,172. b m Cancer of Oral Civity 2.873 St.6 4,900 ~ Cancer of lsophaguv Coronary Artery 2.074 .S2. 2 3.972 M D r Disease 91,797 28. 3 =24,144 All other causes 59,470 17.0 $25,972 3 All eans.s 227,252 24.9 909,622 ~ 2 Z Estiaated Sroa data or pso.peetive.otvdies: stekass' distsibatioo. 19SS; U S population S. eostalit7, 1962. 1962; O ~ ' . . , . Excess deaths over stimber expected lrom soa-saokass' aostalit7 ~ expa: iaace. ~ D Above is the earliest knors tabnlatise of "eseess deaths," preseated by Dr. Mottos L. LevLs is a Cosiressioaal hearing 3a 1965. savenholt, also cited by Diehl as a soarce, did got taatify at the heariai,tiat kis 1964 stateosat to vhicb ni.h1 refasred -• aetnally a lettsr to the editor of a health j owAh N. 12985 CTR-ARCH
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• PpOTECTED BY IMlNNESOTA TOBA . 1)o the tobacco rottepsnies control the 12 * research they sponsort \L..dutatv ntK. Inclchrndent +leirntifie ath•ison .•.:.Iuatv 4 . nt161rx1 ra.a•art•h 1sTull"I"h9s hr indiridw4 .u..l itrtuulium. Aatsrah are matkNtiih tqstrinp .ut.a•h.d .nd a•aeh rs+rarcha•r i. frt•e tn puidish .in.l. ra~ult.. %.hatr.rr tha•y nay he. 1'j• \\ hat about fires caused by the osre- 1 J less use of smokln` materials? l N.. . a.inyllr th•.th or injury caused !w a arcla+. .ilw.itiUK U. twHI tntl It1anY. pta dr ha.r asptested that etiRanttA eould 1v n+r.lr t~i(ferrntlr. sn that they would go out a Iw•u m.t Icrina pufksl.,fksl. Uut the qusstions inrolred .n L.oKiucinR a riRsra•ttr that eendd not• under am t•ir.ltrnhtanlt7b rausr a fire are inerldibk• t..mld... I laMal.. there has heen Kwne {.roRrws .n Ihi..rra-Lsrtieularl. in the devekrpment o1 tar.• anal .rtxdtlrr•ra+istam uldtoWered furniture. •1•ha• rigara•ttr cnnryanit+areeontinuinR, along .o ah tyhar intrra+teel ytrewtf+s and indiridus4. to ..,.r0h f..r ana.% rn to thr seeidemal 6re problent. 14. ls therre a tobacco subsit#y! 'I•hrrc i% ntt tohseeu uth.idv. There h sto.'ern• tna•nt pnir rwyurr rrw/ p.adanr'va r.wral proRram Ihat IrurantaY+ farmen a minimum price for their u.lwa•aa in ra•turn fur striet limits on produetion. tiitnilar Lrc+Krana tkc the sarne for 11 other com• • nwKlitia+. littt tihe netwtay isn't a Rift. It i s k»n. rt•I•aid With intenst. In the + K vrat+ sinee the priee supprt program • l.ty;an. it fas ht•en the rtta.t Nttressful fsrm l+ro• t;ram tbr Rtw•ernntent has ever.had. While making hnln uf fi.7 Ai/!!.M sinee 1911, the program ohoats a na•t hw. on Knvcrnmrcu books of unlv t37 MYIII%NN. 'I'hat utxntnts to just one•tentb of one /ti•ra.+nt uf all kwses kr all eommod'Kvpttce *u1qK.n l.rnt!ranx. /htrinR the ssme•41i vean. ud.acen 'aueluet iwtrehasen have /+sid fideral. ntalr alwl local tressuria more than ~'!90 Ir/Mw in esciac tasas 7 1l111AT00668195
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=t.1t:3...a ax_ 1m 'I inie.. riR.eattr exei..% rsprasent nrarA 4 Iwreant nf t1K+1%tae taa receipb-an irn/+ewtant rtvenur ruerrr for finanrialk ,tra atate Rovrrntnenes. In 1'1+t1. theracwr finsucli rata neari. iV itiilinn and munieiplitis.n itional filrl iniilinn. Sinre ly+ 1. M hen the eunrnt kderal exenr N a at. the .vrtare wtr ciprette tax rete ha. in• erea..d Nt1 peyrent. . Cin.rette e+eei.as are eaCreaive. taking a hiRhrr f+rolwrtiwn of ineotne fean thae w•ith kn.•er esrninp than from thas with Rrearr ina.mca. . Combined fiderdL aate and lecd exeises and sdrs taxea average :4 avnts per pack. ahetat 97 prreent of the manufaeturrn' i+riea. . ~ ~ .eat.mik a.,t<leutio" 10 The tobacco indtwery eauributs mightily to the V.SA eeonotnr. Led. SeeN•n in :0 atata on an atim.ted 276A00 farm.k h b the.ixth IarRat 1J.SA cash ero{+. The u.3. is ala the IeadinR eriwtees of tebaeee and the largst im f+orter. The r.wlt is a pa.iti.a net centributton of morr than ! 1.9 billion per 2•ear to the V.S& internatmnal balance at pa. ments. Amerieatp spent !:7 billion ior tobscee peoduets in 19Y0. N'hw Is the tob.eeo indwtry doing to * ltdp resolve the aaeWng atd ha.fth oontrowrayt mer. So f.r. the tobacco indu+try 1w committed than $100 million br independent raesreh aa ~ smoking and hahh quatietr. In mnpr )es+a% induury avrarda esaeded shot of anr go.•ernment it 6r exeeedad the dsparteeent. have aMm .mokin~ and r~.areh wndins of all rolun• . taq• health a.oeMtient..rhiehr.~ula~ly .psnd ma+e of their datst.d /bnds fer adminwrstion and public relatiata p.i~s than br rateardt. The tobacco indwtt}~iem- .iitt eanmicted to ad• wneins aiattilk itpuie7 Into the gapt in kno•e i• adge in the W++ohi" eontra ers,r. lNUIT00668196
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-3- I9t. !'Wl'L: L pt taA trOV CAA W.a. rwraiG a04Aaw e.a..... And they had pl.aty of tima to check the figures oves. (9) As aaother iourae, toots cited Dr. Sarold S. Dishl of the Ameriean Gaee= Soei.t7, who was seated with his at the witness table. sut Di.6l, in a vrittsa stateaeat given to the Senate n Comittse, passid the respoasibility to two others. 8s said ~ A that Dr. Mortoa Levin of Rowall Park M.morial Iastitute in Mw 3 York had given data at a.dieal meetings in 1964 rhieh sbovsd 2 "that amng salka tsasa are 224.717 deaths amssally In this 0 eountry attributable to cigarette smoking." (10) sae 2 717 .aeh .ar! 224 ~ , M In addition, Diebl said, Dr. 2.isert.Ravsnholt of the University of Haihiaston School of Medicine in Seattle bad published a statsmeat in 1964 vhiea said that "ia 1962 roughly a quarter of a million excess deaths ia this eomtry were due to smokia j. " Bora vas at the hearia=, and spoke up. Be started to say taat the "excess dsaths" talk ool• had to do with reported higher death ratu amont smokars, without the implication that saokiap vas the aaws. 3ut than he switched to asssrtioas of eassss, vent far beyoad the Surgeon C.osral's report In thia raspsat, and eams up with yet aaother aaabsr •- 135,000: Ds. 'ORp: The lis+ae of 123.000 •- which is a very low sstiaate of the total aumbsr of deaths -• Vfiisti rsprsssats the eseess aomber of dsatM , oeons In cigarette saoksrs over ahat voald have oesstrrad it they wre to die at the saae rate as p.opls vhe had never ssoksd sigarsttss. It consists of appl the 1962 death rates to the dissasss in which a eausa relatioe+ship has bsoa indicated. These include sosoaarp heart dissass, hs canaer, brooebitis osd amph7HS, eaaesr of tIIe oral ea.ity, aatoss of the ssophaffu. cancer of the larpdc, and cancer of the bladder. iiN 21983 CTR-ARCH i ... . . . . . . . _.. __ .. _ , _ ~.~ .._. .. .. .._~.. . ~ .. . . .. . . ...._«,f _._ ...
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rew1CL~ UTXWnON P*Q he ~ most asked'quesUons about .:. :~ . -.,_..:_~... ~ ~ a Smokez Norsaolroz 0 Wo ma!!er how tl l P i c .,~ $ome quea an.. eop o et . :. . i D Jt ~ i Oq C Qni+. a aaa e ~r AG+. more or lea p.opld imoldnp aow? • =t.t • i ;.~f. . . . Dow odvvBifng oavae bdi b ibrt tmo* `'" -- Wlicty tho kftse 1...arcb an oebarPropley'a1pa~ .i .• those oppo.ed b am oliinq` i~clui~lr~p Q~w~d amth* . . ' Ameican Cana.r Socl.ty. You'II 1ea:a more about vihat the bduihry ii ddnp b Flrially, whaC. ~e bb6ooQ'inda~tr~r doReq b at~s~ra _ Fys;, ': otber qua.tion.? - ~. '. •• ~ -,._.- , ~. Below yo11l Mt.~r ~loo~, ~A~M~ls b*t~fe. •IDO~~ qw.tlons ebout dpar.ltar.~ ?. In it rou'n e.ad importarit $adinq~ and ob.ar:atiaesi br-ir.n O` .eek ari.wem .. • . • . And Tou'U aome a.rawlth a b.d.r und.e- T .fandiap of tb. bsw. invdv.d. . ' the vaa! _ Foe your~~ y, wrlt.c Th: Tobscoo ~~ Suit.'80?.18?~ LT: Str..t Nor&rnL Wathtndba, '.• ;, AC 20006. We otfer it to rou ia thm beYeE tbat (ufl and !iw -discu.dozs dee.e Mgmetsnt pub$c iruM is in Oe : that tm "tt.ri oi adult social cud=@6 Ameriosns Loeior i c~'ho1o.~ 1ndlvidual 4i& ~ +1 S THSIDES . ' s~ovo~u raicesIoES. : iL ~ ... . : ..:•. - ~'... • . ~...• ~ . I Ti. • i 1 A 2 4
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i pRGTECTEO SY YINNESOTA TO/ACCO U1IGATION PAOTECTIVIE oAOEA THESE TAXES WITHOUT lIECEMNG A001- T10NAL SERVICES. As one VtrQinia Conqnttt} Tan pointed out: -They are eeueelin• eare taseo from smokers than from non-ea+okers. what wiM Mopen when they IueaeeN In rerein4 sntokea M tauit, thus losing cmlnty ta= revonuas? Will IM -Supenisors Gnd new sourCetl of revMN/e, or wIM they cut baek loeal servi0es?" 19 who Is tAe tobaeo. VAVW,r .oMv to help resnh" pte snteklnf atN health eontre.eny? In the last 2s years tM tobacco industry has tfO* viaed Torf than $70 million for indapMasnt research regarding tsuestioro related lo seakMts and health. In many of these year: this o0/llalit- e+ant had e=eeedea that of any OswrnttNM N- parta+entL and has been substantially nror. ttian the researeh espenditure reportatt by aM tnf voluntary health assoeiations who speM a n+ajer ponion of their donated funds for Nrniniatntiat and for publie relations e.ampaiqns. The tobaeeo inaustry Is eoe+e+Utea Is a0vanei'rq $oientifb inquiry in this area. 2000 the tob.eee eenqenNe t>onlret tM research tA.fr spauor? Absolutely netl The oo+netitnieM of tM tobaee:o ntanufaaturers to resolve tne smokiap antl health controversy has never been fullr a00OCIIIIIII& Orants are maee with no Nrin4II sttaeMd sao.pt a pledge to sPtlhr the money to ItpilMfN kolMt' ttGe research. Each nseareher Is hee, Ie pu0* lish h,it study results, wMltlvaf ttiey /flftO& 21 what Is tM "..e+ wllMtip pNrat.f It is not a toeaeee su0ei0y PleEren --E Is a te- baeee Pnee stabiNSalien pre4raw. S M a loae program esaelty pb IM pna0raa /w wh.tl aM other priotatlual ooAMneelitlN M flabihb ~ so farmers ean 4et a rnasonablt rMwe on ttmir Investments. The program ataMaqs quotW Wnitinp tfw ser.aqe a fanna eae tts• /a 1obom • I r ( peoMrq anti tM powtda4e he ean a.o. TIte pno• Ofi/u ay0 allm tlN SobaCCO faf00K to boffow n10ney. YeUt/ thsi IOOae00 ee eeqaterat. With011t N~b~baeo~0 ~ be IatEor. not aeWler. wlajmrM a a netto~tlq, 1o0ooeo price oil- tiilliati0n ptwrMS htq ib m0.1 yaars Paitt beah narb to th. Eowrnatlnt tAae It benewed. This a Oawath 1111861111096 eo0aeso arone a$ 0081" for the bae olua intaNt qn ee hNt1 lor up to ha ri.eo b.ton boM+O toa at a tieto of high dtwntub. EU+a 1M propwe began in ts13, tha eunwlatiw realitatl bss to tM haerM 9owrn• nlMt hai boNl 1111,0111111111 w0 nWOpn, part of which was efhN by interqt inoenN. MAis compared to the bss stratalno by tM eorn Itabiliutlon proqram which Aab oft tM ooveretnertt =ti.! bilMOn sinq tpM TIMa, tM tob.eeo proqrarn Is ene of qN Nnst atpensiw and nast sraeasam ol tM brrs ofMtnqdlly pro~yanN, Tobaooe la atN af tM Lw erops that stiN utllltp fatnily I+antl Ibber tlnd ProvltNti a nuborr able, Groanb on a trnoM hnft Isrnt. Toeaatm ErowUp is labor UhnotvL YVhqe t; taka apores. firlasly, peaires aw+.hEeors 10 ~ on. at~.~ r ef bbatsaa If tM tobaw prke aaONlsaqon program were .eda4 wa E00.000 fann faetiNea would be affeentt. (Tobaooe h ppwe on ove. 4IOt1A00 fannb in IM v.S. On twany of these tarths, nror" t1m ent fatNly depends on tM ineont. from ta e.eoe sa*L) ' wey of ut«o famteea wowa be 111110,11" to Nok o1NM terttte af eatpoyrnera, ene ~ ot~0ointA>Mf wtlfaro nslb, tlf+d tfiM1- Ot1 OCtobtlt lt, 1l1E, tltsel iMdiOaq, Oow h.Mt1MN dMnr.fr Carlor atW abaR th. tObeea Pda e1.Mrsauos pMey, 1 peraenalyr s.o m n.of to do away wltlt a Oro,ratn ttta soaes tM peweImtent "d IP noWYto, whllsi onabl4p km ntanlr hetrtt warhlnp fmmM Is wn a IMnE.r f Ni\A 3_ _
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~ . . . . •. .. . ...-. . . . ._ ..• . •6- . . . . . . . i w~ . _ ~ . .~ i .~. ~ :..:....~ .. ~ ..•w«.~. - have appeared in statmsnts od thePnhl;e 8saleh'~ssvics as lon= a=o as last Aupnst, and to Dr. Lsvia, vbe has published these fipures and is, I believe, scheduled to testify tomorrov. The nueber of deaths fros coronary disease, vbiob is included in that, is approsimatal0,000. The ausber of deaths from •..~. .~..~ I. 7• • emp~iyieai is•16,500_ Cancer et the osal cavitp- isopha~us , larynx and bladds, add up to 8,000. Zhis tota,b Lib 000, vhich is a littlethan the original estiaate ek 123,000, but ia based on applyiag these to estimated 1965 deaths fras these causes. This tiguae is obiained by applying rates oaly for these specific diieases and oel~ to ~ra, sinoe the bnllc of the epidesiolofical studies vhich havo been doas have be:a done on msa. (11) Then it vas Dr. Lsvin's tvra. In a prepared statosnt for the coaeittee, he placed the blams for nearly a qtsarter il.llioa "excessdeaths" on sookiai. Eo also presented his definition of the term: Dr. Paul sheahe and I have .ade such an estimate. t@hiag into acconnt the a=e distribution of the zals popalatioo. the numbars of smokers and aon-saolcsrs, sad tbe aaibar of ' Z00,000 deaths, deaths from various causes in 1962. 0!wr are dw to excess .ortalitr about on. ia ewry four , amoni cigarette s.olcers. Of the estimated 658,000 dsaths among .ale eitarette smokers, over 33 psrant vase sasss deaths. LM6 caacer, chronic respiratory dissate, Md coronary bea;t disease acootimted for 'tlss larpst asaibar •• 131,000 -= of the excess deaths asoag aitarette smokers. Levin provided a tabulation of his sstiaate (sse table). fuc he did not :xplaia the basis for the aumbert oo Aich his I calculations depended. (12) ItN 1298! CTR-AP.CH .. ...~..._~. . .... __ ..__. ;...... . ....__.._._.......~._ .. .
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• PROTECTED BY INiNNESOT fOeACCO LT10 MI CT'IVE O ie ~: most asked questions g a~".u~ c~ arees. Heri s what two meioe opponents of .moktmg said oo this nsbject 1. The Su:p.c,o Greneral Qearlr and dmp1T put he has not concluded ham }Ltf eCleAdC htelaturis rawAfws that dQarelte .moke causes diseain fn acn.mok.rs. 2'Ihe Am.eionn Caaoer Sodelr. A:.noet ao.ednq 17 reaes aad.omeZOQ,000~op1e te~dicatadthet'..ooe~baod'.eaok. bes Sndp:it8aant .~ed co hmq-0ena.r rsles in ooesmokae. Fad from a repoet nub8sbed by due Steti.tlcal Dtr.cior of t!u Soci.tt in JuMA 198L A reo.at Ia?an... .tudt mede daims about hma ca:lo.r rate. ~~ wd ~qwttia~~ed ffi.Mm.dt~eal~ llt.r~st<~ite by a•a:ietr of esnerN around the woeld. Like you, we eeek answers. The bbacoo indusiry hns oommift.d more tundt kr tnde- peadeat research on smoldaq snd health than any ooa-qo.r:a. mental qroup. More tl,an the American Cancer Socletr. tbe Amer lean Heart A.eodndoss, and the American Lung As.ociatbn coaabined.The:wearchers we fund arm encouraged b publiah whsb..er theT find. Wbat• ever the outoome. If rou'd like more iaforraatlca, w:lte iw our booklet, "Answers b the mod atked quaioa about dQarettes.' Addrerr The Tobsoo~ latoulL Suit. 856.18?S Eye SM.et Northwe.t Washinqtoo, AG 20006. We o6er it ta the b.Uef tbat !uII and hee discu.sdon of these impo:tant public itauet is ia t}w public tntier..t WEIGH BOTH SIDES BEFORE YOU TAKE SIDESI 1 fh A 002 49
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, . PROTECTEO 9Y MINNESOTA TOSACCO UTIGATION PRO'MCTryE OROEA 51 Chaptet P1+s Coads.fea sd Mallara On b[ay 12. 1986, p.rtidpantr ia a ~esI atitled "Shta and Loeal Iafdadae oe Iarolontery Smoking," eor+nned by the Amotiaet Lmg ArodatJan during its annal meeti~ wera given a manorsndum "(t* assist Lot Aroolathm 94ff and voiaatars to aoater 101ofmony by fob.eaa industry consultants ...:'+ An attaebed "Rebattal to CrIddsms of Patitw SmoldaB Aeaerch by Tobacco Industry Consnitants" ea`vad pbrddaa aad eetentlses who arpe "that sweareh Is incondwive marding ahronie health edbeh boet sa.ieaama4l tobemo moice, and tbat it ie an InsltniilCint part ot iadoor a{r poDOtia" Of "...~ws OpiniORs that are "/hinpw. self-.,, v,,,g. and do not itand the te/t oi /datfis fcllitlay."• , The "rebuttal" daim.d that weh Podm aad edaitid= believe that "ther» can be so cf •ponsible opposition to the tobaeoo yia+upoint, .Na betare mmmdfie ar~umeats ate bessd." But when a aontinoing medlnl eduotla oo~raa was eebeduleds m~oe o:d.rrdty m~I eenter three months Lber p:.da~ dor 9a patpoee of heariag thoee argunmtr and .~bjeeeiaE both adee of the aw of "the tset at sci.atlse .avWq," the phddat of the buW aaodatlon sent a tdegram to the president d @r wimdtr arging thst tbe owteraoe be amaDed. Scientists who bad agreed to p te is tLe prow a~ w.n wepboad by aotH~oidaB aeelvlw and pressured to withdrew. DI o~ thaY did aa, and tAe oantana-ita program w.alraed and any exchange of views likely to bunbaluiad-wae caaeell.d just daya before it was uLednted to be heid.' Such tactics do not eeens condetmt with the spirit of open ocienttlk inquiry and debate-or, indeed, with reasonable oonBdake that asw'e podlioa would withstand tbe ftor of .dent3!!e scrutiny. This report on the udatng identiso $ter~ ha attempted to elae* the iyws. It is not the place to ugue whether the author of the "rebuttal" eirenlat.d by the hwS arodas3on; who long has been active (and Is often compaated for V.akW in the eampaign against smoking and holds no graduate degree In the health uienea, is-as be aeawd those with oppNainn~ viewpoints of bemE-"Ielt ssrft." But it J1 the plhot-and, trgtndy, the ti>ae-to adc whiel~ .ide ot the public wno{dnE iww Is a4v&i In what the author of the "erbutta!" termed "sd. entiIIcaUy unsupported hand•vraring ar=umeata." The question Is an urgat one beeasMe the answer to It tmpliestes the inte:rity of the s~der~ti!!c process itselt. It also Is urgent b.rsoso-ae the episodes aromaated In Chapter ~e of this report suggest-the pres.ure oA Kientia" to Vriw at ooodudm that wiA - apport the sati-ssnoldng movement "(fJrom a political point of view"6 i's mouattnt. Increasingly, that presyore has taken two torrnr 11leoasidsred attompts by iAdivIdual autbors to arrive at "quantitative risk as..aaeata" for ucpornre to a.ironmental tobacco imoke and global conclusions to tbe effect that, althou6 the ida 4 iaOndosive, eow rbh b"plausible" and minimi:ing noaanokers' espoaue to M is tberefoer "petideat" as a matter. oi policy. Chapter 14ro 'o` this npoit hoi dsmoastra4d th.t, aa a e-11 al seiaeiBa laet; oxpowre to environmental tobaeQ aaoate hst aot been shown to aaw lmg aae In aamsmolc.re. Chapter Three has desnomstratod that arb * agpoare has not bea don to baptlt the reepbatory or eardtovanvlar balth at aoewmoldm adulta or ehilde.a, ar to moabato prooxfobt dbea.e im these X!'ONpe, of to ca1iM Wa*toms 00 a phpd0{ogW butL And ye~. In a piTdCOlW'y unioramat.* examplo ot abua oi th. risk awsanOst te~moep was peaaitod to a eonEretdonal aboommittee on September 17, 1956, Uft~ a"peom&aey tidc aaamat for passive em~ rwated that E'1'S onwd ~ d7,000 "prerat.ble deatha" eah year in the United 8tatee.' The peomnl~ t6at amnber-ladeld at W a& appas.ady "hird," quantitstive attmst.-Buanataa badNws but b d.eaptin .ad attarly madndas in A 114 I
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• 1a.11-l026-jo INWttIFqrr ms l•lt~Mt~7~•1:1. ts it ttw th.t emper eiM..ett Ooehs lp.eias tenr e1n be w co~itdto i~ iNil~etee.e`hl~itef Na'1'hr.e io m. hw« fw thi% coften heani eunaw. Tvpie.ilv. a.wai ynvJt that a t~eetain numlwr c~p.ek..rill help t.nwide wch thio>p M dial.••=. om-Itfui.ueWe.• ar tinw in an iron IunK bt, a elwldw xs m.m• .k+Q.n t.wr.td the purchase of a wh.elrhair. CiR.rettv ia hn•e ftx m.n. ,resro made .ise.ble eont~ions to health rase..oh. educ.• tioa .nd aoei.l and euRued a•sus. IAot awne of this eerpwae phibnthna/w• im•olve..edempion oi enq+eg p.eln. 16. Ant.wrhautw~in 12% 1._ twla.e>~ TVo. t41ie.lone wauld demett,t..te cha eo.ette m.Ywo. dm.dr (wed »•ith a avnerert~of r im ah • t IK tl fllll}t 1l~f~ INOdulf. M•nuld not MItH an t11e. w&h th.le~.7 .nd ethie.l tnMiti.•itis mari- ju.n.. Dspite eumots to the eentnu.. the eotn nt.s do not own l.nd en vehie F~ F~ to grow nwni.na. Nor h.re thevre~w ered am m.ri- ju.na tn.de n.ms, aueh :~ •Jleapuke C+old. Dsrwo h.w to be a t+mok.r to worh 1. for The Te+b.eeo ltatlwte! Na In f.etL ttt.ny Toti.eeo imtitute emplovs elwaa net te.moke. The dee:ion to anwk~ or not i..nd should t~ttn.in a p.non.l one to be nudeby the indiridwl. The lnatitute helievs that the ittdiridu.l'. ft+eedam to m.he that ehttiee shouid not be t.dttln.d .nd it dttan na attempt te do a.eith io emplow•.s. The Tob.oee Institute oHen this booklet in the belief that Iull and irte dMeus.ien of impott.nt public i.ws i. In the public intrn.t. • 1lUT00668196
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0 4 . .. • . . 0 the astonishing basis for his own "asasss dsaths" ao*atation. (13) Re began vith a report fro- 8asmoad of the dserieaa Caacer Society vhich stated that over a esrtaia period thsra vars ...VV . . d . J a.. «...~~~ V YYaV.M •W/Ya •~~VYj/ V~ YAY •MV ~MY YZ~W Ni.NY ~b~r+w~), aad 1,385 dsaths asoa= a similar =roisp vbo had bsss neksrs. The "ssesss," as hs noted by subtractions, aas 723. Amoa= the aoasaoksrs, 12 deaths were attsiDutsd to lmj cancer. havsaholt observed, and asong the smokers 110, for a total of 122 and an "excess" asosj ssokars.of !3. With no wcplanatioo, bs then iasarntably deelarsd that because the ratio of all the long eatiesr deaths (12Z) to all the "axesss deaths aaoai smokers" (723) was approximately ose to sis, all one as'sdsd to do to figas out ho+r many "atcsss deaths" from smoking ailft oecsa ia any >aas in the vbols popalatiea vould be to aultiplf the total hn= eaacar deaths by sis! Thns, bora of invention rather than actual obsssiration or e:plainable logic, and clothed ia data vhioh defy aoalysis, the "excsss deaths" aoncept continued its aarch th:ough tba ' history of the saekiad aad health eeetrowrsy. Although the Advisory Co.aittss which prepared tbo 1964 Surseoa General's report bad retns.d to sislead the potilic by ; guessing about "asoass d.atlu," that :os8 aoo Goaaral hiadrelf felt no such ralostaeao. ta itaf of 1963 Dr. Lotbsr Sos's7 parsn.d the phantom asssb.rs in a spaech at the assnal setisg of the National Tuberculosis Association !a Chioaio: Last Jannart 11 there aas a=raat hva sad cry vAn ' Zmsrsoa Toots, &ha3saao of ths lfatiosal Iutaraladey Couacil on Imkia= and 8salth, declared that eidastttes jtN 2z886 CTR-ARCH ...._.~.. . .... „<_....~..___... .... _ ..
