Tobacco Documents Online

f .2 3 4 5 10 11 12 13 14 15 16 17 18 19 20 21 22 23 2 4 'ede.al Reporters, Inc. n 1 DEPARTMENT OF HEALTH, EDUCATION, AND L7ELFARE :, . JESSEE L. STEINFELD, M.D. Surgeon General of the U. S. Public Health Service DANIEL HORN, M."D. '- Director National Clearinghouse for Smoking and Health Room 5051 North HEW IIu3lding '' Washington,.D:C. 0 24'798 TIMN 0113384 ~; Tsas0s3 25

! ~ 1 2 3 4 5 6 7 8 9 10 11 12 2 P R 0 C E E D I N G 5 DR. STEINFELD: Good morning. With me this morning is Dr. Daniel Horn, Director of the National Clearinghouse on Smoking and Health. Fle and I will attempt to answer any questions you may have after I present'a short opening statement. ..Research on smoking and health over the past year has confirmed and strengthened previous findings regarding . . •t, the significance of cigarette smoking as one of the Nation's most serious public health problems. The number of deaths in the U. S. clearly related to cigarette smoking is far in excess of those caused by epidemics of poliomyelitis, cholera, typhus, or similar infectious diseases. - But the measures previously.taken to combat cigarett4 17 18 19 smoking by citizens and government alike fall far short of• the measures taken by society to protect itself against communicable diseases. Of course, the difference is that cigarette-smoking is largely a personal thing whereby the cigarette smoker harms_only himself (if one assumes the non-smoker does not have equal rights, and is not subject to any harm from his cigarette-smokirig'neighbor) .'I'IlVIN 0113385 Our society has been most successfull in combatting 24 "e~aral Reporters, Inc. 25 public health problems when the citizen has been passive• T11 That is, we have purified our water supplies, we've prevented 064

. r ~ I ~ 1 2 3 5 6 7 8 •9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 `•:_'•?tal Reporters, ine. 25 3 sewage from entering our drinking water, we've pasteurized milk, made certain that meat products did not transmit trichinosis, brucellosis, and tuberculosis, and we've immunized our citizens after researchers developed vaccines against smallpox, polio, measles, and the like. But we have not been successful when the citizen had to take an active and continuing and responsible role: when he must exercise, when•hp, must choose foods to avoid obesity and arteriosclero-. sis, when he must restrict his' alcohol•intake and when he must restrict or eliminate smoking of cigarettes. Ourr failures have been when we require an active role on the part of our citizens. • Now,'iehat is the proper role for Government in a free society? Is it to protect citizens from harming themselve~-? . ,# If so, and if by January 10, 1972, we have determined Govern- f ment's prop er.•• role, it is far from being successful in that cigarette smoking and disease from cigarette smoking continue in our society. On the positive side, 29 million Americans have ~ stopped•smoking. But on the negative, 44 million Americans continue to sm9ke. In the final analysis, education and en- ® ~ lightened self-interest should result in a non=smoking society, ~ 4•Ihile,I am clearly dissatisfied with the.success W 00 of our efforts to date, I do want to emphasize th at without T115 65 the concerted governmental and citizen campaigns which"have

. ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 . 15 16 17 18 19 20 21 22 23 24 4 been mounted over the last seven years, we could have a Nation of perhaps 75 million smokers and many more deaths due to cigarette smoking: SJhen I reviewed this report last weekend, I also read a newspaper account of what happened to cigarette con- sumption in the United States in 1971. I have since learned' that the newspaper account was somewhat more flattering to the sales efforts of the cigarette industry than the facts , „ . . warrant, but the facts are still bad enough. . Sales of cigarettes in 1971 increased by one.and a half percent, and while this represents'no increase in per capita consumption, because our adult population increased in 1971 by the same amount, it represents certainly no drop in cigarette consumption. At the moment, we are at a stalemate. I hope that in the next year, each American citizen will review for himself the summary findings of what is no , longer an honest disagreement among*medical scientists about the hazards'of cigarette smoking. There is no disagreement-- cigarette smoking is deadly. For a full review of our current knowledge, I refer you to the report before you. TIMN 0113387 ~ I would like to emphasize four points in the report which reinforce previous data, and I the three new chapters very briefly. would like to mention ~:~•:ral Reporters, Inc. F irst and most important, because it affects -the

5 5 1 2 3 4 5 6 7 8 9 10 unborn, it has been shown in two prospective studies in Sweden, designed specifically for this purpose, that pregnant women who smoke have a higher incidence of abortions, and pregnant women who smoke have a higher number of stillborn babies; babies who die within the first few days or weeks of life, and babies who die within one year of birth. This is not a small number of excess deaths. There is a.t least a third excess deaths among smoking pregnant women as compared to non-smoking pregnant women. Secondly, in the area of coronary heart disease,. the data continue. to accumulate which shows'that cigarette smoking is a major risk factor and contributes to the develop- ment of coronary heart disease. Thirdly, and very important, in a'very large 15 16 17 18 19 20 21 22 23 24 ~=ra1 ~eportr.rs, Inc. 25 Japanese prospective study to determine incidence of disease and death associated with cigarette smoking, thp findings largely confirm those of previous American studies, and previous Western civilization studies. These data are important not only because in Japan we have a difference genetic, cultural'group, a group with different diet,, different mores, but because rather than having a self-selected population for a prospective study, a factor which has been criticized in our previous prospective T 1150 studies, approximately ninety-five percent of the citizens of selected portions of Japan 4rere followed in this p-rospective 67

