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C a t a 1 o g o f T h e m e s a n d A n t i - S m o k i n g R e c o m m e n d a t i o n s National Commission on Smoking & Public Policy (American Cancer Society appointed and funded) "Public" hearings March 22 - June 16, 1977 TIMN 288507 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

SCHEDULE OF REGIONAL FORUMS THE NATlONAL COMMISSION ON SMOKING AND PUBLIC POLICY Los Angeles Tuesday, March 22, 1977 Denver Thursday, May 12, 1977 Seattle Tuesday, May 17, 1977 St. Louis Thursday, May 19, 1977 Chicago Wednesday, May 25, 1977 Boston Thursday, June 2, 1977 Atlanta Tuesday, June 14, 1977 Philadelphia Thursday, June 16, 1977 Please address inquiries to: Victor Weingarten Executive Director National Commission on Smoking and Public Policy 801 Second Avenue New York; New York 10017 212/889-6760 Code no. 0580 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288508

. THE NATIONAL COMMISSION ON SMOKING AND PUSLIC POLICY : The Agenda While the Commission recognizes the difficulty in fixing precise boundaries for its inquiry it is adopting a broad view of its charge and will specifically explore the following questions: 1. Estimated number of deaths in the region due to cigarette smoking and the economic costs of such preventable illness. 2. Assessment of effectiveness of the anti-smoking campaign. 3. Proposed legislation or regulatory actions which might be considered: a. Increased tax on high nicotine cigarettes or on all cigarettes. b. Further controls over cigarette advertising. c. Stronger and more prominent warning labels on all cigarette packages. d. Strengthening controls of cigarette sales to minors. e. Smoking in public places. f. Mandated tar and nicotine levels in cigarettes. g. Federal support for purchase of television time for anti-smoking messages. 4. Problems of teenage smokers. 5. Smoking rooms in schools. 6. Special smoking and non-smoking sections in restaurants. 7. Mandated school education programs on the dangers of smoking. 8. Employee rights to non-smoking environment. 9. Effectiveness and ability of smoking cessation clinics. 10. Regulation of outdoor billboard advertising. 11. Efforts on a regional basis to obtain coopera- tion on a sustained and organized basis from physicians, dentists, nurses, and other health personnel. 12. Efforts by industry and labor to curb the sale of cigarettes in plants and offices and other joint management-labor programs to help curtail smoking. In performing its assigned task the Commission welcomes the active participation of all individuals, organizations and institutions concerned with develo- ping a broad and realistic mandate which would lead to more effective control of cigarette smoking and its resulting health hazards. TIMN 288509 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

- -- These, among others, were the reasons the Board of Directors of the American Cancer Society has em- barked upon an ambitious five-year program to reduce smoking among adults by 25 percent (12'h million men and women); among teenagers by 50 percent (4'/z million youngsters); to reduce the tar and nicotine content in cigarettes by 50 percent; and to work to phase out the tobacco subsidy. Fact-Finding The formation of the National Commission is a major element in this effort. The Commission will seek to determine, on the basis of testimony it will take from knowledgeable and expert witnesses in eight regions of the country, what is being done, what is not being done that might be attempted, how effective or ineffective various cigarette cessation pro- grams are, and what might be proposed to strengthen the ability of regulatory agencies, legislative bodies and voluntary organizations on a local, state, and federal level to deal with the problems caused by excessive cigarette smoking. To help in its fact-finding, eight Regional Forums are planned to provide an opportunity for persons concerned with this problem to discuss with the Commission their activities and programs and to des- cribe their needs and plans for future work. This testimony will be supplemented by other data gathered directly from those providing major resources and services in this field. Analysis and Evaluation A major portion of the Commission's activity will be devoted to analyzing the data gathered. It will seek to identify the factors that are currently effected as well as those that act as impediments to a suc- cessful effort to reduce the health risks involved in cigarette smoking. Recommendations Following this analysis, the Commission will rec- ommend to the Society new approaches and pro- grams, as well as possible new directions to help the Society achieve its goals and objectives. Whether those recommendationswili involve public or private responsibilities or a combination of both will remain open-ended until the initial fact-finding and evaluation phases of the Commission's work are completed. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION The Agenda While the Commission recognizes the difficulty in fixing precise boundaries for its inquiry it is adopting a broad view of its charge and will specifically explore the following questions: 1. Estimated number of deaths in the region due to cigarette smoking and the economic costs of such preventable illness. 2. Assessment of effectiveness of the anti-smoking campaign. 3. Proposed legislation or' regulatory actions which might be considered: a. Increased tax on high nicotine cigarettes or on all cigarettes. b. Further controls over cigarette advertising. c. Stronger and more prominent warning labels on all cigarette packages. d. Strengthening controls of cigarette sales to minors. e. Smoking in public places. f. Mandated tar and nicotine levels in cigarettes. g. Federal support for purchase of television time for anti-smoking messages. 4. Problems of teenage smokers. 5. Smoking rooms in schools. 6. Special smoking and non-smoking sections in restaurants. 7. Mandated school education programs on the dangers of smoking. 8. Employee rights to non-smoking environment. 9. Effectiveness and ability of smoking cessation clinics. 10. Regulation of outdoor billboard advertising. 11. Efforts on a regional basis to obtain coopera- tion on a sustained and organized basis from physicians, dentists, nurses, and other health personnel. 12. Efforts by industry and labor to curb the sale of cigarettes in plants and offices and other joint management-labor programs to help curtail smoking. In performing its assigned task the Commission welcomes the active participation of all individuals, organizations and institutions concerned with develo- ping a broad and realistic mandate which would lead to more effective control of cigarette smoking and its resulting health hazards. TIMN 288510

C a t a 1 o g C o_n -E e n t s P age ACS Criticism 1 - 7 Addiction 8 - 15 Advertising 16 - 27 Allergy 28 - 29 Anti-Smoking Spots 30 - 34 Behavioral Research 35_ - 39 Concessions 40 - 61a Contradictions 62 - 69 Education 70 - 87 Exaggeration 88 - 125a Excess Health Costs 126 - 133 Farm Support & P.L. 480 134 - 140 Fire Hazard 141 - 144 Health Professional Role 145 - 149 Heart Disease 150 - 154 Inadequacy of Evidence 155 - 157 Ingredient Limitation 158 - 158a CONFIDENTIAL: TIMN 288511 MINNESOTA TOBACCO LITIGATION

Contents -2 Page Insurance 159 - 163 Legislation - Misc. 164 - 189a Lung Cancer 190 - 205 Lung Disease 206 - 208 Nonsmoker Enforcement 209 - 211 Nonsmoker "may-can" Evasion 212 - 213 Nonsmoker Health Harm 214 - 222a Nonsmoker Health Harm - Children 223 - 224a Oral Disease 225 - 225a Peptic Ulcer 226 Pregnancy 227 - 231 Promotion Restrictions 232 Quit Smoking Methods 233 - 239 Safe Cigarette 240 - 249a Sales Curtailment 250 - 254 Smoking Restriction - Employment 255 - 265 Smoking Restriction - Hospitals 266 - 267 Smoking Restriction - Public 268.- 280a TIMN 288512

Contents -3 Page Smoking Restriction - TV, Films 281 Smoking Trends 282 - 287 Social Unacceptability 288 - 294 Tar, Nicotine & Carbon Monoxide 295 - 301 302 - 309 Taxes 310 - 314 Warning Label TIMN 288513 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

A C S C R I T I C I S M What you are doing now is actually taking the heat off the industry. The American Cancer Society, if they are really to solve the problems of health of the American public, will have to take an entirely different approach. Ida Honorof, publisher of consumer newsletters, Sherman Oaks, California, 3/22 LA Tape 6, Rev. 02. The only way I heard about this conference you were having, or seminar, or whatever you want to call it, was through Dr. Sterling, who called me from Canada. Which is strange, because I have a radio show. In fact, I've received numerous awards for the type of program that I do. I have a radio show on National Public Radio ((unintelligible)). They didn't get a copy. They had no notification of the fact that your meeting would be held today. I learned about it through Dr. Sterling. Now would you like to ask me some questions? After all, I have challenged the American Cancer Society. Allan Jonas: I have no questions, but I wonder if I might just make a comment. First of all, we're delighted you came. Honorof: Thank you very much. Allan Jonas: Sorry we couldn't get greater publicity. We are operating on a very close budget. Every one of the witnesses came and .go from out of town at their own expense. Honorof• You had an awful lot of media here this morning, I was told. • The press showed up, which means you are going to get a lot of coverage. A11an'Jonas: Well, I hope so, because it is so complex an issue. This ~ commission is concerned with cigarette smoking--tobacco abuse, rather--and public policy. Honorof: But it's only the tip of the iceberg, sir. - Allan Jonas: We agree. And I just wanted to assure you and anyone in the room who wondered whether this was the end-all and be-all of the American Cancer Society's thrust against environmental carcinogens. Let me assure you it isn't. We are committed as you, maybe not as well informed at the moment as you, to see this committee through the whole field of environmental carcinogens, not just tobacco. Ida Honorof, publisher of consumer newsletters, Sherman Oaks, California, 3/22 LA Tape 6, Rev. 163. If you people are really interested in doing something about cancer, not only lung cancer but overall cancer, you're going to have to change your whole scope. Ida Honorof, as cited by ACS LA Film, 3/22 LA. CONFIDENTIAL: TIMN 288514 MINNESOTA TOBACCO LITIGATION

A C S C R I T I C I S M (page two) Program priorities within the American Cancer Society are misplaced. Dexter T. Suzuki, Student Activities, Coordinator, Kailua High School, Honolulu, Hawaii, 3/22 LA statement, p. 1. 1) The "Target 5" program, to reduce the number of smoking adults by 25% and the number of smoking teenagers by 50%, is somewhat too ambitious. Salvatore V. Zagona, Assoc, prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, p.5. It would seem more productive to set more realistic goals, and to proceed by increments. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, pp. 5-6. Commission member: Dr. Horn, if you'll come back just a minute to Mr. Jonas' question about the younger age, I think you're familiar with the Yankelovitch survey and you'll recall that one of the findings there was that 6 out of 10 of the girls ((unintelligible)) commenced before they were 13. Is this a reliable statistic? Horn: NO. Daniel Horn, Director NCSH, 3/22 LA Tape, 6, Rev. 530. The policy of the North Carolina Division is not to engage in political or legislative actions against any product or industry. It confines its efforts to fighting the total cancer problem. J.E.McDowell, President, N.C. Div. of ACS, 6/l4 Atlanta p. 1. The legislative platform and the tobacco subsidy elimination portions of Target 5 az'e particuarly onerous to many of our citizens, and we have had repercussions from around the state. The general statement from long-time volunteers and contributors has been, "I thought I was working for (or contributing to) the fight against cancer, not against tobacco! Let me know when you stop fighting tobacco and start fighting cancer and maybe I will work as a volunteer (or contribute) again." It is apparent from this that efforts to curtail cigarette production through legislation or tax penalties, in North Carolina, is counter-productive. J.E.McDowell, President, N.C. Div. of ACS, 6/11+ Atlanta p.3. CONFIDENTIAL: TIMN 288515 MINNESOTA TOBACCO LITIGATION

A C S C R I T I C I S M (page three) If the ultimate goal of Target 5 (to reduce tobacco related disease and death) is to be realized in North Carolina, we must not antagonize a major portion of our population. J.E.McDowell, President, N.C. Div. of ACS, 6/14 Atlanta p.4. We must confine our activities to "fighting cancer"--not tobacco--and this does not include engaging in political or legislative actions against any product or industry. We will dedicate ourselves to fighting the total cancer problem through ever-increasing education and service efforts. J.E.McDowell, President, N.C.Div. of ACS, 6/l4 Atlanta p.1+. Now another shibboleth -- and this will be painful to the American Cancer Society -- I'm sorry to say this -- but there's no evidence that people are going to the doctor any earlier than they used to. Looking at incidence statistics and data from 30 years ago, the time for advanced lung cancer now that's most likely to be symptomatic -- the time from onset of symptoms to diagnosis was five months 30 years ago, in our data. It was five months 20 years ago and it was five months 10 years and it's still five months. So there's no particular reason to think that people seek medical attention earlier. Frederick F. Holmes, M.D., Professor of Medicine, U. of Kansas Medical Center and Director of Cancer Data Service, Mid-America Cancer Center Program, 5/19 St. Louis, Tape. 2, Side 1, Rev. 1078. ...the rhetoric of extremism that has often characterized public pro- nouncements and policy solutions on both sides. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. Cheyenne has an active cancer society, lung organization and heart association. I have been upset with all of these organizations, in that none of them have made any effort to inform the general public about the dangers of cigarette smoking and the major roles that cigarettes play in causing cancer, heart disease and lung problems. I have wondered how these organizations could have their fund drives and not mention the major cause of the disease. Robert Taylor, M.D., Orthopedic Surgeon, Cheyenne, Wyoming, 5/12 Denver, p.6. CONFIDENTIAL: TIMN 288516 MINNESOTA TOBACCO LITIGATION

A C S C R I T I C I S M (page four) ...The tobacco lobbyist I spoke of previously is a director of the Wyoming Heart Association ((who)) did not disclose this information to others on the board ((but was)) very helpful with the fund raising and politics that are needed for heart fund activities. It also became obvious that he used the same power to effectively block any public education about the health hazards of smoking... a clear conflict of interest... I have seen ((the tobacco industry's)) tactics in my small town of Cheyenne and I wonder what other schemes they are up to on a national scale in the cancer society. Robert Taylor, M.D., orthopedic surgeon, Cheyenne, Wyoming; 5/12 Denver, pp. 6-7. ... As I look at this board, I wonder could one of you people be being paid under the table, on the side ... I'm not accusing you. I can't be- lieve that you fellows could sneak by here. But I'll bet you that some- where in this cancer organization there could be a retired general that's got a conflict of interest and is effectively blocking our programs. .. I've seen their dirty tricks in Wyoming. .. Robert Taylor, M.D., orthopedic surgeon, Cheyenne; Wyoming; 5/12 Denver, Tape 2, Rev. 255. ... The cancer society needs to take a close look at every member on every level and see what tricks ... who they've infiltrated ... Robert Taylor, M.D., orthopedic surgeon, Cheyenne, Wyoming; 5/12 Denver, Tape 2, Rev. 257. A legal petition has been filed by John Banzhaf's organization asking the FDA to assert its jurisdiction over cigarets containing nicotine and to regulate them. Will the Cancer Society at long last show some guts and act? I hope the answer is a loud and strong "YES." I urge the ACS to give this legal petition every kind of strong support. The credibility of the ACS is at stake right now. Alexander R. Beard, unscheduled witness, 6/16 Philadelphia p.2. Quietly, without coughing at all, I developed what my surgeon described in his report as a "huge" tumor five centimeters across with localized spread into several lymph nodes. Could it be that the publicity given to "cough or hoarseness" creates a false sense of security in the minds of some smokers? Rodney P. Adair, lung cancer victim, vice president, Interpol, New York City, 6/16, Philadelphia, p.4. CONFIDENTIAL: TIMN 288517 MINNESOTA TOBACCO LITIGATION i

-5- A C S C R I T I C I S M (page five) Question: Doctor, you've advocated more research, particularly in the field of changing people's motivation. The ACS for years has wanted to have more research in this area, but we get a very few applications. Mausner: The ACS, I beg to differ, sir, has consistently turned down most grant requests in this area in the last five or six years... And I know of several that have been turned down that might have looked promising. Bernard Mausner, Ph.D., prof. of psych., Beaver College, Glenside, PA., Philadelphia 6/16/77, Reel 1, Side 2, rev. 446. I may be misled, but I called up the state office of the Cancer Society, and I understand they have a room provided for smokers. So they can smoke generally now in there. But I have been at the national office and they were smoking, and I have been in the state office, and they were smoking. ...I don't think there ought to be any smoking; I think it ought to be enforced. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston,*Tape 1, side 1, rev. 1144. I would suggest that it ((dialogue between the tobacco industry, health officials, government, etc.)) starts informally and that it be done by high-ranking people in the American Cancer Society or members of this Commission, and that it should be done not in front of the lights but that it should be done quietly behind the scenes, and I think what you'll discover as I said in my presentation that you'll learn very quickly that the industry is very internally divided. The only time they become cohesive in terms of their views is when they feel they are dealing with a bunch of fanatical zealots.who want to eliminate cigarette smoking. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 1, side 2, rev. 668. The points that I had wanted to make that I suggest the American Cancer Society might want to consider, to some extent, questions what you are doing on this Commission, which I do. First I think you ought to consider establishing a group to begin a thorough investigation of policy options, their costs and benefits. I would consider what you are doing now simply airing rather than thorough investigation. This was an idea that has long historical precedent. The Surgeon General's Commission had originally intended to have a second portion of their report. That was never followed up on. The results turned out to be too controversial and the federal govern- ment wasn't ready at the time to do anything. And as I said before, the past efforts have really always had kickers in them. They haven't worked the way they were intended and I don't want to go through them but they have been really disastrous, it seems to me, from the standpoint of the health interest groups. You've symbolically won major battles but you've lost wars. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 9. , TIMN 288518

A C S C R I T I C I S M (page six) I think the ACS ought to come out for more than they have. They have been very reluctant as far as I know in my area and most areas, to get involved as witnesses, based on documented scientific evidence to support this kind of legislation in legislative forums... (rev. 288.) ...the ACS ((should)) join the lung association, which has been fabulous, fabulous in all this around the state.t Now they say it might affect con- tributions and get them embroiled in controversies...ACS ought to be helping us. (rev. 373.) Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2. (former ACS Md. State board) One last thing I have to say, and this is at the risk of creating some enemies within this Society. I'd like to make the observation that with all these facts before them, we have members of this Society...who still smoke cigarettes, knowing what they know. Joseph Harner, M.D., president of Ala. ACS Div., Anniston, Ala., 6/14 Atlanta, Tape 1, side 2, rev. 441. My second policy recominendation'to the Cancer Society is that they themselves set a proper example. They can take two actions immediately that will be consistent with their objectives. First, ban smoking in all regional and national society offices. They should request, respectively, that all employees of the Society abstain from smoking when any other person might see them. Employees of any health agency should not condone cigarette smok- ing practice in public. In a country with high unemployment and where the majority of the adults are non-smokers there should be no problem in recruit- ment. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2, Boston, p. 3. .1 do not believe that the American Cancer Society or the American Heart Association should employ anyone or accept any volunteer who smokes. If we don't believe in our message how can we convert others? Just adopting such a policy would cause many such employees and volunteers to stop. Robert L. Schmitz, M.D., Mercy Hospital and Medical Center, board member of Ill. ACS, Chicago, Ill., 5/25 Chicago, p. 3. ~ .. . We believe that you should first try to protect the individuals who have shown that they can resist the media hype, before you try to save the smokers from themselves. Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta, p. 5. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288519

-7- A C S C R I T I C I S M (page seven) There are several societies and organizations engaged in antismoking programs, all in different directions, going nowhere, and accomplishing very little: The American Cancer Society (Georgia Division) and its facilitator program, and a feeble effort to get into schools, the Georgia Lung Association, the Georgia Thoracic Society, the Geor ia Heart Association, ((and)) Smokenders (a private group)... Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 15. ...reducing tar and nicotine dosage will more likely produce much'more successful health consequences than the apparently symbolically satis- fying, but relatively inpffective "war against cigarettes." Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, p. 3. 1 I CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288520 I

A D D I C T I 0 N ...cigarettes should be labeled a drug. Dolphin Lair, accused felon, L.A., 3/22LA state- ment,• p. 1. I'm not arguing with any dummy who says it's just a habit. I know it's an addiction... George Crawford, Ph.D., Weber St. College, Odgen, Utah, 3/22LA statement, p. 2. The most effective things we can do to succeed in Target Five are:... 3. Reject all compromises of low tar, etc. cigarettes because these are nothing but ways of selling more cigarettes for the addicts to get their highs. George Crawford, Ph.D., Weber St. College, Odgen, Utah, 3/22LA statement, p. 8. I cannot stand idly by while we fail to apply that kind of knowledge ((use of laboratory tests)) to the problems which the addicted cigarette smoker faces in trying to understand his addiction and to quantify his progress toward breaking it. John R. Goldsmith, M.D., public health and pulmonary disease specialist, California State Dept. of Health, 3/22LA Tape 2, rev. 505. We have had with us for a long time individuals who think that somehow this can all be explained away by some kind of physiological addiction to nicotine. The scientific evidence on that point has grown rapidly to show that you cannot account for smoking behavior on the basis of some such simple kind of physical addiction to nicotine that is proposed and there is good evidence to show that this is not so. Daniel Horn, Ph.D., as cited by ACS LA Film, 3/22LA. Suppose you reduce the nicotine, which is the addicting substance. Let's say the person then starts inhaling more. If you reduce the nicotine alone and you start to inhale more, you'll absorb more carbon monoxide. And so you have a problem there. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22LA statement, tape 3, rev. 638. I Whether nicotine is addicting is an open question. Dr. Robert Shank, National Commission on Smoking & Public Policy, interviewed by Ann Keith, KMOX, "At Your Service," 5/17/77, St. Louis, p. 3 (transcript). TIMN 288521

A D D I C T I 0 N (page two) Q: Is cigarette smoking an addiction? A: The short answer is no. A more detailed answer would say that there is a pharmacological reaction to smoking, probably caused by nicotine, or else people wouldn't smoke. However, people do not become as much addicted to the nicotine as they do to all the surrounding habits, emotions, attitudes, and associations of smoking. ACS Handout, 5/17 Seattle, p. 4. I am convinced that cigarette smoking is truly addicting as science is now showing. Robert Taylor, M.D., orthopedic surgeon, Cheyenne, Wyo., 5/12 Denver, p. 3. Tobacco products should be put under tha jurisdiction of the U.S. Food and Drug Administration. Tobacco can be construed as a drug in every way. Stanley Stein, Pharmacist, The Colorado Pharmacal Association, 5/12 Denver, p. 3. There is a steady progression of those hooked on cigarettes from the 10th grade to the 12th grade. Norma Keeton, Counselor, Parkview High School, Little Rock, Ark., 5/12 Denver, p. 2. It's been harder to stay off cigarettes than to get a Ph.D., in clinical psychology...My own feelings, those of others,•and research...lead me to conclude that smoking is an addiction, if_we use recidivism as the criteria for abstinence, an addiction as potent as heroin... Dr. J. P. Herter, Clinical Psychologist, Jackson Hole, Wyo., 5/12 Denver, p. 1. ...66% of all smokers said that they never would have started had they known that nicotine was addicting--had they known that they'd be hooked. Dr. J. P. Herter, Clinical Psychologist, Jackson Hole, Wyo., 5/12 Denver, p. 2. One puff is taken for a try--not too good, but then another try, and by the third time the reinforcement outweighs the aversive properties of tobacco and we have a budding addiction. 1. A preventative anti-smoking campaign must stress the addictive aspects of smoking. Addiction must be adequately defined. Dr. J. P. Herter, Clinical Psychologist, Jackson Hole, Wyo., 5/12 Denver, p. 3. TIMN 288522 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

A D D I C T I 0 N (page three) C) Cigarette smoking, probably because of the alkaloid content, is habituating, so that in addition to the somatic effect the behavioral and psychic effect represent major public health problems. The onset of smoking in late grammar school and in high school years virtually assures the continuation of the habit in a majority of those who start to smoke cigarettes. The difficulty in reversing habituation to any psychopharmacologic agent is well known and the costs in addressing this aspect of the problem though difficult to specifically quantify are very large. Dr. Paul Kotin, medical director, Johns-Manville, 5/12 Denver. , p. 3. Eighth grade girls seem to be heaviest users, not only of tobacco but other drugs as well. Don Shaw, Coordinator of Health Education, Jefferson County Schools, Denver, Co1o., 5/12 Denver, p. 1. ...the nicotine abusing teen-ager... Zenon Deputat, teacher, North Tonawanda (N.Y.) Public Schools, 6/16 Philadelphia, p. 1. Smoking is often used as a crutch for teenagers who use the excuse that they are "hooked" on cigarettes to continue their smoking which is really a social prop used to look "cool". ' John Dean, high school student, Mamaroneck, New York, 6/16 Philadelphia, p. 1. ...the premise that nicotine is a drug... George Browne, Commissioner, Dept. of Drug and Alcohol Addiction, Nassau County, New York, 6/16 Philadelphia, p. 2. The acceptance of the fact that, since nicotine is a drug with known physiologic effects and has been shown to have addicting properties, it should rightly fall under the control of the F.D. and A. J. Mostyn Davis, M.D.,P.C., Shamokin, PA.,,6/16 Philadelphia, p.2. Why should we, the American people, allow one industry to get rich by peddling an addictive and deadly pai,son? And why should we allow the government to share in this dirty money, while at the same making half- hearted token gestures toward discouraging the consumption of this poison? Leonard Bachman, M.D., PA Sec. of Health, 6/16 Philadelphia, p.9. CONFIDENTIAL: TIMN 288523 MINNESOTA TOBACCO LITIGATION I

A D D I C T I O N (page four) A complex over learned habit such as smoking... Ernst Wynder, M.D., Naylor Dana Institute for Disease Prevention and the Health Maintenance institute, American Health Foundation, 6/16 Philadelphia,, p. 6. ...babies may be born addicted to nicotine and suffer withdrawal symptoms for the three months it takes the nicotine to gotten out of the babi.es' systems. Janith Stewart Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 2. People go on smoking for sinister reasons, because nicotine is a drug of addiction and once hooked becomes extremely difficult to get off. It's also a unique drug in that it provides relaxation at the same time it (?) subject remains alert. No other drugs we have in medicine, like valium and the other drugs that calm people down provides those two things, relaxation, while remaining alert. Withdrawal symptons can be very real to people addicted to nicotine. Roger Secker-Walker, Director of the Pulmonary Division, Dept. of Internal Medicine, St. Louis University School of Medicine, 5/19 St. Louis, Tape 2, side 1, rev. 351. Nicotine is a powerful stimulant and is clearly addictive, both pharma- cologically and phychologically. Ernest W. Johnson, M.D., Chairman, Dept. of Physical Medicine_, Ohio State University School of Medicine, Columbus, Ohio, 5/25 Chicago, page 2. Active efforts must be made to prohibit promotion of this insidiously addicting habit. Ernest W. Johnson, M.D., Chairman, Dept. of Physical Medicine , Ohio State University School of Medicine, Columbus, Ohio, 5/25 Chicago, page 3. Many of us fail to realize that the nicotine in tobacco is a habituating substance. It results in a dependence that shows many of the withdrawal symptoms that often occur from other drugs. The smoker builds a tolerance to the nicotine in tobacco smoke and some students of the subject feel this is a contributing cause to many smokers increasing their smoking habit. Paul Q. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 2. CONFIDENTIAL: TIMN 288524 MINNESOTA TOBACCO LITIGATION

-12- A D D I C T I O N (page five) Peer pressure and availability encourage smoking; addiction perpetuates it. Sherwyn Warren, M.D., Chairman, Illinois Interagency Council on Smoking and Disease, Winnetka, Ill., 5/25 Chicago, page 2. ... I don't think the smoking problem is an intellectual one but more of a gut-level one and the need for something to take its place, to replace that coping method, method if you will, or that addiction ... L. Loring Brock, M.D., Director, Heart-Lung Center, Denver; 5/12 Denver, Tape 1, Rev. 364. Duval: Then this is a social addiction not a pharmacological addiction. Herter: I think it could be both. . Merlin DuVal, NCSPP panel member, and Dr. J.P. Herter, Clinical Psychologist, Jackson Hole, Wyoming; 5/12 Denver, Tape 2, rev. 209-210. I think it's about time we called cigarette smoking a dirty, stinking rotten addiction for most people. Now, not everyone. . . is addicted, but for a lot of people it's a dirty, stinking addiction. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 118. The time has come to limit ((cigarette)) production to the absolute requirements of those addicted to nicotine. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, p. 1. Demand a debate on the fact that nicotine is an addictive drug. it should be controlled by the Food and Drug Administration. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, p. 2. People take up smoking because of peer pressures. phenomenon. Down through the that is innate to man...It is have to be recognized when we It's a social kind of eons of evolution, smoking is not something addicting and I think that all of those things talk about why the problem exists today. Jesse Steinfeld, M.D., former surgeon general, now dean of the Medical College of Virginia, VCU, Richmond, at ACS 2/1/77 news conference, NYC, rev. 576. CONFIDENTIAL: TIMN 288525 MINNESOTA TOBACCO LITIGATION

A D D I C T I O N (page six) There wouldn't be 50 million smokers in this country today if it were easy for people to quit after they'd started. It's not easy. It is an addiction. Dr. Luther Terry, former surgeon general, educational consultant, at ACS 2/1/77 news conference, NYC, rev. 9. Why does a person who has given up cigarette smoking go back to the habit? A major reason is doubtless the habit factor. In addition (sic), a psychological need has been established, based on the oral and manual gratification of handling a cigarette, lighting it, putting it between the lips, etc. ACS Handout to press at Philadelphia forum 6/16/77. Cigarette smoking...can be a powerful addiction. Rodney P. Adair, lung cancer victim, vice president, Interpol, New York City, Philadelphia 6/16/77, p. 2. Many untold, perhaps millions of individuals have stopped smoking without the aid of specific help, without clinics, without particular techniques, and as a response to information. ...those individuals who simply stop, who are able to stop smoking on the basis of media, and media information.... Brendan A. Aiaher, Ph.D., Professor of the Psychology of Personality and Chairman, Department of Psychology and Social Relations, Harvard Univ., Cambridge, Mass., 6/2 Boston, Tape 1, side 1, rev. 969. It's been proven in England that in their alcohol, addiction, drug, and dependent drug center, that nicotine is a more dependent-type drug than virtually any of the other barbiturates, amphetamines, and so forth that have been studied in the clinic. Samuel E. Molind, D.M.D., oral pathologist, Montpelier, Vt., 6/2 Boston, Tape 2, side 1, rev. 528. There is no question in my mind that in my reading and my experience with patients that it is the nicotine that is addictive. I don't have any thought that the other components of the cigarette smoking have any real 'hang' to it type of hold on the smoker. I feel that it is the nicotine that is addictive. Laurence H. Bates, M.D., Meridian Medical, Indianapolis, Ind., 5/25 Chicago, Tape 2, side 2, rev. 270. Nicotine is basically a drug. It was in the U.S. Pharmacopeia up until 1906. Some of the people don't seem to know that it is an addicting drug. Ernest W. Johnson, M.D., Director of Physical Medicine, Ohio State Univ. School of Medicine, Columbus, Ohio, 5/25 Chicago, Tape 1, rev. 410. TIMN 288526

-14- A D D I C T I 0 N (page seven) It ((cigarette smoking)) is an addicting habit that needs to be controlled, needs to be helped. Arthur W. Weaver, M.D., Northville, Mich., 5/25 Chicago, Tape 2, rev. 468. I'm a former drug addict myself, meaning nicotine... ' Janith S. Kice, M.D., Garden City, N.Y., 6/16 Phila., Tape 2, rev. 179. When I was told I had lung cancer, I stopped ((smoking)). Now why? I know from my own point of view, if you like, it's a very strong addiction. Why was I able to give it up easily? Now, I don't mean to say that I don't want to smoke -- I still want to smoke. But I don't have any difficulty in not smoking. Rodney P. Adair, lung cancer victim and Vice President- Finance, Interpol, New York, NY., 6/16 Phila., Tape 2, side 1, rev. 754. ...the smoking complex, that is that group of behaviors which constitute the habit of cigarette smoking... Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2, rev. 684. People who tend to be tense...people who experience dysphoric states, tend to have a much higher rate of relapse than people who do not. Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2, rev. 840. ...this is addiction, and there is no question about that... Walter C. Payne, Jr.,_M.D., P.A., general and thoracic surgeon and medical representative, Escambia County (Fla.) Interagency . -•- - , Council on Smoking & Health,'Pensacola, Fla., 6/14 Atlanta, Tape 1, side 2, rev. 58~ Because of...their own addiction to smoking, parents and teachers disregard their responsibility of trying to prevent youngsters from smoking. Gene Bridges, Supervisor of Physical & Drivers Education, Escambia County, Pensacola, Fla., 6/14 Atlanta, p. 3. CONFIDENTIAL: TIMN 288527 MINNESOTA TOBACCO LITIGATION

A D D I C T I 0 N (page eight) For the first six months, if I was conscious, I was thinking about the "next" cigarette that I was not going to smoke. My withdrawal symptoms were terrible. I experienced dizziness for the first three months, tunnel vision, itching, loss of memory, and difficulty maintaining my train of thought. I became very irritable and short tempered. My appetite increased tremendously. My sense of smell and taste became very sensitive, and I produced a very offen- sive body odor for the first few weeks. I developed very severe pains in my chest and thought I was having a heart attack. These symptoms lasted for several months and gradually diminished after the first year. It was three years before I truly felt I had the ability and the willpower to stop smoking. Barney Burks, Jr., Mayor, Pensacola, Fla., 6/14 Atlanta, pp. 1-2. ...we do feel the firmed conviction beyond a shadow of a doubt that smoking in a great majority of smokers is a true drug addiction. Walter C. Payne, Jr., M.D., P.A., general and thoracic surgeon and medical representative, Escambia County (Fla.) Interagency Council on Smoking & Health, Pensacola, Fla., 6/14"Atlanta, p. 2. While some argue that smoking is a psychological addiction others argue it is a physical addiction; it is probably that it is both. Jonathan Fielding, M.D., Mass. Commissioner of Public Health, 6/2 Boston, p. 5. CONFIDENTIAL: TIMN 288528 MINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G I am against further regul.ations by government agencies and I am also against cigarette advertising in any form. Arthur L. Cole, Pres. Cole Communications, consultant to FTC, 3/22 LA statement, p.l. Since...to totally ban all cigarette advertising is contingent upon serious Constitutional questions, it is not likely nor do I personally condone that approach... Arthur L. Cole, Pres. Cole Communications, consultant to FTC, 3/22 LA statement, pp. 5-6. When all the cigarette advertising can claim, in print, is that "our brand tastes better than their brand" against a broadcast campaign about not smoking and what's good for your health, the power of antismoking messages could make a significant impact on cigarette sales. Eventually an antismoking campaign could actually cause merchandisers to reassess advertising of cigarettes as we know it today; in effect, retreat and re-group, perhaps in another format more palatable to those wishing to tell the truth. I am suggesting an ANTISMOKING CAMPAIGN CAN CAUSE A RECESSION OF CIGARETTE ADVERTISING. And I am personally committed to this objective. Arthur L. Cole, Pres. Cole Communications consultant to FTC, 3/22 LA statement, p.8. OBJECTIVE #1: cigarette companies should be required to increase the prominence of the Surgeon General's warning statements in 411 advertising. Melvin A. Jensen, L.A. advertising agency executive, Mormon spokesman, 3/22 LA statement, p.2. OBJECTIVE #2: pictures of models should be eliminated from all cigarette advertisements ... The lure to the young non-smoker to`start smoking and the urge to the smoker to switch brands is very subtle and powerful. Melvin A. Jensen, L.A. advertising agency executive, Mormon spokesman, 3/22 LA statement, p.2. There's certainly one recommendation that Dr. Fasal made that representatives of The Tobacco Institute who are here today and monitoring very carefully our proceedings could take and act upon voluntarily with no legislation. That is of course the elimination of the use of models in advertising. It's an interesting thought. Allan K. Jonas, Los Angeles, chairman, ACS National Tobacco and Cancer Committee, 3/22 LA Tape 4, Rev. 285. CONFIDENTIAL: TIMN 288529 MINNESOTA TOBACCO LITIGATION

-17- A D V E R T I S I N G (page two) There are public policy issues i_nvolving the communications media...Can public policy dictate the participation of broadcast media, which are already in the public domain? Can public policy be defined and implemented for advertisements: use of live models, etc? Are newspapers and magazines exempt from public policy initiatives? Dale Houghland. chairman, Calif. Interagency Council on Smoking ana Health, 3/22LA statement, p. 2. I believe we must encourage and support federal legislation that_would require the United States Government to: 5. Impose restrictions on printed advertisements of cigarettes limiting depiction to the product itself and eliminating persons or scenery. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22LA statement, p. 3. TV advertising ((of cigarettes)) should be restored. George Crawford, Ph.D., Weber St. College, Odgen, Utah, 3/22LA statement, p. 5. The National Congress of Parents and Teachers has been on record since 1963 as opposing advertising of tobacco. Jean C. Berg, representing Washington Congress of Parents, Teachers & Students Association, 5/17, Seattle, p. 1. 5. All smoking advertising should be banned and a rigorous anti-smoking media program pursued. Dr. J. P. Herter, Clinical psychologist, Jackson Hole, Wyo., 5/12 Denver, p. 3. 3. The Federal Trade Commission should ban all cigarette advertisements in any media. The loss of revenues can be replaced by government funds provided for the very innovative people in the advertising field to convince people they should not smoke. Stanley Stein, Pharmacist, Colorado Pharmacal Ass., 5/12 Denver, p. 3. The tobacco industry has already "divided and conquored (sic)." They have divided and "targeted" the Spanish-surnamed Americans with their adver- tisements. And they have conquored (sic) because people have responded to those efforts. Lupe Zamarripa, Special counsel to Texas Secretary of State, Austin, Texas, 5/12 Denver, p. 10. CONFIDENTIAL: TIMN 288530 MINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G (page three) (RE: corporate responsibility) A) There can be no doubt that while the tobacco industry is in compliance with the letter of the law and regulations, cigarette advertising represents the most flagrant circumvention of the currently existing "truth in adver- tising" maxim. The positive emphasis on "gratification" and...the cavalier unconcern over ill health unite to create a situation analagous to failure to pasteurize milk, chlorinate water or sterilize parenteral medication. Dr. Paul Kotin, medical director, Johns-Manville, 5/12 Denver„ pp. 4-5. I'm not lobbying necessarily for the return of cigarettes to television, even though as a broadcaster I feel that my industry has been discrimi- nated against. I do think that cigarette advertising should either be banned altogether or be permitted in broadcasting as well as in the print media. It is not likely that the government would seek to ban all ciga- rette advertising, but it is inconsistent that a ban still exists for one industry but not for all the advertising media. Herbert V. Skaggs, Director, Programming, KTVI TV Station, President, St. Louis County ACS, 5/19 St. Louis, p. 2. I am aware, also, of a plan suggested by a television executive in New England that would allow access to the airways of those brands whose entire Iine...king size, menthol, hard pack, etc.... is below 9 mg. tar and..7 mg nicotine. These ratings would be subject to review taking into consideration later research and product development. These reviews could lead to lowering the ratings even further...an incentive to cigarette manufacturers to reduce the harmful ingredients in cigarette tobacco. Herbert V. Skaggs, Director, Programming, KTVI TV Station, President, St. Louis County ACS, 5/19 St'. Louis,.•p. 3. If the profit motives were removed and cigarette advertising forbidden, powerful forces which probably instigate and maintain much smoking would cease to exist. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis, p- 17. ...the laws that permit advertising to tell certain lies are probably going to make it difficult in at least the near future to restrain the advertising that the cigarette industry does in print. Ivan L. Preston, Professor, School of Journalism, University of Wisconsin, Madison, Wisconsin, 5/25 Chicago, page 1. CONFIDENTIAL: TIMN 288531 MINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G (page four) ...when you go to a grocery story you always see large numbers of various kinds of cigarettes right by the cash register. It seems to me that cigarettes should not be on display, that this might be an innovative way of making them less available or at least less apparent, so that a person has to sort of go and ask if there are cigarettes for sale rather than having them stare you right in the face as you go through the line to buy your hamburger or whatever it is that you want. David B. Thomas, M.D., Dr. P.H., epidemiologist, Fred Hutchinson Cancer Research Center, 5/17 Seattle, Tape. 1, Side, 1, Rev. 245. (Asked if he objects to legislation to control advertising--he's already said he is recommending no legislation). No, I don't, to a degree, but I'm not a believer in a lot of government interferences in any way, in any case. It has often been said, the less government the better. William Hutchinson, M.D., director, Fred Hutchinson Cancer Research Center, 5/17 Seattle, Tape 1, Side 1, Rev. 789. I would encourage this commission to consider everything it can to reduce the advertising of the tobacco industry--billboards, magazines. We don't let people advertise. They should not drive their cars at 300 miles an hour and kill pedestrians. Recently a computer game has been taken out of the recreation rooms because it teaches kids to gun down pedes- trians. The advertising industry is encouraging smoking. Edmund Truelove, D.D.S., chairman, Dept. of Oral Diagnosis, Univ. of Wash. School of Dentistry,5/17 Seattle Tape 1, Side 2, Rev. 160. There is no question in my mind that we need a total ban on cigarette advertising. The tobacco industries claim only that they design ads only Z to switch smokers from one brand to another is pure poppycock ... Compensation ~ to the advertising companies could take the form of using them to ~ devise and design anti-smoking materials, programs and patterns. ~ J. Mostyn Davis, M.D., P.C., Shamokin, PA, 6/16 Phila. F p. 10. ~ I think advertisin ercent to the number of contributes more than 50 g p ~ youngsters who smoke. WQ~ , Nola Mae Morgan, Ph.D., Principal, Shenandoah ~i O Elementary School, St. Louis, 5/19 St. Louis, Tape 1, zzW ~ Side 1, Rev. 1213. O[-~i I do suggest that cigarette smoking will not just wither away even if all 0 advertising were banned... Herbert V. Skaggs, President, St. Louis County ACS, TV Station KTVI Programming Director, 5/19 St. Louis, Tape. 1, Side 2, Rev. 632.

-20- A D V E R T I S I N G (page five) (Asked if cigarette advertising is a major factor in young people starting to smoke) No. When we were at the model legislature the kids were giving their views on what else could be done, stuff like stronger warnings on packages and T & N labels printed. Really, they decided, the kids, that this and less glamorizing advertising, or stopping it altogether, didn't really make any difference, 'cause they already knew what brands they were going to snioke (?) like the warnings -- they didn't know it, they didn't see it. Christa Lira, high school student, Centerville, Iowa, 5/19 St. Louis, Tape 2, side 1, rev. 726. If advertising of this deadly product is to be permitted in the future, the truth in advertising laws should require that at least one-half of the space of each advertisement be used to describe the poisonous nature of the material and its effects on those who use it. David T. Carr, M.D., Associate Director for Cancer Control, Mayo Clinic, Rochester, Minnesota, 5/25 Chicago, page 2. Past governmental policy (and health interest group efforts) has over- simplified the problem and ignored important questions of brand intro- duction, product change and their implications for public health. Such a simplified strategy including elimination of TV and radio cigarette adver- tising and the FTC's 10-year moratorium on advertising of tar and nicotine content, has probably slowed the tar and nicotine reduction that might have occurred with greater brand competition. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue JJniversity, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 1. ...industry advertising expenditures have decreased in real dollar terms since the 1971 advertising ban. Furthermore most present industry adver- tising is spent on low tar brands. While the tobacco industry is fighting FTC efforts to probe industry advertising techniques and policies, it is clear that certain types of advertising (switching smokers to lower tar and nicotine cigarettes) would be in the public interest and are not inconsistent with maintaining overall tobacco industry profits. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. ...industry efforts at reduced tar and nicotine levels and increased filtration are not facilitated by the TV and radio advertising ban. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 5. CONFIDENTIAL: TIMN 288533 MINNESOTA TOBACCO LITIGATION

A D V E R T.:I S I N G (page six) In light of the health hazards of smoking and the many governmental programs designed to protect the health of our citizens, it is difficult for me to understand why tobacco companies are allowed to take tax deductions for tobacco advertising costs... Paul Q. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 4. It seems to me that we should prohibit all advertising so that young people will not be subjected to the constant barrage of direct and subliminal messages enticing them to start smoking. Paul Q. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 5. We must continue to fight the advertising of tobacco products by any means possible. We should particularly approach the industrial volunteers in such organizations as the American Cancer Society, American Heart Asso- ciation who deal with the various media not to accept such advertising. Robert L. Schmitz, M.D., Mercy Hospital and Medical Center; Board Member of Illinois ACS; Chicago, Ill.; 5/25 Chicago, page 3. ...the Alliance of Non-Smokers believes there should be a total ban on advertising in this country as there is in England and Italy. A total ban would make a big dent in the smoking problem by 1995 in a gradual way. Fewer teens would start smoking, some young adults who are already addicted would have quit, and the older people would have died. In this way the tobacco growers could over the next 20 years arrange another means of likelihood as tobacco would become less profitable. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 4. One student in five believes that advertising by the tobacco companies is definitely a major factor in influencing teenagers to smoke. Thirty percent of the students say the advertising is not a major factor. ((50% don't know)). Robert W. Wandberg, Health Dept. Chairman, Olson Junior High School, Bloomington, Minnesota, 5/25 Chicago, page 2. TIMN 288534 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G (page seven) Manufacturers and promoters of smoking materials are more than innocent scapegoats however. They are exploiters of people's weaknesses and bad habits. They strive to create a delicious and glamorous aura associated with smoking. They beguile the young, impressionable and weak by the most tantalizing and sophisticated means. Certainly, there is no justification for allowing billboard, magazine, and newspaper advertising of cigarettes. The only excuse is money. It is better that we pay a few pennies more for our printed pages than hundreds of dollars more for our medical bills. Sherwyn Warren, M.D., Chairman, Illinois Interagency Council on Smoking and Disease, Winnetka, Ill., 5/25 Chicago, page 2. ALL forms of tobacco advertising should be banned. Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, page 2. While these masters of deceit in their advertising appeal have targeted and sent their messages to browns, others have not. At present, the tobacco industry promotes low tar ... smoke, but the tobacco auctioneer, the tobacco hucksters, the tobacco prostitutes, have increased tars in their advertising appeal. Lupe Zamarripa, Special Counsel to the Texas Secretary of State, Austin; 5/12 Denver, Tape 4, rev. 307. Simonds: Has there been any position taken by the American Association of Broadcasters in the area of smoking and smoking advertising? Cohen: You're referring to the National Association ((of Broad- casters)). No, they seem still to be smarting from the fact that we can't carry that advertising while the newspapers can. I would like the newspapers banned also. Simonds: Is that a recommendation you are making? Cohen: Yes, certainly. I think in all advertising media. It's not fair to single one advertising medium. Israel Cohen, President, WCAP, Lowell, Mass.; 6/2 Boston, Tape 2, side 1, rev. 890. The only magazine that I read is Good Housekeeping, because it does not accept tobacco advertising. --.~_a Dorothy L. Mims, employee ed`ucation chairman,^ Flo'rence, S. C., ACS; 6/14 Atlanta, Tape 1, side 2, rev. 1230. CONFIDENTIAL: TIMN 288535 3VIINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G (page eight) I noted that the commission's baseline data gives no reference to the possibility of a move to achieve all-out prohibition. I think that is wise. I think the area of consideration, major consideration, must be among the youth. George Gingell, VP, WRBL-TV, Columbus, Georgia; 6/14 Atlanta, Tape 1, side 1, rev. 340. Weingarten: Do you think there would be merit in petitioning the FCC to remove the ban on cigarette advertising pro- viding the Fairness Doctrine prevailed? Gingell: I'm afraid I'm going to be quoted. I don't think there's real merit in that. George Gingell, Vp, WRBL-TV, Columbus, Georgia; 6/14 Atlanta, Tape 1, side 1, rev. 340. ...I don't think a petition to the FCC to restore the right to broadcast cigarette advertising would be meaningful. I regret that any type of advertising should be removed without due reason. I say due reason. Tobacco has not been outlawed. George Gingell, VP, WRBL-TV, Columbus, Georgia; 6/14 Atlanta, Tape 1, side 1, rev. 340. in the case of the recent decision for cigarette manufacturers to advertise the tar and nicotine content of the cigarettes that they manufacture, this has been the greatest boon of all for the cigarette manufacturers of this country, because they were able to go from 15 brands to 170 brands by stretching the shape, they size, the color, the package and the tar and nicotine content. Louis U. Fink, retired businessman, Orlando, FLA., member of IUCC workshop on smoking & health, 6/14 Atlanta, Tape 2, side 1, rev. 1112. I think that the FTC has a perfect case if it isn't interfered with by the Congress of putting all cigarette advertising to bed, due to the type of misleading which is going on and has gone on for many years. Louis U. Fink, retired businessman, Orlando, FLA., member of IUCC workshop on smoking & health, 6/14 Atlanta, Tape 2, side 1, rev. 1133. CONFIDENTIAL: TIMN 288536 MINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G (pagenine) It seems that not to advertise on radio and T. V. should also mean not to advertise on billboards, in newspapers and magazines, etc. or at least these media could be required to run anti-smoking campaigns. William W. Campbell, commercial manager, WPRO Radio, Providence, R. I., ACS volunteer, 6/2 Boston, p. 2. I do...have an argument with recruiting young teenagers as smokers by the wiles of the advertising industry in any public media. Blake Cady, M.D., surgeon, Lahey Clinic, Boston, MASS., 6/2 Boston, P. 1. The most insidious effect of this wealthy industry is not that of mani- pulating our legislators but of converting our children to smokers. The entire advertising effort of the tobacco industry is designed for one end--to increase the number of smokers and the number of cigarettes smoked by each. Blake Cady, M.D., surgeon, Lahey Clinic, Boston; MASS., 6/2 Boston, p. 3. ...one of the questions that this investigation ((FTC advertising inves- tigation)) will hopefully determine and we have said this before, is to what extent cigarette advertising gets people to start smoking as opposed to what the cigarette industry has maintained for many years about cigarette advertising influences brand preferences and determines brand preferences. We don't know what the answer to that is. And we are seeking documents which go to this issue among others and we hope to resolve this question for the foreseeable future. But we don't know the answer. Mark Gordon, Esq., Div. of National Advertising, Bureau of Consumer Protection, FTC, 6/16 Phila., p. 5. ...we'd be very interested in any testimony which has taken place in this meeting and also in others across the country. As I say, this is the beginning of an investigation and we have yet not received any data that goes to the subject and certainly we are interested in getting data wherever we can find it. Mark Gordon, Esq., Div. of National Advertising, Bureau of Consumer Protection, FTC, 6/16 Phila., p. 6. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288537

A D V E R T I S I N G (page ten) In a test which I produced and passed out to over 130 student (sic) grades 7 through 12...Only 25% overall thought that advertisements had anything to do with their smoking! Kevin Young, high school student, Holland, New York, Philadelphia 6/16/77, p. 2. ...the enormous advertising campaign that goes on by the industry that counters, I think, certainly is weighter in scope than any other kind of message in the opposite direction. ...in summary, I believe that the facts on cigarettes are not as well known as they ought to be and commend your commission on what it's doing and undoubtedly there'll be improvement in that situation as a result of your work. J,Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. Question: In your judgement, does media advertising by the cigarette industry play a major role in inducing young kids to smoke? Maher: Most of the evidence suggests ... that is not the case. Brendan A. Maher, Ph.D. Professor of the Psychology of Personality and Chairman, Dept. of Psychology and Social Relations, Harvard Univ. Cambridge, Mass., 6/2 Boston, Tape 1, side 1, rev. 975 ...Such advertisements of any or all tobacco products should only describe the product and not contain subliminal messages... Steven R. Homel, M.D., Director, Center for Health Educ., Phila., Pa., 6/16 Phila., Tape 2, rev. 83. The Tobacco Institute's contribution to research ... amounts to less than one-half of l percent of what they're spending for advertising. Joseph M. Deignan, M.D., Winchester, Va., 6/16 Phila., Tape 2, side 2, rev. 1250 Not too many days ago, those of us in the legislature were given pamphlets describing what's available for the tourist and the vacationer in New York State. And I got a number of those in my office and was about to send them out to various groups and organizations and my secretary turned it over. On the back page -- it's a lovely production, it's glossy, colored pictures throughout -- and on the back page of this brochure was a massive ad by one of the major cigarette manufacturers in the state of New York. So it's a clear indication in my mind that someone, someone in a position of respon- sibility, somehow hasn't quite gotten the message. Frederick G. Field, Jr., N.Y. State Assemblyman, Albany, N.Y., 6/16 Phila., Tape 2, side 1, rev. 223. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288538

A D V E R T I S I N G (page eleven) In the area of taxes, why not eliminate the tax deduction for advertisiny, tobacco products, at least cigarettes. Why should somebody get a tax deduction to kill people? I don't understand that. It's a misuse of Congressional power. Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 419. Fisher: ...I do not know of any products you can't get a deduction for... If cigarette consumption and manufacturing were determined to be against public policy -- in other words, if killing 5,000 people a week was against public policy, there would be no tax deduction ((for advertising)). Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 493. If the outcome of that would be an outpouring of your anti-smoking commercials, my answer would be resoundingly yes ((the Commission should recommend lifting the broadcast advertising ban)). Because I don't think that movie actors and pretty girls and soft music and filtered camera work is a match for those anti-smoking commercials done by skilled people. I think it's Mohammed Ali against a cripple. And if that`s your research and you would get your anti- smoking commercials back on, I'd say yes. Jack Valenti, president, Motion Picture Assn. of America, 6/16 Phila., Tape 1, side 1, rev. 1103.• ...the January 12, 1976, issue of Time magazine ...had a whole centerfold article on the nonsmokers rights movement...a very unfavorable, derogatory review of what the movement ((and)) its aims were all about...the back page, the inside front page, four full inside pages, 2 1/3 pages and 1 1/2 pages were purchased by tobacco advertisements ... when you take advertising dollars out of'TV, they put them somewheres in the printed media and editorial policy is influenced. Steven Sklar, Maryland fiouse of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2, rev. 272. Ebersol: Do you advocate a complete ban on cigarette advertising? Blum: I just don't know what to think about that. ...Of course, it should be banned, but the effect of it will be perpetuated as long as people still accept it socially. For now, then, I could only want to increase our opposition and have that fair choice...Let people compare, and that probably would be a lot more effective than a total ban... Alan Blum'...M.D., Miami, ami. , Fla., 6/14 Atlanta, Tape 1, side 2, rev. 218, (Lisbon Room). CONFIDENTIAL: TIMN 288539 MINNESOTA TOBACCO LITIGATION

A D V E R T I S I N G (page twelve) I had never seen any advertising the government has done that in my opinion was very effective. Not only that, for every dollar the government spends on advertising, it means they have to collect several dollars from the tax- payer in order to pay for it. Yank Dean, President, Allied Sports Co., Eufaula, Ala., 6/14 Atlanta, Tape 1, side 1, rev. unknown. I don't think you'll ever get this passed through: ... any form of tobacco advertising would have to have an area of space one-third of its advertising space with that statement ((warning)) in big, bold letters. Roger Setters, Pres., Louisville Chapter, GASP, Louisville, Ky., 6/14 Atlanta, Tape 1, side 1, rev. 304. ...teenagers often fail to come grips with the deadly consequences in terms of their own age group. This distortion of reality is fully understood, however, by the tobacco industry, whose advertising agencies continue to reinforce the image of young smokers as attractive, health, sexy, finan- cially successful, and socially adroit young people. R. Bruce Dunlap, Ph.D., Dept. of Chemistry, Univ. of S.C., Columbia, S.C., 6/14 Atlanta, p. 4. -27- The first thing I think we must do is to enact into law what The American Cancer Society called for at its fall board meeting in 1967, almost ten years ago. That is, a complete cessation of all advertising for cigarettes. (p. 5-6.) As one who has spent his life in advertising, I have absolutely no doubt that if you can eliminate all advertising for cigarettes and then mount a really massive campaign against cigarettes through educationall advertising, you will accomplish a great deal in reducing smoking. (p. 6.) George Washington Hill...often emphasized to me the great value he saw in ciga- rette advertising for expanding the total market for cigarettes, as well as for building up our own brands, Lucky Strike, etc...Any advertising man who really thinks cigarettes rose in volum from I billion a year to 600 billion a year without the impetus of advertising, ought to get out of the advertising business. (p. 7.) Emerson Foote, former chairman, Interagency Council on Smoking & Health, 6/2 Boston. CONFIDENTIAL: NiINNESOTA TOBACCO LITIGATION TIMN 288540

A L L E R G Y Perhaps my concern for all nonsmokers stems from the years of discomfort caused by my own hypersensitivity to smoke... (T)here were indeed many fellow-sufferers... Ruth Gilbert, Medical librarian, VA Hosp., Denver, Colorado, 5/12 Denver, p. 1. The tobacco merchants continue to claim there is no allergy to tobacco smoke. I am living proof that they lie in this and many other ways, impeding at every turn the flow of factual information to the public about this major. public health problem. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 2. Dr. H. G. Rapaport, former President of the American College of Allergy, states that industry loses 184 million days of work annually because of employees who have allergies. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 4. One out of every 6 Americans is highly allergic to smoke. That's 37,000,000 people. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, I11 „ 5/25 Chicago, page 2. If every restaurant had nonsmoking sections 37,000,000 more Americans (the allergic ones) could come out of hiding and could dine out without the fear of allergic reactions. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 3. Smoking may also affect the digestive system and liver functions. And smokers have a 20 percent greater incidence of skin allergies that frequently clear up when they quit. As a smoker, nothing is in your favor. Soldier magazine, July 1977, submitted to Atlanta forum, 6/14/77 by SP/5 S. D. Bates, Ft. Gordon, Ga. CONFIDENTIAL: TIMN 288541 MINNESOTA TOBACCO LITIGATION