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, : _ .ti~• .....ti.r ... _... _.. .:kC• _ .: ....~,. .... . d' 1-4 m .~ A CONFIDE.'VTIAL: MINNESOTA TOBACCO LITIGATION ® . -.r:?S:.2:1 ~ ~ Aff TIlVIN 0079849 _ k 0
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A P Fact or Fancy? THE TOEACCO M/fTfrlRt ,ps I senH. Monew..i wa.ninqson. D.C. 3OM It" MT TIMN 0133740 TI KU 000018542 - - -- - -- - - - --~ .
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17 \ 1.... Snat i, unl. half•hrarta.ll. i a~rn unralualh. a nt...,.,i INVa•al. ali.ra-/t11 b~r aII IMN - antl all 1... aneuaa•ma•ut. ..n.•linl la.a.- arr al•/w.M.riata• tn ra•1<adatr ..1.. ......r. its .a Ina•h Ihcra• im it a•kar harartl..ueh s* •.... l...t-. n. Iler Inavnra• ti( ~.aadiur. Ikat thr~%• .... ..n... a...:,r~ a Iha'n g...1 pulf;ma•/tlt aYNmawwM . •..•~. •. a.ral OOllll:al U.I{T:ati.Na .IMN/kI alialatr I. 1.... .... •l...t Gw r%anqdr. a.ill aas t.. /h. lY.tlltu/1 lit .111a1k111g aINI 1wwlhl1w11lInR 1•.w..u• a. th.• naa•a) r.i.u.. Gw it i. in thc hu.i. lu •...' Ir•.1 inla•ra11s. '1 I.. n...p.ria. .d.qw.ka•rt aun rraalil% alaNrnnine a IN .. ......kulr i% iaaulqN•.qsiatr. atwl aalaa•n ha•J its a taa.awlalflr tnannrr M• wwntatne L..la I.NIIa•tatl IN Nlwaka• N 111 r~rra•he a1a.AQ\'. 80 \\'ha tne/lrates antl-smoklnt grotrpat 11a./.ua• ha•altb avarnint,'s tlwt luve all.eatsd on all ..a:+.atta' I•aa•ka`•a. faK Inau.•.•a•any a.mall nutnher :d ~ n+ luat,~ln tlhralaV'w anQ fd/,..t 1lteir atll clt aa., a1:.1in.t a tul+aa•a'u pn.iuat-ci~anltaa \oar w a. t1sa u.cn. arf tlar lanalutt .alna arr tlae taryCrts J. tlu• Arnt/•./nukcn. aaterrtt/.t tu.uhjret thrm 141 jn.l+ha ah.Api.nmal ataal rulia•ulr. ' 1 hr ant i•.fnukrrs-• a.naall IninaMity uf the non• .nw.ka r* ~ It11a1N' flar IaNe its h?Irlet Or INOI11Mt thr u.a• uf wlwa•a« .a•rkinj: its atMrert a custom lutu a a'linx•. 9. \\'h.t's the etlTeet ef teb.eeo ts:esr '1 a.l.ara•u. an.unK t/w: n.c.t heavilv t.ced eomntner /.rawlaoa't•. I•ran•iJ.+ nwMr than !t~ i hilliun annually fn dita.•t umas tta fa'tlaval. st.te.nd loeal Roa•• a•rnma•nt. ha•II•inR its laa.• 6w wxh thieKS as mar tran.lr.rlatiun and .MNa• ra•t1Wa•aI.'1'he U.S. •) rra.at n edla•c•tw !t rrnt. utt errn• aaek ol eiR- afa•tta•• v.lat. itaaliviahlal s+tata* fratatl 4 to :) fento anal atMala• n ) I11UnK11aalltlll fn11/t I to 13 lena. hinra• thr fin.t (raleral tas awt kdnat•trrt in 11162. mnrr than ! 1 i 1 Lillitwt Iwae haa•n eallrcted by .Il Ir,o rl. u/ y;aw•aKtatlN Ilt. s !lNAT00668193 .~ .... . . . • .-... _,. . _ .. -.~-.~--•.. ,T.-.,..-~--.. - -
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?A TOBACCO' UnGAT}ON PROTECTIVE ORDER n. the anmq•here rarelr eserads 10 psrts I+er sniNqn 1~~ t tmd is elONr t0 3~~.- in puMie 1IKA M/t11 normal Yentiiation. OOIIt QRtIrA are a ep hrlWA tht limit ot $0 Illlm ne~emmended b% aaww health aReneia tx.wken eapora•d a ef an eiRht•hetur iaerind. aa'R Nnall anNMl/lt..o( nw•.Rinr in titc atnN.{•invr w•ktail MwulL%%. n*taurww.. Iww.tatilNw .1u.l eitlitN ta•rminal.. I{aM1i tMl tiMttt /1N1W/h1lNtlt• ul+.ulaantt •.p lx•A tu tuiwtaalxskv. 4e.e tfitwe rra<I.r.~f ehe litarWarr..timat.•d Ihat j mNM/Mdt\ralw/kI haaeur.{ oi•m) 11NIIMwu+.arainho In t/1..~1K~kia•t hrr tu illluie tilr atptivaknt 4 a •uM;k fihcrtil• cilprette. , (.. eb .4 a•arhtwt ntwKnhle tCO/ arr aRmta.l Iw ~ aun. 4teaus-a•nnkinK and heaittg ayuii•lllont. nwtas.•ehitla% and indlntrial /wuaa+.v•. e.cn th. I numhrr o/ peol•le anwnd. hactwr CO it grncrat.•al I.. Arlk ntetaholi.mu liut as e peominsnt Xe.. J:we. 1~.h.rmacoloRia rafd recently. em iram m.ntN uwlis, suss.u eha the CO in tnhaceu snale hta littir ie»p+a on the tontent d teewu aN, e.e.ya under A*Al,r.r.ryrAad eondition.. l'Iw..mla of studia conducted under realistic entwbttnn+ indicated thu CO ivn u6at:eo smoke / . Are public esnokinig Itnrs n.eessary! l here a an ail too common tendency toda.• to lurn te ruhlit authorities te tr,r to t~orrecc N•hat n+eRht he botheeome heh.vior in othee+. Hut can u e ask law enforrenunt aReneia te strtrtch their slresd.• limited touourea to police unokinR rwtriniar3 Poliee Rrouts hare called weh laws •. orsuan.• unenforeeahle .nd -. Mr.ne of eniorce• mem time.- Fe.. would not .R.es widv the National Nlark 1'dire OQieen Averiaion dRei.Y who Lointed au that -the limited anwunt of personnel we do h.ae tvukl better spend their time in makinR eur nriRhborboods afe.- Tatlav. when tnart jurindietinur tut sir.pi.ed for iuntii and i+eo/+rieton be=tvdRe ea•ery new i+enn.• de~eruinR eats-ind.ed. a a,n time-e.n we realh• wM+ms iwas that ereett estra exisnse .nd inconrautnee and emse eonfrontations? 4 0 0 !lNAT00668192
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4 4 FACT OR FA!1CY' • Smoking causes wrinkles in women • Smoking causes lov-veisht babies • Women •vho smoke birth harm their babies before and a: : e: • Women are smoking like men and dying like men Of course you've noticed. It's difficult not to. Women are nov the special target of those who would stamp out sao- kin8. And standard, unsubstantiated charges having failed, these crusaders are nov trying to hit vomen where they think them to be most vulnerable -- with threats to their babies and their good looks, and, yes, even their ses lives. In the belief that full, frs• and informed discussion of the smokin= controversy is in the pablic.intersst, The Tobacco Institute has assembled the most frequently heard allegations concerning women and smoking -- and created a dialogue encom- passin= the current scientific knowledge on each point. Sere, then, are so me questions about vomen and smoking -- and answers, at least vhsre they are knovn. M TIlVIN 0133741 1 TI KU 000018543 m N m r
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TI ?!'3LICAT:CNS More t:an 630,000 TI-oroduced ter:odi=als a,d oubl:cat:o::s were c::: -to the hands of*the Seneral public in the year ezdi n8 ~d I.:::e 's:e total included 377,800 copies of the six-a-year Tobacco Observer, which in its three years has become the world's largest tabac:o specialty publication. it also included some 250,000 copies of TI-produced booklets, folders and one sheeters on the history, culture and production of to•vac=o, its economic importance and health aspects of smo'ke and smoking. it does not include 20,800 cop ies of the ?6-a-year ':I ~'ewsle tter , which -- unlike The Tobacco Observer, which is pro- vided free to all and any who request it -- has controlled circu- lation within the tobacco community. Iaclsd:::g t::e 19-book state series on tobacco today and - yesterday (15,362 were mailed in 12 months and they barely nosed out in popularity the Califano bumper stickers, at 15,160) TI stocked some 60 separate titles. That counts only publications produced within TI's Public Relations and does not count lists compiled and maintained by other TI departments, TA,Y materials, re~r:zts of helpf•il medical journal articles or publications of otzer assoc:ations or individuals. Since July 1 of this year, six publications have been updated and redesigmed and five new ones have been added. There being no real bencamark against which to measure t::=s a:mLal distribution of almost t~o-th.rds of a million pieces of T:•generated material, we can only compare our current arsenal to that of a decade ago, when TI had perhaps a do:en state books, a four-page dissertation on the smoking issue and a 46-page document, ":'he C:lar ette Controversy: E:;ht Questions and a+nswer s," dr a: ted by a TI public relations consultant, edited heavily by the then r.ew TI PR director and sent in i::dividual, hand-assembled folders to certain members of Congress and the press in advance of the 1969 c:8arette hear:ngs. Ln :ollcwing is a list of currently available TI publications. N 3evond that ar e recommendations for :uture publication pro j ects . ~ CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION MWjMT1 0100815
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0 4 •9- .~. t.~ .. I.... •1t AAA ..-Or.w..O .1OtrA• and msy6s as as 100,000 dsaths, In the United Scates a 7.as~orated, the critics said. The Public fealtb S.ivie• believes these utioatas are valid. Studies of.morrality ratios of ssoksrs and aoa•saoksrs indicate that 240,000 ss will this yew die prsmats:rel7 froo dissases associated with cigarette .wrd.. w. sAw"r 11A AAA w1 thaaA •sooAa or slsslateQs deaths vill be fros'diseases clearly and ds~'initslp assoeiatsd with sookinj, sueb as cancer of the 1 , 1as~s, oral awi ,.esophawns amd bladdsr, as v.l as broaahitis, ssps.n sad oAroosr7 heart dis.ass. Another 102,000 excess or preaatars deaths W.*ll r.sult froa diseases rhsri the relatioasb.ty to ei=ar.ttt sookia=. vhiis not so ebvions; is a..stbslsss, el.arly Udieat.d. This total of 2i0,000 pruattss dsaths appli.s to ass 0017, because in .ost tasu the data for ress are taad.quats to aaks.preeis• estimatea. lihsr" data are available for ros~sn, aostalitp ratios for oarablo levels of saokin= appear to bU siailar to tboapara b loos. for ms, but somewhat lowr. A reasonable estissats of so.ss deaths amo~t Mosa; added to tbe total of 2i0,000 for aea,, Moaid brini th. overall total to 300,000. I consider this total to be a rusoaablo •stieats." (14) T.rry's decision to disregard his advisorf eesitta's judpsat was oae thing. Ewa mrs disturbias, however, vas the easual vs7 ho added Mossa to the illusory total, ia the last thr.e sentences quoted abovs. pe taw not the sliiht.st basis for his "r.asoaable sstiaats of excess deaths asoag roasa." haveaholt rsappearid brisfl7, applying bis Qstorioos formula for the first time to 1966 V. S. dsaths, ia a 1967 speech to an sati•saokiai ooaforanee in psw Tork. lWis yielded him 901,360 "eaoess deaths" aaoog Mksss. (U). The 300,000 iigure was satisfaetOr? to Dr. oillir Si. Stewart, then U. _. suttoos General, vb.a ba appsar.d before a Ao+as Appropriations Subooo>zittso in 1267. 1!. said that bsoaos• early "excess deaths" itatisties wYs based ooly on ra, these fisures sbouid be ravis.d upward for population growth aad b 1 N 12987 CTR-ARCH
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PROTECTED SY MINNESOTA TOtlACCO LtT1GATION PROTSCTIVE OROER 0 49 17. DiNardi, S.R, "AmsaS ecpowrm tio rapitabio wpondod portkbo ftoa eav(tmeneatv tob.ao aaoke In the ladoor stivirommik" Pre.ea4tioa to ebe ComaaittN an Pardve Smok. inE, National Reu.aseb CoaneA National Aademy of Sdoaeo, hAUary 29. 1956. • 18. Rep.ee, J.L. and Loarr.y, A.B., "Iadooe arc pollution, tob.ooo onoke and pablk b..Id," Seioa 208: 166-172, 1950. 19. Spergler, J., et .1., 'Zon;•t.rm mesrurameb of t+espieable wlfita and pattWa instds ind outside boaue,•• Aftor S=irw 16(1k 2W, 1951. 20. Eudy, L.W., et ol., "Stndiea an the vapor partkolsts phase d1oftbutlon of environmaitsl nicotine by selected trsppia; and deteedoa metbodo," Presented at the Tobaoeo Chemists Resareb Conference, Yoatred, Canada, Qat. !-6,, 19aL 21. Nishten6ale, T.L., st al., "Ctpe.tte onoko inbatstioa and blood do.n markers In BaSIs dop," Tasia AppL PSwnt ea 461-67, W1. 22. Jarvis, MJ., Ruaell, L[.A.A. &ed Feyerb.od, C., "Aa.oepeiou of aiaotloe wd earboo atiozooddo from pwive smoldnc andes natural eooitiooe," ?'Aores si: Sl94i, 1983. 23. Jarvis, M., et e1., "Htodumiai tawken of snoke aborpefoa .nd edf•tepoet.d eupoaua to pusive sunokins." JSpidm CmBioU ai: 83&39, 1954. 24. Schwartz, S.L., "P6armeaoktn.tie oonuideesttoae ia the an of biolosieal madc.n of expowre to environ mental tobaooo tinoke," ProMntstlon to the Committ.e an Passive Smoldm Na tioruj Reaeanh Couno7, Nsetonol Aosdoaq of Sdaao, Jaau.ry 29, 1.9m. 25. Benowits, N.L., et el.. "InterirAlv(dual vartoblkr io tb..meNaolism wd ardiovasmilar eiieets of oicotine in maa," J Pllarmaeol Fsp TAR 221: a63a??, 19il. 26. Schwart:, S.L., "Iater.cetoa of aiootw and other smines with the andoeyde and ezoaytie luaedons of muropk..*.e," Fid Proe s5: ibai, 1976. 27. Benowits, N.L. et a1., ."Cotinwe diepotdtioa and e!lieta," G'W* PAsmaeo! TJler 34: 606-11, 1983. 28. Msteukur., S.. et ai., "ESed of p8 aod arinm flow on nrinarl a~olia..:ocretton a!'!er unolduS dpretta," Clia PAarvaeol TA.r 25: 519454, 1979. 29. Wald, N.J., et s1., "Urinary eodnins as markers of breathing othor p.aple's toboeeo smoke," Laned 1: 230•31, 1984. 30. Lynch, C•J., "H.li•Uva of selected tob:ooo smoke exposure m.rk.re," linr J Rap Dv (Suppl No 133) 65: 6147, 1934. • 831. Balter, N•J. and Cstranovs, V., "EavironmenW tobsooo smoke The oontr9bWoo to tndoos air poUuttoa," Preo.ntatioo to the CoeeIrMse an Passive Bmoldag Natlond R.Naerh Council, National Academy of Sdmao, Jannaty 29. 19i6. 32. Seve, J. and Kmos, 9r., "LnaS o~ae is asaitim minm ad ke bam acpoa~rs to tadoa dwShter peadueb," Aee1tA PAP 80: 6i3i7. 1l76. 33. US. Enviroamst.l Protaedon ABaielr, The Bjb* of Aow YalaeNoR Spotewo on Indoor RadowDavpka U.eto, ZPA 620/6T7411, October 197=. 36.~ C.. ICin~ 8L and Axeloo0. 0., "li.don b hoena-, possible atw of Imi= cancer." Seo~ed J Wor* xnoim XeeJtlti 10(lx Z6S6, 1964. 85. Robatroa, G., "Iave.tiSstlnS the 'eiok bu6ft qnde+ove': BTS in omaUM" Prwatstlon to the Comidtt.e on Passive Saakn& Natlonal R.r.aeeh CoweII, Natisn.l Academy of Sdeoaeo, January 29, 1986. •.u..-s..wii¢ v
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) A i . . . ....* . Oae moath later, as lebsnM 13 at a Coes=s.ssioaal beasias, he attsibated to ei=asstte ssokiag 13.000 deaths froe ehsoeia bsotehitis aad espbys.s, 173,000 dsaths fsos baast disease aad 100,000 deaths fm oaaser, and stated this total to bo "moss than 320,000." L=a.e ao sosuae for aaY of his fi=ases. Reiths: did he eaplais .hp or bov the heart disease fi8w* f.ll by 45,000 dsaths betwea Jasnszy 11 aad T.bsnasp iS,.os Ar ehronie bronchitis asd e.phYseaa wse iselnded in his :ebsvasY 13 total biat aot ts his Jattaasy U total. (23) I IIadoubeedly, ibwatioa of "data" to snppost a poiat ef .isv is tssptiai and, in so~s cases, an isrssistable tsptatios. Invented data em indsd pezsnadej they assmot inloss. A stat..st by a distiaguisD.d physician dosia= bL 1!69 eoa=sssaioaal testiaooy on smokiai and b.alth is pestiast. Said Dr. Miltoa f. kosenblatt, "me widely pabli4ised aoevsatioas of himdseds of tbonsaads of d.atbs caused by aisassttes, and of shortening life espeataaey a speeifie smbas of szioates per , eiiustts ovok.d, are fanciful estsapolatioas aod oot faotval data." (24) The Tobaeso Institute tla, 1378 JtN 22090 i CTR-ARCH r m m
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i iacidence of ulcers, not to mention smaller babies and evea :ar3er goveri3ezt disability costs for esphvsesa. -1MWAar*.i the Dercent of vosen in the =eoeral popelattAWUko •toke la i not lar=er, and if ro.en •aokef~~t:~t-~ssoklas •ose, tb.s' it is ditficult to ses vbY aay higher iscideacs of disease is t attributed to cisaretteel MT TPIN 0133744 6 Ti KU 000018546; . .`i 1 M~ r_.. . ..
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r CO!1"rV"S Paae Smokiag Women 5 Small Babies 7 Pregnancy Outcome 13 Child Grovth 15 Effects on Children 17 Sex and Reproduction , 19 Facial Wrinkles 21 Advertising 23 Ulcers 25 Lung Cancer 27 Heart and Vascular Disease 33 Chronic Respiratory Disease 47 Increased Morbidity 49 Suasary 51 Reference Sources .33 My TIlVIN 0133742 3 TI KU 000018544 , . . - .. _ . . ~,-'
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, Q. ?irst of all, is it true that more women are smoking ;:day t`.:arr evez before? A. 'he nusber of adult American women who choose to smoke is apparently larger than ever. Dut so is the number of vomen :a the U.S. population. The ia idencA of smoking among vomern tye rate, or percenta=e of woses Who ssokai-- is, hovever, ast., low as it was before sorld tiar IN when vosen first began smo- king in significant numbers. - Public surveys over the last 40 years show an increase- from 1935 to 1944, when sore than four out of 10 rossn said they smoked, and a gradual drop to the less than three out of 10 estimated by the Public Sealth Service in 1975 (3S, 37-39, 103, 104, 114). The question of the amount of ssoking _is •uch more diffi- cult to resolve because there is the knovn tendency of persons to underestimate the number of cigarettes smoked daily. Bov- ever, in cossentin= on a 1975 survey of adult smokin=, a con- sulting psychologist vho has directed government smoking sur- veys since 1967 said of vosen's ssoking levals during the last decade, "No, they. 're not smoking •ore cigarettes" (41). Sose persons who disapprove of cigarette smolcing say that the larger nu~mbe~r of women ssoking todap accounts for every- thing from hi=h-.r lung cancer death rates to an allegedly higher s TIlVIIV 0133743 hff TI KU 000018545. ,, . t
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. . :: norcalicv races were cocpared for :hose iafan:s of saoKers and nonsxoicers veigai^.; :ess :haa :500 ;rams, :he i :san:s of ::on- saoKers ap?aren:lv-nad a considerab:v er r:sK chan did :hose of s3oiCers :_- i:asis added. > WMTIlVIlN 0133749 11 Ln ~ ~ TI KU 000018551 ~ ~ m N P r ~ :. " :+. ...
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3 ;.~.~...i.. :.n+!...+~+r..+.._.- ~t~ - Footaota R&tsroaaa • pap 2 16. II. S. Bowa of Sapr.asatativ.a, "Dopartaaata of Labor and 8.alth. Edueation a4d Welfare Appropsiations for 196S," hsutais balors Appsopsiatioaa snbeaaittaa on Dapartasats o! Labor and Bsaltb Zdnaatien, and V.1laro and 6.latad nsaaeiu ,?art 4, Hb1ia 8salth Sasrioa. 'aia 78. 1967. 17 to0nve++. Dr. twoaomd N.. Vaivassitv of Mtaauota sebool of Public Bsalth, Miaa.apolis addrass to xatiosal Torm on Office Maaa=amaat of Smoking trobfass, Cbiea=o. I11., 4/11•12/61. la. United Statas Saaats, tisarinis on Ci=aratta S•ekins and Diisaa., batora Snbeommdttaa on s.alth, Co..ittaa oa Labor and Public Wallars. TabsaarT 19, 1976, p. 113. 19. Staiaarolm, Dr. l.tsr J. , Wsahititea (D. C. ) r Star, 11/2Z/6~. 20. Tort,. Dr. Joel, reported ia th. Pontiac pst.oh. )ILM, 12/1/70. 21. Staiafald, 'Dr: ' Jossia 1.. . 0. S. aass.oe Csaral it,tasKawd by Daaoa Clark, iiIC•i9, Washington, a. C. , 2/16j71. 22. Splitt.r, Dr. Sanford a., iatasaiat. Barkalsy Calil., letter to American Cancer Soeiat~ 's xatioaal C~asLos on lsolds= and 11ib1iC Policy, 3/Z2/77. 23. U. !~ Housa of bepressatati..o, hsasi.ai before Camodttss on Iatsrstata and Toraiia Comaros, Snbaosittas on Ssalth, 2/ls/7i. 24. U. S. ffioasa of rssastativ.s, "Ciiarstt. ddwrtisin= ad Labeling •- 1969, haarinss b.iore the Co"ttsa on Xtarstata and Torai=a Caoares, pa=a 1256. 1 iI N ZZ99l CTR-ARCH :6 I-A .