, „ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 -l 8 19 20 21 22 23 2 4 :1da+al Repor,ers, Ine. study. This is very significant, because this study similarly shows a quantitative relationship between cigarette smoking . and lung cancer. The more the citizens of Japan smoke cigarettes, the higher their incidence of lung cancer. And finally, in areas wherein we have had previous data, when high.schooZ-students smoke cigarettes, they have more,.symptoms of pulmonary function which is impaired as.. .. compared with non-smoking high• school students. So cigarette smoking does not take twenty or thirty years to exact its toll. it may take that long before death occurs, but symptoms of impaired pulmonary.function are found as early as in the high school years. Now finally, the three new chapters. We have a chapter on allergy, which shows not only do the constituents of cigarette smoke act as allergents, but there is a non- specific effect of cigarette smoke in exacerbating the allergie of individuals who are allergic to a wide variety of substan- ces; particularly this is true among children,who do not smoke Secondly, there is a chapte•r on the effect of cigarette smoking on the non-smoker, the so-called passive . And here we find it is extremely significant cigarette smoker. that levels of carbon monoxide, which wz-previously had not associated with harm and previously did not associate'wi , tT115p68 25 ~~ the development s,rmptontatology, we find that the non-srttoker

7 1 2 is exposed to levels of carbon monoxide and develops carboxy-. hemoglobin within his own system, to the extent that it can impair visual acuity, auditory -- hearing, that is -- and ability to drive. The levels of .'carboxyhemoglobin developing in 7 8 14 18 19 20 21 221 1 23! smoke-filled rooms and automobiles are indeed significant, and of course all of our animal experiments showing effects on the.pul,monary system, that is, emphysema and chronic dy.splasia, and ultimately cancers;.all of these findings are 'similar to that of the non-smoker, because the-animals exposed to cigarette smoke inhaled..it passively, and this .is similar to that of the non-smoker exposed to the smoke by his cigarette-smoking neighbors. Finally, there is a chapter on the harmful constituents of tobacco. We have identified these in a number of ways. In addition to tar and nicotine, about which much has been written over the years, we include among the prime harmful constituents now carborl monoxide. And if one is to take action, it certainly'should be agains't those ingredients of cigarette smoke which we have identified as contj:ibuting to a.health hazard. These_would be, then, tar, nicotine, and carbon monoxide. And in our studies, the carbon monoxide levels seem to parallel that of the -tar level within the cigarette. TIMN 0113390 T11 5 S•;nat that all adds up to is the fact that this last 69

8 ~ 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 year we continued to accumulate scientific data indicting cigarette smoking as a major public health hazard. We are' far from having contained the problem in the United States. Now Dr. Horn and I would be pleased to try to answer any questions you may have. QUESTION: Dr. Steinfeld, in the report, the report makes extensive mention of the effect of carbon monoxide on'non-smokers, people who are in the same room with smokers. ~. . And expecially persons who suffer from lung and heart disease. Are there any indications that the cancer-producing agents that-are contained -- the cancer-causing agents that are contained in tar also have an effect on the non-smokers? DR. STEINFELD: The question is, there is consider- able space devoted to the effects of carbon monoxide affecting non-smokers -- carbon monoxide produced by cigarette smoke. What is the effect of the carcinogenic• 'hydrocarbons and other carcinogenic materials in cigarettes upon the non- smoker? I tried to answer this in a left-handed way because it would be very difficult to do any kind of humari experiment.--in fact, I hope we never do such experiments , by pointing out that animals exposed passively to cigarette smoke do develop the changes, and in certain species what would be construed as neo-pzasms, although not the type produced in man. TIMN 0113391 Tii5070

9 a. 1 2 3 4 5 7 8 10 11 12 13 14 . 15 16 17 18 19 20 21 22 23 24 Rcportcrs, Inc. 25 So this would be the closest we could come to the human experiment, that is, by using animal experiments. Of course, the length of time for the development of a neo-. plasm is much unlike that for the development of carboxy- hemoglobin, which occurs rapidly. Carbon monoxide has some- thing like ten times the affinity and medically, carbon monoxid will attach to hemoglobin remains for a long time. ;, The kind of experiment one needs for the carcino- gensis study would be longterm. . QUESTION: A follow-up on that question. Since the report does contain new findings on the harmful effects on the non-smoker, do I detect a conflict? Because you say in prepared statement that the cigarette smoker'harms only himself.- DR. STEINFELD: No. I said in the statement that the cigarette smoker primarily affects himself, if one assumes the non-smoker does not have equal rights, and if he is not harmed by his cigarette-smoking neighbor, which I added. QUESTION: Dr. Steinfeld, did I- understand you to say that•the carbon monoxide danger is in your mind equal to the*tar danger?. TIMN 0113392 , ti ' DR. STEINFELD: No, I didn't say it is equal to the . T115 '71 tar danger. I said it is easier to measure the carbon mono;d.de concentration in a room, and easier to measure the carboxyheMoglobin levels in the smo.;er and non-smokers having your IL .

