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something of the spirit of this city, which has something warm and unifying about it. Austria has traditionally exercised a sort of bridging function; we see ourselves as mediators between ideological principles and scientific evidence. I am there- fore very happy that you have selected Vienna as your venue, and wish you a pleasant stay here. DR. KURT STEYRER Ministry of Health and Environmental Protection Stubenring 1 A-1010 Vienna, Austria ,

eRL•VtNTtvE MEllIC1Nli 13, 55y-5611 (1984) :al !lcome 'assive avaria, like to -. Kurt nt, the dentin. -sident lere in ate has we are med at of pas- :levant aimed r infor- vn into age of 0 : entage .n: this 1ress a RTN ER -clicine ntrums It Tirul Uustria Proceedings of the International Symposium on Medical Perspectives on Passive Smoking' Opening Address Mr. Federal Minister, Mr. Landesminister, ladies, and gentlemen: On behalf of the executive committee of the German Society of Occupational Medicine, and also on behalf of the standing committee, the supervisory com- mittee (Kuratorium), and the managing directors of the Bavarian Academy for Occupational and Social Medicine, I should like to welcome you most cordially to our convention of experts. My special thanks go to the Austrian Federal Min- ister of Health and the Environment, Dr. Kurt Steyrer, who has undertaken the patronage of this event, and to the Bavarian Minister of Labor and Social Affairs, Dr. Fritz Pirkl, who willingly agreed to take on the sponsorship. Mention must also be made of the World Health Organization in Geneva and the International Green Cross, also in Geneva, whom I should also like to thank for their ready cooperation. My special greetings to the active participants from all countries represented, who deserve our thanks for their readiness to come here and report on their results, insights, and experience. Our topic, "Medical Perspectives on Passive Smoking," has, over the last 14 years, attracted increasi,ng attention in numerous areas of public life and has acquired considerable importance. This applies not only to the working world, but also to the environment. In this connection, I should like to remind you that as long ago as the spring of 1977, the Bavarian Academy for Occupational and Social Medicine organized a convention, "Passive Smoking at the Workplace," in Munich. Together with numerous specialists from the German-speaking countries, an interdisciplinary scientific stock-taking of the phenomenon of passive smoking was then undertaken, and an analysis of social, medical, and legal aspects was made. At that time, the impression was gained that the topie had been dealt with objectively, appropriately, and exhaustively. Since then, however, the phenom- enon of passive smoking has acquired new international dimensions and topicality through the publication of further epidemiological, toxicological, and function- analytical studies. As a result, discussions on the dangers to the health of passive smoking have been both expanded and intensified, and have also become increas- ingly polarized. This has been the stimulus for the convening from across national borders of a number of scientific organizations, together with representatives of international research and science, with the aim of discussing the present situation with respect to the passive smoking problem. The participation of high-ranking representatives of the.Warid Health Organization. and the adoption by this or- 1 Aprit 9-12. 1984, VVienna. Austria. 559 TI BU 31554 0091-74351h4 i3.110 Cupyngtx ti IYlH by AcuJnmc Pre». Inc. .111 nghls ui ropruJUCuuo in sny iurm rcxrvcJ.