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Once somsona. ao maa*r what his os ha= emartise os objectivity miiht be, had broken the iee sad .ads the elais publicly, maay others felt free to quote it. A sionth latar, for s:ampls, Dr. Horn, vho bad baeos* chief of the apaetal Projects Section vithia H.E.V.'s Cancer Control Prosras, told school admiaistrators ia Atlantic City that "Lsrrsva Toots, Chaismaa of the National Iataraianey Cotaieil on fsolcing: aad Health, has stated that cigarette swoking ia rssponsibis for at lsast 125,000 pr.matttre deaths this year." (e) In Kareh, 1963, the 0. S. Senate be=as hearings to detesaida what legislation mi=ht be appropriate in lidht of tha Sorisoa General's report. Toote tastified. Senator ?h:vstoe 9lorton told him-that Hora had quoted "you as hii anthosity." Toota laid the "baby" on the doorstep of the v. S. Public H.alth Service. 0 SEHATOR MOR?OIQ: ..This iatarasts ski, that the seieatist, the doctor, should be quoting you, the advertis ageat.. I suppose you quote hia. That is the way thuss tat going. Sbay support each other. HR• FOOZE: Absolutely not. May I Cosreet the i.preasioo created? SENA?OR MORTON: Cartaialy. lDt. FOOTE: Would pou like to ksov vhsre I Sot those lipras? Or would you aare? . ~ SII9ATOR MOR?ON: I vould be glad to bear where 7oa Sot the figures. I ae ssrelp saying that Dr. aosa is aov qnotisf you as the authority for these didnris. MR. FOOTE: If ha qnots a., that is fine. I dida't uk hia to qvota r, and I an not the authority for the iisusas. Would you eare to lasar vhers I got the ligures? SEfiATOR !lORTOp: Csrtaialy. O t N 2,Z882 CTR-AF?CH
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> jk ww!l- .iL~N... .......... _..«._... 1. Califaao, Jos.ph i., letter to risa*.rs of Coairus, 1/11/7S. 2. Calilaao, Joseph A., address to liatioaal Interagency Comeil oa Sankini and Bsalth, Nuhir4tos. D.C., 1/11/7,. ~ . • q. ... .I wL. w.~a.~..• P.~I..Ir ~mohiai and lablle Tol1e~,~~T.v Tosk itp, 1/31/7i"'"--- ~ 4. N.ubs: .r, Mausiae 1.. _ . page 13. (?rait oo , 961 . s. U. S. Public 1ealth Sssriae, ,~MS ~d~ sos~c ~ I4 f~ ~ ~Tiu63sttmo . .0 6. 'Rundloq, Dr. Jass K. Assistant U. S• S~.os Q.~asal, trasseript• of aa+rs eohter.aee rejussd by II. S. Public tslth e., 1/11/64. 7. Toote, messoo, Chaiima, National IatersSena> Comail on S.okias aerA 8.alth, stat.msat released by the Coamail, S.thssda. Md., 171u6s• • e. Bora, Dr. Daniel Cancer ~:atroi tr~ogras, Di~r3sioa of Chroaio Dis.ases, U. S. ~oparesaant of Stii, "Cigsette i.oieisi ie the High Sehools,"sp e.ea to /1.esiem Association o! :ahool Admiaistratoss, llelastia City, 1.J., 2/17/dS. 9. V. f. Seaate, "Ci=aretto Laboliai and Ad~rertisin="f hearia=s before the Senate Co~eree Cossitts., d9tD Congress, first. Session, pages 1Z)-4, 3/23/6S. . 10. 2bi ., pa~s 107. .11. Zbi ., pais 133. 12. _, pap 145 and 1N . 13. Assrioaa Journal o! ?.blia Lalth, Yel. Sd. go. 11. Wo.eber 1964, paju 1924-i. • lt. Ters7, Dr. Lntb.: L. U. :.'=asp.aa as.ral, "~S~ Aeti- Saokia= dativitiu oI ths t.dsai Go~ssa.st," asp~.eh to t6e National Tuberculosis Assoeiatioe Amsnal Matius, i0~isa~e, tll., s/31/6!. 13. kav.aholt, nr. t. T., Dir.etor, Population Service, 0ltioo of . the tiar as , O.S. De}arasat of :tato "Ciia~tte i.olda== l~tassievdd of tasasd," address tb Norld ~oates.aee oa Ssokiai aad 8ealth, Mv sork Cit~, 9/11/i7. biN 22991 CTR-ARCH
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! : obstetric experience and sex and whether it a:so a::ect veig:^.; (:3). access to adequate health is a f irst or, care• A say, fifth child can :o control :or as nany of these differences as possible, Si:veraan decided to look at veight differences in pairs of in- fants born to the same mother. And she located 1016 suc4 pairs, one third of them born to women who had begun smoking aometisLe after their first pregnancies. Silverman reasoned that if smoking alone causes birth- veight reduction, the mean weight differences betveen first and second babies of mothers who smoked only during the second pregnancy would be significantly greater when compared to those observed where mothers smoked in both pregnancies, or neither. And the second babies of the "changed ssokers" would be lighter than the first. Neither supposition proved true. There were all the ex- pected differences -- smokers generally had lighter babies than nonsmokers and the "changed smokers" produced babirs with veights between smokers and nonssokers. 1at the differences vere not largs enough to establish that they could not have occurred by chance. Strangely enough, the babies born to smoking sothers vho had not ssioked in the previous pregnancy were slightly h.= on the average than their older brothers and sisters had been. .TI1~Il~i 0133746 , lVj~. TI KU 000018549 I
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0 i i . ' !M~.. -,f.lOi6 . r. '. • ... • .' •0- • . W ~ 1.~. . iacluda aSuess aboLt .xeess deaths amoas vom.n• A challenge by Con=seisaan 8ull rotudin= the inte=rity of his elaim appsared not to tronble Dr. Stavart at all. Stevart said simplp that his nti:mbor vas "derived fros aetbodolop of Dr. Morton Ls.in and brought up to date from the tiaa be did it." 3ut he addad that this vas "adsittodly a esude eati.ata." (16) Most but not all critics of ssioking have stuck to the 300,000 figure. Dr. Leonard K. fchmea of the Oai..rsitj of Him.sou'r School of Public Iealtb took first place In the "oseus deaths", sw.pstakss, and still holds the r.eerd, xb.n ha said In a 1966 speech In Chicago that trore than 160.0" deaths ia 1965, n.arly half of all II. S. duths, "were lrom diseases usoeiat.d with tobacco use." Ths bulk of his ntiab.r• -- srora then half a sillion -- eaae froo heart diseue siortality. (17) ?at a causal coaasction betwea smkin= and baart disease was dispated by the top hsalt)i official in the U. S. Departarat of lioalth, . Education, and Welfare as recently as 1976. (11). Ayear later, Dr. Peter J. Stoiaerohn, a spndieatad naos- paper coltmnist., tnoted the SusS.on Csaeral u saying that 365,000 "excess deaths" wre caused ia 1965 by tobaaeo. (l9) , Dr. Joel Fort, director of a San TrancisCS baaltb Qenter, raised the ambsr to 400,000 In 1970. (20) 3at by t.bsvary, 1971, a e.w Surgeon General. Dr. Jesse Steinfeld, laaned back on the side of caution in ealealatinj "excess deaths." j1 N 22388 CTR-ARCH .. ~ '~.I3,f:• : F..1 r " . . . • .~.y..y-..- n. ~. ~ .... .. . . ~ ..w~. . . I
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gs: this was tlought to have occurred because of the youth of •^ese mothers when they bore their first children. =„_^ers produce small babies. °oung Si:verman claimed her study failed to confirm t:at infant weig:: is dependent on innate characteristics of the mother rather than any effect of smoking. Dut she said the observa- tion that future smokers before they began smoking tended to have lighter infants than nonsmokers was "more consistent vith the self-selection hypothesis" (94). Ser findings were •consistent with two other studias indi- cating that some women will have smaller babies whether or not they smoke in pregnancy. One, a large California project, -in- cluded women who began smoking after delivering their first children. Those children, born be the mother smoked, vere lighter than the nonsmokers' infants in the study (121). The other study, done in Scotland, reported that sisters of •vomen who delivered lov-veight intants also tended to have lighter babies (60). At least one large-scale study -- of •ritish births in one week in 1958 -- indicated that ssokiag mothers have heavier babies if they quit or cut dovn on smoking atter the fourth month (14). More recent research, published in 1977, sug- gests that any fetal veigbt reduction attributed to smoking do:s not' occur in the later months -- if indeed it Jj caused by smoking. Studying more than 1000 pregnant vomtn registered r 9 TIlVIN 0133747 ~' TI Ku 000018549
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r Q. :hen why tie s:ogan chat pregnant wonen who smoke enda::;er .wo ._ves'. A. Who knows -- perhaps because so many we::-3eaninp persons who nowadays seem to want to improve the lives of others accept oId myths. But propaganda based on such ignorance can only de- lay scientific progress. Some studies have shown a higher rate of spontaneous abor- tion, stillbirth and infant deaths among smoking women (13, 22, 36, 6'9). Other studies, hovever, have shown no difference at all (27, 80, 83, 90, 102, 120). But the conflict in evi- dence is not considered by those who disapprove of smoking. And they ignore the paradox that the U.S. infant mortality rate continues to droo (105) while the deniirators of cigarettes claim that sore women than ever -- and presumably many mothers- to-be are smoking. Nor do the anti-smoking tracts and speakers cite.other factors that •ay affect the unborn child. tven a partial listing would have to include occupational esposuresh viruses, 7C-rays, interval between pregnancies, both obesity and insuffi- cient weight gain by the mother, use of hormones, aspirin, antibiotics, vitamins -- and, of course, illicit drugs (12, 21, 52). One of the sost recently identified factors is the pro:i- sity to airports, unbelievable as it appears (7). 13 T11VIIN0133750 TI KU 000018552
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r yea:s later, when they were 11. The doctor and the scaclati- c:a- v':o had designed the study reported in 1973 that vhat •fa::a:ions tiere were were small compared to differences asso- _ia:ed v:t!: social class and family size (15). For instance, cosparison shoved that a child from a household vith no older children was on average 16 months behind in general ability vhen compared vith the child vho had three or sore older sis- ters and brothers at home. The averaSe difference in reading ability was 29 months, in mathematics 14 months. And the child with no older sisters and brothers taller on the averase at 11. was 4 centimeters Coincidentally, other researchers using the same Dritish study data shoved that near-sishted children are sore than a year ahead of the averase at age 11 in matb and general ability (81). • 8 u t t h os e vho look only at vhether mother ssolced or not continue to clais that ber ssokia= isptdes ber cbild's =rovth and learnini skills... i MT TIlVIN 0133752 16 TI KU 000016554
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r Ve. =ver-!oze's heard tae o:d admonition that smoking s:s-: a?ou^;s:er's grov::i. What a5ou: tie new claim :1a: ,.:-gs :e: s vaose zo:aers smoked while carrying t::em are shor:er :::a- :.`.e:r cor.:emporaries whose mothers didn't smoke' A. :'hose who say this cite research in England that purpor:e3 :o show that children of smoking mothers were shorter, on aver- age, at age 7(40). The difference in average height was : cencimeter, or about three-tenths of an inch. Aad the same study found that at age 7 the child of a blue-collar family was on average 1.3 centimeters shorter than the child of vealth- ier parents. The fourth child was 2.3 centimeters shorter than a firstborn. The saae Dritish survey is used for the allegation that smokers' children lag behind in reading ability at age 7(2S). The claimed difference is four aonths. No such differences were found in a Johns Sopkins study of heights and intellectual abilities of 7-year-old childsen of smoking and nonssokin= sothers (48). In Srasil, a study vhich compared the physical grovth rates of LIV babies of ssokers as vell as nonssokers with infants of average weight shoved that the LSW babies grev faster and had•essentially caught up by the second year of life (8). And the Dritish researchers seasured little difference in either physical or sental development in the sase cliildren four 1 s TIlVIN 0133751 hff TI KU 0000,8553 cn ~ _j N ~ :.=.r
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4 51721 1012 MI"TI M N 0079847 Anwers to 1be aast aslced qa~ a6aut dgareites. DOES aGAREITE. AMTM CAUSE KIDS TO SfART ~ ~r.~Mir~ o~rhlr r ~al ~. a~ TW.lawO pM.rAar al w. r `.~.~iry~ o.l adMr.l.w ~...a...~.. w.~....11i a1~. i. st" ....woN., ft..r.MIR No A..wL.N C..o« Soal.l~..pwr :twlr4. ~" ~.~ 1M 1~.. &.w...a 17 O.n.Nl wU lUrt Mnr..nW a.n.M...» &w'1 *AA wd..lmM a.ot.8NO11w r.w.~drM aira.6««I aw ~.Mw.~d IN/ow.d ~ N~'dm b I M:rm mft braw bootl.t'Aw.wi. 1. M~. w" ..l.d ~..Ns" .6" alo«.U..' Aadaw TI" Toll.oo. MdNi~ ar~. Ma?0 y. Bw..{ No~ir M.a~M..Nll~i.6 /rM..dW.dl.. owdaw d N~ /".d..l p.lio rww r/s rl~. ...~ ..,~.N„ d wop~~ A..kow ro.. Idti./ar.14..da~. d ah.lo:~ WEIGII ROTII SIDES BEFORE YOU TAKE. SIDES.
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v : Do blacks, whose skin is not susceptible to sun- caused caazges, develop similar wrinkles if they smoiCe? 3• :` snokilg Ls the "priae" cause of facial vrinkling, ::ow does it create the wrinkles? They designed a controlled study, and, unlike the Cali- fornia "research," included blacks. They reported that black smokers were no more wrinkled than black nonsmokers, and they conclu.ded in an article published in the Journal r_al LL the American Medical Association that sun exposure -- got sm -- causes early crov's feet (1). The anti-smokers, hovever, continue to cite vhat one nevs service reporter called "the latest v.apon in the a;senal of che anci-smokin= crusads...an appeal based on the presumsd vanity of women" (33). Wr 22 TIlVIN 0133758 W tr KU ocooiasso i I
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, I Ml11,•• ae aald, It e afir0 CO 5401. •6ai vwrut YMW.a v& sxcess deathr associated with ci=arette s.okinj. Dnt there is no question that it is the major public hialtb problem ia the 0.5. today, both for sea and for vomee. 2stt, unfortoratelp. . . . ve cannot p=pos.nt exactiy the nveio.r ua "ciw. wsw. usociated with ciVrette saokins." (21) As recently as March of 1977 a=erlcsiap; Calitosaia internist, Dr. i tantord D. aplitter, cosssaicatad with the aaeriean Cmcas Soeiet7's "xational Ca.diaioa os iaoktaj end rublie Policy" to present sooe "evidence ef the health aeass- queaees of smokin;." hu he warned the ACS; ta,ths words of the 1966 Easseon General's report, that "ebo total , I - of escess deaths eaasally related. to cigarette aaotinf in,the 0.=S population cannot be accurately estiaated." (22) , Larlp in 197i; Secretary Calilaao aaneuneid a new "nar on ssokia="•by the Departsent of aaalth, Ldveatioe, and iieltare. The blizzard otAivspaper co" and editosials rbioh followed repeated, in almoit every instaace, the =icretary's elalae of 320,000 "euest deaths." ia some cases tbe iiWe vu attribated to Calitaao= in aanp others it tia• roportod u a fact which appareatl7 needed so attribaties. In his Janvarp 11, 197i,speeeb at a0iaisD of the tiatioaal 2atera=enc7 Caumefi on taokinj aad IIealth, Calilsoo stated that ia 1977, s,okin0 eauued 220,000 deatlis lroo hoart disease, 78,000 lrom iung cancer and 22,000 iron othar cancers iaelddieS bladder cancer ios a total of 320,000. dIN s19ae CTR-PRCH P r N N N e
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r C:garette saoking, he added, aay contribute more to tye ':az-cs.s o.' 11ng cancer than i: does to producizg the diaeaae _:se:° -- ::: aea as vell as vomen. TIlVIrT 0133765 TI KU 0OO01aS67 28
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Z" Q. Is it true taat smoking causes facial vrinicles' A. Those who may not be familia: vith the medical literature, vc: =ay ^ave merely repeated what they've been to11 by others, say smokers have more facial wrinkles than nonsmokers, and so smoking obviously causes wrinkles. One doctor, an internal medicine specialist in California, is the originator of this claim. He reported in 1971 that ason= his patients, friends and caaual visitors the ssokers had aore and deeper crow's feet around the eyes than the nonssokers (24). He admitted that his grading systes for the severity of wrinkling was "crude" and said he didn't think that any observ- er bias could explain the nonssoker-ssoker differences found. "The additional evaluations by fresh, naive observers of the same subjects vould sees to support this viev," he siid. The catch was that the fresh, naive observers in his "scientific" ezperiaant -- who seasured wrinkles in pictures of 400 persons year-old. - were two high school sophosores and a 12- Shortly after these observations were published, three Navy doctors set out to check the Californian's conclusions, asking thesselves three questions: _ 1. •if ssokinp is the sost isportant factor in producing wrinkling, why does it occur in san-esposed arsas and not on all skin areas? 21 TIMN 0133757 r Tt KU 00001e5s9 MM
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0 0. Do women who ssoke vaile they're pregnant tend to have ;_a__e- Sabies' A. ':as, taeir ba5:es usua:ly weigh less tian tie SaS:es o: xo:-ers who don't smoke (109). Detractors of smoking emphasize the reduced weigh: of saoRers' babies because, they say, birth weight is one of tae mos,t important predictors of risk in infancy. And because smokers have smaller newborns -- whatever the cause -- they are more likely than nonsmokers to bear infants that are lov-birth- veight (LB'a), an arbitrarily set measure of below 2501 grams (about 5.5 pounds) (116). "It is now generally accepted that maternal smoking is re- lated to a reduction in birth veight," National Institutes of Nealth researcher Debra Silversan wrote in the June 1977 American Jou n gj Eoidesioloav (94). She said: ?he critical issue is whether ssoking causes a reduction in birth weight (the causal hy- pothesis) or whether ssokers are a self- selected group that differs from nonssoksrs in vays unrelated to ssoking, including the production of lover veight babies (the self- selection hypothesis). Some other differences amon= women which are associated with varying birth weights of their children, or outeomes of their pre=nancies -- but do not nacessasil7 cause those varia- tions -- are socioeconomic level, race, age, height, previous MT TIlYIN 0133745 7 TI KU 000018547 ~ ~ N r m N ~
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r !!ore recently, a four-year study of 5700 youngsters in :.::3:and and Scot:and identified a so-called "cooRing effec;" an:ag other environmental and socioeconomic factors in the pre- va:ezce of respiratory symptoms and diseases (78).' Boys and girls from homes in which gas was used for cooking had more coughs, "colds going into the chest" and bronchitis than chi:- dren whose homes had electric stoves. The researchers concluded that products of fuel combustion might be the cause of the in- creased respiratory illness. - It is difficult to understand why parental smoking is blamed for a child's coughs or vheesss, in viev of these con- flicts in research findings. i cn ig TIMN 0133754 N . ~.. Tj 'N oooo2assg ~ N %C . ~ . . . _. . •.4" ','.t.!M . . w.. . ._, . ~.V
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Q. :s there anythizg to the caarge that smoking can inte::ere vi:= sexual and reproductive rinc:ions of both men _':a: i: :a•: :ower tae libido and impair fertility' and women A. :;is °avorite attention-getter of anti-saoke:s shcws up ::on tiae to time, particularly in stories supplied to loca: newspapers by fund-raising organizations in health fiel3s. There are -limited and nonscientific data on animals aaC less on humans, most representing uncontrolled "clinical" ob- servations and questionnaire surveys of individuals who claimed "sexual problems." Some eminently refutable claims about im- paired sex activity were included in a popular national tamily health magazine in 1974 (99). 8 u t, 11 I!T?', tw dfttrrsetiess3- tetestltitopebltsaties, Jour r _ _e; W l.s.arati, }s~lts~s• "1!-Csitieal Laetee ok keport• om"tVa*i!-iat• e!-:a.1tmt ee'lar7r sK f.}"1tt}+' a com- prehensive survey of 41 medical papers, datin= back to 1923 (97). The authors concluded: An Ohio physician, a longtime anti-smoking volunteer, vith refzeshina candor more recently told an American Cancer Society meeting in Chicago the same thin=. Only "a ttiorou8h=oins sta- 19 TEWN 0133755 TI KU 000018557 iVIF r
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d PROTECTEO 9Y•MINNESOTA TOlACCO l[t1GATI0N PROTECTIVE OROER 0 a Yitw•of the !ut that M has oava baat ihonA .e3aatidnAy to mua aay adwee bealth e&eh in noamtokert, much lw a iitO d4Gels. ' . Qoantitati.e risk ea.eoment Is a oool fae du:.daiaiat the pot*utial ad.eae balt>s eotiaw qnmees of bnn+aaUpo." to a w6.tanai that has b«a iadepend.atl shown to eaw a egeet. As Chapter Qw lw notod, tlwe tatpoetsat ed~e aoaf~ aa the rol~ea~t 6~aw concluded tbat FrTS bae, not beea ebows to eawe adwne badtb effects amone aoaaswkaw, a conelaeion underscored by tbe datsit.d analydt of the Btasmra iA C>vpten 1ti.o aad 17m fiba author of the paper presented to Coosraea that It war "aot poa~ble in a papae of this scope to give a detailed and topliistkat.d ~~~, ~ of sach step" of his aaaiys;s 8nt beams the first et.p-acapting, a. "mort re8abia" tbe ~ data tbai Cbapt.e 1" >sat diown to be eaentially I- der-.rss aLi amy tbep eK aD wdeNqueat 11141116. ..em il "aopW tkxted," can 1qd ta onty an die.cdoe: towd a waD deaeev nd abifiriaa. Mors threatening to the intqity a["adtaee than aea ipedao. "ritlc estimatea" Is r.Qtat e.ide„oe that even io form3dable a body ae tae Hatlonal Andaoy af Sdeeoes Is npabi. of a~aida~ policy neommendatioaa baead od aptoolatlae aad eoa.emima tatbar tlaa obJaatl.. dab aad established l.et. When asked by Congres to iaratipta the qnaUty of air wltbiA ebe eabins of oonunercal airliners, an NAS Ia...tigaft paad aaAehWad that Maa reeeateh .raa n.oe:ary oa a host of potential problems and aoataiabaata, bat that-dapita the absence of aeienti& aapportt- ciearetta unokinf on commercial aircraft ehould be bauned. Tb. pnd concluded that tobacco amoke mi Irritste aononokdni pawAdsra and ~t adaeady aCeat tlse beaitb of aWine mish employee:.$ But it conceded, In .iieet; tkat it had no sclen tii3e pevof af aoch barm, aAd It i~ocrd the only aetual memmmente that do Wit measuremnts ahowia< tbat levels of aioo&. In aircraft cabin air are eactrernely low ia the atooma= section, and .irtoally affwdt.at In sY.n that part of the nonunoking section that ia within aat or two rowe of the eeetSon.N To be ezpoad to the amount of nicotias In a ata~la ei~antt~., tl~oas mea~~a~~~owedft a a4& amoker would have to complete .i=ht oontianovs Now York to Toiq0 toaad trtp ftta. If the National Academy of Sciences Is susceptible to tbepreown being extrtad by thae who would distort or isnore Kientilfc rvldeeute for the eake of their a~st aiaold~ It is upon Individual aaentistt and pAyeikiaaa that the bnrdea of rsy~a~p~ edintilk isMpty mast fall. For many such indiriduals that burden will not be aligAt oaa. aeadtg it wiII raquire arldnliy exunininr the literature, or at Iad sn& amuaarla of it at are ooataiaed In tl6 and other reports. It will require putting asid. opWo= about the way aoe wonld "tiks" dw evidence on environmental tobacco anoke to come oat. It wDl Inroiw, ia aboet, the application of sdentme objectivity to an imperfeat and incomplete body of hetr tkat can be, as one report on the NAS testimony put it, as "wispy" and "eladn as the anoke itaeli»"u • A 14 ~.. 7. • .. .. .. . .. .. ~ • . ..