have earlier about exposure of the non-smoker to these carcinogenic hydrocarbons becomes significant. I would add, of course, that we are exposed to the 10 1 the higher level, and we know in terms of occupational studies 2 and other studies what levels of carboxyhemoglobin may impair 3 whether the visual, audi- various kinds of human performance , :: 4 tory, the ability to reason, or the ability to manipulate 5 things. 6 It is much more difficult of course to quantitate 7 the tar levels or to determine whether or not there is a 8 threshhold in terms of carciogenesis. All of our data in terms 9 of chemical carcinogenesis would indicate there is no ' 10 threshhold and therefore the questions,questions that we. 14 15 16 17 18 19 20 21 22 23 241 =1 R^_potters, Inr,. I 25 + exhaust of automobiles and to a number-of carcinogenic • • hydrocarbons in-our environment. •QUESTION: Dr. Steinfeld, is this the reason that you didn't make a flat condemnation of the effects.of smoking on non-smokers, as you did of smoking on sniokers? DR. STEIrIFELD: Oh, well, I would make a flat condemnation of the effect of smokers on non-smokers, but we can't quantitate, it in terms of carcinogenic hydrocarbons. W7e can in terms of carbon monoxide, in places which are , . . _ '-- - . , .. . . . . . not well ventilated. we can in terms of allergic individuals who get a:zon-specific response to the allergens contained t•i9.Lhin c;igarette s:ijo,ce, and in terms of discomfort and irri- 72

1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 '18 19 20 21 22 23 24 i R--a;,rycters, inc. 25 tation, certainly, I feel as I did last year that the non- smoker should have the Bill of Rights interpreted for him and i am pleased to point out that there is no smoking in this auditorium this year, while last year there was. And there is no smoking in any HEW auditorium this year. QUESTION: This business of the problem of the innocent bystander has been alluded to by a lot of people. You sazd.~ometha.ng about it last year. Now it is embodied in an official Government-document. Do you think this will be the basis for some sort of action by people like ASH and others to cut down on smoking in public places? DR. STEINFELD: Well, the data which the Clearing- house -- Dr. Horn's group -- has been preparing over•the years does form the scientific foundation for actions not- on2y by voluntary groups but by our elected Representatives. And I do hope that this report will continue to stimulate new actions by members of our society, whether they he the elected Representatives, the Executive Branch, or voluntary groups of our citizens. QUESTIqN: You talk about stimulating some kind of dction. Is your office going to try to urge legislation of any kir.d to put better controls on cigarettes, to lower the amount of tar and nicotine, or have it on the label or anything like that? TIMN 0113394 T1150'7.3,

12 1 2 3 5 6 7 8 .9 10 11 12 13 Let me say that there are a number of actions that can be taken in the area of cigarette smoking. Education, of course, is one. We are engaged in educational activities. These can be expanded. There is the problem of the subsidy for the tobacco farmers. There is the question of whether all advertising should be banned. There is the question as to whether. there should be a limit on tar and nicotine in cigarettq s,. ~ ~. . or whether they should be taxed in,terms of tar and nicotine content. The Office of the Surgeon General has for some years taken a very clearcut stand against cigarette smoking, and for all of.those activities, we would contribute to lessening the cigarette smoking or producing a less hazardous cigarette. But in our society, we have not only the Office 18 19 20 • 21 22 23 ?e~orters, 2c. I 25I of the Surgeon General, but we have a Department of the Treasury, which collects.taxes; we have the Department of Agriculture which is related to the growing of crops; we have a Justice Department; we have other aspects of HEW concerned with education; ar~d the Congress, of course, if I didn't men-Lion the Congress. and our people. T115074 And I think that the actions we take on cigarette smo::ing are largely a reflection of whare societ-y is willing to go at a particular time in terms of health. I can think of

13 1 3 4 6 11 12 13 14 15 16 17 18 19 20 21 22 23 24 -Fe:;:.rai Rcportcrs, Inc. 25 no bigger public health hazard about which we know and about which we can do something. QUESTION: But you are saying we can do it,*but • we aren't likely to? DR. STEINFELD: I didn't say we aren't likely to. I think we have taken a number of actions in the last seven years, but what the next action will be, I can't predict. ; QUESTION: In line with these findings, then, and what you have just said, what are you prepared to recommend then in terms of action? DR. STEINFELD: I have recommended all kinds of actions, but this then becomes something within the Executive Branch, and it's a subject for discussion. Miat ultimately the Admini•stration will recommend, I cannot say at this time. QUESTION: Are you.prepared, as the Surgeon General, to recommend any one of these? A ban on advertising, or a limit of the amount of nicotine? Or are you prepared to recommend that the Treasury Department do without the tobacco tax? .... TIMN 0113396 DR. STEINFELD: As I mentioned earlier, the role the person concprned with health is a very clear one. And I wbuld recommend all those actions which would result in decreasing the smQking within our societl. T115075 QUESTION: You say you would. Will you? DR. STLIidI'L•'LD : I certainly would, and have > of

