Tobacco Documents Online

~~ ~% /- 4ct_",~Z WHERE T'rB ACTION IS ON S..OIZING* By C'narlas A. LcMsistra, M.D. More than a year ago, with other members of the Surgeon General's Advisory Committee on Smoking and Health, I attended your-first con. ference in Washington. The•date of your meeting, I recall, marked the first anniversary, on January 11, 1965, of the Committee's report. I assume that an important purpose of your meeting in the next two days will be to undertake a critical and thorough examination of the progress and shortcomings of action taken thus far in response to the Advisory Committee's report. I am delighted to participate in this undertaking. At the outset, I would like to present my understanding of the task. The call to action two years ago was clear enough. The judgment of ' the Advisory Committee, after a careful evaluation of evidence in more 10,000 studies, is summed up in that sentence so familiar to us all: •"Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action." The conclusions of the com;aittee were sound and they have been confirmed, extended and strengthened by subsequent research. Indeed no conclusion has been refuted or even infringed in the last two years. than '* Presented at the Nationa7. Interagenc"y Conference on Smoking and Health.. College Park.. Maryland., ,iay 1,, 1966. _. . ~'-~2~SE~1 TIMN 0112534 t I .j

-2- onal information available from the last two'years reinforces ,at smoking is a haalth hazard. For example, the Surgeon :ch 'summarized a report, soon to be published, on the : cigarette enoking to morbidity, disability, and bed dis- It is based on interviews in 42,000 households during'"the 1, 1964 to July 1, 1965, by the Public Health Service's r for Health Statistics. When the results of these inter- ted to the sraokLng habits of the respondents, they show: 0 more chronic conditions reported by Aaericans 17 years old der than would be the case if everyone had the same prevalence •onic conditions as non-cigarette smokers; :xtra coronary attacks; ) extra cases oi' chronic bronchitis or emphysema; ,000,000 extra cases of sinusitis; • i 1,000,000 extra cases of peptic ulcer; 0 more man days of restricted activity reported among cigarette rs, 000 more days spent ill in bed. , urgeon General pointed out, "We cannot say with certainty how . ~ represents a cause-and-effect relationship subject to reduction ~ ~ :ette smoking. But the probability is that the reductions would :~ . ~ i k TIMN 0112535 i .r

i . , i 3 ~ I ' .. ~ -3- New revs:ations about the economic costs to the nation of smoking giYe renewed support and visibility to the warnings of the Committee. F The Social Security Administration pays more than $o0'million a year ~ ~ to men disabled by emphysema, which has become second to heart disease • as a cause of disability. The Surgeon General has suggested that when' ~ _. E the figures for work-3.oBs days are available we will be able to estimate ; ~ the annual cost to the nation in lost services and earnings of men and ' I 'women killed and disabled prematurely by cigarettes and that it could ~ > c run into billions of dollars. The evidence against cigarettes as a health hazard is indisputable. We have gathered the information and with its publication in the Report on Smoking and Health, we brought to a close Phase One of the program i to combat smoking as a health hazard. We have now entered p}1aae Two, which is the period of appropriate remedial action; action programs have begun. However, so long as large numbers of people continue to smoke, so long as deaths from smoking can be counted in the hundreds of thousands and sickness and disability from smoking in the millions~we cannot say yet that our information has been used effeatively. , c . ~ ~ TIMN 0112536 ~ ~ T~ ~,~ s~3