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Q. '::ere are those vno call for an end to ciga:ette adver- ::s:-g because, tzev say, it persuades pecpie to begin saoki::a, :he young female, smoking in girls and vo mea is due entirely :e-. Oces adve:tisi-g create cev snoicers' A. No more than advertising a specific brand of toothpaste causes more people to use toothpaste. in an era of new f reedo: for vc- r brand sdvertisia=, aimed at interestins ssokers in svitching& brands and is creating brand loyalty` A Wayne State University economics professor said in a study supported by the American Cancer Society that cigarette advertising is a "competitive weapon that companies have used to divide the cigarette market; it has not been used as a means for espanding the cigarette market" (46). And the chairman of Sarvard's department of psychology•and social relations told an ACS meeting in June 1977 that most of the evidence indicates that advertising does not play a major role in inducin= youngsters to smoke (74). sut perhaps the best ansver lies in the vords of a voman a yew York advertising agency president and ACS consultant vho is active in Cancer Society affairs: 1 I Ofsdrett• advertising is& ~ TIMN 0133759 Lq ...I don't think the increase in ciiarette F~ ~ N f-+ /-+ 23 m T I KU 000018561 ' ~
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. tistical analysis of a siseable population" could prove any p:in: about smoking and sexual dysfunction, he =ave not ye: seen such a study..." (63). said, "and : Never:heless, the issue shows that history does have a way of repeating itself. A contemporary historian devoted two pages in a tobacco history to some claims of 19th century re- formers and evangelista (87). While some of them warned that tobacco would render users impotent, others spoke of "tobacco excitement" and cautioned: JYA v o yould ¢: Eure j& yj= love-inatinct, cast this sensualisia: Lire JjU You. 20 • ,~ ~ ~ AIIJ. N TEIN 0133756 ~ m . W ~ tI KU 000018 ' 558 I
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I v::a :aree maternity units, a British researcher found no sta- ::s::=a:l;> >ignificant veight difference be;veea the babies _: szoR:ng xo:aers who quit ear:y in pregnancy and those who aa: qui: bu; resumed smoking in the last four months (26). W!:a: 1:::-e difference there was -- an average of 2.8 ounces :ess -- was, he said, in the opposite direction to that which would be expected if smoking in late pregnancy reduced the birth weight. The researcher also found that there was no proportional decrease in birth weight with increasing amount smoked by the mother and he said this appeared to support what he called "the ocher-factors hypothesis". LBW infants are not necessarily premature (born too soon). They are small for their gestational age and are the subject of concern because their risk of death la almost 10 times greater than that of infants in the nezt highest veight category, 20 times greater than infants of the moat common birth weight category (116). What opponents of amoking fail to point out, however, ia that almost all the research on the subject has shova that the Ther 1973' Public. Sealth Ser.ice report, "Ths •salth Cosae- quences of Smoking," says: TIIVIIq 0133'148 10 W Tj KU 000018ssC a
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r or even largely to skillful, manipulative advertising. Essentially we are dealing with a broad cultural development; a good deal of the behavior that has been man's alone for so long is now open to vomen... :a::sding cigarettes on a man-sized scale (42) . W 24 TIlVIN 0133761 TI KU OOpp1aS63
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10 r Q. Lf vomen are smoking "on a man-sized scale," is that vhy :iey are said to be getting more ulcers? A. !!ore vosen seem :n recent years to be getting u::ers, or, as one government publication said recently probably not en- t:rely tongue-in-check, they are "seizing the longtime badge of success for businesmen" (43). Thirty years cers about ago men had ul- 20 times more frequently than vomen, but the ratio is now about 2 to 1, according to hospital and clinical records studied at the University of California. Sut that's only be- cause the incidence in males is falling (44). Smoking has been associated vith ulcers -- as have stress, heredity, alcohol, coffee and aspirin (109)., Ulcers vill s trike one in every 20 vomen at some tise in life (S8), and they are reported more frequently in vomen vbo snoke than in women vho don't (119). But fev if any 8astroenterologists claim a causal association. And "The nature of the relation betveen smolcini. and ulcers is not understood," says Dr. 'Morton J. Grossman, director of UCLA's Center for Ulcer tesearch and Ldacation. But, he says, genetic factors clearly contribute to both gastric and duodenal ulcers, although they are inherited independently. - Writing in a current leading medieal- testbook (43), Dr. Grossman noted the tendency to concordance for ulcers in W TIlVIN 0133762 2 S TI KU 000010594 F-+ m W J
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r ide.^.t:cal tvias, who, of course, have like penes. Ia other va::s, t: one tvis has ulcers, chances are the other tvin will a:sc. '.`.e presence of ulcers in the second tvin is more co3non :4en:ica: tvins than in fraternal twin pairs. Fte called this "stront evidence that the increased famil- ial incidence of ulcer is due to genetic factors to a shared environment." and not simply The role of psychic conflict -- job stress or identity crisis, perhaps, in today's "liberated" voman -- has not been adequately e:ploredp sut various hypotheses exist, many of them involving a predisposition tovard ulcer through inheri- tance or a locked-in vay of life. The type of tespara.ent that leads to stress probless also leads tovard use of vhat a forser president of the American Gastroenterolo=ical Association calls "stress relievers." "The person vho ssokes 40 cijarettes a day usually also drinks eight cups of coffee and has a tev martiais," Dr. S.nry D. Janovits has said in B_ar's asaar (37). "The additive aitect of these and other stress-copia= habits is the cause of trouble." In a recent roundup of develop.snts in alcer therapy a national news publication pointed oat that "despite the pro- sress, modern medicine still can't esplain vhat causes alcars" Uft1'IMN 0133763 26 TZIM 0000j8W
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r Q. A:e lung cancer dea: h rates rising more rapid;y in wase;; _-a-: :n mez' and is :i:s becasse more vomen are saij to :e s=:R_..3, A. Lung cancer death rates reported for U.S. vomen have been rising faster year to year than those in men since 1961. An- ,ual increases in lung cancer rates for women have exceeded :'.^.ose increases in male rates since 1963 (92). Hovever, the proportion of cases of the lun= cancer cell type that has been. related statistically to smoking has changed little in women over the past 25 years,~,.and various research r'sports have shorn that from 15 to more than 40 percent of the lung cancer cases . in women occur in those who have never smokads(9, 64, 117). Some scientists believe that the recent rise in lun= can- cer in women is more apparent than real, because physicians order diagnostic tests more frequently now for women patients they know to be smokers. Therefore, they diagnose sore lung cancer where it might not have been found in earlier years. An epidemiolotist at Tale has found in a 12-year study of hospital records that the use of sputum ssear tests increased dramatically in women, from 52 percent of woman lung cancer patients in 1953 to 78 percent by 1964. (30-32). He said: This increase in the search rate for women may possibly play a role in various recent reports of rising rates of lung cancer in women (32). M 27 'TIlVIN 0133764 TI KU 00001esss . . - . . . . . . . . . . . . . . . •~.' _ . 7
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r ! :,znd tsat 'S percent of vomez vit4 lung cancer diagsosed be- _'a oeft .9 6 4, and ?9 S-~ we:e " at 'loae" women, and :4 percent o; ..:se -..cse SacRg.rou^.ds were knovn were vorking vose;; (9). :- _ases d:a3nosed there between 1969 and I9%2, :ess tian ;a:: t;e :e= a:e Lung cancer patients were "at home." The proportio:: idec:tified as working women had more than doubled, to 36 aer- ;ezt. A retrospective study of lung cancer and smokin6 in women in one British hospital, 19SS-1971, led the investigating path- ologist to conclude that "the current increase in incidence of lung cancer in women may be due not to smoking but to some as yet unrecognized cause" (64). He suggested subsequently in a letter to the journal Lancec that "to concentrate all our efforts on a reduction in the smoking habit ay lead us to neglect" other factors asso- ciated with lung cancer (65). And that, of course, is the consuming danger when re- searchers investigate lung cancer in women and look only at whether or not they smoked. MT TIMN 0133768 31 TI KU 00Q01QS70 1-+ m W
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r Q. Is it t:ue that smoking mothers can harm their babies after ': :rth -- that children of vomen vho smorce suffer more respira- ;orv il:aesses, especially bronchitis and pneumonia? A. This is a frequent emotion-laden claim against cigarettes. Children have more respiratory infections as a vhole thaa adu:ts. They are thought to be more susceptible to airborne germs, smog and other environmental effects. So a number of researchers have set out to investigate the effects of parental smoking -- vith conflicting results. Statements that the child's health is harmed by a parent's cigarette smoke are usually based on research in Texas and Michigan (17, 18), in England (20) and in Israel dating as far back as 1969. (72), (49), The f in,~ dinto f," conclusions th~es_.. ata,~dies, hov_e,v_er,, _lav,e kM ouestioned kj j" 1E.J. tu aalth Serice eca se 11 taultv •t dv de{}an (108, 111). Three other studies here and abroad have failed to demon- strate any adverse relationship. One was conducted among ss- cond graders in Chattanooga by government health officials (93). Another, supported by the Public Sealth Service, was done by researchers from Yale and Johns Hoptins (91). The TIlVIN 0133753 17 ~ Ln TI KU OOOOlesss; ~ N
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r Q. There are t.°lose who cal l for an end to cigarette adver- _ 13.':3 because, :..eV :ie young say, i: persuades pecp:e :0 3eg:n saokini, fema:e, in an era o: new freedow :or vz- ce::. >>es advert:sing create nev smoRers' A. vo nore than advertising a specific brand of toothpaste causes more people to use toothpaste. Cigarette advertising is, brand idvertisin`, aimed at interestinB smokers in svitchingA brands and in creating brand loyalty j6 A Wayne State University economics professor said in a study supported by the American Cancer Society that cigarette advertising is a "competitive veapon that companies have used to divide the cigarette market; it has not been used as a means for expandins the cigarette market" (46). And the chairman of fl arvard's department of psychology and social relations told an ACS meeting in June 1977 that most of the evidence indicates that advertising does not play a major role in inducin` youngsters to smoke (74). But perhaps the best ansver lies in the vords of a voman -- a Nav York advertising agency president and ACS consultant vho is active in Cancer Society affairs: Arl T TIlVIN 0133760 ...I don't think the increase in cigarette smokin= in girls and vomen is due entirely 23 TI KU 000019562 Ln ~ ~ N
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r 0. Do those vomen who saoke and get lung cancer have anyth:ng e:se in common that could have caused the disease? A. Soae researchers have hypothesized that it may be -;e smolce: rather than the smok~~ that should be investigated in relation to the varied diseases and conditions associate'd with cigarettes. Those who have studied groups of saokers and nonsaokers have found generally that the saokers tend to be different per- sonality types than the nonsaokers: aore coaaunicative, aore energetic (51), aore prone to drink quantities of black coffee and liquor (76), and to like spicy or salty foods in contra-st to a blander diet (82). As a group, they are aore likely*to have had parents with heart disease and hypertension (97). They have had aore aarriages, aore jobs, aors residences (71), living in what aight be called overdrive (77), as one re- searcher has put it, searching for alas and purposes (51). Dut aost researchers who have concentrated on voaen vith lung cancer have looked shortsightedly only at whether or not they saoke. And it is possible that the kind of vosan who smokes ia also the kind of person most prone to developing lung cancer. 8er life style would certainly, on average, appear to be different froa that of the nonsaoke~~ !rl r TIlWIN 0133766 Could occupational e:posure be responsible for the recent reported increase in lvn= cancer aaoni woaent Consider the re- 29 TI KU 00001tS6• . ..~+..,~., , , . . . ~
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t cardiovas:ular front to a decrease in the proportion of the ;,opa:a:ion tha: smokes. vot necessari:y so, says a Pub:i: =e a:-i Serv::e e3ployee, Thomas 41. Thom, who works wi:h numbers a: t^e g:ve:::=ent's Yational Eieart, Lung a::d 3:ood :ast:tute He notes that the decrease in smoking in men has been grea:er than that in women, whereas the CHD death rates have dropped in both sexes, in all age groups. This pattern, he says, "throws some doubt ori the notion that giving up cigarette smoking has contributed to the declining trend." Thom describes the trend in CHD death rates as the most significant aspect of the changing pattern of cardiovasculaY mortality, because C8D accounts for two-thirds of all cardio- vascular deaths and because CSD vas until a decade or so ago the only major subgroup of the overall cardiovascular category that was rising. 34 MY TUAN 0133770 T I kV D~41eS~2 .
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r 'h :s new hy?othesis about CHD in men is, ot course, ao :ose scienti;:cal'_y es:ablished than vhat one researcher has ;ze "c:assically accepted opinion" that ea::y menopause eyua:s :nc:eased CHD risic in vomen• TIMN 0133777 . ~ ~ 1 TI KU 000018579 ~ N m (n N
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0. Are women who smoke more likely to have heart attacks a^.: sc:okes than those who don't' A. 3oae atud:es have siown that there are more smokers tnan no::smoRers among women with atheroselerosis and other cardio- vascular conditions (110). But as a former member of the va- tional Heart Advisory Board wrote recently: -m! s,+:-f:r--.. t.=-r 'tnr"*1T~ &i. t7s a -- ~i He suggested that smoking may be part of a personali.ty pattern that may itself contribute to hardening of the arte- ries, a forerunner of heart attack and stroke. Although a heart disease-prone personality pattern has been established in large-scale studies of inen (11), so far wo- men have not been so investigated in really significant numbers. One project on the tiest Coast nearly 20 years ago did, hovevar, examine 257 vomen, and found four times more clinical heart disease in those exhibiting an overt behavior pattern alrsady labeled in men as Type A -- or mors coronary prone (aa). The Type A person is chronically in a hurry, pnshing eon- stantly in a drive for recognition, advanc.ment, achievement -- auffering from vhat the tvo physician ressarehers vho have identified the patterns call "a paucity of tiae itself." r 3 s NeI' TIlVIN 0133771 Ln J TI KU 000018573 ~
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r ;ncreasing social, economic. s•lres, they ?ro!essional and business pre3_ sa?, can '.ead to the indiv:dua2's yeing boxed i:::: a:,_:-er no way out azd'Zo personally acceptable opt:cns. -e -esu:__-; _°ee:i.^.;s of hopelessness and he:p:essness ia- .:ease ::ze production of stress hormones by the body. :hs :esu:t, in the extreme: heart disease. ~ TVIN 0133780 46 TI KU 000019562 m ILn (n
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r age at which menopause occurs. For instance, in a 1966 Fub;ic 3ea:_1 Service s:udy of 1200 vomen the median aenopausil age :e-da: :: be ea:::e: in black women, in those in lower iacome :ackets and in those who lived in rural areas (73). There was indication, too, that lean vo:en had slightly earlier aeno- pauses. And the thinner their measured skinfolds the earlier the change in the menses. The leanness factor -- this time measured by a formuli of height and weight -- popped up again in the government's Framingham project. The authors reported in 1976 that women who had undergone natural menopause (as opposed to surgical) were significantly leaner than controls of the eame age who were premenopausal (55). Women who smoke have been found to be leaner -- lighter in weight and thinner in skinfold measurement -- than women vho do not (10, 54, 67). Leaner voaen e:perience earlier menopauaea i on average. Is it because they smoke or because they are leaner , -- or because of the type of persons they are? Ia it thesmoke or the smoker? Furtheraors, there would appear to be several thin=s vron= with the assumption that the age at vhich menopause occurs is important to cardiovascular riat: Nff TIlVIN 0133774 1. The vital statistics don't bear it ont. 2. The evidence is far from conclasive. Two 3s TI KU 000010576
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r As in the larger studies on men before and since, the vo- aea identified as Type A's had higher cho:esterol levels and h:ood ?.ressure, o!ten more rapid blood coagulation. They smoked aore than their more easygoing Type 3 sisters. And, said the authors, the "strikingly higher incidence of clinica: disease" could not be ascribed to any of the measured risk fac- tors, including smoking. They said this strongly suggested "that the Type A behavior pattern is itself in some way largely responsible." The nation's most comprehensive continuing study of heart disease, begun in 1948, includes almost all the adult man and women in Framingham, Massachusetts. All the factors knovn to be associated with cardiovascular illnesses, except personality type, have been studied. The project's director said recently that smoking "tends to be a minor cardiovascular factor, over- all, in women" (61). MT TIlVIN 0133772 TI Ku oooo1as74 36 I
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r Q. Is it true that smok:::g vosen reach aenopause earlier than -:nssoRing vomen, anf, i: so, what dif:erence does it make, ;ea A. A videly publicised study on smoking and menopause was published in June 1977 and has been much referred to since (59). :: indicated that in groups of hospitalized women ages 44 to 33 a greater propor:ion of smokers than of nonsmokers had passed menopause in any tvo-year age group. Among e:-smokers so di- vided by age group, the percent lay between the smokers and nonsmokers. The voluntary health associations, other anti-smoking groups and some of the lay press quickly pointed out that early onset of change of life deprived a vomen of the hormonal pro- tection she is believed to have against cardiovascular disease in her reproductive•years. The purported "protection" is affected, the theory goes, as her endocrine balance changes at approach of inenopause and sex hormone levels diminish ther'eatter. She smoked. She ex- perienced change of life up to two years earlier. And she subjected herself to an early risk of cardiovascular disease. Or, at least, that's the reasoning of• tbose who bring up the smoking/early menopaase relationship. MT TIlVIN 0133773 flovever, statistical relationship does sot establish causality, and other differeaces have been associated vith the 37 TI KU OOOOlaS7S
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f stud:es reported no difference in cardiovascs- :ar c::anges or iacideace i:: caztro:s and in vomen :+ho :ad uadergone surgica: rem-.va: of .`:e ovaries (~3, 79).. One stsdy vnich did `:-= increased cardiovascu:ar iacideace after =ea:pas:see castioned that the case ::unbers vere s=a:: and conciaded the differences "could not be explaiaed by the changes recorded in any of t1e usual risk factors, singly or in com- bization" (62). =videace refuting the menopause/increased CflD risk theory appears in a recent study of younger vomen vith advanced hard- eaiat of the arteries (29). It found no indication they were de:icient in the sex hormone estrogen, as postmenopausal women mi6ht be. Family history of coronary disease, hypertension or diabetes appeared to be the aost important risk factor in the occurrence of early atherosclerosis in these premenopausal women. The failure of vital statistics to support the claim of increased cardiovascular risk after menopause has been consid- ered by some medical authorities. ?he.praaiashas authors, for instance, commented that "the reported cardiovascular disease death rates rise steadily and vith no acceleration through the menopausal span" (62). The sritish journal La said more recently, in an editorial about C8D in young voaans Mortality statistics do not seem to support .the suggestion that the manopausa,has any sffect on the risk of CBD, since the deatb- rate from this disease increases steadily with advancing a=a (70). 39 Wff TIlVIN 0133775 Tl ~ 000, aS)7 '
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•- A:e women who take birth-control pills more :ikely :o s__?e: ca:diovasc..:ar d:sease if they s:oRe'. A. a:: asss:a:._e that users of the are :ess :iice:v :o _e•:eio2 cer:ain diseases if they stop smoking has r.o: been s:ienti:ical:y established. Such an assurance is, however, im- p ::ed in the warning now required in packages of oral contra- ceptives by tae Food and Drug Administration (34). In oversight hearings before a Congressional committee in late 1978, prominent scientists took the FDA to task for the quality of the evidence on which FDA based its decision man- dating the warning. The studies relied on by the TDA, several statisticians testified, vere flaved by design veaknesses and su:fered from inadequate numbers and other methodological pro- blems. Conclusions dravn froa such data, they said, vere im- p roper (50). Writing in the british medical journal La about smoking and use of the pill, tvo other scientists urged that epidemiological and laboratory studies be desi=ned to distin- guish among other possible causal influences. They called these "a sis of factors," vhich, they said, aay be "aore coa- plex than we think" (iS). MT TIlVN 0133778 43 Ln ~ J TI KU OOOOi8Se0 ~
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Q. ls heart disease, :iice lung cancer, primarily a ma n•s d:sease' A. i: ias Seea said that women seem somehow in3une to hear: disease until their later years, when they catch up to men in cardiovascular disease. U.S. government figures show that male death rates for ischemic heart disease -- also called coronary heart disease, or CBD, and the major heart killer -- are 3 to 4 times higher than those of females until around age 55 (1:3). The male and female rates draw closer together thereafter and the male rate is only about 15 percent =reater at age 85 and over. Women do not really ever "catch up". The male-female difference is not so pronounced in blacks, among whom both men and vomen esperience aore major heart di- sease at younger ages (106). 8eart disease rates for black vo- men, for instance, are 3 to 4 times higher than those of white women under 50. There is no established scientific esplanation f or this racial disparity nor for the overall iale-feuale dif- ference. Somo type of genstic and/or environsantal varianct is suggested. In any event, ~ TIlVIN 0133769 Not surprisingly, sone have credited the good nevs on the 33 TI KU 00001s571 r . .. . . . . . . _~.