A L L E R G Y (page two) In the severely allergic person, tobacco as well as other types of smoke and fumes can and does cause mild to suicidal depression, anger, paranoia, unreasonable fear, anxiety, hostility and an unresolvable feeling of hopelessness. I know! I'm one of those severely allergic people. Stephen Sedberry, musician, Birmingham, Alabama & Roxbury Crossing, MASS., Boston 6/2/77, p. 1. I'm one of those unfortunate 34 million Americans who are very susceptible and allergic to tobacco smoke... after some very touch-and-go treatment where I just barely survived and I even went so far as to have the last rites, I went through a series of desensitizing shots... Harry Spata' ro, City Councilman and Delta Airlines pilot, Downers Grove, Ill., 5/25 Chicago, Tape 1, rev. 109. I am very bothered by smoke. I have now started taking tobacco allergy shots every two weeks and they hurt. I'm also allergic to dust and mildew. ...and now I've found out at thirty that I'm allergic to one-half of my favorite foods and drinks...taking shots...regular allergy shots... they don't really hurt. The tobacco shots hurt...I suffer. Why should I quit my job? It pays well and has terrific benefits that I can share with my parents. Diana Brown, flight attendant, GASP & Ga. ALA volunteer, Marietta, Ga., 6/14 Atlanta, Tape 2, side 1, rev. 354. In allergic people it has been proven that tobacco smoke ... enlarges the mucous cells ... producing too much mucous, ((making allergic individuals)) more susceptible to infection. This in turn causes chronic bronchitis. Side- stream smoke which goes directly into the air from the burning end of the cigarette or cigar causes allergic attacks, ...wheezing. The non-smoker is also subjected, like I said, to`mainstream smoke... ((which)) can aggravate symptoms of asthmatic children and even trigger asthma attacks. Allergic people...can suffer smoke-caused asthma attacks even in non-asthmatic and non-allergic children, as my son. A team of researchers found that respira- tory illnesses happen twice as often to young children whose parents smoke at home compared with those of non-smoking parents... Debbie Tyson, ALA and GASP volunteer, Kennesaw, Ga., 6/14 Atlanta, Tape 2, side 1, rev. 137. MINNCSOTAO T sACCO LITIGATION TIMN 288542 ITIGATION

CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION A N T I-S M O K I N G S P O T S Recommendations: 7. Mass media campaigns to promote nonsmoking and other favorable health behaviors should be funded by government and voluntary associations. -30- 8. Foremost should be campaigns directed at young people to encourage them not to smoke and to help them quit if they have already started. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health 3/22 LA statement, p. 14. ...I am responding to your request for testimony today about even further regulatory attempts by asking that you consider a change in direction away from seeking relief through regulation and toward increased use of tools that have already proven successful; the tools used by the cigarette industry and the only proven resource currently at our disposal that remains unused-- professionally conceived, hard-hitting attitudinal/behavioral change anti- smoking commercials for airplay on prime-time TV. Arthur L. Cole, Pres. Cole Communications, consultant to FTC, 3/22 LA statement, pp. 3-4. ...the 17 percent fall-off in this period was responsible in considerable measure, was associated with the required anti-cigarette messages on the airways. It appears then, apart fromthe statistical evidence, it seems to me then that common sense would suggest that $40 million a year in broadcast advertising, no matter what you're trying to say, is going to have some important impact. And, indeed, I think that was the lesson of that important period. Larry Agran, attorney, UCLA law instructor, director of NCI-funded History of Cancer Control Project, 3/22 LA Tape 3, Rev. 316. It would seem to me a very important step for this commission to take, or for the American Cancer Society generally in states and throughout the country, to really get involved in trying to promote legislation of this sort ((California Gregorio bill, which provides for general fund monies to buy TV commercials against cigarettes)) based upon the national experience, which indicated to us what can be done by way of broadcast advertising...And it's perfectly proper I think, indeed a responsible role, for government to urge that kind of action upon people. Larry Agran, attorney, UCLA law instructor, director of NCI-funded History of Cancer Control Project, 3/22 LA M d' kn 00 Tape 3, Rev. 363. 00 Now the way things stand, when you approach a station in the absence of any legal requirement y9u are simply on a footing with other public interest groups and so forth who plead for time, really, to please run either anti- N cigarette messages or whatever the message might be. Larry Agran, attorney, UCLA law instructor, director of NCI-funded History of Cancer Control Project, 3/22 LA Tape 3, Rev. 379. . ~

ANTI-SMOKING SPOTS (page two) Since a large part of one group session is devoted to the advertising of cigarettes and our group members grow to be acutely aware of how they have been "duped" by the tobacco industry, I wish to urge the Task Force to do everything possible to use the power of the media as a positive reinforcement for people to refrain from smoking or to quit once they've started. Jeannette M. Jacobson, Stop Smoking Program Coor- dinator, ACS, 5/17 Seattle, p. 6. Creative thought process is vital at this stage as there has to be a way to prove to the public that cigarette smoking is tremendously harzardous (sic). Perhaps pictures of the lungs of victims of smoking or lung cancer could be shown on a national basis on television. Perhaps an entire half hour with alot (sic) of advance publicity could be put on television. John Ralston, former head football coach & general manager, Denver Broncos (NFL), 5/12 Denver p. 3. Two things are wrong with "typical" health messages as just described. First, they emphasize avoiding risks rather than being healthy. Second, they are disorganized, failing to suggest to the individual a manageable, general strategy which he might pursue. In their place, public health messages should emphasize a wholistic approach to the pursuit of good health, encouraging the practice of as many healthy activities as possi- ble rather than the avoidance of diverse risks. Instead of sensitizing individuals to particular risks, media campaigns should provide indivi- duals with skills and information by which they might weigh. risks and make their own decisions as to how to combine the value of good health with the other sources of satisfaction in their lives. E. B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ., St. Louis, Missouri, 5/19 St. Louis „ p. 15. I doubt, though, that the absence of commercials or public service announce- ments has seriously affected smoking incidence. George A. Gingell, GA Assn. of Broadcasters & Mass Media chairman of GA Div. of ACS, 6/14 Atlanta, p. 2. ...pass legislation that would require the FCC to provide a certain amount of prime-time public service announcements donated to the issue of no-smoking. Before a network could renew its license, these requirements would have to be met. Douglas S. Lloyd, M.D., Conn. Commissioner of Health, 6/2 Boston, p. 4. CONFIDENTIAL: MINNESOTA TOBACC O LITIGATION TIMN 288544

A N T I-S M O K I N G S P OT S (page three ) The FCC should exert its authority to discourage radio and television programming and story content from depicting smoking as a positive aspect of a life-style. What's more, it should revive its previous stipulation that stations devote a certain amount of air time to public service spots, or, better yet, develop special anti-smoking messages for children to be aired during the Saturday morning cartoon viewing time. Leonard Bachman, M.D., Penn. Sec. of Health, 6/16 Philadelphia, p.8. The removal of cigarette advertising from broadcasting was the worst thing to happen to the anti-smoking movement. Tom Cousins, Promotion Director, WCCO-TV; ACS volunteer, Minneapolis, Minnesota, 5/25 Chicago, page 3. ...the only way to counter the cigarette industry's advertising is with anti-smoking ads that have a similar degree of impact on the public. Ivan L. Preston, Professor, School of Journalism, University of Wisconsin, Madison, Wisconsin, 5/25 Chicago, page 2. The anti-smoking forces should make sure that a good component of their persuasion effort is devoted to this emotional and nonfactual level of argument that advertisers use. Ivan L. Preston, Professor, School of Journalism, University of Wisconsin, Madison, Wisconsin,'5/25 Chicago, page 4. Today the (advertising) standard is higher, but it's still low; lies can still be told. And I can appreciate that there would be a natural dislike on the part of your National Commission to prepare anti-smoking advertising that met such a low standards I have thought about that, however;-s.nd I-believe on the whole that that's exactly what you should do. You say you`re-too•decent to-fight that way? Well, I think you should ask yourselves: Do you want to be nice? Or do you want to save lives? Ivan L. Preston, Professor, School of Journalism, University of Wisconsin, Madison, Wisconsin, 5/25 Chicago, pages 4 and 5. CONFIDENTIAL: TIMN 288545 MINNESOTA TOBACCO LITIGATION

ANT I- SMOKING S P 0T S(page four) As you know, prime time on TV is just about sold out all over the country. It's virtually impossible to buy time, let alone get free time. Victor Weingarten., NCSPP Director, during testimony of George Gingell; 6/14 Atlanta, Tape 1, side 1, rev. 449. Gingell: I think you mentioned somewhere in some of your material the possibility of buying the time. I thought I read that somewhere. That was the -- Weingarten: It's not a.commission suggestion. But other witnesses have suggested to the commission that we consider recommending purchase of time. Gingell: Well, I recommend-you check in on the cost.of the time and I think you will not pursue that. George Gingell, VP, WRBL-TV, Columbus; Georgia; 6/14 Atlanta, Tape 1, side 1, rev. 485. Shank: You do make several suggestions -- one is that there be developed more innovative and interesting TV spots. Who should do that? Lloyd: Interesting question. I wish I had a good answer. I think the state -- like Jonathan, I feel there's a responsibility in there for the states. I think there are a lot of state health departments such as Mass. and Conn. that are looking more towards the idea of seeing the state health departments and local health departments reassume a role in toxic hazards. Health departments, as Jonathan pointed out, made their mark on basic sanitation and infectious diseases. But in Conn., less than 1.2 percent of all deaths are from infectious diseases. Douglas S. Lloyd, M. D., M. P. H., Conn. Commissioner of Health, 6/2 Boston, Tape 1, side 1, rev. 510. WE NEED A CAMPAIGN - we sure do - our slogan should be "the cure for lung cancer is to stop smoking", or some "catchy" phrase that would draw instant attention. Jeanne A. Cunnius, vice president, Business Careers, New York City, 6/16 Philadelphia, p. 3. 2t has been brought to my attention that the current television campaign "we mind very much if you smoke" which shows people lighting cigarettes invariably inspires smokers to light up despite the guilt feeling the commercial promotes. Jeanne A. Cunnius, vice president, Business Careers, New York City, 6/16 Philadelphia, p. 4. CONFIDENTIAL: TIMN 288546 MINNESOTA TOBACCO LITIGATION

ANTI-SMOKING S P 0T S(page five) A great deal of public pressure, or a great advertising campaign to get people to speak up to enforce these regulations that do exist, even though they're not national, would be very, very helpful, because people are shy to do this quite often. We must give them the backbone to help enforce the rules, because I don't think the police are ever going to do it. John B. Kelly, Jr, councilman at large, Phila., Pa., and first vice president of U.S. Olympic Committee, 6/16 Phila., Tape 2, side 1, rev. 376. Without any question, the single most durable impress that's been made on these ((5th - 8th grade)) children's minds comes from television, from the anti-smoking ads... (rev. 984.) If I were managing the ACS and I wanted to counter those who would like to see more people smoke, I would try to double and triple the kind of ingenius, dramatically constructed programs that are done by amply skilled professionals. There is simple no known counter agent to that in the field... (rev. 1006) -34- Television ads, the messages on television, may be the single most potent weapon that you have in convincing people of the need not to smoke... (rev. 1054.) My judgment is that TV executives are human beings. If they are tugged and pulled at with enough persuasion, if the issue is crucial, there is something more than merely a public service involved, ((they will run anti-smoking spots)) if they could be persuaded by their lawyer that they wouldn't be assaulted by the lawyers from the other side demanding equal time...But there's nothing to prevent the local station from airing these things if he thinks they're in the public interest. The lawyers may take you to the mat on it, but I think it's a cause that can be fought and won. (rev. 1079.) Jack Valenti, president, Motion Picture Assn. of America, 6/16 Phila., Tape 1, side 1. I must say, that when I look at the anti-smoking campaigns that have occurred in the past and have been produced by many organizations, I am totally turned off by their effectiveness (sic). William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, p. 2. On the state and local level, an effective way to increase time spots would be to have organizations send letters to local stations stating smoking is a serious problem which needs more attention. Explain it is felt the station needs to increase no-smoking coverage and programs about smoking. State that someone will be watching to see that it is taken care of and if no increase is seen, effective means will be taken when the network's license renewal comes up. Douglas S. Lloyd, M.D., Conn. Commissioner of Health, 6/2 Boston, p. 4. CONFIDENTIAL: TIMN 288547 MINNESOTA TOBACCO LITIGATION

B E H A V I 0 R A L R E S E A R C H The most important role that the ACS can play in all this is in the support of behavioral research in the reduction of exposure to cigarette smoke. The trend in government support for research in the behavioral sciences has been towards the imposition of so many controls for the protection of the individual, that much of the research in this area cannot be done effectively. I am not criticizing this trend, since there are many philosophical considerations that support placing limits on the control over the individual that government may exert. Nevertheless, it means that non-governmental money•must be used to support the develop- ment of sound, scientific research projects in behavioral change that results in improved health. Daniel Horn, Ph.D., Director, National Clearinghouse for Smoking & Health, 3/22LA statement, pp. 5-6. I would suggest the following: 4) Sponsored research on smoking in the behavioral sciences should be less basic and more applied in nature, and should be aimed toward the development of realistic education program-- even if it means engaging in traditional motivational research methods: that is, determine how and when to persuade young people, and organize relentless campaigns built around this information. Socio-economic and ethnic group differences in susceptibility to specific forms of appeal should be investigated and the resulting data should be built into anti- smoking propaganda aimed at specific groups. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22LA statement, p. 6. Those people in the social sciences who are interested in doing smoking research use smoking research, or have used smoking research in many instances, in order to promote their own professional careers, to build up their publication lists and to conduct research on personality organi- zations and other and related aspects that"are only slightly related to the problem that we're facing. Salvatore V. Zagona, assoc.'~professo`r of psychology,' -Univ:-of Arizona, Director - Center for Research on Smoking & Health, as cited by ACS LA Film, 3/22 LA. I suggest that the Cancer Society pay attention to the findings of beha- vioral scientists particularly those involved in motivation and attitude change...We must find out the mechanisms that turn young people onto cigarettes and effectively discover news ways to turn them off... We need effective weapons with which to.wage a psychological war against tobacco. Dr. J. P. Herter, clinical psychologist, Jackson Hole, Wyo., 5/12 Denver, p. 4. TIMN 288548 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

-36- B E H A V I O R A L R E S E A R C H (page two) The only truly effective means of eliminating smoking is the development of alternative ways of dealing with stress, tension, and boredom. For those already under the influence of tobacco, emphasis should be directed toward developing effective programs that lead to a change in lifestyle, a life- style void of cigarettes. It is evident that greater research is needed in behavior modification. In addition to basic research, funds are needed to adequately train effective clinic leaders. Avery Harvill, P.E.D., Clayton Junior College, Morrow, Georgia, 6/14 Atlanta,p. 2. (Briefly described his own research on quit.methods, said subjects identified as suggestible had a 41.4% quit rate after six months, while non-suggestibles had only 16.7%) So one point which one might consider when beginning stop- smoking treatments is to determine the individual is suggestible or non- suggestible and I would recommend that further research be conducted in personality variables which might predict the outcome of smoking. Mitchell A. Alevy, Clinical Psychologist, St. Louis, 5/19 St. Louis,. Tape 2, side 1, rev. 586. With so much effort and money spent on ways to cure cancer and other illnesses, woefully little has been spent to try to understand the reasons why people smoke and how to modify this behavior. Sherwyn Warren, M.D., Illinois Interagency Council on Smoking and Disease, Winnetka, Ill., 5/25 Chicago, page 2. O Behavior modification is very complex and the success ratio of persuading people to give up a habit from which they derive gratification and social approval is both limited and discouraging. Albert Zack, Principal (ACS member); Ken Duckworth, student; Jill Ochalek, student; Bentley High School, Livonia, Michigan, 5/25 Chicago, page 1. 0*~ We have to bring in the behavioral scientists because they do bring in a ~ heavy input into why people keep eating too much, drinking too much, and 00 00 smoking too much, all health hazards that can be modified. Loring Brock, M.D., Director of Heart-Lung Center, Denver; 5/12 Denver, Tape 1, rev. 368 N 9 N . .[T]he need for more behavioral research ...[w)hat we need more of now is how do we get people to stop smoking, and I think we must be careful that we not lose sight of the fact that people are the real problem, not cigarettes. Rick Guyton, Health Educator, University of Arkansas, Fayette; 5/12 Denver, Tape 3, rev. 356-358.

B E H A V I O R A L R E S E A R C H (page three) if we can clarify motivation in the various groups we can organize our attack effectively. Dwight Emary Harken, M.D., clinical professor of surgery, emeritus, Harvard Medical School, Cambridge, MASS., 6/2 Boston, p, 5. Dr. Gallup feels that his study ((behavioral research/public opinion)) would cost something of the order of $10,000.00 to $15,000.00.' That seems a small price to pay for a cardinal, diagnostic test. Dwight Emary Harken, M.D., clinical professor of surgery, emeritus, Harvard Medical School, Cambridge, MASS., 6/2 Boston, p_ 6. It is the general opinion of investigators into this field that there is probably no genetic factor that characterizes the habitual smoker. In addition, there appears to be little evidence that any personality char- acteristic signals the presence of a habitual smoker, a non-quitter, a quitter, or a non-smoker. Louis A. Leone, M.D., Director, Dept. of Medical Oncology, R. I. Hospital, Providence, R. I., 6/2 Boston, p. 6. Research should be carried before proceeding ((with any effort to eliminate smoking)) so that strategy and tactics of the activity may be based on the realities, revealed by the research. This should be entrusted to a recognized public opinion polling organization. The research should attempt to isolate motives for smoking and not smoking, the present atti- tudes individuals of the most diversified kind have towards smoking, the influences that make for smoking and the stopping of smoking. E. L. Bernays, retired PR consultant, 6/2 Boston, p. 1. Research in this area ((effectiveness of anti-smoking campaigns)) is hampered by a lack of consensus about the definition and measurement of terms. Thus the label smoker has been sometimes applied to individuals who have ever smoked (even if only once) as well as to those who smoke one or more packs a day. Smoking behavior has been measured by self-report questionnaire, by direct observation, by records of cigarette sales, by the counting of cigarette remains in ash trays, etc. It seems clear that the development of a reliable body of knowledge about smoking will be helped significantly by the establishment of an agreed terminology, definitions and measures to be used in research. Brendan A. Maher, Ph.D., Professor of Psychology of Personality and chairman, Dept. of Psychology & Social Relations, Harvard University, 6/2 Boston, p. 2. CONFIDENTIAL: TIMN 288550 MINNESOTA TOBACCO LITIGATION

B E H A V I O R A L R E S E A R C H (page four) Smoking ((among youth)) appear to be related to limited educational as- pirations, to feelings of low personal control over the future, to poor self control, and, in the case of female students, to a general rejection of conventional mores. All of these are suggestive findings rather than definitive conclusions and we need large scale systematic research on the problem before we can have confidence in our knowledge of the factors that produce smoking in the young. Brendan A. Maher, Ph.D., Professor of Psychology of Personality and chairman, Dept. of Psychology & Social Relations, Harvard University, 6/2 Boston, p. 7. Little attention has been given to the processes by which the many millions of ex-smokers managed to quit smoking without the aid of special clinics or other individual help. Some part of our research effort should be aimed at locating these people and identifying the events in their environment that led them to quit smoking. . Brendan A. Maher, Ph.D., Professor of Psychology of Personality and chairman, Dept. of Psychology & Social Relations, Harvard University, 6/2 Boston, p. 10. We also hope, not unselfishly, that ACS will begin to provide financial support for comprehensive, individualized programs which focus on teaching smokers how to creatively control their own behavior. Robert E. Shute, D.Ed., Health Education Program, Penn. State Univ., University Park, PA, 6/16 Phila., p. 26- The American Cancer Society should make a commitment to:...2. Fund research on prevention -- especially long term research efforts (at least three year studies). Robert E. Shute, D.Ed., Health Education Program, Penn. State Univ., University Park, PA, 6/16 Phila., p. 26. Question: Doctor, you've advocated more research, particularly in the field of changing people's motivation. The ACS for years has wanted to have more research in this area, but we get a very few applications. Mausner: The ACS, I beg to differ, sir, has consistently turned down most grant requests in this area in the last five or six years...And I know of several that have been turned down that might have looked promising. Bernard Mausner, Ph.D., prof. of psych., Beaver College, Glenside, PA., 6/16 Philadelphia, Reel 1, Side 2, Rev. 446. TIMN 288551 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

-39- B E H A V I O R A L R E S E A R C H (page five) I know that the current tendency is for researchers to go where there's promise of support. My wife's an epidemiologist and I peek over her shoulder as she and her colleagues respond to the RFPs from Washington. To my knowledge, there's never been an RFP devoted to the issue of attempts to find ways to persuade people that not smoking is a desirable way of life. I'm sure that if there were, that there would be some responses and they wouldn't be too bad... I think that a really clear statement of objectives, on the part of someone willing to give support, would bring an awful lot of people out of the woodwork. I may be wrong, I don't know. Bernard Mausner, Ph.D., prof. of psych., Beaver College, Glenside, PA., Philadelphia 6/16/77, Reel 1, Side 2, , rev. 446. The behavioral technology is such that it is not that difficult to get people to stop smoking -- briefly. Where the real challenge is in research at this time is getting people to stay off, having quit. This is really where our major problems are at this time. Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2, rev. 751. - One of the problems we do have, however, is that we would like to study the impact of this particular intervention ((a Philadelphia TV ser`ies on giving up smoking)) in a more formal way and at this point have been frustrated in our attempts to find some source of funding to follow it up. Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2, rev. 790. Preliminary indications in the arena of behavioral change point to seeking the more superficial but immediately visible reasons for lifestyle modi- fication. James W. Alley, M.D., Director, Div. of Phys. Health, Ga. Dept. of Human Resources, Atlanta, Ga., 6/14 Atlanta, p. 4. There is a great need for research on methods of smoking cessation and prevention. Douglas 0. Draper, Ph.D., clinical psychologist, Jackson, Miss., 6/14 Atlanta, p. 5. Further efforts must be made in behavioral research to develop more effective and permanent methods of promoting and evaluating smoking cessation efforts. Jonathan Fielding, M.D., Mass. Commissioner of Public Health, 6/2 Boston, p. 6. TIMN 288552 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

C O N C E S S I O N S Passive smoking may also result in absorption of other potentially harmful substances. Tobacco smoke contains tar, volatile hydrocarbons including 3, 4-benzpyrene, oxides of nitrogen, hydrogen cyanide, volatile nitriles, acrolein, aldehydes, phenols, and other substances. The effect of these substances absorbed by passive smoking on cardio-pulmonary function remains to be determined. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 11. Whether or not passive smoking predisposes to atheroscherosis or pulmonary carcinomas is unknown. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 11. Luquette and associates exposed 40 children, mean age 9.8 years, 3 children at a time, to smoke-filled and smoke-free atmospheres in a poorly ventilated environmental chamber with dimensions of 12 x 7 x 7 feet. After 30 minutes exposure, during which time 6 cigarettes were smoked by 2 smokers also present in the chamber, the children had a mean increase in heart rate of 6 beats per minute, a mean increase in systolic blood pressure of 4 mm Hg, and a mean increase in diastolic blood pressure of 5 mm Hg. While in the nonsmoking atmosphere, the mean heart rate increased one beat per minute, the mean systolic blood pressure decreased 4 mm Hg, and the mean diastolic blood pressure did not change. However, the experiemtnal design of this study has been questioned. Moreover Harke and Bleichert found no significant change in blood pressure or in heart rate in nonsmoking adults exposed to greater concentrations of tobacco smoke. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p.7. The total number of excess deaths causally related to cigarette smoking in the U.S. population cannot be accurately estimated... Stanford D. Splitter, M.D., internist, Berkeley, Calif., 3/22 LA statement, p. 2. Program priorities within the American Cancer Society are misplaced. Dexter T. Suzuki, Student Activities Coordinator, Kailua High School, and ACS volunteer, Honolulu, 3/22 LA, p. 1. I feel efforts to gain stronger and more prominent warning labels on all cigarette packages, stronger controls of cigarette sales to minors, and man- dated tar and nicotine levels would for the most part be a waste of time and energy. Roni Rechnitz, Dir., Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, p. 7. CONFIDENTIAL: TIMN 288553 MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I O N S (page two) One may ask - frThat•has the City of Manteca vending machine ordinance accomplished? The answer thus far is probably not a great deal. However, the Manteca City Council upon the inception of this local ordinance ac- knowLedged that young people-within the community would continue to obtain cigarettes from older friends, vending machines outside of the city limits, violators who continue to sell over the counter to individuals under the age of 1S and, sad as it may seem, even parents will continue to supply their children with cigarettes. Trena Relley. Vice-Mayor, aanteca, Calif., 3/22Ld statement, p. 2. Countless other factors are responsible for some cancers of the lung. Chemicals in smog, chronic lung disease which produces scarring and cell change, lung scars from old tuberculosis, asbestos, silica and so on. The iacidence of lung cancer is unquestionabL-y higher in humans with any kind of chronic disease. Drake W. Wi.ll, M.D., Chief, Pathology, The Queen's Medical Center, Honolulu, 3/22LA statement, p. 2. And we have a real high risk population, too. The Hawaiians. A target group. Only 9% of Hawaii's population, their problem into cancer of the lung is unique. Almost as many women as men have lung cancer and they have the disease and die of it ten years earlier than any other population or ethnic group in the United States. We do not have smog nor particulate air pollution, little asbestos, fairly high tuberculosis but little emphysema or other chronic lung disease. Ethnic super-susceptibility? Maybe. But one thing is clear. The Hawaiians smoke cigarettes: Drake W. Will, M.D., Chief, Pathology, The Queen's Medical Center, Honolulu, 3/22 LA statement, p. 2. More recently, however, the rationalizations have taken an ominous turn: they express a growing resentment against "political decisions" in public health matters. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, p. 4. The loss of confidence in government seems to have generalized to a loss in confidence in what government does--even in public health matters. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, p.4. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288554

CONCES S I01YS (page three) How can psychology contribute to the aims of the ACS and others in solving the vexing problem we're considering here today? I'm frankly pessimistic about a clear-cut solution. Psychology traditionally has confined itself to the understanding and prediction of behavior rather than in its control. Those few forays into control (such as motivational research and behavior modification methods) have made the pubLic very uneasy, to say the least. People simply don't want to be manipulated. So we have no reason to hope that we will be any more instrumental in bringing about changes in smoking than we have been in bringing about changes in social discrimination, group conflict (war, for example), alcoholism, drug addiction, or even the inci- dence of mental illness, for that matter. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22LA statement, p. 5. 1) The "Target 5" program, to reduce the number of smoking adults by 25% and the aumber of smoking teenagers by 50%, is somewhat too ambitious. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Ceater for Research on Smoking & Health, 3/22LA statement, p. 3. Jonas: Now it's one of those problems that beset those of us in the American Cancer Society and since smoking is not a moral thing with us--it's a health thing--I guess if someone were to propose such a safe cigarette, we would stop our opposition to it. You say that's not likely to happen. Allan K. Jonas, Los Angeles, chairman, ACS National Tobacco and Cancer Committee, in conversation with Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, Tape 3, Revs. 610-633. To be entirely honest and objective, I must tell you that the cigarette is a comparatively poor, ineffective source of ignition. It is nothing like the flame from a match, for example, which can start something burning just from a momentary contact. The glowing combustion from'a cigarette needs time to do its work, and it needs a particular type of fuel, You can't ignite a piece of paper or fabric just by touching it with a lighted cigarette. If that surprises you, try it. Cigarettes burn a lot of holes in clothing, but they don't catch them on fire. Philip C. Favro, Calif. State Fire Marshal, 3/22 LA statement, p. 4. CONFIDENTIAL: TIMN 288555 MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page four) Commission member: Dr. Horn, if you'll come back just a minute to Mr. Jonas' question about the younger age, I think you're familiar with the Yankelovitch survey and you'll recall that one of the findings there was that 6 out of 10 of the girls ((unintelligible)) commenced before they were 13. Is this a reliable statistics? Horn: No. Daniel Horn, Director, NCSH, 3/22LP. Tape 6, rev. 530. I'm not sure that despite the fact that the industry may react in a aega- tive way ((to a self-extinguishing cigarette)) that the smoking public itself wouldn't react in a negative way...It's a simple matter of wi11 it be done or not. I rather doubt it at this point. Philip C. Favro, California State Fire Marshal, 3/22LA Tape 2, rev. 292. . It is not terribly easy to document with great clarity that there are grave disease consequences and I don't want to overstate that I think that it is a matter of providing people with a comfortable and health- ful work environment, or living environment, or social environment, rather than as primarily a means to prevent grave disease in the passive smoker. Dr. John H. Goldsmith, as cited by ACS LA Film, 3/22LA. A recent study by Dr. Meyer at Johns Hopkins dealing with data from Ontario is compared in the final table of my handout with data obtained from the Kaiser Foundation Health Plan in Alameda County. And you'll see in table 3 that of the unfavorable outcomes of pregnancy, those for example associated with prematurity, from 5 to 15 percent can be attributed to cigarette smoking. And of those deaths that occur in the perinatal period, from 1 to 10 percent can be attributed to cigarette smoking. Of course, the differences in these rates depends greatly on the underlying presence of other factors and the level of health care. John R. Goldsmith, M.D., California State Dept. of Health, 3/22 LA Tape 2, Rev. 466. Finally, I hope it does not sound too pessimistic for me to say that although our best methods may have a gradual and slight effect`on the incidence of smoking, the consensus among our respondents at Arizona is that nothing short of legislation curbing the production and distribution of tobacco with all its prohibition-like ills-will significantly alter smoking patterns in the United States in the foreseeable future. Salvatore V. Zagona, Assoc, prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, p. 7. CONFIDENTIAL: TIMN 288556 MINNESOTA TOBACCO LITIGATION

C 6 N C` E S S: L 0 Y S (pagefive) We have not favored total ban of smoking in hospitals simply because it becomes uncontrollable...Total bans just seem to drive them underground and create a sneaky use, which adds significairtly to the problem rather than solving it. Philip C. Favro, California State Fire Marshall, 3/22LA Tape 2, rev. 260. The California Hospital. Association supports the concept that there be special smoking and nonsmoking sections in all public areas, including hospitals... The basic thrust of the program of the California Hospital Association is to advise its hospitals to take the utmost care in an attempt to separate the smoking patient from the nonsmoking patient. Now I would only ask the commission to understand our problem in this regard. The state and the federal departments of health are screaming that our occupancy is too low and the vacant bed costs money and Medicare and Medical are expensive for that reason, etc. If we overlay the smoking- nonsmoking over top of the diagnosis problem, the mix of sex and the rest of things, our occupancy is going to drop considerably, believe me. W. Kevin Hegarty, board chairman, California Hospital Assn., 3/22LA Tape 8, rev. 41.. I would suggest the following: 5) More public information and preparation should precede the control of smoking areas in public places, the placement of cigarette machines, and so forth. Premature control induces resentment. As an instance: in my place of business (I own and operate the oldest and finest Italian restaurant in Arizona), I removed the cigarette machine out of anti-smoking zeal. The public reaction was an angry one, and within a short time I was forced to return the machine. I then placed a small sign on the machine which said, "proceeds of this machine are donated to the American Cancer Society." I could not have anticipated the violent reaction, and today the machine rests in its usual place, without a sign, doing a good business-a symbol of my defeat as an anti-smoking missionary. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, p. 7. In "Modification of Smoking Behavior: An Evaluative Review" dated 1969, Douglas Bernstein adds to the above-mentioned methods of smoking cessation the results of anti-smoking legislation, tobacco taxation and anti-smoking campaigns. He states, "There is little evidence at present that selective bans on health warnings on cigarette packs are effective in curtailing the continuing increase in cigarette consumption." in Great Britain where tobacco taxes have steadily increased since 1962, there is no measurable change in the behavior of that country's smokers." Douglas Bernstein as quoted by Ann Hammond, Executive Dir. Health Education Center, Palo Alto, Calif., 3/22 LA statement, p. 2. CONFIDENTIAL: . TIMN 288557 MINNESOTA TOBACCO LITIGATION

-45- CONCES S IONS (page six) Walker Merryman: There is that acknowledged statistical link. The prudent researcher would then ask the question, "What causes that link? Is there something in how the study is constructed? Is it something in the tobacco smoke? Is it something in the people_who smoke? Are they somehow alike? Is there some possibility for genetic ((transmission)) of these diseases Those are the many questions that.we think must still be answered. Dr. Robert Shank: ...there's no question that total answers do depend on more research. 5/17/77, KMOX "At Your Service," Ann Keith interviewing Dr. Robert Shank (National Commission on Smoking and Public Policy) and Walker Merryman (Tobacco Institute), St. Louis, p. 2 (Transcript). Ann Keith: And do you feel that you should protect people in public places from other smokers? Do you feel that my smoking is going to injure the health of the man sitting next to me who is a non-smoker? Dr. Robert Shank: This is again something that needs a good deal of study. 5/17%77, KMOX "At Your Service," Ann Keith interviewing Dr. Robert Shank (National Commission on Smoking and Public Policy), St. Louis, p. 10 (Transcript). Publicity has not been very successful in curbing this smoking habit. Doswe want or need legislation? I think not. It certainly did not curb drinking, and government interference is distasteful. William B. Hutchinson, M.D., Director, Fred Hutchinson Cancer Research Center, 5/17 Seattle,•p. 4. We were all pleased two years ago=when Alaska became one of the first states to pass smoking regulations in public places. However, since that time, this bill has proved worthless because of no apparent way to enforce people's habits. But remember we have never been successful at legislating rules aginst popular human habits. Donald Rogers, M.D., Pathologist, Anchorage, Chairman, Alaska Division of ACS, 5/17 Seattle, p. 4. Until the metabolites which are dangerous to the fetus are identified _with certainty, efforts to substitute an alternative to tobacco cigarettes seem premature. George T. Schneider, M.D., Prof. of Obstetrics & Gyn., LA State University School of Medicine, 5/12 Denver, pp. 5-6. CONFIDENTIAL: TIMN 288558 MINNESOTA TOBACCO LITIGATION

-46- C 0 N C E S S I 0 N S (page seven) Anti-smoking clinics for established smokers have not been successful enough to justify future expenditure of energy and funding. I place this activity on the bottom of any public policy priority listing. I have assisted with such clinics and am fully aware of their limitations. Ample data is widely available and all smokers in this country are well aware of the liazards involved. Those who are not severely addicted and can stop--will stop--without being coddled by expensive ineffectual clinic support. Ray G. Cowley, M.D., Director, Missouri State Chest Hospital, Mt. Vernon, Missouri, 5/19 St. Louis, p.2. Other tried or suggested programs for achieving control of smoking that in my opinion are not worthy of high priority consideration for new legislation or widespread expenditure of health resources are: 1) increased taxes on cigarettes. 2) warning labels on cigarette packs. 3) more lowering of tar and nicotine contents. 4) regulation of advertising. 5) control of smoking in public places. Ray G. Cowley, M.D., Director, Missouri State Chest Hospital, Mt. Vernon, Missouri, 5/19 St. Louis, p.. 2. 4. Cigarette smoking alters the electrocardiogram in some (emphasis supplied) patients with coronary artery disease depending on the severity of this disease. It does not produce changes in healthy, young individuals. 5. An enigma exists in that cigar and pipe smokers absorb nicotine as well as cigarette smokers but do not have greater prevalence of coronary artery disease... ~ z Or L7 H O Manfred Thurmann, M.D., President, St. Louis Heart Assn., 5/19 St. Louis, P• 2- There appear to be more people of personality Type A who are' heavy smokers of cigarettes than those with Type B personality. Manfred Thurmaan, M.D., President, St. Louis Heart Assn., 5/19 St. Louis, p. 3. ~ d I question the trend toward concentrating this effort on the very ~ young. There has been a tendency to try working with adults, to be ~~ disappointed with the results and then to trying working with teenagers ~.,e in the high school, to be disappointed with the results and then start U O working with them in junior high schools and then in the elementary ~ schools and getting down in the kindergarten and except for our opportunities to get at them when they're still in the uterus, through the mother, none of this really looked very promising. ,~ Daniel Horn, TI "Target 5" film, ACS LA speakers, p. 12 9 H

-47- C O N C E S S I O N S (page eight) (Asked by Weingarten if there's any doubt in his mind about the linkage between cigarette smoking and lung cancer) There's none in mine. (Asked if he knows of anything in the scientific literature that refutes the linkage) There are articles that do disagree with that to some extent. Let me just hedge on that. William Hutchinson, M.D., director, Fred Hutchinson Cancer Research Center, 5J17• Seattle, Tape 1, Side 1, rev. 810. Since smoking is the major risk factor, we have to presume that smoking is more of a problem in these areas (referring to map in his handout) than in the other parts of the state. So we have to presume it, because we don't really know. What we need to know for sure is whether or not that's true. And I think maybe we've been missing a step, a simple step. We've been spending a lot of our time collecting evidence on the (untelligible) and we've been missing the thing we are trying to work with, I think we need a lot more information, like the exact frequency of smoking in different areas and in different populations groups. The problem is very big and I can't say we've been terribly successful. William Morton, Professor of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, Rev. 1220. ...from preliminary study it does look as though smoking is not equally related to all the different kinds of lung cancer. It also looks as though they have different geographic distribution patterns...with different relationships to socioeconomic status and different relationships to job patterns. Now there is a possibility, in other words, that we can solve this particular problem by breaking it into components. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, Rev. 1227. I guess we might sum this up by saying I think we're speculating too much about smoking. I think we need to know exactly how many people do it, when they begin and the differences in different geographic areas and different population groups. It's not safe to extrapolate from one part of the country to another, one population group to another in problems this size. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, Rev. 1244. (Asked how he would respond to claims by the TI that virtually all the data is not scientific) Obviously since cancer is a multifactorial problem--and in some cases it's related to alcohol intake and another liver disfunction, nutritional deficiency and another is tobacco--I recognize their complaint that the data is soft. Edmund Truelove, D.D.S, chairman, Dept. of Oral TIMN 288560 Diagnosis, Univ. of Wash. School of Dentistry, 5/17 Seattle, Tape 1, Side 2, Rev. 290.

C O N C E S S I O N S (page nine) The policy of the North Carolina Division is not to engage in political or legislative actions against any product or industry. It confines its efforts to fighting the total cancer problem. J. E. McDowell,*President, N. C. Division of ACS, 6/14 Atlanta, .. p. 1. We must confine our activities to "fighting cancer"--not tobacco-and this does not include engaging in political or legislative actions against any product or industry. We will dedicate ourselves-to fighting the total cancer problem through ever-increasing education and service efforts. J. E. McDowell, President, N.C. Div. of ACS, 6/14 Atlanta, p. 4. in light of the vast amount of scientific evidence linking smoking with premature death and disease, there is an appalling lack of evidence of the effect that working in an environment contaminated with tobacco has on the honsmoker...No evidence could be found linking nonsmokers with pre- mature death and disease as a result of breathing air contaminated with tobacco smoke. FAA grievance case, 4/3/75, cited by Jimmy Spradley, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, p. 3. The habit of smoking originates in an individual's search for contentment. The act of smoking is basically a psychological and social stimulation rather than a physiological dependency. As such, the significant beneficial effects of smoking occur primarily in the area of mental health. Unfortunately, the benefits derived from smoking are not measurable; and, therefore, there is no basis on which to compare the relative benefits of smoking to the smoker against the hazards of breathing tobacco polluted air to the nonsmoker. FAA grievance case, 4/3/75, cited by Jimmy Spradley, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, p. 3. An air quality survey was conducted at the Ft. Worth Air Route Traffic Control Center (ARTCC) by -the FAA Aeronautical Center Industrial Hygiene Section, AAC-162, as requested. Carbon monoxide gas and smoke particulates generated by smoking employees in two work areas were measured and compared with standards for such contaminants. It was determined that the levels of both were far below the workplace standards and consequently can only be considered an annoyance to the nonsmoking employees. Air Quality Survey by FAA on a grievance complaint, 9/23/74, cited by Jimmy Spradley, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta. CONFIDENTIAL: TIMN 288561 MINNESOTA TOBACCO LITIGATION

-49- C O N C E S S I O N S (page ten) We do agree that, to the nonsmoker, particularly the hypersensitive one, smoking by others in the same area can be extremely annoying and dis- tracting. However, if smoking is to be prohibited in workplaces, it should be a decision not based on the hazards to health of nonsmokers. It will have to be predicated on other factors such as morale, perfor- mance, fire hazard, etc. Air Quality Survey by FAA on a grievance complaint, 9/23/74, cited by Jimmy Spradley, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, Attachment. A complex overlearned habit such as smoking... Ernst L. Wynder, M.D., Naylor Dana Institute for Disease Prevention and the Health Maintenance Institute, American Health Foundation, 6/16 Philadelphia, p. 6. Mrs. Perkins: When the students ask why does the government allow smoking even though it's bad for you (?) You know, they can go in their cars, they can ride their motor- cycles on traffic, they can do all these fool things that endanger their health also. And we are not legis- lating against it. They have a freedom of choice. They also have a brain. Now we offer them the option. If they don't want to use them, you know, that's up to them. I think it's objective on an adult level when you say, 'We've told you, we often tell you to wear your helmet on your motorcycle. If you don't want to do it and get killed, you know we told you." I don't know how else you can reason with these kids except to just level with them. Mrs. Marlin Perkins, NCSPP Commissioner, during testimony of John King, Director of Education for DATE (Drug, Alcohol & Tobacco Education), a division of Christian Civic Foundation, 5/19 St. Louis, Tape 2, side 1. There really is no way as far as I know that a pathologist can say by looking at somebody's lungs that that patient smoked. Frederick F. Holmes, M.D., Associate Professor of Medicine, U. of Kansas Medical Center and Director of Cancer Data Service, Mid-America Cancer Center Program, 5/19 St. Louis, Tape 2, side 1, rev. 1174. One is that I'm not going to press my bill to increase the Missouri cigarette tax on high nicotine cigarettes which I filed the first of this year. A sub- sequent poll shows that only 43 percent of my constituents favor this pro- posal.' Missouri State Representative Carl H. Muckler, 5/19 St. Louis, Tape 3, side 1, rev. 114. CONFIDENTIAL: TIMN 288562 MINNESOTA TOBACCO LITIGATION 1

C 0 N C E S S I 0 N S (page eleven) And what I would make a plea for in a realistic way, knowing what we can achieve in terms of preventing people from smoking.and getting people to stop smoking,is that we must have more research into the actual causes of tobacco-related diseases and particularly heart disease. Jerome Cohen, M.D., Clinical Cardiologist, St. Louis University Hospital, 5/19 St. Louis, Tape 2, side 2, rev. 552. While several significant studies had been conducted earlier, such as those by Hammond and Horn (6,7), they were for the most part not based on scientifically designed probability samples, and were therefore more subject to the criticism that the finding could not be generalized to the total population. Ronald Wilson, National Center for Health Statistics, 6/16 Philadelphia statement, p. 2. However, just as the earlier studies were subject to criticism because of their sample designs, this study ((1964-5 morbidity study from NCHS)) was criticized because the diagnostic information came from reporting in household interviews rather than from physician diagnoses. Ronald Wi3son, National Center for Health Statistics, 6/16 Philadelphia, p. 2. ...the rhetoric of extremism that has often characterized public pro- nouncements and policy solutions on both sides. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. Opportunities for creative cooperation and dialogue between the medical community and the tobacco industry appear to have the possibility of a very high payoff as measured by reduced morbidity and mortality. Recent scientific findings by Cuyler Hammond, et. al. and discussion by Gio Gori indicate the possible public benefits of more rapid switching to low tar and nicotine brands, and while the American Cancer Society has not yet acknowledged the fact, it appears that innocuous cigarettes already exist, if smoked in moderation. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. ...reducing tar and nicotine dosage will more likely produce much more successful health consequences than the apparently symbolically satis- fying, but relatively ineffective "war against cigarettes." Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3.

C 0 N C E S S I 0 N S (p ag e twe lve ) ...industry efforts at reduced tar and nicotine levels and increased filtration are not facilitated by the TV and radio advertising ban. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 5. Present cigarette consumption measures are of very limited relevance and do not reflect changes in the cigarettes themselves. Thus, filtration, per capita consumption and total numbers of cigarettes sold are much less useful than measures of tar.and nicotine dosage showing sales-weighted consumption over time. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 5. Past government policy has not worked as expected and a case can be made that less hazardous cigarettes would be more prevalent today in the ab- sence of governmental involvement. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 6. As far as we [Armco Steel] can determine, there is little or no pressure to isolate or otherwise protect people who do not wish to smoke... Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 5. It is my conviction that we have not yet reached a level of awareness on the importance of a non-smoking environment to generate the support that would be necessary'either to pass legislation or to overcome the inertia that still exists. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 12. Finally, in 1971 Ochsner wrote an article on the adverse effects of smoking on pregnancy -- and on sexuality. But his report of the ill- effects of smoking on sexual functioning dealt with selected instances and was not a thoroughgoing statistical analysis of a sizeable popula- tion. I have not yet seen such a study confirming his impressions, but if it appears, especially in the less inhibited climate of today's society, it will do much to make our anti-smoking work easier. Saul R. Kelson, M.D., Cardiologist, President of Toledo, Ohio, ACS, Toledo, Ohio, 5/25 Chicago, page 5. CONFIDENTIAL: TIMN 288564 MINNESOTA rI'OSACCO LITIGATION

C 0 N C E S S I 0 N S (page thirteen) ...we do not have that fundamental condition["something that would prove the case against smoking so strongly that no one would any longer be able to deny it"] existing yet,... Ivan L. Preston, Professor, School of Journalism, University of Wisconsin, Madison, Wisconsin, 5/25 Chicago, page 3. [O]ne must admit that smokers have rights, too. Dick Poole, health educator; 5/12 Denver, Tape 3, rev. 255. ... I admit . . . that cause and effect in terms of control groups doesn't exist and will never exist in human beings ... Thomas L. Petty, M.D., Head, Division of Pulmonary Sciences, University of Colorado Medical Center; 5/12 Denver, Tape 2, rev. 174. [T]here is a real addiction, but that lasts a very short period of time, probably three to five days. After that, it's an habituation. Alton Ochsner, M.D., founder of Ochsner Clinic, New Orleans; 5/12 Denver, Tape 1, rev. 222. I don't know enough about what happens to cigarettes when you take the tobacco out or the high tar content tobacco and replace it with something else. I don't frankly know whether it affects the carbon monoxide level ... I don't know whether that is a serious hazard. Anthony Robbins, M.D.,Executive Director, State of Colorado Dept. of Health; 5/12 Denver, Tape 1, rev. 265. Another area that requires investigation has to do with the CO that is present in the smoke of the inhaled cigarette and what its effects are. There are studies showing some slowdown of mental agility as the CO level rises in the smoker, as it does -- the COHb level. And yet whether there's a permanent damage from this CO is unknown. And it's really unknown whether second -- that is whether the fellow who's in a room where smoking is going on is deleterious to him and how. John L. Pool, M.D., thoracic surgeon, Norwalk, Conn.; 6/2 Boston, Tape 2, side 1, rev. 575. Dr. Simonds: Dr. Pool, from time to time the tobacco interests make a point there is not clear scientific evidence that there is a linkage between smoking and lung cancer. Do you know of any scientific or clinical data that refutes the linkage between smoking and lung cancer? (cont.) CONFIDENTIAL: TIMN 288565 MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page fourteen) (continued) Dr. Pool: That refutes the linkage? I have looked at the data on the other side. I haven't really looked at the data on that side. John L. Pool, M.D., thoracic surgeon, Norwalk, Conn.; 6/2 Boston, Tape 2, side 1, rev. 596. As you know, prime time on TV is just about sold out all over the country. It's virtually impossible to buy time, let alone get free time. Victor Weingarten, NCSPP Director, during testimony of George Gingell; 6/14 Atlanta, Tape 1, side 1, rev. 449. Is there any harmful effect of passive smoking? Most of the articles I have read have to do with the CO content in the air or some alleged slightly increased incidence let's say of lung cancer or oral cancer, for that matter. I think we really have to document that hard and fast and I don't think that that has been pushed enough or documented intensely enough... Roy Korson, M.D., prof. of pathology, U. of Vt. College of Medicine and Vt. State ACS president, 6/2 Boston, Tape 1, side 2, rev. 872. Smoking is thought to be more deleterious than drinking, ((in oral cancer causation)) but the data remains somewhat inconclusive because the sample populations studied thus far contain too few non-smoking, heavy drinkers. Samuel E. Molind, D.M.D., oral pathologist, Montpelier, Vt., 6/2 Boston, p. 2. Now there has been a lot of discussion of the question: Is it really rP ovec3. that cigarettes cause cancer? And there is a fair amount of propaganda from various sides -- a fair amount of analysis, if you wish, from various sides saying that that's not true, that the association is only, is merely statistical. And it's clear to me that that's not a fair way to look at the problem. A fair way to look at the problem is to say: Is it established that cigarettes cause cancer, to the extent that any scientist would want to act on that information? And the answer is yes. The answer is yes for a very simple reason, which is thAt nothing is ever really proven in science. If it was, we'd all go out of business. David Baltimore, Ph.D., professor of biology, MIT, and -NCSPP panellist, at ACS 2/1/77 news conference, NYC, rev. 321. CONFIDENTIAL: TIMN 288566 MINNESOTA TOBACCO LITIGATION

C O N C E S S I O N S (page fifteen) Early in the 70's, in the furor of the drug abuse scare, our Legislature mandated teaching about drugs, alcohol and tobacco at all levels by all teachers but, as you can imagine, this became an unworkable morass of information from uninterested teachers to unresponsive pupils. Except for formal health classes in the 7th and in the 10th grades, no one really knows who is teaching what about smoking throughout the State. Jane H. Frelick, R.N., former chairman of Delaware Inter-agency Council on Smoking & Health, Wilmington, Delaware, Philadelphia 6/16/77, p. 1. Baltimore: Is it possible to identify a smoker at autopsy on the basis of his or her lung condition? Overholt: No, I don't think so. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, Tape 1, side 1, rev. 1149. (Questioned about the impact of increased taxation on cigarette consumption) ...I've noticed that every time the cost of cigarette$ went up, I don't think it slowed down any smokers. Joseph Rizzo, Phila. Fire Commissioner, 6/16 Phila., Tape 1, side 1, rev. 927. ...most of the large-scale studies on smoking and health have tended to investigate the role of smoking independent of other behavioral variables, such as alcohol consumption and other lifestyle factors, occupational and environmental hazards, and certain psychological factors. These variables are known to be related to health status, and many are also related to cigarette smoking. Thus, it may well be that the elimination of smoking without any changes in the other factors will have only a partial impact on health status. Ronald Wilson, Chief of the Health Status and Demographic Analysis Branch, Div. of Analysis, National Center for Health Statistics, 6/16 Phila., Tape 1, side 1, rev. 394. (In response to a question about his personal views on "the hazards of smoking") I don't think there's any question that the relationships have shown up in a wide range of studies; that there is a strong statistical relation- ship between cigarette smoking and adverse health characteristics. There's a lot of criticism of these relationships... we do know there are other factors. Ronald Wilson, Chief of the Health Status and Demographic Analysis Branch, Div. of Analysis, National Center for H alth Statistics, 6/16 Phila., Tape 1, side 1, rev. 475. CONFIDENTIAL: TIMN 288567 MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page sixteen) Weingarten: Doctor, in pediatrics are you aware of newborn infants suffering anomalies because their mothers have smoked during pregnancy? Allen: Well, we see a good many children with newborn anomalies. I don't think any one in the medical profession has put down A, B, this is absolutely due to smoking. We do have a lot of problems, of course, with premature infants...but as far as tobacco in itself, I don't think anyone has identified absolute evidence that this is the result of the chronic or even acute smoking by the mother. James E. Allen, M.D., peditric surgeon, ACS volunteer, Snyder, N.Y., before NCSPP forum, 6/16 Phila., Tape 2, side 2, rev. 767. (Weingarten quoted figures from government showing a large amount of time lost from work because of cigarette-related illness and said the commission had been unable to find the medical director of any major company who had recommended or taken any action at all to limit smoking in work places. He asked if Burbank's professional group, the N.Y. State Society of Industrial Medicine, had taken any position on this) Not to my knowledge, as a unified body. (Would it be possible to make such a recommendation, Weingarten asked) One of the difficulties, speaking for myself, is the figures you quote, along with figures on alcoholism and how much time is lost -- I know alcoholism is bad and I know smoking is bad. But I can't say I can honestly believe the figures like that... this type of persuasion, if that's what it is -- has been used ((with)) management for a number of years, particularly to justify medical programs... and I think we're a little jaded with that. It's not hard enough evidence. We need harder evidence. Bernerd (sic) Burbank, M.D., Medical Director, McGraw-Hill, 6/16 Phila., Tape 2, side 1, rev. 10 (Evans asked if Burbank had heard earlier testimony that "within 13 minutes inside a room where smokers" -- unintelligible, but something about outside air standards) I did hear it. I'm not sure I_heard it in the _total context. I also heard ...an industrial hygienist ((tell_me)} thatfthey'd made a study in a bar of the CO levels, over a number of hours, that the bartender got. And I can't think of any more hazardous area. And his figures were not dangerous to the individual. So I don't know... Bernerd (sic) Burbank, M.D., Medical Director, McGraw-Hill, 6/16 Phila., Tape 2, side 1, rev. 51. , TIMN 288568 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page seventeen) The men have been at 23 cigarettes a day since 1964. Women have increased from 17 to 19. That's not a great huge increase. No, they're not smoking more cigarettes. Dorothy Green, Ph.D., psychologist, consultant to NCI and former employee of NCSH, Arlington, Va., 6/16 Phila., Tape 1, side 1, rev. 277. Weingarten: Dr. Hammond told this commission last fall that he believes there were new carcinogenic substances in some of the new low tar and low nicotine cigarettes, but because the industry has no accountability there's no way to find out. Can you comment on that? Green: I don't know... There's no way of knowing when we don't know what constituents in the smoke are really causing the various diseases. So you can take out a lot of constituents and put in some, but you just don't know. Dorothy Green, Ph.D., psychologist, consultant to NCI and former employee of NCSH, Arlington, Va., 6/16 Phila., Tape 1, side 1, rev. 294. Let me tell you first what you don't need to do. You don't need to tell people they ought to quit smoking...no need to make people feel guilty because they're still smoking... I don't think we ought to make people feel guilty about it. I think there are two things that we need to do, with adults who continue to smoke. One is, quit again, you've already tried it two or three times. Try it again. This time you might make it... The first message is to get people to try again ((to quit)). The second message is be there. While they're trying, they need support ... every kind of support we can give them. Dorothy Green, Ph.D., psycholgist, consultant to NCI and former employee of NCSH, Arlington, Va., 6/16 Phila., Tape 1, side 1, rev. 308. Clearly, the amount of squamous cell carcinoma that we've seen proportion- ately in the last 10 years has decreased rapidly. And the amount of adeno- carcinoma we're seeing is increasing by the same proportion. Now, there are a number of factors that can account for this. As you know, the rate of - incidence of cancer in women has doubled in the last 10 years. They are more prone to have adenocarcinoma than squamous cell carcinoma, but this does not account for the difference by itself. Some selected industrial environ- ments will cause us a greater increase of adenocarcinoma, but that doesn't account for it either. And since the Kreyberg modifications of the pathology in 1967, there have been some changes of definition, which would lean this way a little bit, but that still doesn't account for the great change that we're seeing. Ronald G. Vincent, M.D., chief of thoracic surgery, Roswell Park Memorial Inst. and former pres., Erie County ACS Unit, Buffalo, N.Y., 6/16 Phila., Tape 2, side 1, rev. 587. TIMN 288569 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page eighteen) ...Minnesota's Clean Indoor Act is a good piece of legislation ((Rechnitz of Mass. Citizens for Clean Air doesn't think so)). But it's wholly in- appropriate for an area like the Southeast, where there's tobacco. Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2, rev. 391. What can realistically be accomplished in the political arena? And it is my view that as I judge the political and economic climate that relates to tobacco-related issues, is that we would be unlikely to get a law passed through Congress that would force a high tax on certain levels of tar and nicotine...You cannot really set a limit, you know -- the lower the better... (rev. 1072.) The tobacco industry obviously has now developed considerable technology to now bring cigarettes under the 10 mg level...that is about all we can expect in this country, where we will do it on the basis of private enter- prise. And while in England they have been able to set up specific levels, I doubt that this could happen in this country...What would be ideal...as low as possible that is commensurate with still sufficient smoking satis- faction. In other words, you couldn't really get me to say it's got to be 15 or it's got to be 10, or a specific level. (rev. 1081.) Does it have a relationship to humans? A key question which relates to carbon monoxide, because I attended a meeting in Germany just recently... There were half a dozen experts who were interested in myocardial infarction and the relative significance of nicotine and carbon monoxide in the ((devel- opment)) of myocardial infarction and artersclerosis. I drew a diagram and asked each one to put up the relative significance of CO and nicotine, both to arteriosclerosis and to sudden death. And every one of those six people gave me a different answer...which clearly indicated we hadn't proved this particular issue. (rev. 1100.) Carbon monoxide, we gotta come to grips with the fact: Does CO play a• role in arteriosclerosis? It certainly works in rabbits, but there's considerable doubt whether it works in man. (rev. 1110.) Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2. Room #1. I said to a woman, "I see you smoke." She said, "How can you tell?" I said, "From your complexion." She went totally pale, and she did not smoke again for the entire cocktail party. Now...this is a bit cruel. I don't have any idea whether smoking ... hurts your complexion. I have no such evidence. I have a personal conviction that a person's image of himself or herself is more important than knowledge that he's going to get lung cancer 30 years from now. Merlin K. DuVal, M.D., moderator, Atlanta Forum, Nat'l. Commission on Smoking & Public Policy, 6/14 Atlanta, Tape 1, side 2, rev. 2. CONFIDENTIAL: TIMN 288570 MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page nineteen) The air exhaust system in the restaurant is very important. We found that in some restaurants it's almost needless to have this -nonsmoking area simply because the exhaust system is excellent and very few people are bothered unless they happen to be exceptionally close to a diner next to them who happens to be smoking. So that is another way...of attacking this problem--simply to give a minimum amount of turnover per minute of the air space in that restaurant or public place... Bob Butterfield, area manager, The Magic Pan, Inc., Atlanta, Ga., 6/14 Atlanta, Tape 1, side 1, rev. 317. I'm against smoking. But more than that, I am against the government getting involved in anything that's not a government function. I think this includes putting taxes on tobacco ... Taxes should be levied to finance the government and should not be levied to control smoking, energy consumption, inflation or whatever. I think in many cases the government has used taxes to control various things, yet I know of no case where it's done much good, if any good. (rev. unknown.) ...a lot of people are advocating the government legislating smoking and non- smoking _ areas...I am against the government getting involved in anything that's not a government function. I think that this includes...putting controls on business or getting involved in no-smoking advertising...I also think business has too many controls imposed upon them and I certainly don't think they need any controls in order to give nonsmokers a smoke-free envir- onment or whatever. As I see it, the nonsmoker has the freedom to change jobs or do whatever he wants to do to find a smoke-free area...I was up in Minnesota a month or so ago, and in that area they have legislation which tells restaurants that they have to have smoking and non-smoking areas... Everywhere I went people would complain -- they couldn't get seated at a restaurant. But on a voluntary basis it works, where on a forced basis, it doesn't work. (rev. unknown.) I know of no government program that has managed to cut smoking in any group by 44%, I think if this program ((at my plant)) can be adjusted effectively for any business or at least a program similar to it, and we have certainly seen good results and we did it without getting the government involved. (rev. unknown.) Yank Dean, president, Allied Sports Co., Eufaula, Ala., 6/14 Atlanta, Tape 1, side 1. Fanatics or people demanding that I support their measures or face the loss of their vote usually turn my vote the other way. And on the smoking issue, unfortunately, there are overzealous people who do the cause more harm than good. James A. Swomley, State Assemblyman and Exec. Director, Conn. Lung Assn., 6/2 Boston, p. 6. CONFIDENTIAL: TIMN 288571 MINNESOTA TOBACCO LITIGATION