560 H. VALENTIN ganization of the scientific patronage of this symposium serve as evidence of the world-wide interest in an objective scientific clarification of the questions in- voived. In the spring of 1983, the societies and institutions represented on the organizing committee decided to hold a further convention with the aim of re- viewing the present state of our knowledge and detining the importance of the issue from the medical point of view. We all shared the opinion that the time was ripe for a new scientific symposium. It might be emphasized: here that, as I see it, the statutes and regulations of the organizing societies and institutions give them not only the right but also the duty to declare their position on current problems of occupational and social medicine, and on the protection of health and the assessment of risks. In general, this is realized in the form of special events in which experts in.the field concerned give a lecture which is then fol- lowed by discussions among a•wider circle of participants. The scientific program over the next two days is compact. An attempt has been made to give suitable consideration to all aspects of the problem. The objective of our joint discussions, free of all emotion, ideology, or even utopian ideas, is_ to arrive at scientifically immaculate and verifiable results. In this manner, it is to be hoped that science can contribute toward ensuring that the politicians re- ceirve reliable, consistent data, with an eye toward enabling them to enact positive legislative measures. Before concluding, I would like to say a word about our venue and our host country. lt was no accident that Vienna was selected as the site of our meeting. Since April of last year, Austria has become the first European country to pass a workers' protection act aimed at protecting the employee from the effects of tobacco smoke. In my view, this new regulation incorporates both the interna- tionally recognized penchant of the Austrians for due diplomatic procedure, and alsu the possibility of keeping open the door to the latest scientific insights. While recognizing the need to protect the nonsmoker from tobacco smoke in the work- place, the act nevertheless avoids demanding a blanket prohibitiQn on smoking. Rather, it is flexible enough to take into account existing conditions in the work- place by requiring a regulation adapted to the prevailing situation. The spectrum of possible measures extends from improved room ventilation to the physical separation of smokers and nonsmokers and localized no-smoking areas. lf leg- islative control is considered necessary at all, the Austrian regulations would seem to be both appropriate and moderate. It is, however, of interest, and this should perhaps provide us with food for thought. that, in its protection program for nonsmokers, the Federal Republic of Germany, which is otherwise known for the perfectionism of its legislation, merely makes recommendations with no legal character, putting its main hope in the ability of smokers and nonsmokers to reach an amicable agreement. I end my address of welcome with the hope that, in addition to the scientific discussions, you will also find time to take a look at some of the sights that this venerable, cultured, and tradition-rich city of Vienna has to offer. Thank you. H. VALENTIN Institute for Occupational and Social Medicine University of Erlungen-Niirnberg Schillerstrasse 25-29 D-8520 Erlangen, Federal Republic of Germany TI BU 31555 rKiV Mr. 4 mu: Mir ia 11 etfe LI&L mir thia furt wu yea itut Sal unl Jut sut an cur clu t Un in shc ~s. thu: the

560 H. VALENTIN ganization of the scientific patronage of this symposium serve as evidence of the world-wide interest in an objective scientific clarification of the questions in- voived. In the spring of 1983, the societies and institutions represented on the organizing committee decided to hold a further convention with the aim of re- viewing the present state of our knowledge and detining the importance of the issue from the medical point of view. We all shared the opinion that the time was ripe for a new scientific symposium. It might be emphasized: here that, as I see it, the statutes and regulations of the organizing societies and institutions give them not only the right but also the duty to declare their position on current problems of occupational and social medicine, and on the protection of health and the assessment of risks. In general, this is realized in the form of special events in which experts in.the field concerned give a lecture which is then fol- lowed by discussions among a•wider circle of participants. The scientific program over the next two days is compact. An attempt has been made to give suitable consideration to all aspects of the problem. The objective of our joint discussions, free of all emotion, ideology, or even utopian ideas, is_ to arrive at scientifically immaculate and verifiable