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r vosen ia tae survey (119). 'ha: vomen vho smoked mo:e than 40 cigarettes dail,v re- mo:e o°. everytiing, iac:uding arthritis and sin-js:tis, would seem a re.'lection of the kinds of ch roa:_ persons :hev are and hov they live rather than an effect of cigarette smoking. MT TIMN 0133784 s o. TI KU oooo1esas F-+ B Ln l0
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r r aaong the chronic conditions about vhich intervievers inquired ':!9!, in .°orma:ion on vlica iacidence was derived was based on v::sn:eered responses or intervievers' judgments. 'he original caveat about the self-diagnosis of bronchitis was forgotten by PBS vhen it picked the convenient 3-to-1 sta- tistic for its anti-smoking pamphlets. Since then it has been repeated by many groups providing anti-ci=arette material to the public directly and through the local and national media. Also ignored is discovery of a=enetic disorder in vhich an enzyme deficiency seems to detersine susceptibility to chronic bronchitis and emphysema. This inherited metabolic abnormality is thought to be present in about one in 20 persons (107). But there is a recent suggestion that even if the'level of the enzyme is high enough to protect the lung, the enzyme system might not be functioning properly (84, 85). There is additional evidence that chronic respiratory diseases are genetically influenced. hff TEwN 0133782 1. The diseases occur sore than tvice as frequently in whites as in blacks, but strike blacks at earlier a8es (102, 109). 2. Children of bronchitie parents are more likely to have the disease, and the tendency is sis times hi=h- er if both parents have bronchitis than if only one parent does (95). 3. Twin studies have shown that if oni identical smoking tvin has chronic coush, the other tends to as vell, whether or not the second tvis ssotes (19). •8 TI KU 000018584
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1 0 Dackground on... Tobacco and Health Research S '1'he subject of smoking and health continues to nnke news. Charges against tobacco have been widely publicized, hufless atttention is given e - i(>, Me views of those who do not accept these charges. . oA.ccn Ms brtn IAe srA/cr1 of hi.sd c/Nklww, .wd ca....pw1 pdse. /MfuseMMN ls Ms/n/y. In the Os1 kw rc..s Ihr.e bss 6.cw calaMk..hk .NeMilro No snh.eeo, esptrldy e1p.seHes, heeaM/se o1 f h./Krt I/u1 awly(Iwg w.s.clsi.tlr caNsieg ca/aiw Jlse.sri. .yrrMllY bnR e.n.r/. 7 he eb..Res we/e Msn/ uw /sNh1i- rd rss4KlNMew slwlirs. wlit b spw//ed . pesl deal a/ /t• sr:nfb In k..w .mae nh..al she e.Mses u/ 1he dheses in ipwslMM, «nl hs.kMs.winc wh./1KS anw~iMw w..l~w~lvcd. RraeMly se.lrr.l inlr/esl in Ld.xco .nd (hesMA m.r bw.c (iw•w she Mwl/r..i..n /hal senrn•IAiws new has lwee dbraoned he ilnldicale hA.arcu. I bis bs wisksding bw prssilA~ Ac/ll.ly 'Mssrll .ese..ch nM.Md 1. Mw Msl kw a a-s s.e. N ndra N w ':ew, sn/M/ /h.w Are 'n. •.1. '' s1 e1eMve, N»41iNC h% s.Naa/lre .•./n/ In 1o hso e..nm as.nl/, aksiNll. we p.6 1, lll~ Iw- aeaMlg e.Nence /lui .k.se: lw" /My e nlle. (11Met aci. ew/Ms eNe po.e.Mws 1.11g inkt/inos, prlsksllaey Mnco• /asb, s Aa.ieg 0 arnerlinw. Ewska.ale111 Is .IIMMa MnpM Nti ilw/ks ahns. Nlal d"csllcee sa+lts s+mr wMkly bclsxe/l wA.w.wl swal aen. Wslceo cNks a1 slwNal siie a+d ./es. and 4e/wceM di11..~aM aa.m/ks-swd IAtse NNIi/i1111s IIN MA c/N1/nIM M MMding pNIaA{. (i1kY l.rhws.ee d.w htlwg s/llllied, in.hulbightsedNy .wd InM.i- IMewa# dAkkwrks Is+ litn/ se.esn.le, sckMip. ne MrAtills InM/ the c/- 1ec1 n/ slsess IM.i s/soin. Iwk al esenbt. lic/edilr, del. hnannn.l dilleaewres. ulAw•c.• lue anl aft.wy ollln pssl• Aililies. /1 b w+M/b s>,Ming /lwu henl dlsesse Is the kalll/lg cNMw sa dcaA awwenR wonsnws(en. as weN rs nwwll. snndic/s. h.. ..I ..bw.11N.u+ Itd..eNA. 'ILe 0 11 11 hd .snri.- 1bw ahdlen M.e eal.e In /a a.eA aNks+l .s" an In MeM swe.11Mft. MoN bMKU/1Mklmn o{.a Nw .asncb• IMIw sldiet dn INM Iwose csir mel Atc1. ' The I/lgea sxed /or.y r 1.r sl.wll seseaels b do• Inwlllle ik la[b shwnN .Nn ArsAA p~Mtllls. wUfrA .u ./1WA1/esNy dillenwl s«ve asnle pteple e/e " M1WI. (The .wn.ge likspw ill Aww sk. has klcsenfcd (sawl Sd / yews iM119211b691)Yxsin 1939. Msq/ ll"calcc/ caw. acw s#1e/ .ge 55.) The /11yi1N r/Ala'IfM tlI cellcelff Me MC uNKIIN .4 c.wcee esul hewl aisraa. 5lwlks af Msle.cce slnelm hc eaMlll.ed.Anil; wNb slasNes al Mlles swyuYb Il..wevct, esnNMw b ncclkd in cv.dw-Aing sllms/iuws ns a1.i1NS Ib:N Ikb u/ /btN swq;4 l:w hw 1% Ihe co1pN Ars'e1N.no c sa .illl pliArd nwsrt•./s /Ney nnly .d..clnc the Ical slsle n/ Mn.rwl 51721 1008 s( KAINTUM s~.7aM ~ ozi.~a 0 _.ir
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r fac:s" (4). Ttie :ndas:ry, however, does quarrel with those who :a~e: hyrot::eses ar.d opizions as facts. Causality has not been proved in any of the diseases and conditions liaked statistically with ci=arette smoking -- in vomen or men. The controversy must be resolved by acientific research. The tobacco industry does not try to persuade anyone to smoke. Nor does it discourage anyone vho •ake• up his or her mind to quit. Smoking is an adult custom, to be decided by mature, thinking persons -- mea,gL vosea. MT TIlVIN 0133786 r f TI KU oooolases Ln 52 ~ N F+ . . . . . . . ~ •• . .. .'"'', ~.3 : .. . . . ~. . . . - • ' • ' ~ . .. . . . . . .. ~
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r Those who support the aenopause/iacreased CSD theory claia expiaias why 3en get so such 9ore cerebrovascular disease a-: CvD ua::1 the races begin to converge after age 50. ;ut in ea::± 1978, anocaer hypothesis to explain that phenosenon was pub:ished ia the Dritish Mca Journal (53). Two physician researchers in London released a logarithsic aaalysis of the proportionate changes in sen's and vomen's C8D death rates by five-year age brackets. What they found, they said, indicated that it isn't that the ladies lose "protection" around age 50, it's that the aen lose a factor that say up to that age have enhanced their CSD risk. There was no acceleration of the voaen's CSD rates after 50. in fact, they sloved dovn a little. 1ut the aen's rates sloved down even sore, indicating that ssaller year-to-year increases in the sen vere responsible for the narrovia= sale- fesale gap. "Apparently, at around the aga of 50 sen begin to lose a factor that had previously put thea at inereased risk," they vrote. "Male ses horsones say be risk factors for CBD, and fur- ther studies are needed to clarify their role in the aetiologY of C8D in sen." They said the trend they had observed in the II1C data for the last quarter century "sa.u also to be sisilar in other parts of the Western vorld, including the USA". ~` TIlVIlV 0133776 •o tZ Ku 0000,0711 F+ m Ln r
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REFERENCES Allen, H.B., e: al. Smoker's Wrinkles? Journal of :':e Aseri:aa !!edical Association 225/9: 1067-1069, Aug. 27, 19?3. : A:eri:an Cancer Sociecy. Whea a Woman Smoices. Paxphle:, 1975. 3. American Cancer Society. In: Snoking Takes Its Tol: of Women. Winston-Salem Journal, Feb. 29, 1976. 4. American Cancer Society. Cancer Facts and Figures/ 1976. 5. American Heart Association. The American Heart Asso- • ciation Has Something Important to Say. Pamphlet, 1977. 6. American Lung Association. Young Lungs Are for Life. Annual Report 1976-1977. 7. Ando, Y., et al. Etfects of Noise on Husan Placental Lactogen (HPL) Levels in Maternal Plassa. Sritish Journal of Obstetrics and Gynaecology 84/2: 115-118, February 1977. 8. Barbieri, M.A. A Longitudinal Study of Grovth of Lov-Birth-Weight Infants. Tb• Joarnal of Pediatrics 89/2: 322, August 1976. 9. Beasis, J. T. ,Jr. , at al. Changin8 Ep idesiology of Lu ng Cancer: Increasing Incidence in Women. Medical Clinics of xorth America 59/2: 315-325, March 1975. 10. Bjelke, E. Variation in Height and Weight in the Norvegian Population. British Journal of Preventive Social Medicine, 1971, 25: 192-202. 11. Brand, s.J. Comparison of Coronary Haart Disease Prediction in the Western Collaborative Group Study Using the Structured Interviev and the Jenkins Activi- ty Survey Assesssents of the Coronary-Prone Type A. Dabavior Pattern. Presented at the 18th Annual Con- ference on Cardiovascular Disease Epideaiology ot the American Heart Association, Orlando, lla., March 12-16, 1978. 12. Brody, J.E. Hov a Mother Affects Har Unborn Saby. National Institute of Child Healtb'and Hasaa Develop- ment, National Institutes of Healtb, Public Health Service, II.S. Department of Health, Edncation and Welfare. teprint, 1970. 53 TIIVIN 0133787 rj K, lese9 ' r
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r Q. Wouldn't stress p:ay a part in explaining vhy men are sore suscep:ible :o cardiovascuiar disease tnan vomen' :h:;;R i: does, witness the hypothesis of the '••pe A persor.al::7. Hypertension is also thought to par: in development of cardiovascular disease 9u: the voman's blood pressure is on average lover than the man's (68) and may not normally rise as high in stress situa- tion's, an artifact from the primitive breadwinner's need for surviva-l. A heightened response to stress in the caveman enabled him to fight or flee. And nov that safeguard of early man is con- sidered a major risk factor. And this is because modern man no longer fights or runs away and, therefore, does not dissipate the sustained effects of esotional stress on his cardiovascular system (86). This stress factor -• and the general belief that the man has the harder life, with sore responsibilities and complica- tions -- has been cited in the past as reason for wosen's rela- t ive f reedo• f ro• heart problems. ltov, of coutse, there is in- creasin= 'recognition that the woian's lot is not always the easier one. play an ispo:tan: in both sexes. Two Oaaha cardiologists who wrote recently in the Jo__ nal LL-the A.:_riean Me Association includi vo.en in their "in- visible entrapment" theory of stress and heart disease (28). MT TIlVIN 0133779 4s TI KU 000018581 Ln ~ ~J N N ~ m Ln ~
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r Q. ~ces the tobacco :c.a.ustry agree v:th tite more vocal f.1es - -=3arec_es on anv-hing' A. ': es . I: a;rees with the American Cancer Society that t;ere saould not be a prohibition on cigarettes (89). Ic agrees with former Health, Education and Welfare Secretary Joseph Califano, vho said he did not advocate ban on cigarette advertising (16). a It agrees with the American Heart Association that "we still don't knov the cause of coronary heart disease" (S). It agrees with the statement in a Public Health Service monograph that "although epidemiological data has clearly es- tablished the existence of a correlation betveen smoking and cancer, a clear-cut causal relationship has not been demon- strated" (115). It agrees with the American Lung Association that there should be a new emphasis on finding the answers about "Job-in- flieted lung disease" (6). It agrees vith all of thee that young people should not smoke. And it agrees with the Aserican Cancer Society's stated "convietion" that "adult individuals must aake up their own minds about smoking but it requires that individuals know the r1 0 00001e5a7 ~ TININ 0133785 s l
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r cezt and increasing exposure of women to eavironmencal and ~:::er stresses ou:side tae home. As a greater proportion a: wo=er, zas entered the work force and moved :rom tae traditional :ena:e Jobs into indus:ries where they compete with men, re- searciers have begun to show interest in their work exposure. A physician who for 15 years headed the National Cancer Lnstitute's environmental cancer program felt that not enough attention had been paid to the exposure of vomen to respiratory carcinogens in the vorkplace. He wrote that the adoption' of smoking by vomen can not explain their lung cancer patterns in the U.S. or other countries (56). A statistician with a lon=time interest in industrial ex- posures came to a like conclusion in the Ame_ rican Journal 11 Public Hea th (98). "Much sore significant than changes in vo- men's smoking habits," he wrote, "have been the changes in their employment." He said the lnng cancer incidence among vo- men in industrial occupations is as high if not higher than that of inen. And he concluded: MT TIlVIN 0133767 The secular trend of lung cancer in sen runs counter to the smokin=-lani cancer hypothe- sis, while the secular tresd of lung cancer in women just as easily supports the hypoth- esis that the major antecsdest of lung can- cer may be found in_occupational exposures rather than in smoking. •Purther evidence that the anti-amokers may be on the vron8 track comes from Doston's Lahey Clinic. A detailed study there 30 Tj KU 0oo0i8ss9 ~ ~ N 1-+ F-m N
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1 R 120. Yerushalmy, J. The Relationship of Parents' Cigs- rette Smoking to Outcove of Pregnancy -- Implications as to the Problem of Interring Causation from Ob- served Associations• American Journal of Lpidemiol- ogy 93/6: 443-456, June 1971. 121. Yerushalsy, J. Infants vith Lov Dirth Weight Dora Before Their Mothers Started to Smoke Cigarettes. American Journal of Obstetrics and Gynecology 112/2: 277-84, Jan. 15, 1972. The Tobacco Institute August 19*79 64 W TIMN 0133798 TI KU 000011600
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Q. Are women who smoke more often sick and absent from work .-an :hose who don't? A. ia:e _aarge probably originated with that 1964-65 Pub:ic aea::': Service household-interviev survey (119). The smoker- nonsmoker health findings were spotty, often coatradictory (96), but the survey did find that vomen vho said they smoked as much as a half pack a day had better health records than those who did not smoke at all. Women smokers overall reported proportionately fever chronic conditions than nonsmokers, including coronary heart disease. uomen vho smoked a pack a day or less reported fever days of restricted activity and days actually sick in bed than did nonsmoking women. But the smoking vosen, as a vhole, did average 1.S sore work days lost in a year and reported sore digestive disorders, for instance, and sore injuries, which could account for those average extra 1.8 vork-loss days. One use made of this PBS data illustrates how statistics can be twisted and misrepresented for scare propaganda. A cur- rent Aserican Cancer Society pamphlet about women says those vho smoke loss three times as sany work days as women who don't (2). The government data, however, show this kind of differ- ence only for vosan who bad A= smoked sors than tmo packs daily. These vosen represented less that 1 percent of all IkArar TIlVIN 0133783 49 TI KU OocZasgs r
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r Q, »hac are ttie risks of empaysema and chronic bronciit:s in 1:ae;; 11o smoRe? A. ";e a-sver :o tais question depends on whom you read. .=e instance, says the emphysema rate among women is five c_mes ^:gher for those with a history 'of smoking (3). tt e ?;:b=ic aealth Service has said that vomen who smoke have near:v :h:ee tiaes as much chronic bronchitis and emphysema as women vno don't smoke (112). The Cancer Society's figure, reported in 1976, is no different from the one it reported in 1966. It vas derived from data collected in its so-called million-person survey, begun in 1959, and is based on a total of 45 deaths -- 24 smokers and 21 nonsmokers -- out of a total of 500,000 vomen originally enrolled in the continuing study (47). The Public Health Service claim is based on a P8S house- hold-interviev survey, more than 10 years old, vhich compared smoking habits and prevalence of various diseases and condi- tions claimed for members of 72,000 housebolds (119). The survey report carefully pointed out that the bronchitis re- ported in the intervievs "is not necessarily the same as a phy- sician's diagnosis... It is quite possible that some of the self-diagnosed cases may in fact be 'smokers' coueb'." Or, it could, fos that matter, be the result of occupational ezposure or other environmental pollution. Because emphysema vas not MT TIlVIlN 0133781 47 ti KU 00001ese3
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51721 1074 0 .. m ~ 0 o 0 0 ~ Y /--
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PROTFCTED 9Y MINNESOTA TOOACCO UTIGATION PROTECTIVE OROER 47 are a symptom of the aroch more daAproaa proble:a of pooely a>eintabud aod ded~ed ventilation ~ P~t indoor dr quatitr complaints een be raohed only if b"ni mwEers and opesatoei ate prepared to hcs on those tystems in an y"ro- M priata manner. Conclusion Environmental tobacco smoke (ETS) Is a.oomplex, dynamic mtslure of ddeatnam and crbaled mainstream anoke that In an Indoor environment Is Ereatiy dfluted b room air and substantially chaneed, phydc.Ay and ebewically, by the phenomenon of "aging.' Chaeg.s in temperature, humidity and mqEenatiou ewnit In changes In p.rBde tla and chemical eompodtioa. Any aw sesement of a nonanoker's exposure to E'i'S it a~ heth.r by dillennt patNrns of bresthint pardeJs depos>ttos and gas abeotpdon, and llae ettecb of edeme diiut3on, .erti• lation, Eltnttoa and edteraxa to room ratioss. CA@soqwmtly, eoadndaan drawn about eaeaped smoke are .d~en~' that an beeed an the ~t ef ~eheadaUs, Eeuerated sl desteeaen are ca~t in terms oPrettie .qahralfAb," while perhaps ~uel~d for p4de~ e~dentilk me"u.. ments into an easily understood p.rspeeetve ean be mi:ladtnf if used to wa .et that nonsmokers may be "srnokinE" some portic~t of a cijsrNte, when in lact t>sey an not. Attempts to measure exposure to ETS have foated upon the measurement ott respirable suspended particulates (RSPJ in room air, or upon the measurement of "bbloEical marker." in human body fluids. Tbe former method has rolfered >rom a tai>are to account for "backirognd" RSP from the inany sources other than ETS, and the latter technique Is limited by individual metabolic diiferences and the tact that no marker has yet been found for chronic rather thiaa' very recent exposures. Reeeareh Into the health effects, ff any, of M will continue to be aomplicsted ltutha by the emstenw of many oo- and confounditg variables. These fnrlode diet and ltfwtyle, heredity and psychological factors and-above aD-tbe stubborn aomptedly ol the indoor environment, which indudu such ubiquitons contaminants at a11erreak dnata, miciobee and their eporee, mineral fibers and volatile organic compo®de to name a few. On the other hand the very eoaipleadty af indoor SnvUonmente suggests tNat the current scientific focus on ETS ia too narrow, aed that ratearrh aAd remedtl aetion ehould be directed toward solvins the larpr and mutlh aare serious problem ol iadoor air pollutton. Whenever ETS accumulates indoors to the poiat a[ beieK noticeable it is like>Z that the Inadequate .entOstion responsible for that aacurnuladon lo ela permitted a bott of ooatatninaah-'ome of them Een• ninely threatening to health but largely invisible-to aamAulste as well. The e>imination of emok• inE in such a eituat3on may elimiaate oa symptom of tbe problem, but not the problem itsdK which will persist and may eomp`eoise the Dealth of .mokeri and noiamokers elike. lf, as seems 1Dcelr, tDe evrrent iatetert In the eeieaoe of .n.iroae.ntal tobeeoo anoke 1ssds to a renewed and more .opbietieated science of iodox sawbonmentt, and to a peseekal empbada on the impev..d .ent~stfou a[ t!~~ aMramenh and aa todoor tlr quft generaVy, edena and eodety wfl1 Lare beea we9 served. As a edaW& nutter, and at a aiathr of enUEhtened public pdiry, it b not nonsmokers who oeed to be protected hom emoker% but all of us who need to,be protect.d from stale, drty, eoantima radioadhn aad all too often contuntnated, polluted air. A 001 496
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r 13. 9utler, N.R., and Alberman, E.D. (Editors). Perinata: ?rableas, =. and S. Livingstone, Ltd., Edinburgh, 1969. 3u:ler, N.R., et al. Cigarette Smoking in Pregnancy: Its Influence on Birth Weight and Perinatal Mortality. British Medical Journal, 1972, 4: 127-130, April 15, 1972. 15. Butler, N.R., and Goldstein, H. Ssoking in Pregnancy and Subsequent Child Davelopsent. British Medical Journal, 1973, 4: 573-575, Dec. 8, 1973. 16. Califano, J.A., Jr. Testisony before Subcossittee • on Health and the Znvironsent, Interstate and Foreign Comserce Cossittee, U.S. Rouse of Representatives, 95th Congress, Second Session, Feb. 15, 1978. 17. Cameron, P. , at al. The Health of Stokers' and Non- smokers' Children. Journal of Alleri7 43/6: 336- 341, June 1969. • 18. Cameron, P., and Robertson, D. tffsct of Rose Lnvir- onsent Tobacco Ssoke on Pasily Health. Journal of Applied Psychology 57/2: 142-147, 1973. 19. Cederlof, t., st al. Hereditary tactors, "Spontan- sous Couth" and "Snoker's Cough": A Study on 7,800 Tvin-Pairs vith the Aid of Mailed Questionnaires. Archives of Environsental Health 14/3: 401-406, March 1967. 20. Colley, J.l.T. Respiratory Sysptoss in Children and Parental Saokin= and Phie=s Prodaction. British Medical Journal, 1974, 2: 201-204, April 27, 1974. 21. Collins, S., and Tnrnsr, G. Maternal Effects of Regular lalicylate In=.stioa in Pregnancy. Lancet, 1973, 2: 333-338, Aug. 23, 1973. 22. Cosstock, G.V., •t al. Low Birth Yei=ht and Nsonatal Mo rtality Rate tslated to Maternal =sokins and Socio- econosic ltatas. Asericas Journal of Obstetrics and Gynecolot7 111/1: S3-S9, Sept. 1, 1971. 23. Corday, _* and Corday, S.t., Prevention of Heart Disease by Control of Risk lactors: The Tise tas Coss to Pacs the ?acts. Aserican Journal of Cardiol- o p 35/2: 330-333, February 1973. 24. Daniell, H.V. Ssoksr's Vrinkles: A Study in the NJ TEViN 0133788 54 rr Ku 000018590
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r Epideaiolagv of "Crov's Feet." Annals of tnte:na: !iedi::ie 75/6: 873-880, Deceaber /971. 25. Davie, R., at al• From sirth to Seven: The Se:and Report of the National Child Development Studv (1958 Cohort). Longman in association vith che !iational Chi:dren's Bureau, London, 1972. 26. Donovan, J.W. Randoaized Controlled Trial of Anti- Smoking Advice in Pregnancy. British Journal of Pre- ventive and Social Medicine 31/1: 6-12, March 1977. 27. Dovning, G.C., and Chapsan, W.E. Ssoking and Preg- nancy: A Statistical Study of 3,659 Patients. California Medicine 104/3: 187, March 1966. 28. Eliot, R.S., and Porker, A.D. Esiotional Stress and Cardiac Disease. Journal of the Aserican Medical Association 236/20: 2325-2326, Nov. 15, 1976. 29. Engel, S.J., et al. Coronary Artery Disease in Young Women. Journal of the Aaerican Medical Association 230/11: 1531-1534, Dec. 16, 1974. 30. Feinstein, A.R., and Wells, C.L. Cigarette Ssoking and Lung Cancer: The Probless of "Detection Dias" in Epidesiologic Rates of Disease. Abitract. Cli.nical Research 22/3: SSSA, April 1974. 31.. Feinstein, A.i. In: "Detection Dias" May Siks Cancer Rate in Ssokers. Medical Tribune, June 19, 1974. 32. Feinstein, A.R. In: Saoking Link to Lung Ca Tersed Diagnostic Dias. Fasily Practice lfevs, July 15, 1974. 33. FotB, S. Scientific Finding: Ilsv Wrinkle Seen in Ssoking Dispute. Long Island Press, Sept. 9, 1973. 34. Food and Drug Adainistration, Departsent of Sealth. Education and Nelfare. Oral Contraceptives, Require- sent of Labeling Directed to the Patient. Federal Register 43/21 Part 2: 4214-4234, Jan. 31, 1978. 35. Fortune. The Portune SurveP, July 1935. 36. Frasier, T.M., at al. Cigarette Saoking and Pr.- aaturity: A Prospective Stndy. Aserican Journal of Obstetrics and Gynecology 81/S: -988-996, May 1961. 37. Gallup, G. Aserican Institute of Public Opinion, June 7, 1939. Coaputer printout fros Roper Public s s TEMN 0133789 TI KU OW18591 ~
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0 0 r. r L tc~ titc• .1lu't .V'Lc•d ~ )ttc•tit tctttti ~1t~ctut ~'t!':trc(Ic` ..t . a . ~`. TIlV.IN 013395471 KU oooois24
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1975. Bureau of Health Education. Center for Disease Control, and National Cancer Institute, "lational Institutes of Health, U.S. Department of Health, Education and Welfare, June 1976. 105. U.S. Public Health Service. Monthly Vital Statistics Report. Vol. 26, No. 12. National Center for Health Statistics, U.S. Department of Health, Education and Welfare, DHEW Pub. No. (PHS) 78-1120, March 13, 1978. 106. U.S. Public Health Service. Monthly Vital Statistics Report: Final Mortality Statistics, 1975. Vol.25, No. 11, Supplement. National Center for Health Sta- tistics, Health Resources Administration, U.S. De- partment of Health, Education and Welfare, DREW Pub. No. (HRA) 77-1120, Feb. 11, 1977. 107. U.S. Public Health Service. The Health Consequences , of Smoking: A Report of the Surgeon General: 1971. National Clearinghous• for Smoking and Health, Health Services and Mental Health Adainistrat.ion, U.S. De- partment of Health, Education and Welfare, DREW Pub. No. (HSM) 71-7513. 108. U.S. Public Health Service. The Health Consequences of Smoking: A Report of the Surgeon General: 1972. National Clearinghouse for Smoking and Health, Health Services and Men:al Health Adm:zistration, U.S. De- partmeat of Health, Education and Welfare, DREW Pub. No. (HSK) 72-7516. 109. U.S. Pubic Health Servics. The Health Consequences of Smoking: January 1973. National Clearinghouse for Smoking and Health, Health Services and Mental Health Administration, II.S. Department of Health, Education and Welfare, DREW Pub. Xo. (HSM) 73-8704. 110. U.S. Public Health Service. The Health Consequences of Smoking: January 1974. National Clearin=bouse for Saoking and Healtb, Center for Disease Control, U.S. Department of Health, Zdncation and Welfare., DREW Pub. No. (CDC) 74-8704. 111. U.S. Publie Health Ser.ice. The Health Consequences of Smokin=s 1973. lfational Clearinghouse for Smoking and Health, Center for Disease Control, U.S. Department of Health, Education and Welfare, DHEW Pub. No. (CDC) 76-8704. 112. U.S. Public Health Service. The Surprisin8 Ners - About Women 4 Smoking. National Clearinihouse for 'Aff TIlVIN 0133796 62 TI KU 000018598 ~ ~ N N ,
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r Smoking and Hea::h. Center for Disease Contral, ;;.S, Depar:mea: o: Hsalth, Educa:ion and ;:e:.are. DHE;; Pub. No. (CDC) 7+-8'33. ;13. ...S. ?ub:ic Health Service. '.. S. Vi:a: Statis:.ics :9%3, Vo: 1:, P.. A. vational Center for Eiea'ta Statis:ics, Heal:h Resources Adninistration, C.S. Departmer.: of Health, Educacion and ~ielfare, DH?,; Pub. No. (HRA) 77-1101, 1977. 114. U.S. Public Health Service. Use of Tobacco• Practices, Attitudes, Knovledge and Beliefs, U.S.. Fall 1964 and Spring 1966. National Clearinghouse for Smoking and Health, Health Services and Mental Hea2th Administration, U.S. Department of Health, . Education and Welfare, July 1969. 115. Van Lancker, J.L. Smokint and Disease. In: Research on Smoking Behavior, Research Monograph Series 17. vacional Institute on Drug Abuse, Alcohol, Drug Abuse and Mental Health Administration, Public Health Service, U.S. Department of Health, rducation and Welfare, DREW Pub. No. (AD!!) 78-58.1, 1977. 116. Ventura, S.J., et al. Selected Vital and Health Statistics in Poverty and Nonpoverty Areas of 19 Large Cities, U.S.., 1969-71. Data from the National Vital Statistics System, S*ries 21, No. 26. National Center for Health Statistics, Health Resources Ad- ministration, U.S. Pubic Health Service, U.S. Depart- ment of Health, Education and Welfare, DREW Pub. No. (HRA) 76-1904, Moveaber 1975. 117. Vincent, R.C., et al. The Chan=ing Histopathology of Lung Cancer. A Reviev of 1682 Cases. Cancer 39/4: 1647-1635, April 1977. 118 Wilder, C.S. Current Estiaates from the Health Inter- viev Survey, U.S., July 1964-June 1965. Vital and Health Statistics, Data from the National Health Sur- vey, Series 10, No. 25. National Center for Health Statistics, U.S. Public Health Service, U.S. Depart- ment of Health, Education and Welfare, November 1965. 119. Wilson,•i.V. Ci=arette Ssokin= and Health Charac- teristics, U.S., July 196i-Jun• 1963- YVital and Health Statistics, Data from the 1lational Health Sur- vey, vey, S.ries 10, No.34. National Center for Health Statistics, U.S. Public Health Service, O.S. Dapart- meat of Health, Education and Welfare, May 1967. T1 Ku oooo18s99 M'; TIlVIN 0133797 6 3
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r cion 20/9: 532-588, September 1970. 9•. Si:ver3aa, D... `!acernal Saokin= and 3irc':veigh:. A=er:caa Journal of.:pide3:ology 105/6: 513-52:, :u.^.e 1977. 95. Sp e:zer, F.E., et al. Faailial Aggrega:i*n of Chronic Respiratory Disease: Use of National Fiealt!: Interview Survey Data for Specific Hypothesis :esc- ting. International Journal of Epidemioloiy 5/2: 167-172, June 1976. 96. Sterling, T.D. A Reviev of the Claim that Excess Morbidity and Disability Can Be Ascribed to Smoking. Journal of Amer.ican Statistical Association 66/334: 251-257, June 1971. 97. Sterling, T.D., and Kobayashi, D. A Critical Reviev of Reports on the Effect of Smoking on Sex and Fertility. Journal of Sex Research 11/3: 201-217, August 1975. 98. Sterling, T.D. The Cigarette Smoking/Lung Cancer Eivpo:`:esis. AaericaZ Journal of Public Health 66/2: 161-154, Februar9 1976. 99. Subak-Sharpe, G.J. Is your Sax Life Going up in Smoke? Today's Health, August 1974. 100. Thom, T.J. Aserica's Changing Cardiovascular Disease Pattern. Mesorandua to Robert I. Levy, director, National Heart, Luns and Blood Institute, National Institutes of Health, Public Health Service, II.S. Department of Health, Education and Welfare, Oct.27, 1977. 101. Thoaas, C.S. Paailial and Epidesiolo=ic Aspects of Coronary Disease and Hypertension. Journa-l of Chronic Diseases .7/3: 198-205, March 1958. 102. Qndervood, P.B., et al. Parental Saokin= E10pirically Helated to Pregnancy Oatcosa. Obstetrics and Gyne- colo=y 29/1: 1-S, January 1967. 103. U.S. Public Health Service. Adult Use of Tobacco - 1970. National Clearinghouse for Saoking and Health, Center for Disease Control, II.S. Departsent of _ Health, Education and Welfare, DBEW Pub. No. (HSK) 73-827, Juna 1973. 104. U.S. Public Health Service. Adult Use of Saoking - MT TIMN 0133795 61 TI KU oooo1as9~! . . . , , - . . - ~ !." 4 • r~ 1C . . . . ,%. ~.. T. a• . ~ ~. . ~ =a. , , .