C O N C E S S I O N S (page twenty) Dr. LeMaistre: In the age adjusted incidence rates related to density, is it -- would you be surprised if decades from now the same trend in density relationship occurred for women as for men? Meigs• I don't know how to answer that. I think that the data suggest to me.along with the studies of others that cigarette smoking is such an overwhelming factor that it will drown out most other considerations. But before being able to answer that, I believe that we must have surveys by population density and socio-economic status and considerably more occupational study. I hope that we will be doing that. J. Wister Meigs,'_"f.D., Director, Conn. Cancer Epidemiology Unit and Clinical Prof. of Epidemiology, Yale Univ., 6/2 Boston, Tape 2, side 1, rev. 823. (Asked if he thought you drive an addicting substance out of the market by increasing its price) I don't think you can...it will have some effect on people if you drive up the cost of tobacco but what the psychodynamics of it happen to be, I don't know. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, Tape 1, side 2, rev. 106. We have a committee called the Georgia Cancer Management Network...This committee discussed a recommendation to ask the legislature to add to the cigarette tax money, earmarking it specifically for anti-smoking, anti-cancer activities. There's a philosophical problem here. Even those against smoking and willing to do something about cancer, they don't feel, some of them, that this is the democratic American way to go. Joe Wilbur, Ph.D., Director of Young Adults Program, Div. of Phys. Health, Ga. Dept of Human Resources, Atlanta, Ga., 6/14 Atlanta, Tape 1, side 1, rev. 107. The effects of cigarette smoke on healthy non-smokers consists mainly of the discomfort of eye and throat irritation. Paul Q. Peterson, M.D., Director, Ill. Dept. of Public Health, 5/25 Chicago, p. 3. ...even if we could eliminate the ads in magazines and newspapers, our young people would continue to be tempted to take up smoking because smoking is going on all around them. Gene Bridges, Supervisor of Physical & Driver Education, Escambia County, Pensacola, Fla., 6/14 Atlanta,p. 1. CONFIDENTIAL: TIMN 288572 MINNESOTA TOBACCO LITIGATION

C 0 N C E S S I 0 N S (page twenty-one) -60- On September 28 and 29, 1976, Dr. E. A. Richardson, C hief, Environmental Health Branch, made an environmental health inspection of the Jackson- ville Center control room. The Observation and Conclusions of his report were:...In view of the fact that the tobacco smoke product concentrations measured in this survey do not violate workplace air standards, on this basis, it must be concluded that a health hazard does not exist for the nonsmoker. 3/4/77 FAA ARTC staff memo, submitted at NCSPP forum by Jimmy Spradley, 6/14 Atlanta, p. 2. Since our society thrives on freedom of choice, it would be foolhardy to attempt to prohibit cigarette smoking among this or any group of people. Such an approach would simply reinforce the actions of the smoker and turn the battle against smoking into a confrontation with personal rights and freedoms. Instead, we must continue to offer each individual a choice between smoking and nonsmoking. R. Bruce Dunlap, Ph.D., Dept. of Chemistry, Univ. of S.C., Columbia, S.C., 6/14 Atlanta, p. 4. For the past several years...the Atlanta Bureau of Fire Services has had numerous requests...to enact ordinances ((prohibiting)) smoking in hospitals, office buildings, restaurants, night clubs, schools, department stores and elevators ((but)) we feel that such a request is without justification to enact ordinances regulating smoking in the various types of businesses men- tioned. In effect, it would put the City of Atlanta in a position of regu- lating policies of private business. James B. Gossett, Chief & Fire Marshall, Atlanta Bureau of Fire Services, Atlanta, Ga., 6/14 Atlanta, p. 4. ...there has been little scientific work that has been done, in order to see the relationship of the nonsmoker to his environment when exposed to large quantities of cigarette induced pollutants. On a clinical basis it is my opinion that there is a relationship and ((exposure to others' smoke)) accounts for some of the non-smokers that we see with serious problems that we usually contribute to the smoker. In each case that this occurred in our experience we have been able to document this high incidence of atmospheric exposure. (p. 2.) The effect of the regulation of cigarette smoking in the air industry on planes can be demonstrated time and again, as I have had many patients who tell me that since the rule has been in effect, that they can fly whereas they have been unable to fly before. (p. 3.) William A. Hopkins, M.D., cardiothroacic surgeon, Atlanta, Ga., 6/14 Atlanta. Being realistic, we must acknowledge that we cannot prevent all smoking in the daily working environment... Carrie Nelle Thompson, Director, UNICEF, Atlanta, Ga., 6/14 Atlanta, p. 2. CONFIDENTIAL: TIMN 288573 MINNESOTA TOBACCO LITIGATION

-61- C 0 N C E S S I 0 N S (page twenty-two) It is doubtful that legislation will be acceptable because of the economic factor involved. (p. 20.) I would like to close with: WORDS WORTH RECALLING TODAY ((by Abraham Lincoln))... "You cannot help man permanently by doing for them what they could and should do for themselves." (p. 21.) Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta. While restrictive measures, such as increased taxes and laws limiting legal smoking, may be effective, care should be taken that they not be implemented in a manner likely to provoke black markets, open defiance, or other forms of subversion. Such reactions may negate particular measures as they tend to undermine the authority and respect of the campaign of which a given measure may be a component. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology and lecturer in Psych. and Law, Washington Univ., St. Louis, Mo., 5/19 St. Louis, p. 13. Age-adjusted death rates from arteriosclerotic or ischemis heart disease... began to decline in the late '60s...Some have suggested, of course, that it's due to the diminishing of smoking among adult males but...this has not been documented. Ronald Wilson, Chief of the Health Status and Demographic Analysis Branch, Div. of Analysis, National Center for Health Statistics, 6/16 Phila., Tape 1, side 1, rev. 400. I don't think that the graduated tax proposal of Kennedy and Hart is a good idea...it may lead to two things that would backfire, which I am sure you know. One is, of course, it's not very progressive for lower-income people; it discriminates against them. And second, the styles of smoking are incredi- bly important in terms of the risks that are involved. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 72. The lung cancer death rate of female smokers has doubled in 10 years and threatens to equal that of men.3 The statistical data to date is by no means conclusive... (p. 2.) Most people know that everyone who smokes will not develop a smoking related disability and that non-smokers develop cardiopulmonary diseases. The corre- lation between smoking and health hazards has been made but it is not infallible. If one does not smoke it does not guarantee escape from disease. (p. 2.) Suzanne Baxter, R.N., faculty, Boston Univ. School of Nursing, repres. Mass. Nurses' Assn., 6/2 Boston. COrrFInENTIAL: TIMN 288574 MINNESOTA TOBACCO LITIGATION

-61a- C 0 N C E S S I 0 N S (page twenty-three) ...we were not taking a moral stand on this issue; nor were we particularly con- cerned about the absence, in some people's views, of a definite causal ralation- ship between smoking and an increased likelihood of death from one or more of the causes cited. As insurance managers and actuaries, we were interested in the statistical, rather than the pathological or epidemiological validity of the studies. Michael J. Cowell, Vice President and Chief Actuary, State Mutual Life Assurance Co. of America, Worcester, Mass., 6/2 Boston, p. 2. Although the literature does not provide clear evidence of a direct cause and effect relationship between tobacco and oral cancer in animal subjects, statis- tics do indicate that the occurance of oral cancer in humans occurs four times more frequently in smokers than nonsmokers. John DiBiaggio, M.D., Vice President for Health Affairs, Univ. of Conn., New Britain, Ct., 6/2 Boston, p. 2. In most cases, the OSHA 8-hour standard for carbon monoxide does not apply to tobacco smoke since a level of 50 ppm is rarely reached in the average workplace. Douglas S. Lloyd, M.D., Conn. Commissioner of Health, 6/2 Boston, p. 6. ... it is hopeless to believe that we can turn America into a non-smoking society. Lila M. Sapinsley, R.I. State Senator, 6/2 Boston, p. 6. Very little work has been done on the effects of second-hand smoke on the patient with COPD. A. Marshall Smith, Jr., M.D., head, respiratory medicine section, Eastern Maine Medical Center, Bangor, Me., 6/2 Boston, p. 1. CONFIDENTIAL: TIMN 288575 MINNESOTA TOBACCO LITIGATION

-62- C O N T R A D I C T I O N S Luquette and associates exposed 40 children, mean age 9.8 years, 3 children at a time, to smoke-filled and smoke-free atmospheres in a poorly ventilated environmental chamber with dimensions of 12 x 7 x 7 feet. After 30 minutes exposure, during which time 6 cigarettes were smoked by 2 smokers also present in the chamber, the children had a mean increase in heart rate of 6 beats per minute, a mean increase in systolic blobd pressure of 4 mm Hg, and a mean increase in diastolic blood pressure of 5 mm Hg. While in the nonsmoking atmosphere, the mean heart rate increased one beat per minute, the mean systolic blood pressure decreased 4 mm Hg, and the mean diastolic blood pressure did not change. However, the experimental design of this study has been questioned. Moreover, Harke and Bleichert found no significant change in blood pressure or in heart rate in nonsmoking adults exposed to greater concentrations of tobacco smoke. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospita, 3/22 LA statement, p. 7. Cameron and associates administered an acute illness questionnaire by phone to 727 families in the Detroit metropolitcan area. These investigators found that children 16 years or younger living in a home with tobacco smoke present had more frequent acute respiratory illnesses than children of nonsmoking parents. However, Shy and associates in a study of second grade Chattanooga school children did not demonstrate a relationship between parental smoking habits and the respiratory illness rates of their children. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 7. (Explaining how she had originated the sign for use in private homes in 1966 because a simple "No Smoking" was too rude)...but you know it really killed me when they put that in the grocery stores, "Thank You For Not Smoking." And then they added to it, "Cooperation is Better Than Legislation." Now--we've tried two years to get that passed ((no smoking in grocery or department stores)) but we're getting it done because, with a "Thank You For Not Smoking" on a voluntary basis the majority of people will comply with the signs. The majority of people are polite and considerate and it's working very well in Arizona. Betty Carnes, anti-smoking activist, Scottsdale, Ariz. 3/22 LA, Tape 7, Rev. 169-175. And we have a real high risk population, too. The Hawaiians. A target group. Only 9% of Hawaii's population, their problem into cancer of the lung is unique. Almost as many women as men have lung cancer and they have the disease and die of it ten years earlier than any other population or ethnic group in the United States. We do not have smog nor particulate air pollution, little asbestos, fairly high tuberculosis but little emphysema or other chronic lung disease. Ethnic super-susceptibility? Maybe. But one thing is clear. The Hawaiians smoke cigarettes: Drake W. Will, M.D., Chief, Pathology, The Queen's Medical Center, Honolulu, 3/22 LA statement, p. 2. CONFIDENTIAL: TIMN 288576 MINNESOTA TOBACCO LITIGATION

CONTRADICTIONS (page two) 1) The "Target 511 program, to reduce the number of smoking adults by 25% and the number of smoking teenagers by 50%, is somewhat too ambitious. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22LA statement, p. 5. It would seem more productive to set more realistic goals, and to proceed by increments. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22LA statement, pp. 5-6. I would suggest the following: 2) Less emphasis should be placed on withdrawal clinics and the environmental control of smoking, and more emphasis on building up motivation to quit (or not to start) smoking. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22LA statement, p. 6. "About eight years ago I stopped selling cigarettes in my three pharmacies after the death of a close•friend from lung cancer," said Sylvan Sandler, president of Medical West Pharmacies, Inc. Sylvan Sandler, representing American Pharmaceutical Assn., St. Louis Post news item attached to St. Louis, We are in continues 5/19. the midst of the epidemic of coronary artery disease_which to kill epidemic is to be in causing artery reduced. and disable a great number of women and men. If this controlled all factors that we consider as important disease must be eliminated, or at least markedly Manfred Thurmann, M.D., President, St. Louis Heart Assn., 5/19 St. Louis, p. 1- Death and suffering directly ascribable to the cigarette seems to be out ahead of all other human scourges except perhaps obesity. David A. Penner, M.D., Thoracic and Cardiovascular Surgeon, Detroit, Michigan, 5/25 Chicago, page 1. CONFIDENTIAL: TIMN 288577 MINNESOTA TOBACCO LITIGATION _ / --

-64- C O N T R A D I C T I O N S (page three) We're having a very interesting experience in Jacksonville, Florida, where I'm from now.- We have experienced three times the national average in lung cancer death rates in nine counties outside of my own in North- east Florida as compared with anywhere in the country. We have a grant request in now to do an etiological study, which is going to be done by the Department of Public Health at the University of Miami to try to find out why we have this increased death rate, because there's no more smoking going on there than anywhere else. There are other factors involved. Ashbell C. Williams, M.D., former ACS president, now honorary life member, ACS, Jacksonville, FLA. 6/14 Atlanta, Tape 1, side 1, rev. 1182. Simonds: Do you use any or do you know anything about sputum cytology as a screening method? Maloof: Yes. Simonds: What do you think about it? We've had testimony -- Maloof: I think it's a gimmick. Simonds: You think it's a gimmick? Maloof: Yes. There's no reason why we shouldn't use the biopsy • method, taking the tissue and examining it. When you're taking sputum or the oral exfoliative cytology method, there's too many chances for false negatives. You have a lesion here that you can even penetrate, you can watch, you can make a nice excision biopsy and there's no reason to do the other. Edward C. Maloof, DMD, MPH, Dental Director, Teamsters Union 25 Health Services & Insurance Plan, Boston; 6/2 Boston, Tape 1, side 2, rev. 585. I was involved with a school district that initiated a hard line approach by suspending students violating the no-smoking policy from three to ten days. The student's third offense could lead to possible expulsion from school. James C. Manley, Ph.D., Asst. Superintendent, Northgate School Dist., Pittsburgh, PA., 6/16 Philadelphia, p. 3. CONFIDENTIAL: 'rIMN 288578 MINNESOTA TOBACCO LITIGATION

C O N T R A D I C T I O N S (page four) In humans there is an association between smoking and this disease of such strength ((lung cancer)) that, at least for men, an accurate history of never having smoked is sufficient evidence to rule out a diagnosis of lung cancer with confidence approaching 100%. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hospital, 6/16 Philadelphia, p, 1. Furthermore, smoking is an adequate explanation for this disease in well over 90% of the cases. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, p. 2. The development of cancer requires the coalescence of several circum- stances in space and time, that is, its causation is multifactorial, and two or more agents may act in concert to multiply the risk. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, p. 2. ...lung cancer rarely occurs in these workers ((asbestos workers, uranium, miners, etc.)) if they do not smoke. In other words, without the cigarette, the worker's jeapordy (sic) is negligible. This has an important impication (sic) for the control of lung cancer: elimination of cigarette smoking will eliminate the disease regardless of the occupational exposure. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, pp. 2-3. For a very potent carcinogen such as bis(chloromethyl) ether, the risk seems to be higher in the nonsmoker than in the smoker. The tobacco industry has inferred from this that smoking is protective. This is an absurdity designed to gull the public into thinking that the cigarette has a virtue. Such an inference is like crawling across the Schuylkill Expressway at rush hour to escape an elephant stampede, an unlikely hazard in Philadelphia. in any case, occupational exposure to chloromethyl ethers has been eliminated since 1971. I wish I could say the same for the cigarette. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, p. 3. CONFIDENTIAL: TIMN 288579 MINNESOTA TOBACCO LITIGATION

-66- C O N T R A D I C T I O N S (page five) Smoking stains the teeth and irritates the salivary glands to produce excess saliva. Ernest M. Fidance, D.D.S., Wilmington, De., Philadelphia 6/16/77, p. 2. Why does a person who has given up cigarette smoking go back to the habit? A major reason is doubtless the habit factor. in addition, a psychological need has been established, based on the oral and manual gratification of handling a cigarette, lighting it, putting it between the lips, etc. ACS Handout to press at Philadelphia forum 6/16/77. ~ U W <C g a , acco re to ~ J-o Schulz: What percentage are not?' How can you tell? OU F~ Schulz: ((tape is unintelligible, but VCH notes indicate that he said: ~ don't know.")) "I Milford Schulz, M.D., radiologist and Senior Consultant, Mass. General Hosp., Boston, Mass., 6/2 Boston, Tape 5, side 1, rev. 360. It is somewhat ironic that health care institutions such as hospitals and nursing homes allow smoking in light of the deleterious consequences associated with this practice. The.other side of the coin is that for some patients in institutions, smoking represents one'of the last few pleasures in lives which are rapidly drawing to a close. Alice Van Landingham, president, American Ass. of Retired Persons, Wash., D. C., Philadelphia 6/16/77, p. 4. ...I would urge that we search together for those ideas which are saleable to the Congress which make smoking financially unattractive and does not lay specters of bans and inhibition of constitutional free choice rights and things of that type. J, Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. Weingarten: ...in the course of your work as a thoracic surgeon, how many cases of lung cancer have you seen which were not cigarette related, in your opinion? Overholt: About 3%; about 97% were. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, Tape 1, side 1, rev. 1146. Weingarten: In terms of lung cancer, what percentage would you say are not arette-related? or ci ted - l b TIMN 288580

C 0 N T R A D I C T I 0 N S (page six) In one-to-one confrontations smokers are a polite group ... However, in the general public and without formal enforcement measures smokers tend to ignore signs. Keith Colonna, President, Students Opposed to Smoking, Va. Commonwealth Univ., Richmond, Va., 6/16 Phila., Tape 1, side 2, rev. 887. Perhaps you can get the problem out of the Congressional arena, which might be a gain. Perhaps instead of the Congress being the one that writes the label and having to deal with each issue, there could be an authority given to somebody. It probably fits better under the Toxic Substances Act or something like that -- the Consumer Product Safety Commission, because it's pretty hard to get cigarettes to be either a food or a drug by any definition, but it clearly is a toxic substance. J. Richard Crout, M.D., Director, Bureau of Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 562. Room #1. In 1973 the Department of Health, Education and Welfare published the "Health Consequences of Smoking." When mortalities of all types were considered, those for cigarette smokers were 64 percent higher than for nonsmokers. It was estimated that there are 11 million more cases of chronic diseases annually in the U.S. than if the entire population had the same chronic disease prevalence as nonsmokers. (cf. Ronald Wilson) Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 651. If a very good test were ever developed for the early diagnosis of lung cancer such as we have mammography for breast cancer, if such a test were accomplished, ((William Weiss)) calculated that the net reduction in mor- tality would be about 2 percent from early detection, whereas, if we could eliminate smoking we would reduce the cancer deaths -- the lung cancer death rate -- by about 81 percent... a 40 times greater accomplishment by prevention than by early detection. Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 729. ...the smoking complex, that is that group of behaviors which constitute the habit of cigarette smoking... Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2, rev. 684. CONFIDENTIAL: TIMN 288581 MINNESOTA TOBACCO LITIGATION

CONTRADICT IONS (pageseven) People who tend to be tense...people who experience dysphoric states, tend to have a much higher rate of relapse than people who do not. Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2, rev. 840. I do feel that passing ((smoking limitation)) legislation on a local level or even a state level is really not the answer. I think it should be on a national level. Just as we should have I think traffic regulations the same all over the country we should have regulations on public health iden- tical all over the country. John B. Kelly, Jr., councilman at large, Phila., Pa., and first vice president of U.S. Olympic Committee, 6/16 Phila., Tape 2, side 1, rev. 315. ...My only hope for protection ((from allergy)) is going to have to come from OSHA or the CAB and that protection is going to have to come in banning com- pletely cigarette smoking on the aircraft. (rev. 297.) I believe the solution to aircraft smoking is a complete ban from smoking on the aircraft of flights less than one hour. (rev. 301.) Janet Roth, flight attendant, Marietta, Ga., 6/14 Atlanta, Tape 2, side 1. Our particular group sees between 2,500 and 3,000 new patients each year. These patients generally fall into three (3) major categories. 1) coronary artery disease, 2) cancer of the lung, 3) chronic bronchitis and emphysema... It becomes more and more apparent when you study these cases and look at the smoking habits of these patients that there is no question that the relation- ship ((with smoking)) is there. However, there is a significant number of'people with these diseases that we are seeing who have never given a definite history of consumption of any material number of cigarettes in their past life. At first, we thought that there must be some extrinsic cause and upon more careful examination of the history of these patients, we found that almost 90% of those people who were non-smokers had one of the above mentioned diseases, and had a strong exposure to atmosphere laden with cigarette smoke...I realize that this study is based upon simple clinical experience, but at the same time we have a significant number of people on whom an effort has been made to determine the relation- ship of the atmosphere polluted environment and those that are not associated with such an environment and the difference is striking. (pp. 1-2.) The effect of the regulation of cigarette smoking in the air industry on planes can be demonstrated time and again, as I have had many patients who tell me that since the rule has been in effect, that they can fly whereas they have been unable to fly before. (p. 3.) William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta. -68- CONFIDENTIAL: TIMN 288582 MINNESOTA TOBACCO LITIGATION

C 0 N T R A D I C T I 0 N S (page eight) ...students who have ability and who have demonstrated achievement are ones who develop the cigaret habit...It was concluced that there is little apparent difference intelligence between smoking and non smoking Teens, but it was evidenced that habitual teen smokers are more frequently among those who fall behind in scholastic achievement... (p. 3.) Approximately 60% of the total number of Honor Roll Students are smokers, 40% do not smoke. (p. 4.) Livingston Ivy, Jr., principal, Washington High School; Pensacola, Fla., 6/14 Atlanta. I am appalled at the airlines restricting smoking in limited sections of the airplane. It is nothing more than a feeble effort for once the plane leaves the ground, the smokers begin to light up their cigarettes, and you have to endure the air pollution. (p. 16.) Laws & People (editorial) "Federalist No. 62, written anonymously by either Alexander Hamilton or James Madison, observed that 'the facility and excess of lawmaking seems to be the disease to which our governments are most liable."' (p. 18.) -69- I would like to close with: WORDS WORTH RECALLING TODAY ((by Abraham Lincoln))... "You cannot help man permanently by doing for them what they could and should do for themselves." (p. 21.) Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta. I would feel that educational efforts at kids'are probably not worth the dollar return. Charles Howard, attorney, Minneapolis, and president, Assn. of Nonsmokers Rights, 5/25 Chicago, Tape 1, side 2, rev. 553. CONFIDENTIAL: TIMN 288583 MINNESOTA TOBACCO LITIGATION

E D U C A T I O N ...just a little over one-third of all the people ((in California)) who ever smoked have given up the habit for good. This suggests that all has not been lost-in the campaign to educate the public to the health hazards of cigarette smoking--that in fact some significant progress has been made. Robert W. Jamplis, M.D., pres. Calif. Div. Amer. Cancer Society; Director, Palo Alto Medical Clinic, 3/22 LA statement, p. 2. I question the trend toward concentrating our efforts on the very young. It is easy to brainwash youngsters but when the hormones start to flow and self-images start to change at ages 12 and 13 and 14, and continue through the next few years, there is a whole new problem that needs to be faced right then, when the issue is most salient. Daniel Horn, Ph.D., Director, National Clearinghouse for Smoking & Health, 3/22 LA statement, p. 4. OBJECTIVE #5: make available the American Cancer Society Youth Education Program to all churches. We strongly recommend that the present pre- adolescent and high school education program of the American Cancer Society, be expanded to all churches ... Children at the age of 4 and 5 are not too young to be taught about the dangers of cigarette smoking. Melvin A. Jensen, L.A. advertising agency executive, Mormon spokesman, 3/22 LA statement, p. 4. This project ((CLASP)) is particularly important in light of the National Clearinghouse finding that the Berkeley project which provided education only and not peer counselling or group therapy, showed no significant change in smoking behavior among school children. It is undoubtedly true as Dr. McAlister has pointed out, that many young people begin to smoke because they lack the resistance to social and environmental pres- sures. They wish to conform to the image of maturity by engaging in "mature" behavior, that is, smoking. The CLASP project is specifically designed to help school children deal with peer pressures in specific si.tuations. Ann Hammond, Executive Dr., Health Eeucation Center, Palo Alto, Calif., 3/22 LA statement, p. 7. I believe we must encourage and support federal legislation that would require the United States Government to: 6. Require that the Department of Health, Education and Welfare conduct an ongoing public education program on the role of smoking and other hazardous environmental agents in the causation of cancer and other chronic diseases. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22 LA statement, p. 3. CONFIDENTIAL: TIMN 288584 MINNESOTA TOBACCO LITIGATION

E D U C A T I 0N (page two) In schools, from the first grade on up, these motives ((social disapproval and health aspects)) are very effective. George Crawford, Ph.D., Business Administration „ ACS anti-smoking program advocate, 3/22LA statement, p. 7. Before I'm through, I'm going to have something that's going to get into the consciousness o£ small children, so they will never want to smoke. Betty Carnes, anti-smoking activist, Scottsdale, Ariz., 3/22ZA tape 7, rev. 64. It's a shame that in our community everytime they hear the words Kailua High School it's something bad and not good. Dexter T. Suzuki, Student Activities Coordinator, Kailua High School, Honolulu, Hawaii, 3/22LA statement, p. 7. There are signs that the availability of Legal smoking places in the school plant appears to be directly correlated with an increase in teen- age girls smoking. Dexter T. Suzuki, Student Activities Coordinator, KaiLua.High SchooL, Honolulu, Hawaii, 3/22LA statement, p. 1. A comparison of our-L964,. 1968 aad 1973 results showed na significant differences in either smoking zncidencee or attitudes toward smoking. (But there was a difference in knowledge about the harmfuL effects of smoking.) Salvatore-V. 2agona, Assoc. prof. of psychology, Unz.v. or Arizona, liirector--t:enter ror Ltesearcn on Smokfng. & ' Sea,S th, 3/ 22LA s tatement , p. 3. r think we could_ do a great deal, morer And L think thatt probahLy the greatest strength'iff what we do: wiLl have ta, come_ about from the deveL opment of a unified approach toward the whole• substance abuse.problem•, the development of a total approach toward invoLving-people in making choices about the_way im which they are going to live, about the kinds of foods they are going to eat, about the way they are going to accept or reject the various substances that affect mood and affect the way they.feeL. This I think is.-the most exciting prospect that we have.for an expanded role• of. the gubLic_ Healtlt Service. Daniel Horn, Director, YCSH, 3/Z2LA Tape 6, rev. 413. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288585

E D U C A T 1 0 N (page three) I don't believe that the psychiatric approach in dealing with this problem is going to be any more successful than the psychiatric approach has been in dealing with the alcohol problem or the drug abuse problem. Daniel Horn, Director, NCSH, 3/22LA Tape 6, rev. 413. When we teach about health to very young children, it is very difficult to get the health concept across as being a subsidiary value, so that it's overemphasized as a primary value. And then it just doesn't fit in with the way children actually learn other people feel and they feel about it as they begin to grow older, and so they reject it. Daniel Horn, Director, NCSH, 3/22LA Tape 6, rev. 475. I'm sure that the churches of this nation, if they were approached in the right way--from the top-can disseminate this education down through their ranks• and down through their dioceses. Melvin. A.-:Jensea, LA advertising agencyexecutiver Mormou!spokesman,' 3j22LA Tape 7, rev. 338._ ' : The-problems primarily are identified-at the secondary- Ieve•L and r really feel as- some of the- evidence given: to you today that the problems really are at the- elementary- level ancE-that's.where- our• emphasis. should be. Youngsters who, have A= commitment at •the" sixth grade have a commitment h t at may Last them_ the rest of their -Lives. -- - -_ - "_ Sida.eg Ottmaa, -PFs.D-;. Santa Barbara, California Congress af= Farents, and_ T'eachers:, • 3'/22LA 'rape 4-, rev-. 306 « One recommendation that I would make is that there be some research in the area of measuring the effectiveness of health programs in the e1e- mentary grades, because I think we need to look at the long range to find out whether or not effective programs at the elementary level are in fact going- to succeed over the long run. Yes., we may have a commitment at the end of the sixth grade that the child does not want to learn to smoke, but the-peer pressures- and the adult pressures to become an adult may be too much for him.. We should know which systems are most effective in doing that. Sidney Ottman, Ph.D.T Santa•Barbara, California Congress of Farents and Teacherg,. 1/22Ia. 7a.pe 4-, rev. 422.. _• CONFIDENTIAL: 'j'jAIN 2885,g6 MINNESOTA TOBACCO LITIGATION

E D U C A T I O N (page four) Sometimes in education, we make it very rough on the teacher. When a student becomes well-informed the questions will begin to sound like this: Why_wouldn't the Federal government ban smoking when they know it is much,worse than cycimates (sic), saccharine, etc. and yet these products are removed from the market? Who would like to answer that question? Don Shaw, Coordinator of Health Education, Jefferson County Schools, Denver, 5/12 Denver, p. 3. To reach youth through health education, it was considered essential to communicate in terms of their concerns...that not smoking, rather than smoking, shows independence. By not smoking, young people can protect their own immediate environment from pollution; they can increase their physical well being, their attractiveness, their strength; they can, in a sense, show their rebellion toward adults by not smoking, by not copying their elders who have set the example. For boys, sports and physical fitness are often primary motives not to smoke; for girs (sic), bad breath, cigarette odor, and damage to their unborn children are main concerns. Lung cancer and emphysema ultimately may be lethal, but it is today's concerns that are more likely to sway youth and encourage their turning away from cigarette smoking. Non smoking must be considered sophisticated, cool, a symbol of real adulthood. _ Charles_ A. LeMaistre, M.D., Chrm. ACS Texas Division _ Study C_o_mm. on Tobacco & Cancer, later member of NCSPP panel, ~ 5/12 Denver, p. 7A. ---- -- ° ...when scare tactics are used by a public health service they fail to be effective because of a lack of direct relationship to the smoker. Mitchell Alan Alevy, Ph.D., Clinical psychologist, 5/19 St. Louis, p. 1. Two of the high schools have a $25 fine imposed for smoking in and around the school. Jerome R. Porath, Asst. Superintendendent, St. Louis Archdiocesan Schools, 5/19 St. Louis, p. 1. ...the teachers have complained that the available materials are often unsatisfactory. The common remark is that they are too heavily laden _with propaganda. Students find it difficult to accept books, films and other materials which constantly and exclusively highlight the dangers of smoking. Students find it impossible to accept that cigarette smoking is totally dangerous when they see a wide-spread use and enjoyment of cigarettes in the world around them. Teachers have asked for materials that have a more~"balanced" approach. Jerome R. Porath, Asst. Superintendendent, St. Louis Archdiocesan Schools, 5/19 St. Louis, p_ CONFIDENTIAL: TIMN 288587 MINNESOTA TOBACCO LITIGATION

EDUCATION (page five) What is proposed is an in-depth academic course on smoking and health for academic credit...in college and universities...regarding the substances in tobacco and tobacco smoke and their immediate effects; tobacco as it relates to cancer, cardiovascular disease, chronic bronchitis, emphysema, and certain other diseases, tobacco and illness, tobacco and disability, efforts to reduce smoking, counter attacks, non-smoking rights, dissenting opinions, who smokes and why, giving up smoking, government responsibility, and successful teaching methods for educating youth about tobacco as it relates to health. E. D. Glover, Ph.D., Asst. Prof., Univ. of Kansas Health Dept., Lawrence, Kansas, 5/19 St. Louis, p. 3. This spring semester, the 'Smoking & Health' course was Ltaught at the University of Kansas. The course was well received and proved to be a popular course as 131 students officially enrolled in the class--of which 98 were smokers. The next step is to evaluate and improve=with the hope that the idea_will spread to colleges and universities everywhere. E. D. Glover, Ph.D., Asst. Prof., Univ. of Kansas Health Dept., Lawrence, Kansas, 5/19 St. Louis, p. 4. ...on the basis of my past experience in this field I place school based health education programs at the top of the priority list for immediate and major action... Ray G. Cowley, M.D., Director, Missouri State Chest Hospital, Mt. Vernon, Missouri, 5/19 St. Louis, p. 3. There must be required programs with ironclad mandates in every school system in the U.S.A. to overcome the apathy, disinterest, lack of motivation, and diffusion of effort demonstrated by the majority of school systems to this time. This can be done legally, without violation of constitutional rights, and must be done if we are to control the smoking problem. I consider all other suggested smoking control programs as secondary by comparison. Ray G. Cowley, M.D., Director, Missouri State Chest Hospital, Mt. Vernon, Missouri, 5/19 St. Louis, p. 5. We are all aware of how important an automoble is to the boy old enough to have a driver's license. It recently occurred to me that in Nebraska a pack of cigarettes costs about as much as a gallon of gasoline. Per- haps we could suggest to the adolescent that if he smoked less he could drive more. Warren Bosley, M.D., Pediatrician, Grand Island, Neb., 5/19 St. Louis, p. 4. CONFIDENTIAL: TIMN 288588 MINNESOTA TOBACCO LITIGATION

E D U C A T I O N (page six) I question the trend toward concentrating this effort on the very young. There has been a tendency to try working with adults, to be disappointed with the results and then to trying working with teenagers in the high school, to be disappointed with the results and then start' working with them in junior high schools and then in the elementary schools and getting down in the kindergarten and except for our opportunities to get at them when they're still in the uterus, through the mother, none of this really looked very promising. Daniel Horn,. TI "Target 5" film, ACS LA speakers, p. 12 I would suggest consideration to increase the cost of smoking through taxation or whatever other means to deter from a financial standpoint the desire to smoke. The monies generated could go for educational purposes. Edmund Truelove, D.D.S., chairman, Dept. of Oral Diagnosis, Univ. of Wash. School of Dentistry, 5/17 Seattle, Tape 1, side 2, rev. 160. (Asked by Weingarten if Assn. urges members to give anti-smoking education) We do have a problem of cost these days and when we add any service, no matter how worthwhile or generally constructive it is in the direction of better health to the public, it is a cost that's viewed with alarm in many quarters. I think that there is--we have crossed some hurdles in the past where we've had to argue with government agencies that educational costs are reimbursable that they are important. They're not directly related to the treatment of a specific condition or a disease. But they are properly a part of a hospital's operating expenses. John Bigelow, executive director, Wash. State Hosp. Assn., 5/17 Seattle, Tape 1, Side 2, rev. 422. - (Asked by Weingarten"if such costs are reimbursable by Blue Cross, Medicaid and Medicare) Yes, they are...They are part of an overall budget but they have to be identified specifically. (in other words, the service rendered has to be identified and an amount attributed to it to be reimbursable?) That is correct. But they are allowable ... Where there is an extensive program, an acceptable overall program, it would amount to $2 or $3 a day (per patient). John Bigelow, executive director, Wash. State Hosp. Assn., 5/17 Seattle, Tape 1, Side 2, rev. 432. CONFIDENTIAL: TIMN 288589 MINNESOTA TOBACCO LITIGATION

E D U C A T I O N (page seven) I support the recommendation that A.C.S. sponsor a meeting of appropriate education authorities to develop the strategy-curricular-teaching materials for incorporating the health hazards of smoking as a part of health education programs in teacher training institutions, universities, and other educa- tional establishments. Rufus, R. Hackney, Dean of Students, Francis Marion College, Florence, South Carolina, 6/14 Atlanta, p. 5. Efforts should be made to find better ways to help people deal with stress, tension, and boredom, and to assist them in changing their lifestyles rather than expending large sums of money in attempts to develop a "safe" cigarette. Avery Harvill, P.E.D., Clayton Junior College, Morrow, Georgia, 6/14 Atlanta., p. 2. Tobacco education in the schools could become very effective if our govern- ment promoted the study of High Level Wellness in the schools as vigorously as it promotes the production of tobacco. S. Eugene Barnes, Ph.D., Assoc. Prof. of Health, Univ. of Sou. Miss., Hattiesburg, MS, 6/14 Atlanta, p. 7. ...one mother who was involved in a smoking and health education program declared that the information related to the influence of tobacco smoke in heart disease, cancer, and other diseases was not motivating to her, but the very fact that her own smoking might have caused her children to be ill or even less than optimally healthy was so repulsive to her that she would never again smoke cigarettes. S. Eugene Barnes, Ph.D., Assoc. Prof. of Health, Univ. of Sou. Miss., Hattiesburg, MS, 6/14 Atlanta, P. 9. ...around the classroom and the school, and the comic books were available for the children to read. We had certificates of award for parents ((of our first graders)) who quit smoking. Remegia Simone, teacher, New Hyde Park, New York, 6/16 Philadelphia, p. 6. A special National Impact Council on Teen-Age Smoking (NICOTAS) should be organized to plan and coordinate a nationwide campaign. Maurice Bleifeld, former principal, Martin Van Buren High School & Vice chairman, Public Education Comm., Queens Div. of ACS, 6/16 Philadelphia, p. 12. CONFIDENTIAL: TIMN 288590 MINNESOTA TOBACCO LITIGATION

E D U C A T I.0 N (page eight) (Asked about how to approach youngsters of 8, 10 and 11 who think about starting to smoke) I think realistic help for the young kids, start them out early and tell them the real dangers, serious, not scare tactics, you know, really exaggerated things. The real truth is scarey enough. Christa Lira, high school student, Centerville, Iowa, 5/19 St. Louis, Tape 2, side 1, rev. 706. Scare techniques are snmewhat effective and they're effective momentarily, but over a long range they're not very effective. In other words, scare tactics really don't work, because you scare the wrong people. In other words, if you put them on a continuum of one to ten, the people that are avowed as potential abusive health behaviors are in that middle group and those aren't the ones you usually affect because when you use scare tech- niques you usually scare the ones on the far end of the continuum who probably weren't going to be involved in abusive health behaviors of some kind. Elbert D. Glover, Assistant Professor, Health Dept., University of Kansas, 5/19 St. Louis, Tape 2, side 1, rev. 870. I'm not sure that the seventh and eighth grade is necessarily the place to begin that kind of program, although I think it's important that a program such as the program at Shenandoah School. I think we need to start earlier, need to start before nursery school. Dr. Robert M. Bruce, M.D., Assistant Professor of Medicine, Washington U. School of Medicine (PUD,PD, U. of Minn. Med School, lic. 1972), 5/19 St. Louis, Tape 2, side 2, rev. 1018. And, again, I think if some of the side effects of smoking, not necessarily the health effects but the cosmetic effects, were emphasized this might also be a way to discourage people from taking up smoking. I think if women knew what it does to their skin, and this is an absolute fact -- you can see this yourself -- you'll never see a woman who smokes heavy who has a good skin, especially if she combines the smoking with a lot of sun. H .i...i a z~ OF F Harry Pope, Restaurateur, St. Louis, 5/19 St. Louis, Tape 2, side 2, rev. 266. Although we have substantial evidence to prove that smoking is injurious to the health of young people, we have almost no evidence which can pro- vide guidance relative to the best way to educate young people about smoking...We must embark upon a crash program which can provide us with the needed insight necessary to reach young people -- probably children at a very young age -- and convince them not to smoke. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 3. Just as our public schools teach the ABC's and that 2-4- 2 = 4, our educational system must also teach the dangers of smoking. 9 Senator Birch Bayh (D.-Ind.),.5/25 Chicago, page 4.

E D U C A T I O N (page nine) It is vital for all of us who realize the importance of education in the crusade against smoking to explore ways to convince vast media organiza- tions that they have a public responsibility to join in this crusade. Let us find a way to convince major television and radio networks and stations and the major newspaper chains to join in these efforts. Here again, to be successful we must learn the most effective means of reaching prospective smokers at the most impressive time span in their lives. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, pages 4 and 5. The basic structure of our value system is developed before the age of six... young people should be taught that smoking is against the rules of good conduct for good health at the pre-school age level. Christine Caffrey, student, ACS volunteer, Edina, Minnesota, 5/25 Chicago, page 5. Finally, in 1971 Ochsner wrote an article on the adverse effects of smoking on pregnancy -- and on sexuality. But his report of the ill- effects of smoking on sexual functioning dealth with selected instances and was not a thoroughgoing, statistical analysis of a sizeable population. I have not yet seen such a study confirming his impressions, but if it appears, especially in the less inhibited climate of today's society, it will do much to make our anti-smoking work easier. Saul R. Kelson, M.D., Cardiologist, President of Toledo, Ohio, ACS, Toledo, Ohio, 5/25 Chicago, page 5. When a school is mandated to include in its curriculum the teaching of accepted personal health habits, which includes education on the dangers of tobacco smoking, and then permits students to smoke in or around the school building, it becomes a farce. Richard J. Martwick, Supt. of Schools, Educational Service Region, Cook County, Illinois, 5/25 Chicago, page 3. I would like to see each Board of Education adopt a position against all smoking in the schools -- not only among students but among the faculty as well. Richard J. Martwick, Supt. of Schools, Educational Service Region, Cook County, Illinois, 5/25 Chicago, page 4. CONrrInEVTIAL. TIMN 288592 MINNESOTA TOBACCO LITIGATION

EDUCATION (pageten) Students of today are well informed about the dangers of smoking. The cigarette packages all carry their own warning and the media -- radio, TV and newspapers -- do a good job of informing... Pat Patterson, ACS volunteer, cancer victim, 5/25 Chicago, page 3. I suggest that federal and state governments insist through adequate legislation that programs be initiated in all elementary schools, re- quiring that a certain amount of hours be directed to the subject of tobacco use and cigarette smoking. Martin G. Swaney, Public Health Educator, City of Milwaukee Health Dept., Milwaukee, Wisconsin, 5/25 Chicago, page 5. All educational programs in the school must involve parents and child. It is suggested that there be mandated programs for parents of all pupils. Both parent and child (children) would attend informational programs on the hazards associated with the smoking of cigarettes. Each parent would be required to sign a commitment not to start smoking, or if they are now smoking, to agree to attend a certain number of smoking cessation clinic sessions in an attempt to stop smoking so as to set a good example for their children. Martin G. Swaney, Public Health Educator, City of Milwaukee Health Dept., Milwaukee, Wisconsin, 5/25 Chicago, page 5. I would think that if we could use the sports world as a vehicle here to perhaps produce a top-level program that we could sell to Commissioner Pete Rozelle, for instance, and the National Football League, if we could do the same with the National Basketball Associa- tion, if we could do the same thing with the baseball people . . . To me, therein is a vehicle that we could just utilize tremendously ... John Ralston, former head football coach and general manager of the Denver Broncos, National Football League; 5/12 Denver, Tape 1, rev. 326. We even let the kids go out and see, if something burns down in the area, that could be caused by cigarettes that actually started the fire. You're not just stressing the damage to them, but what could happen. You could be burned to death. Your house can burn down as the result of starting a fire and that could be from smoking; it could be from anything. Mitch Modrall, Alcohol/Drug Education Specialist, Ft. McClelland, Alabama; 6/14 Atlanta, Tape 1, side 2, rev. 518. CONFIDENTIAL: TIMN 288593 MINNESOTA TOBACCO LITIGATION

E D U C A T I 0 N (page eleven) Well, what the ((older)) kids did -- something like a doll house. They constructed this and then they put dolls and things in there and then we set the thing on fire outside, let them see. And then they examined to see the parts and so forth. And it becomes rather impressive to them. I think we are missing the boat if we go around and say, "Aw, it's gonna cause cancer, it's gonna do that. You might be burned to death from someone else's cigarette and not be smoking." Mitch Modrall, Alcohol/Drug Education Specialist, Ft. McClelland, Alabama; 6/14 Atlanta, Tape 1, side 2, rev. 520. I went with the attitude, "Look , I know you're too smart to smoke." I didn't go in ((to Sunday schools and other groups)) and say, "Don't smoke." I just showed them the beautiful, clean cow's lungs and I tell 'em the cow's too smart to smoke." And then I was able to show them the pictures, the results of ((unintelligible). Jack L. Mathis, President, R. L. Mathis Certified Dairy, Decatur, Georgia; 6/14 Atlanta, Tape 1, side 1, rev. 318. It just doesn't pay to attack an industry in our country. I think education rather is the answer. I use a manual in these stop-smoking programs which was put out by the California Division of the ACS. And in that manual it says we do not ask people to stop smoking. Just as some of these other people have said, we point out the effects of smoking and excessive smoking and we let them make up their own minds. Stephen F. Woodson, ACS volunteer and former tobacco company salesman, Raleigh, N. C.; 6/14 Atlanta, Tape 1, side 1, rev. 712. Once they're 12, 13, 14,15, it's too late. We need to tell these children the truth. We don't need to soft-pedal it. We need to show gory pictures of what cigarette smoking can do...It has to start in kindergarten. Richard Marks, Jr., M.D., Department of Radiation Therapy, Medical University of South Carolina, Charleston, S. C.; 6/14 Atlanta, Tape 2, side 2, rev. 106. Hitler did a good job. He browbeated (sic) everybody. They believed in him at age 12. We need to use the same tactics. Richard Marks, Jr., M.D., Department of Radiation Therapy, Medical University of South Carolina, Charleston, S. C.; 6/14 Atlanta, Tape 2, side 2, rev. 144. Parents need to provide some incentive -- and I'm afraid it has to be monetary. If children are not to smoke, they need to be given some reward. That's the first point I want to make. And that's the most important. Richard Marks, Jr., M.D., Dept. of Radiation Therapy, Medical University of South Carolina, Charleston, S. C.; 6/14 Atlanta, Tape 2, side 2, rev. 147.

E D U C A T I O N (page twelve) In Connecticut there are 34,000 youngsters enrolled in some kind of formal day-care experience. We are told that attitude formation takes place at this early age. What needs to be done is train those people associated with the day-care movement in some of the factors involved in smoking as they relate to preschool education. Milton Geyer, Chief, Public Health Education Section, Conn. State Dept of Health, .6/2 Boston, p. 5. A national program that promotes adult participation in sports similar to the national programs that develop the young athletes would change attitudes towards such physically debilitating activities as smoking. William W. Campbell, commercial manager, WPRO Radio, Providence, R. I., ACS volunteer,rQ/2 Boston, p. 3. Vivid photographs of healthy and cancerous lungs placed side by side get the point across quickly without having to expose children to another long, boring speech by some hypocritical teacher who probably smokes at home. These photos could be posted on the bare walls of hallways, in the gym and in the locker rooms and bathrooms of all schools. Colleges could post them in similar areas as well as in fraternity houses and in recreation areas. Stephen Sedberry, musician, Birmingham, Alabama & Roxbury Crossing, MASS., 6/2 Boston, p. 5. Don't rely on education or persuasion or labels of warning on cigarettes to do the job.-..The missing ingredient needed to accomplish the goal of massive re-education in cancer-causing smoking is TOUGHNESS. Bill Caldwell, newspaper editor & larynx cancer victim, Damariscotta, Maine, 6/2 Boston, p. 3. A major effort must be directed at the young non-smoker and it seems wise to consider seriously the direction of information at much younger age groups than those that we have considered until now. A program of infor- mational inoculation in the lower school grades would be worthy of serious attention. Brendan A. Maher, Ph.D., Professor of Psychology of Personality and chairman, Dept. of Psychology & Social Relations, Harvard University, 6/2 Boston, p. 9. CONFIDENTIALs MINNESOTA TOBACCO LITIGATION TIMN 288595

E D U C A T I 0 N (page thirteen) ...we're discovering that we're rearhing our childreri too late. By the time we've been giving them programs in health education in high school they are already habituated to cigarette smoking. So this coming year, through Project 5 (sic) we're going into the kindergarten through third grades for the first time to try to get the young people to understand the hazards of smoking, at that time in their lives when they are forming health habits. We think it's none too early. Allan K. Jonas,:.L1A businessman, chairman of ACS Task force on Tobacco and Health and IdOSPH:-panellist, at ACS 2/1/77 news conference, NYC, rev. 426. Early in the 70's, in the furor of the drug abuse scare, our Legislature mandated teaching about drugs, alcohol and tobacco at all levels by all teachers but, as you can imagine, this became an unworkable morass of information from uninterested teachers to unresponsive pupils. Except for formal health classes in the 7th and in the 10th grades, no one really knows who is teaching what about smoking throughout the State. Jane H. Frelick, R. N., former chairman of Delaware Inter-agency Council on Smoking & Health, Wilmington, Delaware, 6/16 Philadelphia, p. 1. There was more legislation ((in N. Y. State this session)) introduced regarding the possible evasion of paying the cigarette tax than there was in doing something about educating children not to smoke. Once more the almighty dollar reigns supreme_ _Fred G. Field, Jr., N. Y. State Assemblyman, member of bd. of directors, ACS N. Y. Div., Albany, N. Y., 6/16 Philadelphia, p. 3. Many of the counties of the State ((N. Y.)) are appropriating county funds to assist educators in creating, developing and implementing programs to teach children why they shouldn't smoke. Fred G. Field, Jr., N. Y. State Assemblyman, member of bd. of directors, ACS N. Y. Div., Albany, N.Y., 6/16 Philadelphia, p. 4. ..scare tactics don't work. In a recent survey on alcohol abuse, involving 9.500 teenagers, only two reported that they don't drink because it is illegal. Fred G. Field, Jr., N. Y. State Assemblyman, member of bd. of directors, ACS N. Y. Div., Albany, N.Y., 6/16 Philadelphia, p. 8. , CONFIDENTIAL: TIMN 288596 MINNESOTA TOBACCO LITIGATION

E D U C A T I O N (page fourteen) We are also studying a proposal that would allocate one percent of our state's annual cigarette and alcohol tax revenues for the funding of increased anti-drug and tobacco instructional efforts in our schools. Niore than $5 million would thereby be made available for educational programs. Fred G. Field, Jr., N. Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., Philadelphia 6/16/77, p. 9. I do not agree that the facts on cigarette smoking and their health hazards are well known to the public at the present time. J: Rich.Crout, M.D., Director, Bur. of Drugs, Fed. Food and Drug Adm., 6/16 Phila, Room #3, Tape 1. What is the best age to emphasize this educational program? We really don't know. What is the most effective medium to communicate the dangers of smoking? We really don't know. Sen. Birch Bayh (D-Ind.), 5/25 Chicago, Tape 1, Rev. 167. We have had problems when the federal government has tried to mandate a curriculum. That leads to thought control and all of the concerns we have had about the national government's controlling the thought processes of our children. But I think with private organizations such as yours and other concerned citizens and with funding of programs at the federal level to go back to local communities in the health area we can emphasize there that attacking smoking or health problems related to smoking should be one of the matters considered. Sen. Birch Bayh (D-Ind.), 5/25 Chicago, Tape 1, rev. 322. I have had some people who have suggested that the Clearinghouse has not been as successful as it could have been. O Sen. Birch Bayh (D-Ind.), 5/25 Chicago, Tape 1, rev. 289 ~ It was pointed out this morning that we must start ((anti-smoking education)) Ut early, and I don't think the grade school is early enough. H .. H David T. Carr, M.D., Associate Director for Cancer Control, Mayo Comprehensive Cancer Center, Rochester, Minn., O 5/25 Chicago, Tape 1, rev. 658. ~ U I don't believe the success of our efforts lies in the education program... ~ O If you take a look at the experience with drug education --drug education ~ has not reduced the experience of teenagers and youth on drugs. We can take a look at sex education. Sex education has not been particularly suc- cessful cessful in reducing venerealdisease and promoting proper sexual habits. I c) don't believe that we are going to have success in that area. ~ William Sederberg, Ph.D., director of research, program section, Mich. House of Reps. GOP Caucus, and president, Mich. Lung Assn., 5/25 Chicago, Tape 1, side 2, rev. 87. TIMN 288597

E D U C A T I 0 N (page fifteen) I have been in public school administration or teaching for 38 years. I think smoking areas are a cop-out. They are not effective, they never have been... The kids used those when they didn't have any place else they could get to. Robert J. Beard, administrative assistant to Supt. of Schools, Chambersburg, Pa.,Area School District, 6/16 Phila., Tape 2, side 1, rev. 1075. The one instrument of education, the most pervasive thing that this country has ever encountered in all its long and hopefully continuing history is television. The numbers are mindboggling. A hundred million people a day watch television. More people will watch just the two evening news programs, the CBS and NBC, on two nights, two nights, than will see all the movies in this country, in every theater, in every city, in six weeks. (rev. 992.) I think the way out of this is to diminish the number of smokers. And you do that the same way totalitarian countries and as far back as Aristotle. You start them young, indoctrinating them. And you do that with the greatest teacher that the mind of man have invented. And that's television. (rev. 1015.) Jack Valenti, president, Motion Picture Assn. of America, 6/16 Phila., Tape 1, side 1. (Asked by LeMaistre if she thinks the church has any responsibility in a community health education program) I think that the church should be set aside and it should be for religious background. And I don't think we should burden them with things that should be of a personal or educational nature. I do think that our moral substruc- turep begin in our church, and if they lay that foundation that lifts our morals, why then I think that perhaps we are more willing to learn. Carolyn Cole, housewife, mother and ACS quit smoking coordinator, Pensacola, Fla., 6/14 Atlanta, Tape 1, side 2, rev. 921. The gentleman preceding me said he did not believe in scare tactics. I don't think that we should go in a sensational way about this, but I think scare tactics are good as long as scare tactics are realistic...I don't believe that ((edu- cational programs for students in public schools)) should be done on a state level...((they)) should be done on•the local school system level. Carrie Nelle Thompson, Director, Southeastern Region, UNICEF, Atlanta, Ga., 6/14 Atlanta, Tape 1, side 2, rev. 513. CONFIDENTIAL: TIMN 288598 MINNESOTA TOBACCO LITIGATION i

E D U C A T I 0 N (page sixteen) ..many young people are not overly concerned about the prospect of future lung cancer, emphysema or heart disease. There is a possibility that greater success could be achieved by campaigns emphasizing that•cigarettes increase facial wrinkles, make the teeth yellow, and cause bad breath. James W. Alley, M.D., Director, Div. of Phys. Health, Ga. Dept. of Human Resources, Atlanta, Ga., 6/14 Atlanta, p. 4. Our fourth and fifth grades have been used as target grades in one such program where we have incorporated anti-smoking materials into a unit entitled "Poison Prevention." Gene Bridges, Supervisor of Physical & Drivers Education, Escambia County, Pensacola, Fla., 6/14 Atlanta, p. 2. ...it is important for smoking to be constantly controlled and monitored in our schools, and for the deadly facts about smoking to be impressed upon our youngsters before they get the chance to start smoking. Farris Bryant, former governor of Fla., President, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, p. 5. ...many schools have actually provided special smoking areas for students. These areas certainly must convenience young smokers and probably serve to stimulate both the rate of smoking among teenagers and the conversion of certain nonsmokers to smokers for obvious social reasons. (p. 3.) ...we must be careful to avoid preaching the sermon of antismoking to these people. Teenagers very often reject the overbearing approach regardless of weight of facts and statistics. (p. 4.) R. Bruce Dunlap, Ph.D., Dept. of Chemistry, Univ. of S.C., Columbia, S.C., 6/14 Atlanta. We feel it is a moot question to recommend the "mandating of school education programs on the dangers of smoking." One of the few laws legislating school curriculum in this state has mandated that we teach the "evils of tobacco and alcohol annually" in our schools. This law is forty years old. (p. 1.) If educational programs are to be effective they must begin in the primary grades for it is too late by the seventh grade...Fourth and fifth grades appear to be the prime ages for anti-smoking educational efforts. It is possible to present scientific and health related information to kinder- garten children if it is appropriately designed, and no doubt this is the most desirable place to begin. (p. 2.) Billy E. Gober, Ph.D., Chairman, Comprehensive Health Education Project, Ga. PTA Health Commission and health and physical education coordinator, DeKalb County School System, 6/14 Atlanta. CONFIDENTIAL: TIMN 288599 MINNESOTA TOBACCO LITIGATION