The two and a half years since the Report appeared have been charac- terized by action, but also by quarreling, mutual criticism, and high emotion. Some of the debate which has taken place on smoking and health reflects an unrealistic emotionalism that has sapped the potential strength of logic and reason. Yet is it any wonder that there is an emotional, tense, and confused reaction to a problem with such ramifications? A look at the history surrounding every major health problem wi11l reveal similar confusion and disturbance in the difficulty of making the initial social adjustments necessary to bring about health protective measures. Cigarettes also have social and economic implications, in addition to their health significance, and these relationships are changed only with discomfort and difficulty. You are aware of the ties that link cigarettes with industry, advertising, agriculture, tax receipts, and with the people who, for whatever reason, want to continue to smoke. Nevertheless, despite the controversy and inevitable dispute, action has begun. I want to direct my subsequent remarks to the view from my limited perspective as to the accomplishments. In effect, I want to talk with you about "Where The Action Is." ;1A 2 SF;.1 TIMN 0112537 , ,

The Report on Smoking and Health has stimulated action and reaction, of quite different kinds, from the tobacco industry, the medical profes•.. sion,voluntary agencies, Congress, the government, and the public at large. Each action and reaction is based on the universal acknowledge- ment, by everyone concerned, that smoking is a health problem, that'it is causing death and illness and tragedy. One of the main immediate consequences of the identification of smoking as a health hazard was an impetus to further research. More than 1300 additional studies have been published since our report on January 11, 1964, The isolation of carcinogens in the urine of smokers, in relation to the study of bladder cancer, is another type of recent research finding that takes the demonstration of smoking-related etiology a step beyond the converging lines of evidence relied upon by-the Advisory'Committee. The Surgeon General states that, in the area of basic physiological research, the National Cancer Institute and the National Heart Institute have intensified their research related to smoking since publication of. the report. He adds that the Heart Institute is cuft-ently supporting 63 grants at a cost of $5,332,350 to further illuminate the relationships ~ between smoking and cardiovascular disease~ana that National Heart Institute population studies under its Collaborative Studies program have been expanded to survey the smoking habits of nearly 400,000 men in the United States, ~ .Israel, Norway, England, and Yugoslavia. Also,that National Cancer Institute grantees are exploring the properties of tobacco and tobacco smoke which may be carcinogenic and the effects of tobacco and-'tobacco smoke on the human body. Research is also being furthered by the grant of the tobacco industry of $10 million to the American Medical Association's Educational Research • • '7 +~ r• r Foundation to conduct studies in the area of smoking and health. Z'_~ . TIIVIN 0112538

-6- t As a member of the grants co,:-.,ittee of the A,ti:A which scrutinizes applications for research supoort in the field of smoking and health, I believe the research to which the $10 million from the tobacco industry will go is very worthwhile. Almost half the money has been committed and an additional $5 million will be committed. The tobacco industry has also adopted a Cigarette Advertising Code and we must welcome this effort to eliminate some of the more extreme abuses in cigarette advertising. I am well aware that the code is criticized for being ineffective, but it is a response by the industry to the report on smoking and it is recognition.-- insufficient perhaps as yet -- that cigarette advertising should not be directed to young people. The existence of the code is acknowledgment of an obligation to protect people's health and acknowledgment of the message that cigarettes are hazardous to health. To the list of actions stimulated by the Report on Smoking and Health we can add passage of the cigarette labeling act. Your organization played an important role in the Congressional hearings that led to the law requiring warning labels on cigarette packages. Personally, I do riot feel that mere labeling of the cigarette package is worth the expenditure of time and effort that went into assembling the conclusions that were published in the report. The important thing about the cigarette labeling act, however., is that it signals the acceptance by the Congress of the fact that a health problem does exist. TIMN 0112539 T'A "A- 5 C G