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r Ou:iag ?;egnancy Have a:,ong-Term Effect on the :ai:d' -ancet, 19':, 2: 1332-1336, Dec. 2 3, 19 :. 09. :?ar:ap, S., and Davies, A.M. infant Admissio:.s :o Hosp i:al and Maternal Smoking. Lancet, 19 74 , 1: 5:9- ~ :3:, ~!ar:a 30, 19,~+. 50. Hearing before a subcommittee of the Committee on Government 0?erations, House of Representatives, 95t:. Congress, 2nd Session. Quality of Scientific Evi- dence in FDA Regulatory Decisions (The Adoptioe: o' an Antismoking Warnini in Oral Contraceptive Label- ing), Oct. 4, 1978, 293 pp. 5:. Heath, C.W. Differences 8etveen Smokers and `tonsmok- ers. Archives of Internal Medicine 101/2: 377-388, February 1958. 52. Heinonen, O.P.,et al. Cardiovascular Dirth Defects and Antenatal Exposure to Penale Sex Hormones. :1ev England Journal of Medicine 296/2: 67-70, Jan. 13, 1977. 53. Heller, 1t.l.,and Jacobs, 14. Coronary Reatt Diseaie in Relation to Ase, Sex, and the Menopause. Sricish Medical Journal, 1978, 1: 472-474, Tsb. 25, 1978. 54. Higgins, M.V., and [jelsber=, M. Characteristics of Smokers and Nonsmokers in Tecumseh, Michigan. II. The Distribution of Selected Physical Measurements and Physiologic Variables and the Prevalence of Cer- tain Diseases in Smokers and Nonsmokers. Aiserican Journal of Epidesiolo=y 86/1: 60-77, July 1967. 55. Hjortland, M.C., at al. Sose Atheroienic Concomi- tants of Menopause: The Pramingham Study. American Journal of Epidemiolosy 103/3: 304-311, September 1976. 56. Hueper, V.C. Lung Cancer and Smoking is Perspective. In: Lavyers' Medical tncylopedia of Personal Injuries and Allied Specialties, tevis6d ool. 5, Pt. D, Sec- tions 37.1a to 38.99. The Allen Smith Co., Indianap- olis, 1972. 57. Janovits, H.O. In: Glcers and Colitis: The Price of Success? Harper's Dasaar, Novembsr 1975. 58. Jaroslovsky, t. Peptic Prognosis: Mysteries and Mytha of Ulcers Giving Way to Modern Research. Wall Street Journal, Sept. 29, 1976. ~ TIlVIN 0133791 . Ln ~ t i KV 000016593 ° n ~ ~ m m a,
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r. 59. Jick, H., at al. Relation Detveen Smoking and Age of !iatural !lenopause: Report from the Boston Collabora- tive Drug Surveil:ance Program, Boston Lniversity Medical.Center. Lancet, 1977, 1: 1354-1355, Jur:e 25, 1977. 50. Johzatone, F., and Inglis, L. Familial Trends in Low Birth Weight. British 'iedical Journal, 1974, 3: 659-61, Sept. 14, 1974. 61. Rannel, W.D., at al. A General Cardiovascular Risk Profile: The Framingham Study. American Journal of Cardiology 38/1: 46-51, July 1976. 62. Rannal, W.S., at al. Menopause and Risk of Cardio- vascular Disease: The Framinghaa Study. Annals of Internal Medicine 8S/4: 447-432, October 1976. 63. Kelson, S.R. Testimony before the American Cancer Society's National Commission on Smoking and Public Policy, Chicago, May 25, 1977. 64. Kennedy, A. Relationship Detvean Cigarette Smoking and HistoloSical Type of Lung Cancer in Woasn. Thorax 28/2: 204-208, March 1973. 65. Rennedy , A. Mortality from Lung Cancer. Lancet, 1976, 1: 965, May 1, 1976. 66. ICerrebijn, L.?., at al. Chronic Vonspscific.taspira- tory Disease in Children, a tivo Tear lollov-Op Study. Acta Pasdiatrica Scandanavica Supplement 261: 1977. 67. xopcsynski, J. Seisbt and Veilbt of Adults in Cracov. III. Wai=ht by Ags and Cigarette SsoBing. Epidesio- loSy of lfoainfectioas Diseases, Epidsaiolosical Rs• viev 26/4: 452-464, 1972. 68. xrants, J.C., Jr., at al. The PhariacoloSic Princi- plas of Medical Practice. Villiaas and Wilkins, Daltisors, Seventh Edition, 1969. 69. Lullander, S., and [allen, D. A Prospective Study of Smoking and Pregnancy. Acta Obstetrica at Gynecolo- gica Scandanavica S0/1: 83-94, 1971. 70. Lancet. Editorial: Coronary Etart Disease in Toung Women. Lancet, 1977, 2: 282-283, Aus. 6, 1977. 7:. Lilisnteld, A.M. Emotional and Other Selected Characteristics of Ci=arstt• Saokers and l/oassokers ~ sa TiM 0133792 TI KU °°°°les9.
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0 E~esybodr'~ ~ot ~a ooinio~ ae se+oidn~. But a lot ot ~o~s atsived at tlkas witl+out ~f m ~nae~ Otath. A2=4 w dw P~sidetu af The Tob.am (a:oeuts At+d Pre =ot ~on~e won tl~+d ~n otl'at;om~.oon rUgou t;lasesaaAd•~aoio~ pop~pdi ityau ve an svdienae wM'dbe smee.ad fd yTraoodatupa ta. in ad~se.at pee~pemww aasa~apoow about aur b~di+~s! a~d M.o tf~dr qusoona m a rery m~poeoM wbN= Attar a!L hov aa ws dea~mioe t~s wl~ole e ou facts ou -run gY ~ wo et m . . ttucb witet anh Atl[ tAe hM3, Co~e.i.Dra~A.~aw..I atl.~dsti~r Misxt i I lJ.S Rqra.laia. (LrA. a~~ow ralwaruel_ /6r.~e a.re~i~! I6. w.vs 1'i.f /wnncMCwm a erR aw u.S. Cdq.a r dr GEASwas.Wtiesw !e ww .mwwwie e~a~nrP.w i~ Ltio A+u"a. n.n. lia a..~t a„n~.~at .~"~. r~a.6~rA~OR tm 1SaWL .v tr wounro^ D.C 10006 a.csOrJi001 OiW6. . #4 MI Mi TIlVIN 0133711 TI KU 000018409
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i Or YouAe seenthemon~ood ~' netiv5... the ceriwrk Now hear them in person atyaur dub meeting orcom~ntion. fin c ssde :! y+v seory :~ane aoe le.. Lipqcpl rlt mntelD-+c ~OOnedt t0~k1q . e t9 `! .^. R! O iR0 »l~001lr 0!'lWI~01{t Of i~it S0 iffOm00f1{. 3MC ~1~MQ ZNv ~~ s~y ~~~ r~it f~rn1s rt i)t CM t00~®11M0~1q w~ m TD!!~ ~ al! ~1iCMlMIL~ d1~' iltt wf ~ft :~rlm1 b We OYO~~C aId j~11101~.~~011t C~ O' pMllti! ilyOM O :ve oesw. -.Me oosa ~aocw dr.. ~a oe. und f~o~~ar dn+~fa. cnlon.6ea~~m~. :ooR u:•e :nfidqi., ewf a~o1Y~ ~ ~t~ ~c sJ~f1 swB ud~o ata~eoas!sf 1 ~or ~~~~~NMM16M ~:a°°eeeeosn~ amossrmYr~ -~ ~ ' ~ '~ e c~rr.~ e:+oR a~t rarC Ae.t dra40oe~ s~esr w ae ~n+~abr at o~CS fo~ndof~l'~a :1ary Mtitlf 3tOCS7i~. 00101e tlNp Mpd +onrs vc ssYa fpeawnt ~ ar ~ee aue~nu. opaluns cn0 1t Cnt ~arsee I~CC dr Ian1 af o~eq e irr.enqn a+waa 0~~ a ra~ .e AootO~you ~ wh'ktbc ~e+a w ~raac oo p•e aett y~opls~ ~6 ~ ewd e~1~,~ OeoYs >~Y ef~ out d1t. xOCyd ~:e.r n..d a sY~c (aa sam x~. a11uK uid .c osG(e~e et s~oiets~i~++oyn~~raNees~s. ~~ a ds*+lok au~A Ftee food for thou~ht ~+~,:>~! ~ *~,cTss:sse c•ss. yns-+na feov,•1se:e +. s:a,ti on :cpcsaoon, p.er:~tt pow b+d aaer Nih TIMN 0133707 TI KU 000018405 ~ ~ J N f+ «' w MAIMwMtw:ff w1.....r ~~
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C ONTTDEr°TIAL: MINNESOTA TOBACCO LITIGATION THE ANSM WE sEEx A Tobacco Institute Film September 1975 Aff TIlVIN 0076952
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Consideration for others is a two-way street . .C: _-C •- :--o0 .a 3ar%. - , ,C•- :a . . -; :ac es. o6c -.s'c dre s, a'ew .ir Jne zsr : .s _a~.c 3cc -coacc* -r z-~ a! On A Vejr •0 cJr'ec! !re Whe'- "~ a^.. ,:! or^e's 7t. urnorg •o go%,ernment T",.s Ae can rr.oose r;:: ;z-•'zis :n •re oCc3Siond1 errant nor, otower. °r -_s,c ,re^t* or -e c:gare.^e smooter 3ut .e` -sr +!ec! loon !ne Jreeicraole !art v a soc er. •nar -esrr}crs Wrsonal ~reedom n:aw7 Freedom of Choice 'r4i-e^ •-e ong arn•s ane notorousty -nstnsrnve 'ar.cs J! y0~e•r.menr srart makrng rhest 9n%ate ar•ar,;er,e^rs. ail of us. rhe suifererj as werl as tht .,cvisc o6s wrorrarors. bse 'har finr oit of :Oe'".-OUr *reecorn of Choice. TaKe imoKmg. for :nsrance. First of all. it is mocr'anr 'o :ncerstand that there is no convincing :%,ce-c: nar •ooac:o smoke causes diseast in non• sr"oKers In -ac-. the ;ast Surgeon General's report or •nar s%,oier saic exoiicCtly. ••Healthy nonsmokers zV^ossc 'o c:garerre smoke have iittle or no physio- ogic -escorse !o the smoke. and what response does cc: ,r Ta~ be due ro osychobgresl factors." Ir said aiso •*,ar existence of a:rue tobacco smoke allergy ^.as ^.or zeen :neeuivocaily established. Outlaw Kids, Radios? If •ooacco smoke doesn't harm the nonsmoker. ^e ssue " ecomes slmply one of annoyance. And an>i•beedom :~4cr-s •o 'esrr.cr public smoking become _ .,~o ct. :s avtr •o •-e :e-. .. -; :i 'vr:•CC:rg lare^rS 'o 4M e 'rt . ::crer .nose ••e^!-g -.,nr ot.r:av.Ing *or•aoie •aaos. A amoKer :an VSVaIn. ae°se Ari~ a! ~ A-es r m.ignt Ot :m..arooer !o ige!.r ,.0. r•t^a:":~ -c :-t can orooe0% ooler. '0 •ne :On-r-on•;:-s: ' 2 oi r•.ot smoKrng :n ve6ators. :n Mor•% areas or other c:early :naooroor.are -)iaces indi%rduai managers of 'ac:uttes +ne•e aeoo,e ;a•-r• can and do arrange. :n tr.e:r own irre*ests. 'or '-e mutuai comforr of rherr smoKrng anc -onsrroKur'C - patrons. Most. obvrousiy. •..ouid ar0er !o crs.4:-are smoking areas oy; their cnoice. not h av. The Ancient Courtesy Mutual comfoR is a two•wft street Amo^e annoyed by tobacco smoke or me Tany ocre' occurrences that can trouble us ct??arnfy sno.ra remind orhers of their preferences -n a "trre ar:c friendly Way. "Would you mind. please lowering your radio ... hushing your eog refraining from sToking?.. Conversely. no one ever went wrong obstnrng rht anoent coutsesy. "Do you mind if I sfnoke" Mutusi comfort entails mutual consrderanon- purposeiul. reciprocal concern for others' preferences and feelings. The individual resoecr. tolerance and accommodation needed to resoiiie mosr everyday aggrsvarions can't yt iegrsrarea. tio one should expect them to be. Mun,al considennon is and must oe the busi• ness of peopk. not of government. - Consideration br others is and must be a Iw0• way street. MT TpIN 0133706 Ln TI KU 000018404 N ~
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51721 1083 At • V~ Li,fuj1ih1 791, ~ ~ ; ~ o ~ a n 14 M , f .
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soccal commentator Robert J. Sstnuelson has writien. 'The goal is to breed intolerartce and to alter behavior," he says. Smokers and fair-minded nonsmokers a¢ee vnth Samuelson: There are limits to whst government - can-and should-do to control lawful personal behavior. 'Anu-smoking ctusaders,' Samuelson maintaitts. 'are reaching those limits.' 8 IIG A'kAv DO We Go 2h,oA18eTe' Z9lee Iss»es ... And llte Ffu,'fd Indoor Air Quality and Smoking Restrictions Since the late 1970s the anci-smoking lobby. thuaued in its e8orrs to have staokitg banned has sought to make stnoking and smokers soc:ally utacceprabie. to exert neK pressare by disturbut= the relative equilibrium between smokeri and nonsraokers.'Iluy have relied increasingly upon the claim that the cigtrette smoke of other3- enmironmental tobacco smoke (Ef5)-poses a health haxsrd to the nonsmoker. In paiating the stttoker as a threat to society-ar.d the nonsmoker as the innocent victim-the ETS issue ie designed to make smoker3 feel 8uilty about the alleged effects of their smoking on family and 4lendsL while inciting fear and hostility among notwtwkem 'Ilte goal Is to make nottsnwkers feel they have a right-evea a moral duty-to harase atnokers. Is ett<irotunental tobacco atake a proven health harird to nonsmokers? Is ETS the major contributor to the growing problem of Mdoor air pollution? And do NSWIscoraM erd businesees. hsve an oblfptloa to -prouct,' at at4 coak the public h+om ETS? Fact: 8artroamental tobacco saaoke has not be.a shown sdeadseall7 to be a heakti hasard to aonsokers. tn t9s5, the latertntlonal Asau.y for Research on Caeuer reviewed the qualiq~ of the evidence in the pubrithed reports than a.aihbit on the E'PS/lun8 caaeer question.'lhe:epoet was critical of ETS. but concluded of those publWnd reports tlmt'eadt Is compatible eitlfer..ith an Mceeare or with an 9 TI KU 000019164 TIlM 0133936 r N r B t0 l71
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, CONFIDE.VTIaL: .NiDi,N'ESOTA TOBACCO LITIGaTION -3- OR. There are certain resOonses which are not--disease res;onses wR4cia art no: dse ac:ually t: wha: we think is cese::ive res~or.se to it. :he disease-prrducing agent, :ut :o our bdy's =ardiac disease, hypertension, certain types of so-called ailer;ic disease•-:ney are ai1 excessive reactions of our body against insults which to do require such an excessive response. NARRA'OR: Stress is Most comnonty associated with heart disease--man's numoer one -kiiler: The second is cancer. Simply stated, cancer is a malignant growth somewhere in the body which tends to spread. Cancer can attack any part or element of the anatompr. OR. FJRST: When does a„roup of tissues become abnoral? So far we haven't the slightest idea. Why does a normal ce11 suddenly change into a cancer cell? DR. OBER: There are literally thousands, if not hundreds of thousands, or millions of possible causes for cancer. And instead of speaking about the cause-of cancer, I think we should speak of the causes of cancers. - NARRATOR: New discoveries suggest viruses as possible causes of some types of can- cers. Studies are going on at the Jackson Laboratory in Qar Harbor, Maine. DR. ME?ER: Viruses do cause cancer. We are working on genes which control certain cellular compounds which we call ribonucleic acid. It's like a virus by phys•icai- ciesM cai and biological behavior. It is unlike the coewon type of virus in that it is not tranWtted horizontally from individual to individual, but It is the product of each individual's inheritance. MRRA;OR: An apparent genetic susceptibility to cancers has been noted by others. M71` TIMN 0076955 ; -o02„402 ; 0-
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51721 1085 f ! i « R 12 a vi ~ S . ~ • ~$bp- e ~ ~ p •~, . . ~~ ~ ~~~ s~ayy~~ J 1111111 f' w + •V %D I t . 1 .
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i 41 COnFIDEVrIU: NiLv~'ESOTa TOBACCO LITIGaTION PROF. 9RGWNL::: There have been studies fsr ethnic groups in the United States, e:-r,i: gr:ups moving in as a body from various curopean countries. :t is found :~a: :ae lung cancer rate for aese etani: groups corr_sMcnds more closeiy with :r.eir ar'g:nai Elropean compatriots than with the general U.S. population. This s:rong'.y suggests a strong genetic component of this disease. NARR:.;uR: In recent years, no illness has provoked more questions--more controversy-- tran cancer of the lung. NearTy everybody knows about the apparent statjstical asso- ciatiori between smoking and lung cancer. One of the largest surveys which helped to produce these statistics was conducted by the American Cancer Society, which selected more•than a million men and women to fill out questionnaires about health, past illnesses, smoking and other aspects of living. OR. NWNO: And I had our computer do a matching probleo. I--for this analysis-- took the records of men who'd never smoked regularly and the records of men who'd smoked 20 or more cigarettes a day. Then I had the computer take the first man who'd never smoked regularly and look through all the files for a smoker who was as auch like him as possible. NARRATOR: Dr. Hamaond managed to find 39,000 such pairs. DR. HAliF1M: At the end of 44 months, there were 600 and soea deaths In the non- smokers and 1300 and soaR deaths in the smokers. About iS or 20 times as many smok- ers as nonsmokers had died of lung cancer. U'RR1TOR: From the very first, highly respected me~Abers of the scientific c:amunity took vigorous exception to how these numbers were used. For exas~1e, most of the people surveyed were from the industrial northeast and aridwest. Yirtually none was from the Mountain States. MTrIlVIN 0076956 _ / 0020403 r r r w
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CONFIDE.r"TLAL: XLYNESOTA TOBACCO LITIGaTION _IH'e ANSWERS IdE S-:< NAARA'C R: This is America today--the pace fast..the c=etition great. We live with more tension, more emotion, more concern about our health, more everyt.tiing t.tian ever before. DR. ROSE'VMAN: In our type of socioeconomic environment, if you want to achieve more and you have more obstructions, traffic, persons, things, what do you do a- day? We11, either you become more fr,istrated--or you hurry. OR._ S'e:YE: You use up energy to resist an infection, to fight intoxication. You use up energy to think. And the more energy you use, the more you are under stress. DR. RATCLIFFE: What we are doing to ourselves is what's killing us off at an un- necessarily early tiaie. - NARRATOR: One controversial aspect of the stressful lives we lead is tobacco and its use--particularly in cigarettes. For the next few minutes we will be looking into this. And we will call on world-renowned scientists and experts from several disciplines to help us. (VISUAL ROLL OF PARTICIPANTS, EACH IDENTIFIED BY MEDICAL SPECIALTY AND IATER, ON APPEIRANC:, BY BRIEF, WHITE SUPEREO IDENTIFICATION ACRQSS BOTTOM OF SCRE~1: SURGERY: Hireai T. Lanaston, M.D., Thoracic Surgeon and Professor,of Surgery, University of Illinois College of Medicine. PATHOLOGY: William 8. Ober, M.O., Clinical Professor of Pathology, New York Medical College. Herbert L. Ratcliffe, Sc.D., Pithologist and Professor Emeritis, University of Pennsylvania. MT TEWN 0076953
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r The cigarette controversy eight qUeations and answers MT 111!'ii\ 0000471
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0 , COnTnE•rrIAL: -s- MQ.~(VESOTa TOBACCO LITIGaTION 0 S: Lung cancer is predominantly a disease of peopie who live in large citi.es or in industrial areas, whereas :ecplt Nhc ;ive in rural Co.:znunit`es have a"luch ?ower inC'.denCe of lung cancer. CR. ::J:yE: ihere art substances in the air in tvery city in the United States-- and I suspect in every city in the world=-which are known to produce cancer. `ALung cancer has been found to be increasing among ducks a: the Phila- delphia Zoo--located in a typical city air pollution area. DR. RATCLIPF_: It seems to us possible that they were ingesting material that has been deposited in this mud and that excretion by way of the lungs is a possible exit of the carcinogens that are taken in through the mouth. The other possibility is t:zat t.`.ey ar: inhaling it. NARRATOR: Not long ago, an outdoor-dwelling Siberian tiger died In the Philadelphia Zoo. Cause of death as determined by autopsy? Cancer of the lung. Others point out additional factors statistically associated with lung cancer. DR. LANGSTON: This disease is a male disease. Moaen do 9et the disease, it Is true. But they do not get it»in the same-- with the same frequency as the aole. OR._OB ,ER_: The actual number of cases of lung cancer-although recogniuble and significant--is not terribly, terribly large, whereas the number of people who smoke cigarettes is extremely large. And any theory which explains why A causes B also has to explain why A does not cause B in the people in rrhom it does not. ocCur. And this is one thing which these people have not explained. It's an incomplets theory. 'MT TIlVIIV 0076957 _' Uli;ajaO•} /
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f 1. How many The aovee"runent estiautes tnere people are appeoxt:nateiv 3 i miilion smake? Mneriw+s. or about 32 per:eat of persons aged 20 or oider. who emoks: among tsen. nearly 35 percent ind sasott; wromea. 29.5 percent. Teetur sawkitg has deciined sub.tsntislly it~ recent wats. Tbe curree+t percentage of aisn scaool scttdeats wbo smoke reportedly is the lowest in s deeade. Aeeord'ettg to Sovetottment dui daily eiianette use by teenagers cropped more than 35 petcntt between 1977 and 1984. A somewhat higher pee+e.at.ie of o.eaa;e fanafes thsa males smoke. aut smoking rata for both sexes continue to decline. 2. Hgw mmy c4pw*m are sold atssoatly in 1110 U.S.? Close to 680 bi(lion. 3, pop CIPI.moS ~~ The answer to the fust question is appareatly not. The second is laas eleat Sotne p.opl. who disapprove of smoking by 4r% te sies ..ek(tit ff ••aes, ..bot sayrooe of .V age claim cigarette advertiaesi epusa taasas ers to staet and eaeooraps smokers ~..T '.vho want to quat not to. Oehers ki f d to smo ng as aemg y oppose admit tltot tw.nr.b on ebe question is not perstutistve. now R.s~...e..ww data h.lp show tlw eipLrate beaed aas 1u~.o ae eFfeet oe dr peevafeme of soldu& Cbsy.r ia tlie peeesatare of teenaies ..1o .molW & sW eorrapoad wieh Is.reb oE .. adr:e~ 4..d'iag. :~.itbsr do adult smoking ' R~..meb.es _s~oep tltat a~aeott! IM~~ttded to • ~ bri0~d of OopfYt~li. Ads b0~r ~~ 1~a~ or to pati~ tmoli/!f to give tbe syd..ee~d blond a teyt r. MY T]1dN 0133955. in ~.. TI KU Qp00192?S N r r
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> COIYFIDEVTLAL: •6- .viL~TESOTa TOBACCO LITiGaTiON !LiR_;CR: The U.S. Surgeon General's report which dealt with smoking back in :he S'x:ies sMecifically sta:ed that "statistical :eetaods cannot establish proof of a :ausa' rela:iortshi; in an asscciation." Scnokins, cf :ourse, has been associated statistically with other health problems. One of them is coronary illness. OR. !aAh.M0K: We found that there wert more than twice as many smokers tna: diec of heart disease as nonsmokers. NARRATOR: Some headlines reflect the smoking adversary view that there is a cause and effec: relationship between smoking and health. But conclusions based on simple statistics do not satisfy many. They feel that more meaningful research should focus on the smaker rat!ter than tye smoke. Do smokers differ from nonsmokers? OR. 5"e? TE: Smokers tend to be more aggressive, out-going, extroverted people: hard-driving, full of tension. They tend to aarry more often, divorce more often, move their homes more often, change their occupations aore often than do nonsmokers. OR. SELYE: The hunan being saokes only betause he likes to ssoke. Nobody smokes because he has to smoke. Nobody can coaannd you to smoke. NARRATOR • Dr. Ray Rosen= i s di rector of what i s al l ed the Western Col l abora:i ve Group Study. He has'found a striking usociation between behavior types and heart disease. • OR. ROSEMAN: The behavior pattern that we're studying is concerned first with personality attributes, such as aggressiveness, ambition, drive•-the drive to achieve, :ye drive to get things done--competitiveness. .Type A individuals are simply individuals who exhibit most or all of these different r personality facets to an enhanced degree••an exaggerated degree. TUO::UqU$ Tnvlav 0076958
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CON'FTDEr'TIAL: .ViLti~'ESOTA TOBACCO LITIGATiON -Z- ST 111;:S_:CS: K. Alexander 3r:wn'-ee, M.A., Re:ired Ass,cia:e Professor of Staa s- tics, University cf ;:hicayo. ::+R::G'!: Ray Rosannan, M..'., Associate Director, Harold 3runn Irtsti:ate of Carriovascular Resear:h, San Francisco. CHEM ICA L Arthur Furst, Ph.D., Director, Institute of Chemical Biology, Univer- B:DLCGY: ' sity of San Francisco. 3ENE':CS: Han_ s Meer, D.V.M., Senior Staff Scientist, Jackson Laooratory, 3ar Harbor, Me., and Member, Scientific Advisory Board,_Council for To- bacco Research - USA. MEDICGtL Philio Burch, Ph.D., Professor of Medical Physics, University of PHYSICS: Leeds, England. PULMONARY Edwin R. Levine, M.D., Director, Depar=nt of Inhalation Therapy DISEASES: and the Cardiopulmonary Laboratory, Edyewater Hospital, Chicago. MESS Hans , M.D., Director, Institute of Experimental Medicine and - PHYS I OLOGY : Sur9ery, University of Montreal, Canada. 'ePIDEMIQLOGY• Rune Cederlof, Ph.D., Associate Professor of Environmental HY9iene, National Institute of Public liealth, Stockholm, Sweden. E. Cuvter Hamnond, Sc.D., Vice President for Epidemiology, American Cancer Society. Carl C. Settzer, Ph.D., Senior Research Associate in Biological Anthropology, Harvard University School of Pub1 ic Health. ) NARRATOR: We seek answers all of us ne" to important questions ... The wear and tea the life we lead Is considered by some as contributing directly to the type of oisease one will die from. t r MT TIlVIN 0076954 70020401
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which in the judgment of the Secretary poses a health risk' HHS is reGuired by law to conduct and support research and to inform the public of any relationship between tobacco products and health and to recommend legislative or administnuve acnon. Cigarette packaging and advertising must by law carry four rotating warning messages: broadcast advertising of cigarettes is forbidden. Cigarette brand adeertisutg is monitored and regulsted by the Federal'trade Contmission (FTC), which Ls required by law to report annually to Congress on that subject The FTC has for many years required cigarette manufacturers to submit detailed information annually on advertising and promotional expenditures. Law requires an interagency committee (ICSH), headed by the Surgeon General and including HIHS, FTC. and the Departinents of Labor (DOL) and Education (DOE), to review both public and private sector activities on smoidttg and health and to recommend policy initiatives. A second interagency committee that fnchaded the Consumer Product Safety Commission (CPSC), the US. Fire Administration (USFA) and FHS directed the eSorts of a technical study group CTSG) focusing on ways to alter cigarettes and lfctle cigars to reduce igrition propensity. The last pha.e of. this federal scudy effort was completed at the end of 1987. Regulations of the Bureau of Alcohol. Tobacco and Ffreatms (BATF) of the Department of the heaxtry (DOT) tequite certain lnformation to appear on every tobacco product carton or pacloge. The Federal Aviation Administradon (FAA) of the Department of'haatpottation (DoT) overaees the current two-year ban on Smoldng on short-haul airlfne Bights. General Services Administration (GSA) regulation has restricted snwhing in most federal buildings. 6 In addidon. stste and local governments have enacted more than 900 laws or ordinances ut recent Yeats testricting smoking of tobacco products in public places andfor the workplace. ar.d some ha%.e attempted to regulate advertising and promotional activities. Almost eVery state prohibits the sale and/or possession of tobacco producra by minors. That taxati.on is a form of regulation la demonstrated by the demands of anti-smokers for increased taxes to stitle saies. The 16-cent federal excise tax, exci:es imposed by 50 states aad the District of Cohuabii plus those of 392 citiesL towns and counties accotutted for aimost a third of the average retail price of cigarettes in 1Q88. Enough b enough? Not to s:eoking control a6vcates. In the 100th Congreas,14S additional restrictions were offered- • Banning cigarette advertising in all media • Banning all promocion of cipttettes , • Requiring additional warning labelb on cigarette pacloges and advertising • Doubling the dgaeette ezcise tax • Bannatg the saM of cigarettes in vending tnachinea • Requfeing the CPSC or Food and Deug ~ to regWate cigarettes in new but largrl;y uttepecl6.d wsys • Elindnating tlte tax deduetions for cfgarette advertisint • Banning smo{dag in all pubtk comeyances $C3CmIIg the LIdt3 'Anti-satoking advocates see touglur govWnmeru restrictions as a way of oscacising anokers and i;ttitaidating thetn into stoppMg,' economist and MT 7 TI KU 000019163 i