results. In this manner, it is to be hoped that science can contribute toward ensuring that the politicians re- ceirve reliable, consistent data, with an eye toward enabling them to enact positive legislative measures. Before concluding, I would like to say a word about our venue and our host country. lt was no accident that Vienna was selected as the site of our meeting. Since April of last year, Austria has become the first European country to pass a workers' protection act aimed at protecting the employee from the effects of tobacco smoke. In my view, this new regulation incorporates both the interna- tionally recognized penchant of the Austrians for due diplomatic procedure, and alsu the possibility of keeping open the door to the latest scientific insights. While recognizing the need to protect the nonsmoker from tobacco smoke in the work- place, the act nevertheless avoids demanding a blanket prohibitiQn on smoking. Rather, it is flexible enough to take into account existing conditions in the work- place by requiring a regulation adapted to the prevailing situation. The spectrum of possible measures extends from improved room ventilation to the physical separation of smokers and nonsmokers and localized no-smoking areas. lf leg- islative control is considered necessary at all, the Austrian regulations would seem to be both appropriate and moderate. It is, however, of interest, and this should perhaps provide us with food for thought. that, in its protection program for nonsmokers, the Federal Republic of Germany, which is otherwise known for the perfectionism of its legislation, merely makes recommendations with no legal character, putting its main hope in the ability of smokers and nonsmokers to reach an amicable agreement. I end my address of welcome with the hope that, in addition to the scientific discussions, you will also find time to take a look at some of the sights that this venerable, cultured, and tradition-rich city of Vienna has to offer. Thank you. H. VALENTIN Institute for Occupational and Social Medicine University of Erlungen-Niirnberg Schillerstrasse 25-29 D-8520 Erlangen, Federal Republic of Germany TI BU 31555 rKiV Mr. 4 mu: Mir ia 11 etfe LI&L mir thia furt wu yea itut Sal unl Jut sut an cur clu t Un in shc ~s. thu: the

PUtVENTIVE NEllIC1NE 13, 557 (1984) Medical Perspectives on Passive Smoking: Foreword to Passive Inhalation . The well-being of the public is the foremost responsibility of the physician and scientist alike. Considerations of cost, convenience, and custom must all be sub- urdinated to safeguarding health. ln an increasingly complex society, however, many public health issues involve low-order associations and, as such, are emo- tionalljr charged and prone to elude definitive scientitic/medical resolution. Pas- sive inhalation of tobacco smoke presents a case in point. The lay community is engaged in intense debate over laws regarding smoking in public places and in the workplace. At the same time, the scientific community is engaged in a broad spectrum of research to clarify the issue as to the breadth, or even existence, of any possible public health hazard. . it is precisely because this question is so intensely debated by the public and scientists alike that it is appropriate to convene meetings of those most intimately involved with the problem in order to review the state of the art of research from their respective points of view. History has, time and again, shown that where an association is not a de- monstrably strong one, different investigators employing different techniques will emerge with differing conclusions. As a consequence, it is fundamentally impor- tant in such cases to marshal investigators with distinct areas of expertise- chemistry, biology, physiology, epidemiology, and public health. Recognizing that each of these disciplines has limitations; their totality is such that the resultiilg effort brings to a scientific issue the maximum feasible clarity with the minimum distortion. This then permits us to determine whether the data at hand have a certain consistency and to recommend appropriate courses df action accordingly, using the process clearly described in the tirst Surgeon General's Report on Smoking and Health in a chapter entitled "Criteria of Judgment." It is the uni- formity and degree of various associations that makes the case for an associa- tion-or fails to do so. The papers presented here represent the state of the art for data regarding the issue of passive inhalation as it exists today. Undoubtedly, it will be refined and improved upon in the future. 'Thus, the materials contained herein should be considered a catalyst for further inquiry into this important public health issue. These papers provide a valuable addition to the body of scientific literature and bring us closer to achieving a consensus of opinion as to the existence of an association between passive inhalation and lung cancer and other chronic dis- eases. The public deserves a definitive answer. We trust that the Vienna confer- ence will hasten the day when that answer is at hand. GERHARD LEHNERT Direktur, Zetrtrulinstitut Jitr Arbeiesnredizin .adupk-Schunf'rlder-Sn•usse J D-?OU Huutburg 76, Fetlerul Republic ul'Gerutuiry ERNST L. WYNDER Presidertt. Autrrirun Hculth Furcndutiua 320 East 43rd Strert, Nrw York, 1Yrw Yurk 1(1017 557 0091-7435184 53.00 l'upynghl G tYWt by .icaJemic Pre». lnc. All nt{hla ui repruducuue in rey turm reaerved. TI BU 31552