14 l 2 3 4 5 6 7 8 9 10 ll 12 13 14 15 QUESTION: Your campaign has been almost entirely against cigarette smoking. Can you, Dr. Horn or Dr. Steirifeld, give us some idea of the impact on the non-smoker or cigars and pipes, as opposed to cigarettes? , DR. HORN: I don't think I have to answer that. I am sure all of you who have been in the room with cigar- or pipe smokers know the effect they have. In terms of the amount,-of.,smoke that gets into the atmosphere, at least the cigarette smoker has the courtesy of filtering the smoke through his own lungs before he exhales it into the room, and as a_result the concentration of unpleasant substances is somewhat reduced compared to the cigar and pipe smoker. I think the general conviction that cigar and pipe smoke pollutes the atmosphere more rapidly than cigarettes . is a valid one. QUESTION: Since you are up there, could you 17 18 19 20 21 22 23 explain how, on page two of Dr. Steinfeld's statement, you reached the conclusion that without government efforts, we. would have 75 million smokers,and instead we.have only 44 million, -a reduction of some 31 million?. T115076 DR. HOR~1: If you look b ack on the history of the I growth of cigarette smoking in the United States after World War II, there was a fairly rapid increment in the per capita 241 25~ consumption of cigaret-tes, and th is continued right up th rough L9 5 3, whi ch was t:~ze f 1e1r in wh ich cigare tte smoking-- ~.rst^~ ~.. __-__---

15 + I 2 3 4 5 6 lung cancer relationship was brought to the public's attention. There was a very sharp reduction in per capita consumption beginning in 1954, and a retardation of the growth of cigarette consumption since that time. If cigarette consumption had increased at the rate at which it was increasing from 1947 to 1953, we would have in the neighborhood of 75 million cigarette smokers in the United Btates today, instead of the 44 or 45 million that we do have. QUESTION: Dr. Steinfeld, taking into account the 11 13 12 14 15 16 17 18 19 20 21 22 23 24 :cm! Reportcrs, Ic. I difference in q uantity smoked, between marijuana and tobacco, and overlooking the fact that one is illegal and the other legal.; which -- from a purely public health point of view is more dangerous to the user? DR. STEINFELD: Well, they are both dangerous to the user. And they are dangerous in different ways. The marijuana smoker gets an immediate effect upon him. It.is generally a younger smoker. He is using this as-an escape• from reality. I think it interferes with~our youngsters' ability to cope with reality. It puts him in touch with the underworld becausb these things are illegal. , T 11507'7 "" There are a variety of reasons why it is harmful. Cigarette smoking is harmful for a series of diffe-rent reasons. Of course, it is. not illegal. It is harmful both to the individual who smokes -- and we are now

16 y 1 accumulating data showing that i.t is harmful to the individual 2 3 4 5 6 3 9 in the room with the person who smokes. I agree with Dr. Horn. It is very considerate for the cigarette, smoker to filter the smoke. I think it is involuntary, however. QUESTION: Since you feel so strongly about this', why are you reluctant to specifically,reco:nmend that'the Congress_t4ke action to order a safer cigarette, or put that ban on cigarette advertising? Why don't you come right out and recommend that the Administration take that action? , DR. STEINFELD: Well, the role of the Surgeon 12 General is not really to recommend to the Congress. 'The 13 Surgeon Generall works in fIEW, and makes his recommendations 14 to an Assistant Secretary, and to the Secretary of HEW. . 15 So I am not reluctant, but what I am saying though' 16 is that the final actions which are taken by the Administra- 17 tion are the result of many f actors, and may other people lodk- 18 ing into the problem, in addition to that of my office. 19 QUESTION : Iiave you forcefully made that 20 recommendation to your superiors? 21 DR. STEIiiFELD : I have made a number of additional 22 recor~mendations on smoking and health. 23 QUESTION : , t4hich are they? T1150 : 8 24 DR. STEIidFELD:. I have indicated the general tenor 1 I Reaoaters, Inc. ! TIMN 0113399 - of all of them. 2 5 . !

17 y 1 QUESTION: P7hat do you mean by that?' How come 2 3 4 5 7 8 you can't be specific, instead of indicating a general trend? DR. STEINFELD: Well, I have indicated, I thought, when I listed all of the possible actions which could result in decreasing cigarette smoking -- any of and all of those, I am in favor of. QUESTION: Don't you have a larger responsibility to the,pu~,lic beyond this Administration and your superiors, if you feel this strongly, to go public and to make these specific recommendations? DR. STEINFELD: You mean you think that if I 14 15 . 16 17 18 19 20 21 22 23 24 ::.'aral Repcrters, Irc. 25 werit public and made these recommendations, that something would happen other than my getting fired? :_ - (Laughter.) QUESTION: Is that what you are concerned about? •DR•. STEINFELD: No. No. IIut the question that anybody in public life has to determine, whenever he takes an action, is wha t good will result overall from this action, and I am satisfied that the actions I have-.-taken I hope will lead to some good. QUESTION: You are not concerned because of what happcned wi th the phosphates? TIMN 0113400. T115-© : 9 DR. STEINFELD: I would stick with every statetnent I made regarding phosphates, and I would like to take this opportunity to 're--emphasize those. First of all, I•think if