E D U C A T I 0 N (page seventeen) One principal had an interesting theory stating that he felt that so much of the "smoking is bad for you" type programs in some cases only whetted the curiosity appetite and was an inducement for the curiosity seekers to try smoking just to see what was so bad about it. Fred Herren, head football coach, Newberry College, Newberry, S.C., 6/14 Atlanta, p. 2. I feel that the governmental agencies are also to blame for not insisting on complete and total health information, beginning in kindergarden and carried throughout all grades for all school children... William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, p. 4. Students recommend for a better relationship between, School Boards, Govern- mental bodies, Parents, School Administrators, and teachers that: 1. The state government take a look at the laws regarding Teenage smoking. If a Teen becomes an adult at age 18 and is privileged with the rights of an adult, then an 18 year old high school student should be privileged to smoke. (p. 6.) 2. The local school boards and schools re-evaluate disciplinarian actions regarding student smokers at school. (p. 6.) ..:the choice of "to smoke or not to smoke" ((be left)) to the students even though the ills of smoking will be known from the ((anti-smoking)) session. (p. 6.) Livingston Ivy, Jr., principal, Washington High School, Pensacola, Fla., 6/14 Atlanta. As a former teacher in both public and private high schools and in the Job Cgrps, I believe that it is a physical impossibility to enforce a no-smoking regulation. But I strongly believe we can at least convert this problem area into a learning situation by requiring any smoking student to take a mini course on the medical ramifications of smoking. Carrie Nelle Thompson, Director, UNICEF, Atlanta, Ga., 6/14 Atlanta, p. 2. ..one of the ((school)) administrators notes.'that the schools conduct anti-smoking campaigns, display posters, and have guest speakers on the subject.. He feels for the most part that this is a waste of time, because the problem is deeply rooted in our society as indicated by the permissive- ness of parents and a way of life. (p. 13.) One approach offered by one of the administrators is through Title IX, Funds to schools for the underprivileged and handicapped. He suggests penalizing (cont.) CONFIDENTIAL: TIMN 288600 MINNESOTA TOBACCO LITIGATION

E D U C A T I 0 N (page eighteen) - 87- (cont.) by withholding of funds for failure to invoke antismoking rules and regula- tions on the premises of the schools, (p. 13.) Hoke Wammock, M.D., Enoch Callaway Cancer Clinic. LaGrange, Ga., 6/14 Atlanta. This must be done by influencing lifestyles at an early age. Health education should begin at kindergarten and continue through grade twelve on a continu- ous basis with smoking education at each grade level. By the time students reach fifth or sixth grade it is already to (sic) late. (p. 2.) Student input into formulating programs should be sought as much as possible. One excellent example of this kind of student participation program is the School Health Curriculum Project based at the Bureau of Health Education, Center for Disease Control, Atlanta, Georgia. (p. 2.) Health education programs should not use scare tactics with students but discuss the particular component positively. Long term effects should be stated but also the short term effects. In other words health education programs should deal with the here and now aspects of the problem. (p. 3.) Another avenue schools should explore in addition to or in conjunction with the health curriculum is using high school students to talk to elementary level students about health education. Particularly about those problems, such as smbking that have to do with peer group pressure image and acceptance... Many elementary level students look up to high school students and will absorb much of the information they present. (p. 3.) Patricia E. White, health educator, Clayton County Health Dept., Jonesboro, Ga., 6/14 Atlanta. I would feel that educational efforts at kids are probably not worth the dollar return. Charles Howard, attorney, Minneapolis, and president, Assn. of Nonsmokers Rights, 5/25 Chicago, Tape 1, side 2, rev. 553. Since aesthetics are a primary concern to virtually everyone, it would seem that careful educational programs pointing out the possibility of disfigurement from oral cancer, might discourage the use of tobacco among young people to a greater degree than does the threat of the development of lung cancer or coronary disease...Such efforts would have to be managed rather carefully, minimizing the shock effect while increasing awareness. John DiBiaggio, M.D., Vice President for Health Affairs, Univ. of Conn., New Britain, Ct., 6/2 Boston, p. 3. CONFIDENTIAL: TIMN 288601 MINNESOTA TOBACCO LITIGATION i

E.X I G G E R& T LON It ig.known that a I pack per day smokerswho quits statistically adds seven years to his Lif-e-.. If we take a group of: 200 people and achieve. 50Z cessatiom we have 100 peonle.x T years 3 700 years of productive Life. Lf *.re assume their average earaing capacity to be $20,000 per year, we have 700 r. $20,000 or $7.L million society is being saved at. a cost of $500 per person x 200 people for 50z cessation 3$100,000.. One hundred, th,ousand dollars. to save society fourteen mi.llion! That Looks cos t effective ta me! Ann Hammond, Executive-Dir., Heal.th Educatiou Center, Pala Alto, Calif.,. 3/22Ld statement, p. 6. The assistant Surgeon General reports that the- Yational C.learinghouse for Smoking and HeaLth receives severall million inquiries each year from indi- viduals seeking assistance to stop smoking. Francis r.. Randall, Hawaii, 3/22.La, submitted statement, anti-smoking tape p 6. The lack of non-smoking sections and Limitation laws might be hurting the overall.economy of the country. Her= Perlmxitter, founder &-co-chairman, Californians for Cleam Ladoor jAi.r, 3/ZZLa statement, p. Z.. . The poor innocent non-smoker, obliged to spend several hours in a smoke-filled room, will have had up to eight percent of his red blood corpuscles inactivated by carbon monoxide, and that's like giving up almost a pint of blood: Dr. E. R3.chard Mertz as quoted by Herm Perimutter, 3/22 LA statement attachment. Cigarette smoke contains 250 parts per million (ppm) of nitrogen dioxide, an acutely irritating gas possible giving rise to nitrate, a potentially mutogenic agent. Pollution alert levels in Los Angeles have gone as high as 3 ppm. American Lung Association as quoted by Herm Perlmutter, 3/22 LA statement attachment. Hydrogen cyanide is not found in customary forms of air pollution, yet is a highly active enzyme poison, found in cigarette smoke. Long term exposure to levels of about 10 ppm in considered dangerous. Concentration in cigarette smoke is 1,600 ppm. American Lung Association as quoted by Herm Perlmutter, 3/22 LA statement attachment. CONFIDENTIAL: TIMN 288602 MINNESOTA TOBACCO LITIGATION

-89- E. g A G 0 c. QA T' Z 0 a ( page• two ) Tan cigarettes smoked in a closede automobile produce carbon monoxide levels up to 90 ppm.. ?,merican Lung Association as quoted by Sera Perlmutter, 3"/22IA statement attachment. The American Medical Association es timates that at Leas t 34. million Ameri- cans, are sensitive to cigarette smoke. American Lung Association. as quoted by Serat ParLmutter, 3/2Z2A statement attachment. Lt was shociting to be reminded, while viewing the TV showing of QB VII, that the Yazi gas chambers were killing, humaa beings at: a peak race of tCvent,v thousand oer day? It is a grimly- sobering coincidence. that thats is precisely the estimated world.deathe rate attributabLe to tobacco smoking, and that is a conservative estimate. You do indeed pay twice for cigarettes--when you get them and.when they gett you. Dr.. E. Richard Mertz by 3err1 Perlmutter, 3/22LA statement attachment. Smoking. is directly related to I million "extra" cases of peptic ulcer each year! ACS. a& cited by- Fzaacis. RandaLL, Hasaaii, 3/22LA submitted s t$tement:, p.. 2., (attachment) .. The infant death rate for the first few days after birth is 26% higher smoking mothers: World Conference 1975 as cited by Francis Randall. Hawaii, 3/22 LA submitted statement, p. 2. (attachment). If the initial success of this test can be applied to a mass screening program, the incidence of lung cancer deaths in the United States may be dramatically reduced in a short period of time. Kent Wm. Sorensen, president, Micronetic Laboratories, San Jose, Calif., 3/22 LA statement, p. 2. May I first congratulate the American Cancer Society for once more taking the leadership in educating the American public on this important issue by holding these nine open hearings throughout the nation. Sheridan L. Weinstein, M.D., Asst. Surgeon General, Regional Health Administrator, U.S. Public Health Service, Dept. of HEW, 3/22 LA statement, p. 1. (delivered by Ms. Cherry Y. Tsutsumida). TIlYIN 288603 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

EXg G G SRA T 10 F ( p ag°•. three ) The PubLic Hea•lth: Service.- has loBg- enjoyed a resaar-d.ing re-latioBship with the Society.- We have relied heavily on your scientists in the forsu- Latiou of aationaL policy related to cancer. Sheridan L. Weinstein, H..D., Lsst. Surgeon General, Regional.gealth Administrator, U.S. Public Eealta Service, Dept. of.HEW, 3/2=1 statement, p. 1. (delivered.by as. Cherry Y.. Tsutsumida). The health consequences of cigarette smoking are well established. and have been cLearLy understood for tea years.. The- causal relationship between cigarette- smoking an.d. the excess risk of developiag, cardiovas- cular disease•, respiratory tract cancers,-and chronic obstructive lung disease, as weL1 as the risk to the fetus-, are well documented and. ac- cept=d by the scientific and.healtlr communities. Asst.--Secy.. of SEW as cited by Sheridan L« Weinstein, M.D., Asst. Surgeon General, Regional Health Adminis- trator, U.S. Public SeaLth Service, Dept. of HEW, 3/22LA statement, p~ Z.. (deLivered by Ms. Cherry Y. Tsucsumida). The Public Health Service, therefore, concurs with the American Cancer Society that the purpose of these hearings is not to ask whether smoking is hazardous to health. The purpose should be to gather guidance from as wide a spectrum of the public as possible in focusing on an informed policy direction. Sheridan L. Weinstein, M.D., Asst. Surgeon General, Regional Health Administrator, U.S. Public Health Service, Dept. of HEW, 3/22 LA statement, p. 2. (delivered by Ms. Cherry Y. Tsutsumida). The government's function is to enable people to make sound decisions about their health, to equip them with the information and skills and other resources to translate these decisions into action, and to aid in the removal of legal, economic, physical, or other barriers that might prevent them from acting accordingly. Therefore, where this (plan) suggests options for action which depend on changes in people's behavior, it should be understood that as far as government actions are concerned the proposals are intended solely to provide opportunities and incentives for people to assume full responsibility for their own health. Sheridan L. Weinstein, M.D., Asst. Surgeon General, Regional Health Administrator, U.S. Public Health Service, Dept. of HEW, 3/22 LA statement, p. 4. (delivered by Ms. Cherry Y. Tsutsumida). CONFIDENTIAL: TIMN 288604 MINNESOTA TOBACCO LITIGATION

-91- EKAGG r, &AT Z0 Y- (pagew four) The risks czeatad by smoking cannot be. Left to the Laisez faire menta- Lity. Yor caa the smoking i.ssue• be diffused by the uncha.Llenged thinking that says-, "WeLL, it's getting to the• point waere everything is bad for you.." The•: scientific evidence on smoking is too compelling for such smoke screens.. HEW 1976 rorward Plan, as cited by Sheridan L.- Weinstein, H.D.,. Asst..~Surgeoa General, RegionaL ffeaLth Administrator, U.S.. Public Sealth Service, Dept- of HEW, 3/22hA statement, p.. 4.. (deLivered. by -!is- Cherry T.. Tsutsumida).. The Clearinghouse,_we hope, shaLL continue to provide the states• and communities with. a. central focus whereby data, Legis Lation, information, and exaertise can. be made avaiLab ie.- .Sheridan L_ Weinst_in, M.D., Asst.. Surgeon General, RegionaL ;Lealtb Administrator, U.S.. Public 3ealth Service, Dep t. of ffE'?rT, 3/ 22LA s tatement, p f ~.. (delivered by Ms- Cherry Y.. Tsutsumi.da). The American Cancer Society says that, in 1977, 98,000 cases of new cancers of the Lung will be diagnosed and that 89,000 peopLe will die of cancer of the Lung...Zf you put the figures together--new cases and. dead. of cancer-- you have nearly 200,000 peopLe.- One-tenth, nearly, of our popuLation.. DraSce. V. Will,, ti.D.., Chief,. Pathology-, The Queen's MedicaL Center, HonoLulu, 3/22LA statement, p.. I- ...The wasted time caused by actors under the nervous pressure of getting a scene, being addicted to tobacco, after a certain point feel that they have to take a 10-minute break and go have a cigarette. Now, a lost 10 minutes in a shooting day may seem to trivial an event to mention. But in film production a shooting day costs upwards of $30,000. So the loss of 10 minutes is not insignificant, aside from the irritation and pressure up on those of us who have to wait while this happens. Charlton Heston, movie star, 3/22 LA tape 1, Rev. 848-855. Acting is done under highly concentrated conditions where the nervous pressures are considerable. The attempt to create something valuable is fraught enough with difficulties without having it further complicated by the pressures exerted on everyone by the smokers, both when they do smoke and when they can't smoke in a scene. Even I suppose an unusual complaint is the unpleasantness, even the disgust you feel, playing a love scene with a woman who smokes if you yourself don't. in private life, if this offends you, you just pick another girl--but I do this for a living. Charlton Heston, movie star, 3/22 LA tape 1, Rev. 855-867. CONFIDENTIAL: TIMN 288605 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I O N (page fi.ve) Cirrhosis of the liver and cancer of the prostrate occur at twice the rate in smokers. Francis F. Randall, 3/22 LA, Rev. 220, Part 1. The constant cycle of metabolic speeding results in wrinkling, premature aging and reduced life expectancy among cigarette smokers than non- smokers. Francis F. Randall, 3/22 LA, Rev. 226, part 1. There are 300,000 unnecessary deaths of smokers each year which are caused by lung cancer, heart disease, chronic bronchitis and other illnesses directly related to smoking. Francis F. Randall, 3/22 LA, Rev. 230, part 1. The death toll exceeds in two months the total loss of American lives during the 12 years of the Vietnam war. Francis F. Randall, 3/22 LA, Rev. 238, part 1. Even persons who smoke only five cigarettes a day have a higher incidence of premature deaths. Francis F. Randall, 3/22 LA, Rev. 245, part 1. Surely the purpose of the meeting should be to declare smoking: war on cigarette Pat Caulfield, as cited by ACS LA Film, 3/22 LA. The lack of no-smoking sections may indeed be detrimental to America's economy, by virture of the fact that hundreds, thousands, ten of thousands, hundreds of thousands of people are forced to stay home rather than go out to places of entertainment. For example, I myself would rather stay home and read a book or watch television than enjoy dancing in a very smoke-filled room. Therefore, I will save my $20, and multiply this by tens of thousands and I think my point will become clear. Herm Perl.mutter, LA, founder and co-chairman of Californians for Clean Indoor Air, 3/22 LA, Tape 7, Rev. 594. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIIVIN 288606

EXAGGERAT I ON (page six) A recent study by Dr. Meyer at Johns Hopkins dealing with data from Ontario is compared in the final table of my handout with data obtained from the Kaiser Foundation Health Plan in Alameda County. And you'11 see in table 3 that of the unfavorable outcomes of pregnancy, those for example associated _with prematurity, from 5 to 15 percent can be attributed to cigarette smoking. And of those deaths that occur in the perinatal period, from I to 10 percent can be attributed to cigarette smoking. Of course, the differences in these rates depends greatly on the underlying presence of other factors and the level of health care. John R. Goldsmith, M.D., California State Dept. of Health, 3/22LA Tape 2, rev. 466. Hello, my name is Dolphin Lair, and like I'd like to thank everyone for inviting me to come down here today. If no one knows of me, I did an anti-smoking demonstration on December the sixth, 1976. Dolphin Lair, accused felon, Los Angeles, 3/22LA statement, Tape 1. The tar content of cigarettes is also reduced by adding to the tobacco synthetic products which have very little.tar... ACS Handout, 5/17 Seattle, p. 2. Q: Is there anything specific in cigarette smoke that may cause lung cancer? A: A number of chemical agents have been found that are capable of causing cancer, and a number of others (known as co-carcinogens)_which assist the action of cancer-causing chemicals. ACS Handout, 5/17 Seattle, p. 5. Q: It has recently been reported that cigarettes have poison gas in them. Is that true? A: Yes. Approximately 92 percent of cigarette smoke is composed mostly of a number of lethal gases including carbon monoxide. ACS Handout, 5/17 Seattle, P• 6. The elimination of cigarette smoking would mean the prevention of 15 per cent of all cancer deaths. - William B. Hutchinson, M.D., Director, Fred Hutchinson Cancer Research Center, 5/17 Seattle, p. 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288607

EXAGGE RATION (page seven) Over 1300 men and 400 women in this state ((Washington)) develop cancer each year as a resultaof their smoking habits. Most are victims of lung cancer, but an appreciable number also develop the other smoking-related neoplasms. David B. Thomas, M.D. , Dr...•_P.H. , Fred Hu _ tchinso_n Cancer Research Center, Seattle, 5/17 Seattle, p. 6. ~ Research has shown that smoke in enclosed areas causes physiological changes in the non-smoker: a faster heart beat, a rise in blood pressure, and increases in carbon monoxide levels. Second-hand smoke has been shown to be even more lethal than the smoke inhaled by the smoker. Rep. Georgette Valle, State of Washington, 5/17 Seattle, p. 4. Sidestream smoke contains two times as much nicotine and tar, five times as much carbon monoxide, four times as much nitrous oxide and 50 times as much ammonia. Rep. Georgette Valle, State of Washington, 5/17 Seattle, p. 5. The foul air and smoke takes its toll as the third largest killer of people in the United States and we give billion of dollars to other countries but what do receive for medical research. (sic) Raymond Reese, emphysema victim, Denver, Colo., 5/12 Denver, p. 3. ...I explain that I make my money from those who do not believe in what I say, for most of my professional income is derived from taking care of the wrecks of the tobacco industry. D. S. Bachman, M.D. Little Rock, Ark., 5/12 Denver, p. 1. There is nothing new in the statistics of the great explosion of female smokers. And among smokers, equal rights really means equal rights, because females are rapidly losing their distinction as the stronger sex. More and more of the serious social diseases--heart disease, lung cancer, and emphysema are being found in the female population where smoking is acting as the great equalizer. Earl B. Flanagan, M.D., Carlsbad, N.M., 5/12 Denver, p. 3. CONFIDENTIAL: TIMN 288608 MINNESOTA TOBACCO LITIGATION

E g A G G E R A T I O N (page eight) Cigarette smoking is the major cause of disability in the United States. Harvey Phelps, M.D., Colorado State Senator, 5/12 Denver, p. 1. CIGARETTES...(taken from a form in the statement)...1. I know it will shorten my life by an average of 8 years. Dr. Robert Taylor, M.D., Cheyenne, Wyo., 5/12 Denver, p. I have always been...frankly fascinated at the masochistic method that avid cigarette smokers have of injuring their bodies. I suspect that anyone would think us ridiculous if we suggested they lean over a bonfire and inhale the smoke, but millions of our population, with great relish, bring a small bonfire to their lips and inhale obviously toxic smoke. Stanley Stein, Pharmacist, Colo. Pharmacal Assn., 5/12 Denver, p. 1. The use of tobacco is the.greatest public health hazard we have in the United States, and has been so declared by the last five Surgeons General in the Public Health Service...The evidence now is so overwhelming that it must be accepted. In addition to cancer of the lung there is a definite relationship between the incidence of smoking and cancer of the lip, tongue, mouth, pharynx, larynx, esophagus, bladder and pancreas. Additionally, the use of tobacco is the principal cause of cardiovascular disease and is a major factor in premature aging, premature death, and disabling diseases. Alton Ochsner, M.D., Founder, Ochsner Clinic, New Orleans, 5/12 Denver, p. 1 Aside from the fact that I know it will be much easier to never start smoking than to start and have to try to quit; aside from the fact that I hate breathing other people's repulsive cigarette smoke; aside from the fact that I hate the stale smell of tobacco that lingers on people's breath, on their clothes, in their hair, in their homes, -- and even on me after I've been around them; aside from the fact that I hate to think of how much good that money could do if channeled elsewhere, for example at least a couple of new summer outfits and several banana splits a week; aside from the fact that music and singing is very important to me and I have heard the irritation and scratchiness that can develop in a smoker's voice; aside from the fact that I gave up my pacifier at the age of three and hate to think of getting another crutch; aside from the fact that I like to feel independent and hate to think of developing a dependency; aside from these considerations, the most important reason swhen I think of_why I would never smoke is the health aspect. Kathy Borgaard, high school student, Cheyenne, Wyo., 5/12 Denver, p. 2. 2. CONFIDENTIAL: TIMN 288609 MINNESOTA TOBACCO LITIGATION

E%AGGE RATIaN (pagenine) In essence the general population is almost universally at risk and the data demonstrating the magnitude of the risk are tragically though perhaps monotonously repeated in the Annual Public Health Reports The Health Consequences of Smoking. Dr. Paul Kotin, medical director, Johns-Manville, Denver, Colo., 5/12 Denver, pp. 2. Cigarette manufacture, distribution and sales, along with universal consumer availability and use, constitutes the most pervasive human scourge known to man, as measured by morbidity and mortality, including the accumulated toll of wars through the centuries. The negative impact of cigarette smoking is manifest in virtually every sphere of human activity: health, cultural and social values, corporate.responsibility and legislative action and regulations. Dr. Paul Kotin, medical director, Johns-Manville, Denver, Colo., 5/12 Denver, pp. 2-3. (ACS President Benjamin) Byrd also made a distinction between cigarette and other potentially harmful consumer products: "Cigarettes, and tobacco products, are unique among the products bought legally by consumers. Used as intended, that is to say smoked, cigarettes are inevitably and entirely a health hazard." Dr. Paul Kotin, medical director, Johns-Manville, Denver, Colo., Fact Sheet attached to 5/12 Denver, p. 1 There is evidence that sidestream smoke in a cockpit impairs up to 25% of the pilot's ability to function, at a time when hundreds of passen- gers depend upon him for their safety. E. D. Glover, Ph.D., Asst. Prof., Univ. of Kansas Health Dept., Lawrence, Kansas, 5/19 St. Louis, p. 1. I am 31 years old and have worked in an underground iron mine for the past 12 years. ___Tom Fite,.laryngectomy patient, Sullivan, Missouri, 5/19 St. Louis, P• 1• Cigarette smoking is directly or indirectly involved in one in every three deaths in the United States, and is directly responsible for the staggering increase in cancer of the lung and chronic bronchitis and emphysema that have taken place over the last forty years. Roger H. Secker-Walker, Assoc. Prof. of Medicine & Physiology, Director, Pulmonary Div. Dept. of Int. Med., St. Louis Univ. School of Medicine, St. Louis, Mo., St. Louis, 5/19 p. x. CONFIDENTIAL: TIMN 288610 MIMVESOTA TOBACCO LITIGATION

EXAGGERATION (page ten) Many people are concerned about "hyperactive children" these days, and many causes have been proposed for this behavior disorder. An interesting possibility was described a few years ago in a report from Candad (sic), which suggested that "hyperactivity" may be a withdrawal symptom in the infant born to a smoking mother, since there appeared to be some increased incidence of this condition in those children. In this regard, a few weeks ago when I saw one of my patients who I believe has true "hyper- activity," his father reported that several days before this visit the child has eaten 2-3 cigarette buttts (sic) which had been left in the ashtray. His father reported that his behavior was much more agreeable for two or three days following this episode, and the school had fewer complaints. I certainly do not suggest that tobacco and smoking be used in the treatment of "hyperactivity," although I am sure that perhaps everything else has been tried. Warren Bosley, M.D., Pediatrician, Grand Island, Nebraska, 5/19 St. Louis, pp. 2-3. A powerful carcinogen, derived from benz-pyrene (which is present in cigarette smoke) has been shown to localize in the genetic material of the cells that make up the bronchial epithelium, thus completing the link. between cigarette smoking and lung cancer. Roger H. Secker-Walker, Assoc. Prof. of Medicine & Physiology, Director, Pulmonary Div. Dept. of Int. Med., St. Louis Univ. School of Medicine, 5/19 St. Louis, p. 2. Given current programs discouraging smoking, unsafe driving, and stress- ful life styles; campaigns urging regular visits to dentists, gyneco- logists, optometrists, and family doctors; campaigns urging daily con- sumption of the "basic four"; and, finally, routine announcements of new discoveries of health risks inherent in everything from the owning. of dogs to the purchase of hot dogs, we may confidently suppose that the individual American feels that he has a free, unsolicited, and irrevocable subscription to the "Risk of the Week Club." E. B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ., St. Louis, Missouri, 5/19 St. Louis, P• 14• The EPA national primary and secondary ambiant air quality standards have established that the maximum safe level of carbon monoxide is nine parts per million. The OSHA maximum safe level is 50 parts per million. It is hard to explain why the EPA has standards that are five times as high for tolerance as compared with OSHA. Oscar_Austa_d,_President, Austad Co., Sioux Falls, S.D., 5/19 St. Louis, P- 4. CONFIDENTIAL: TIMN 288611 MINNESOTA TOBACCO LITIGATION

-98- E X A G G E R A T I 0 N (page eleven) It seems odd that OSHA, which goes to great expensive lengths to make a big issue of some hazard that is not likely to cause an accident in 100 years, will not lift a finger to protect the right of an employee to breathe pure air while on the job. In a discussion with one of the OSHA officials, and he will not permit us to quote him by name, he indicated that the problem is political. Apparently the tobacco lobby is too strong in Washington. The OSHA officer indicates that Congress should be pres- surized to strengthen the law. I suggest that this is simply "passing the buck" as they already have all the authority they need. Why should it be necessary for us to have to wait for Congress to pressure an agency to perform a job that they were already set up to do and so authorized. (sic) I understand that there is a possibility that another fine and effective non-smoking agency called Action on Smoking and Health may file suit against OSHA for failing to perform their duties in this important area. Oscar Austad, President, Austad Co., Sioux Falls, S.D., 5/19 St. Louis, . P- 5. Now nearly 4,000,000 Mormons are in the vanguard of the efforts to protect humanity against the dangers of smoking. Melvin Jensen, advertising exec., Mormon spokesman, TI "Target 5" film, ACS LA speakers, p. 7. Since the Surgeon General's report warning against cigarette smoking was issued in 1964, 3,900,000 men and women have died of lung cancer alone. About eight times that number have died from coronary heart disease asso- ciated with cigarettes smoking and with a host of other illnesses. And so we're presented here with a major preventable public health problem. Victor Weingarten, executive director, National Commission on Smoking & Public Health, 5/17 Seattle, Tape 1, Side 1, Rev. 43. ~ In general, my observation has been that heavy tobacco users have a decreased feeling of well-being as compared to other members of society. Edmund Truelove, D.D.S., chairman, Dept. of Oral Diagnosis, Univ. of Wash. School of Dentistry, 5/17 Seattle Tape 1, side 2, rev. 6. Ninety-seven percent of all individuals developing oral cancer have at one time used tobacco. Edmund Truelove, D.D.S., chairman, Dept. of Oral Diagnosis, Univ. of Wash. School of Dentistry, 5/17 Seattle Tape 1, side 2, rev. 13. CONFIDENTIAL: TIMN 288612 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I O N (page twelve) Smoking clearly alters the nutritional intake of heavy smokers. They have a significant loss of taste, very often increased snacking, increased utilization of high-carbohydrate food and develop somewhat deviant nutri- tional intake patterns. We also notice the significant decrease in oral hygiene in heavy smokers. They have less concern about their overall oral health. Edmund Truelove, D.D.S., chairman, Dept. of Oral Diagnosis, Univ. of Wash. School of Dentistry, 5/17 Seattle, Tape 1, Side 2, rev. 51. We know that at the least it's a dirty social habit and in its most severe form may contribute to severe disfigurement and death. Edmund Truelove, D.D.S., chairman, Dept. of Oral Diagnosis, Univ. of Wash. School of Dentistry, 5/17 Seattle, Tape 1, Side 2, rev. 160. Cigarette free give-aways, in packages of five cigarettes, were initiated in trains, aircraft commercial flights, and on street corners, to have non- smokers try smoking. Louis U. Fink, Orlando, Florida, 6/14 Atlanta, p. 4. For more than ten years to date, the tobacco industry through its 'tobacco bloc in the Congress' has, under Federal Law which defined 'tobacco products' as 'Food' been able to ship more than $700 millions value in tobacco products to 'needy nations' with payment for same being made to the tobacco manufacturers by an agency of the federal government. Not a single recipient nation has ever repaid our government for these shipments. Louis U. Fink, Orlando, Florida, 6/14 Atlanta, p. 2. ...it is nothing short of malpractice for a physician to fail to include "Cigarette Habituation" as a problem on the patient's medical record. Alan Blum, M.D., Miami, Florida,6/14 Atlanta, p. 2. Tobacco industry money directly defeated former Senator Moss. Although it failed to remove Representative Drinan, its influence is being exerted, among other ways, in the form of "spontaneous grassroots" (quotes mine) petitions urging the Civil Aeronautics Board to go against safety and health by continuing to permit smoke in airplane compartments. Alan Blum, M.D. Miami, Florida, 6/14 Atlanta, p. 9. CONFIDENTIAL: TIMN 288613 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I O N (page thirteen) ...ci.garette smoking remains one of the critical health problems of our time. Morbidity and mortality rates could be reduced by persuading a substantial number of smokers to stop. Indeed, public health agencies have a moral responsibility to marshall programs that will decrease sickness and premature death. W. Bernard Suttake, health educator, Bergen County, New Jersey Health Dept. 6/16 Philadelphia p. 3. The subliminal seductionists look for the less obvious: Salem, re- arranged, spells the word "males"; Benson & Hedges' extra length stands for an extra-long penis; the one-humped camel of the brand by the same name symbolizes pregnancy; the name Virginia i~ Slims connotes a "slim virgin." If their suspicions are correct, eliminating the seduc- tive lure of cigarettes is going to require much more than the elimination of cigarette advertising: It may mean giving the brands numbers instead of names...avoiding, of course, the number 69. Ann H. Dailey, Vice President, Torrieri-Myers Adver- tising, Inc., Baltimore, Maryland, 6/16 Philadelphia pp. 8-9. Polluted air has become a serious problem yet many people who complain about it deliberately inhale contaminated air when they smoke. Attachment to George Browne statement, Commissioner, Dept. of Drug and Alcohol Addiction, Nassau County, New York, 6/16 Philadelphia. Excessive tobacco usage has been well demonstrated to have a far greater impact on ill health than most other environmental factors. Ernst L. Wynder, M.D., Naylor Dana Institute for Disease Prevention and the Health Maintenance Institute, American Health Foundation, '6/16 Philadelphia,p, 9. It was proven a few years ago by our British medical cohorts that the side- stream smoke is more damaging to the non-smoker than the main stream is to the drug addict. Janith S. Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 3. Once cadmium gets into your lungs it stays there for ever, thus contra- dicting the adage of long standing that once you give up smoking, if you don't have cancer or emphysema, they will return to normal. Janith S. Kice, M.D., Garden City, New York, 6/17 Philadelphia, P• 3- CONFIDENTIAL: TIMN 288614 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page fourteen) ...the average age of drug addiction, namely to nicotine, has dropped precipitously to the 4th grade level. Janith S. Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 3- The astronomical cost of cigarettes also lessens the amount of available money for the purchase of nutritious food for the children as well as the smoking parents. Janith S. Kice, M.D., Garden City, New York, 6/16 Philadelphia, P. 4. In spite of the fact that cigarette smoke has a hundred million times more air pollution than the worst air pollution disaster ever, people still go on smoking. Roger Secker-Walker, Director of the Pulmonary Division, Dept. of Internal Medicine, St. Louis University School of Medicine, 5/19 St. Louis, Tape 2, side 1, rev. 347. I've gotten to the point, I believe, I can almost identify the smokers on sight. Because I've noticed that, specially women, who smoke heavily in- variably have very wrinkled skins. And you can see a woman with white hair and nice smooth complexion you can be sure that she is not a smoker. Harry Pope, Restaurateur, St. Louis, 5/19 St. Louis, Tape 2, side 2, rev. 266. Heart disease is the No. 1 killer in this country. It accounts for 685,000 deaths every year. It is estimated that 25 percent of those deaths could be avoided if we could get people to stop smoking cigarettes. Jerome Cohen, M.D., Clinical Cardiologist, St. Louis University Hospital, 5/19 St. Louis, Tape 2, side 2. ~ rev. 552. Why...does industry perpetuate a double standard, preventing the use of alcohol and other drugs on the job but permitting the use of a toxic sub- stance labeled as harmful to health? What company would permit an employee to bring a fifth of liquor to the workplace for daily consumption...or permit the paraphernalia of a"hardv drug habit to clutter the desk in preparation for a "fix?" Even more thought-provoking is the realization that neither of these habits immediately and adversely affect the health of the innocent bystander...whereas smoking is harmful to everyone.. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 3. CONFIDENTIAL: TIMN 288615 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page f if teen) Time and motion studies show a loss of productivity among smoking employees ranging from 2 to 10% Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 8. Cigarette smoking is the foremost among the preventable environmental hazards which threaten the health of our nation. Other tools Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 1. should be considered in an all-out assault against smoking. Senator Birch Bayh (D.-Ind.)_, 5/25 Chicago, page 6. What about the label on the package? Instead of the innocuous sounding names and the meaningless geometric designs, I submit that the package should have the universally recognized sign of poison, the skull and crossbones,along with the word POISON in large letters. David T. Carr, M.D., Associate Director for Cancer Control, Mayo Clinic, Rochester, Minnesota, 5/25 Chicago, page two. If advertising of this deadly product is to be permitted in the future, the truth in advertising laws should require that at least one-half of the space of each advertisement be used to describe the poisonous nature of the material and its effects on those who use it. David T. Carr, M.D., Associate Director for Cancer Control, Mayo Clinic, Rochester, Minnesota, 5/25 Chicago, page 2. Earlier I referred to those who manufacture and sell tobacco as the tobacco industry. They were more accurately named by Sir George Godber of England who was chairman of the Third World Conference on Smoking and Health in 1975. He called them The Merchants of Death. David T. Carr, M.D., Associate Director for Cancer Control, Mayo Clinic, Rochester, Minnesota, 5/25 Chicago, page 3. CONFIDENTIAL: TIMN 288616 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page sixteen) I submit that the medical profession should begin to diagnose chronic tobacco poisoning whenever it occurs whether it is manifested as lung cancer, chronic bronchitis and emphysema, or damage to the cardio- vascular system. Finally, we come to the end, as do so many smokers, and we must consider death certificates. The cause of death should be stated clearly and completely on each certificate. If a person's death is due to chronic tobacco poisoning the death certificate should state this fact. Imagine the reaction if our vital statistics suddenly began to tell the whole truth and indicated that chronic tobacco poisoning was high up in the list of the ten most common causes of death in our country. Or perhaps, the death certificate should read chronic suicide. One definition of suicide is "One who dies by his own hand" and surely anyone who strikes a match and sets fire to dried vegetable material so that the poisonous fumes can be sucked into the lungs is committing chronic suicide. David T. Carr, M.D., Associate Director for Cancer Control, Mayo Clinic, Rochester, Minnesota, 5/25 Chicago, page 4. the new standards adopted by OSHA has a limit for emissions from coke ovens that represents an 8-hour exposure to coal tars that is lower than the exposure the same employee would get from smoking just one low- tar cigarette. Perhaps this contrast makes the point that government regulations have become extremely stringent in many work place environ- ments, and at the same time exercise very little control over the use of tobacco. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, ohio, 5/25 Chicago, page 4. there is little logic in tolerating smoking at working places at a time when considerably less hazardous emissions have been limited and certain harmful substances have been banned. Millions of dollars are being spent to eliminate emissions that we know are less hazardous to health than cigarette smoking. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 5. Dr. John J. McKetta, a professor in the Department of Chemical Engineering at the University of Texas, points out the illogic of our piecemeal approach in this way: "To put things in perspective, let me point out that the average concentration of carbon monoxide in Austin, Texas, is about 1.5 parts per million. In downtown Houston, in heavy traffic, it sometimes builds up to 15 or 20 ppm. In Los Angeles it gets to be as high as 35 ppm. In parking garages and tunnels it is sometimes 50 ppm." Then he goes on to add the clincher when he says this: "Here lies a surprise for most people -- did you know that the carbon monoxide content -j--1 Mtj z880-7

E X A G G E R A T I 0 N (page seventeen) (statement continued from preceding page) of cigarette smoke is as high as 42,000 parts per million? The CO con- centration in practically any smoke-filled room grossly exceeds the safety standards we allow in our facilities. Of course, 35 to 50 ppm CO should not be ignored but there are so many of us who subject ourselves to CO concentrations voluntarily (and involuntarily) that are greater than those of our most polluted cities, including the Holland Tunnel in New York, without any catastrophic effects. It is not at all unusual for CO concentrations to reach 100-200 ppm. range in poorly ventilated smoke-filled rooms. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 7. In a heavy pipe smoker (have you ever seen a picture of Arthur Burns, head of the Federal Reserve, without a pipe in his mouth?), contemplate that up to 15 per cent of the brain power is out of action when the oxygen can't be delivered. President Ford and his chief adviser also treasure pipes! Ernest W. Johnson, M.D., Chairman, Dept. of Physical Medicine, Ohio State University, School of Medicine, Columbus, Ohio, in '76 reprint with 5/25 Chicago statement. Being in the business that I am and doing countless commercials each day for a myriad of products, I should have realized that the industry needed some kind of spokesperson to counteract the truth. You see, profit is the most important thing to the tobacco industry. But profit at the expense of human life is going too far. ' Roy Leonard, WGN Radio, Chicago, Illinois, 5/25 Chicago, page 1. We must call a halt to the indiscriminate distribution of cigarettes on street corners. Handing someone a pack of these is similar to handing someone a gun. Roy Leonard, WGN Radio, Chicago, Illinois, 5/25 Chicago, page 1. Those interested in cleaner air might be interested to know that nearly forty tons of solid air pollutants in the form of smoke particles are sent into the atmosphere each day by American smokers. How about this one? The butts and wrappers of eighty million packs of cigarettes smoked daily in this country add up to 1,760 tons of trash, not count- ing the cartons and shipping boxes. Roy Leonard, WGN Radio, Chicago, Illinois, 5/25 Chicago, page 2. CONFIDENTIAL: TIMN 288618 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page eighteen) To sanction a student smoking area on school premises is analogous to having a drug area or a cocktail lounge in our schools. This com- parison is based on the statistics that show smoking kills more people than drugs or alcohol. Richard J. Martwick, Supt. of Schools, Educational Service region, Cook County, Illinois, 5/25 Chicago, page 5. After my surgery [laryngectomy] and the three heart attacks, also as a result of my smoking history... Pat Patterson, ACS Volunteer, Cancer victim, 5/25 Chicago, page 2. The American Cancer Society would like nothing better than to have to close their doors for lack of business. Pat Patterson, ACS Volunteer, Cancer victim, 5/25 Chicago, page 3. A major step in the right direction would be abolition of tobacco smoking. But instead of the FDA applying pressure in this direction, where the evidence is overwhelming, they are busying themselves with cyclamates, saccharin, pesticides, areas in which the evidence is weaker or equivocal and in which the numbers of persons involved is not nearly so great. Robert L. Schmitz, M.D., Mercy Hospital and Medical Center; Board Member of Illinois ACS; Chicago, Ill.; 5/25 Chicago, page 1. ...the Government collects $6 billion in tobacco taxes, spends $60 million of it on tobacco subsidies (most of which go to corporations and not to the small farmer) and gives a"generous" $90,000 (sic) to the National Clearing House on Smoking and Health. Robert L. Schmitz, M.D., Mercy Hospital and Medical Center; Board Member of Illinois ACS, Chicago, Ill., 5/25 Chicago, page 1. Although physicians concerned with exposure to carbon monoxide, from the standpoint of public health, are worried when the concentration of this gas approaches 100 parts per million, it is not generally known that the exposure resulting from cigarette smoking is enormously greater. The inhaled smoke of the cigarette contains not 100, but closer to 50,000 parts per million of carbon monoxide! Harry Spataro, Delta Airlines Pilot; City Councilman, Downers Grove, Ill.; 5/25 Chicago statement. CONFIDENTIAL: TIMN 288619 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (p age nine t e en ) Everyone's health is adversely affected by tobacco smoke. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, I11., 5/25 Chicago, page 1. A Harvard Medical School doctor says that smokers produce 40 tons of air pollution a day. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 1. One out of every 6 Americans is highly allergic to smoke. That's 37,000,000 people. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill.,5/25 Chicago, page 2. If every restaurant had nonsmoking sections 37,000,000 more Americans (the allergic ones) could come out of hiding and could dine out without the fear of allergic reactions. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 3. 30,000 Americans have quit. By losing these 30,000,000 customers the tobacco industry is losing over $6,000,000,000 in business each year. So they've stepped up their advertising campaigns. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill.; 5/25 Chicago, page 4. We know there are poison gases in tobacco products and that cigarettes are addictive. It should be illegal to pass out poison and drugs in the form of free sample cigarettes on street corners. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 5. ...nicotine, carbon monoxide, and the more than 200 other chemicals in tobacco smoke are as much drugs as cannabis, cocaine, heroin, ampheta- mine, valium, or seconal. Sherwyn Warren, M.D., Chairman, Illinois Interagency Council on Smoking and Disease, Winnetka, Ill., 5/25 Chicago, page 2. CONFIDENTIAL: TIMN 288620 IVIINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page twenty) Our whole approach to hazardous 3ubstances borders on irrational and schizophrenic thinking. We ban the cyclamates, propose a ban on saccharin, restrict the sale of asbestos products, and look for cars that will emit oxygen while continuing to subsidize, advertise, and distribute tobacco. In short, "We strain out the gnat and swallow a camel." Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, page 1. ...the chances are about 99% certain that I could have avoided the problem (lung cancer] if only I had quit smoking. H. P. Zhorne, Cancer victim, Glenview, Illinois, 5/25 Chicago, page 1. DuVal: . . . Could I ask you what your judgment would be about the impact, say, on the incidence of smoking in young girls if I told you unequivocally that you would in- crease the chance of having acne, that you would lose your beauty and your skin would wrinkle earlier? Would that have any more or less impact than knowledge about its effect on your general health? Borgaard: That could very easily have more of an effect ... especially the young girls . . . Merlin DuVal, NCSPP member, and Kathy Borgaard, high school student, Cheyenne Wyo.; 5/12 Denver, Tape 2, rev. 76-78. ... jT]he number of pollutant particles per cubic millimeter in the smoke from a non-filtered cigarette are 5 billion, as contrasted with the number of particles of pollutants in the.highest reported urban population of 100,000. Now one cannot condone air pollution . . . but it's miniscule as compared with the air pollution one produces himself. Alton Ochsner, M.D., founder of Ochsner Clinic, New Orleans; 5/12 Denver, Tape 1, rev. 192. If you would lay the dead smoking bodies head to toe on a highway, that slaughter line would stretch for 350 miles, almost the distance between Denver and Santa Fe, New Mexico. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 88. TIMN 288621 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

-108- E X A G G E R A T I 0 N (page twenty-one) [The report to the Surgeon General] . . . has not been refuted in the years that have passed since 1964. It still stands and the burden of proof is on those that say this is not scientific evidence indicting cigarette smoking. Charles A. LeMaistre, M.D., Chairman, ACS Texas Division, Study Committee on Tobacco and Cancer; of NCSPP panel, 5/12 Denver, Tape 2, Rev. 333. later member ((Asked by Huff what motivated her to become a stop-smoking volunteer and why she is so against smoking)): I love America. The only way that we can be a free, healthy America is to get rid of all the things that are hazardous to our health, and I think that cigarettes come in that category, and as a matter of fact I think they top the list. Because I find that if someone is plagued by common diseases and not really having the ability to exert a lot of energy during the day they are generally smokers. When you get them off their cigarettes they begin to eat better, which means they begin to think better. Thinking is going to make us a better country. Mrs. Carolyn Cole, housewife, mother and ACS Quit Smoking Coordinator, Pensacola; 6/14 Atlanta, Tape 1, side 2, rev. 933. ((Tape picks her up in the middle, but AHD notes show she claimed a $730 a.year cost to the employer for every smoking absentee, whatever that could mean)) Dot Mims, employee education chairman, Florence County, South Carolina, ACS; 6/14 Atlanta, tape 1, side 2, rev. 1175-1238. ....50 percent of the patients that we see have cancer that is primarily attributable to smoking. ~ Richard Marks, Jr., M.D., Department of Radiation -~+ Therapy, Medical University of S. C., Charleston, S.C.; ~ 6/14 Atlanta, Tape 2, side 2, rev. 53. ~ ~~..~ U Cancer of the lung, cancer of the throat, cancer of the larynx, cancer of the mouth, cancer of the esophagus, cancer of the bladder --,100 percent caused by smoking. ~~ Richard Marks, Jr., M.D., Department of Radiation W d Therapy, Medical University'of S. Car., Charleston, S.C.; ~ 6/14 Atlanta, Tape 2, side 2, rev. 78. O H ..Americans are finally realizing, I think, that they've been duped, that ~ H they're being killed, and maimed not so much through their own weaknesses, O although that's partially true, but by conscious attempts on the part of ~ people whose only regard is the bottom line. Jonathan Fielding, M.D., Massachusetts Commissioner of Public Health; 6/2 Boston, Tape 1, side 1, rev. 182. TIMN 288622

E X A G G E R A T I 0 N (page twenty-two) Heavy smoking is not dangerous only for the smoker but for the human race. Hugues J. P. Ryser, M.D., prof.,of pathology & pharmacology, 'Boston Univ. Sch. of Med., Boston, Mass., 6/2 Boston, Tape 1, side l, rev. 829, West Room. Smoking may also affect the digestive system and liver functions. And smokers have a 20 percent greater incidence of skin allergies that frequently clear up when they quit. As a smoker, nothing is in your favor. Soldier magazine, July 1977, submitted to Atlanta forum, 6/14/77 by SP5 S.D. Bates, Ft. Gordon, GA. I did see one 17 year old who died with laryngeal cancer who started smoking when he was six. Ashbell C. Williams, M.D., former ACS president, now honorary life member, ACS, Jacksonville, FLA., 6/14 Atlanta, Tape 1, side 2, rev. 2. The reports to the stockholders ((of the cigarette mfgrs.))mention the fact that the warning label on the cigarettes and the microscopic portion in the advertisements ((T&N yield)) preclude any plaintiff from winning any of these actions due to the fact that oui judicial procedures claim that when there is a warning there is contributory negligence on the part of the plaintiff_ Louis U. Fink, retired businessman, Orlando, FLA., member of IUCC workshop on smoking & health, 6/14 Atlanta, Tape 2, side 1, rev. 1112. Last week I was surprised that Joseph Califano, our new HEW administrator, member of the Cabinet, came out against smoking. He was one of the strongest of the lawyers working for Philip Morris to defeat governmental attempts to control Philip Morris practices. Louis U. Fink, retired businessman, Orlando FLA., member of IUCC workshop on smoking & health, 6/14 Atlanta, Tape 2, side 1, rev. 1152. It all comes out of here. We control all the tobacco business in the entire world. Every bit of it. There are no real independents. Louis U. Fink, retired businessman, Orlando, FLA., member of IUCC workshop on smoking & health, 6/14 Atlanta, Tape 2, side 1, rev. 1173. CONFIDENTIAL: TjMN 288623 MINNESOTA TOBACCO LITIGATION f

E X A G G E R A T I 0 N (page twenty-three) The increased risks of anesthesia in smokers is also worthy of mention. Seebert J. Goldowsky, M.D., retired surgeon, medical director, R. I. Blue Cross/Blue Shield, Providence, immediate past president of R. I. Interagency Council on Smoking, 6/2'"Boston, p. 2. Why a significant segment of the population are bent on self destruction through cigarette smoking is unknown. The pathological force that impells the alcoholic or the speeding driver to suicide is equally mysterious. Louis A. Leone, M.D., Director, Dept. of Medical Oncology, R. I. Hospital, Providence, R. I., 6/2 Boston, p. 1. At issue here is whether or not the smoker's fullfilment of his need for oral gratification represents an imposition of the rights of his non-smoking neighbors? The answer to that question is an unequivocable yes. Lois G. Pines, State representative, Newton, MASS., 6/2 Boston,' • p. 2. Delivered by Leg. Asst. Douglas Husette. Our campaigns ((public service anti-smoking)) must have worked because the tobacco industry lobbied to have all of their advertising on radio and T. V. banned... William W. Campbell, commercial manager, WPRO Radio, Providence, R_ I_, ACS volunteer, 6/2 Boston, p. 2. The American Lung Association has printed tens of thousands of attractive slogan buttons which read "thanks for not smoking" and "Yes, I mind if you smoke," but if you wear these or similar symbols of protest, your chances for getting a face full of smoke multiplies by ten fold. Stephen Sedberry, musician, Birmingham, Alabama & Roxbury Crossing, MASS., 6/2 Boston p. 4. There is a need not for the reduction of the battle to improve ecology, but for a much higher priority in the battle against diseases caused by tobacco use. Two packages of cigarettes per day exceed in air pollutant equivalence by a factor of five, the damage done to a person from the worst day of London smog. John W. Turner, M. D., Radiologist, Wesson Memorial Unit, Baystate Medical Center, Springfield, MASS., president, Mass. Div. ACS,6/2 Boston, p. 2. -110- I CONFIDENTIAL: TIMN 288624 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page twenty-four) One can specalate whether saccharin would ever be banned if that industry had even one-hundredth the economic muscle of the tobacco industry. Blake Cady, M.D., surgeon, Lahey Clinic, Boston, MASS., 6/2 Boston, P- 2 This ((tobacco)) industry is systematically poisoning nv.3re than one- quarter of our population and aggressively recruiting more adherents and urging greater usage! Blake Cady, M.D., surgeon, Lahey Clinic, Boston, MASS., 6/2 Boston, pp. 2-3. In every reliable scientific study performed, indications are that bodily function and physical and mental processes are nearly univer- sally impaired by smoking. Blake Cady, M.D., surgeon, Lahey Clinic, Boston, MASS., 6/2 Boston, p. 3. Following all types of surgery smokers have a higher morbidity and mortality than nonsmokers and more frequently require management in intensive care units. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, p. 1. An all out effort should be made to eventually create a nonsmoking society. Then one-half of all cancers would never develop. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, p. 4. Dr. H. W. Daniel (sic), of Redding, Cal. has clearly demonstrated that prominent facial wrinkling and smoking are related in all age groups. Walter Kloss, president, American Lung Assn. of Mass., Director of the 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 2. ...everyone who purchases a new car, whether he smokes or not, must pay for the habit. The ashtrays and cigarette lighters in the new automobile are standard equipment and not options. Walter Kloss, president, American Lung Assn. of Mass., Director of the 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 6. CONFIDENTIAL: Z'IMN 288625 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page twenty-five) Temperature-control engineers estimate that the air-conditioning capacity required to accommodate smoking within a building is six times greater than would be required if it were disigned (sic) for nonsmokers. Walter Kloss, president, American Lung Assn. of Mass., Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass.,-6/2'Boston, p. 7. One cigarette smoked, it is calculated, wastes approximately 25 mg. of vitamin C from the smokers body resources. When the official minimum daily requirement is considered to be 60 mg. of vitamin C per day, one can easily see what a very few cigarettes will do. Ernest M. Fidance, D.D.S., Wilmington, De., 6/16 Philadelphia, pp. 2-3. There are many reasons for changes in your red cell count: stress, illness, lack of oxygen at high altitudes, are some examples. Dr. Milton Eisen of New York City has presented evidence that smoking causes an increase in red blood cells. The clinical research reports indicate that when his patients stop smoking, their red cell counts dropped and it increased again when they resumed smoking. Ernest M. Fidance, D.D.S., Wilmington, De., 6/16 Philadelphia, p. 3. The rapid weight gain after smoking is discontinued, is not always due to an increase in food consumption, but is often due to rehydration of the body with a result in thinner blood. Ernest M. Fidance, D.D.S., Wilmington, De., 6/16 Philadelphia, p, 3. ...the heavy smoker who wears full dentures is considered lucky if he lost his teeth before he lost his life from lung cancer, emphysema or early heart attack. Ernest M. Fidance, D.D.S., Wilmington, De., 6/16 Philadelphia, p. 4. I heard on the morning news this month a fast statistic; for every cigarette a person smokes, 5 1/2 minutes is gone from his or her life. I hadn't heard if before and I will probably not hear it again statistic from a reliable medical source. Jeanne A. Cunnius, vice president, Business Careers, New York City, 6/16 Philadelphia, p. 3. MZNNESOTAOTOBACCO L' TIMN 288626 LITIGATION j

-113- E X A G G E R A T I 0 N (page twenty-six) This is an unconscionable industry that has known for decades that they were profitting from a dangerous product, but they went about soliciting the endorsement of movie stars and doctors to help addict a new generation. Not only does this industry have great profits at its disposal to use in advertising, but they also have enough voters among the farmers, tobacco factory workers, and small vendors in key Southern states to frustrate progressive legislation. Joseph M. Deignan, M.D. thoracic & cardiovascular surgeon, Winchester, Va., 6/16 Philadelphia, p. 2. One month ago in San Francisco, William Dwyer, a spokesman for the Tobacco institute, launced (sic) a counter attack against the American Cancer Society, The Lung Association and Heart Association, charging them of victimizing the American public with their annual campaigns for funds to support public education and research. The Tobacco Institute likes to brag that they have spent $40 million since 1954 to support various research projects, relevant to the questions of tobacco and health. Of course, when one compares this $40 million in research grants to the estimated $400 million the industry spends annually for advertising, one could conclude that the research contribution by the tobacco industry is a mere diversionary activity of token proportions. Joseph M. Deignan, M.D., thoracic & cardiovascular surgeon, Winchester, Va., 6/16 Philadelphia, p. 2. We need new and vigorous public health campaigns to expose the havoc of cigarette smoking and the callousness of the Tobacco Industry. Joseph M. Deignan, M.D., thoracic & cardiovascular surgeon, Winchester, Va., 6/16 Philadelphia, p. 3, ...more than 250,000 Americans each year...contract lung cancer, bronchitis, emphysema, or heart disease as a direct result of cigarette smoking. Nick Rahall, U. S. Congressman, (D-W. Va.), 6/16 Philadelphia, p. 1. The total callousness with which the tobacco industry views this alarming ((lung cancer increase)) ...is characterized in a speech made by Joseph Williams, President of Tobacco Associates Inc., in which he is quoted as urging his organization to enter into "a bitter fight against the common enemies - health and taxes." Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, p. 1. CONFIDENTIAL: TIMN 288627 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page twenty-seven) Do you realize that smokers cost my family and non-smoking families in the United States an estimated $250 each year in HIGHER PREMIUMS for LIFE, HEALTH, FIRE & AUTO INSURANCE HIGHER PRICES for ALL GOODS AND SERVICES (because of increased absenteeism, disease, and disability related to smoking). HIGHER TAXES FEDERAL STATE, AND LOCAL (because of increased public health payments,'fire and cigarette damage to public property, and increased costs for cleaning public buildings). Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, 6/16 Philadelphia, p. 1. All these abuses ((by smokers)) and many others cause the loss of thousands of lives of innocent non-smokers. Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, 6/16 Philadelphia, p. 1. ...My statement before the House Committee on the Hazards and Economics of Smoking - April 23, 1969... Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, 6/16 Philadelphia, p. 2. ...the net, net expense that smokers cost our nation is about $20 billion dollars a year. Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, 6/16 Philadelphia, p. 2. ...the economic benefits to the so-called tobacco states derived from the tobacco industry are minimal and have been declining. Over the years, the tobacco industry has contributed little or nothing to the growth of those tobacco states. We are talking less about the effects of tobacco on the economy of a few states. What it boils down to is protection for a few companies at the expense of the whole nation. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, 6/16 Philadelphia, CONFIDENTIAL: TIMN 288628 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page twenty-eight) Lighting a cigarette and smoking the cigarette while they are driving causes many accidents. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, "6/16 Philadelphia. I have here an estimate of what is required to produce the results of a 50-percent reduction in cigarette smoking in 10 years at a gradual rate of 5 percent a year. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, N. Y., 6/16 Philadelphia. Now, gentlemen, 625,000 families receive $1.4 billion annually. That is $2,240 a family. No wonder...the father, mother, teenage sons and daughters have to go to the field in the production of the crop, and the sweat streams. I thought that 50 years ago we got rid of our sweatshops. We apparently still have them there caused by the tobacco industry. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, N. Y., 6/16 Philadelphia. ...a person can feel a whole lot worse after smoking than after drinking; it depends on the person and to what extent he may be drinking or smoking. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, N. Y., 6/16 Philadelphia. ...I feel that in time an objective study should be made into all of these important areas--cigarette smoking, liquor, automobiles--to make certain that people who use these different products do not place an undue burden on the others that do not use them and that the payment that they make should be equal to the costs that they create. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, N. Y., 6/16 Philadelphia. Roth first began to reckon the dollar costs in 1963. A careful study showed that smoking employes'were costing the bank $7 a week each in lower productivity, higher absenteeism, burned furniture and rugs. Since half the 2400 employes smoked, Roth figured that this was draining off more than $436,000 a year. Reader's Digest (introduction) 3/72 article cited by Arthur Roth, former bd. chairman, Franklin National Bank, Rockville Centre, N. Y., 6/16 Philadelphia. CONFIDENTIAL: TIMN 288629 MINNESOTA TOBACCO LITIGATION