PRBVENTIVE MEDICINE 13, 561-562 (1984) the ~ in- the t re- the was see give rent :alth -cial tol- ieen :tive ;, is it is s re- itive host ting. pass ts of : rna- and /hile ork- :ing. c)rk- :rum sical leg- ould this ;rarn lfur egal -s to ;tific this )u. vTIN rine berg '5-?9 runy Proceedings of the International Symposium on Medical Perspectives on Passive Smoking' Opening Address Mr. L.andesminister, committee members, ladies, and gentlemen: As Federal Minister of Health and Environment, I should like to welcome you most cordially to Vienna and to Austria. For me, both as a physician and as the Minister of Health, this symposium is extremely important. We know-and there is little controversy on this point-that active smoking has extremely injurious effects on the respiratory and cardiovascular systems. But, time and again, the cigarette manufacturing industry and the highly expensive advertising in this area minimize the effects of passive smoking. For this reason, I hope very much that this symposium will provide data that will help the ministry make decisions on further action. On the basis of my experience as a doctor of medicine (I have worked both as a doctor at a large firm and privately as a dermatologist for 30 years and am well acquainted with much of the damage caused by smoking), we initiated a large-scale campaign against smoking. My predecessor in office, Dr. Saicher, rode into battle with the slogan "Ohne Rauch geht's auch" (don't smoke unless you have to). I have, however, become pessimistic about the ability of the smoker to change. Therefore, I would like to ask you to produce scientific evi- dence for the dangers of passive smoking, so that our injunction can be medically tiubstantiated. An important action instituted by my ministry was the founding of an organization for patient information and education. I am sure that we shall continue with these measures, although, as I have already mentioned, they are clouded for me by a certain degree of pessimism. If the scientist can "set the tiignals." then, I believe, the politicians must act. One of the most important priorities is the fight against smoking in the schools. Unfortunateiy,.Austria has permitted the introduction of special smoking rooms in tchools. I am of one opinion with the Minister of Education that these rooms ihould be abolished, as they represent a clear sign that the state accepts smoking as a normal social phenomenon. For this reason, we must oppose these school smoking rooms. On the other hand, the workers' protection law is a useful mea- !iure that can provide protection for nonsmokers at their places of work. We in Austria will continue along this diplomatic path-and, Mr. President, I thank you for your recognition of our efforts-aimed at providing protection for the nonsmoker through a flexible application of legislation. I hope, ladies and gentlemen, that despite the inclement weather you will feel . ' April 9-12. 1984. Vienna, Austria. 561 001-7435/84 S3.00 CopYnglu i 1%4 by Ac;udemic Yreaa- lne. Ali nghts ul repruJucUUn in any turm rcaarveJ. TI BU 31556

PlttVl:NfIVE NtillIC1NE 13, 563-56411984) about ielves there- you a :YRER t'Ctlolt ring I ustria 0 Proceedings of the International Symposium on Medical Perspectives on Passive Smoking' Opening Address Mr. Federal Minister, Mr. President, ladies, and gentlemen: First of all, I should like to thank the organizers for making this meeting pos- ~.ible and for all,the effort they have-put into the preparations necessary for such a meeting. I would also like to express my sincere thanks to you, Mr. Federal Minister, for your hospitality and your friendly words of welcome. Finally, I thank all the participants for taking the trouble to attend and contribute. When I agreed to the plans of the Bavarian Academy for Occupational and Social Medicine to hold a working meeting on "Passive Smoking at the Work- place" in the spring of 1977 and took over its patronage, 1 felt the meeting fulfilled an urgent need for sound scientific information. It had been preceded by nu- merous complaints presented by nonsmoker initiatives, questions asked by mem- bers of parliament in the House, court decisibns that resulted in newspaper head- lines, and, above all, by the repeated demands of a pugnacious Bavarian doctor and university professor, who called for the prohibition of smoking at the work- place as the "dictate of the