18 1 there was an error made, it was made when one assumed that 2 the.reduction of phosphates in detergents would result in 3 clearing up a eutrophication problem irresp•ective of where 4 this occurred in the United States. I believe the way to 5 combat the eutrophication problem is to identify where it ~ 6 occurs and to do the most effective means of combatting it, 7 which is removing all of the phosphates that have been going 8 into the lake, or stream, if-phosphates were the cause. .-That 9 is first of all. 10 Secondly, the materials which-are safest in terms of 11 human health are soaps and phosphate detergents. And I would 12 stand by that. They are safe. 13 14 15 16 17 18 19 20 21 22 23 24 -2f]~ n@poftFls, 1tiC. 25 Thirdly, the non-phosphate detergents are harmful to children if they are effective washing materials, because they have a high alkilinity and can cause corrosion of.the esophagus or trachea. blindness or And finally, I think all dishwashing products ought to be kept out of the reach of children. Now the interpretations of what I have said have been all•over the map. But I would like to clarify that I have never changed my mind, my belief that washing materials should be, around the house, kept out of reach of children. Children cannot read warning signs, and children do not always do what their parents hope they will, and they get into materials. TIMN 0113401 Tii5080

19 ~ l And I think in terms.of public health exactly what I have thought for the past year. 3 QUESTION: • One last question on that -- 4 DR. STEINFELD: Let me move on to someone else. 5 QUESTION: May I finish the line of-,questioning? 6 DR. STEINFELD: In a little while. 7 QUESTION: Let me ask an easier one on this line. 8 Can we assume that the Administration or HEW will make any 9 recommendations to deal with the smoke and health problem? 10 DR. STEINFELD: The Administration is considering 11 a whole series of additional recommendations dealing with the 12 .smoking and health problem. But I cannot at this point say. 13 what will come out of these deliberations. 14 QUESTION: When you said yoiu would recommend the . 15 general tenor of this to your superiors, have you specifical].y, * ;: 16 recommended that there be a safer cigarette, and that the 17 advertising in newspapers or magazines, or whatever be done; 18 that the warning be put in the advertis 'ing? TIlVIN 0113402 19 Have you made those two recommendations? ; 20 .DR. STEINFELD: I have made those two, and other 21 recommendations, regarding action which would result in 22 decreased smoking in the United States, yes. 23 QUESTION: There has been some thought that one 24 of the losses during the past year has been the reduction of ,.t~ral S2eporters, Inc. 25 T11508, anti-cigarette messages on television. First, do•you consider

20 1 2 3 4 5 6 7 8 9 10 11 12 . 13 14 15 16 17 18 19 20 21 22 21) 24 `ar;l ?t_pcrters, Inc. 25 that,those messages were important, and secondly, do you have any recommendations for getting them back? DR. STEINEELD: Well, certainly the anti-smoking commercials have been helpful. And they have diminished or just about disappeared. ~ It would be useful to continue to have them as part of.an overall educational program, and I think if we are to be successful, we will have to have not only those, but some ,~ ;. . additional efforts, as is evidenced by the fact that some Americans continue to smoke. QUESTION:. Dr. Steinfeld, you discussed phosphates. As long as you are opening the press conference to other things besides smoking, I'd like to ask you about the closing of the six"Public Health Service hospitals. DR. STEINFELD: I didn't open it to that subject, and I am not really up to date on the closing of the hospitals. QUESTION: In the opening paragraph of your state- ment, Dr. Steinfeld, you refer to a number of deaths in the United States clearly related to cigarette smoking, far in excess of those caused by epidemics, et cete'ra. What is the number of deaths? TIlVIN 0113403 T115osz , I DR. STEINPELD: We have estimated variously -- Dr. Iiorn's group -- that the excess deaths associated with cigarette smoking vary between 225,000 and 300,000. These are deaths that occur not only among those who have smoked for_

1 24 :=ral Rvpoaters, Inc. 25 21 twenty, thirty, or forty years, but these are deaths, in many instances, of people in the prime of life, that is, males in . 2 1 their thirties, forties and fifties, females'also in,these . 3 lower age groups. 4 " However, the bulk of the deaths are in the -6lder age group wherein life is shortened by a matter of a year or 5 6 7 8 two. . QUESTION: Jurt to make it absolutely clear when you talk of excess deaths,. do you mean that these are deaths which would not have occurred last year if these individuals 9 10 had not been smoking? 11 12 DR. STEINFELD: When we talk about excess deaths, we mean these are deaths which would not h ave occurred . 13 if the individual did not smoke, (a) at all, and (b) we have 14 shown repeatedly,both in this report and in previous.reports, .15 that when an,individual gives up smoking, his death rate from coronary heart disease decreases fairly precipitously, and within a short time his death rate from coronary heart disease approaches that of a non-smoker. . In the case of• a lung cancer, it is about two years, 20 before the death rate from lung cancer -- that is, two years 21 after stopping smoking -- begins to decrease sharply, and as 22 long as eight to ten years before the death rate due to lung 23 cancer is equal to that of the non-smoker. TiiSO8 3 This isn't so mysterious if you think of lung _"