-1~6- E X A G G E R A T I 0 N (page twenty-nine) While it is true that many fine organizations and groups are engaged in the fight against cigarette smoking, total victory is too slow in coming, and the amount of continuing human suffering to smokers and non-smokers is too high a price to pay for further delays. What is needed is total national commitment to stamp out smoking TOTALLY-NOW! Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., '6/16 Philadelphia. An all-out war on cigarette smoking is necessary because the manufacture, distribution, promotion, sale and consumption of cigarettes has been proven to be a clear and present danger to the health of our citizens. The danger is clear enough and serious enough to justify an immediate all-out effort to eliminate it. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., 6/16 Philadelphia. Death rates from all causes rise sharply with the number of cigarettes smoked. (40% higher for smoker of less than 10 cigarettes a day; 70% for 10-19, 90% for 20-36 and 120% for 40 or more). Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., 6/16 Philadelphia. Evidence is beginning to show that cigarette smoking attacks the central nervous system. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., 6/16 Philadelphia. A non-smoker is forced against his will to breathe almost as much carbon monoxide, tar and nicotine as the active smoker sitting next to him. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., 6/16 Philadelphia. . Organize boycottsI! against sellers of cigarettes. Also against products of companies who manufacture cigarettes. Set up booths throughout the area for people to VOLUNTEER for the ARMY TO FIGHT SMOKING...Organize non-violent marches and demonstrations by volunteers using a skull and crossbones as symbol. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., 6/16 Philadelphia. CONFIDENTIAL: TIMN 288630 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 014 (page thirty) ...some of the same forces which perpetuate cigarette smoking also per- petuate alcohol, also perpetuate the continuation of the plague.of homocides due to handguns and to a certain extent are also due to our inability to respond properly to the energy shortage. Bernard Mausner, Ph.D., prof. of psych., Beaver College, Glenside, PA., Philadelphia 6/16/77, Reel 1, Side 2, Rev. 446. ...in the Washington arena it is quite clear that political opinion leaders, particularly prominent Southern congressmen, continue to deceive the public, continue to be caught in their own political problems, in their own constituencies, and what I'm sure they do not recognize is the proper, better health policy. I think one can see examples, for example, of a congressman who, in one setting, will be very prominent on behalf of health issues, and turn right around and force privately the supporting of the tobacco industry, the subsidies and undermine, when it comes to cigarettes, confidence in the message that is dealing with a true and severe hazard. J. Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. We are talking about maybe 35% of the people in the industrial population smoke, a little over a third maybe, so two-thirds don't. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, Tape 2, rev. 113. I suggest that we put this on the MCAT; that is, that on the bottom line is "if you smoke you don't get into medical.school"... the average length of life is 8 or 9 years less and so why fund that person when you know he is not going to practice as long. Ernest W. Johnson, M.D. Director of Physical Medicine, Ohio State Univ. School of Medicine, Columbus, Ohio, 5/25 Chicago, Tape l, rev. 795. ...I would hope that somewhere along the line, someone makes a study of the smoking habits of cigarette company executives and workers, and if by chance...he finds out that some high executive of a cigarette company has died of lung cancer -- and it seems to me a year or so ago, one of the Reynolds family did -- to approach the close relatives of those people and get them on our side. Saul R. Kelson, M.D., cardiologist and President, Toledo, Ohio ACS, Toledo, Ohio, 5/25 Chicago, Tape 2, side 2, rev. 579. CONFIDENTIAL: TIMN 288631 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page thirty-one) Probably 80-85% of my practice is dealing with the ravages of the cigarette on the American scene because I deal with lung cancer, esophageal cancer, pacemakers that deal with heart, and many of those smoke. David A. Penner, M.D., thoracic and cardiovascular surgeon, Royal Oak, Mich., 5/25 Ghicago, Tape 2, rev. 510. Perhaps if we put it ((magnitude of mortality from cigarette smoking)) in terms of the Vietnam War, the Vietnam War as you recall, there were 50,000 mortalities during that 15-year period. Now let's convert that into just lung cancer statistics alone. That's two Vietnam Wars every year of Ameri- cans. The mortality - that's two Vietnam War factors. Now let's add on another five Vietnam Wars due to emphysema, cancer of the larynx, cancer of the pharynx, cancer of the pancreas, and heart disease, so that we have about seven Vietnam War mortalities going on every single year on the American scene. David A. Penner, M.D., thoracic and cardiovascular surgeon, Royal Oak, Mich., 5/25 Chicago, Tape 2, rev. 517. We will allow those families who have plantations ((emphasis added)) down south and so on to convert ovYer ((from growing tobacco to some other crop)) and perhaps even give them some sort of incentive bonus... David A. Penner, M.D., thoracic and cardiovascular surgeon, Royal Oak, Mich., 5/25 Chicago, Tape 2, rev. 575. I'm one of those unfortuante 34 million Americans who are very susceptible and allergic to tobacco smoke... after some very touch-and-go treatment where I just barely survived and I even went so far as to have the last rites, I went through a series of desensitizing shots... Harry Spataro, City Councilman and Delta Airlines pilot, Downers Grove, I11., 5/25 Chicago, Tape 1, rev. 109. There are about a 1,000 people,, as I look at it, dying every related diseases ... prematurely. day from tobacco- Arthur W. Weaver, M.D., Northville, Mich., 5/25 Chicago, Tape 2, rev. 490. ((Titles of anti-smoking posters displayed during statement.) "Obey Your Lungs -- Stop Smoking"... "Don't Let Your Health Go Up in Smoke"... "A Pack a Day Takes A Life Away"... "A Real Cool Guy Who's Seeing How to Die"... "To Smoke or Not to Smoke - That's the Question"... "It's Your Life - Live It Wisely"... "You'll Surely Turn Green With Nicotine"... "When You're Dying, You'll Regret All the Smoke That You Did Get"... George Browne, Commissioner, Dept. of Drug and Alcohol Addiction, Town of Hempstead, N.Y., 6/16 Phila., Tape 1, side 2, rev. 727-737. CONFIDENTIAL: TIMN 288632 MINNESOTA TOBACCO LITIGATION

-119- E X A G G E R A T I 0 N (page thirty-two) Probably the basic problem in smoking is that some people's inability to get along without cigarettes has been elevated in stature to adulthood and manhood and then has been packaged and sold to children who are looking for status. That's probably what it boils down to. Steven R. Homel, M.D., Director, Center for Health, Educ., Phila., Pa., 6/16 Phila-., Tape 2, rev. 26. Do you know how many cigarettes you could smoke in one hour? If you smoked them continuously? A great number. You'd probably smoke more than a pack of cigarettes in one hour. James E. Allen, M.D., pediatric surgeon, ACS volunteer, Snyder, N.Y., before NCSPP forum, 6/16 Phila., Tape 2, side 2, rev. 718. I noticed that the young man ((Paul Samuel)) testified that his sexual ability had decreased with heavy cigarette smoking. And there's good sound reason for this, because you obliterate the hypogastric artery...I think if every physician would take this history and ask the young man 35, 45, 50 years of age, "How is your sex life?" This should be a part of the inves- tigation. You'd be surprised -- they won't volunteer the fact -- but you'd be surprised how many of them that are heavy cigarettes (sic) and say, "Well, it's not as good as it used to be." Crawford W. Adams, M.D., cardiologist and chest specialist, Nashville, Tenn., 6/14 Atlanta, Tape 2, side 1, rev. 587. To me the most dramatic thing is that in our dogs that smoked we found that these ((emphysematous)) changes occurred at the end of 24 days. And if you remember'that in school, in high school, the athletic coaches didn't like the youngsters on their team (sic) because they knew long before the medical profession that that youngster who smoked, when he got on the field, was winded. He was winded because within the period of 24 days we are able to see the first changes of emphysema. Oscar Auerbach, M.D. pathologist and senior medical investigator, VA Hosp., East Orange, N.J., 6/16 Phila., Tape 1, side 1, rev. 577. Why aren't cig companies legally liable for the smoking deaths that they cause and the disabilities that they cause? If cigs killed your father, your mother, your brother, your sister, why is it you can sue your doctor, you can sue your lawyer, you can sue your CPA, but by federal law, you are prohibited from suing the cigarette companies? ~ Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 422. TIMN 288633 M~OTA TOBACCO L~ LITIGATION

E% A G G E R A T I 0 N (page thirty- three) Fisher: ...the cig companies...had some specific legislation introduced that specifically excluded cigs from all the rules and regulations that other food, drug and various items are covered by. Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 519. Although I am a pathologist, for me to comment further on the tissue changes relating to smoking after Dr. Auerbach's presentation would be tantamount to plagerizing coals to Newcastle. Robert V. P. Hutter, M.D. Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 646. 1 With the existing knowledge one third more of cancers could be eliminated without any further scientific breakthrough ((with elimination of cigarette smoking)). Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 665. Death among patients with chronic tuberculosis is higher among smokers. Even death due to complications from hernia is higher among smokers. Peptic ulcer is aggravated by smoking. Even premature facial wrinkling has been related to excess smoking. Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, M.J., 6/16 Phila., Tape 1, side 1, rev. 695. Dr. Byrd: I think that we are all aware that smoking and alcohol, smoking and asbestos exposure, have a cocarcinogenic activity. It has even been suggested outside the U.S. that there may be a cocarcinogenic activity between smoking behavior and the development of breast cancer... Hutter: There's no question that there may be, may well be, multiple factors involved in the genesis of the diseases ((associated with smoking)) Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 774. I've always been a sort of a bug on the subject ((of smoking))... Back in my dating days and in the last 10 years I've beenn back in the dating game again, I will not take out young ladies who smoke. If they do I give them a very hard time and if they persist they just don't get asked out again. (rev. 292.) (cont.) CONFIDENTIAL: TIMN 288634 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page thirty-four) (cont.) I have read that smoking impedes your sex drive a little bit. This is some- thing...that young people can appreciate a little bit more than what might happen to them maybe 20, 30 or 40 years in the future, or sometimes, never. (rev. 360.) John B. Kelly, Jr., councilman at large, Phila., Pa., and first vice president of U.S. Olympic Committee, 6/16 Phila., Tape 2, side 1. ...I know as a small child in travelling with my father on vacations I could see first hand what smoking was doing to his health, especially the times he would pass out from lack of getting sufficient air into his nose and because of the congestion in his lungs. Nick Joe Rahall,(D-W. Va.), U.S. Congress, Beckley, W. Va., 6/16 Phila., Tape 1, side 1, rev. 402. Lighting a cigarette gave you a chance to set a scene ((in a movie in earlier days)). It gave you a chance to create a mood. We don't do that today. We go to bedrooms very quickly. (Laughter.) That has replaced the cigarette as a national sport. (rev. 976.) I think the way out of this is to diminish the number of smokers. And you do that the same way totalitarian countries and as far back as Aristotle. You start them young, indoctrinating them. And you do that with the greatest teacher that the mind of man have invented. And that's television. (rev. 1015.) Weingarten: ...when the FCC banned Television advertising... (rev. 1091.) Jack Valenti, president, Motion Picture Assn., of America, 6/16 Phila., Tape 1, side 1. Now, what are some of the arguments you run into from the Institute, the Tobacco Institute and some of the other opponents? First they try to char- acterize you as kooks. This is not important stuff. They're a bunch of z crazies. There are a lot of isolated cases out there. This does not affect O the general public. These people are crazy. (rev. 178.) rQ' So somebody says, "Suppose you walk into a restaurant and everybody's a ~ smoker and you're a nonsmoker, and you ask the waiter or the maitre d' for a nonsmoking section. If you're the waiter, what do you tell the patron?" :" " ' " ~' (rev. 206.) re standing in it ,,,~ My answer is, You } 1_~ The Tobacco Institute has made more money off of my legislation because I've ~~ U~ put in for six-seven years now and they keep defeating it and I keep putting it back. And their lobbyists ought to be paying me a commission for all the ~ ~ legislation I've put in. 'Cause they go back to their bosses and say, "Hell, ~ E-4 we gotta fight Maryland again." And you know, they're really gearing up. r 0 -!~ U O Cn They got three more votes last year and thi.s, and it s a real big deal. And they come in there with those little brochures, you know. So they're making a lot of dough and, of course, the ultimate consumer is paying for their efforts to fight this legislation. (rev. 341.) Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2. TIMN 288635

E X A G G E R A T I 0 N (page thirty-five) Another important lesson to be learned from the history of preventive medicine is that you must not ((do not have to)) understand the mechanisms in order to prevent the disease. Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2, rev. 1063. Room #1. I said to a woman, "I see you smoke." She said, "How can you tell?" I said, "From your complexion." She went totally pale, and she did not smoke again for the entire cocktail party. Now...this is a bit cruel. I don't have any idea whether smoking...hurts your complexion. I have no such evidence. I have a personal conviction that a person's image of himself or herself is more important than knowledge that he's going to get lung cancer 30 years from now. Merlin K. DuVal, M.D., moderator, Atlanta Forum, Nat'l. Commission on Smoking & Public Policy, 6/14 Atlanta, Tape 1, side 2, rev. 2. Smoking is a potent parasympathetic and sympathetic nervous system stimu- lant. Sympathetic nervous system causes contraction of various smooth muscles over the body, and relaxation of others. The parasympathetic does the same. This ((smoking)) stimulates both, so your....organs for your muscle control of all your blood vessels and other organs in the body that contain smooth muscle like the stomach really get confused and they go haywire. Mostly they go into a spasm. Of course, people as they get older, develop arteriosclerosis of the leg muscles, mainly, and the heart muscles. You get gangrene of limbs from ((deficiency)) in blood supply; you get coronary infarction, coronary heart disease from the plain disease in coronary arteries. The addition of spasm to these arteries from the stimulation of nicotine will frequently mean the difference between losing a leg or having a coronary attack. Joseph Harner, M.D., president of Alabama ACS Div., Anniston, Ala., 6/14 Atlanta, Tape 1, side 2, rev. 435. Q A non-smoker is in great danger being just in the presence of a smoker... ~ Even in this so-called enlightened age, in our county, I find that dismally ~ few of my own patients coming to me have any conception of the fact that ~ sitting next to a man out in some reception room they are undergoing just F.., about as much danger as they could if they smoked themselves, more true in 3 a an automobile or small closed space. (rev. 568.) 0 DuVal: Is it possible that this Commission should be advised that on coming to grips with the problem as significantly as the one you addressed that we W~ should put the tobacco companies on notice and say we understand your problem ~ 0 and will help you out of this, but we want you to understand that ((the U.S. [-4 is)) out of the tobacco business by January, X date? O E-~+ Payne: Absolutely...As a matter of fact that's the only logical way, is to O phase it out...in a reasonably short time... (rev. 594.) Walter C. Payne, M.D. general and thoracic surgeon and medical representative, Escambia County (Fla.) Interagency Council on Smoking & Health, 6/14 Atlanta, Tape 1, side 2.

E X A G G E R A T I 0 N (page thirty-six) The airlines believe that we're there to serve this passenger that blows smoke in our face...they think that since we receive a salary that we are to endure the smoke, that we are not to wear any butLons, we're not to voice our opinions, we are to be robots. Janet Roth, flight attendant, Marietta, Ga., 6/14 Atlanta, Tape 2, side 1, rev. 323. Everybody knows and...the facts have shown that there are health hazards in cigarette smoke for the smoker and the nonsmoker alike. Anybody that says otherwise is either a fool or he's playing pretty fast and loose with the facts. (rev. 257.) ((The smoker's)) not a second-class citizen--we want to let them know they're unwanted citizens. (rev. 270.) Roger Setters, President, Louisville Chapter, Group Against Smokers' Pollution, Louisville, Ky., 6/14 Atlanta, Tape 1, side 1. The tobacco industry is fighting bitterly to prevent any curtailment of smoking in the workplace and is hustling about the country buying TV time, conducting misleading surveys, and corrupting the health of our young people. Donna Shimp, Exec. Dir., Environment Improvement Associates, Salem, N.J., 6/16 Phila., p. 6. There is a possibility that the value systems of health professionals and the public at large may be at some variance. If the desired outcome is achieved, it makes little difference whether an individual stops smoking to save health or to improve appearance. James W. Alley, M.D., Director, Div. of Phys. Health, Ga. Dept. of Human Resources, Atlanta, Ga., 6/14 Atlanta, p. 4. ...we do know the cause for at least one-third of all cases of cancer and this is smoking. Farris Bryant, former governor of Fla., President, Voyager ,Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, p. 5. I charge the tobacco industry with directly contributing to more than 125,000 premature deaths of Americans each year. It would seem to be exactly the same as charging the automobile industry with deaths caused by automobiles on the highways. But, I will say this for the automobile industry; they have done everything that they can to improve the safety in automobiles... However, all the tobacco industry have done is try to make cigarettes with less tars and nicotine. (p. 3.) The automobile industry may encourage people not to drive too fast, but have you ever- heard of the tobacco industry advertising, "Smoke only 10 cigarettes today so you can be safe and not have any of these diseases"? At the same time (cont.) CONFIDENTIAL: TIMN 288637 MINNESOTA TOBACCO LITIGATION

E X A G G E R A T I 0 N (page thirty-seven) (cont.) the tobacco industry has been guilty of this approach, the Federal and local governments have also aided and abetted them by not instituting controls and laws that have to do with public safety. Just like in the automobile area, the governmental agencies control the rate of speed, not because it is going to cause the automobile to deteriorate but because it is for the safety of not only those that are driving, but of the general public and yet we have done nothing in this regard for cigarette smoking. (p. 4.) Our particular group sees between 2,500 and 3,000 new patients each year. These patients generally fall into three (3) major categories. 1) coronary artery disease, 2) cancer of-the lung, 3) chronic bronchitis and emphysema... It becomes more and more apparent when you study these cases and look at the smoking habits of these patients that there is no question that the relation- ship ((with smoking)) is there. -124- However, there is a significant number of people with these diseases that we are seeing who have never given a definite history of consumption of any material number of cigarettes in their past life. At first, we thought that there must be some extrinsic cause and upon more careful examination of the history of these patients, we found that almost 90% of those people who were non-smokers had one of the above mentioned diseases, and had a strong exposure to atmosphere laden with cigarette smoke...I realize that this study is based upon simple clinical experience, but at the same time we have a significant number of people on whom an effort has been made to determine the relationship of the atmosphere polluted environment and those that are not associated with such an environment and the difference is striking. (pp. 1-2.) William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta. .r since it has been proved that cigarette smoking causes cancer then why doesn't Ralph Nader ban theffi? I feel that we might not ever conquer the smoking habit unless there is some drastic change in the morals of our country. Diane Krumel,.student, Pensacola Jr. College, Pensacola, Fla., 6/14 Atlanta, p. 2. Over 300,000 people die each year from diseases attributable to smoking of tobacco products. (p. 1.) ...the tobacco industry is still very profitable, with some 14 billion dollars in net earnings in 1975! (p. 2.) The first big victory ((for NS rights)) was when ASH obtained'a ruling from the FCC that television stations had to provide free air time for anti-smoking messages in response to cigarette advertisement. This foreshadowed a later FCC ban on cigarette advertising on the airwaves. (p. 3.) (cont.) TIMN 288638 NrINlvESOT ° ogAC~'p LITIGATION , TIGATION

-125- E X A G G E R A T I 0 N (page thirty-eight) (cont.) One ((tobacco)) industry official has been reported as saying that they are no longer concerned by the health issue, but they are becoming concerned about the public smoking ban issue. The Tobacco Institute, the tobacco industry's lobby group, has been particularly vociferous in its attacks upon the nonsmokers rights movement. (p. 4.) ...we are creating a"grass-roots" movement that is starting to scare the tobacco industry. Finally, if nothing else, we are at least forcing the tobacco industry to use some of their 300 million dollar annual advertising budget to fight us instead of brainwashing the public. (p. 5.) Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta. With our present knowledge of the health damage done by tobacco smoking, the access of cigarettes to the child through vending machines and what we are presently doing to prevent it, we could in a very few years have full blown cases of lung cancer and emphysema - among other•things - by people in their very late twenties. Carl Sturm, D.M.D., Louisville, Ky., 6/14 Atlanta, p. 3. On the controversy to legalize marijuana, may I add that cigarette smoking usually precedes pot. Less cigarette smoking would tend to decrease chances of pot smoking. (p. 1.) An eminent authority, research scientist Dr. Hardin B. Jones, professor of medical physics and physiology, and Assistant Director of the famed Conner Laboratory at the University of California, terms the effect of cigarette smoking thusly, and I quote, "The person who smokes a pack a day has his life reduced by eight years." (p. 2.) Israel Cohen, President, WCAP, Lowell, Mass., 6/2 Boston. Armed with its marketing.research data and media techniques, the industry should in all likelihood threaten the concept of motherhood should it so desire. It is not enough for the Cancer Society to wage this battle alone. It requires a commitment from the Federal Government that goes beyond clearinghouses and futile warnings stamped_on cigarette packages. It requires from this State not just rhetoric, but legislation to further restrict areas where smoking is permitted and the provision of incentives to encourage smokers to cease. Jonathan Fielding, M.D., Mass. Commissioner of Public Health, 6/2 Boston, p. 8. I have conducted some simple experiments that indicate that paper bags and plastic bags absorb smoke and retain the odor of smoke for long periods of time. Foods packed in them can absorb the smoke odor. Roy Korson, M.D., prof. of pathology, Univ. of Vt. College of Medicine, and Vt. State ACS pres., 6/2 Boston, p. 1. CONFIDENTIAL: TIMN 288639 MINNESOTA TOBACCO LITIGATION

-125a- E X A G G E R A T I 0 N (page thirty-nine) ...in addition to its output of cigarettes this industry has another product: the annual production of 250,000 dead bodies...you have one death resulting from cigarette smoking every 2 minutes and 6 seconds -- on the average. (pp. 1-2.) The industry, through its Tobacco Institute, has been prodigiously effective in finding scientists in various parts of the world who will spew out streams of words which would confuse almost anybody -- anybody except those who know. (p. 2.) It is time for our nation to adopt a new perspective on the whole matter of cigarettes. We should no longer be misled and confused by what is said by a very small minority of scientists. Where so many lives are at stake, it is almost irrational to be influenced by comments of scientists found, by what- ever means, by the tobacco industry. (p. 5.) Emerson Foote, former chairman, Interagency Council on Smoking & Health, 6/2 Boston. ...at least 90% of my work is directly or indirectly related to the effects of smoking. A. Marshall Smith, Jr., M.D., head, respiratory medicine section, Eastern Maine Medical Center, Bangor, Me., 6/2 Boston, p. 1. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288640

E X C E S S H E A L T H C 0 S T S The statistics and numbers from 1968 indicate that the smoking population costs our country three-quarters as much as defense and we're all footing the bill for it. Pat Caulfield, as cited by ACS LA Film, 3/22LA. In as much as the smoker has poorer health from the standpoint of disease frequency, physical fitness, work-days lost, and disability support, it goes without saying that the health of this nation will be dependent upon the discontinuance of smoking. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Co1o., 5/12 Denver, p. 2. ...Theodore Cooper, former Assistant Secretary for Health, HEW, testified last year that the medical costs of smoking run $11.5 billion annually. Dr. Paul Kotin, medical director, Johns-Manville, Denver, Fact sheet attached to 5/12 Denver, p. 1. It is of interest that the majority of coal miners who receive benefits under the Federal Coal Mine Health and Safety Act actually have severe chronic obstructive lung disease which is related to cigarette smoking, rather than the pulmonary fibrosis associated with working in the coal mines at jobs known to produce pulmonary fibrosis. One can only speculate how much money is being spent on disability associated with cigarette smoking. I am concerned that those who are really entitled to benefits are being denied because of confusion in medical circles over obstructive lung disease and pneumonicosis... ...The individual who has chronic obstructive lung disease associated with cigarette smoking has a long difficult road ahead...The individual who has chronic obstructive lung disease suffers on and on. The indi- vidual suffers, his family suffers; and that is not all - the disease virtually bankrupts the family, and in the end may bankrupt the nation. Harvey Phelps, M.D., Colo. State Senator, 5/12 Denver, p. 2. One study I read estimated that heavy cigarette smoking cost our nation $17 billion a year. Lila M. Sapinsley, R.I. State Senator, 6/2 Boston, p. 6. CONFIDENTIAL: TIMN 288641 MINNESOTA TOBACCO LITIGATION

EXCE S S HEALTH COSTS (pagetwo) There is no better time than now because cigarette smoking is responsible for the deaths of at least 250,000 Americans each year! At that rate, in the total United States, there are 30 deaths every hour or one death every 2 minutes which are attributable to smoking. Regionally, for the 8 southern States represented at this meeting, there are approximately 45,000 excess deaths annually from cigarette smoking. John J. Witte, M.D., Deputy Director, Nati. Clearinghouse for Smoking & Health, Bureau of Health Education, HEW, Atlanta, 6/14 Atlanta, p. 2. Task Force on Tobacco and Cancer tells us that seventeen billion dollars a year is the overall cost of heavy smoking. Thirteen billion dollars is attributed to absenteeism, accidents, and lost output, and $4 billion in medical costs which most companies pay on an in-kind basis with their employees for various types of medical plans. Mrs. Dorothy L. Mims, Employee education chairman, Florence County, ACS, South Carolina, 6/14 Atlanta, p. 1. The cost of smoker's illnesses and deaths are figured at more than $5 billion a. year. Janith Stewart Kice, M.D. Garden City, New York 6/16 Philadelphia, p. 4. According to Benjamin Byrd, President of the American Cancer Society, 80 percent, or 70,000 of the 84,000 annual lung cancer deaths in the United States are directly related to cigarette smoking. When added to the 180,000 annual deaths from heart attacks directly associated with smoking, the 2,000 deaths a year caused by accidents with matches used in smoking, and the annual deaths by other diseases for which smoking is the single biggest risk factor, (such as emphysema, and cancer of the lip, tongue, and bladder) a total of over 350,000 persons are thought to die each year in the United States alone as a direct result of cigarette smoking. Robert Eyerly, M.D., Danville, PA., 6/16 Philadelphia, p. 4. In the industrialized nations, cigarette smoking is the greatest single cause of excess morbidity and mortality from lung and other cancer, from heart attacks, and also from emphysema in both men and women. J. Mostyn Davis, M.D., P.C., Shamokin, PA., 6/16 Philadelphia, p. 1. CONFIDENTIAL: TIMN 288642 MINNESOTA TOBACCO LITIGATION

E X C E S S H E A L T H C O S T S (page three) The American Cancer Society estimates the loss, to the country, of seventeen million dollars, annually, as the result of smoking related medical care, absenteeism, lost work out-put, and accidents caused by smoking. The World Health Organization has estimated that smoking related illnesses each year cost the United States seventy-seven million work days lost, eighty-eight million days spent ill in bed and three hundred and six million days of restricted activity. It becomes obvious that this invariably raises the over-all cost of health insurance and taxpayer supported health programs. J. Mostyn Davis, M.D., P.C., Shamokin, PA, 6/16 Philadelphia, p. 2. One in three deaths is either directly or indirectly caused by smoking, that's one in three deaths in the U. S., 700,000 deaths a year. Roger Secker-Walker, Director of the Pulmonary Division, Dept. of Internal Medicine, St. Louis University School of Medicine, 5/19 St. Louis, Tape 2, side 1, rev. 254. ..if the number of excess bed days were calculated, as they were for the earlier anti-smoking campaigns, we would find that there were almost 150 million (145,894,000) excess bed days among smokers and former smokers. Of course, this type of data manipulation assumes that the smokers and former smokers would experience the same rate of bed disability if they did not smoke as did those who had actually never smoked cigarettes. Whether this assumption is correct is not known, but it does lead to interesting speculation. Ronald Wilson, National Center for Health Statistics, 6/16 Philadelphia, p. 8. Dr. H. G. Rapaport, former President of the American College of Allergy, states that industry loses 184 million days of work annually because of employees who have allergies. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 4. --In addition to the loss of life and human suffering, cigarette smoking adds over $11.5 billion to the already burgeoning costs of health care in the United States; Senator Birch Bayh, (D.-Ind.), 5/25 Chicago, page 2. MINNESOTAOTOBACp ~ LITIGATION TIMN 288643

EXCES S HEALTH COSTS (pagefour) President Carter should be urged to appoint one of our most prestigious study firms (e.g. Brookings Institute, Washington) to quantify the cost of the cigarette. David A. Penner, M.D., Thoracic and Cardiovascular Surgeon, Detroit, Michigan, 5/25 Chicago, page 2. The hazards of smoking are so well known that they hardly need repetition by me -- in the United States more than 300,000 premature deaths each year result from smoking; in the State of Illinois, 50 per day. It is easy to create scapegoats for this appalling statistic ((300,000 deaths a year)): - those who encourage smoking, such as advertising agencies and cigarette companies. - those who accept smoking, such as television talk shows and restaurants. - those who tolerate smoking, such as schools and hospitals. Sherwyn Warren, M.D., Chairman, Illinois Interagency Council on Smoking and Disease, Winnetka, Ill., 5/25 Chicago, page 1. It is estimated that in disability alone in the U. S. between the Federal Coal Mine Safety Act and those who have obstructive lung disease and those who have emphysema, chronic bronchitis ... associated with cigarette smoking, that it is now costing us somewhere better than $15 billion a year. Harvey Phelps, M.D., State Senator, Pueblo, Colo.; 5/12 Denver, Tape 2, rev. 107. Is there any question why we amputated about 150,000 gangrenous extremities every year, many of them thanks to cigarettes? Oh, we've got a lot of cigarette smokers sitting in wheelchairs today. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 129. CONFIDENTIAL: TIMN 288644 MINNESOTA TOBACCO LITIGATION

EXCES S HEALTH COSTS (pagefive) In 1975, various estimates have been made that $11.5 bi~lion was spent in the U.S. for health care and other costs associated with cigarette smoking. ((Cite in Lloyd's written statement for this claim is a JAMA piece by Weldon Walker in 1974 which, in turn, cited a NCHS booklet, "Mortality Trends for Leading Causes of Death: U.S. 1950-69," deals in deaths and death rates for various categories of diseases but gives no money figures related to these causes of death.)) Douglas S. Lloyd, M.D., M.P.H., Connecticut Commissioner of Health, 6/2 Boston, Tape 1, side 1, rev. 372. In dollars and cents, for hospitalization alone, it is estimated that at Uncas on Thames Hospital -- a state cancer facility -- the average cost per day in 1976 was $183.00, and the average length of hospitalization was 90 days for a hospital cost of $16,500. per case. Multiplying this by the 8,740 youngsters, who today may end up with cancer of the lung due to smoking, the cost of dying because of this condition runs in the vicinity of more than $144,000,000. This is not counting out-of-hospital eypenses, time lost from work, etc. . Milton Geyer, Chief, Public Health Education Section, Conn. State Dept. of Health, 6/2 Boston, p. 2. Lung cancer deaths will be about 43 per 100,000 in Massachusetts, as contrasted to 17 per 100,000 in Utah. The difference is that in Utah, 72% of the population are of the Mormon faith, which includes abstinence from tobacco. John W. Turner, M.D., radiologist, Wesson Memorial Unit, Baystate Medical Center, Springfield, MASS., President Mass. Div. ACS, 6/2 Boston, p. 1. When you are relating costs charged against smoking to how people's health may be affected you are dealing with a proximate cause. But if you get beyond that and start talking about forest fires and health insurance premiums and so forth, you get out into the range where there are so many different factors being brought to bear that really it is not very meaningful to try to pin i t on smoking. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, 6/16 Philadelphia. CONFIDENTIAL: TIMN 288645 MINNESOTA TOBACCO LITIGATION

EXCESS HEALTH COS TS (page six) The ACS says it cost $4 billion this year in medical costs to treat illness caused by smoking. Bill Caldwell, newspaper editor & larynx cancer victim, Damariscotta, Maine, 6/2 Boston, - p. 5. In Massachusetts, the total health care costs are calculated at 3.7 billion dollars a year. I estimate that 20% of all health care costs among cigarette smokers are directly related to their habit. Thus, 5%, at least, of all health care costs are smoking related. Simple mathematics indicate that a minimum of $185,000,000 is spent each year in the Commonwealth for illnesses caused by tobacco. Blake Cady, M.D., surgeon, Lahey Clinic, Boston, MASS., 6/2 Boston, p. 5. The American Heart Association should be able to supply figures on the costs to care for heart and circulatory disease patients. Half of this total expense can be charged up to nicotine poisoning. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, p. 2. By a conservative estimate, at least 20 percent of the hospital population today are ill with chronic lung disease, lung cancer, or other diseases aggravated by smoking. This means tYiat a community hospital of 300 beds serving a 100,000 people has to increase its number of beds by at least 50 because of the smokers in the community. Since each hospital bed costs an average of $40,000, those 50 beds for cigarette smokers cost over $2 million. In addition, it costs $150 a day to care for each person suffering from emphysema and other chronic lung diseases (nurses, orderlies, inhalation therapists, oxygen, equipment). The physical investment in terms of beds and hospital space for the total United States hospital community is truly staggering. Six hundred thousand beds out of a total of 3 million across America represent an increased burden on the health-care industry of $24 billion--not including the extra personnel, equipment, and supply cost. Walter K1oss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 4. CONFIDENTIAL: TIMN 288646 MINNESOTA TOBACCO LITIGATION I

-132- EXCE S S HEALTH C0 STS (page seven) Statistically, over 30 percent of heavy smokers develop some degree of clinical emphysema...It has been estimated that, from the time he develops his symptoms until the time he dies, the average smoker with clinical emphysema will cost the taxpayer over $100,000. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 5. Studies have proved that the incidence of absenteeism by smokers as a result of respiratory disease is 4.5 times more than in nonsmokers... If we calculate the work production ratio as five to one and assume that the average working man earns $25 a day, a production value of $125 a day for each year due to tobacco smoking. Compare just this one statistic to the average total yearly revenue from tobacco at $4.3 billion. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 6. We need 10 times the $5.9 billion in taxes generated from tobacco products each year to support the health and welfare costs of tobacco related illnesses in our population. . Joseph M. Deignan, M.D., thoracic & cardiovascular surgeon, Winchester, Va., 6/16 Philadelphia, p. 3. ...self-inflicted harm is a factor which causes many individuals to seek health care. Much of this self-imposed damage stems from the consumption of tobacco products. A reduction in the use of these substances should lead to a concomitant decrease in the need for various health services. Alice Van Landingham, president, American Assn. of Retired Persons, Wash., D. C., 6/16 Philadelphia, p. 5. ...the net, net expense that smokers cost our nation is about $20 billion dollars a year. Arthur T. Roth; former bd. chairman, Franklin National Bank, Rockville Centre, New York 6/16 Phi.ladelphia, p. 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288647

E XCE S S HEALTH COS TS (page eight) Workers who smoke cigarettes spend over 1/3 again as much time away from their jobs because of illness than those who never smoked cigarettes. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., Philadelphia 6/16/77. You all know about the taxes that are generated ((by cigarette sales)) and I'd just like to echo what some of our earlier speakers have said -- $5.9 billion seems like a lot of taxes but it's really only about 10 percent of what we need to cover the health and welfare expenses generated by tobacco-related illnesses. Joseph M. Deignan, M.D., Winchester, Va., 6/16 Phila., Tape 2, side 2, rev. 1257. Of the 98,000 new lung cancer cases to be diagnosed in 1977, 3,600 will be so diagnosed in my state of New Jersey. Ninety percent of these, or over 3,000, could have been prevented by the elimination of smoking. Of the 89,000 deaths from lung cancer in the U.S. in 1977,•3,200 will occur in my state, in New Jersey. Ninety percent of these, or over 2,800, could have been prevented by the elimination of smoking. Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 670. CONFIDENTIAL: TIMN 288648 MINNESOTA TOBACCO LITIGATION

FARM S UP P0 RT &P.L. 480 I believe.we must encourage and support federal legislation that would require the United States Government to: 1. Stop all subsidies to farmers who grow tobacco. According to the Secretary of Agriculture, up to 80 million dollars are earmarked for this purpose in the current year. 2. Subsidize tobacco farmers.who switch to other crops. 3. Substantially increase the federal tax on cigarettes and use the excess revenue to cover the subsidies proposed for farmers.who switch crops. Such a tax increase can be expected to decrease cigarette consumption and recruitment, particularly among the young. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22LA statement, p. 3. The elimination of subsidies probably would have no effect on the health issues involved in smoking. Dr. Daniel Horn, as cited by ACS LA Film, 3/22LA. I believe we must encourage and support Federal legislation thatswould require the United States government to (1) stop all subsidies to farmers =who grow tobacco. Dr. Elfriede Fasal, as cited by ACS LA Film, 3/22LA. The Departments of Agriculture, Commerce, Interior and Treasury could jointly develop a tobacco-crop elimination program. A viable grain-crop substitution system could be evolved so that over a predetermined period (ca. 20 yrs.) cigarette tobacco would be replaced either by other agri- cultural products or by industrial expansion which could absorb the liberatedaworkforce. Dr. Paul Kotin, medical director, Johns-Manville, Denver, Colo., 5/12 Denver, p. 8. (2) Federal funding for tobacco production through the Dept. of Agri- culture_which results in the manufacture of disease, and funding for HEW for the control of the same disease is a dichotomy_which must be stopped, as they are in direct conflict=with each other, using public funds in both. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 5. CONFIDENTIAL: TIMN 288649 MINNESOTA TOBACCO LITIGATION

FARM SUPPORT & P. L. 480 (page two) I, for one, can't understand how the government can appropriate money to support tobacco growing and then at the same time, allocate money to educate the public to the dangers of smoking. This just does not make sense to me. John Ralston, former head football coach & general manger, Denver Broncos, 5/12 Denver, p. 1. Our federal government continues to subsidize tobacco growers, while issuing scientific information that details the health hazards of smoking. Millions of dollars are spent by various federal agencies to treat and research health problems caused by tobacco products... What can be done in the future to erase the tobacco menace? Personally, I would like to see our national government take a more definitive stand on the smoking issue. Either stop subsidizing the tobacco industry, or stop supporting tobacco-related health research and treatment programs. Richard E. Poole, Administrator, Eastside Neighborhood Health Center, Denver, Colo., 5/12 Denver, pp. 2-3. A high priority should be attached to the gradual phase-out of federal price supports for the growing of tobacco. The federal government should get out of the cigarette manufacturing business. The reason I suggest a gradual phase-out is that any precipitous action would most likely cause dramatic economic disruptions for small growers. Tobacco growers hould (sic) be encouraged to switch over to agricultural products which will contribute to the health, well-being, and nutrition of people. Charles E. Grassley, U.S. Congressman,(R-Iowa) delivered by Stephen Roberts, 5/19 St. Louis, p. 3. Weingarten: Do you have any strong feelings one way or another about the need for more government regulation of the cigarette industry? Morton: Well, I'd say the best thing that could be done would be to remove some of the governmental financial support of the tobacco industry rather than actually put it down by coercive manner. I think that would fit more with the beneficial part of our government and it would avoid the problem we got into with Prohibition. If we could simply take away some of the artificial supports that should--and continue to develop the information we have been developing over the years, that should hopefully take care of the problem. William Morton, professor of environmental medicine, Univ. of Oregon, Eugene, Ore.,5/17 Seattle, Tape 1, Side 1, Rev. 1248. MINNESOTAOTOBACCO ITI ~'IAjj\j 288650 GATION .

-136- FARM SUPPORT & P. L.480 (pagethree) It has been suggested that those producers switch to another crop in lieu of tobacco. This is being naive with a capital "N". No other crop produces as much cash income as tobacco (up to $3,000 per acre). The average producer has only 3 acres. These growers know how to produce and cure tobacco -- they would have to learn how to grow any other crop. Their ages are like 56 to 57 years, rather old to start learning all over about farming. Most agricultural crops today are controlled with acreage allotments, and producers find it difficult to get allotments. They also have millions of dollars tied up in machines and equipment built for producing tobacco, and these items would be worthless; so this switching crops is a poor suggestion. Stephen Frontis Woodson, ACS Volunteer, former tobacco salesman, Raleigh, N.C.,6j!14 Atlanta, pp. 4-5. Tobacco is by far the most profitable crop our farmers can grow and their expertise in growing, curing, and grading the tobacco is the result of life-long training, in many cases by their parents, who were trained by their parents, etc., on the same family farm. The only way to stop this tradition is to eliminate the demand for the product. J. E. McDowell, President, N.C. Div. of ACS, & general agent, Southern Life insurance, Greensboro, N.C., 6/14 Atlanta,p. 2. We're going to have to diversify that industry and then plow under the tobacco fields. The Federal government must stop profiting from the tobacco industry, and divert taxes from it from general funds to programs of research, education, and self-help clinics for those millions of smokers who want to quit. The farmers who grow tobacco should be given strong financial incentives to plow it under, and should be helped to establish a means of converting tobacco acreage to a different, less harmful cash crop. Leonard Bachman, M.D., Penn. Sec. of Health, 6/16 Philadelphia, p. 6. Research must be done to find another use for tobacco so our tobacco farmers won't be too drastically hurt, or help them develop another crop equally profitable to them. Quit subsidizing tobacco! On one hand our government is pouring millions into Cancer Research and on the other hand subsidizing tobacco which they are aware causes cancer and other health problems...otherwise why does the government require a health warning on cigarette packages. Tom Cousins, Promotion Director, WCCO-TV; ACS volunteer, Minneapolis, Minnesota, 5/25 Chicago, page 3. CONFIDENTIAL: TIMN 288651 MINNESOTA TOBACCO LITIGATION

-137- F A R M S U P 0 R T & P. L. 480 (page four) ...efforts to decrease cigarette consumption could increase the amount of tobacco crops supported under government price support programs and hence the Federal government's investment in tobacco stocks. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 2. ...the Government collects $6 billion in tobacco taxes, spends $60 million of it on tobacco subsidies (most of which go to corporations and not to the small farmer) and gives a "generous" $90,000 (sic) to the National Clearing House on Smoking and Health . I Robert L. Schmitz, M.D., Mercy Hospital and Medical Center, also Board.Member of Illinois ACS, Chicago, Illinois, 5/25 Chicago, page 1. The supreme hypocrisy is by our federal government, which seeks to protect us from the cancer-causing dangers of Red Dye #2 and saccharine, mandates warning messages on cigarette packages, yet spends sixty million dollars each year to subsidize the tobacco industry. Sherwyn Warren, M.D., Chairman, I7.linois Interagency Council on Smoking and Disease, Winnetka, Ill., 5/25 Chicago, page 3. I think that very possibly there is legislation that could be done at a high level that may be as necessary and that is to convert all of these fields of tobacco that are being grown to fields of food that could feed a hungry world. Earl B. Flanagan, M.D., Carlsbad, N.M.; 5/12 Denver, Tape 2, rev. 397. I believe that this real estate, we might call it, this farm land, this beautiful country of ours cari be put to better use than growing tobacco. I think if the price supports are cut we can grow food that is much needed. Dot Mims, employee education chairman, Florence County, South Carolina, ACS; 6/14 Atlanta, Tape 1, side 2, rev. 1214. The U.S. government is not in the business of fostering death and disability as it appears to do by subsidizing tobacco. Douglas S. Lloyd, M.D., Conn. Commissioner of Health, 6/2 Boston, p. 3. MTNNESOTAOTOEACCO jT TIMN 288.652 IGATION

F A R M S mUP ~~ & P.-L._ 4 8 0 0 R T. (page five As I understand it, the subsidy program costs the -- $80 million is spent, of our tax dollars, to provide a stabilization, or subsidy, and it's really -- if my information is correct -- it's really more like a loan. The dollars are spent to purchase the tobacco from the warehouse floor when it's not being purchased by one of the tobacco companies... I think there's that much money available for the price support but it comes back into the government coffers. J..F6. McDowell, general agent, Southern Life insurance, Greensboro, N.C., president N.C. ACS Div., '6/14; Atlanta, Tape 1, side 1, rev. 1021. I'm familiar with Public Law 480 which -- the CARE food that's being sent. They want to eliminate tobacco to those Third World countries as part of the Food for Peace that goes there and folks in the tobacco industry are protesting this. I don't agree with that. I think if they send food, that's fine. I don't think they need to send tobacco, I really don't, although I'm aware that we need to do something about our balance of payments. Mrs. Huff: Well -- McDowell: They're also shipping Coca-Cola. Mrs. Huff: (in a little voice): Yes. J. E. McDowell, general agent, Southern Life Insurance, Greensboro, N. C., president N. C. ACS Div., 6/14 Atlanta, Tape 1, side i, rev. 1108. The Food for Peace bill in the last 10 years has cost the American taxpayer'$760 million, payment to cigarette manufacturers for shipping cigarettes to so-called needy nations. Not one of these needy nations has ever repaid a cent of the $760 million... Louis U. Fink, retired businessman, Orlando, FLA., member of IUCC workshop on smoking & health, 6/14 Atlanta, Tape 2, side 1, rev. 1152. The energy crisis is forcing research in using a mixture of alcohol and gasoline as fuel for automobiles. If successful, why can't that %60 million subsidize farmers to grow crops for the production of fuel- alcohol -- or to support more research in the cause and cure of cancer? Bernerd Burbank, M.D., medical director, McGraw-Hill, New York City, 6/16 Philadelphia, p. 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288653

F A R M SUPP_0RT &~P. L. 48 0(pagesix) I was appalled to learn just a few weeks ago that the Department of Agriculture has announced an increase in the amount of subsidies provided to tobacco farmers in 1977 to insure a profit. The continued support of the tobacco agricultural and manufacturing interests by the United States Congress needs vigorous investigation. Joseph M. Deignan, M.D., thoracic & cardiovascular surgeon, Winchester, Va., Philadelphia 6/16/77, p. 3. ...the economic benefits to the so-called tobacco states derived from the tobacco industry are minimal and have been declining. Over the years, the tobacco industr'y has contributed little or nothing to the growth of those tobacco states. We are talking less about the effects of tobacco on the economy of a few states. What it boils down to is protection for a few companies at the expense of the whole nation. Attachment to statement of Arthur T• Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, Philadelphia 6/16/77. By 1964 when the last census of agriculture was taken, 55% of the commercial tobacco farms had average incomes of about $2,600 or $50 a week for a family of four. Half of these families averaged only $1,300 or $25 a week. And these are farms where farming is mostly a full-time occupation. The haves, some 30,000 tobacco farms of a total of 170,000, or 17.5%, had annual average incomes of $18,60©. The rest, making up 27.5% of the tobacco farms, averaged $7,055 annually. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, Philadelphia 6/16/77. Now, gentlemen, 625,000 families receive $1.4 billion annually. That is $2,240 a family. No wonder...the father, mother, teenage sons and daughters have to go to the field in the production of the crop and the sweat streams. I thought that 60 years ago we got rid of our sweatshops. We apparently still have them there caused by the tobacco industry. Attachment to statement of Arthur T. Roth, former bd. chairman, Franklin National Bank, Rockville Centre, New York, Philadelphia 6/16/77. Instead of subsidizing tobacco farmers to grow tobacco, the country would be a lot better off to subsidize them to not grow tobacco. ...Grow corn, soybeans, cotton whatever else might be available and the government will write you out a check to compensate you for whatever revenue you've lost for your family and suffering. Sen. Birch Bayh (D-Ind.), 5/25 Chicago, Tape 1, rev. 271. CONFIDENTIAL: TIMN 288654 MINNESOTA TOBACCO LITIGATION

F A R M S U P P 0 R T & P. L. 480 (page seven) ...I think it would be fine if maybe they would grow corn or something and then they wouldn't need to worry about killing the rest of us off. We'd be around to eat the corn. Donna M. Shimp, Exec. Director, Environmental Improvement Associates, 6/16 Phila., Tape 1, side 1, rev. 213. Weingarten: Do you think it would pay the government to pay tobacco farmers not to grow tobacco? If they can't find a substitute crop which could be heavily subsidized? 'Woodson: I don't think it would pay because Mexico or somebody else would grow it. And even if they passed a law it will be bootlegged in here. I just don't think there's any way to answer the problem. I don't think leg- islation is the answer. Steve Woodson, ACS volunteer and former tobacco company salesman, Raleigh, N.C., 6/14 Atlanta, Tape 1, side 1, rev. 817. Nicotine is the principal alkaloid of tobacco, and is effective as a contact insecticide for plants and control of insects on animals. Pure nicotine, C1 H14N2, is highly poisonous. Considering the problem of continued use of DII~ and the ecology, it may be appropriate to study the potential usefulness and expanded application of nicotine in the fields of medical and veterinary entomology, and of agricultural and forest entomology respectively. Contact poisons have been useful for controlling sucking insects and for killing adult flies, mosquitoes and similar flying species, and for destroying insects, eggs and pupae, perhaps there is a role for the tobacco industry to have a world-wide impact in major conversion effort to the production of insecticides. The effort to minimize such problems as malaria, world-wide, and to maximize food production, world-wide, are worthy objectives. John W. Turner, M.D., radiologist, Wesson Memorial Unit. Baystate Medical Center, Springfield, Mass., and President, Mass. Div. ACS, 6/2 Boston, p. 2. 4. Tobacco farmers should be penalized by a severe tax for raising the tobacco leaf and subsidized generously for raising substitute crops. Stanley Stein; pharmacist,'Colorado Pharmacal Assn., 5/12 Denver, p. 3. CONFIDENTIAL: ATINNESOTA TOBA CCO LITIGATION TIMN 288655

F IRS H& Z A RD It would be easy enough to make cigarettes so they would go out quickly if not continually puffed, and this has been advocated as a means to discourage some smoking--and of course to reduce the fire hazard poten- tial. However, there is reason for viewing this proposal as a mixed blessing. While "self-eztinguishing" cigarettes would no doubt cause far fewer fires, it seems reasonable to assume that far more lightings with matches or lighters would occur, and these acts are themselves major•fire causes. Philip C. Favro, Calif. State Fire Marshal, 3/22LA statement, p. 2. In 1975, there were about'1,260,000 building fires in the United States. Nearly 138,000 of these-about 19Z--were attributed to smoking-related causes. Incidentally, three-fourths of al•I building fires were in resi- deatial occupancies, over half in one or two-family dwellings. Philip C.. Favro, Calif. State Fire Marshal, 3/22LA statement, p. 3. It is worth mentioning, too, that an additional listed category of national fire causes is "children and fire," for which the 1975 number is 64,200. a safe- assumption that most of these were due to children playing . . with matches. It is aa equally safe. assumption that the great majority Zt is of matches the children found to ptay-with were there because _ smoked cigarettes- ' someone _ Philip C.• Favro, Cali=.. State Fire- Marshal, 3/2'ZLA statement, pp- 3-- 4.. , , .. .. _ _ . .- . , . . - - • - - --- -._ _ be- eatireLy- tonest= and' ofrjective-, r-must. tell. you. that the cigarette is a comparative-Iy- poorr ineffective- scurce of. igaition.- rt is nothing- fuel .-Iike the flame..from a. match.,, for example, which caa starn something p, burning just:frotz x momentary_ cnntact.. T'ae-. glowing: combustion from a. cigarette- needs time to- dn its. work, and-' %t needs, a particular type of You can't ignite a.piece of paper or fabric just by touching it with a Lighted cigarette.. If that surprises you, try it. Cigarettes burn a lot of holes in clothing, but they don.`t catch them on fire. Phili C.. Favro, Calif. State Fire.Marshal, 3/22LA statement, p. 4. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ;

-142- F IRE HAZAHD (page two) There are issues focused on the economic costs of fires and fire preven- tion activities. What is the total economic impact of fire insurance premiums that may be attributed to smoking? What proportion of costs of maintaining fire departments can be assigned to smoking? What is the total annual cost of property loss, inciuding timber, which is due to smoking? What are the tota3l costs of maintaining buildings, cleaning and replacing carpeting, maintaining ashstands, etc.? Dale Houghland, chairman, Calif. Interagency Council on Smoking and Health, 3/22LA statement, p. 3. There hasn't been any study ((in California, of the effectiveness.of en- forcenient of fire regulation prohibitions)), but I would guess that it's been rather poor. Philip C. Favro, California State Fire Marshal, 3/22LA Tape 2, rev. 285. I'm not sure that"despite the fact that the industry may react in a aega- tive way ((to a self-extinguishing cigarette)) that the smoking public itself wouldn't react in a negative way...It's a simple matter of will it be done or not. I rather doubt it at this point. Philip C. Favro, California State Fire Marshal, 3I22Z.A Tape 2, rev. 292. Careless smoking is responsible-'for over 140,000 fires in the United States annually. According to.National Fire Protection Association - statistics,-fires caused_by 'careless smoking-represent property 'damage exceeding $167,000,000.annually... Philadelphia has experienced its share = of large loss smoking related tragedies.' `JosepYt Rizzo, fire.commissioner, Philadelphia; PA, . . .- _ .... _ : _ . .6 16 Philadelphia, p 2. / ~ , The National Fire Protection Association linked.107,200 building fires ,~_ , i,lr of about $100'millton with• abou,t _ 1~800 Amer- ~.can deaths-i. pAbo~t r6-5~o'rsmore -*o.t . these, were apartments and houses. " - Janith Stewart Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 4. CONFIDENTIAL: MINNE5OTA TOBACCO LITIGATION = TIMN 288657

-143- F I R E H A Z A R D (page th re e) Occasionally, the news media bring to our attention the tragic results of nursing home fires. The inadequacy of many homes in meeting fire safety standards is deplorable and represents a situation which requires immediate correction. Yet, an often overlooked fact is that many of these fires are caused by patients who smoke. Alice Van Landingham, president, American Assn. of Retired Persons, Wash., D. C., Philadelphia 6/16/77, pp. 3-4. As a people we spend vast amounts of money for its consumption, burn holes in our clothes and furniture, ignite fires in the beds on which we sleep, destroy our lungs, and almost surely develop cancer. That is freedom of choice gone wild. Farris Bryant, former governor of Fla., President, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, p. 2. Of the thirty-one categories listing the causes of fires, careless smoking and the careless use of matches constitutes the second major cause of all building fires in the country. In the United States alone, over 115,000 buildings were either destroyed or seriously damaged by the careless act of smoking resulting in more than $150,000 in property loss. It is esti- mated that 6,000 deaths and 100,000 injuries were attributed to fires caused by the careless act of smoking materials. The burning characteristics of smoking materials creates a potential fire hazard. Cigarettes are especially hazardous since they continue to burn after being discarded and temperatures produced from cigarettes are high enough to ignite most combustibles, solids, gases and liquids. (p. 1.) Last year ((1976)), Atlanta had 1,849 building fires of which 414 were caused by careless smoking resulting in a property loss of $1,200,000. Twenty-eight persons lost their lives and 50% of the fatalities were in fires where careless smoking was the cause. Of the 119 injuries sustained in fire situations, 30 were involved where careless smoking was the fire cause. (p. 2.) In occupancies where management controls employee smoking, fire caused by smoking is greatly reduced. For example, in industrial occupancies where strict control is institutes, only 4% of the fires in this type occupancy are caused by careless smoking. In churches and other places of worship, out of respect, patrons refrain from smoking and only 4.5% of fires in this type of occupancy is attributed to smoking. In schools and colleges where the "no smokino" policy is rigidly enforced by school authorities, only 1.5% of all fires are caused by careless smoking. ,(cont.) CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288658

F I R E H A Z A R D (page four) (cont.) On the other hand, where no smoking regulations are in effect, fire caused by smoking run considerably higher. For instance, fires in apartments caused by smoking account for 33.5%; in the single and two family dwellings, 26%; in nursing homes, 53%; hospitals, 26%; hotels and motels, 21.5%. ((All Atlanta figures.)) (pp. 2-3.) .... 93.5% of all fire fatalities ((in Atlanta)) occur in residential type occupancies and 56% of all these fire deaths are caused by fires resulting from careless smoking. (p. 3.) James B. Gossett, Chief & Fire Marshall, Atlanta Bureau of Fire Services,Atlanta, Ga., 6/14 Atlanta. -144- CONFIDENTIAL, TIMN 288659 MINNESOTA TOBACCO LITIGATION

-145- H E A L T H P R O F E S S I O N A L R O L E Unfortunately, when health workers are themselves smokers their influence becomes very powerful, in the wrong direction. Daniel Horn, Ph.D., Director, National Clearinghouse for Smoking & Health, 3/22 LA statement, p. 5. In the physician's office it takes very little time to offer advice on how to quit. Every physician should ask each patient about his or her smoking habits, point out evidence of smoking's harmful effects on the respiratory and cardiovascular systems, present a strong statement about quitting, and if the patient wishes, offer advice on how to quit or make referrals to voluntary or commercial methods. Unfortunately, few physi- cians are willing to take time to counsel patients how to quit or even to make referrals. I have found that long-term support maintenance is necessary even if it is minimal, such as followup telephone calls. Most physicians are reluctant to offer any followup support, although it could easily be done by mail or by telephone by the office nurse or receptionist. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif, Dept. of Health, 3/22 LA statement, pp. 11-12. Messages from "high credibility" sources (the medical profession still enjoys that prestige) with a minimum of political overtones are effective. No substitute has been found to be more effective than one's physician telling him he must stop smoking. Salvatore V.,Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22 LA statement, p. 6. I would like to applaud the emphasis in your program on the attempts to increase the influence of health professionals in the reduction of smoking. I feel the voluntary health agencies can do something that government cannot do in this area in accomplishing significant improvements. Daniel Horn, Director, NCSH, 3/22 LA Tape 6, Rev. 380. At the beginning of this century, two out of every three persons employed in the health field were physicians: Today the proportion is one out of every twelve. This change in the relationship of manpower is altering the role of the physician...We need to return to the doctor-patient relationship of the days gone by. If you have rapport with your patient, you can walk him across the Atlantic ((or get him to quit smoking, presumably)). Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 9. CONFIDENTIAL: TIMN 288660 MINNESOTA TOBACCO LITIGATION