hour." Prior to the meeting, a joint notification was issued by the Bavarian Chancellery and the nine Bavarian Ministries, aimed at protecting the passive smoker working for the public authorities. With this noti- fication, the Bavarian State Government wished to set an example with a regu- lation based on consideration for others and tolerance. A notice wa,S signed by the 10 heads of the Bavarian ministerial offices, 7 of them nonsmokers and 3 smokers, that is to say, a mixed body. The 1977 meeting, in brief, concluded that: (a) Nonsmokers may be inconvenienced, and might pos- sibly be hampered in their work, but their health is not endangered; (b) it is the task of a health policy to prevent-as far as this is possible-damage to health. In accordance with the state of our knowledge at that time, as expressed in the discussions, no necessity was therefore seen for legislation: and (c) in the absence of tolerance, it is not possible to achieve a satisfactory state of balance between the opposing interests of smokers and nonsmokers. Response to this event was mixed. In general, reporting by the press was objective, and the discussions and the papers published in a brochure were pos- itively assessed by the public at large as a welcome clarification of a diffiCult problem. However, the opponents of tobacco, and in particular, the proponents of the theory that passive smoking has a detrimental effect on health, expressed dissatisfaction,. sometimes of a polemic nature,. and wme made personal attacks ' April 9-12, 1984. VVienna, Austria. 563 0091-7435/84 33.110 Cupynght il 1994 by .{o:ulemta P'eas. Inc. All nghta o/ repruJuctwn tn .ny turm reaGrved. TI BU 31558 0

PRBVENTIVE MEDICINE 13, 561-562 (1984) the ~ in- the t re- the was see give rent :alth -cial tol- ieen :tive ;, is it is s re- itive host ting. pass ts of : rna- and /hile ork- :ing. c)rk- :rum sical leg- ould this ;rarn lfur egal -s to ;tific this )u. vTIN rine berg '5-?9 runy Proceedings of the International Symposium on Medical Perspectives on Passive Smoking' Opening Address Mr. L.andesminister, committee members, ladies, and gentlemen: As Federal Minister of Health and Environment, I should like to welcome you most cordially to Vienna and to Austria. For me, both as a physician and as the Minister of Health, this symposium is extremely important. We know-and there is little controversy on this point-that active smoking has extremely injurious effects on the respiratory and cardiovascular systems. But, time and again, the cigarette manufacturing industry and the highly expensive advertising in this area minimize the effects of passive smoking. For this reason, I hope very much that this symposium will provide data that will help the ministry make decisions on further action. On the basis of my experience as a doctor of medicine (I have worked both as a doctor at a large firm and privately as a dermatologist for 30 years and am well acquainted with much of the damage caused by smoking), we initiated a large-scale campaign against smoking. My predecessor in office, Dr. Saicher, rode into battle with the slogan "Ohne Rauch geht's auch" (don't smoke unless you have to). I have, however, become pessimistic about the ability of the smoker to change. Therefore, I would like to ask you to produce scientific evi- dence for the dangers of passive smoking, so that our injunction can be medically tiubstantiated. An important action instituted by my ministry was the founding of an organization for patient information and education. I am sure that we shall continue with these measures, although, as I have already mentioned, they are clouded for me by a certain degree of pessimism. If the scientist can "set the tiignals." then, I believe, the politicians must act. One of the most important priorities is the fight against smoking in the schools. Unfortunateiy,.Austria has permitted the introduction of special smoking rooms in tchools. I am of one opinion with the Minister of Education that these rooms ihould be abolished, as they represent a clear sign that the state accepts smoking as a normal social phenomenon. For this reason, we must oppose these school smoking rooms. On the other hand, the workers' protection law is a useful mea- !iure that can provide protection for nonsmokers at their places of work. We in Austria will continue along this diplomatic path-and, Mr. President, I thank you for your recognition of our efforts-aimed at providing protection for the nonsmoker through a flexible application of legislation. I hope, ladies and gentlemen, that despite the inclement weather you will feel . ' April 9-12. 1984. Vienna, Austria. 561 001-7435/84 S3.00 CopYnglu i 1%4 by Ac;udemic Yreaa- lne. Ali nghts ul repruJucUUn in any turm rcaarveJ. TI BU 31556