22 1 2 3 4 5 6 7 8 cancer not as something that appears suddenly, but"as one cell dividing into two, two to four, four to eight, and if the time is a matter of weeks to a month or two,:b y the time a tunlor the size of the end of your little finger could be diagnozed, it would require a billion tumor celYs,at least thirty divisions, so a lung cancer has been around for quite some time. QUESTION: *Nrhat can you tell me in one, two, three • . order, which.major categories of diseases are represented in the 300,000? DR. STEINFELD: Primarily it would be coronary artery-disease. Second would be bronchogenic carcinoma, things of f,ewer'numbers. emphysema, chronic bronchitis. Then there would'be other QUESTION: Are these the many more deaths that you . 16 17 18 19 20 21 . 22 23 24__rat ftr.porters, Irtic. ~ 251 attribute to Government action in your statement on page two? Many more deaths due to cigarette smoking each year have been prevented.. Are you talking about the'250,000 to 300,000? DR. STEIIaFELD:' Well, we haven't calculated the actual number of deaths that may have been prevented. As you know, and I know, people have stopped smoking before the first report was issued and people will continue to stop smoking for various reasons. But there is no doubt that without the co.ncerted both citizen and governmental actions,that we would have far more cigarette smokers than we do.Tl.lso84

23 ~ 1 2 3 4 5 6 7 8 9 10 11 12 '13 QUESTION: This may not be exactly.your field. I understand Senator Moss is going to hold hearings February 1 on this problem, and suggest legislation. He has . also charged that cigarette companies are getting away with cigarette advertising on television by calling them small cigars, and they are brown and that's about the only difference Do you have any opinion about is this happening? And are.these just as dangerous? , ;. DR. STEINFELD: Ile don't have the actual data re- garding the danger of the small cigars.. If they contain••the kind of tobacco that cigars generally individual.s do not inhale, then there hazard. contain; and if would be a far lesser The reason is primarily because people don't inhale 18 19 20 21 22 23 from cigars. whether or not they are beging advertised on the T.V. -- at least the commercials I have seen where small cigars are being.advertised, they impl:y that very pretty young girls like th'em and men who smoke them get dates with pretty girls. I don't•know if that's the case. I doubt it. QUESTION: Could you answer my question I asked before. You described a very serious health problem here, , . . and,said the anti~smoking messages were important. You don't have them anymore. You wish you did. Are you going to do anything about this? Do you have any recommendations about -"~ R`p°'`e'S, ;"`. Il getting them back on the air? TIMN 0113406 T11.5Q$S 25111

24 .L. 2 3 4 5 6 7 8 9 10 11 12 DR. STEINFELD: We have a whole series of recommenda tions regarding the whole problem of cigarette smoking, as I have mentioned eearlier. But I won't get tied down to a specific one at this point. . QUESTION: Did I understand you earlier to say, in. equally response to Bill Hane's question, that there•.arey hazardous results from*marijuana and tobacco? DR. STEINFELD: I said the hazards from marijuana smoking are different from cigarette smoking. QUESTION: Does the marij uana leaf produce 23 mil].io~ grams of carbon monoxide into the air? DR. STEINFELD: We currently are studying the products of pyrolysis, or burning, of the marijuana leaf. 17 18 19 20 21 22 23 24 rat fteporicrs, Inc. 25 There are approximately 1200 different compotinds identified in cigarette smoke, and I am sure that any leafy vegetable fiber will produce many compounds, and I would pursue this, because I think it's important. One.of •the arguments against that cigarettes are hazardous has been because they seem to be associated with so many different diseases. . TIMN 0113407 QUESTION: Which I am getting to. Does marijuana asso,ciate itself witli so many different diseases? •DR.-STEINFELD: We don't have data on marijuana in the sense fihat•we do on the experiment in the United States of millions of people smoking two, three, one pack of TZI-50

• 25 1 2 3 4 5 6 7 8 9 10 11 12 .13 14 15 . 16 17 18 19 20 21 22 23 24 Rr_portcrs, lnc. 25 cigarettes a day for twenty, thirty, forty years provides us with a great deal of data.s We don't have that on marijuana. But the point I want to make is, when an individua7l voluntarily subjects himself to 1200 chemicals in various amounts, about which we know very little physiologically, other than some are'hazard- ous to health and reduce life, then the odds are that any other leafy material, vegetable fiber, similarly smoked, will , •:. variety produce a variety of chemicals which will have a wide of reactions on the body. QUESTION: But that is the point, that marijuana is not smoked with either the frequency or guan-City that cigare ttes are. Nobody ever turned on with thirty or forty joints a day, that I ever heard of. DR. STEINFELD: Yes, but we don't know• what.all the other things in marijuana are, so we don't know what the effects are. QUESTIOU: The story out of Lexington, Kentucky, this morning, said scientists have developed a breed of low nicotine tobacco which has the same taste *and aroma as normall strains, and one-half the percent of nicotine. ' Are V you Jaware of this,•arid is it along the line of a less hazardous cigarette?. TIMN 0113408 T115 8'7 DR. STEINFELD: 11e11, the question is -- let me generalize it. What is being done to develop a less hazardous

26 1 2 3 4 5 6 7 8 9 10 il 12 13 14 . 15 16 17 18 19 20 21 22 23 24 :~tat RrportCts, Inc. 25 cigarette. «e do have a group working.under the auspices of the National Cancer Institute, which is attempting to iden- tify the harmful ingredients in cigarettes and produce i cigarettes which contain less of these harmful ingredients. The three identified are tar, nicotine and carbon monoxide, and as I mentioned, the carbon monoxide seems proportional to the tar content. But for those individuals who continue to smoke .;, and until a less hazardous cigarette is developed, there are ways to smoke which are safer. First 6f all is not to light the cigarette, as has been pointed out . But if one lights•it, one should not in- i hale, take fewer puffs, take it out of his mouth,°put it out when it is a long butt, and smoke in a ventilated room, and be certain his associates are not objecting to his smoking. QUESTION: If 44 million Americans are.still smoking, where have you failed here? If 44'million Americans are still smoking,-I don't understand. DR. STEINFELD: I think the failure is a shared one. As I tried to indicate in the opening stateinent, smoking is an individual matter, and it is an individiual decision. , And I think the 44 million Americans who are , smoking are the ones who have failed. I think there is much that can be done by Government and by voluntary citizen groups and by citizens as well, to l:ake care of this problem, TIMN 0113409 T115088