-146- HEALTH PROFE S S IONAL ROLE (page two) 7. All health care providers should be encouraged to discontinue smoking and order their patients to do likewise. As a pharmacist, I think it unethical professionally for a colleague to allow tobacco products to be sold in the place he or she is practicing. Stanley Stein, pharmacist, Colo. Pharmacal Ass., 5/12 Denver, p. 4. The vested interests in smoking and the effects of it, include the grower, the manufacturer and distributor, the tax base, the income from vending machines, and the sickness care industry. These vested interests must be eliminated before any change for successful improvement of the health of the people of this nation can occur. Much greater funding from voluntary and governmental agencies for public education and awareness will be necessary to change the social as well as medical models to prevent disease resulting from smoking. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 6. One fundamental recommendation of the Texas Study Committee focused upon preparation of personnel to aid in cessation programs. Selected Texas colleges and universities are being asked to establish credit courses in community based health education and to emphasize training to conduct courses to discourage prospective smokers. As they become available these educators_would be involved in a wide range of cessation programs. Charles L. Lepsa.istre, M.D., Chrm. ACS Texas Div. Study Comm. on Tobacco & Cancer, 5/12 Denver, p. 8. ...rules which prohibit teachers from smoking in front of students may be conterproductive since the students know that many of their teachers smoke. Screening smoking in front of students by attempting to hide it in a teachers' lounge may again reinforce the notion that smoking is a sign of being an adult. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psvch. and Law, Washington Univ., St. Louis; 6/19 St. Louis, p. 16. I told these people, many hundreds of them now, that I think as a physician it's my responsibility to educate people about the risks of smoking but I don't think that government for example should prohibit smoking because we've learned, especially with tobacco, that that doesn't work very well. Donald Rogers, M.D., pathologist, Alaska Hosp. , and chairman of the exec. comm. of Alaska Div. of ACS, 5/17 Seattle Tape 1, side 1, rev. 1135. CONFIDENTIAL: TIMN 288661 MINNESOTA TOBACCO LITIGATION

HEALTH P ROFE S S IONAL ROLE (page three) As nurses in this health care system, we, as patient advocates, need to become more committed both as role models and as health teachers in the "Anti-Smoking" campaign to protect our public. Patricia E. Lenihan, R. N., Kenmore, New York, 6/16 Philadelphia, P. 1- ...to help patients regain their optimal health we should commit ourselves to develop more of a knowledge base regarding smoking, should activate ourselves as anti-smoking advocates, and creatively assist patients in their attempts to discontinue such a dangerous habit. Patricia E. Lenihan, R. N., Kenmore, New York, 6/16 Philadelphia, p- 4• Of the non-smokers among teenagers surveyed by the Lieberman Associates, 72 per cent said physicans were the one group that could persuade them not to start smoking. Of the smokers, 42 per cent said that advice from a physician would influence them to stop. Yet a recent American Cancer Society study found that most teen-age smokers asserted that their doctors never had warned them of the dangers of cigarette smoking! Saul R. Kelson, M.D., Cardiologist, President of Toledo, Ohio, ACS, Toledo, Ohio, 5/25 Chicago, page 2. Pediatricians play a vital part in influencing the child against smoking and in protecting the infant against the now recognized ill-effects of smoke from the mother's cigarettes -- perhaps the most emphatic example of "the rights of the nonsmoker." Saul R. Kelson, M.D., Cardiologist, President of Toledo, Ohio, ACS, Toledo, Ohio, 5/25 Chicago, page 3. I would recommend setting up a separate department in the American Cancer Society, or perhaps a national interagency group, concerned solely with galvanizing doctors into anti-smoking efforts, with separate committees of each American Cancer Society division and local unit to carry on per- sistent and intensive efforts with medical groups and individual doctors osteopaths as well as physicians -- in their areas. Saul R. Kelson, M.D., Cardiologist, President of Toledo, Ohio, ACS, Toledo, Ohio, 5/25 Chicago, page 5. CONFIDENTIAL: T'IMN 288662 MINNESOTA TOBACCO LITIGATION

__ H,,E,•A L_T_ H___P_R-0 F E S S,I 0 N A L. R 0 L_4__" (page four) Public health workers [in Illinois Department of Public Health] are en- couraged to set an example of good health practices and one of these is to refrain from smoking. Paul Q. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 3. Simonds: Do you think that a physician is obligated to get information from patients about their smoking habits? Do you think he is obligated to educate them about it? Is it unethical practice if he doesn't or should it be a source of malpractice? Schilling: I like every other physician hope more and more people hate the word malpractice. I don't think we should practice good medicine by the threat of malpractice. I think we should practice good medicine because we want to be of benefit to our patients. Albert Schilling, M.D., medical oncologist and director, Rhode Island Cancer Control Program, Providence, R.I., Boston 6/2/77, Tape 1, side 2, rev. 480. DiBiaggio: Well, I think that greater encouragement, perhaps a reward system, and perhaps even a critical evaluation of practitioners in terms of peer review process to determine whether they are actually providing educational as well as therapeutic services. Simonds: In other words, you are suggesting that if there was a PRSO~ kind of operation that went around to look at private practices that within that context some attention to smoking behavior in oral health and counselling patients should be a part of the audit. DiBiaggio: Exactly. John DiBiaggio, M.D., vice president health affairs, U. of Conn., New Britain, Boston 6/2/77, Tape 1, side 2, rev. 748. If we don't know these things, we should! Therefore, dentists, local dental societies, and national dental organizations who smoke should be preached to about the effects involved. Local and national campaigns should be sponsored by dental societies. Ernest M. Fidance, D.D.S., Wilmington, De., Philadelphia 6/16/77, p. 4. I suggest that we put this on the MCAT; that is, that on the bottom line is "if you smoke you don't get into hiedical school"...the average length of life is 8 or 9 years less and so why fund that person when you know he is not going to practice as long. Ernest W. Johnson, M.D., Director of Physical Medicine, Ohio State Univ. School of Medicine, Columbus, Ohio, 5/25 Chicago, Tape 1, rev. 795. TIMN 288663 CONFIDENTIAL: MINNE5OTA TOBACCO LITIGATION

-149- HEALTH PROFES S IONAL ROLE (pagefive) t I think we can do much if we recruit the pharmacists and get them to give up selling cigarettes in drug stores. Impress on them that they are health agencies... It's difficult because when a person comes in for a package of cigarettes, he may go out with a twenty-dollar order, three enema bags, and so on before he leaves, but it is very much worth doing. Saul R. Kelson, M.D., cardiologist and President, Toledo, Ohio ACS, Toledo, Ohio, 5/25 Chicago, Tape 2, side 2, rev. 576. ...I feel that nurses should quit...so that they can effectively serve as role models. Patricia E. Lenihan, R.N., B.S.N., Brooklyn, N.Y., 6/16 Phila., Tape 1, side 2, rev. 220. Disappointed I have been with...the interest and support from the scientific and medical community. Most scientists in cancer research are not involved in tobacco related issues...when we talk about smoke cessation programs, there are very few doctors who are really involved in that. And my disap- pointment really goes with many of my medical colleagues who could really help us a great deal in health modification in their various practices. But we as doctors are both under and overtrained in my view to effectively work in these areas. Ernst Wynder, M.D., president, American Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2, rev. 974. Room #1. There is a possibility that the value systems of health professionals and the public at large may be at some variance. If the desired outcome is achieved, it makes little difference whether an individual stops smoking to save health or to improve appearance. James W. Alley, M.D., Director, Div. of Phys. Health, Ga. Dept of Human Resources, Atlanta, Ga., 6/14 Atlanta, p. 4. I had the good fortune to train under Dr. Alton Ochsner, one of the world's pioneers in recognizing the dangers of smoking to health. I have continued his precepts down through my own surgical career. Not many years after I was in my own career did I realize the opportunity that a Surgeon has to influence the lives of his patients. I found that I could convert a high percent of my smoking surgical patients to nonsmokers if I gave sufficient attention to each as an individual. W. C. Payne, Jr., M.D., P.A., general & thoracic surgeon, Pensacola, Fla, 6/14 Atlanta, p. 1. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288664

H E A R T D I S E A S E The relationship of cigarette smoking to atherosclerosis and cardio- vascular disease has been subtle and the pathophysiology of this association only recently demonstrated. Stanford D. Splitter, M.D., internist, Berkeley, Calif., 3/22LA statement, p. 1. , Coronary heart disease is the most frequent cause of death and is the most important cause of excess mortality in cigarette smokers. Stanford D. Splitter, M.D., internist, Berkeley, Calif., 3/22LA statement, p. 2. The total number of excess deaths causally related to cigarette smoking in the U.S. population cannot be accurately estimated, but some estimate of premature deaths from coronary artery disease related to smoking have been as high as 200,000 per year. Stanford D. Splitter, M.D., internist, Berkeley, Calif., 3/22LA statement, p. 2. Again...common sense told me if one of the factors causing hypertension was constriction of blood vessels, or if coronary heart disease was due to narrowed vessels, surely cigarette smoking that had the same effect on vessels, must be bad. Earl B. Flanagan, M.D., Carlsbad, N.M., 5/12 Denver, p. 1. Cigarette smoking is implicated in the causation of atherosclerosis-- or hardening of the arteries--which is the fundamental pathology leading to heart attack and stroke. It greatly increases the likelihood of sudden death in heart disease. Its effects on the heart, the lungs, and the brain reduce physical and mental fitness for work and play. The direct, as well as indirect costs in money and suffering, are enormous. L. Loring Brock, M.D., Director, Heart-Lung Center,5/12 Denver, Colo., 5/12 Denver, p. 1. (According to ACS President Benjamin Byrd)...(S)ome 180,000 deaths from heart attack are directly associated with cigarettes each year. Dr. Paul Kotin, medical director, Johns-Manville,5/12 Denver, Fact sheet attached to 5/12 Denver, p. l. CONFIDENTIAL: TIMN 288665 MINNESOTA TOBACCO LITIGATION

HEART DISEASE (page two) We are in the midst of the epidemic of coronary artery disease which continues to kill and disable a great number of women and men. If this epidemic is to be controlled all factors that we consider as important in causing artery disease must be eliminated, or at least markedly reduced. Manfred Thurmann, M.D., President, St. Louis Heart Assn.,5/19 St._ Louis, p. 1. 3. Cigarette smoking induces acute increases in pulse rate, blood pressure, plasma lipids and peripheral arterial vasal (sic)-constriction. These changes cause an increase in myocardial oxygen demand. All these effects can be duplicated by the oral or parenteral administration of nicotine. There is also a.greater number of heart rhythm disturbances some of which are fatal, in the smoker of cigarettes. 4. Cigarette smoking alters the electrocardiogram in some (emphasis supplied) patients with coronary artery disease depending on the severity of this disease. It does not produce changes in healthy, young individuals. 5. An enigma exists in that cigar and pipe smokers absorb nicotine as well as cigarette smokers but do not have greater prevalence of coronary artery disease... 9. An all important fact is that cigarette tobacco, being a powerful stimulator of the autonomic nervous system, but not an essential arterial pathogen, becomes one in a large population that is also exposed to the other risk factor of ingesting a diet high in cholesterol and animal fat and in a population that may have high blood pressure... 12. There appear (sic) to be more people of personality Type A who are heavy smokers of cigarettes than those with Type B personality. Manfred Thurmann, M.D., President, St. Louis Heart Assn., 5/19 St. Louis, pp. 1-3. Smoking increases the heartbeat 25 times faster per minute. Can this be relaxing physiologically? NO. Because nicotine is a stimulant - your heart is working 25 times as hard. Smoking increases blood pressure. Attachment to George $rownesta.tement, Commissioner, Dept. of Drug and Alcohol Addiction, Nassau County, New York, 6/16 Philadelphia. CONFIDENTIAL: TIMN 288666 MINNESOTA TOBACCO LITIGATION

H E A R T D I S E A S E (page three) Heart disease is the No. 1 killer in this country. It accounts for 685,000 deaths every year. It is estimated that 25 percent of those deaths could be avoided if we could get people to stop smoking cigarettes. Jerome Cohen, M.D., Clinical Cardiologist, St. Louis University Hospital, 5/19 St. Louis, Tape 2, side 2, rev. 552. And what I would make a plea for in a realistic way, knowing what we can achieve in terms of preventing people from smoking and getting people to stop smoking,is that we must have more research into the actual causes of tobacco-related diseases and particularly heart disease. Jerome Cohen, M.D., Clinical Cardiologist, St. Louis University Hospital, 5/19 St. Louis, Tape 2, side 2, rev. 552. --Cigarette smoking is one of the leading identifiable causes of cardio- vascular disease known to scientists; Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 2. Cigarette smoking actually lowers the high density lipoproteins, which is unfortunate, so in this respect cigarette smoking is a disadvantage to reversing ((the atherosclerotic)) process. Crawford W. Adams, M.D., cardiologist and chest specialist, Nashville, 6/14 Atlanta, Tape 2, side 1, rev. 618. (is plus or minus 15 cigarettes a day the dividing line between heavy/ light smoking?) I think any investigator can estalbish whatever he wants. I personally feel that the effects last for one hour and if you smoke six cigarettes a day that's six hours of continuous vasal constriction. So I think you shouldn't smoke at all. Period...This ((effect of smoking)) has been documented by infrared photography with ---- Lindsay's work. He's shown a drop in the skin temperature of 2 or 3 degrees centigrade. Grace Ross' work back in 1959... Crawford W. Adams, M.D., cardiologist and chest specialist, Nashville, 6/14 Atlanta, Tape 2, side 1, rev. 740. CONFIDEN'^IAL; TIMN 288667 A1INNESOTA TOBACCO LITIGATION

H E A R T D I S E A S E (page four) ((Dr. H. W. Daniel] )) also discovered a correlation between heavy wrinkling and heart attacks. Deep facial wrinkles can be a significant warning sign. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., Boston, 6/2/77, p. 2. Hardening of the arteries (arteriosclerosis) today causes some 54 percent of deaths in the United States. It is widely known that this disease is related to high-fat diet. There is now increasing evidence that nicotine, and possibly other chemicals absorbed from various forms of tobacco, enhance the deposit of this fatty material, chiefly cholesterol, within the inner walls of the arteries. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., Philadelphia 6/16/77. Heart disease has been the leading cause of death in this country for more than 50 years. It is also one of the diseases that is most highly related to cigarette smoking. Age-adjusted death rates from arteriosclerotic or ischemic heart disease had been gradually increasing up to the early 1960s. Then the rate began to decline in the late '60s... Whether the reason for this downturn and whether it will continue are unknown. Some have suggested, of course, that it's due to the diminishing of smoking among adult males but...this has not been documented. Ronald Wilson, Chief of the Health Status and Demographic Analysis Branch, Div. of Analysis, National Center for Health Statistics, 6/16 Phila., Tape 1, side 1, rev. 400. What we are trying to create is a peer pressure that makes the nonsmoking child, the thin child, the athletic child, the child that watches his nu- trition, as the peer to mimic...At the age of 10, 40 percent of our children have one risk factor for heart attack. (rev. 1002.) Does it have a relationship to humans? A key question which relates to carbon monoxide, because I attended a meeting in Germany just recently...There were half a dozen experts who were interested in myocardial infarction and the relative significance of nicotine and carbon monoxide in the ((development)) of myocardial infarction and arteriosclerosis. I drew a diagram and asked each one to put up the relative significance of CO and nicotine, both to arteriosclerosis and to sudden death. And every one of those six people gave me a different answer...which clearly indi.cated we hadn't proved this particular issue. It's a key one, because it is my hypothesis that nico- tine probably plays a key role in sudden death through ventricular arrhythmia but not in arteriosclerosis. And next now we gotta determine if it does play a key role. And let's say it does this at 1.2 mg but not at .6mg; then this we need to know because then, for terms of arteriosclerosis, for sudden death the safety limit would be .6. I don't say it is, but I'm giving an example... (rev. 1100.) (cont.) CONFIDENTIAL: TIMN 288668 MINNESOTA TOBACCO LITIGATION

HEART D I S EAS E(page five) Carbon monoxide, we gotta come to grips with the fact: Does CO play a role in arteriosclerosis? It certainly works in rabbits, but there's considerable doubt whether it works in man. (rev. 1110.) ...smoking in terms of heart attacks works really in unison with an under- lying arteriosclerosis as principally induced by hyperlipidemias. So it's a complex area that we must pursue further. (rev. 1117.) Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2. Room #1. Most people know that everyone who smokes will not develop a smoking related disability and that non-smokers develop cardiopulmonary diseases . Suzanne Baxter, R.N., faculty, Boston Univ. School of Nursing, repres. Mass. Nurses' Assn., 6/2 Boston, p. 2. -154- CONFIDENTIAL: TIMN 288669 MINNESOTA TOBACCO LITIGATION

I N A D E Q U A C Y O F E V I D E N C E On the technical level, existing evidence appears to be derived from many inadequate studies. By and large studies on the effects of pollutants are so designed that they tend to underplay the effects of industrial or air pollution on health, while studies on the effects of smoking are so designed that they would over-estimate the effects of smoking on health. A more serious hindrance than these technical flaws is the pall of secrecy that hangs over much of the crucial information that is needed to form valid conclusions. Almost all parties involved in these areas of investi- gation--industry, private agencies, and government research centers--have been guilty of withholding data from the community of concerned scientists and violating the fundamental tenets of science that its transactions must be public. In light of these problems it is difficult to justify any but the most tentative conclusions concerning the relative role of pollution and smoking...The assessment of the effects of pollutants and of smoking are beset by many technical problems and hindered by shrouds of secrecy that must be uncovered before a biometricians skill can be applied with any profit. T.D. Sterling as quoted by Ida Honorof, consumer newsletter publisher, 3/22 LA statement, p. 2. The two most prominent studies linking smoking to lung cancer and other diseases (those of Dr. Doll and Dr. Hammond) contain so many statistical and methodological flaws as to cast serious doubts on any claims based on their results. T.D. Sterling as quoted by Ida Honorof, consumer newsletter publisher, 3/22 LA statement, p. 3. How could one intentionally design a selection procedure that would ensure that males prone to eventually die from lung cancer, somehow are included at twice the rate typical for the U.S. population? T.D. Sterling as quoted by Ida Honorof, consumer newsletter publisher, 3/22 LA statement, p. 4. Passive smoking may also result in absorption of other potentially harm- ful substances. Tobacco smoke contains tar, volatile hydrocarbons including 3, 4-benzpyrene, oxides of nitrogen, hydrogen cyanide, volatile nitriles, acrolein, aldehydes, phenols, and other substances. The effect of these substances absorbed by passive smoking on cardio-pulmonary function remains to be determined. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 11. CONFIDENTIAL: TIMN 288670 MINNESOTA TOBACCO LITIGATION

-156- I N A D E Q U A C Y O F E V I D E P1 C E (page two ) Luquette and associates exposed 40 children, mean age 9.8 years, 3 children at a time, to smoke-filled and smoke-free atmospheres in a poorly venti- lated environmental chamber with dimensions of 12 x 7 x 7 feet. After 30 minutes exposure, during which time 6 cigarettes were smoked by 2 smokers also present in the chamber, the children had a mean increase in heart rate of 6 beats per minute, a mean increase in systolic blood pressure of 4 mm Hg, and a mean increase in diastolic blood pressure of 5 mm Hg. While in the nonsmoking atmosphere, the mean heart rate increased one beat per minute, the mean systolic blood pressure decreased 4 mm Hg, and the mean diastolic blood pressure did not change. However, the experimental design of this study has been questioned. Moreover, Harke and Bleichert found no significant change in blood pressure or in heart rate in nonsmoking adults exposed to greater concentrations of tobacco smoke. Wilbert A. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 7. Colley found that the prevalence of cough in 2,426 children between 6 to 14 years of age in Aylesbury, England, was associated with their parents' smoking habits. The prevalence of cough was highest when both parents were smdkers, lowest when both parents were nonsmokers, and intermediate when one parent was a smoker. When parental phlegm production was held constant, there was a suggestion of a weak association between parental smoking and chest symp- toms in their children, but it was not statistically significant. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 8. (Asked what proportion of the deaths in the tables she had presented for the years 1971 through 1975 for the City of St. Louis was caused by smoking) These statistics don't speak of smoking. They speak of resident deaths...but they do not mention the relationship to smoking. Wilma Claseman, M.D., Assistant Health Commissioner, City of St. Louis, 5/19 St. Louis, Tape 1, Side 1, Rev. 239. (Asked by Weingarten if he was aware of any studies that refute the claims that cigarettes are harmful to health, he said that "basically, statistics go so far...it's difficult to say X plus Y equals Z" on the basis of statistics alone...tape indecipherable; AHD has notes) Roger J. Adams, DDS, Senior Resident, Dept. of Oral Pathology, Washington University, 5/19 St. Louis, Tape 1, Side 1. Simonds: Are you aware of any diagnostic or screening methods that will pick up damage to the lungs prior to the appearance of overt symptoms or X rays? Secker-Walker: Oh, yes. There are several available in lung function CONFIDENTIAL: TIMN 288671 (cont. ) MINNESOTA TOBACCO LITIGATION

-157- I-NADEQUACY OF EVIDENCE (page three) (cont.) sensitive tests for damage to the'small airways. They are nonspecific and they don't necessarily indicate that smoking is the cause, but if you have a smoker who has these changes then you can be well advised to stop them smoking and they would be well advised to stop smoking. Roger Secker-Walker, Director of the Pulmonary Division, Dept. of Internal Medicine, St. Louis University School of Medicine, 5/19 St. Louis, Tape 2, side 1, rev. 420. ...we do not have that fundamental condition ["something that would prove the case against smoking so strongly that no one would any longer be able to deny it"] existing yet.... Ivan L. Preston, Professor, School of Journalism, University of Wisconsin, Madison, Wisconsin, 5/25 Chicago, page 3. Another area that requires investigation has to do with the CO that is present in the smoke of the inhaled cigarette and what its effects are. There are studies showing some slowdown of mental agility as the CO level rises in the smoker, as it does -- the COHb level. And yet whether there's a permanent damage from this CO is unknown. And it's really unknown whether second -- that is whether the fellow who's in a room where smoking is going on is deleterious to him and how. John L. Pool, M.D., thoracic surgeon, Norwalk, Conn.; 6/2 Boston, Tape 2, side 1, rev. 575. We need to really understand better the problem of involuntary smoking. Jonathan Fielding, M.D., Massachusetts Commissioner of Public Health; 6/2 Boston, Tape 1, side 1, rev. 138. ...there has been little scientific work that has been done, in order to see the relationship of the non-smoker to his environment when exposed to large quantities of cigarette induced pollutants. On a clinical basis it is my opinion that there is a relationship and ((exposure to others' smoke)) accounts for some of the non-smokers that we see with serious problems that we usually contribute to the smoker. In each case that this occurred in our experience we have been able to document this high incidence of atmospheric exposure. William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, p. 2. CONFIDENTIAL: TIMN 288672 MINNESOTA TOBACCO LITIGATION

I N G R E D I E N T L I M I T A T I O N ...the ingredients in the cigarette should be more specified. Dolphin Lair, accused felon, LA., 3/22 LA statement, p. 1. OBJECTIVE #4: require cigarette companies to reduce all tar, nicotine and gases to absolute minimum levels. Due to pressure from the American Cancer Society and other important groups, tobacco tars have been reduced by 60% over the past 20 years and are 30% lower than 10 years ago. That is a good gain. But, not enough. We strongly recommend that forceful efforts be exerted to get the cigarette companies to reduce all tar, nicotine and the poisonous gases (CO NO2 HCN) to minimum possible levels by 1979. Melvin A. Jensen, L.A. advertising agency executive, Mormon spokesman, 3/22 LA statement. p. 4. I believe we must encourage and support federal legislation that would require the United States Government to: 4. Set limits on tar, nicotine and carbon monoxide levels of cigarettes manufactured and/or sold in the United States. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22 LA statement, p. 3. At the very least, the FDA should have the authority to set the maximum levels of tar and nicotine in cigarettes. I intend to introduce legis- lation to give the FDA this authority in the very near future. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 6. An alternative approach to controlling tar and nicotine content is the federal excise tax based upon tar and nicotine proposed by Senators Hart and Kennedy. Under this proposal, a graduated tar and nicotine tax would encourage smokers to consider the additional risks of highly toxic cigar- ettes and would provide an incentive for smokers to switch to less hazardous brands. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 6. Legislative action should be initiated to severly reduce the maximum permis- stble level of tar and perhaps also nicotine content of cigarettes sold in the United States. Jonathan Fielding, M.D., Mass. Commissioner of Public Health, 6/2 Boston, p. 7. CONFIDENTIAL: TIMN 288673 MINNESOTA TOBACCO LITIGATION

-158a- INGRED IENT LIMITATION (pagetwo) ...the lowering of the maximum tar and nicotine levels below the 1973 averages, 19.2 mg tar and 1.3 mg nicotine, would decrease some of the hazardous effects of smoking. Douglas S. Lloyd, M.D., Conn. Commissioner of Health, 6/2 Boston, p. 3. I feel efforts to gain stronger and more prominent warning labels on all ciga- rette packages, stronger controls of cigarette sales to minors, and mandated tar and nicotine levels would for the most part be a waste of time and energy. Roni Rechnitz, Dir., Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, p. 7. CONFIDENTIAL: TIMN 288674 MINNESOTA TOBACCO LITIGATION

-159- I N S U R A N C E Recommendations: ... 9. Life and health insurance companies and prepaid health plans should offer lower rates to nonsmokers. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health. 3/22 LA statement, p. 6. With the proliferation of commercial methods, it is critical that some group--preferably disinterested cessation experts--be given the respon- sibility of setting guidelines and evaluating the success of methods sponsored by both profit and nonprofit groups. If we are going to ask physicians, voluntary agencies, and health departments to make referrals to smoking clinics, then we must protect the public by providing advice on the value of available withdrawal methods. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health. 3/22 LA statement, p. 13. All kinds of ((stores)) are doing it ((banning smoking)) and they're quite satisfied with the results. They are able to have a cleaner atmos- phere, more comfortable shopping, reduced maintenance costs--this is a definite advantage--less damage to stock. This is especially applicable to department and clothing stores. And their fire insurance can go down in the future. I believe this could go down. Herm Perimutter, LA, founder and co-chairman of Californians for Clean Indoor Air, 3/22LA Tape 7, rev. 668. Insurance systems, the backbone of funding for "health" care, must truly develop a system for health rather than sickness care. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 5. For instance, setting life, auto and health insurance rates to provide economic incentives for not smoking can be continued and enlarged perhaps to include incentives for the control of other tax incentives to com- panies which employ such procedures and, in other ways, promote healthy lifestyles among their customers and employees. The government might, itself, provide incentives, perhaps through tax rebates, for individuals who act responsibly for their health. E. B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ., St. Louis, Missouri, 5/19 St. Louis, p. 1. MINNESOTAOTOBACCO LITIGATION TIMN 288675

I N S U R A N C E (page two) Government contracts, tax incentives, federal grants and aid are all powerful incentives which can be manipulated to increase activities of the private sector and of state and local governments to encourage not smoking. For instance, the practice of life and auto insurance premium reductions for non smokers could be encouraged and, thereby, expanded by tax incentives for corporations which implement such practices. Similarly, innovative state and local programs which encourage non.smoking and other healthy behaviors might be encouraged through appropriate revenue sharing policies. It could be established that private carriers or a national health insurance system would provide lower premiums or a lower deductible amount for non smokers and those who control other voluntary risk factors, such as obesity. E.B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ. St. Louis, Missouri, 5/19 St. Louis, pp. 12-13. The State of Missouri did a study based on our experience and confirmed to their own satisfaction that it was a reasonable basis for setting up a separate category for drivers. Actually, using our experience in the State of Missouri report, the figures that they got from our records showed that the accident frequency for property damage among smokers was approximately 173 percent of that among NS. Now that's just property damage and of course there are other aspects to an automobile insurance policy. David McCord, Vice President and Actuary, Farmers New World Life Insurance Co., Seattle, an affiliate of Farmers Insurance Group, Los Angeles (casualty and homeowners insurance), 5/17Seattle, Tape 4. We have two rates on a plan -- let's take a whole life plan. We have an NS rate and a smoker's rate and I think you would find that our NS rate is extremely competitive, probably better than most -- not all, but most. And our smoker's rate is not as competitive. And because of that, in effect, there's an up charge, because the smokers' rates do reflect an expected higher mortality. David McCord, Vice President and Actuary, Farmers New World Life Insurance Co., Seattle, an affiliate of Farmers Insurance Group, Los Angeles (casualty and homeowners insurance), 5/17Seattle, Tape 4. CONFIDENTIAL: TIMN 288676 MINNESOTA TOBACCO LITIGATION

I N S U R A N C E (page three) This financial burden [caused by smokers] is spread evenly over the buyers of health insurance without regard to their utilization, with smokers and non-smokers paying the same rates. The same problem applies to the insurance industry as a whole, with equal rates for all but with unequal automobile insurance and home fire insurance claims by the smoker and the non-smoker. Laurence H. Bates, M.D., Oncologist, 5/25 Chicago, page 1. Place these enormous costs -- multiple billions -- on the smoker rather than on the citizen-at-large, through: Higher medical insurance premiums; Higher life insurance premiums; Higher disability insurance premiums; Higher Social.Security premiums; Higher cigarette taxes - possibly triple David A. Penner, M.D., Thoracic and Cardiovascular Surgeon, Detroit, Michigan, 5/25 Chicago, page 3: However, nonsmokers are finally doing some huffing and puffing of their own. They realize that smokers start fires and nonsmokers share the burden of high insurance premiums. Nonsmokers are outraged that through health insurance premiums they pay billions of dollars for hospitalization and medical care for smokers diseases. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 2. Dr. Shank: I have only a comment to make. There's at least one test that's being rather widely applied in trying to detect smokers, the thiocyanate test on blood and on urine and it's being used primarily in clinical trials of the Heart Institute. It's not-a-per,fect•test,-but it's one that's being applied widely and might actually be adaptable by insurance companies, I believe. Dr. Robert Shank, Wash. Univ., St. Louis, NCSPP member, during testimony of Roy Korson, M.D., 6/2/77 Boston, Tape 1, side 2, rev. 960. Futher, I have proposed that non-smokers be given lower auto insurance rates than smokers. The general health and alertness of non-smoking drivers is superior to that of smokers and should be a factor in determining rates. Lois G. Pines, State representative, Newton, MASS., 6/2 Boston, p. 3. Delivered by Leg. Asst. Douglas Husette. CONFIDENTIAL: TIMN 288677 MINNESOTA TOBACCO LITIGATION

-162- I N S U R A N C E (page four) ...we can work together to promote a trend that has already occured in the insurance companies to deal with differential premiums to nonsmokers and smokers, the same ways we do for persons with other risk factors in life insurance and other kinds of insurance. J: Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. Question: It has been suggested several times that smokers should be charged premium rates for life insurance, health insurance, and so on. How do you react to this suggestion from the standpoint of Blue Cross/Blue Shield? Goldowsky: I think that it would be a difficult thing for them to adopt this policy, because of their tendency to give a community rate for direct subscribers, or to group rates for those who are in industry, for example. I think some of these things may be a little farther down the road.... Seebert J. Goldowsky, M.D., retired surgeon, Medical Director, R.I. Blue Cross/Blue Shield and immediate Past President, R.I. Interagency on Smoking, Providence, R.I., 6/2 Boston, Tape 4, side 1, rev. 225. Individuals who smoke are at greater risk for disease and this ought to be reflected by rated insurance premiums, whether it's life insurance, fire insurance, health insurance or disability insurance. Steven R. Homel, M.D., Director, Center for Health Educ., Phila., Pa., 6/16 Phila., Tape 2, rev. 80. I some months ago went to one of the leading hospitals in N.Y. -- it's a general hospital -- and having just read that they had bought an M.E. .Scanner, ((a)) diagnostic x-ray machine ... that is quite a bit used, though its cost effectiveness could be debated. And I said now that you've just done that why don't you establish a smoke cessation clinc. And I was told by the president of the hospital that since Blue Cross didn't pay for it they obviously couldn't afford ((a cessation clinic)). Ernst Wynder, M.D., president, American Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2, rev. 981. Room #1. (Asked by Maull if his company has nonsmoker insurance rates) ..the marketing realities are such as of this time that we have not taken that step. Farris Bryant, former Fla. governor and president, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, Tape 1, side 1, rev. 169. %_,~ -C, ...I think that the insurance industry, as well as governmental agencies Q have not encouraged the premium reduction to non-smokers as an absolute ~ necessity. William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, p. 4.

-163- I N S U R A Di C E (page f ive ) A third bill we were successful getting adopted was a prohibition against smoking in grocery stores. This one did not come immediately out of the Lung Association or a committee. Instead it came strangely enough, from the restaurant owners, who-((had)) discovered they could get 25-30 percent reduc- tion on their insurance policies -- fire insurance -- by prohibiting smoking. So they quickly backed that prohibition and that currently is in effect in Michigan.. William Sederberg, Ph.D., director of research, program section, Mich. House of Reps GOP Caucus, and president, Mich. Lung Assn., 5/25 Chicago, Tape 1, side 2, rev. 222. In 1964, the year in which the Surgeon General's now famous Report was published, State Mutual announced that, on the basis of these scientific studies showing a high degree of relationship between heavy cigarette smoking and diseases of the lungs and the heart, we felt it was part of our business, as a life insurance company, to acknowledge the risk that people take when they smoke. Ours was the first public statement by a major life insurer on smoking and health. (p. 1.) ...we were not taking a moral stand on this issue; nor were we particularly concerned about the absence, in some people's views, of a definite causal rela- tionship between smoking and an increased likelihood of death from one or more of the causes cited. As insurance managers and actuaries, we were interested in the statistical, rather than the pathological or epidemiological validity of the studies. (p. 2.) ...some of our competition called the plan a "gimmick". (p. 3.) As of 1976, we were aware of about thirty other U.S. companies, including five of the major life insurance companies, who were offering one or more non-smoker insurance plans. (p. 4.) We have been in the non-smoker insurance market now for just over thirteen years. We are beginning.to develop our own statistically credible life insurance ex- perience on the mortality of non-cigarette smokers, and expect that it will add further support to the findings published in the Surgeon General's 1964 Report and in the various sequels to that report. (p. 4.) ...about two-thirds being sold on this basis...consistent with the percentage of non-smokers among the socio-economic group that comprises our insurance market. (p. 4.) ...we have strengthened the Company's financial position by adding to our insurance rolls thousands of satisfied customers whose low mortality characteristics are the envy of the life insurance business. (p. 4.) Michael J. Cowell, Vice President and Chief Actuary, State Mutual Life Assurance Company of America, Worcester, Mass., 6/2 Boston. CONFIDENTIAL: TIMN 288679 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I© N-- M I S C. I believe we must encourage and support federal legislation that would require the United States Government to: 7. Establish an independent commission within the Federal Government which would have the responsibility for the formulation of a public Policy on smoking, the implementation of the requirements set forth under 1-6 above, and the coordination of activities by the departments involved. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22LA statement, p. 3. (RE: LEGISLATIVE ACTION AND REGULATION:) ...Suffice it to say that (1) the assurance of continuing vigor of the tobacco industry by its annual transfusion of dollar subsidies, (2) the nonexistence of an effective means of redress to injured parties in a manner like that of workers' compensation, and (3) the specific exclusion of tobacco from regu- latory authority all present a threat to the general welfare that is being addressed in a woefully inadequate manner, if at all. Dr. Paul Kotin, medical director,. Johns-Manville, Denver, 5/12 Denver, p. 5. Regulation can be achieved by immediately incorporating cigarettes under the Toxic Substances Control Act which would neatly circumvent the now vola- tile issue of the Delaney clause in the Food, Drug and Cosmetic Act while at the same time treating tobacco no differently than any other environ- mentally hazardous chemical to which man is exposed. Dr. Paul Kotin, medical director, Johns-Manville, Denver, 5/12 Denver, p. 6. If the profit motives were removed and cigarette advertising forbidden, powerful forces which probably instigate and maintain much smoking would cease to exist. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology ~ lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis, p. 17. CONFIDENTIAL: TIMN 288680 MINNESOTA TOBACCO LITIGATION

-165- L E G I S L A T I 0 N-- M I S C. (page two) For instance, setting life, auto and health insurance rates to provide economic incentives for not smoking can be continued and enlarged perhaps to include incentives for the control of other tax incentives to com- panies which employ such procedures and, in other ways, promote healthy lifestyles among their customers and employees. The government might, itself, provide incentives, perhaps through tax rebates, for individuals who act responsibly for their health. E. B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ., St. Louis, Missouri, 5/19 St. Louis, p. 1. Perhaps the American Cancer Society and other concerned voluntary or governmental bodies might institute a study of how, over the next twenty years, the manufacture and sale of tobacco for piofit may be phased out of our economy without the loss of a single job of any American. The goal of such a phasing would be a system in which cigarettes would continue to be manufactured and sold, but not for profit and only on a regulated basis, perhaps through liquor stores or pharmacies. Edwin B. Fisher, Jr., Ph.D., Asst. Prof.•of. Psychology & lecturer in Psych. and Law, Washington Univ., 5/19'St. Louis, p. 17. Clearly, there is as much justification for governmental interference in the manufacture and distribution of tobacco products as there is for governmental intervention in and regulation of the sale of foods, drugs, and alcohol. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis, p. 18. _ As an individual I find the smoking of tobacco to be an offensive and disgusting drug habit...But as a State Representative I must attempt to represent myself strictly to amending the law in a manner which provides reasonable protection to the public with a minimum of governmental inter- ference and regulation. Carl H. Muckler, Missouri State Representative, 5/19 St. Louis, p. 1. As a realist, I feel that if the tobacco industry is allowed to lobby the Congress to protect their product and their industry, the American Cancer Society should be free to lobby for the protection of the American public. Ashbell C.williams, M.D., Jacksonville, Florida, 6/14 Atlanta, P• 2- CONFID]CNTIAL: TIMN 288681 MINNESOTA TOBAC C O LITIGATION

L E G I S L A T I O N-- M I S C. (page three) in the area of legislative and regulatory remedies, I recommend a careful approach; especially in such matters as the regulation or control of advertising by the Federal Government, punitive tax measures, the removal of subsidies to tobacco farmers, etc. The likelihood of obtaining such legislative or regulatory measures should be questioned...The possibility of passage, within the foreseeable future, ought to be among the consider- ations when determining a course of legislative action. George A. Gingell, Georgia Assn. of Broadcasters & Mass Media chairman, GA. Div. of ACS, 6/14 Atlanta, p. 1. If the Federal government can protect the rights of the handicapped by withholding money from SEPTA ((transit system)) for not considering special ramps in new construction to provide for wheelchairs, then Federal dollars should be denied SEPTA until they begin to protect the health of the majority of suffering non-smokers. Jerry Silverman,Philadelphia commuter, 6/16 Phila., p. Subsidize the tobacco industry to switch to the production of non-lethal products. Robert Eyerly, M.D., Danville, PA, 6/16 Philadelphia, p. 5. Require cigarette companies to pay for anti-smoking messages in news- papers, magazines, events programs, on billboards, etc_ Robert Eyerly, M.D., Danville, PA, 6/16 Philadelphia, p. 5. . Make cigarette manufacturers legally responsible for dollar damages caused by cigarette smoking. Institute class-action suits on the part of the victims of smoking-caused cancer deaths. Robert Eyerly, M.D., Danville, PA, ,6/16 Philadelphia, p. 6. Fifty percent of the profits of the cigarette manufacturers should be given to smokers' survivors. Robert Eyerly, M.D., Danville, PA, 6/16 Philadelphia, p. 6. Appoint a Task Force to summarize the existing scientific evidence demonstrating the physical damage inflicted on non-smokers by smokers. Robert Eyerly, M.D., Danville, PA, 6/16 Philadelphia, p. 6. 1. CONMENTIAL; TIMN 288682 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I O N -- M I S C. (page four) Obtain an Executive Order from the President banning sales of cigarettes on government property (PX's, office buildings, etc.) Robert Eyerly, M.D., Danville, PA, 6/16 Philadelphia, p. 7. Ban cigarettes under the Pure Food and Drug Act. Robert Eyerly, M.D., Danville, PA, 6/16 Philadelphia, p. 7. Warnings on cigarette packages should be more specific. "The Surgeon General Has Determined That Cigarette Smoke is Dangerous to Your Health and That of Your Children." Janith Stewart Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 5. In view of the fact that tobacco-related cancers account for approximately one-third of the total cancer deaths in males and an increasing number of such deaths are being evidenced in females, the total funds available for smoking related preventive programs as part of the National Cancer effort, appears trivial, at best. In addition to greater funding, it is necessary for various government and voluntary health agencies to coordinate specific chemical, biological, clinical and educational research programs in an effort to combat these diseases. Ernst L. Wynder, M.D., Naylor Dana institute for Disease Prevention and the Health Maintenance Institute, American Health Foundation, 6/16 Philadelphia, pp. 8-g. Federal legislation at this time appears impractical, but both local and state legislative areas are available for carefully prepared and well supported programs. That legislative climate now appears good for the anti-smoking majority to make its feelings known. J. Mostyn Davis, M.D., P.C., Shamokin, PA, 6/16 Philadelphia, p.' 8. Fourthly, the National Clearinghouse for Smoking and Health must be strengthened to the extent that it can award Federal grants to states and local governments for the purposes of health education on smoking and health, research, and other appropriate anti-smoking activities. Leonard Bachman, M.D., PA Sec. of Health, 6/16 Philadelphia, p. 7. TIMN 288683 MINNESOTAO OBAC~Cp L: LITIGATION y

LEGISLATION -- MIS C. (pagefive) Now I, in my youthful naivete, have stated in my outline that we've got to get Congress to do something about the Labelling Act of 1969 in order to take out the prohibition to the Federal Trade Commission. And I suppose that is an easy thing to say and a difficult thing to do. And I guess it is. It seems to me that a good place to start is right here in the State of Washington, with two Senators who are very forceful and very powerful and one Senator who has already expressed an interest in this by passing -- or sponsoring, rather -- the Labelling Act of 1969. That's Warren Magnuson. And I would hope that the results of the com- mission and perhaps the results of the general public's urgings upon their Congressional delegations, especially our Congressional delegation, could bring about some kind of change, as far as this preclusion to the Federal Trade Commission's ability to pass regulations is concerned. And I feel virtually certain that if we were to mass some kind of populist attack that we could, at least with our Senators here in this State, get some kind of response and perhaps some further inquiry into the problem. Bruce Flynn, Attorney, Karr, Tuttle, Koch, Campbell, Mawer and Morrow, Seattle, Wash., 5/17Seattle, Tape 3. (Tape is incomprehensible, but AHD notes show Cowley explaining in answer to a question from Mrs. Perkins that legislation is not the answer, education is.) Ray G. Cowley, M.D., Director, Missouri State Chest Hospital, Mount Vernon, Mo. 5/19 St. Louis, Tape 1 side 1. At the very least, the FDA should have the authority to set the maximum levels of tar and nicotine in cigarettes. I intend to introduce legis- lation to give the FDA this authority in the very near future. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 6. Policy is needed which is much more sensitive to the reduction of the health consequences of cigarette smoking, rather than the much more difficult elimination of a social habit. Such a policy would shun basically symbolic gestures (such as package warnings), which have almost no impact on cooperation from the tobacco industry in reducing the tar and nicotine dosage of its products. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 1. CONFIDENTIAL: TIMN 288684 MINNESOTA TOBACCO LITIGATION

-169- LEGI S L A T IflN--MI S C. (page six) ACS should establish a group to begin the thorough investigation of policy options, their costs and benefits. This was an idea considered by the Surgeon General's Committee in their deliberations, but was left to a sub- sequent effort that was never undertaken. As the report of the National Task Force on Tobacco and Cancer of the American Cancer Society acknowledged past governmental initiatives have not had intended results and have in fact produced "serious drawbacks." Such an effort should include social scientists and representatives of tobacco agriculture and manufacturing in addition to health professionals. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, pages 2 and 3. Past government policy has not worked as expected and a case can be made that less hazardous cigarettes would be more prevalent today in the absence of governmental involvement. Kenneth M. Friedmaa, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 6. It is myconviction that we have not yet reached a level of awareness on the importance of a non-smoking environment to generate the support that would be necessary either to pass legislation or to overcome the inertia that still exists. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 12. I am in support of a bill in the Illinois Legislature initiated by the Illinois Interagency Council on Smoking and Disease which will prohibit smoking in designated areas such as hospital patient rooms, patient areas, elevators, indoor theaters, libraries, art museums, concert halls and buses... We need to not only support enactment of such laws in every state but also encourage active enforcement. Paul Q. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 4. I suggest that federal and state governments insist through adequate legislation that programs be initiated in all elementary schools, re- quiring that a certain amount of hours be directed to the subject of tobacco use and cigarette smoking. Martin G. Swaney, Public Health Educator, City of Milwaukee Health Dept., Milwaukee, Wisconsin, 5/25 Chicago, page 5. CONFIDENTIAL: TIMN 288685 MINNESOTA TOBACCO LITIGATION !

L E G I S L A T I 0 N-- M I S C. (page seven) ..[I suggest]that in all of the schools, it be a requirement that no teacher, principal, or any employed person on the school property be permitted to smoke during school hours, or at any school-related function when pupils of that school are present. Martin G. Swaney, Public Health Educator, City of Milwaukee Health Dept., Milwaukee, Wisconsin, 5/25 Chicago, page 5. All educational programs in the school must involve parents and child. It is suggested that there be mandated programs for parents of all pupils. Both parent and child (children) would attend informational programs on the hazards associated with the smoking of cigarettes. Each parent would be required to sign a commitment not to start smoking, or if they are now smoking, to agree to attend a certain number of smoking cessation clinic sessions in an attempt to stop smoking so as to set a good example for their children. Martin G. Swaney, Public Health Educator, City of Milwaukee Health Dept., Milwaukee, Wisconsin, 5/25 Chicago, page 5. [Proposed increased cigarette taxes should be used for] reimbursement to the General Treasury for funds depleted by disability payments for the prematurely ill and hospital payments for losses incurred due to tobacco induced illness. Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, page 2. I think that one major area of deficiency in smoking and health has been the poor utilization, almost non-utilization, of the various organizations which plague me. When I talk to the Environmental Defense Fund, and to the Health Research Group, and to the Sierra Club ... I can only assume Z that these people are at least as highly motivated as I am. Why in the ~ hell aren't they involved with cigarettes? :..[T]hey`re not on the ~ cigarette band wagon for lots of reasons . . [b]ut these agencies, ~ these volunteer organizations, these consumer groups, can, and if neces- ro sary, if not voluntarily, be forced into taking a position. aa Paul Kotin, M.D., Medical Director for Johns- Manville Corp., Denver; 5/12 Denver, Tape 3, Rev. 55-66. ..:[A]ny solution ultimately that we bring to bear . . . or try to bring to bear on the issue of tobacco has got to recognize monied interests. I don't say that critically. I respect monied interests, but I think you cannot just bring into play some kind of a moralistic response without recognizing the importance of the fact that money drives the machine. Merlin DuVal, NCSPP panel member, Denver; 5/12 Denver, Tape 3, Rev. 243. TIMN 288686

L E G I S L A T I 0 N-- M I S C. (page eight) Identify those persons running for office or for re-election as favorable in relation to limited smoking legislation. Support favorable candidates to assist in their election. Jack Ogg, Texas State Sen.; 5/12 Denver, pp. 4-5. Weingarten: Do you think it would pay the government to pay tobacco farmers not to grow tobacco? If they can't find a sub- stitute crop which could be heavily subsidized? Woodson: I don't think it would pay because Mexico or somebody else would grow it. And even if they passed a law it will be bootlegged in here. I just don't think there's any way to answer the problem. I don't think legislation is the answer. It wasn't with liquor. Steve Woodson, ACS volunteer and former tobacco company salesman, Raleigh, North Carolina; 6/14 Atlanta, Tape 1, side 1, rev. 817. We need to support smoking cessation clinics. There have to be public monies appropriated so that we have not only SmokEnders, which is a private, profit-making group, but the equivalent in the public sector, supported by tax dollars and that in my view is a lot better investment than some of the high technology investment that currently is going in to the health care industry. Jonathan Fielding, M. D., Massachusetts Commissioner of Health; 6/2 Boston, Tape 1, side 1, rev. 150. ...I think that there has to be with an insurance scheme, I think within National Health Insurance, if we get that, or certainly under a third party, and under Medicaid or Medicare, there has to be payment with very little leeway for charlatanism. Jonathan Fielding, M. D., Massachusetts Commissioner of Public Health; 6/2 Boston, Tape 1, side 1, rev. 268. ...I would suggest you consider trying to fund the agency ((the CDC's Bureau of Health Education)) that was set up last year but with no money whatsoever to try and push health education and to foster efforts in the area of prevention. Jonathan Fielding, M.D., Massachusetts Commissioner of Public Health; 6/2 Boston, Tape 1, side 1, rev. 314. CONFIDENTIAL: TIMN 288687 MINNESOTA TOBACCO LITIGATION

LE GI SLATION--MI SC. (pagenine) ...because of our feeling about the astronomical increase in smoking behavior in young women and the increase in mortality in women in general, we have applied and are part of the community based cancer program in Conn. funded by the NCI believe that Conn. will be getting an implementation grant. Part of that will be to set up some programs for smoking behavior modification and for smoking education. These will be federal funds. Douglas S. Lloyd, M.D., M. P. H., Conn. Commissioner of Health, 6/2 Boston, Tape 1, Side 1, rev. 579. I would suggest that it is the obligation of those of us in government to regulate this health hazard ((ambient smoke)) for the good of the public. Lawrence DiCara, Boston City Council member, .6/2 Boston, p. 2. ...this year, the tobacco lobby paid an out-of-state physician, who did not register as required, to testify against the smoking bill at a public hearing. The Secretary of State has recommended that our Attorney General pursue changes for violation of the state's lobbying laws. James A. Swomley, State Assemblyman & Executive Director, Conn. Lung Association, 6/2 Boston, p. 4. Fanatics or people demanding that I support their measures or face the loss of their vote usually turn my vote the other way. And on the smoking issue, unfortunately, there are overzealous people who do the cause more harm than good. James A. Swomley, State Assemblyman & Executive Director, Conn. Lung Association, 6/2 Boston, p. 6. You know, sometimes I look upon it -- the government taking action -- being a bit like the cat eating the grindstone. It happens over a period of time, if he's sufficiently persistent, but it's also very slow. Never- theless, I think we have made progress in getting government action, not only on the part of the congress, but on the part of the regulatory agencies...we do get things done. But, traditionally, our government is a government of evolution and thank God not one of revolution. Dr. Luther Terry, former surgeon general, educational consultant, at ACS 2/1/77 news conference, NYC, rev. 692. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288688

L E G I S L A T I O N-- M I S C. (page ten) ...in Pennsylvania, Public Code 872 was enacted on June 24, 1939 and focuses on the sale of tobacco to minors (section 647), the furnishing of cigarettes or cigarette papers to minors (section 648) and the failure of a minor to divulge information (section 649). Nowhere in this law does it prohibit teenagers from possessing and/or using tobacco. As a result, there is no legal basis for controlling the possession or use of cigarettes by teenagers in Pennsylvania. James C. Manley, Ph.D., Asst. Superintendent, Northgate School Dist., Pittsburgh, PA., 6/16 Philadelphia, p. 2. "No Smoking" Ordinance - Several school districts have been able to work cooperatively with their local governmental officials to pass an ordi- nance prohibiting smoking in public places. Usually people violating this policy (adults and teenagers) are subject to a fine...One advantage is that students are fined and not suspended from school and, therefore, have an uninterrupted educational program. James C. Manley, Ph.D., Asst. Superintendent, Northgate School Dist., Pittsburgh, PA.,6/16 Philadelphia, p. 4. The general public--smokers and nonsmokers--are ready to take remedial action. Nonsmokers do not want to be annoyed by smoking. Most smokers would like to quit. So we have a receptive audience. More than ever before, people will be willing to have regulatory rules concerning smoking imposed upon them. They will be more willing to help enforce such rules. Dorothy E. Green, Ph.D., consultant to NCI, Arlington, Va., 6/16 Philadelphia, pp. 3-4. We need a committee to get the government involved to make it more costly for the cigarette manufacturers to continue producing cigarettes which are chea for them and dangerous to people's health. Jeanne A. Cunnius, vice president, Business Careers, New York City, 6/16 Philadelphia p. 5. The Federal Government has a clear responsiblity (sic) to meet the smoking problem by enacting legislation to encourage people to stop smoking, provide incentives for the use of less deleterious cigarettes by those who insist on continuing their habit, and protect the rights of the majority of Americans who do not smoke. Nick Rahall, U. S. Congressman, (D-W. Va.), 6/16 Philadelphia, p. 1. I am sure we can count on the Commission and the American Cancer Society to help in the push to fight cancer through Federal legislation. Nick Rahall, U. S. Congressman, (D-W. Va.), 6/16 Philadelphia, p. 4. CONFIDENTIAL: TIMN 288689 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I O N-- M I S C. (page eleven) Since the responsibility for the entire ((mandated school health)) program rests in one Department and since this Department is accountable to the State Legislature the possibility exists of exposure to the highly professional, well endowed, lobbying efforts of the cigarette industries where their capacity to disrupt even the best conceived strategies is well known. Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, p. 8. We could utilize the tobacco tax, which in New York State amounts to several hundred million dollars, totally to educating the people not to smoke, to create non-smoking clinics, to educate teachers in non-smoking curriculum, to publicly advocating the rights of the non-smoker to unpolluted air in his place or work, his home or wherever he gathers. We could use these tax dollars to prevent the littering of our streets with tobacco products such as crushed-out cigarettes, cigar butts, pipe ashes and the like. We could organize and promote parental education programs in our schools and community centers. Fred G. Field, Jr., N.Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., 6/16 Philadelphia, p. 2. Why not just come out and tell them they can't smoke-period and let them take the case to court if they are that concerned with their right to smoke. Fred G. Field, Jr., N.Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., 6/16 Philadelphia, p. 3. ...the Consumer Product Safety Commission, the EPA and the FDA do not have jurisdiction over cigarettes in any way at the present time and there's quite a legislative history to that effect and quite a series of formal opinions by the lawyers of those agencies to that effect and from the Comptroller General ... the Congress has clearly in both its legislative history and in subsequent testimony taken unto itself the reserved right under itself for policy decision on cigarettes. J. Rich.Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., -6/16 Phila:, Room #3, Tape 1. ...if you want to regulate something with minimal societal resistance and maximum effectiveness, go for the pocketbook. Do not think in terms of necessarily bans and trade-offs of that type but find a way to make the offending item economically unattractive. J, Rich.Crout, M.D., Director, Fur. of Drugs, Fed. Food & Drug Acla., 6/16 Phi1a:, Room #3, Tape 1. CONFIDENTIAL: TIMN 288690 MINNESOTA TOBACCO LITIGATION

-175- L E G I S L A T I O N-- M I S C. (page twelve) But the Congress is really where the action is in forming public policy on cigarettes. ,T.Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. ...from an institutional standpoint right now, it is not our problem... in the formal sense. j. Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. Full consideration ought to be given to increasing appropriations for public education programs. Charles E. Grassley, U.S. Congress (R-Iowa),(delivered by Stephen Roberts),,5/19 St. Louis, p. 4. Question: I wonder if you could tell us what kinds of pressures have come to bear on the legislators from the tobacco industry at the local and state level to oppose this sort of legislative activity? Husette: It has not been as heavy a lobby campaign on the state level as we see on the federal level, basically because it hasn't been necessary. There are a majority of legislators who are smokers. Legislative leadership are people who don't treat the issue very seriously. Lois G. Pines, Mass. State Rep., Boston,.Mass., (represented Doug Husette), 6/2 Boston, Tape 1, side 2, rev. 439 The answer to this has got to be, in my estimation, finally and definitively, a ban on the tobacco industry.... Samuel E. Molind, D.M.D., oral pathologist, Montpelier, Vt., 6/2 Boston, Tape 2, side 1, rev. 551. The legislative route is politically unpopular, economically unpopular, ...to the advertising media, to the tobacco industry, and obviously to the govern- ment.... The legislative route is a tough one. You can't legislate personal habits. You have to attack it by education. To attempt to ban smoking -- I think, well, may I say a pipe dream is a pipe dream -- and probably would meet the same type of fate that the Volstead prohibition act met. Robert E. Biron, M.D., pathologist, Manchester, N.H., 6/2 Boston, Tape 2, side 1, rev. 1183 TIMN 288691 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION - by

L E G I S L A T I 0 N -- M I S C. (page thirteen) We have had problems when the federal government has tried to mandate a curriculum. That leads to thought control and all of the concerns we have had about the national government's controlling the thought processes of our children. But I think with private organizations such as yours and other concerned citizens and with funding of programs at the federal level to go back to local communities in the health area we can emphasize there that attacking smoking or health problems related to smoking should be one of the matters considered. Sen. Birch Bayh (D-Ind.), 5/25 Chicago, Tape 1, rev. 322. ...imagine if this were a commission on the auto industry, and you were talking about the rapidity of change in oil and mileage, fuel economy. I think in many respects we could say that the tobacco industry has really made very major steps in this direction... No I don't think ((the rate of tobacco industry's change)) acceptable. I think it could go a lot faster, but I think there have also been pieces of legislation, in a sense, and this can be shown from the data very easily, the rate of change has declined, and part of the reasons for the decline is the inability of the tobacco industry to advertise its new products. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 30. Weingarten: Do you believe that the present legislative efforts to limit smoking in public places are counterproductive? Friedman: No, I don't think they're counterproductive but I would certainly not encourage the American Cancer Society to devote much of its efforts to it. Mostly because I think again it's a symbolic type of activity. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 51. I don't think that the graduated tax proposal of Kennedy and Hart is a good idea... it may lead to two things that would backfire, which I am sure you know. One is, of course, it's not very progressive for lower-income people; it discriminates against them. And second, the styles of smoking are incredi- bly important in terms of the risks that are involved. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 72. CONFIDErJTIAL: Tj~N 288692 MIIyNESOTA TOBACCO LITIGATI ON