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_g_ lurg cancsr, :ard=ovascular disease and so on. OR. CS_: : tiink we hive a gre=t de:l t: le3rn and : think far too Wy Mecple have rsshed .c a r. ._,-na::re ~+.-nt -asad u. •c~. ~ vey inadeq;:a:e evide..ce, cn.~ery . ,;~..,.t e. r,/ because of the tremendous L=tional need ta overs:.-gl'fy and Take things easy and palatable for the public, for medical students as well as for legisla::rs. WARRA'CR: The tobaca industry is ccncerned about the implicat{on for its prcCucts. It believes infored discussion is essential to the public interest. Its dollar cemmit-nent to independent scientific research in the area of smoking and health exceeds the combined support of the cancer society and the heart and lung associations and is growing yearly as we seek the answers that we need. DR_NRS7: The biggest thing we need is a good idea. We need more good idei*s and we need aore good quallity research. CONFIDENTIAL: N1IlVNESOTA TOBACCO LTTIGATION MTTEWN 0076961 September 1975 7"0~2G4Gb .r 1-+ r 00
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I CONFIDENTIAL: 8 .NILrti'ESOTA TOBACCO LTTIGATION (VISUAL QUOTE ON SCREEN: "'4e tend to :bscure our i gnoranc! by maki ng it seem :hat a arooiem has beln soived when i: has, in fact, been only half-soived.") -VR The Sur?eon General's Repor: related a higher death rate to smokers than nonsmokers in more than 20 different areas--including accidents and suicide. :e:'s icok at Just one mors--eaQhysema. Si,~ly s-„ated, emphysema occurs when the lungs lose their elasticity so t.'tat it becomes progressively more difficult to breathe. it's aajor cause of disability. DR. Eep hysena in the United States is caused primarily by smoking and OR.: Well, my feeling is that there is no evidenc= that cigaret•rs smoking has a direct causal relationship with emphysemt. The origin of euphysem:. is shrouded in a great deal of pstery. iVARRA'OR: A government report stmis it up by observing that 'since there are no clear-cut leads as to the cause or causes of eaQhysema, no quick solution to the problem can be anticipated.' More complex questions reaain.to be answered. As our society accelerites at an inereasingty faster pace and grows more coaQlicated, we are forced to seek true answers, based not on. stitistial coincidence but on meaningful research into causes. OR. 3URCK: we still live in an era of environmental detenainism. That's to say, we have an essentially optimistic philosophy. We want to believe that all our ills can be attributed to something in the environnrnt. It means that all we have to do is to eliminate smoking, eliminate soft water and so on. And we will eliminate MT TIMN 0076960 7-u0::0q„7
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PROTECTED BY MINNESOTA TOBACCO LITIGATION PROTECTIVE ORDEA K systems were cleaned and venti>ation rates were modified, the indoor air qudty impmed dr& mstfcsily. Tobaeoo smoking continued to be pe:mitted throughout the bm7din< wit#mnt anx fortber discomfort or adverse efiest8 being raported.» Although ACVA has found that tobaooo may add to the particulate bnrden In an indoor spsce, tobamo emoke bae aete as the signal for the eadstenee of a more ~aiseint indoor air quality problem primarily pooe ventilatim the lack of an elddeat ucbaliet system and an iadequste apply of bub air. An overemphasis upon the aewned particnlate aontrsbution from environmentd tobacco smoke could lead a buildiAg manager to overlook the mne,h more fnndamenCd problem of a poorly designed and maintained HYAC Ttsm. Robertion's presentation provided some vivid ilkudzstioac "Dead birds, inseeb. rodent es:cutes and feoes and exwt amounts of dust have been lbmd in many bnildinp where employeea have complained of eye irritstion. betdaebee. awslas and general ree~piratory prob>~u.... I[o~rement within an enclosed speae can stir up paper doele. teat0e ~bers, looN Sber~Iaea partldu and asbestoa.... H'iah levels of oubon momdde In oEau have been trased to tlN duuet from automobiles in parldnE garages below the buOng. This gas an permeate a building through elevator shsRs or stairerells. ACVA also has dboowrd high amounts of carbon dioxdde in raveral buildings, as well as measurable levels of osoae and formaldehyde. Oeganie oompounde are releared into the sir by building materiale. sdhesivn. ae:oeoli, paint, aowaetics, eleaain` sdvents, pestiddes and burnin= fueb." Robertson piled example upon example. ranging from hospital operating room air ducts doggid with lint and textile libers, to flocked waApaper ebeddinf into the air of a federal ooartbousai to putriIIed bird carcasses in a Dutch bospitaPa BYAC system that had caused four infante' deaths. to a large bank'e delibaate blockage of hah ais iataloa to ore eneea. to the fun filled environment of a Washington. D.C. ~-etmmeet offia bo~ that a Natlooai Institute~toe Ooeupadonsl Safety and Iiealth mkrobiobsbe 6arKterised ae "sort of like a ebiaken eoop."I" His concluding remarks are worth reprinting in tbeir entireq. In pert beawse they provide further support for the notion that systematic dentisc work In the llan needs to to beyond the Investigation of ETS to focus upon the larger W more e1=ai![eaAtpeob1em.ol ladoor air pollution from all sources. More hnporeandy. ' Robertson ideotllld a practical solution to that problem, and correctly warned of the deo anokers and soamokers alike-tbat is presented by ignoring the forest for one rdatiwly iwignifiamt IN ACVA's investisationa have esteblished that a multitude of faetors contribute to poor indoor air quality. The eonfoundinf assodated with thess faetors make their analysis and nubseqoent, reaolutioa To eonon-trate~poa one demait of this matrix, environmental tobacco t~noke, would be iaeffident aad It would be ~ naive to a~e that the removal or oontroi of 6?S. the most vMleair poDutaat, would eolve W indox air poDudon problems fonad In "ddc bWWhp." That itep ipioees the many hidden aonraa at iodoor eoatamindon, and an lad-at Iwt in the dmrt run-to a falss saun at security. ACVA's work and experienee. and evaluatione ocndnetdby NIOSB. indinte tbat iadoor air qaality can be Improved significantly with pMes maintenanee of and ti~n the HVAC ey~em. Aiearing the Introduction of tGtered ont~de air. aaaindinieg efffiltration tysteeru. ongoini monitoring at a!r qualtb, dearAng and repdrinf due!*rork and improving the designs of ventilation systems an aeadeary steps for the aebievement of acceptable indoor air quality. BiEh concentrations Of 40ANnineatat tobacco smoke :A 14967
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a 51721 1125 ~~ T.,.~,... O I
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CONFIDEN'PIAL: N-0NNESOTA TOBACCO LTTIGATION :n gene.-al, the Type 8 individual is mci more relaxed, muci more easy-going-- ~,•.RR~ CR: :n a nine-year st::dy of 3,200 California men, Cr. Roseman and his ass:c'a:es found Type Aman tend to be heavier sa.okers. And also... :R. RCS:'MAN: Men with the Type A behavior pattern have almost more than twice the ccr,nary rate of inen with the Type 8 behavior pattern. As you might very well exaect, the behavior pattern is related to the smoking habit. CR. CE7ERLOF: Say that you are a certain type of person and you like to smoke. You may also then be more apt to start drinking or more apt to have a stressing job or something like that. w:RRA'DR: Dr. Rune Cederlof has found that among twins--people with identical genetic make-upe but differing smokin9 habits•-there was no difference between them in heart disease. DR. CM. ERLOF: I would siaa up what we have found here that smoking does not seom to cause heart disease, that is the kind of heart disease we are studying--coronary heart disease. It's not likely. There seem to be other explanations for it and we ire trying of course also to see what other explanations there art, then. NA_ In recent years, coronary death rates have been declining. The Nationat Heart and Lung Institute points out that we've learned so Such about how to tr a heart ailments that we overlook how little we know about their causes. MTTM 0076959 TaR'~1) 40 b ; ~ ~ N o~
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X , The /acts and slalsnwils M Nds document ere preseMsd by The Tobacco ImNhrN In IM OeMsf Mal tM rrr.ny conIrowrslai quesNons concerning snakMq and health musl WNarale/y be answered by hrrther sclenN/b research and new Rnowl- edpe-and pot tbll, hee, and Inloreisd pubNo d.cwslon Is essenMN In po puDNc Interest. The clparNN csalrowrp/NOM queN/owe awd answers ~;4:G T~; TeDM o/ eestsrrN Preface ........................................ 4 1 Ooes sclsnMc evldsrrce reaNy eslsbNsh a cae spsNrsl clparNNsl ........... 7 2 WhN.re soMe o/ Nw sa.W dslsNs b Ihe s1.Msllcal case against clpareMes9............ 13 3 Are there other pu:Nnp conMrslon. In Ihs s1.IbMaN cass? ............................ 17 4 What h.ppens to the research Mai does not candei r dp..etles7 ................. 21 S A most erlsle.dMq st.Msro on dp.relNs: How was M arrWed Nl ............................ 25 1{ Have rou Heen rMsled by •sclerNNk surveye•• ebaN clparellee9............ 29 7 Are smokers a "dlllerenl kind of peopN7" ....................... 33 e What are Ihe tobacco people dolrq about smoking and haaltht ........................ 37 Bibliography .................................... 41
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Hansas and Viassachusetts legislatures were asked to corsider measures proisibiting smoking throughout sieir states.'Nording of a smoking restriction law in R'atsomille. Califorttia. left unciear wnether city fathers meant to limit smoking at drive-in movies. And on the indoor lront, the Atlanta city council considered a workplace measure perraittirtg smoking in priroate ofiices of government employees only if doors remained closed for at least five minutes thereafter. Today smokers are forced to deal with harassment and other excesses tr+om a-.•ocal minority. In their adamant refusal to accept even reasonable accommodation. anti-smoking actremists are leading society down dangerous patht. Smokers and tair•atinded nonsmokers alike an uying'Enough ss enough!' We've reached the limit Opposition to Further Restrictions According to a poU completed ia Decesaber LQ88, a large majority of respondents support stricter regulation on a number of fronts. inciuding govesrtnent utispeetion of food processbtg plants and transportation and disposal of toxic chemicals. In contrast, an overwhelnting msjority of respondents opposeArr/eer anei••tmokinp froris- and are satisJted tc+itli the current letaeLs 4j reaaZCtiona on smoking in workplaces and in restaurants. The random poll of 1,500 adutt Americans age 1$ and over was conducted by the Washington, D.C. polling firm of Hamilton. Frederick & Schaeiders for The Tobacco Institute. Among the poll's findings: • Almost 8 out of 10 respondents belkve the current policy of allowing emgloyees and_. eatployea to datermim wodcpJape -2- ~~•~'r . s~.„ow r policies should cont3nue. 'sti en amoog norsmokets, better than 70 percent support the current systesn. • Seventy-four percent support current artangements thu allow reazausaras to offer stttoking and nonsmoking sections to customers. Among nonstnokers. more tban 60 percent support the current syacem. • A ma)ority of Anuricans (57 percent) say they believe cigarette advertising reetricrions should either tansin as they are (34 percentN or be eliminated entirely (23 pereent), with cigarette adverdsing being tseated as any other product adverasirg. • Most Arnerieans do not support an increase In the cigatette excise tix. In fact. 33 pereettt said they believe that escise tases-amounting to about a tliird of the price of a pack of ciptreaes -should stay the same (g8 percent) or be sigailkantly reduced (15 perrent). MeanwhUe, Larger lssnes Are Ignored The sitt;lr•enMded focus on smoldng tte,s coate at the expetae of addmesitts knpoetant public issues and txu+eatens key Cotisduidonal and other righca. Mti-sa+oken, for essntph, wwjl& • Encour.ge smoking baus tlM leave tutregvlated tht ttrost itnpoetant factors cocutibu" to diny oake air. • Ban dpreete adMatishtg despite the ltap.ct on our Fhst Anwadmew rigbtt. • Impose regreasive; moraltsde tax ineresxs on those who can last afford to pay. • Have employ= uaWateraliy adopt satoldng caarictioe._!Mpo%woe"• ~~ .. , ~ ? . . . .,• •. . KU OOOOi9161. .29 e444-wr± •;JF •yr~ • W: ~ .' ~ ~ r + , " ~s~.~ _ •~ : ~ . ~ - . _- u7 ~ N V
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,~,..~•. .~,~f.~.,t;.,.>: =:~:-:^... •a,s_ . . . . ;r;• i _. . ' ,..-a~'r:~:~?v'r,k., ~c:~aa~ + ... ._• .. _ _ _
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the League of United Latin American Cltir.ette and the Congressionsl Black Caucus, to nasne a few, sll are vehemently opposed to excises. The Coalition on Human Yeeds. a nationwide alliance of civil rl$hta& labor, religious. pass roots and advocacy Voups, has said, 'if thetn is any tax that Ls more unfair to the poor than the excise tax. we hope Conpess never discovers it' And the Anurian Apricvkute Movement, an orgaaizstion dediated to protecting Amerias family farmera, noted, 'Facise texs are the most regrassive form of taxatioti, bittig hardest those who can least aftord to pay them.' Fact: Risher cisarette ezdse taaes will not sipiisantly reduce consumption. Supporters of higher cigarette excise taoes srgue that increases w i11 discoura=e smoldM parocularly amoni Ameria's youth. Hov.ever. there is absolutely no convincin evidence to snaest that incressing excise taxes has any lastitg effect on ciprette consumption. According to a 1988 study by the Institute for Social Research at the Univasty of Michi=an,'dsarette smoktng has not dropped among high scbool seniors since 19B4.' This is despice a doub" of the federal excise tax the previous yest: Faet "Earmarked" eisarette excise taxes are an unrellaale eoerce of re.en.e. Sometimes governments LtcKet specise products, and the people who buy them, foe tsntIotl, and ,earRtirlC" a set itnoYnt of the taxes collected to lluld speciIIc jovaltulent se:vices. Olter, thMe services have litW or nothing to do with the ased product and beaelit the =eneeal publk. not just the people who pay those particular taxes. Cigarette taxes have been used to flnance police and flre depattmenss, hWhmsys, water cleanitp and health proaams. Tlut's ttiot bgical-and it's not fiir. 22 EUMVldnS encourIes wastetltt spending. When states esrntsrk Ms, tRey can PArt and eraand proF+tns because Atndi are lestantly available- not necessarily because the proaams are really needed When excise tates instead go to the =eneral fund. new proQams must compete with other services for lUndit+j priority. This competition encouraQes review and streanlining of Propams-before tax dollars are committed. Earmarldng is unreliable because it forces the #OVetrmaM to rely solely on one group of the population to sccotttplish a broad publictoal. lswasakers may escablish propams, only to lfnd that the poojected earmarlced revenue did not roll in as plmned What then? Fam Cigarette eseLe taxes sse bad taz potlq. lf diarettt e:ci.e taxes were iacres.ed, they would bit hardest those least sble to patt young people woald sdll experiment with psoldng; and teas of tboasands ofJobs would be at stnlte withls the tobacco Industry and it. sappliers. W 23 TI KU 0000191T1 TIIVIlV 0133943 41
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a oasas? 111s a cardinal prNnclpb Ihal s1alislks.lono cannot prove the causo of any dboasa. 1hs any now evldenco that actually convicts clparolles been reported in recent years9 No. Inlereslinpiy^ some of /hs nwsl slow sNw new evldsnce has Inmplicslsd /acbrs ollssr ihan clparellos. The roN of eenollonnl stress In dlsess. for Instance. Ooes smohhp cause dlssass? ThN question Is dNl an open ons. 51721 1122 i Ooes sdaNillC.vWencA tedly estabN.ll a cas. p-Nat dPrsflss? T~wrw :•7 I a .
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four percent of all cascs. And even those casea. Sndinp show, can be solved with unproved ventilation. '.'hat means lawmaker. and busfness managers `+ill accomplish little or noching even if they succeed in removtng every IZSt w+:p of tobacco smoke tom the workplace. Compl.^•uus of health problems and irntatiotLs will persist. Studies by the NationA: Institute for Occupadonal Safety and Health (?RC SS), and by a leading prh'ate air quality analysis SruL. have determined that just two to four perceru of ia quality complaints were atmburable to ETS. Or the other hattdL air quality problems were traced directly to inadequate ventilation in 52 to 37percent of the cases. Under normal conditions with ventilation that is operating according to established building codes, tobacco smoke very qrickiy dissipates.'tZtis disappearing act confLms that the ventilation system in an indoor ama is working properiy. In those few naes where visible ETS persists. the ventilation tnust be an.z pect immediately. Problems with ci:aretta smoke should be viewed as a"tip o8' to the much more serious underlying problem of inadequate or improper vendiadoet The good news is that once the underlying problem of poor air circulation is corrected, so too is any problem with EIS. Faat: In an effort to aa smoking and smokers from ptsbllic bnUdtnV:, proponents ot smoklns restrictioas ipore .3ry real threats to workers' bealtb caused by iavi.ibUe pollutants that contribute to the gto..iag problem of "sick building syndtn ~me." In recent years. scienti.m have discovered a Qeat deal about the nature : rd causes of indoor air pollution. These iSndio.;s, In research conducted by the federal governmen: ae ..eII as private !!gms, exonerate ETS as the cause of the vast ttWotibr of indoor air quality prob.es:m At the sa;ae ttme, the data revea! a hidden indoor air qnality problem- often called •sick builr'fn= syndrome'-readdng i2 nearcrtsts pevpor3ons nation..ide, csused by invisible cawauram that Post direct tlueas to the health of millions of Anmfcan workers. Anti-sutokets continue to ignore or dismiss the pertinent data. In doing so. they are not oNy perpetuuing false assuatptione about smokers and . ETS, but also are turnmS attention away from the ttue causes of indoor air pollution and llrom the soltttions that wtll protect the American people. Bvitdtng occupant coatplaitus of eye irritation. headaches, fatigue. sore throats and nausea may suggest problems in the design, operuion or maattenance oi a building's vauilation or air handling sq:cem. And in situations where ventilation is snadeQna:e. serious health threats may e4st trotn pollution sources such as ofJlce machine and Nmishin$ contaminants. ehemicala from photocopiers and carbon dtoxide kosa the building's heating system. Fltrcherttaee, the lack of taaintenaace of ventilation systems allows mtcrobes, t1uto and bacteria to accumulate within the systems and to cirLVJatt throughout tM buildin=. A ditty system also can keep Indoor ait from ciradatittg pe'operiy, allowing abnormal buildup of pses and llaaes. Often the problem b aaavued when tlte system is operated tncorractly, such as when outdoor dr.ents are closed to seve energy, forcini building occup.nts to breathe recycled itdoor aiG 1l&O saslapees are capable at determining on their owa approprLu responses to the emoldap isae. d,ddttloaai go.erameat segolatloa in aanece.ssry and may adresselr a3eet tb..e basiaesss. AatNmokas bave used the myths about E'i5 to toeoe sainpat seaoldeg re.ark:tioer an the hoepisaUq iedueay. However, tAe eaecrs of dEFVOU iaacayr saoldng polides Mve a4eady besn fett dJeectly et tlw c..h tegista MF 13 TI KU 000019166
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absence of ruk.' In other words, none establi,shed rLsk with any certainty. U.S. Surgeon General C. Everett Koop acknowledged in December 1986 that more than halt the studiee used in his 1986 report on •involuntary smoking' found no consistent. sutisticaUy significant relationship between ETS and lung cancer in nonsmoketx !n fact a much higher percentage of the studies that have been done fail to and a statmticaUy signiAcsnt relationship between ETS exposure and lung cancer in nonsmokers who are married to smokers. A National Academy of Sciences (NAS) committee charged with nsnewing the titentiue rNated to ETS reported late in I9B6 that there is nothing in the scientific literantre to prove the conclusion that casual exposure to environmental tobacco smoke in public places-including the workplace- constitutes a health risk to nonsmokers. Groups of eminent scientists have concluded that ETS has not been shown to cause or increase the risk of lung cancer among nottsmokers. Refutations of the pretnise ttutt exposure to ETS causes adverse health effects in nonsmokers were also recorded in a Febnwry 1986 report in Medicat Wortd News that stated that'[s)olid scientific evidence of passive snnokit4s health risks to nonsmokers is as elusive as the ssnoke iwhC Yet another study in the July 1986 edition of the British Journal ojCancer concludes tbat environmental tobacco smoke carries no significant increase in risk of ltuts cancer, bronchitis or heart disesse. Serious weaknesses in ETS imatigttions cited by the Surgeon General have been noted by prominent independent scientists. The sciaatift comteuanity continues to point up the Oaws in interpretation as well as some research noethodologies applied,. Respected German biosndsileian K Uberta, In a 1967 tevievw of the stattsdcol evidence pubilshed in the Ialerrtarional drekives ojOcctrpctfono! cnd Envirorernental fleoWa, stated "1'lte vo)ume of accwttuiated data is conaiccanS and inconciusive. The observations on nonsmokers that hmv beea made so far are compatible with e1Ner an increased risk lrom passive smokitt= or an absence of rssk Appiyit>s the criteria proposed by L1FtC (lnterraoonal Agency for Research on Cancer) there is a state of inadeQuate evidence In a guest editorial in the June 1987 iswe of AmerioaA Revieto of Respimtory Diseost, two noted Harvard Medical School protessors, expressing tbeh opinions against active smokittt and in support of the Surgeon Genersl's Report. stated: 'T2te health imp.ct of exposure to (E15I at work except for it; ieriatton, Is lsrgely uctiknowa. The report is on Its weakest ground scientifically ltere.' Calling for tnom research on the issue. the NAS committee and the Surgeon General also ackno..ied jed that tbete i= instttlicieat evidence to prove claims tfiat etvhvnsnental tobacco anoke itnpaits eespitatory Nttction or c.anses hsart disease or allagks ia adult nonsmokers. As a ittrtlter matter of scientific Lct, exposure to ET3 in normal, ereryday, envuonttunts b eztremely low. For example, a atv* using sampling methods dev~Noped by the Harvard School of Public Health and analysd established by tbe Natbnal Insctnue for Ooatpationsl Sateq and Healeh (NIOBH) hsdieaoe tl4t a noeasenotd" snpioyee in a typtMl New York City oQke would have to work nonstop for atnost 24 dtys-more than 550 unhterrupted ltotQS-t,a be elip aed to the nicodae •eqitlvalent• of one ciSa:Kte. Fs>et VWbh tobaeeo ssolu L a sMtosa, raelber duaa a mjor eame, of ladeor air 4~4 p~M~ tobacoo When it com.s to poor ktdoor air quality, stuoke appeaes to be amoetg the Ism ot our wot:i... RepoRS by tedetal and private espets show tbac estvb+oeanesaat tobacco smoke M a canse of discontfoit by buildMf ocaP.ats In just two to MT 11 TI KU 000019165 r I
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-L f 51721 1133 ~. , i Hm y0Y bom /NIilld ~ i S 29 by "+.d«*ac wwv.W .b" aoMaftz /VI....~.~ 0
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A major goal of the antismoking movemer.t is to ban all ciguette adveft-fing and promoaon ove.-riding the protections of the Fiat.Mnendment. L^, ac:rsuit of the goal. ana-smoking advocates have proposed a vartety of inea;ures. Some are pressing to ban aA cigarette advertising and promotion -forbidding ciptette advertising in newspapers or ttvtgaanes or on billboards. and er.ding sponsorship of cuttural or athletic events. Free disirtbution of new brands also would be prohibited and retailers would not even be able to adrerti.se that they sell cigarettes, or the brands and prices available. Other anti-smoking advocates are trying to prr%•ent manufacturers from deducting cigarette afi•erti.sing as a business expense for tax purposes. and some even want to make the cigarette companies pay for anti-smoking advertising There also are proposals .o abolish the existing system of uniform national regulation of cigarette advertisiag, and to allow state and local authorities to set their own ruks- however conflicting or inconststent How do the ar.ttsmokera attempt to justify these measures? They say that cigarette advertising influences young people to start smoldag, and they claim t3w fewer people would smoke tf ci=arette advertising and promotion were banned 1Ley also maitttskt that banning cigarette advertising and promotion•rould not violate the Flrst Amerdtnent Here's the real story. Fact: The First Amendment protects not only political and ardsdc ezprerdon but commercial speech as wel1. Over a decade W the Supreme Court held that commercial speech is protected by the F1sst Amendment. As bng as adverdsfnj concerns a legal product and Is neither lalse nor misleading, it 16 cannot be banned or teat;icted unless doing so would directly ltAher a substannal gow: nmental inter.et thu cannot be pursued m any leu restricti<e way. , Cigarette advertising does not influence nonsmokers to start stttokting, and att ad%•er:isu:g ban therefore would not lluther the objective of J teducing the number of people who smoke. Moreover. curtailing cigatette adve:tistng cannot be defended as the 'least tMSUic-ae nteans' of achieving this objecthm more speech rather than less speech is the constitutionally preferred ipproach- Any attempt by government to manipulate our behavior by censoring whst we see and hear would strike at our most cherished values-and set a most dangerous precedent. Fact: Tbe purpose and fmcdon of cigarette adverdsia8 is to maintain brand loyalty or promote brand swlteWas among people who already smolte. In ttuutare product markets-where the product category is lontestablished and awarenei s of the prodvct catepry Is uNvetsal-advertisiq generally does not operate to increase overall denand. AdveaiMAg inatead operates to maintain or expand the market share of the various br ands uitllin the product cate=ory-to tnaintain;the loyalty of coneuroees who already use the brand being adwtt3eed, or to conwit aotupuaers w!w use other btattdL Ulsinteinbtg and eqanding ndrket shats is crucial in atd cotnpetittvt M*MT- Shampoo tnanutacturea do not spend mi0ions to =K connuttets to wash their halr more oitea, but to ae.ure that cotwuaers :.W buy tlVeir brand of shazopoo and not sotrte other btand. Sientlarly, each dpnxte manuftctttter anivr: to asure that smokers will smoke Its beatds-and not those of a oampedcot, &eplet; eomuaets byal to the brand beitti sdvettbed te Jwt as important as wWtin= consumers away trom other brands. MT 17 TI KU 0000191b8 ~ m r.