27 1 2 4 5 7 8 9 10 11 12 13 16 17 19 20 and I think in the final analysis,education. should resolve the problem. 3 But short of that, there are a whole series of activities which can be undertaken. We have discussed some of them earlier. 6 QUESTION: May I ask you a question touching on the matter of civility. It i3 sort of a tradition that when somebody.wants to be nice, he says to somebody next to him, do you mind if I smoke?. And that person, wanting to be nice, says, no, go ahead, even though he may not like it. Do you have any suggestion of how people ought to interact on a situation like that on the basis of this / in:Eormat3.on? 14 15 DR.• STEINFELD: To thine own self be true. QUESTION: You mentioned 29 million Americans have stopped smoking. Is that since the 1964 Surgeon General`s Report? 18 TIMN 0113410 DR. STEIINIFELD: No, this is all-told. We have the Census of 1970, and we estimated there were 29 million Americans who had be.en smokers who no longer smoke.* But since there have 21, 22 I 23 been about ten million people who stopped smoking between . 1966 and 1970, but that, 24 °tizat cigarettes ! =:+;.ral Reportets, .nc. i n,e . 25 ~ t I but a number of them been pointed out a health hazard stopped smoking prior tb 11 , repeatedly, the possibility has been known for a long Anybody who sr;:oke:; coughs a lot and brings up sputum; and -as has are 089 ~

28 ~ 1 when he stops, this usually ceases. 2 So there have been people who stopped smoking many 3 ye ars ago. 4 QUESTION: Does Dr..Horn have the per capita number 5 of cigarette smokers in 1964 and toda1'on the top of his head? 6 Some figures were mentioned in a short story last week. 7 DR. STEINFELD: In the press conference tomorrow, 8 I think,• we-will have a graph -*-:~-.-• the. inter-agency group on 9 smoking and health -- a graph showing the per capita smoking 10 of cigarettes since, I believe, 1947 or 1948. 11 QUESTION : Can he give us a few landmark figures 12 o flesh out this thing? 13 DR. FiORN: Yes, In 1971, the Department of 14 Agriculture estimates just about the same per capita level 15 as 1970, and that would be just under 4,000 cigarettes per 16 person 18 years and over. 17 QUESTION: 3995, or something? 18 DR. HORN*: 3996, I think is the last one. Just 19 under 4,000. That comes to about eleven cigarettes per person 20 per cday. • 21 QUESTIOP: Okay. , T11~09i 22 1 , DR. HORN: The level in 1963, which is the highest . ~ 23 i that we hav e ev er had in this country, and that was just ~ ~ •2 Ll ; before cile Surgeon Goncral's Report, was about 4600. :~ ,..,Po<<.:fs. Inc. ~ i ~ Q,J1,sTlo~a : 4600? TIMN 0113411 1-1

29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 DR. IIOEtN : Yes. QUESTION: Could you just repeat what that statistic -- just under 4,000 -- is? DR. HORN: The number of cigarettes per person eighteen years of age and over in the United States, smoked in a year. QUESTION: All persons? ,-DR. HORN: This is not the average consumption per smoker. This reflects two things. The proportion of people who smoke, and the proportion -- and the number of cigarettes smoked by the'average. QUESTION: What does the 4600 work out to-on a: per person basis -- number of cigarettes_per person per day do you recall? DR. HORN: Well, it's close to twelve, but not quite QUESTION: That was not.-- that figure just smokers? it jaas by population? was not DR. HORN: Total population,. eighteen and over.• QUESTION: Do you have any data on eighteen and under, per capita? TIMN 0113412 DR. HORV: Yes, we have conducted studies of teen- age smoking. The only national studies we have conducted were conducted first four years ago, in January 1968, and T1i then ag zin in January 1970. We are in the field at the moment dni ncs a '';e._:3rc ..tr•,7 inq to, do this every two years, 15091

30 1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 201 21 22 23 ! 2,4 ?cgoc,ets, Inc. I So I can't tell you what the current figure is. Teenagers change very rapidly, because this year's crop of teenagers is quite different from last year's crop. Cigarette smoking among boys reached a•peak about 1960, leveled off and has dropped somewhat since then. At least it did up until 1968, although then it rose again, betwee 1968 and 1970. For girls, cigarette smoking has continued to ~. . - increase over these years. There was a little drop apparently Our best indication at the moment is that it probably has either stayed the same as it.was two years ago, or perhaps even dropped off a little. -If anything, the boys would have dropped off more than the girls. The girls may be continuing to rise. Tr7hat is happening is that the level of smoking by teenage boys and girls is reaching the point where you can tell the difference between them. .. TIMN 0113413 QUESTION: Do you have any handle on the per I capita consumption of cigarettes by smokers? • T115092 , :DR. IIORrI: ' At the present time? The average woman smokes about 17 cigarettes a day. The average man smokes -- reports that he smokes about 23 cigarettes a day. 251