L E G I S L A T I 0 N-- M I S C.T (page fourteen) Its ((Association for Nonsmokers' Rights)) initial job was to obtain the passage of the Minnesota Clean Indoor Air Act and we were successful in obtaining the passage of that act in June of 1975. Now, it was strange. We would like to take credit for being very skilled lobbyists but the tobacco industry never came into Minnesota to oppose any of this legis- lation. We don't really know why that happened, so it was somewhat by default that we have this very, very braod encompassing act. Charles Howard, attorney, and Pres. Assn. for Non- smokers' Rights, Minn., 5/25 Chicago, Tape 1, side 2, rev. 55. I mentioned in airplanes having C02 meters so that when smoking levels get too high even the workers there will automatically turn on these no-smoking signs... Harry Spataro, City Councilman and Delta Airlines pilot, Downers Grove, Ill., 5/25 Chicago, Tape 1, rev. 195. ...you should use all of your recommendations to recommend that it come under the Toxic Substances Act and...under the FDA. One or the other. I mean it's ludicrous to regulate all the things that we experience so seldom and let this major public health problem just walk around aided by all the tobacco lobby money. Donna M. Shimp, Exec. Director, Environmental Improvement Associates, 6/16 Phila., Tape 1, side 1, rev. 208. ...my impression is that substances of this type are best regulated, if you want to constrain them, by going after economic issues, that constraints on the pocketbook are the surest way to change human behavior through regulatory mechanisms, with minimum up blic debate over constitutional issues, free choice issues, and things of that type. J. Richard Crout, M.D. Director, Bureau of Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 455, Room #1. (Asked if the petition to FDA to regulate cigarettes is a blind alley) Yeah, we have not answered that petition in the formal sense. But we think we'd be out, I'm quite sure our lawyers would agree, out on a great limb trying to make the case, if we wanted to. And, No. 2, that's not the credible route to good public policy. I think in the largest sense it,quotes, wouldn't fly. J. Richard Crout, M.D., Director, Bureau pf Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 587. Room #1. CONFIDENTIAL: TIMN 288693 MINNESOTA TOBACCO LITIGATION

L E G I S L A T T 0 N -- M I S C. (page fifteen) (Asked about the prospects of "proper labelling") Not as bad as you might think. Because in my judgment we're seeing several substances today that the public seems to want that don't pass the health laws -- things like cigarettes, marijuana, saccharin, laetril e. For one reason or another, it's conceivable that society in its wisdom would say: we want some things around that don't pass the health laws, providing they can be properly labelled, providing there is an element of free choice, providing there's an administrative review to review that they aren't just absolutely and totally lethal or -- some level of risk is unacceptable. If that kind of a mechanism were available for things that don't pass the health laws, cigarettes would undoubtedly be labelled in a much more forthright way than they are now. J. Richard Crout, M.D. Director, Bureau of Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 628. Room #1. In the area of taxes, why not eliminate the tax deduction for advertising tobacco products, at least cigarettes. Why should somebody get a tax deduction to kill people? I don't understand that. It's a misuse of Congressional power. Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 419. Why isn't cancer and heart disease a reportable disease? You gotta report whooping cough and diphtheria and several other kinds of things but the two leading causes of death in this country are not reportable diseases. There are only six states in this country that make cancer a reportable disease. How are you really gonna get the facts on how many people are in fact dying if you don't have the data? Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 455. Why don't we enact a special federal excise tax taxing cigarette manufacturers, perhaps at a 90 percent rate, for the profits that they earn from cigarette sales? Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 463. Fisher: ...the cig companies...had some specific legislation introduced that specifically excluded cigs from all the rules and regulations that other food, drug and various items are covered by. Samuel M. Fisher, CPA, Samuel M. Fisher & Co., Phila., Pa., 6/16 Phila., Tape 2, side 2, rev. 519. CONFIDENTIAL: TIMN 288694 MINNESOTA TOBACCO LITIGATION

-179- L E G I S L A T I 0 N -- M I S C. (page sixteen) I do feel that passing ((smoking limitation)) legislation on a local level or even a state level is really not the answer. I think it should be on a national level. Just as we should have I think traffic regulations the same all over the country we should have regulations on public health identical all over the country... (rev. 315.) ...I think the ACS and other nationwide organizations should push for nation- wide regulations on ((smoking)), because if one city does it the other city doesn't, the inconsistencies are such that when you travel about you get away with something someplace and you can't another. It's just not the way it should be. (rev. 318.) ...as a result of this conference and others you have had, I would hope that you might assemble a model code of some sort that could be sent to people like me in various governments to be introduced and hopefully passed. Because I am not one who is qualified to write these things. I think though that some people in the American Cancer Society or others might be able to compile a model code and distribute it to all municipalities and state governments... (rev. 382.) John B. Kelly, Jr., councilman at large, Phila., Pa., and first vice president of U.S. Olympic Committee, 6/16 Phila., Tape 2, side 1. A second measure would require a lower cigarette tar and nicotine content and also require that that content be printed on every package. I believe this is an important bill because it is the presence of tars and nicotines (sic) in cigarette smoke which is responsible for most of the harmful effects. (There are no such bills in Congress this year; they died with Moss defeat.) (rev. 357.) These bills are in committee with no hearings scheduled. Really what is involved is pressure on the committee members and on the committee chairmen to at least have hearings. That's the first stage'in any measure that's introduced; hearings on the bill before committee, and I believe that through these hearings, similar to what we're having here today, that we can publicize the need for the legislation, that we can rally the support of the American people behind these bills and make it harder for the tobacco industry to keep these bills bottled up in committees, so to speak. (rev. 421.) (After he had estimated that 80 percent of Congressmen smoke, he was asked if that would be a barrier to getting current anti-smoking bills passed) Well, they won't admit•it if it does. In talking with many of them they want to see something done to provide incentives to health in this regard. I really believe that't their deep feeling, that they think it's harmful and they want to see something done. Yes, they're doing it ((smoking)) themselves. And it's kind of like not practicing what you preach, I guess. (rev. 441.) (cont.) CONFIDENTIAL: TIMN 288695 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I 0 N -- M I S C. (page seventeen) (cont.) Weingarten: Do you think it's possible, given the present domination of these House chairmanships by congressmen from tobacco industry states to get a hearing? Rahall: Yes sir, I would think it's possible. I think most of these chairmen want to have the issue debated and I don't think they would object to a fair and open hearing in which both sides of the issue can be presented. Why they haven't thus far, I don't know. This is my first term and I have not really spoken personally to any of those chairmen. But I would certainly hope that we can get pressure applied to them, that we can get those hearings started. (rev. 449.) Weingarten: What do you believe would have to be done to get hearings on some of these measures? Rahall: Well, first I believe getting those Congressmen such as myself and others that are sympathetic to approach the chairman, possibly as a group, say 10, 15 congressmen going together and asking the chairman to at least hold hearings, not asking him to commit one way or the other right off the bat, just in a slow deliberate process. And once he has scheduled the hearings offer our assistance in any way and bring in panellists to appear and testify. (rev. 457.) Weingarten: We had testimony in Boston a week or two ago...that the legis- lature in Connecticut had introduced a rather modest bill to ban smoking in a very limited number of public places. The registered lobbyists of the tobacco industry reported they had spent $432,000 to defeat that most modest measure. In the short time you've been in the Congress have you been exposed to that kind of pressure, of that magnitude of money being spent to keep those bills bottled up? " Rahall: No, sir, I haven't. I have had no contact myself with tobacco industry lobbyists and I have not seen it. Of course, we have not really had the legislation that would affect them come up yet. And I imagine when that does come up they'll come out of the woodwork, I'm sure. (rev. 481.) (Asked if he thinks the time is ripe for further restrictive legislation) I think there would be more legislation if we can get the ball rolling on what has been introduced already. If we can't, then, no, I wouldn't anticipate any more legislation. (rev. 497.) Nick Joe Rahall, (D-W.Va.), U.S. Congress, Beckley, W. Va., 6/16 Phila., Tape 1, side 1. I've always had great difficulty with trying tounderstand why ((cigarettes)) can not be under the FDA, because clearly there are so many drugs and so many chemicals in the mainstream of cigarettes about which we know so little, that how they can exclude the entire thing on the basis of a very fortuitous ex- clusion from the Pharmacopeia in 1906 is just beyond me. Ronald G. Vincent, M.D., chief of thoracic surgery, Roswell Park Memorial Inst. and former pres., Erie County ACS Unit, Buffalo, N.Y., 6/16 Phila., Tape 2, side 1, rev. 617. -180- CONFIDENTIAL: TIMN 288696 MINNESOTA TOBACCO LITIGATION

LEGISLATION --MI S C. (page eighteen) This business about public education, of awareness on the part of smokers, the attitudes and sensitivities of nonsmokers is very nice, but it won't get'too far. I think you need legislation to actually make this kind of responsibility and respect for others work. (rev. 17.) I would suggest a number of things in an approach that you might suggest as a commission to those legislative bodies around the country interested in such legislation... First, I think we ought to be very clear ...that this legislation for protection of nonsmokers is aimed primarily at the protection of the nonsmoking population... It's not a question of principle we're imposing on someone else. All we're trying to do is preserve our opportunity and our freedom not to breathe polluted air...the danger is if we're not talking just about a health measure, about nonsmokers, we're going to be ((accused of)) really trying to get at smokers and trying to get the tobacco industry and we're interfering, we're invading or jeopardizing a cash product. That's not what we're talking about. (rev. 27.) You have to keep the issue of banning sales of cigarettes, nicotine and tar content levels, taxation, labelling and the whole other business -- any way affected legislatively -- completely separate and distinct from the issue of nonsmokers' rights. That's why, even though I personally agree with all these other measures, I will no way introduce legislation or argue for legislation for the state of Maryland that confuses the issue with non- smokers' rights... (rev. 48.) I don't think we ought to be too keen on the enforcement aspects of legis- lation, either. We shouldn't insist on a $1000 fine and six months in jail and something like that. That's not the purpose of this and when you do `something like that you're an easy target for the opponents of this kind of legislation. Cause they'll say, "Well, your offense of lighting up a cigarette is worse than shoplifting in the downtown department store." And it might be, under some of these proposals. (rev. 69.) I don't think enforcement is really that necessary in any legislation, I mean harsh enforcement. First of all, it gives rise to budget problems because, the first thing you kno,4, the department of.health, who has to enforce this thing, is going to come in and say, "Well, heck, this is going to cost $600,000 to enforce, with additional inspectors and although we like it in theory, we can't support it because we can't do it under our budget. We're not going to request it, either." So enforcement has to be something that I think you downplay in the legislation itself... (rev. 76.) -181- I don't think we should be too self-righteous about this kind of legislation either. I think you have to be very, very careful about the tone of your approach in presenting this legislation and in arguing before the legis- latures, particularly your sponsors on the floor in open debate. It's important to have a sense of balance. You have to on the one hand be very serious about who you're protecting and why you're advocating the measure... ~ oIN I was interviewed once for our ABC affiliate in Baltimore and they wanted \p to know if so many of my colleagues smoke in the legislature, how in the 00 world do you expect to get this legialation through? And I told the inter- N viewer that I thought they'd all vote for it because they're interested in good government and Common Cause ought to back it as well. And they said, "What do you mean by that?" My answer was that ifa you can't get rid of the smokefilled backrooms ate.politics, please get rid of the smoke. (rev. 96.) ~ (Sklar, cont.)

L E G I S L A T I O N ° PZ I S C. (page nineteen) (Sklar, cont.) I was asked by a reporter for a radio (sic) in southern Maryland, which is the heart of the tobacco-growing area in Md., what this legislation was all about...And my answer was that this legislation for nonsmokers...was aimed at protecting the smokers in our state of Maryland. He said, "Protecting the smokers?" I said, "That's right. What this does is say that these militant nonsmoker activists, who are causing all the problems, will have to stay in their own area and leave the smokers alone!" And that's what it does. It really separates them in a facility. So to protect the smokers from these crazy militant nonsmokers... (rev. 117.) ...We in Maryland took the approach that you don't use an omnibus bill to tick off where you want it. You don't put it in one bill. You don't want it all in restaurants and public buildings and in buses and hospitals, doctors' offices. If you put them all in one bill what you do is group together all the opponents that you might have into one cohesive force and they might be enough to beat the whole package... ((so)) put everything into a separate bill... (rev. 133.) ...if you lump ((hospitals, food stores, etc.)) all together with the restaurants, you're dead. Because the restaurant association was against it. So ...we broke it up and I think that's a good way to approach it... I think all those places where the public congregates ought to be included. (rev. 145.) ...Obvi.ously, you don't want every conceivable place in an office building or in the state office buildings covered...because then you're invading the workplace and the privacy of private offices... (rev. 155.) ...you have to have signs and you have to have them in such a way ((as to)) get the message across. We delegated the actual language for most of them to the authority, the state agency, that had the responsibility. So we didn't get involved in the exact wording. (rev. 162.) Do you want ((the smoking restriction bill to be)) criminal or civil in its implication for the violator? And to me a very light criminal fine of $25, $50 fine, a misdemeanor, of course, the lowest that you have. To me a civil penalty is perfectly acceptable as well. We tried criminal first and lost and went the civil route and passed it. (rev. 167.) Then you wanna make sure that the regulations that further amplify the situation, that talk about the responsibility of the proprietor...that's a continuing regulation responsibility with some agency. And make sure you get their approval, before you go into a legislature with a bill. I mean, you don't want that agency opposing you when it's their responsibility... (rev. 173.) ...And in our restaurant bill we exempted any room that had a bar in it, because I thought that anybody drinks will probably be smoking and they are, by fact, and they ought to have all vices reserved to one room and that they'll all be happy there... (rev. 190.) (Sklar cont.) -182- MINNESOTAOTOBACCO TIMN 288698 TIGATION

-183- 'LEGISLATION --MI S C. (page twenty) '(Sklar, cont.) The ((tobacco)) industry will ultimately say that regardless of all the other arguments that this is a foot in the door, it's on the way to banning or restricting the sales of tobacco and that it's on the way to legislating additional taxes or prohibitions on the content of the tobacco product. That's their last argument: This is only the beginning. (rev. 215.) ...I tried out originally in 1971...merely to amend the air quality control laws of the state. And every state has air quality control. All you do is when it says the outdoor atmosphere, after the word out- door, you add two words: and indoor. And that should take care of all this problem. To me it's terribly inconsistent, or ludicrous, to be worried in our laws about what happens outside. In most urban societies, you're there 20 minutes a day, on the way to your car to where it's parked and...when you get out of your car back home... (rev. 223.) ...If you don't do it at the state level, ((do))it at the county and local level, ordinances, by city and by county. State legislation obviously is the easiest and quickest way, most effectively...you can do all this by regulation, under existing authority given your department of health at the state or city level. All this is a health hazard which could be regulated and it can be enforced by present health responsibilities in all states and local laws... (rev. 260.) The legislature and legislative bodies have within their responsibility and competence the prevention, not the cure, but the prevention of cancer, and whether it's holding the lid on air pollution standards that we've had for the last few years, in view of the energy crisis and the need for energy supplied at cheap levels or whether it's the NS rights legis- lation and whether its additives and food and everything else, legislatures have a preventive responsibility and not a treatment responsibility. (rev. 299.) I have as mucti experience as anybody in getting bills defeated. I know all the ins and outs that you can learn through trial and error, and I'll be happy to work with anybody on model legislation. I might add that Minnesota's Clean Indoor Act is a good piece of legislation ((Rechnitz of Mass. Citizens for Clean Air doesn't think so)). But it's wholly in- appropriate for an area like the Southeast, where there's tobacco. (rev. 388.) Steven Sklar, Maryland House of Delegates, Beltimore, Md., 6/16 Phila., Tape 1, side 2. What can realistically be accomplished in the political arena? And it is my view that as I judge the political and economic climate that relates to tobacco-related issues, is that we would be unlikely to get a law passed through Congress that would force a high tax on certain levels of tar and nicotine...You cannot really set a limit, you know -- the lower the better... (rev. 1072.) (cont.) CONFIDENTIAL: TIMN 288699 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I 0 N -- M I S C._ (page twenty-one) -184- (cont.) The tobacco industry obviously has now developed considerable technology to now bring cigarettes under the 10 mg level...that is about all we can expect in this country, where we will do it on the basis of private enterprise. And while in England they have been able to set up specific levels, I doubt that this could happen in this country...What would be ideal...as low as possible that is commensurate with still sufficient smoking satisfaction. In other words, you couldn't really get me to say it's got to be 15 or it's got to be 10, or a specific level. (rev. 1081.) Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2. Room #1. ...we're not going to accomplish the goal that you have in mind solely through legislation. We can put obstacles in the way of continued smoking, we can certainly do some things to prevent new addicts for smoking, but in the final analysis the job upon which this Commission has set out must be accomplished in a voluntary way if it is done at all... Education ((is the best method)) in my judgment ... some of the things can be done by restrictive legislation, but basically it's an educational process that I would encourage you to conclude should be adopted. (rev. 150.) ...in the early 60s ...we were greatly concerned as we are now and should be, about the advances of Communism so we established at state expense require- ments and facilities for education in the American society, American democracy... We promoted what we thought was right rather than trying to pass a law against what was wrong. I think that basically that in smoking, it's this kind of effort the states should make to bring the established facts to the attention of a free society. (rev. 179.) Farris Bryant, former Fla. governor and president, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, Tape 1, side 1. Earlier this year a similar ((smoking restriction)) bill was introduced in the South Carolina senate...the day after that bill was introduced, a sena- tor from a tobacco-growing county ... introduced a bill that prohibited drinking in certain public places and he admitted that yes, that was a joke, that he was just making fun of the non-smoker bill, that if you were going to regulate smoking, then you were going to regulate drinking and everything else. (rev. 53.) ...they are planning to make one change ((in the new smoking restriction)) bill. Instead of calling it a bill to prohibit smoking in certain public places, it's going to be a bill to limit smoking in certain public places... when you start using the worl 'prohibit', you are turning off a lot of the smokers that think that 'Well, they're trying to get me to stop smoking.'... (rev. 59.) (cont.) CONFIDENTIAL: TIMN 288700 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I 0 N -- M I S C. _(page twenty-two) (cont.) DuVal: Could you change the tactics (question directed to Mrs. Martschink) and say this is a bill to guarantee the continuing rights of those who smoke in selected places and restaurants or public places? Martschink: That sounds good. (rev. 77.) Sherry Martschink, former member of S.C. House of Reps., Charleston, S.C., 6/k4 Atlanta, Tape 1, side 2. The Minnesota law ((proposed law is not modelled after the Minnesota law)), I feel, was trying to overly accomodate smokers in actually trying to grant equality to designated smoking areas. -185- Roni Rechnitz, Director, Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, Tape 2, side 1, rev. 1243. I would strongly urge your Commission to promote non-smoking sections in restaurants. Some areas of the country are trying to accomplish this through legislation. Rather than doing that, I would hope that more and more diners request to be seated in non-smoking sections. Robert W. Butterfield-, area supervisor,-The Magic Pan, Atlanta, Ga., 6/14 Atlanta, p. 1. ...I believe, that we must go toward stronger legislative controls of the pollutants. I think this is the right of government. It is very definitely valid for government to control our health problems. William A. Hopkins, M.D. cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, p. 2. Students recommend for a better relationship between, School Boards, Govern- mental bodies, Parents, School Administrators, and teachers that: 1. The state government take a look at the laws regarding Teenage smoking. If a Teen becomes an adult at age 18 and is privileged with the rights of an adult, then an 18 year old high school student should be privileged to smoke. Livingston Ivy, Jr., principal, Washington High School, Pensacola, Fla., 6/14 Atlanta, p. 6. The Federal Communications Commission (FCC) ruled that cigarettes could not be advertised on television or radio. Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta, p. 1. CONFInENTIAL: TIMN 288701 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I 0 N -- M I S C. (page twenty-three) It is doubtful that legislation will be acceptable because of the economic factor involved. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 20. ... we believe that the easy route for us to take in Michigan was to get a law just to ban smoking categorically in public places. And I stick by our original assumption that that may do more harm than good to the rights of the nonsmokers movement. Because if we just try and ban smoking in various places, it might be like the ban we have on smoking in elevators in Michigan -- totally ignored. (rev. 269.) ...there is a great deal of work that can be done at the local and state level, that frankly we need a lot of assistance from. Now for example I happen to be on a county commission in Ingham County, in Michigan, and we're trying our best to adopt a no-smoking policy in the county commission. I am immediately encountered by (sic) opposition by our attorney. Well, I need some sort of legal backup to get some countervailing legal opinions and assistance. We face the same thing with state law. There is no state society, the Lung Association or the Cancer Society, that has the capability to assist us in drafting the legislation that we need, to provide the research background that we need on state legislation. So I would urge this commis- sion to take a serious look at some of those supportive things that you might be able to provide at a national level, from national resources, that we do not have at the state and local levels. (re. 296.) -186- Right now we are exploring what can legally be done to protect the rights of individuals in their place of employment. And we're getting into questions of the OSHA and NIOSHA (sic) laws, something that generally the Lung Association and other organizations aren't very familiar with. And we're kind of caught in between the department of labor and the department of public health and so where we need the legal assistance is to find out whether we can go into the OSHA safety standards or whether we ought to be going into the public health law. And then we need also to -- a tricky business is on the rights of employers... the contractual obligation... (rev. 351.) William Sederberg, Ph.D., director of research, program section, Mich. House of Reps. GOP Caucus, and president, Mich. Lung Assn..., 5/25 Chicago, Tape 1, side 2. There's a lot that can be done on a local level, a state level. State may be ideal. I think it's a little time-consuming to be working at the village councils and cities and counties. State may be the ideal forum. A lot can be done to further nonsmokers rights. (rev. 475.) Now reference was made to a new law in Congress which would have a progressive tax on nicotine and tar, going up to very high levels. We've got a similar bill introduced in Minnesota. We're going to have a hearing on it this sum- mer. And I think we've got probably a better chance of passing it in Minne- sota -- particularly if the same big guns, if you will, that would be willing to testify before Congress, would give a little of their time and come out to (cont.) CONFIDENTIAL: TIMN 288702 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I 0 N -- M I S C.' (page twenty-four) (cont.) Minnesota. Sen. Humphrey, for example, from his bout with cancer, has indicated a real concern with this problem. Well, his testimony alone might be what we need to pursue some of these things in Minnesota. (rev. 480.) A large part of this is a legal nightmare. We do need the help of a central organization to help us come out with the laws that will stand up. I'm sure the tobacco industry has tens and hundreds of high-priced lawyers that are studying it from their side. We do need help, because an individual can be assertive but he can't mastermind the whole legal aspect. (rev. 487.) (Asked about the part of the Minnesota law that applied to offices) -187- Well, it refers in a public place ((which)) means any enclosed indoor area used by the general public or serving as a place of work...Now this hasn't been widely followed ((in private offices)) at this point. The theory of the law is segregation and there are rules and health department regulations as to how things should be segregated -- a four foot spacing and that sort of thing. The same concept that could apply in a restaurant is intended to apply in an office, mainly that they are supposed to survey their people and determine percentage that want a smoking area, nonsmoking area, set it up con- sistent with the ventilation, and give the nonsmoker a nonpolluted environ- ment. This has been done, by the way, in the State Health Department Building. (rev. 500.) I think ((a nonsmokers rights approach)) should be given heavy emphasis and I think that a lot of emphasis should be given to the states rather than taking on the tobacco lobby at the national level. (rev. 607.) Charles Howard, attorney, Minneapolis, and president, Assn. of Nonsmokers Rights, 5/25 Chicago, Tape 1, side 2. (Asked his opinion of bringing "legislative leaders from key states together to foster better communication" and to help those "where they are having problems" or have not yet initiated action on public smoking limitation) Yes sir, I think it would ((be useful))... there is a committee on which each state has approximately a dozen appointees that deal with uniformity of vari- ous laws...I think that would be the natural tool to use. And I think some- thing could be accomplished...if we fail to get conformity at the top, then I think the thing to do is to try to take the mountain to Mohammed. Jack Ogg, Dem. state senator, Texas, 5/12 Denver, Tape 4, rev. 783. CONFIDENTIAL: TIMN 288703 MINNESOTA TOBACCO LITIGATION

L E G I S L A T I 0 N -- M I S C. (page twenty-f ive ) -188- DuVal: My responsibilities at the University of Arizona include overseeing the management of our medical facilities... And I've been willing to stand up and say, "I'm sorry, but I will not let any tobacco product be available inside this facility for purchase." I probably was a fool to do that, be- cause as a lightning rod there's no question that you attract all of those so to speak that are antipathetic to that position...Is it not possible that ultimately the answer to this at the state level would be through the initia- tive petition route rather than through legislation? Phelps: I really don't think so. We had a bill that I thought was a real good bill...a high tax based on the tar content. And so I think we're gradu- ally going to evolve into these things. This is the first step. The next step obviously is going to be...a whopping tax on tar content. And I think the industry and various other people will probably accept this. And then the next step, obviously, is going to be to even have a stiffer ban in public places than that... DuVal: Senator, could I submit that -- at least I have no evidence and know of none that would suggest that ((a higher tar tax)) would make any difference -- You know, gasoline costs $1.75 a gallon in certain countries in Europe, but that doesn't diminish the amount of driving. It gives driving legitimacy, if you're willing to pay for it. I would like respectfully to suggest without personal conviction, but with some sympathy in this direction, that if the people of the state voted on this issue and they voted in favor of imposing restrictions on smoking, this would give the entire issue a form of legitimacy in a democratic society that one could not do by picking it off piece by piece. I hope you'll give that some consideration and somebody would try it out. Phelps: The trouble with that is like any piece of legislation we have to go -- and we've seen that in our own government -- in stepwise measure. For example, many of the programs that we have today, Social Security and what not that say in the 1920s ((were being called)) socialistic or even communis- tic or something else -- that we've gradually evolved into these things... the main thing that appeals to me about a tax on tar content is that you have the choice of buying...unleaded gasoline at 75e, a gallon, or leaded gasoline at $5 a gallon, you know good and well which one you'd buy. Likewise, at a cigarette vending machine, if you have a tar content below say 1 mg, or some- thing like that that was maybe 45-50g, a pack and a tar content of say 10 or so was say $3.00 a pack, you know what cigarette you'd be smoking. DuVal: But wouldn't that also give it a legitimacy and also suggest that there is a direct relationship between the concentration of tar and nicotine and damage? WU Phelps: But you've got to change people's ideas. My personal feeling is a Q~ direct initiative at this time would fail...all one has to do is look at our initiatives here in the state of Colorado this year in which our tin can- ~ H bottle thing and various other things that looked pretty good and all of them d O <C U O rn went down to defeat. And a lot of it was no doubt due to the tremen ous amount of money being plowed into advertising...There's no question in my mind that at this time a referendum wouldn't cut it. But over a period of time, if we keep chipping away, chipping away, that time will come. Harvey Phelps, M.D., pulmonary specialist, Dem. state senator, Pueblo, Colo., 5/12 Denver, Tape 2, rev. 361.

L E G I S L A T I 0 N -- M I S C. (page twenty-six) -189- ((The passage of my bill)) is doubtful and I think as a Republican I am sorry that many of my Republican friends are not supporting it and I think that ...it's going to cost them their political future. I think they are good people. I think they are smart and I would like to have them in public office, but I think that public outcry in Colorado against people who have opposed this kind of reasonable legislation will cost them whatever politi- cal ambition they have. And in my view they deserve it. (rev. 367.) ...people who are in business... still, in this state anyway, retain some control over whom they will serve. Now we have a public accommodation law that's older than any other in the country. We can't deny services to people on account of their race, color or other things. But we could, I think, under the present law, deny them access if they're smoking -- under the present law. But it's almost never done. Now the option characteristic of this ((proposed Colorado law)) is where many people in charge of these quasi-public places have said, "I do not want people smoking in my store," for instance, a person in a...fur shop...Those people have said, "We would like to have some way to bring ourselves under the law, but we recognize that you can't pass a state law because my neighboring store over here just won't tolerate it...I think that there are many people who consider that fairness is equally applied to those who want to smoke and those who are in charge of premises who don't want people to smoke... (rev. 395.) (DuVal suggested that a statewide initiative might be wise on restricted smoking measures) I agree with you. But it takes just as many votes to refer a measure to the people as it does to get the law passed and I would rather pass the law...I am not very much of a fan of the third measure...In Colorado, for instance...we have referred the matter of the death penalty twice to the people and both times they've come back overwhelmingly that, heck, yes, we want the death penalty. But then the legislature turns its back on that popular decision and does something dumb like it causes our death penalty statute to be stripped...I think the legislature is elected to act...in the best interests of the majority of the people, we hope all of the people most of the time... (rev. 425.) I think that many of my colleagues who are not in favor of this legislation are becoming very aware of ((nonsmoker feelings)), especially people in my political party. You know if it's true that the poor people and the minority people and the young people are the heaviest smokers, they are also least likely to be Republicans in the state of Colorado. That means, in my state, if you've a Republican, you'd better be careful about the smoking issue. That's just a flat out political observation. And it's starting to bother some of them. Unfortunately, it's not bothering enough of them, because it's that same body of people who weigh the Constitution frequently and say, "Thou shalt not invade my Constitutional rights. I'll do any damn thing I want to do, even if it's offensive." And that is a difficult situation. (rev. 446.) Hugh Fowler, GOP Colorado state 'senstor, Denver, Color., 5/12 Denver, Tape 3. CONFIDENTIAL: TIMN 288705 MINNESOTA TOBACCO LITIGATION

-189a- L E G I S L A T I 0 N -- M I S C. (page twenty-seven) ...pass legislation that would require the FCC to provide a certain amount of prime-time public service announcements donated to the issue of no-smoking. Before a network could renew its license, these requirements would have to be met. (p. 4.) I recommend that smoking of any kind on flights less than two hours be banned... ((and))' no smoking in small aircraft...because of poor ventilation systems. (p. 5.) In most cases, the OSHA 8-hour standard for carbon monoxide does not apply to tobacco smoke since a level of 50 ppm is rarely reached in the average work- place. I recommend OSHA re-evaluate its carbon monoxide standard to involve the effects of second-hand smoke on the individual. (p. 6.) The federal government should... withhold federal monies from schools which permit smoking. (pp. 6-7.) Douglas S. Lloyd, M.D., Conn. Commissioner of Health, . 6/2 Boston. Nothing I have suggested for Rhode Island is novel, with the possible excep- tion of tax incentives for proprietors who invest in ventilating equipment which will contribute to the comfort of nonsmokers. Lila M. Sapinsley, R.I. State Senator, 6/2 Boston, p. 5. CONFIDENTIAL: TIMN 288706 MINNESOTA TOBACCO LITIGATION

-190- L U N G C A N C E R Smoking is the one overriding factor in the lung cancer epidemic which is upon us. Stated differently, if somehow--miraculously--the cigarette had never been concocted, lung cancer would today be a disease of relatively small proportions. Larry Agran, atty., UCLA law instructor, Director NCI-funded History of Cancer Control Project--3/22 LA statement. p. 2. This testimony is given to bring to the attention of the esteemed members of the National Commission on Smoking and Public Policy that a simple, inexpensive, accurate test is now available to screen cigarette smokers for the detection of premalignant and early malignant lung diseases. Kent wm. Sorensen, president, Micronetic Laboratories, San Jose, Calif., 3/22 LA statement, p. 2. If the initial success of this test can be applied to a mass screening pro- gram, the incidence of lung cancer deaths in the United States may be dra- matically reduced in a short period of time. Kent Wm.. Sorensen, president, Micronetic Laboratories, .San Jose, Calif., 3/22 LA statement. p. 2. Lung cancer is essentially a man-made disease of epidemic proportions of this century. Kent Wcn. Sorensen, president M.i.cronetic Laboratories, San Jose, Calif., 3/22 LA statement. p. 3. Although the carcinogenic effect of smoking may be reduced by low tar or nicotine cigarettes, a recent study reported that the gaseous vapors of cigarette smoke (excluding tars and nicotine) has produced tumors in animals. Kent Wm. Sorensen, president, Micronetic Laboratories, San Jose, Calif., 3/22 LA statement, p. 5. Approximately one of every 200 individuals who have smoked for at least twenty years may (emphasis supplied) produce malignant cells in the sputum before the tumor is large enough to be visible on a plain chest X-ray. Kent Wm. Sorensen, president, Micronetic Laboratories, San Jose, Calif., 3/22 LA statement, p. 2. The criterion documented by NIOSH on coke oven exposure concludes that exposure to volatile coke oven products and not smoking is the primary antecedent for lung cancer in coke oven workers. Ida Honorof, publisher of consumer newsletter, Sherman Oak, Calif., 3/22 LA Tape 6, Rev. 86. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288707 I

L<II N G C.A.Y C-E: EL (page-twa) Countless other factors are responsible for some cancers of the 1ung. Chemicals in smog, chronic Lung diseasa which produces scarring and cell_ change, Lung scars from.old tuberculosis,.asbest•os, silica and so on. The incidence of, lung cancer is unquestiaaably higher in humans with any 'ki.nd of chronic disease.- IIrake W. Will, M.D., Chief, Pathology, The Queen's Medical Center-, Flonolulu, 3/22U statement, p. Z.. And we nave- a. real high riskk population, too. The Hawaiians.~. target group. Only 9Z of Hawaii's. population, thei.r problem into cancer of the lung is uniquef a.].most as many,women as men have Lung cancer and tfiey have the: disease and. die of it ten, years earlier Chan any other population or ethnic group ia the,tTnitad States_ We do not have smog nor particulate air pollution, Little: asbestos, fairLy-high tuberculosis but Litt?e am- physema or other chronic Lung disease.. Ethnic supez-susceptibility? :faybe. 3ut ones thiag, is clear. The Eawaiians smoke cigarettes ! Drake- W'.. Wi.ll, K.D., Chief, Pathology, T8e Queen's ledicaL Canter, gonoLuLu, 3/22LA.statemeat, p.- 2. We know that 80z of alL cancer of the Lung can be Laid squarely and inequivocably at the door of the Lighted ciggrette--smoked.by the daily package oa package•for years and years. Aad for many years now in the face of, a near catastropctic- warning--that- cigarette smoking is proved to be dangerous to our health - Not possibly--not probab Ly--but proved to be. Drake W. Will, M.D., Chief, Pathology, The Queen's Medical Center, Honolulu, 3/22 LA statement, p. 1. -191- ((Asked about the survival rates of lung cancer patients)) Overall, overall, lung cancer rates with some of the worst cancers, like cancer of the esopha- gus, cancer of the pancreas. It's not a good one like cancer of the thyroid, overall. But, now, we've got to qualify that. It depends on the type. And when you talk about lung cancer if you don't put a name in front of it, like small-cell, or squamous cell, we can't even talk. And I flunk the boys on the boards when they start talking that way, I'll tell you, because small-cell carcinoma of the lung is a death warrant diagnosis in 99.9 percent. A squamous cell carcinoma, a person without symptoms, we have a 60 percent survival, five-10 years. So you have to know what kind you're talking about. Robert W. Jamplis, M.D., president, Calif. Division, ACS, Director, Palo Alto Medical Clinic, 3/22 LA Tape 1, Rev. 787-799. Weiss himself reports on an inverse relationship among men exposed to Chloromethyl methyl either between smoking and the incidence of lung cancer. ((Weiss, W., and Boucot, K.R. The Respiratory Effects of Chloromethyl Methyl Ether. Journal of the American Medical Association. 234/11: 1139-42, Dec. 15, 1975)) Ida Honorof, publisher of consumer newsletter, Sherman Oaks, Calif., 3/22 LA Tape 6, Rev. 90. CONFIDENTIAL: TIMN 288708 MINNESOTA TOBACCO LITIGATION

-192- L U N G C A N C E R (page three) This test has been developed ((sputum cytology)), it is currently available, it is new and I think that in any new test, we're going to find much resistance--a lot of it is legitimate--from the medical practice. And I feel that it behooves this commission to spend an exaggerated amount of time in getting the facts... Kent W. Sorensen, president of Micronetic Laboratories, San Jose, Calif., 3/22 LA Tape 2. The elimination of cigarette smoking would mean the prevention of 15 percent of all cancer deaths. William B. Hutchinson, M.D., Director, Fred Hutchinson Cancer Research Center, 5/17 Seattle, p. 2. The consistently low rates in both sexes in the Willamette Valley were unexpected in view of the many years of public complaints about irritant• particulate air pollution there. However, among males, those in the Willamette Valley did manifest the highest proportional increase in lung cancer mortality rate (72%), which may indicate that the field burning of the past decade was adding its toll. William Morton, Professor, Dept. of Environmental Medicine, Univ. of Oregon, 5/17 Seattle, p. 2. We know of three general categories of contributory causes of lung cancer: (a) first and foremost is cigarette smoking which unfortunately remains a major symbol of adolescent "maturity;" (b) occupational exposure to inhaled carpinogens such as arsenic, chromates, nickel carbonyl, chloromethyl methyl ether and the radon daughters given off by uranium ore (many more such substances probably remain to be identified); and (c) there seems to be a slight increase in risk associated with the community air pollutants found in major metropolitan areas. William Morton, Professor, Dept. of Environmental Medicine, Univ. of Oregon, 5/17 Seattle, p. 7. A particularly fertile field of further investigation would be distribution differences among the major histologic types of lung cancer. It is entirely possible that different cellular types of disease may have differences in causes which could allow control of the lung cancer problem one step at a time. William Morton, Professor, Dept. of Environmental Medicine, Univ. of Oregon, 5/17 Seattle, p. 7. We know that smoking causes lung cancer and Alaska, with a true epidemiolog- ical study, would prove this out, when you find that as many native women smokers are treated for lung diseases, including lung cancer, as are native male smokers. Donald Rogers, M.D., Pathologist, Anchorage, Chairman, Alaska Division of ACS, 5/17 Seattle, p. 3.

-193- LUNG CANCER (page four) Of all the known preventable factors relating to heart disease, stroke, lung cancer, bronchitis and emphysema, smoking cigarettes is that factor. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 2. Cigarette smoking has an unparalleled effect in facilitating and enhancing the toxic effect and manifestations of disease associated with other environmental agents. In the practical sense, were it not for the asso- ciation of cigarette smoking with occupational exposure to chemical or physical carcinogens (e.g. uranium mining, asbestos, coke oven exposure, chromates and nickel), lung cancer in these occupational groups would virtually disappear as a hazard of the workplace. Cigarette smoking is in reality the determinant for most of these cancers as well as for an array of lung abnormalities grouped under the generic term chronic ob- structive pulmonary disease. Dr. Paul Kotin, medical director, Johns-Manville, Denver, Co1o., 5/12 Denver, pp. 3-4. According to (former Assistant Secretary for Health Theodore) Cooper, "The risk of developing lung cancer was found to be 10 times greater for cigarette smokers than for non-smokers...". Dr. Paul Kotin, medical director, Johns-Manville, Denver, Colo., Fact Sheet attached to 5/12 Denver, p. 1. A multiple mutation process of alpha radiation induced cancer is consis- tent with both the age distribution of cancer in smokers, the observed species distribution of cancer incidence in mice and men, and other evidence. Insoluble radioactive smoke particles and clusters thereof can accumulate and persist at the bronchial tumor sites in smokers and are capable of inducing lethal and non-lethal changes in the DNA of the surrounding cells at intensities ranging up to many thousands of times the natural rate. Edward A. Martell, National Center for Atmospheric Research, Boulder, Colo, 5/12 Denver, p. 3. Cigarette smoking does cause cancer. There is no doubt about that. C_harles E.RGrassley, U S. Congress_ (R-.jowa), c}eliver,- ~ -F~ _ed by Stephen_ Roberts, _ 5/19 St. Louis, p. 3. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288710 1

--194- L U N G C A N C E R (page f ive) I am perfectly willing to concede that lung cancer is a disease of many causes of which smoking may be one, but the militant fervor with which smoking was promoted as a major, if not the sole, cause of that disease is a serious obstacle to investigators who are concerned with the health effects of the increasing concentrations of microchemical carcinogens in man's environment. Ida Honoroff, publisher, Report to the Consumer, TI "Target 5" film, ACS LA speakers, p.18. Lung cancer incidence among Alaskan natives, especially Eskimos, is extremely high, and it's about equal in males and females. Another parenthetical interesting note is that historically the Arctic Eskimo lives, at least in the Canadian Artic, that is, small block houses which really weren't shaped in the hemisphere of the igloo. They were built of snow blocks and they were really quite insulated actually and they maintained a relatively high temperature compared to the (untelligible--maybe ambient). One of the sources of heat, though,; was the whale-oil lamp. The females of these Eskimo groups had as one of their sole chores in life the tending of these whale- oil lamps. They would literally tend the lamps 24 hours a day, catch an hour or two of sleep and then wake up and start automatically to tend the lamp. As a result females of these tribes or groups breathed smoke from the lamps during their entire life, virtually. I was at a meeting a couple of years ago where an old doctor who attended these Canadian Eskimos in the Canadian Arctic for many, many years stated that lung cancer had been a common disease in these Arctic Eskimos for generations, especially among the females. Donald Rogers, M.D., pathologist, Alaska Hosp. and chairman of the Exec. Comm. of Alaska Div. of ACS, 5/17 Seattle, Tape 1, side 1, rev. 1103. (Asked if he is aware of any scientific literature that refutes the linkage between cigarette smoking and lung cancer and some of the others--by Weingarten) Not really. I'd have to hedge similar to Dr. Hutchinson. ~ I'm not a statistician. I have seen articles I know have been funded by ~ Q the tobacco industry which refute it, but I can't analyze their data very ~ ~ well so the answer is no, I don't know of any valid data that refutes it. ~ 00 ld d E"4 5/17 chairman of the Exec Comm of Alaska Div of ACS . . . , , 0-4 r4 Seattle, Tape 1, side 1, rev. 1177. Q ?!!!7 U Since smoking is the major risk factor, we have to presume that smoking is ~~ more of a problem in these areas (referring to map in his handout) than ~ ©~ in the other parts of the state. So we have to presume it, because we don't tZ Q really know. What we need to know for sure is whether or not that's true. And I think maybe we've been missing a step, a simple step. We've been spending a lot of our time collecting evidence on the (untelligible) and we've missing the thing we are trying to work with, I think we need a lot more information, like the exact frequency of smoking in different areas and in different population groups. The problem is very big and I can't say we've been terribly successful. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore.,5/17 Seattle, Tape 1, Side 1, Rev. 1220. Dona Rogers, M.D., pathologist, Alaska Hosp. an N

-195- LUNG CANCE R (page six) ...from preliminary study it does look as though smoking is not equally related to all the different kinds of lung cancer. It also looks as though they have different geographic distribution patterns...with different relationships to socioeconomic status and different relationships to job patterns. Now there is a possibility, in other words, that we can solve this particular problem by breaking it'into components. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, rev. 1227. ...we should be able, if smoking is the major risk factor as I believe it to be, we should be able to see this dreadful rise in lung cancer mortality topped off and start down within a period of a year or two if we're really going to be successful. I think that (unintelligible). If we don't see that then we need to look for other factors. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, rev. 1233. I guess we might sum this up by saying I think we're speculating too much about smoking. I think we need to know exactly how many people do it, when they begin and the differences in different geographic areas and different population groups. It's not safe to extrapolate from one part of the country to another, one population group to another in problems this size. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, rev. 1244. In our clinic, the average age of females with lung cancer in the late sixties was 62 and they constituted 14 per cent of lung cancer patients. In the early seventies, the number had increased to 20 per cent with the average age being 60. During the last calendar year, one third of all lung cancer patients were female and the average age was 57. Richard Marks, Jr., M.D., Charleston, S.C., Dept. of Radiation Therapy, Medical Univ. of S. C., Charleston, S.C., 6/14 Atlanta,p. 6. It is known that smoking causes at least 80% of lung cancer. Maurice Bleifeld, former principal, Martin Van Buren High School, 6/16 Philadelphia, p. 1. Also Vice-Chairman, Public Education Comm., Queens Div. of ACS. CONFIDENTIAL: TIMN 288712 MINNESOTA TOBACCO LITIGATION

L U N G C A N C E R (page seven) In twelve years of seeing an average of four new lung cancer patients a month, I have yet to find a single case of primary bronchogenic car- cinoma in a non-smoker. I find this to be a marked deviation from the commonly quoted statistics of lung cancer being eleven times as 'common in the smoker as in the non-smoker. Laurence H. Bates, M.D., Oncologist, 5/25 Chicago, page 1. It is estimated that 80% of lung cancer is caused by cigarette smoking. Sanator-Birch..Eayh (D.-Ind.), 5/25 Chicago, page 2. ...the chances are about 99% certain that I could have avoided the problem [lung cancer] if only I had quit smoking. H. P. Zhorne, Cancer victim, Glenview, Illinois, 5/25 Chicago, page 1. In the year 1975, that ratio [male-female ratio for lung cancer] was less than 1. There were more women with new cases of lung cancer diagnosed in the State of Connecticut in 1975 than men. This is the first time that I know of that this has happened. And the number was alarming. There were 30 women in this age group in that one year, and there were 25 men and this indicates a substantial rise in the women's rate in that one year. J. Wister Meigs, Director, Connecticut Cancer Epidemiology Unit.and Clinical Professor of Epidemiology, Yale University; 6/2 Boston, Tape 2, side 1, rev. 806. Dr. LaMaistre: Meigs: In the age adjusted incidence rates related to density, is it -- would you be surprised if decades from now the same trend in density relationship occurred for women as for-men? I don't know how to answer that. I think that the data suggest to me along with the studies of others that cigarette smoking is such an overwhelming factor that it will drown out most other considerations. But be- fore being able to answer that, I believe that we must have surveys by population density and socio-economic status and considerably more occupational study. I hope that we will be doing that. J. Wister Meigs, Director, Connecticut Cancer Epidemiology Unit and Clinical Professr of Epidemiology, Yale University 6/2 Boston, Tape 2, side 1, rev. 823. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288713 I

L U N G C A N C E R (page eight ) In our clinic 10 years ago, the number of males that had cancer of the lung was astronomical, yet the number of females was only 10 percent of the males. The last two years I've surveyed our group in Charleston it's 38 percent in females, almost, well, over 1 in 3. Almost half of the patients we treat with lung cancer are female. And it's occurring at an earlier age. The average age for males with lung cancer used to be 61. That's come down now to 59. The average for the females with lung cancer now is 56, the last two years in our group. Richard Marks, Jr., M.D., Department of Radiation Therapy, Medical University of South Carolina, Charleston, S. C.; 6/14 Atlanta, Tape 2, side 2, rev. 218. The heavy smoker and the heavy drinker will not get out of this world without developing cancer. Ten percent of people under 21 are heavy drinkers. And anybody who's a heavy drinker is going to be a heavy smoker. Richard Marks, Jr., M.D., Department of Radiation Therapy, Medical University of South Carolina, Charleston, S. C.; 6/14 Atlanta, Tape 2, side 2, rev. 263. ...one of the speakers was asked was there any autopsy evidence to show that a person is or isn't a smoker. And the speaker wasn't certain. There is. I would like to refer those who are interested to some work that was done in the pathology department at Vermont by Drs. Craighead and Brody in which they show a crystaline substance in the lungs of smokers. The substance is in the same family as asbestos, is very much related to it morphologically and is easy to show if one does electronmicroscopy on the lung. Roy Korson, M.D., Prof. of pathology, U. of Vt. College of Medicine & Vt. State ACS president, 6/2 Boston, Tape, 1, side 2, rev. 912. We're having a very interesting experience in Jacksonville, Fla., where I'm from now. We have experienced three times the national average in lung cancer rates in nine counties outside of my own in Northeast Florida as compared with anywhere in the country. We have a grant request in now to do an etiological study, which is going to be done by the Department of Public Health at the University of Miami to try to find out why we have this increased death rate, because there's no more smoking going on there than anywhere else. There are other factors involved. Ashbell C. Williams, M.D., former ACS president, now honorary life ACS member, Jacksonville, FLA., 6/14 Atlanta, Tape 1, side 1, rev. 1182. CONFIDENTIAL: TIMN 288714 MINNESOTA TOBACCO LITIGATION

L U N G C A N C E R (page nine) There are presently between 26,000 and 30,000 laryngectomees in the United States today, and an estimated 8,000 become laryngectomees each year. In more than 80 percent of the cases, the operation is necessary because of excessive cigarette smoking. Herbert Landrigan, laryngectomee, Exeter, N. H., ACS volunteer, p. 3. Lung cancer deaths will be about 43 per 100,000 in Massachusetts, as con- trasted to 17 per 100,000 in Utah. The difference is that in Utah, 72% of the population are of the Mormon faith, which includes abstinence from tobacco. John W. Turner, M.D., radiologist, Wesson Memorial Unit, Baystate Medical Center, Springfield, MASS., President, Mass. Div. ACS, 6/2 Boston, p. 1. In the Medical Center Hospital of Vermont, less than 3% of all oral cancer patients are non-smokers. Evidence suggests that the risk of mouth cancer in the heavy smoker and drinker may be as much as fifteen times greater than in those who neither smoke nor drink. Samuel E. Molind, D.M.D., oral pathologist, Montpelier, Vt., 6/2 Boston, , p. 2. The lung of a smoker differs as to color, texture and to-inflation and deflation. In smokers there is evidence of air trapping not seen in nonsmokers. Richard H. Overholt, M.D., thoracic Surgeon, Dedham, Mass., 6/2 Boston, p. 1. ...the historical evidence greatly strengthehs the already overwhelming epidemiologic evidence that cigarette smoking is a major factor in the causation of bronchogenic carcinoma. Oscar Auerbach, M.D., senior medical investigator, V. A. Hospital, East Orange, N. J., .6/16 Philadelphia, p. 3. Tumors were found in the lungs of 36 dogs. The majority of these, both noninvasive and invasive, were in the apical lobes with a predilection for the left. Two tumors were early squamous cell bronchial carcinomas and the others were bronchiolo-alveolar tumors. Oscar Auerbach, M.D., senior medical investigator, V. A. Hospital, East Orange, N. J., 6/16 Philadelphia, p. 10. CONFIDENTIAL: TIMN 288715 MINNESOTA TOBACCO LITIGATION

L U N G C A N C E R (page ten) Although the histologic characteristics of the bronchiolo-alveolar tumors found in our smoking dogs are not identical to the bronchiolo-alveolar tumors described by Liebow in human beings, the overall picture justifies their inclusion in this category. Oscar Auerbach, M.D., senior medical investigator, V. A. Hospital, East Orange, N. J., 6/16 Philadelphia, p. 12. In individuals dying of causes other than lung cancer, the same epithelial changes are present. These changes are proportional to the amount of cigarettes smoked. Oscar Auerbach, M.D., senior medical investigator, V. A. Hospital, East Orange, N. J., '6/16 Philadelphia, p. 12- In humans there is an association between smoking and this disease ((lung cancer)) of such strength that, at least for men, an accurate history of never having smoked is sufficient evidence to rule out a diagnosis of lung cancer with confidence approaching 100%. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, p. 1. While it is true that a statistical association does not prove a cause- and-effect relationship, there are critieria for arriving at a judgment that an association is causal. These were described in the 1964 report of the Surgeon General on smoking and health and expanded by Sir Austin Bradford Hill in 1965. These criteria are as follows: (1) exposure to the agent precedes the appearance of disease, (2) the association is strong, consistent, and specific, (3) there is a dose-response relationship between the agent and the disease, (4) the association is plausible in the light of current know- ledge and coherent with what is known of the diseases, (5) the disease can be reproduced in experimental animals by the agent, and (6) removal of exposure to the agent in humans prevents the disease. All of these criteria have been satisfied for the relationship between smoking and lung cancer. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, pp. 1-2. The plain fact is that smoking is terribly harmful. At least 80% of lung cancer is caused by cigarette smoking. Today, more than 100,000 American men and women have lung cancer and projected figures show that in 1977, 98,000 more Americans will be stricken with this disease, and 89,000 will die of lung cancer. That's about 244 persons each day. To me, that's an outrageous amount of needless deaths; deaths that could be prevented if only these smokers could break a habit. Farris Bryant, former governor of Fla., President, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, pp..y4-5,..

L II N G C A N C E R (page eleven) The development of cancer requires the coalescence of several circum- stances in space and time, that is, its causation is multifactorial, and two or more agents may act in concert to multiply the risk. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, p. 2. ...lung cancer rarely occurs in these workers ((asbestos workers, uranium, miners, etc.)) if they do not smoke. In other words, without the cigarette, the worker's jeapordy (sic) is negligible. This has an important impication (sic) for the control of lung cancer: elimination of cigarette smoking will eliminate the disease regardless of the occupational exposure. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia, pp. 2-3. For a very potent carcinogen such as bis(chloromethyl) ether, the risk seems to be higher in the nonsmoker than in the smoker. The tobacco industry has inferred from this that smoking is protective. This is an absurdity designed to gull the public into thinking that the cigarette has a virtue. Such an inference is like crawling across the Schuylkill Expressway at rush hour to escape an elephant stampede, an unlikely hazard in Philadelphia. In any case, occupational exposure to chloromethyl ethers has been eliminated since 1971. I wish I could say the same for the cigarette. William Weiss, M.D., prof. of Medicine & Director of Div. of Occupational Medicine, Hahnemann Medical College & Hosp., 6/16 Philadelphia p. 3. In all likelihood because of this pandering to a habit ((cigarettes)), I have lost my entire left lung and am left with a right lung that only operates at about 65% efficiency owing to emphysema. Rodney P. Adair, lung cancer victim, vice president, Interpol, New York City, 6/16 Philadelphia, p. 1. ...a two-pack-a-day smoker like me, who had been going at that rate for many years, has a 15 to 23 times greater risk of contracting the disease than a nonsmoker. Rodney P. Adair, lung cancer victim, vice president, Interpol, New York City, 6/16 Philadelphia, p. 4. CONFIDENTIAL: TIMN 288717 MINNESOTA TOBACCO LITIGATION

-201- L U N G C A N C E R (page twelve) So far as I know, lung cancer is the only major form of cancer today whose main cause is known. Rodney P. Adair, lung cancer victim, vice president, Interpol, New York city, 6/16 Philadelphia, . p. 10. ...I am told, $3600 per lung cancer death was spent during 1976 in adver- tising the benefits of smoking and in the same year $60 million was appro- priated by government to support tobacco growing. Rodney P. Adair, lung cancer victim, vice president, Interpol, New York City, 6/16 Philadelphia, p. 11. to cigarette smoking. Presumably the incidence of cancer of the lung should be reduced propor- tionately as the particulate phase of cigarette smoke is reduced. It is, however, by no means certain that the reduction of tar is the total answer to the cancer problem and that in all probability is not the answer to the cardiovascular and circulatory problems that are related Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, p. 2, z II While the cigarette is changing, people's habits are also changing and there is also some evidence the type of lung cancer is changing. In a recent study coapleted at Roswell Park Memorial Institute, it was reported that patients who developed lung cancer since 1968 were more likely to be 2 pack a day smokers while patients who developed lung cancer prior to 1968-were more likely to be 1 pack a day smokers. The progressive reduction of tar content of cigarette smoke during the past decade may account for the apparent need of increased exposure by smokers to cigarettes prior to the initiation of the lung tumor. Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, " pp. 2-3. All histological types of lung cancer have increased in terms of actual numbers but adenocarcinoma in our experience has increased to a greater degree proportional to any other histological type, while squamous cell carcinoma is b ecoming less prevalent. The explanation for this observation may involve a number of factors but one is lead to wonder if changes in the smoking habits or recent design modifications of the filter and contents of cigarettes have changed the characteristics of the smoke to the point that it might influence the type of cancer now being produced. If, with all of these modifications we have succeeded only in diminishing squamous cell carcinoma in order that adenocarcinoma may take its place of prominence, we have created for ourselves a disservice in the sense that the one, two and five year survival for adenocarci.noma is significantly less than squamous cell carcinoma of the lung. 00 Oo 00 N Ronald G. Vincent, M.D., Chief, Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, pp. 3-4.