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The U.S. Department of Agriculture then establishes ofdcial support prices for the %'rloai grades of tobacco, based on reslistic market expecntions. Rthen the crop is sold at federally svpervised auctions. tobacco which is not bid on by a comatercial buyer for at least a cent a pound above the federal support price is taken in by a growerowned cooperaove, which pays the gzower the federal support price. The cooperative borrow money for this purpose from the Department of Agsiculaure, with tobacco taken in used as coDateral to insure payment of the loan. The tobacco is processed, stored and eventually go1d on the commercial market, The loan is then repaid with interest. To insure that :to losses are incurred by the government if sales do not cover loan and related costs, the law has a'loza reserve' Under this provision. the Secretary of Agriculture sets an annual `no net coat' ssaessment which is levied against every pound of tobacco sold throagh the federally supet;ised auetion system. Half Is paid by the grower and half by the commercial buyer who purchases the tobacco. The proceeds go into the coop a'loss reserve,' which is used to cover any deIIdencies. Thus, the p,oyram is daigned to ass:;n tJtat, uniike many otlwr ervp progrUMS, RD tGZPaye* doUass ane rspeaded to mbafdise tobaece psoduetiM But. it is not enough to state that tobacco produetion Is no desin on ts>payas or the US, economy. In additionn it is estimated that the tobacco core xctors in the US, econoupr generated $40.8 billion of the Gross Vatlonal Product in 1987 and employed 725.000 peesoas to produce and deliver tobacco plodnoti atd associated goods and servfees.l7a tobacco indusay's esattoned spendintledne.d hap.ct on America's GNP was 9EU bMion-tar moee t#m espendituras oo tobacco products aiota.'ilds impact was generated by tobacco ladustry .rorlceW 28 eVendau+es on goods and services of other. r.on- tobacco, betsiness sectors throughout the U.S. Tobacco leaf and matlabctared tobacco an important Ameruan expoeLS. Sales abroad for the Arat 10 months of 1988 posted a rt,g billion trade surplus-surpassing by 7 per cent ;he surpbsa generated for aU of 19r, 'Ihis economic phif beneIIt cannot be taken 1ioNly in view of our lwge national trade deIIcu. MT TI KU 000019174 20 TIlVIlN 0133946 F:. ~
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is the idea that citizens should be taxed based on their aetual income, that is, their ability to pay. Ilu poor and the wealthy should not pay the same rates. Another principle links tax to benefit. While it :nay be fatr to tax a subg<oup of the population to pay for a program or service benefitting only that subgroup. it is not fair to maice one subgroup pay for a program or a service that benesta the entire population. Today. and-smokers a&rocate increased cigarette excise taxes-to help reduce the deScit to pay for programs and services benefiting the public as a whole and to discourage people from smoking. What wautd be the effects of such an increase? Who would pay the tax? What would such a departure from ;ax policy principles mean as a legislative precedent? Fact: Cigarette excise taxes an regressive, taldng proportionately more money from those least able to pay. Excise taxes are flat taxes placed on selected products. They take the same amount from each purchases regardless of income. And tobacco excise taxea are regressive in the extretne. Tobacco excise taxes are paid by smokets. who represent about a third of adult Ameridt». many of them members of lo.w income and minority populadotd. Thua, the regrastrity iaherent in uW consumption tsx is exacerbsted in the case of tobacco. In a 1986 study, the Congressional Budget Omce (CBO) examined the distributional eKects of increasing selected exd'e tasesm inch:dietg taxes on cigarettes. After carelW analysts, the CBO found that a $19 billion tncnafe tn these taxes, under consideration by Congess at that ttme, would tall 27 times mott heavib oa the poot than on the wealthy. 20 Speclacally, the CBO study reported that 'an increase in the excise tax on tobacco would be Lhe most regtess}ve of aJ1 the tax incresses'sadied The CBO saudy is just one of matwy satdies demoasaacitg the regtes:ivtty of excise taxes. For exasnptr. • Citizens for Tax Justice ;CTJ). the nuion's leading consumer advocacy tac group, found that in addition to the burden of federal excise taces. snte exc3se and sal.s taxes take up to IIve times mote from the earnings of families maldttf less than f8.600 annually than from the earning; of the rich. The poorest 20 percent of four-member households paid 5.4 percent of their Income in excise iaxes in 1987. • A study commissioned by Rep. MeMn Dymally (DLCA), chairman of the Congressional Black Caucua, found th;t'for all poor families. even a modest increase in excise taxes will take more than aIl the tax relief aQocded them in the 1986'livt Reform Bnt. This wiU considerably magrify the incidence. prevalence. and the enormity of poverty in *;w United States.' • A Wq 1987 satdyr prepared by the Pie.t Matwick Economic Policy Group shows that •excise tsm are highly regt+essiw and are borM dbpsvportionateb by bewiacotne taxpa., vem' Faeo ClSarea,• exd.e tSZes e,ee eaftfs. lladitianauy, the purpo.e of taxation has been to tabe sewema ia.n e*titabk and n painias a..ay as posdble. Taxation should not be the means t11~h•Ntich one sepneat of de populatlon eegW.as purchase decidoeie for another aegnent, patttculae0+ when the tat rrult of such an attempc would be to shitt the ttut burden onw a segatent of . the population already paying taore than ita bir. ahaee. - A tuuaber of orputindotts-feom all sides of the po8tkal spec:surn-have pointed to the uahitnas of e-cbes.'ilte APL4.'10, Citisens for 7iut Justriee, . MT 21 TI 1W 000019170 TIMN 0133942
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iiie Letrs Set nt Record Straiybt. . . ... On "Social Costs" of Smoldng In recent years. anti-smokiq advocates have added a new arrow to their quiver of attacks on smoklni. The newest weapon is couched in economic terminology known as 'tocial casts.' To jusilY+ etiocv to regulate and uhtmately eliminate scnoldng, anti-smokers use social costs to clalm that individuals who sttioke 'eo3t' society money. Their'calculations' hsve become the foundation for much proposed goverament regulation of tobacco products, including large taxes on cigarettes, rescictions or bans on smolting in public places and bans on advertising. Advocates of the 'social cost' theory would have the public believe that stnoking imposas a burden on society ttirough knt productivtty and healtb- related costs incurred by smokers. TAe Jact is that tkost promoting ela0nt QOoat tiYe sociol costs ojsmodrtng have distorted an otAenrise valid ecovmmic tlmrK Aati-smoking ectivLtta have transioaned social camt theory from an economic coticept to a potidCal tool-twbttng !t to snpport their goal of a smoke- 4ee society.lb base real-.vorld decisions on thb distorted economic theory Is to aeate bad public policy that has far-reaching adverse eftels on sodety..'. And-smokiad activvists haw spotbored poIitiCalb' motivated and highly qnewowbie sadtes to clabn that smokers have bigher rates of 9bness and are less prroductive tban no:uenokets.7hey daim that lost producti.ttSr, abeesmmebst and medkal bills u resntt !!om amokW4 and itnpose large costs on society.'IltM studies have aot been %iiitsted or suppotted by iadependesuL reptuable economic dats But even if the studies >cer+e credfble, the socut cost theory has been miaapplied If smokers real:y were absent more often and kss productive than notstwlting collesgues, It would be the individusl smoker who would bear any resulting costs- *dough lost pay, less job edvancemetu, etc. Further, any medical costs that are incurred by smokets are cosrs paid solely by the smoker- not 'joitu' or'societat' cosrs p.id by both smokers and nonsatokem In paa yeaes, as noted eat9ia: anti-smoking sctivists have stepped up efforts to restrict smoking In public places assertins the 'costs' smoldng allegedly itnposes on nonsmokers. However. economic studies have found that tlwre an Rewr coste resulting from blanket anti- stnoldng policies than any tbat might be att;ibutable to envkoatnenul tobacco atnoke. Ownets of public fydlitie: such as raqwranti and hotels hsve an economic inceoefve to provide dw 1dAd of ettvir+onmaa dw setistles all custotners. LspdatM b.ns on stnokle>f tlua result in more ecoeaeaie kWfBCWDdft and soeial coed tflan ailowing t2W b.e m.rkesplaee to do IN ,lob. 'ihe marlatplace wW deterenirte wlM qpss of policies, itatW, are necss.ey. Govesaneot interfereIICe and regulation o* ~"Pnsm 7he thtory of socLl coets is beit<: used by and- smokft activfscs for polian! tather dw economic paepoees. Beeau.e tkey are aot based on aubetaatlve or em credble dam, socW oost; sNouid tac be used to esitablidt real-wotid policy. tn !lretm if tbe W60nolow' meUrodobp of sxial costs wesa applied to otlwtr eres of eeeryday life, the re.ulos ofeudt'smidles" could izwpbe lovetuaeat regulation in a tarieqr of othet areas.' TI KU OOOC1917Z 26 T'IlM 0133944 Ml ~ m W
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Fact: Baaning or restrietlng citarette advertlsing would not reduce smoidng among 7onag People. The cfgarette manufacturets neither condone nor encourage smoking by young people. and their , adver.Lsing is directed to adultt who already smoke. Prominent anti-smoking advocates have long acknowledged that cigarette advertising does not influence young people to start satoking. Former F?C Chairman Michad Pertschuk has stated unequicocally that'no one really pretends that adveromg is a major detenninant of uaoldng in tlus couney or any other.' As the director of the Institute of Child Health and Human Development told Congtns in 1989.'the most forceful determjnanu of smoking (by young peoplej are parents, peers, and older siblingt.' In :nany countries where cigarette advataing has been banned smoking rates among young people are the same as-or higher than-smoking rates where advertising is permitted In F7nlandt where cigarette adVertisin= has been banned completely since 1978. a World Health Organization (WHO) sarvey found that 30 percent of 1S.yearold schoolboys smoked weekly, while in Austria and the L'nited lungdom-where cigarette advertising is allowed-the IIgure was 17 petcent and 23 percent, respectively. In Norway, where ciprette advertising has been completely banned since 1975, the figure was aiso 23 percent-the tous as in the U.K These and other statistics led the WHO raearchers to conclude in a 1986 report that tMre an 'no sysumaac ditferenc.s' between Juvenile smolting habits in ban and non-ban coantries. A May 1987 report to the Finnish National Board of 8eakh by Lniversity of Helstnld researchess dMdo.ed that smoking among,juveniles In Fintand-whkh lud been declming sharply kfM dgaesse advertising was banned-tnalased g/!er the beA was itnpoeed. Fact: Baaaiag or reasiedng dgneette ad.erd.fng would aot redsce saoldat among adults. 18 Ma-smoldng adMOCStef abo have iclMowledged tbat ad.erOM bans do aot operate to reduce the number of adnits who satok#. Dc James L Hamilton told the 3rd wot'Id Conference on Smoidag and Health in 1975 tthat sdvertising bans had •not been an eQecsive Policy for redu=g smokng,' while Karl Wirnberg advLsed the conference that 'there is no e%iderce to support the view that a ban on cigarette advertising would have a posittve effect on smoking habit=,' In 198 i the President's Councii of Economic Advisers reported that'evidence llom other contttries :uggeets that banning advertieft has not discouraged constuaptfon.' The evidence trom free-market countries indicates that dgareae conaunpRion by adults is unaffected by advertising controls. For the mosc part, the consun"on trends before controls were imposed remained unchanged after conaob were imposed. In some cises, the rate of dectine in cigarette consumption slowed or stopped aRer advercising was banrud. In the F•astetnbloc counerlls, where cigarette advertising is not allowed average annual per capita consumption steadiqr increased between 1970 and 1g84, while !ltlling in the USA aiad other conna~ies where cigarette advertising is permitted. Facr Hea.nr.s baanftg or rensiedng cisarette ad.Kd.ing asd proaot[on would not redoee tht aombes at people who smoke, but would Raeaitotrly depeiMe consumers of Iat.essllos to ..Ulek they ase .ntltl.d and.r tb. FlsatAaends.eat and eso.e severe economte hardship for nhose who depmd on Meanes 9com elpatsa" ad.erddap and promotion. Cipsette $ZC3se Taxes Since the US& was founded naee than two centoeis ago, the federal goYernment bas levied ta~ces to pq Dor needed goods and sesvioas. As the tsx code L.r evolved over the ra~s, one of tbe taort impoctant priadples gorezidtt: that code ~ 19 TZ KU 000019169 r Fr m m
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In a recent nanonal aurvey of stnoket:' attitudes toward the hospitzilty industry, three out of four smokers who said they had experienced some form of discr:minadon said they would be less likely to revisit the establiihment where it occvrred. The business cottununity in Beverly Eii11s. Caiifornia. is acutely aware of the perils of alienaeag smoking customets ln Narch 1987, the city council imposed a total smoking ban in most resraurants and shops. Press neports noted that tension and arguments between customers increased substituial(y. Within one month, restaurants were reporting a drop in business of 12 to 30 percent, with some even steeper. Workers were laid off and hours of operat:on wer+e reduced Three and one-half months after lt was enacted the city council repealed the smoking ban and replaced it with language pet:nitting smoking and nonsmoking atsasm requlsing special air IIltsuion systems for smoking areas. Finding the Qkradon requirements unreasonably stringent, the council eveaatally replaced them with reasonable ventilation standard= for restaurants with smoking and nonsmoking areis. Vevertheless, the damage was done. Published estimates of the revenues km during enforcement of the smoking ban are as high as i3 millfon. Fam Workplaee reserleeions mandsted by law or 11Rp0eed Onilitelilly by employlrs trample on workers' ridlw. A growing number of smokers sre fidng a hostile workplace, with smoking bans or resQictions implemented by management or mandated by la.r Even more otNetoas are policies that prohibit hititg people who attwke-on or off the job. Smoking restzictions on the job often aze defended by antli-snokers as part of tbeir "cotmtitut[onsl right' to a:moke4he eavironmeat However, the courts have soundly ryeeted this notion. 14 i Other clsitns fall under common law. bssed on tne theory that etnployen have a duty to provide a resbnably s+afe and heatthy work emtrvnment. With the exception of one lower court in New Jetsey, the courts hsve retksed to expand th;s • concept to embrace workplace senoldng. Soa ic b clear that nonsmokers have no • 'Audarnental rtght' to ban smoking by others at work lb the contrary. the imposition of smoking restrictions frequently violates the rights of others. including labor unions and minorities. Under the National Labor Relations Act. employers cannot make unilateral changes in the terms and conditions of etaploynent-including smoking polkd.s-..ithout bargaining with the rele%znt unions In sdfton, itnposing any tttks that are unreasonable or dfscriminatory may violate applicable collecttve bargaining aQeements. The AFi.CIO has taken a position designed to protect the eyhts of irs smoldng membete,, opposing disaimination against senokets and calling for voluntary smoking policies devised cooperativeyr betrreett labor and tnanagement Sitntlsr>i+, the Lesgue of United Latin American Citizem (LULAC), ncogttbdnd that seaoldng policies may dbproporoloetately stiect clerical and kw.-leeel etaployses, who tend to be assigned to group nttMr el1.a private oQk.e. oppae.s smoking resaekOoti th.t 'ereate nnnecepaty dtvisbns. . . between enlployse.* or discriminate asaitwt HW1niC wCrlle!!. Faed 8erlnseat pablk and worlcpLee smokias resuftdoas snd be;a. Weatea etapbyers' and aayloy..r' slps to d.tesdse eoD.edvely the eoadtdons of..ploymentt threaten yropgi*ton' abili4 to miillstss pzoIIt by dee.radaf" iadi.ldeally tie wl.h.a of their eli.atele; aod expose aD tiadidls oeenpante to the pvwiog problem of Indoor sJr pollsHon, t!e sLltoemwbieh esanot Desoiwd by banutag satotlng. . Wjl 13 TI KU 000019167
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1 0 • Rltat happens to cce stndu in the air? Is it true that senaiu that drifts off :ne end of a cigarette contains far 6reater quantities of "tas" nicotine and carbon monoxide than smoke drawn from the cisarettt by a smolt.r? 6. Yes. if one aieasura directly at the ournin; end. &tt the smoke is unmedssce}y dr7rad by the surroundin; air. to the point that its contribution to che air we breathe is tninintal. One widelv studied componenc of :oi~scco smoke has been carbon monoxide (CO). Its main sources an motor vehideaL industrial processes and nature itseif-not environeaental tobacco smoke. Indoor levels sre affected bv outside le.els and by cooking and beatiaF among oth<er fietoes. Searching for nicotine in tbe air. because its only source is tobacco smoke, Harvatd Lniversity reseacche:s found only tiny amounts in the atsnoephere of cocktail lounges. reacaurantsL bus stations and air:ine ce.-tainala. This suggested to one scientist that a nonsmoker would have to spend 100 houcs straight in the smokiest bar to inhale the equivalent of a sin;ie -7-1tertip ciiarstot. 7. What Ask :i1e people who mnst happens enfotee it. Isw enfoeeemeai when a law a6eneiss acrae~ t7_,!!r re:criecs cr itirsed ofehe raottrea oo ittelude smolcin~? limited enforcement of tmolong 4ws. For example: The Los An6eles County sberiM said "Police sla;Ad spend their time patrolling our stcoetm for bttr6larsm not ptowlin6 office buildinp seatchitK foe iilegal smokers " - :.~' . In Dade County. F4.. the Police Beaerobs:~t '; . Association declared ' We don i have eM4~ poi,et to handle the cri.Ine we have. We don t sioed a st.w . c.me to contend with.' -- : " ` . ~ . The Law Offuer. journal of dw Insernatieaal '- Conferenee of Police Assoeiatione..d'ttoei.iited tbet'~ ' If there was ever an occasion .vhen a law could agree with an'offender' who deelats.' staet should be out easehin~ eriminaL.• this be it." 4 .~ .j The chairman of the Yacional Black Poiice Associa- tton told the New York senau that "the :unlted amount of personnel cS+at we do have could 'oetter spend their titAe in maltie5 our neic}tborhoods saie.' Wkaz good is an unnecessaty law dw is unenforce• able, that creaces expenseL inconvettiences and con- frontations? It breeds disrespect for.ir lavw [t causes al) of us-smoker. and nonsmokers aiike-to lose a little bit of freedoat. 8. Sbaald Advocate: of prohibition often steolan be cite studies that claim to show b.ened Is smokers are absent more fre- tb. quenelx incur higher insurance wvekpLn? eow sad are less productive. Abaenteei1sm e4iaus. howev.r. are pritnarily based on & statistical association that is weak at besc. in fact. aumecons ot6er fatsots are aaociuod with absence. including aI.; u:, family responsibilitiee. job satisfaction and eowmutittg time. CLims dw smokers incur higher medical coen are based on sendia parportins to show that smokers have a hisber accident rate than nonemo(teri. 8ut tacideoae teadr to be higher atnoeK wroricers ~ in aee~maat. physieal aetivit~r which in- .ppoetonitws for aeeidents. Insurance compa- niieP set pe.mitne catea fer workers' compensation. oa by aepioy.e ~ babit. bat by oeeupatiottal oa.goey atd easAer widt the business and e6e sa~toety Isrdeworker.' compensatioe in dw paedontar eate. A. ts pted.ativfipe twe 1lb4 ecudies contradict ~!r el.int t6at asah.a arn lew peoduetiw. The fuae, a eonrey of Z.000 tieio,n npraentatives and Iu btt:n.a, indOery and `ovesnatent. ' uebat smolcittj has *ber a poeidv. effect or .»no.ffiae an pevduea.iqR mw e.coed& by tlnirersity , of e....e olMtea s~i d eka peoplt wbo ~ iteoloeso be ntwrp,WM than eboee wbo do : noe. - . • - Dealiie.. at.olries eseltatS in t!r .rorlcplaoe an tnoeS appeapeiarky aoate.itt.d to tbe 6ood .euts aAd GNMENOW empioy.a. The qao.tioa of whea aad how woeloess may smoioe is the a~es is be+st settled by employer aad eeploy.e eonseaw raeb>tr than by eiqr eouncil r• or agiff lepelaLYtrm j .w- TIlVIIV 0133957' WV cn TI KU 00019217 ~_A _j tJ N N m OD ,P 1 I : :
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a men exceeded Nro /emab rale by 4.7 to one; and lhal by 1965 tho ratio was 8.1 to one." s The ~eoqraOtricat t~r:t. 1/ smoking caused hrng cancer. N would be reawnab/e to expect more oi the disease In countries whore more ciga- retles are smoked per caplla. 8ut consider Ihese examples. A. ANhouph people In t'ireal Difth smoke /ewor cigarettes per person than At+wrlcans, the Inct- dence d NNq cancer k+ 8rllaln b twke as Mph. 8. Per ceplte cigarette st~o/drq In the N.Mur- lands Is Nso less Mnn 11 Is In IM U. S.. trel king cancer death raNs ae about one•pdrd A101n. Mran here. C. Auslralhra .moke almod es many cigarettes par person as do /1N BrNlsh. yel hare Nsa then one-hdl lhe Incldance o/ kitq cancer!'" . • The stslisllcs are spread bo Mrlrl Slalistks have been used to link dparetN smokMq with nes.ly two dozen dlseases, Inclodlnp Nmp cancer, hesA disease, bronchNb, emphysema. cirrhosis of Ihs Hver- nosrly every aiMroM Ihal aNNcis tlro human body " As one noted modk;al stalistlclan has observed, "The Idea that cigarette smoking causes aN qrsse many deaths from all these many causes does kdeed seem serlously ques- Ikonsble. There Is not any sclenlNlcally known pharmaco- loglc or physical explanation for so widespread and mu1N- tarious an e/tocl.-'" These are six major delects. However, authorities have gone on to point out many other contradictions and per- plexitles In the anti-smoklnp statistics. 1t3 17 t r/~ n~• r-w~ ~VI.~..I. T37 51721 1127 I
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a .,. ~...r.-.i.~ VOT\/ • .. 0 . .1 51721 1143 n