31 1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 17 18 pack and a half or two. Because people think of it that way. But if you average it out, it's 23 for men and 17 for women. QUESTION: Is that consistent with the 3996 per capita for everybody? DR. HORN: No, it's lower.. When somebody says usually that his consumption is twenty cigarettes a day, he is talking about the modal number, that is, the number he usually smokes in a day, and he forgets about the extra half pack or two packs that he,smoked at-a party or when he went out • and so on. So it tends to be an understatement.of perhaps fifteen'or twenty percent of actual consumption as recorded by the industry. QI3ESTION: 3996 and 4600 per capita is for a year? DR. HORR.V: Yes, and that is based on what are called warehouse removals, th at is, cigarettes subject to tax, or not subject to tax but shipped to armed services overseas. QUUSTIOZ1,I: Have you attempted to put-.•this in economic terms, how much it costs you to smoke this many cigarettes, versus how much it costs you in terms of bad ' T111093 health? ' P TIMN 0113414 DR. IIORti: On an individual basis, of course, it's a lottery as to just how much bad health you are going to have. There is a rc.port pub].ished in the Public Hea3.th Reports last 1

t 32 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 • 16 17 le 19 20 21 22 23 24' ~ d;rii Repo~tets, Inc. ( 251 .! year by an economist, who attempted to put dollar signs on the totai health problem. What it came to in very rough figures was that the total monetary value of the tobacco industry and the tobacco product was approximately $5.billion a year. The total cost to the economy in terms of lost health, lost services, and fires, came to about five, and a half billion dollars a year. , So that it's roughly a half billion dollar loss. This excludes the tax consideration, because economists identify taxes as being only a paper transaction which••is mov- ing money from one pocket to another. QUESTION: Doesn't a man have a right to destroy himself over a long period of time by smoking if he wants to? DR. HORN: That is a philosophical question. Some- body said we have failed because there are still 44 million smokers. it's never been the position of the Government that a man can be protected against every possible hazard that exists. The first task really, after publication of the Surgeon General's Report in 1964, was to make sure that people had a pretty full understanding of the consequences of their action if they were to smoke cigarettes. .And I think 9 a lArge part of this has been achieved. T115094 At the present time, on the basis of our last survey, which was done a little over a year ago, we find that perhaps seven out of eight cigarette smokers have come

33 1 2 3 4 5 7 8 9 10 11 12 13 14 18 19 20 21 2211 23, 2:; ~:1 R~pottets, Inr,. 25~ _ _.~_- - - ---~ to the point where they recognize that they would probably be better off if they didn't smoke. A large portion of them would like to smoke but you do have to remember that over half of the people who smoke today have tried to quit smoking and have been unsuccessful. Some have been so shatteringly unsuccessful that * they nev er intend to try quitting again. Others would like to quit smoking, but have been una me to do so. • ;. We are dealing with a habit that becomes extremely' difficult to break. This isn't just a matter of their right to smoke. They have lost the right to give up smoking, because they are incapable of doing this, and that is one of the reasons,.when we talk about a.,program on the educational side, one of o-uur problems is to develop better methods to help people who want•to quit smoking, in fact people who have been told by physicians that'they must quit, and have been unable to do so. One.portion of our research efforts has gone to. providing pe'ople with this help. QUESTION: Why have there not been periodic well- publicized reports of this nature on the subject of alcohol 9 and,health7 TIMN 0113416 Ti15a95 DR. STEINFELD: I think there will be with the recent establishment of the National Institute on Alcoholism and Drug z%busc, and I think it may be very helpful. '

t 34 i QUESTION: Mien can we look for the first of those 2 3 alcoholl reports? DR. STEINFELD: I would have to look it up. I 4 believe there is one required by the Congress. But I don't 1 1 have the exact date. Before we conclude, I want to emphasize something 7 that Dr. Iiorn was just describing. These are the youngsters 8 who f aic.e up smoking. We have data that shows there is a 9' higher incidence of smoking among teenagers when one parent 10 smokes, and even higher when both parents smoke. This in our society, in a free society, remains 16 an individual problem, as has been pointed out by a•number of the questions here.- And I would emphasize again, with our 44 million Americans who smoke, that this is a problem which they have, and while the effects may not be immediate, as they may be when one contracts small pox or diphtheria, the effect of smoking for the individual who dies is just 17 13 19 20 as deadly;for the man who dies, the mortality is a hundred percent. Thank you very much. 21 QUESTION: One more question on that figure of 221 29 million -- is that smokers who have not started, and those . ; 23 ; who have given up? TIMN 0113417 Til509s 211! DR, STL'Ii•Tr ELD : Those are individuals who have quit n_rs,i; . ~ 2.3;; smoki.ng. 29 mi.Ll i on, Cza ig., -

35 1 2 4 5 6 17 18 17 20 21 22 `I'h ank y au ve ry much. .(t;hereupon, at 11: 50 a.m., the press briefing was concludea. ) ; i , 231 TIMN 0113418 24 ~~ T115097 ~ ; cri.rai ir::;,;rters, in.c. 2S!1