eRL•VtNTtvE MEllIC1Nli 13, 55y-5611 (1984) :al !lcome 'assive avaria, like to -. Kurt nt, the dentin. -sident lere in ate has we are med at of pas- :levant aimed r infor- vn into age of 0 : entage .n: this 1ress a RTN ER -clicine ntrums It Tirul Uustria Proceedings of the International Symposium on Medical Perspectives on Passive Smoking' Opening Address Mr. Federal Minister, Mr. Landesminister, ladies, and gentlemen: On behalf of the executive committee of the German Society of Occupational Medicine, and also on behalf of the standing committee, the supervisory com- mittee (Kuratorium), and the managing directors of the Bavarian Academy for Occupational and Social Medicine, I should like to welcome you most cordially to our convention of experts. My special thanks go to the Austrian Federal Min- ister of Health and the Environment, Dr. Kurt Steyrer, who has undertaken the patronage of this event, and to the Bavarian Minister of Labor and Social Affairs, Dr. Fritz Pirkl, who willingly agreed to take on the sponsorship. Mention must also be made of the World Health Organization in Geneva and the International Green Cross, also in Geneva, whom I should also like to thank for their ready cooperation. My special greetings to the active participants from all countries represented, who deserve our thanks for their readiness to come here and report on their results, insights, and experience. Our topic, "Medical Perspectives on Passive Smoking," has, over the last 14 years, attracted increasi,ng attention in numerous areas of public life and has acquired considerable importance. This applies not only to the working world, but also to the environment. In this connection, I should like to remind you that as long ago as the spring of 1977, the Bavarian Academy for Occupational and Social Medicine organized a convention, "Passive Smoking at the Workplace," in Munich. Together with numerous specialists from the German-speaking countries, an interdisciplinary scientific stock-taking of the phenomenon of passive smoking was then undertaken, and an analysis of social, medical, and legal aspects was made. At that time, the impression was gained that the topie had been dealt with objectively, appropriately, and exhaustively. Since then, however, the phenom- enon of passive smoking has acquired new international dimensions and topicality through the publication of further epidemiological, toxicological, and function- analytical studies. As a result, discussions on the dangers to the health of passive smoking have been both expanded and intensified, and have also become increas- ingly polarized. This has been the stimulus for the convening from across national borders of a number of scientific organizations, together with representatives of international research and science, with the aim of discussing the present situation with respect to the passive smoking problem. The participation of high-ranking representatives of the.Warid Health Organization. and the adoption by this or- 1 Aprit 9-12. 1984, VVienna. Austria. 559 TI BU 31554 0091-74351h4 i3.110 Cupyngtx ti IYlH by AcuJnmc Pre». Inc. .111 nghls ui ropruJUCuuo in sny iurm rcxrvcJ.

SAA FRITZ PIRKL against the organizers and the presenters of scientific papers. In responding to their numerous letters, I pointed out the many legal modes already available to provide protection from annoyance by smokers, both for the private individual and for employees. This, however, had no effect on the legislative calls for action either in Germany or in other countries. Since then, the discussion gradually has spread into other areas where smokers and nonsmokers come together. I must admit, ladies and gentlemen, that I also experience a certain unease. Was that university professor right, after all, when, he listed 40 carcinogenic substances in tobacco smoke and declared that not only the active smoker, but also the passive smoker, was at risk of contracting cancer'' Nor am I sure that ministerial appeals to smokers to show consideration and to nonsmokers to practice tolerance suffice to calm the fears of so many people. These considerations are in themseiv~s proof of the urgent need for a sym- posium such as this. We simply cannot do without further objective clarification of the problem. And thus, along with you, Mr. Federal Minister, I consider this meeting truly an aid for decision-making for those of us who are forced, in the areas of legislation and administration, to confront the problems at issue. You may therefore be assured, ladies and gentlemen, that we will take careful note of the results of this meeting, and of the scientific declarations made here, with the aim of translating them into a sound basis for action in the administrative and legislative sectors. With this in mind, I wish this symposium every success. I hope, too, that each of you will personally experience a meeting of minds that might provide further stimuli not only in this particular area, but also in others. DR. FRITZ PIRKL Minister of Labor and Social Affairs Schellingstraj3e 9 D-8000 Munchen 40, West Germany TI BU 31559 191t. Ik a !b a r