7 We should ta'tCe note of the creation since your last meeting of the National Clearingnouse for Smo:ti.^,g and Health ie-t'r.in the Public Health Service. This is a base from wcich good work is being done and a base which we can expect to see expanded. Wr.at has been the effect on smokers of the message that smoking is hazardous to health? We dont;, know precisely, but we do know there are more than 13 million adults who are ex-smokers. A smaller percentage of the male population smokes cigarettes than at any time during half a century. I still find the most encouraging progress in the fact that doctors have cut down on their smoking. You may recall that a national survey of more than 80,000 doctors made about two years ago showed that only 22.5% of the U. S. doctors who responded ,smoke cigarettes. 'E'ren allowing for the tendency of continuing smokers to fail to return their a_uestionnaires, the percentage of smokers among physicians is under 30% as compared with over 60% fifteen years ago. Doctors have gotten the health message. The best record in the country with regard to giving up smoking is among the practicir.g members of the medical profession. The next best groups are L.edical students and dental stVe nts, as revealed by a cooperazive study done by the Public Heanh Service with the Student American :.edical Association. When this group of new physicians who graduated in 1961+ were compared to the general male population of the same age, the physicians showed far less tendency to take up cigarettes (55% as against 83%) and among the new physicians who took up s.:.ok:.ng there was a far greater tendency to quit ("% as against 18%). While not quite as strong, the same trend was found among graduating dental students. Tx~_^ TIMN 0112540

-8- That there is such a response on the part of individuals in the medical profession is very encouraainj. Doctors are in a position to influence and guide the health behavior of patients by their own behavior. The good record of the doctors strengthens our hope and belief that smoking can be sionificantly reduced. Quitting may not be easy but it is apparently possible, judged by the achievement within, this one segment of society. I expect many doctors could quit because in our business we are most likely to see, and thus really understand, the effects of smoking. A message, thus delivered, does not have to be repeated many times. The job of getting out the messaoe has fallen upon the shoulders of the interaoency counci:s and the voluntary agencies. You have organized nationally and on the state and local levels. You have initiated community action programs, reached into the schools, testified before Congress, and created.the oraanization that can help determine what appropriate remedial action is needed and then push for it. Let us review now what has been accomplished in the action phase against s..okir.g as a health proble-m. tle have intensified the research on smoking, the tobacco industry has adopted a Cigarette Advertising 0 Code, and supplied $10 million for research.we have a warning label on cigarettes, we have a new agency in the Public Health Service, millions of people have given up smoking, and your group has educational and other action progra:s under way in a large number of communities. Is this the appropriate remedial action we have needed? The only sound measure of success will be a drastic reduction in the rates of death, disability, and illness attributable to s-oking. There is no T_~ indication yet that we have done enough to bring about -that drastic TIMN 0112541

-9- I and desirable chan3ge. The job is not done so long as 300,000 people die and millions more sufier chronic illness traceable to smoking. But I submit the j ob is under way. If the past two and a half years have taught us anything, it is that the solution to the smoking problem will not be coraplete or easily achieved and that we need the appropriate contribution of each segment of society. Multi-faceted approaches should be encouraged and endorsed. The Public Health Service is to be supported in the pump-priming of research in many areas and the American Medical Association Educational Research Foundation for creation of a new research agency in the field. Irn particular, the tobacco industry should be encouraged in its pursuit of research, including that which is dedicated to the production of a less hazardous cigarette. They should be encouraged in their efforts toward self-regulation of The National Interagency Council should pursue its programs of education, information exchange, and interaction with the groups engaged in appropriate remedial action. Perhaps the Council might advertising. consider enlarging its cooperati;ie role to include all responsible efforts in the "ield, regardless of their origin. .. ~ Based on our present kliowledge, individuals-should be encouraged to give up smoking and young people should by all means be encouraged not to start smoking. Voluntary agencies and groups like yours need the support, of all of us in your efforts to bring hazards--of smoking to public attention. TIMN 0112542 T-1

Our puz sose in looking oac'r.-wa._rd tonig ht, over the progress made thus far, is to help us plan more wisely for w:aL lies ahead. Reinhold Yiebuhr provided the words that .:ignt guide us at present and in the f,iture: "God grant me the serenity to accept the things I cannot change; courage to change the things I can, and wisdom to know the difference," •Some progress has been made; much still needs to be done.. Your role is essential. I wish you every success. t r TIIVIN 0112543 .Ia.X ..',.a.) c-~ e 0