L U N G C A N C E R (page thirteen) Animal studies conducted in numerous countries have demonstrated carcino- genicity for cigarette smoke and mainly for its particulate matter, commonly known'as "tar". Fractionations and bioassays have revealed that tobacco smoke contains trace amounts of carcinogens, which act as tumor initiators, cocarcinogens and organ specific carcinogens... Dietrich Hoffmann,Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., P~iladelphia 6/16/77, p. 4. I Since little is known about the organ specific carcinogens in tobacco smoke, we are examining their role in tobacco carcinogenesis in a study which is supported by a grant from the American Cancer Society. Dietrich Hoffmann,Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., philadelphia 6/16/77, p. 4. ...heavy smokers carry along in their urine and in their blood compounds that can cause cancer. Hugues J.-P. Ryser, M.D., Professor of Pathology and Pharma- cology, Boston Univ. School of Medicine, Boston, Mass., 6/2 Boston, Tape 1, side 1, rev. 343.-East Room. Weingarten: ...in the course of your work as a thoracic surgeon, how many cases of lung cancer have you seen which were not cigarette related, in your opinion? Overholt: About 3%; about 97% were. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, Tape 1, side 1, rev. 1146. Baltimore• You raised the question of oat cell carcinoma, which brings up the issue.of differentiation among differing kinds of lung cancer. I wonder whether you might comment on whether there are types of lung cancer that are specifically induced by cigarette smoking, and types that represent a back- ground that may have other causes. Schulz: Apparently, the correlation between tobacco and other pulmonary irritants and cancer is greatest in squamous cell carcinoma of the lung and oat cell carcinoma of the lung. There probably isn't --- the other third type of more or less common carcinoma is adenocarcinoma -- the correlation is, not as clearly defined, but-may.exist as well. Weingarten: In terms of lung cancer, what percentage would you say are not tobacco-related, or cigarette-related? Schulz: What percentage are not? How can you tell? Schulz: ((tape is unintelligible, but VCH notes indicate that he said: don't know.")) - III Milford Schulz, M.D., radiologist and Senior Consultant, Mass. General Hosp., Boston, Mass., 6/2 Boston, Tape 5, side 1, rev. 346. TIMN 288719

L U N G C A N C E R (page fourteen) ...((slides of)) individuals who gave up the smoking habit showed a drop of 40 times in the number of atypical cells and showed a drop of 40 times in carcinoma in situ... Oscar Auerbach, M.D. pathologist and senior medical investigator, VA Hosp., East Orange, N.J., 6/16 Phila., Tape 1, side 1, rev. 543. Our first articles appeared in press in 1954. This is our avenue of meeting the criticism of our peers. And I can say to you that in the period of time I haven't seen a scientific study that has said we're wrong. Oscar Auerbach, M.D. pathologist and senior medical investigator, VA Hosp., East Orange, N.J., 6/16 Phila., Tape 1, side 1, rev. 625. If a very good test were ever developed for the early diagnosis of lung cancer such as we have mammography for breast cancer, if such a test were accomplished, ((William Weiss)) calculated that the net reduction in mor- tality would be about 2 percent from early detection, whereas, if we could eliminate smoking we could reduce the cancer deaths -- the lung cancer death rate -- by about 81 percent... a 40 times greater accomplishment by preven- tion than by early detection. Robert V. P. Hutter, M.D., Director of Pathology, St. Barnabas Medical Center, Livingston, N.J., 6/16 Phila., Tape 1, side 1, rev. 729. Cancer of the lung, cancer of the throat, cancer of the larynx, cancer of the mouth, cancer of the esophagus, cancer of the bladder -- 100 percent caused by smoking. Richard Marks, Jr., M.D., Dept. of Radiation Therapy, Med. Univ. of So. Caro., Charleston, S.C., 6/14 Atlanta, Tape 2, side 2, rev. 78. I did see one 17 year old who died with laryngeal cancer who started smoking when he was six. Ashbell C. Williams, M.D., former ACS president, now honorary life member, ACS, Jacksonville, Fla., 6/14 Atlanta, Tape 1, side 2, rev. 2. It has been stated recently that cancer of the lung in females is becoming prevalent in epidemic proportions. If one would just look back in the statistical evidence of the female consumption of cigarettes he would see that it is approximately 20 - 25 years ago that there was a rapid increase in the number of females consuming large numbers of cigarettes. William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, p. 3. CONFIDENTIAL: TIMN 288720 MINNESOTA TOBACCO LITIGATION

-204- L U N G C A N C E R (page f if t een) Clearly, the amount of squamous cell carcinoma that we've seen propor- tionately in the last 10 years has decreased rapidly. And the amount of adenocarcinoma we're seeing is increasing by the same proportion. Now, there are a number of factors that can account for this. As you know, the rate of -- incidence of cancer in women has doubled in the last 10 years. They are more prone to have adenocarcinoma than squamous cell carcinoma, but this does not account for the difference by itself. Some selected industrial environments will cause us a greater increase of adenocarcinoma, but that doesn't account for it either. And since the Kreyberg modifications of the pathology in 1967, there have been some changes of definition, which would lean this way a little bit, but that still doesn't account for the great change that we're seeing. Ronald G. Vincent, M.D., chief of thoracic surgery, Roswell Parl Memorial Inst. and former pres., Erie County ACS Unit, Buffalo, N.Y., 6/16 Phila., Tape 2, side 1, rev. 587. In the gas phase Dr. Hoffmann now also has found some volatile nitrosamines and clearly one gotta ask himself= Do they have a biological significance? It's always very important to ask ourself, you see, and that's why we again make such a unique team at the American Health Foundation because the chemist can talk to the biologists and they in turn talk to the epidemiologists, because clearly we gotta make a decision -- here's what we find in terms of chemical components. Does it have a relationship to humans? (rev. 1096.) Cuyler Hammond's prospective studies and our very extensive retrospective studies have shown that at the moment the lower the tar yield the more protected you are. And we have demonstrated right now in a study on some 750 lung cancer patients a reduction of lung cancer risk for those smoking filters of 25 percent. (Weingarten asked if Wynder is suggesting that Hammond's caution about potential new carcinogens in low tar and nicotine cigarettes is alarmist) Well, I always believe that you gotta be cautious...in terms of chemical indicators, biology and epidemiology. We are moving in the right direction. (rev. 1139.) Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2. Room #1. In Western Massachusetts, for more than twenty years our focus has been on quantitative correlation of tobacco used and verified diseases. More than 25,000 patients, thirty years and older electively admitted for medical and surgical problems, have been studied. Among verified diseases in patients who have smoked 600,000 cigarettes or more, we find that 42% have emphysema, 35% chronic bronchitis, 9% coronary disease, 6% peptic ulcer, and one of fourteen ((7.1%)) have cancer of the lung. One of thirty- three ((3.0%)) have cancer of the urinary bladder, and one of fifty ((2.0%)) have cancer of the oral pharynx. Our actuarial consultants tell us that step-wise in increments of 100,000 cigarettes, starting at 600,000 cigarettes consumed, regression analysis shows that there is a (cont.) CONFIDENTIAL: TIMN 288721 MINNESOTA TOBACCO LITIGATION

L U N G C A N C E R (page sixteen) r (cont.) significant correlation between the number of cigarettes smoked and the incidence of lung cancer. in this grouping, for every additional 100,000 cigarettes smoked, the chance of a heavy smoker getting lung cancer is increased by 7%, leading to those who have consumed 1,000,000 cigarettes, or more. In this small group, which we term "cigarette millionaires", the incidence of lung cancer is about one in three. John W. Turner, M.D., radiologist, Wesson MemortAl Unit, Baystate Medical Center, Springfield, MASS., President, Mass. Div. ACS, Boston 6/2/77, p. 1. 1. Women are not. immune to lung caincer' and may be no inore resistant than men. 2. Cigarette smoking outdistances by far all other possible causes of lung cancer in women. 3. Present information suggest strongly that the epidemic of lung cancer in women has just begun in earnest. (p. 2.) If successive cohorts of 43-54 year old women, whose prior smoking has increased so dramatically, continue on their current course, another 15 years could see them exceed men in lung cancer rates. (p. 4.) Despite the volume of claims about occupational carcinogens, measurements of atmospheric contaminants in factories show less of the known hazardous materials than were present 40 years ago. Thus, occupational contributions to lung can-- cer should have declined, or at worst, stayed about the same. (p. 5.) Among women, analysis of Third National Cancer Survey results by Williams and Horn showed that heavy smokers had a 16 fold relative odds ratio for lung can- cer compared to a 10 fold ratio for men. This seems to say that women are even more susceptible than men to the carcinogenic effects of smoking. (p. 5.) J. Wister Meigs, M.D., Director, Conn. Cancer Epidemiology Unit and Clinical Prof. of Epidemiology, Yale Univ., 6/2 Boston. Heavy smokers present a significantly increased incidence of cancers of the lung, larynx, esophagus, stomach, bladder, kidney and pancreas. The latter three localizations indicate that carcinogens of tobacco tar are absorbed from the lung and enter the general circulation. The most recent data from .Amesr laboratory further prove this point. They demonstrate that the urine of heavy smokers is mutagenic while the urine of nonsmokers is not. (p. 1.) There exist only very-few mutagens that do not have`carcinogenic properties ' when tested thoroughly in animals (2). Thus, most if not all chemicals-respon- sible for the mutagenic activity of urine must be carcinogens. It can thus be concluded that heavy smokers harbor demonstrable amounts of carcinogens in their blood and urine as well as in their lungs and bronchial tree. (p. 2.) Hugues J.- P. Ryser,, M.D., professor of pathology and pharma- cology, Boston Univ. School of Medicine, 6/2 Boston. CONFIDENTIAL: TIMN 288722 MINNESOTA TOBACCO LITIGATION

L U N G D I S E A S E Of all the known preventable factors relating to heart disease, stroke, lung cancer, bronchitis and emphysema, smoking cigarettes is that factor. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 2. Cigarette smoking has an unparalleled effect in facilitating and enhancing the toxic effect and manifestations of disease associated with other environmental agents. In the practical sense, were it not for the asso- ciation of cigarette smoking with occupational exposure to chemical or physical carcinogens (e.g. uranium mining, asbestos, coke oven exposure, chromates and nickel), lung cancer in these occupational groups would virtually disappear as a hazard of the workplace. Cigarette smoking is in reality the determinant for most of these cancers as well as for an array of lung abnormalities grouped under the generic term chronic ob- structive pulmonary disease. Dr. Paul Kotin, medical director, Johns-Manville, Denver, Co1o., 5/12 Denver, pp. 3-4. Smoking is an established risk factor in many major pulmoriary and non- pulmonary diseases. Lung cancer, chronic bronchitis and/emphysema*are clearly diseases of smokers, for the most part... Thomas L. Petty, M.D., Head, Div. of Pulmonary Sciences, Univ. of Colo. Medical Center, 5/12 Denver, p. 1 Cigarette Smoke Slows Down Cilia Action. Attachment to George Browne $tatement, Commissioner, Dept. of Drug & Alcohol Addiction, Nassau County, New York, 6/16 Philadelphia. The incidence of emphysema is about 50 percent advanced, or severe,emphysema in people who smoke more than one pack of cigarettes a day. There is about one-third advanced, or severe, emphysema in people who smoke less than one pack a day. The incidence is much less on people who smoke pipes and cigars, being around 80 percent, and it's almost nonexistent in nonsmokers, being below 3 percent. Roger Secker-Walker, Director of the Pulmonary Division .Dept. of Internal Medicine, St. Louis University School, of Medicine, 5/19 St. Louis, Tape 2, side 1, rev. 278. --Cigarette smoking is the single leading cause of non-cancerous lung disease (such as emphysema or tuberculosis) in the United States today Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288723

L U N G D I S E A S E (page two ) ... We are talking about 20 million Americans that have emphysema and chronic bronchitis. Unfortunately, I have a hard job as a salesman try- ing to get people interested in doing anything about emphysqma and chronic bronchitis, which are clearly related to smoking. Thomas L. Petty, M.D., Head, Division of Pulmonary Sciences, University of Colorado Medican Center; 5/12 Denver, Tape 2, rev. 158. Since 1954 I have lost my mother, sister, my brother, two uncles and a (sic) aunt plus a cousin. All from respiratory failure. Raymond Reese, emphysema victim, Denver; 5/12 Denver, page 3. Mayo Clinic researchers have indicated that cigarette smoke in the home aggravates symptoms in some asthmatic children and can even trigger asthma attacks. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., Boston 6/2/77, p. 2. Statistically, over 30 percent of heavy smokers develop some degree of clinical emphysema...It has been estimated that, from the time he develops his symptoms until the time he dies, the average smoker with clinical emphysema will cost the taxpayer over $100,000. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Menuorial Hosp., Stoneham, Mass. Boston 6/2/77, p. 5. Chronic obstructive pulmonary disease...is clearly related to cigarette smoking and rarely develops in nonsmokers. Alice Van Landingham, president, American Assn. of Retired Persons, Wash., D. C., Philadelphia 6/16/77, O p. 3. r-i F'Baltimore: Is it possible to identify a smoker at autopsy on the basis of ~ his or her lung condition? ~ .. H Overholt: No, I don't think so. U U W ~ F O I Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Boston, Tape 1, side 1, rev. 1149. To me the most dramatic thing is that in our dogs that smoked we found that these ((emphysematous)) changes occurred at the end of 24 days. And if you remember that in school, in high school, the athletic coaches didn't like the youngsters on their team (sic) because they knew long before the medical profession that that youngster who smoked, when he got on the field, was winded. He was winded because within the period of 24 days we are able to see the first changes of emphysema. (rev. 577.) cont.) TIMN 288724

L U N G D I S E A S E (page three) To answer a question that Mr. Weingarten put, let me say we may have the answer to the question that Dr. Hammond raised, because we are now gathering material on the individuals who have smoked in this era, chiefly the low tar, low nicotine, the filtered cigarettes, comparing them with our study of years ago, which ended around 15 years ago, in which we had the unfiltered cigarette. And so by a comparative study we may have that answer to see whether the incidence of lung cancer, the changes in the bronchial epithelium, are different or the same as the results of the two -- comparing the two different cigarettes. (rev. 591.) Oscar Auerbach, M.D., pathologist and senior medical investigator, VA Hosp., East Orange, N.J., 6/16 Phila., Tape 1, side 1, CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288725

N S E N F O R C E M E N T To admit that one-third of all Americans smoke and yet refuse them a place to smoke and expect them to adhere to the law creates a situation that eventually becomes unenforceable--and very unpopular. Surely, our experience with the Prohibition of alcohol demonstrated this. Bennett Arnberger, pre-law student, UC-Berkeley, 3/22 LA statement. p. 4. The problem with many of these bills and ordinances is that they do not provide for enforcement. The recently approved Berkeley City ordinance tries to remedy this by including a provision for private right of action which allows nonsmokers to sue smokers who defy the law for damages up to $100. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22 LA statement. p. 4. if the kids insist on going off campus to smoke, they are in violation of a possession law and they should be busted for this offense and let the police and parents take care of the problem. If the police don't like such enforcement duty that's too bad--it's the law and must be enforced. George Crawford, Ph.D., Business Administration, ACS anti-smoking program advocate, 3/22 LA statement, pp. 4-5. And enforcement has been a question that many people have brought up...I have found that 99 percent of all people--of all smokers--will comply with a law that they know, once they are knowledgable of the fact that there is a law...The overwhelming majority of people are concerned with one another and I see no problem with enforcement. Herm Perlmutter, LA, founder and co-chairman of Californians for Clean Indoor Air, 3/22 LA, Tape 7, Rev. 686. In many cases regulations relative to smoking bans are not enforced, thus the regulations are generally ignored. August S. Rossano, Dept. of Civil Engineering, 5/17 Seattle, p. 1. We were all pleased two years ago_when Alaska to pass smoking regulations in public places. became one of the first states However, since that time, this bill has proved worthless because of no apparent way to enforce peoples habits. But remember we have never been successful at legislating rules aginst popular human habits. Donald Rogers, M.D., Pathologist, Anchorage, Chairman, Alaska Division of ACS, 5/17 Seattle, p. 4. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288726

N S ENFORCEMENT (page two) I am in support of a bill in the Illinois Legislature initiated by the Illinois Interagency Council on Smoking and Disease which will prohibit smoking in designated areas such as hospital patient rooms, patient areas, elevators, indoor theatres, libraries, art museums, concert halls and buses...We need to not only support enactment of such laws in every state but also encourage active enforcement. Paul Q.Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 4. If we are going to have law and order, we've got to do something ((about enforcing smoking prohibitions)). Fred Magel, River Forest, Ill., 5/25 Chicago, Tape 2, side•2, rev. 58. (Gives example of bus driver who had smokers arrested in violation of city law and had to take half day off as prosecution witness and overall cost was much more than $10 fine for violation) The fine could have been as much as $300 -- that's the limit I think in this case in Philadelphia -- but I think the only answer is to build up public pressure so that the public will enforce these regulations, that people will have the courage to speak out on a public vehicle or on an elevator. (rev. 328.) A great deal of public pressure,~ar a great advertising campaign to get people to speak up to enforce these regulations that do exist, even though they're not national, would be very, very helpful, because people are shy to do this quite often. We must give them the backbone to help enforce the rules, because I don't think the police are ever going to do it. (rev. 376.) John B. Kelly, Jr., councilman at large, Phila., Pa., and first vice president of U.S. Olympic Committee, 6/16 Phila., Tape 2, side 1. I'm not too woried about ((enforcement)) because I think that when you get a bill on the books you're talking about most of the public abiding by it anyway, particularly in elevators and in buses, where signs are readily posted. Additionally, it's a reinforcement to the nonsmoker to enforce the law privately with people who are violating it in their presence. (rev. 87.) People will comply without having an enforcer coming around every week and a half to check a restaurant, believe me. If there's a problem, you'll get complaints and they'll be spotted and then you just go out you could do the whole thing with five inspectors. (rev. 316.) Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2. CONFIDENTIAL: TIMN 288727 MINNESOTA TOBACCO LITIGATION

N S ENFORCEMENT (page three) Schools have rules against smoking but students seem to ignore them and many school officials concede that they are unenforceable. (p. 3.) Our district has school board policy which states that smoking is prohibited for minors and is punishable by up to 10 days (sic) suspension. This is a difficult policy to enforce and is one that causes many headaches for secondary school officials. (p. 3.) -211- Gene Bridges, Supervisor of Physical & Drivers Education, Escambia County, Pensacola, Fla., 6/14 Atlanta. •The State of Georgia, aware of public concern, attempted to regulate smoking in public places by enacting a law whereby smoking is prohibited in public places provided such places have been posted "NO SMOKING." This law is considered to be optional, whereby owners or managers may elect to impose no smoking in'their establishments. ((Since)) this law was enacted ... estab- lishments ((with)) no smoking signs are not imposing the no smoking regu- lations. We have received numerous complaints from citizens charging management with discriminatory practices on the no smoking regulation by permitting patrons to smoke during certain performances and prohibiting patrons from smoking during certain other performances. James B. Gossett, Chief & Fire Marshall, Atlanta Bureau of Fire Services, Atlanta, Ga., 6/14 Atlanta, pp. 3-4. As a former teacher in both public and private high schools and in the Job Corps, I believe that it is a physical impossibility to enforce a no-smoking regulation. But I strongly believe we can at least convert this problem area into a learning situation by requiring any smoking student to take a mini course on the medical ramifications of smoking. (p. 2.) I was told by Dr. W. L. Stanley, Jr., of the Atlanta schools, that absolutely no smoking is permitted in any school and that, indeed, THERE IS NONE. Further, he sent me the policy (#JDD-a) stating that any students smoking on the premises or traveling to or from the school ((emphasis supplied)) would be suspended. Dr. Stanley told me there were no violations of this. I have spoken with numerous students and am assured Dr. Stanley is inaccurate. Furthermore, I feel this, though idealistic, is a totally unrealistic policy. Even Prin- cipal Dodd admits that his dictum is repeatedly violated. (p. 3.) Carrie Nelle Thompson, Director, UNICEF, Atlanta, Ga., 6/14 Atlanta. The Department of Public Health of the State of New York has antismoking laws but has now determined that laws:re ulating smoking in public places are unenforceable. (p. 18.) Legislation prohibiting smoking in public places has merit but so far has been unenforceable. Is it possible for us to pass laws and have them enforced? (p. 20.) Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta. CONFIDENTIAL: T'IMN 288728 MINNESOTA TOBACCO LITIGATION -

NS "may-can" E©AS t0N ...second-hand smoke can (emphasis supplied) have harmful effects on non- smokers... Second Hand Smoke, Amer. Lung Asso. (1975) as quoted by Bennett Arnberger, pre-law student, UC-Berkeley, 3/22LA statement, p. 2. A number of investigations have demonstrated the exposure of passive smokers to carbon monoxide levels which may (emphasis supplied) cause adverse zffects in patients with cardiovascular disease. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach QA Hospital, 3/22LA statement, p. I. Cohen and associates also observed an association between atmospheric carbon monoxide pollution in Los Angeles and case fatality rates for pa- tients with acute myocardial infarction admitted to 35 Los Angeles hos- pitals. These data show that restrictions on cigarette smoking may (emphasis supplied) be necessary in public places to protect patients with cardiovascular disease. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22Lc1 statement, p. 5. Patients with hypoxia due to pulmonary disease also should not be exposed to increased carboxyhemoglobin Levels resulting from passive smoking to prevent further aggravation of bxygen delivery to their tissues. There- fore, restrictions oa cigarette smoking may (emphasis supplied) be necessary in public places to protect_patients with pulmonary disease.. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 5. Passive smoking may (emphasis supplied) also result in absorption of other potentially harmful substances. Tobacco smoke contains tar, volatile hydro- carbons including 3, 4-benz pyrene, oxides of nitrogen, hydrogen cyanide, volatile nitriles, acrolein, aldehydes, phenols, and other substances. The effect of these substances absorbed by passive smoking on cardio-pulmonary function remains to be determined. (emphasis supplied) Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement. p. 11 in conclusion, passive smoking may (emphasis supplied) aggravate cardio- vascular function in patients with cardiovascular disease, may (emphasis supplied) aggravate pulmonary function in patients with pulmonary disease, may (emphasis supplied) lead to an increased incidence of respiratory tract infections, may (emphasis supplied) precipitate or aggravate respiratory symptoms and other symptoms in allergic patients sensitive to tobacco smoke, and may (emphasis supplied) precipitate respiratory and other symptoms in nonallergic patients sensitive to tobacco smoke. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 11. CONFIDENTIAL: TIMN 288729 MINNESOTA TOBACCO LITIGATION -- - - - -- - _- ~

NS "may-can" E V A S I 0 N (page two) On the other hand, people with certain lung, heart, and allergic conditions may have their disease symptoms intensified as a result of exposure to the tobacco smoke of smokers. Paul Qr.. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 3. it is probable that air pollution by smokers is harmful to non-smokers because of the carbon monoxide, tars, and nicotines introduced into the air breathed by all. Bernerd Burbank, M.D., medical director, McGraw-Hill, New York City, 6/16 Philadelphia, p. 1. There is scientific evidence that cigarette smoke under certain con- ditions is injurious to the health of non-smokers. Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA.,6/16 Philadelphia, , p. 1. Smokers can cause injury to non-smokers suffering from asthma, hay fever, sinusitus, chronic bronchitis, coronary problems, emphysema and allergy. Other people's smoking can be a serious danger to their health ... cigarette smoke...can cause headaches to non-smokers by causing air pollution. Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., 6/16 Philadelphia, Attachment to. CONFIDENTIAL: TIMN 288730 MINNESOTA TOBACCO LITIGATION

-214- N S H E A L T H H A R M ...second-hand smoke can (emphasis supplied) have harmful effects on non- smokers... Second Hand Smoke, Amer. Lung A sso. (1975) as quoted by Bennett Arnberger, pre-law student, UC-Berkeley, 3/22 LA statement, p. 2. I am, however, strongly opposed to those people imposing the effects of their habit on me and endangering my life. John V. Briggs, Calif. State Senator, 3/22 LA statement, p. 2. A number of investigations have demonstrated the exposure of passive smokers to carbon monoxide levels which ma (emphasis supplied) cause adverse effects in patients with cardiovascular disease. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 1. Cohen and associates also observed an association between atmospheric carbon monoxide pollution in Los Angeles and case fatality rates for pa- tients with acute myocardial infarction admitted to 35 Los Angeles hos- pitals. These data show that restrictions on cigarette smoking ma (emphasis supplied) be necessary in public places to protect patients with cardiovascular disease. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 5. Patients with hypoxia due to pulmonary disease also should not be exposed to increased Earboxyhemoglobin levels resulting from passive smoking to prevent further aggravation of oxygen delivery to their tissues. There- fore, restrictions on cigarette smoking ma (emphasis supplied) be necessary in public places to protect patients with pulmonary disease. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 5. The non-smoker is daily subjected to the harmful effects and toxins contained in tobacco smoke ... Scientific research has now shown that tobacco is indeed physically harmful to the non-smoker. A wide range of harmful effects are experienced by the non-smoker who must inhale tobacco smoke. Herm Perlmutter, founder & co-chairman, Californians for Clean Indoor Air, 3/22 LA statement, p. 1. Tobacco pollution pervades the health of the American public. Herm Perlmutter, founder & co-chairman, Californians for Clean Indoor Air, 3/22 LA statement, p. 2. CONFIDENTIAL: TIMN 288731 MINNESOTA TOBACCO LITIGATION- -- ---

NS HE ALTH HARM (page two) • An increase of abou*. 1.5 percent in COHb will signify the onset of im- pairment in somebody with established circulatory disease such as angina pectoris or arteriosclerosis of the lower limbs...the increase in non- smokers during commuting is just shy of that on the average. John R. Goldsmith, M.D., California State Dept. of Health, 3/22LA Tape 2, rev. 517. It is not terribly easy to document with great clarity that there are grave disease consequences and I don't want to overstate that L think that it is a matter of providing people with a comfortable and health- ful work environment, or living environment, or social environment, rather than as primarily a means.to prevent grave disease in the passive smoker. Dr. John R. Goldsmith, as cited by ACS LA Film, 3/22LA. There was on Nov. 16, 1975, Dr. Dennis Schuetzle made an environmental study of the ambient air in the Pontiac Stadium during a football game. And, at that particular time, he took samples before the game began in order to determine the pollutants level ((uniatelligible)) the stadium what happens when people smoke. Well, the carbon monoxide level during' the game averaged 35 ppm-that's a three-hour average-compared with 5 ppm before and after the game- This level exceeds the limit established by the U.S. government national ambient air quality standards. The carbon monoxide level exceeded 50 ppm just prior to the half-time break, setting off an alarm in the instruments.. We don't know how high the level actually became,, bu_t it was over 50 ppm°.- The particulate concentration during- the game was found to be 2,1L4 micrograms per cubic meter- during- the game compared to less: than-L00 micrograms per cubic me.ter before•the game.. _P°articulate- IeveLs. during: the, game exceeded by several times - the limits established by the national ambient air-quality standards and- this leveL. would cause- aa,-.air pollution aLert im any- major city- in the- U.S. The n concentration of nitrogen ozi.des- i.a the seadium_ was calculated to be 0.63- ppm- This leveL` ezceeds- the Limits- established by- the nationall ambient ai:r. quality` standards. _ A potent careinogeir,° that is a cancer promoting:- substance,•--dimethyiaitrosamiae,b is< emitted from. cigarette- - smoke-.. -- Laboratory analysis- lras indicated its possible presence: during - tiie game~« There- was: alsn persistent eye__ irritation during the game. as- s observed by the i.avestigatar., The- pred-icted: concentrations of: aldehydeas and.'organic acids- would be sufficient to cause both respiratory and eye irritations. We're talking about a real life situation. Wilbert S.° Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22LA statement, tape-3, rev:- 475.- - - CONFIDENTIAL: TIMN 288732 MINNE5OTA TOBACCO LITIGATION : ~ _ _ _~

N S H E A L T H H A R M (page three) Many nonsmokers are adversely affected by passive exposure to tobacco smoke. Perhaps strong irritants and unpleasant odors resulting from gaseous components produced during tobacco combustion, such as phenols, aldehydes, and organic acids, cause these adverse reactions. ((Cited Hinds and First study)). Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22LA statement, tape 3, rev. 582. These data lead one to conclude that nonsmokers in public places should be protected from the hazards of passive smoking. Breathing air free from tobacco smoke should be a right available to all nonsmokers. There- fore, either tobacco smoke should be prohibited in public places or special _well-ventilated areas should be set aside in public places for those individuals who wish to smoke. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22LA statement, tape 3, rev. 603. Research has shown that smoke in enclosed areas causes physiological changes in the non-smoker: a faster heart beat, a rise in blood pressure, and increases in carbon monoxide levels. Second-hand smoke has been shown to be even more lethal than the smoke inhaled by the smoker. Rep. Georgette Valle, State of Washington, 5/17 Seattle, p. 4. Sidestream smoke contains two times as much nicotine and tar, five times as much carbon monoxide, four times as much nitrous oxide and 50 times as much ammonia. Rep. Georgette Valle, State of Washington, 5/17 Seattle, p. 5. It has been well established that "passive" smoking is a common accom- paniment of indoor air pollution. This is a phenomenon whereby non-smokers develop elevated blood levels of carboxyhemoglobin after exposure in a smoke-filled room. The concentration of nicotine and dust particles in a closed room where smoking is taking place may become so high that the non-smoker inhales as much harmful tobacco by-products as a smoker inhales in 4 to 5 cigarettes. In poorly ventilated smoke-filled rooms, concentrations of carbon monoxide can reach levels that expose non-smokers to a toxic hazard. Finally, it has been shown that smoke from an idling cigarette contaias almost twice the tar and nicotine of smoke inhaled _while puffing on a cigarette. Raymond G. Slavin, M.D., Prof. of Internal Medicine, Director of Allergy &_Immunology Section, St. Louis Univ. Medical School,_ 5/19 St. Louis, p. 1. CONFIDENTYAL= TIMN 288733 MINNESOTA TOBACCO LITIGATION -216- i

N S H E A L T H H A x M page four) My right to function well is jeopardized when I am forced to be in a room heavily saturated with tobacco smoke. Tobacco smoke irritates the throat, eyes, lungs, and the sinuses. It causes the heart to beat faster and it increases blood pressure. Shirley Marsh, Nebraska State Senator, not delivered. 5/19 St. Louis, p. 1. Passive smoking also causes an elevation of the levels of carboxy- hemoglobin in the blood just like heavy polluted air. Manfred Thurmann, M.D., President, St. Louis Heart Assn., 5/19 St. Louis, p. 2. "There can be no doubt that the by-products of burning tobacco are toxic and dp.ngerous to the health of the smoker and the nonsmoker." This state- ment from the decision of the Honorable Philip A. Gruccio, J.S.C., in the case of Shimp vs New Jersey Bell gives nonsmokers around the world new heart. A legal decision by a learned judge, based on outstanding medical evidence- and expert medical opinion, demands that smoking "rights" be dealt with as a medical and not a social issue. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 1. Why...does industry perpetuate a double standard, preventing the use of alcohol and other drugs on the job but permitting the use of a toxic substance labeled as harmful to health? What•company would permit an employee to bring a fifth of liquor to the workplace for daily consumption... or permit the paraphernalia df a "hard" drug habit to clutter the desk in preparation for a "fix?" Even more thought-provoking is the realization that neither of these habits immediately and adversely affect the health of the innocent bystander...whereas smoking is harmful to everyone. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 3. Government statistics show that 9,190,000 persons between 17 and 65 are "seriously jeopardized" by the inhalation of second-hand smoke. The total labor force from 17-65 amounts to 89.3 million, indicating that more than 10% of the working age population suffers from chronic disease and is immediately and adversely affected by exposure to tobacco smoke. In addition, 15 out of every 100 Americans suffer from one or more signifi- cant allergies, which are exacerbated by tobacco smoke exposure. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 4 CONFIDENTIAL: TIMN 288734 MINNESOTA TOBACCO LITIGATION

N S H E A L T H H A R M (page five) My day in court proved two things: (1), tobacco smoke is an unnecessary occupational hazard and (2), an employee may obtain an injunction to pro- tect his or her health when all other remedies have failed. , ., Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, pp. 6-7. There are adverse effects on non-smokers in the vicinity of smokers - many of whom are unconcerned at best or aggressively rude at worst. Ernest W. Johnson, M.D., Chairman, Dept. of Physical Medicine, Ohio State University School of Medicine, Columbus, Ohio, 5/25 Chicago, page 2. The effects of cigarette smoke on healthy non-smokers consists mainly of the discomfort of eye and throat irritation. On the other hand, people with certain lung, heart, and allergic conditions may have their disease symptoms intensified as a result of exposure to the tobacco smoke of smokers. Paul Q. Peterson, M.D., Director, Illinois Dept. of Public Health, 5/25 Chicago, page 3. Everyone's health is adversely affected by tobacco smoke. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, I11., 5/25 Chicago, page 1. In analyzing the sidestream smoke, we find some very interesting figures. The tar and nicotine content of the sidestream smoke is two times higher than the mainstream smoke, three times for the benzopyrene, carbon monoxide five times and ammonia 50 times. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 134. It is also true that probably the various means of isolating smokers is not the best idea. I see a lot of people who have just as many secondary illnesses from being in the same room with smokers as there are people in the room that smoke have the disease. Earl B.,Flanagan, MD., Carlsbad, N. M.; 5/12 Denver, Tape 2, rev. 395. I don't see why, knowing perfectly well that droplet infection spreads viral and bacteriological diseases, that is a cough or a sneeze, why smoke particles don't do exactly the same thing...I don't see why one can't as a matter of fact, induce common staphylococcal food poisoning that way. But I haven't seen studies to that effect. Roy Korson, prof. of Pathology, U. of Vt. College of Medicine & Vt. State ACS president, 6/2 Boston, Tape 1, side 2, rev. 877. CONFIDENTIAL: TIMN 288735 i4iINNESOTA TOBA C C O LITIGATI ON

-219- NS HEALTH HARM (page six) _. , . • ,r:- . Although people should not have to be subjected to ((the inconveniences of ambient smoke fumes)) they do them little harm. The real danger is in the health hazard posed by tobacco smoke inhaled by the non-smoker. Lawrence DiCara, Boston City Council member, 6/2 Boston, p. 1. Since I get confused, forgetful and have trouble concentrating in the presence of smoke, and since I get very depressed or sometimes hyperactive, or sleepy or hostile and even unreasonably suspicious around smoke, my ability to learn suffered. My grades were often poor. After five years in college, I felt incapable of competing in that atmosphere, and I was still without a degree. At the time I didn't understand what was wrong. It was much later before I realized that I not only disliked smoke, but that my mind, the instrument with which I think, was slowed down and altered by the drug, tobacco smoke. Stephen Sedberry, musician, Birmingham, Alabama & Rosbury Crossing, MASS., 6/2 Boston, . pp. 2-3. I would like to see more chemical studies of the circulating air in office buildings and public areas to determine levels of carbon monoxide and other toxic bi-products of tobacco smoke ((cf., Sterling)) Bernerd Burbank, M.D., medical director, McGraw-Hill, New York City, 6/16 Philadelphia, p. 2. Many contaminants invade the lungs. Nicotine is one of them. We do not have to be a smoker to be inflicted with the effects of nicotine. Ernest M. Fidance, D.D.S., Wilmington, De., 6/16 Philadelphia, p. 2. ...nonsmokers as well as smokers suffer adversely from the effects of tobacco smoke. Alice Van Landingham, president, American Assn. of Retired Persons, Wash., D. C., 6/16 Philadelphia, p. 1. All these abuses ((by smokers)) and many others cause the loss of thousands of lives of innocent non-smokers. Arthur T. Roth, former bd.chairman, Franklin National Bank, Rockville Center, New York, 6/16 Philadelphia, p. 1. There are papers published from time to time about the statistical increase in cancer incidence in non-smokers who are subjected in other people's smoke or the increased carbon monoxide content of the air in a smoke-filled room, etc. These need strong documentation. Roy Korson, M.D., prof. of pathology, Univ. of Vt. College of Medicine, and Vt. State ACS pres., 6/2 Boston, p. 2. CONFIDENTIAL: TIMN 288736 MINNESOTA TOBACCO LITIGATION

N S H E A L T H Fi A R M (page seven) Some non-smokers with serious diseases were forced to not fly because the smoke in commercial airplane cabins might kill them. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., Philadelphia 6/16/77. Only recently... the public has become more and more cognizant of the ~ toxic affect on the nonsmoker who is forced to breathe the exhaust of smokers containing deadly tars, nicotine and carbon monoxide. Smoke from the burning end of a cigarette contains twice as much tar and nicotine as the smoke inhaled by the smoker. It likewise contains five times the amount of carbon monoxide, the chemical constituent which competes with oxygen in defusion to red blood cells in the lungs, and 46 times as much ammonia, the substance which causes eye and nose irritation to many nonsmokers and smokers. Sidestream cigarette smoke and second-hand smoke causes real measurable damage to coronary patients and to those who suffer from a whole range of lung diseases including crippling emphysema, chronic bronchitis and asthma. Attachment to statement of Fred G. Field, Jr., N. Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N. Y., Philadelphia 6/16/77, p. 1. In recent years significant changes have occurred in social attitudes towards smoking indicating that the public has accepted ((i.e., become aware of)) the degree of risk to nonsmokers and is concerned about it. Attachment to statement of Fred G. Field, Jr., N. Y. State Assemblyman, member of bd. of directors, ACS N. Y. Div., Albany, N.Y., Philadelphia 6/16/77, p• 2. ...it is a health issue now, not a social issue. Donna M. Shimp, Exec. Director, Environmental Improvement Associates, 6/16 Phila., Tape 1, side 1, rev. 223. (Evans asked if Burbank had heard earlier testimony that "within 13 minutes inside a room where smokers" -- unintelligible, but something about outside air standards) I did hear it. I'm not sure I heard it in the total context. I also heard from ...an industrial hygienist ((told me)) that they'd made a study in a bar of the CO levels, over a number of hours, that the bartender got. And I can't think of any more hazardousLL area. And his figures were not dangerous to the individual. So I don't know... Bernerd (sic) Burbank, M.D., Medical Director, McGraw-Hill, 6/16 Phila., Tape 2, side 1, rev. 51. CONFIDENTIAL: TIMN 288737 MINNESOTA TOBACCO LITIGATION

N S H E A L T H H A R M (page eight) -221- Dr. John J. McKetta, a professor in the Department of Chemical Engineering at the University of Texas, points out the illogic of our piecemeal approach in this way: "To put things in perspective, let me point out that the average concentration of carbon monoxide in Augstin, Texas is about 1.5 parts per million. In downtown Houston, in heavy traffic, it sometimes builds up to 15 or 20 ppm. In Los Ange- les it gets to be as high as 35 ppm. In parking garages and tunnels it is some- times 50 ppm." Then he goes on to add the clincher when he says this: "Here lies a surprise for most people -- did you know that the carbon monoxide content of cigarette smoke is as high as 42,000 parts per million? The CO con- centration in practically any smoke-filled room grossly exceeds the safety standards we allow in our facilities. Of course, 35 to 50 ppm CO should not be ignored but there are so many of us who subject ourselves to CO concentrations voluntarily (and involuntarily) that are greater than those of our most polluted cities, including the Holland Tunnel in New York, without any catastrophic effects. It is not at all unusual for CO concen- trations to reach 100-200 ppm. range in poorly ventilated smoke-filled rooms." Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, p. 7. ...the Surgeon General showed, and the department of health, that the effect of smoke on nonsmokers is clearly documented in many, many ways, many times. (rev. 190.) ...a study done in Maryland by one of our nuclear physicists ((showed)) what happens when you have the average number of smokers, which is about 32 percent in any given population, smoking the average number of times in a ((restaurant)) room that meets present recommended ventilation require- ments. And you can see that within one minute the primary standard is already reached, in air control, within another minute and a half the alert -- if this were outdoors -- the alert would be sounded and in two more minutes you'd reach the warning state -- goes up to emergency and significant harm where all factories in an area would be closed down. All vehicular transportation would be stopped by the state health authori- ties if this were the outside atmosphere. All this takes place within 13 minutes, in the average restaurant room. (rev. 234.) Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2. FAA World magazine published a statement to the effect that the U.S. Surgeon General was wrong about tobacco smoke being hazardous to nonsmokers. With a few exceptions, upper middle and lower level management people simply echo these national office sentiments. 1/24/77 letter from Hilliard, Fla., Air Traffic Controller Edwin Brock to Sen. Chiles and Rep. Bennett,'submitted by Brock at NCSPP forum, Atlanta, 6/14/77, p. 2. CONFIDENTIAL: TIMN 288738 MINNESOTA TOBACCO LITIGATION

N S H E A L T H H A R M (page nine) -222- Our particular group sees between 2,500 and 3,000 new patients each year. These patients generally fall into three (3) major categories. 1) coronary arterytlisease,2) cancer of the lung, 3) chronic bronchitis and emphysema. ...It becomes more and more apparent when you study these cases and look at the smoking habits of these patients that there is no question that the relationship ((with smoking)) is there. However, there is a significant number of people with these diseases that we are seeing who have never given a definite history of consumption of any material number of cigarettes in their past life. At first, we thought that there must be some extrinsic cause and upon more careful examination of the history of these patients, we found that almost 90% of those people who were non-smokers had on e of the above mentioned diseases, and had a strong exposure to atmosphere laden with cigarette smoke...I realize that this study is based upon simple clinical experience, but at the same time we have a significant number of people on whom an effort has been made to determine the relationship of the atmosphere polluted environment and those that are not associated with such an environment and the difference is striking. William A. Hopkins, M.D., cardiothoracic surgeon, Atlanta, Ga., 6/14 Atlanta, pp. 1-2. There is a basis for restricting smoking in public...There is substantial evidence concerning the deleterious effects of tobacco smoke upon the non- smoker. The Surgeon General has identified at least 32 elements in tobacco smoke as irritating/toxic gases or suspended particulates...Numerous studies have shown that nonsmokers are affected by tobacco smoke. Some symptoms shown by nonsmokers around tobacco smoke are increased blood pressure and significant increases in the concentrations of carbon monoxide in the blood- stream. Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta, pp. 2-3. I find that in addition to my knowledge that inhaling other people's smoke is detrimental to my health per se and is.unpleasant to the olfactory senses, the presence of smokers literally irritates my throat to the point that I must constantly take throat lozenges, use mouth sprays and washes and sometimes must excuse myself and walk to a non-smoking area--if such is to be found. Carrie Nelle Thompson, D'irector, UNICEF, Atlanta, Ga., 6/14 Atlanta, p. 1. I am appalled at the airlines restricting smoking in limited sections of the ~ airplane. It is nothing more than a feeble effort, for once the plane leaves the ground, the smokers begin to light up their cigarettes, and you have to endgre the air pollution. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, ,Ga., 6/14 Atlanta, p. 16. CONFIDENTIAL: TIMN 288739 MINNESOTA TOBACCO LITIGATION

N S HEALTH HARM (page ten) Levels of carbon monoxide have been shown to exceed the maximun permitted ambient air limit resulting in decreased attentiveness and alertness and the impairment of psychomotor function. Jonathan Fielding, M.D., Mass. Commissioner of Public Health, 6/2 Boston, p. 3. Dr. F. A. Simone, then surgeon-in-chief at Miriam Hospital and professor of Medical Science at Brown University, said, "Very few now doubt that normal individuals breathing air which has been contaminated with tobacco smoke become poisoned with carbon monoxide." Quoted by R.I. State Senator Lila M. Sapinsley, 6/2 Boston, p. 3. ' CONFIDENTIAL: TIMN 288740 MINNESOTA TOBACCO LITIGATION

NS HEALTH HARM--CHI LDREN Luquette and associates exposed 40 children, mean age 9.8 years, 3 children at a time, to smoke-filled and smoke-free atmospheres in a poorly ventilated environmental chamber with dimensions of 12 x 7 x 7 feet. After 30 minutes exposure, during which time 6 cigarettes were smoked by 2 smokers also present in the chamber, the children had a mean increase in heart rate of 6 beats per minute, a mean increase in systolic blood pressure of 4 mm Hg, and a mean increase in diastolic blood pressure of 5 mm Hg. While in the nonsmoking atmosphere, the mean heart rate increased one beat per minute, the mean systolic blood pressure decreased 4 mm Hg, and the mean diastolic blood pressure did not change. However, the experimental design of this study has been questioned. Moreover, Harke and Bleichert found no significant change in blood pressure or in heart rate in nonsmoking adults exposed to greater concentrations of tobacco smoke. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 7. Cameron and associates administered an acute illness questionnaire by phone to 727 families in the Detroit metropolitan area. These investigators found that children 16 years or youngerTliving in a home with tobacco smoke present had more frequent acute respiratory illnesses than children of nonsmoking parents. However, Shy and associates in a study of second grade Cattanooga school children did not demonstrate a relationship between parental smoking habits and the respiratory illness rates of their children. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 7. Colley found that the prevalence of cough in 2,426 children between 6 to 14- years of age in Aylesbury, England, was associated with their parents' smoking habits. The prevalence of cough was highest when both parents were smokers, lowest when both parents were nonsmokers, and intermediate when one parent was a smoker. When parental phlegm production was held constant, there was a suggestion of a weak association between parental smoking and chest symp- toms in their children, but it was not statistically significant. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, p. 8. Research has found that respiratory illness among children of parents who smoke is twice as common as among children of parents who do not smoke. Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta, p. 3. CONFIDENTIAL: TIMN 288741 MINNE5OTA TOBACCO LITIGATION

..:~:._..__1-4: NS HEALTH HARM--CHILDREN (page two) ... Infants of mothers who smoked had significantly more admissions to the hospital for bronchitis or pneumonia during the first year of life than did children whose mothers did not smoke...Moreover, in later hife it has been found that cigarette smoking is more frequent and begins earlier among children of smokers than among children of non-smokers. -224- George T. Schneider, M.D., Prof. of Obstetrics & Gyn., Louisiana State Univ. School of Medicine, 5/12 Denver, p. 5. A recent study revealed that children under 16 years of age who live in homes of parents who smoke have almost double the number of acute illnesses as those in non-smoking families. Maistre, M.D., Chancellor, Univ. of Texas System, Charles A. Leµ leter'made MCSPP panellist, 5/12 Denver, p. 7A. The largest area of child abuse is parental smoking... Janith Stewart Kice, M.D., Garden City, New York, Philadelphia 6/16, p. 1. Pediatricians play a vital part in influencing the child against smoking and in protecting the infant against the now recognized ill-effects of smoke from the mother's cigarettes -- perhaps the most emphatic example of "the rights of the non-smoker." Saul R. Kelson, M.D., Cardiologist, President of Toledo, Ohio, ACS, Toledo, Ohio, 5/25 Chicago, page 3. Research at Wayne State University in Detroit shows that respiratory illness occurred twice as often in young children of smoking parents as in children with nonsmoking parents. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., Boston, 6/2/77, p. 2. ...when my children came to me and explained that not only was I doing myself damage by smoking, but harming them as well by forcing them to breathe air around them polluted by my cigarette smoke, I knew it was time to stop. Farris Bryant, former governor of Fla., President, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, p. 4. CONFIDENTIAL: TIMN 288742 MINNESOTA TOBACCO LITIGATION

NS HEALTH HARM--CHILDREN (page three) Frederick Barnes, a professor at Brown University said that side stream smoke has a higher concentration of noxious compounds than mainstream smoke inhaled by the smoker. He reported that children whose parents smoke have more respira- tory ailments that (sic) those of non-smoking parents. Quoted by R.I. State Senator Lila M. Sapinsley, 6/2 Boston, p. 4. Bergman and Wiesner ... concluded that "exposure to cigarette smoke (passive smoking) appears to enhance the risk of SIDS for reasons not known." A. Marshall Smith, Jr., M.D., head, respiratory medicine section, Eastern Maine Medical Center, Bangor, Me., 6/2 Boston, p. 3. TEMN 288743 CONFIDENTIAL: MINNE5OTA TOBACCO LITIGATION

O R A L D I S E A S E Leukoplakia results from irritation ((from cigarette!smoke)) and if the irritant is not removed, these lesions tend to become maligant (sic). Ernest M. Fidance, D.D.S., Wilmington, De., Philadelphia 6/16/77, p. 2. in my estimation,!and I think most dentists will agree, tobacco smoke is a definite causative factor of periodontal disease. Ernest M. Fidance, D.D.S., Wilmington, De., Philadelphia 6/16/77, p. 2. The heavy smoker who wears full dentures is considered lucky if he lost his teeth before he lost his life from lung cancer, emphysema or early heart attack. Ernest M. Fidance, D.D.S., Wilmington, De., Philadelphia 6/16/77, p. 4. "Hairy tongue" is a highly undesirable and unsightly condition which is almost exclusively seen among heavy smokers. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., Philadelphia 6/16/77. Tobacco by-products contribute greatly to the formation of heavy accumu- lations of dental calculus (solid concretion) and gum disease. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., Philadelphia 6/16/77. Ninety-seven percent of all individuals developing oral cancer have at one time used tobacco. Edmund Truelove, D.D.S., chairman, Dept. of Oral' Diagnosis, Univ. of Wash. School of Dentistry, Seattle, Wash., 5/17 Seattle, Tape 1, side 2, rev. 13. In the Medical Center Hospital of Vermont, less than 3% of all oral cancer patients are non-smokers. Evidence suggests that the risk of mouth cancer in the heavy smoker and drinker may be as much as fifteen times greater than in those who neither smoke or drink. Samuel E. Molind, D.M.D., oral pathologist, Montpelier, Vt., 6/2 Boston, p. 2. CONFIDENTIAL: TIMN 288744 MINNESOTA TOBACCO LITIGATION

ORAL DISEASE (pagetwo) Although the literature does not provide clear evidence of a direct cause and effect relationship between tobacco and oral cancer in animal subjects, statis- tics do indicate that the occurance of oral cancer in humans occurs four times more'frequently in smokers than nonsmokers. (p. 2.) ~ Oral cancer should be depicted as an environmental disease, controllable in great part by alterations in lif estyle. Recent increases in incidence of oral cancer in females, correlated to the increase in heavy tobacco and alcohol use by women, can be used to support this contention. (p. 4.) John DiBiaggio, M.D., Vice President for Health Affairs, Univ. of C nn., New Britain, Ct., 6/2 Boston. TIMN 288745 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

P E P T I C U L C E R ...even at that time common sense plus budding medical knowledge told me that nicotine and hot tars and thermal effects caused delay of healing of peptic ulcers. One, by reducing circulation through constricted vessels, and two, by direct irritation of the mucosal wall, the healing was delayed. One of my first and most used arguments against smoking in a peptic ulcer pata,ent was that one couldn't be a good smoker without inhaling and one can't inhale_without swallowing and carrying a big bolus of irritating smoke directly into the stomach. Earl B. Flanagan, M.D., Carlsbad, N.M., 5/12 Denver, p. 1. Nicotine is a red-hot poker to the poor stomach. Cigarettes can not only burn holes in blankets, but also in the stomach. We call them ulcers. Elder P. Daniel Bakker, SDA minister, Merrimack, N. H., Boston 6/2/77, p. 4. There are a million excess cases of peptic ulcer in this country every year caused by smoking. Francis F. Randall, Honolulu, unidentified, who presented copyrighted "Prescription for Smoking Control" tape from Physicians' Audio Education Aids, 3/22 LA, rev. 217, part 1. CONFIDENTIAL: TIMN 288746 MINNESOTA TOBACCO LITIGATION

P R E G N A N C Y A recent study by Dr. Meyer at Johns Hopkins dealing with data from Ontario is compared in the final table of my handout with data obtained from the Kaiser Foundation Health Plan in Alameda County. And you'll see in table 3 that of the unfavorable outcomes of pregnancy, those for example associated with prematurity, from 5 to 15 percent can be attributed to cigarette smoking. And of those deaths that occur in tht perinatal period, from 1 to 10 percent can be attributed to cigarette smoking. Of course, the differences in these rates depends greatly on the underlying presence of other factors and the level of health care. John R. Goldsmith, M.D., California State Dept. of Health, 3/22LA Tape 2, rev. 466. ...(S)moking in pregnancy presents a special problem because it is a danger to the child as well as to the mother...Carbon monoxide, nicotine, and cyanates are the factors which seem most likely to have ill-effects on the fetus. Studies of carbon monoxide have indicated that the increase in car- boxyhemoglobin may deprive the fetus of adequate oxygen...Studies have confirmed that fetal breathing movements are reduced in association with cigarette smoking in normal and abnormal pregnancies. The reduction was related to the rise in maternal plasma nicotine levels... George T. Schneider, M.D., Prof. of Obstetrics & Gyn., Louisiana State Univ. School of Medicine, 5/12 Denver, P• Thiocyanate concentrations have been shown to be raised in the cord blood of infants born to smoking mothers, while vitamin B12 levels are lower. George T. Schneider, M.D., Prof. of Obstetrics & Gyn., Louisiana State Univ. School of Medicine, 5/12 Denver, p. 2. ...Australian study found that smoking mothers had a higher pregnancy wastage. The abortion rate...and the stillbirth rate increased . There was also a decrease in fertility, both male and female...The authors in this study concluded that there is a heavy family and financial loss, which in Aus- tralia has been estimated at 100 million dollars each year. George T. Schneider, M.D., Prof. of Obstetrics & Gyn., Louisiana State Univ. School of Medicine, 5/12 Denver, p. 4. The risk is twice as great in smokers compared to non smokers, and fetal and neonatal mortality is higher---12 studies. Roger H. Secker-Walker, Assoc. Prof., Medicine and Physiology, Director, Pulmonary Div. Dept. of Int. Med., St. Louis Univ. School of Medicine, 5/19 St. '71ouis, p, 4. CONFIDENTIAL: TIMN 288747 MINNESOTA TOBACCO LITIGATION

PREGNANCY (page two) Many people are concerned about "hyperactive children" these days, and many causes have been proposed for this behavior disorder. An interesting possibility was described a few years ago in a report from Candad (sic), which suggested that "hyperactivity" may be a withdrawal symptom in the infant born to a smoking mother, since there appeared to be some increased incidence of this condition in those children. In this regard, a few weeks ago when I saw one of my patients who I believe has true "hyper- activity," his father reported that several days before this visit the child has eaten 2-3 cigarette buttts (sic) which had been left in the ashtray. His father reported that his behavior was much more agreeable for two or three days following this episode, and the school had fewer complaints. I certainly do not suggest that tobacco and smoking be used in the treatment of "hyperactivity," although I am sure that perhaps everything else has been tried. Warren Bosley, M.D., Pediatrician, Grand Island, Nebraska, 5/19 St. Louis, pp. 2-3. ...what about the pregnant mother? Is there a great difference in pre- scribing the wrong drug and failing to prescribe no smoking? Thomas McGowan, judge, Buffalo, New York, b/16 Philadelphia, p. 4. Low birth weight infants, increases in the number of miscarriages (thought to be due to smoking induced placental separation), suppression of fetal breathing and long-term damage to the unborn are the problems. J. Mostyn Davis, M.D., P. C., Shamokin, PA, 6/16 Philadelphia, pp. 5-6. It is a well known fact that miscarriages, abortions and worst of all, still-borns, can result when a pregnant woman smokes. Normally, a woman's blood is completely separate from the unborn baby's, but some of the sub- stances in cigarette smoke actually pass through the placenta...Studies show even more carbon monoxide in the blood of the unborn baby than in the blood of the smoking mother! ... While growing in utero, the baby must exercise to develop certain muscles, especailly those necessary for breathing... If a Mother smokes as few as 2 cigarettes, those movements are noted to be lessened and the newborn infant is not only born underweight but also with possibly a heart deformity and a greatly lessened resistance to all medical problems the first year of life. Janith Stewart Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 1. CONFIDENTIAL: TIMN 288748 ----- MINNESOTA TOBACCO LITIGATION ___~~

P R E G N A N C Y (page three) in studies of the umbilical cords from newborn infants of mothers who smoke there is clear damage to the tissues in the cord itself. But nicotine, for example, can cause the blood vessels of the placenta to con- strict and thus further diminish the supply of food and oxygen to the unborn baby. Janith Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 2. The infants born of mothers who smoked 10 or more cigarettes a day during pregnancy are not only apt to be shorter in stature at 7 years of age but also to read less well and to be less well socially adjusted. Janith S. Kice, M.D., Garden City, New York, 6/16 Philadelphia, p. 2. ...[A)11 articles to some extent and various degrees report of various problems that arise in fetuses whose mothers are smoking. George T. Schneider, M.D., Professor of Obstetrics and Gynecology, Louisiana State University School of Medicine; 5/12 Denver, Tape 1, rev. 280. The fact that the heavy smoker carries mutagenic compounds in his urine has health implications which go beyond the cancer problem. It is known that mutagens circulating during early pregnancy are likely to cause birth defects. It is knownalso that about 5 percent of human diseases are genetic diseases. That means that they can be traced to one or several mutations which are transmitted from parents to children. So one cannot escape the conclusion that having mutagenic compounds circulating in the blood of young adults will increase the risk of causing genetic mutation and hence also the risk of occurence of genetic diseases. Hugues J.-P. Ryser, M.D., professor of pathology & pharmacology, Boston Univ. School of Medicine, 6/2 Boston, Tape 1, Side 1, Rev. 985. Dr. George Nicholson, a British physician, suggests that some babies are born addicted to nicotine and suffer withdrawal symptoms soon after birth. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 2. Research by Dr. Winea Simpson, of Loma Linda University in California, demonstrated a significant increase in premature menopause, glandular disorders, premature births, and menstrual problems in women smokers. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, pp. 2-3. CONFIDENTIAL: TIMN 288749 MINNESOTA TOBACCO LITIGATION

P REGNANCY (page four) Why is it dangerous for women to smoke while pregnant? Recent evidence links smoking while pregnant to 1) stillbirths, 2) increased mortality among newborns and 3) low birth weight. Lower- than normal birth weight is associated with a child's poor physical and emotional development. Handout to press at Philadelphia forum 6/16/77. (ACS) Smoking mothers also have more miscarriages.and stillbirths, and more of their babies die within 1 month of birth. Attachment to statement of Samuel M. Fisher, CPA, Samuel M. Fisher & Company, Philadelphia, PA., Philadelphia 6/16/77. Weingarten: Doctor, in pediatrics are you aware of newborn infants suffering anomalies because their mothers have smoked during pregnancy? Allen: Well, we see a good many children with newborn anomalies. I don't think any one in the medical profession has put down A, B, this is absolutely due to smoking. We do have a lot of problems, of course, with premature infants...but as far as tobacco in itself, I donft think anyone has identified absolute evidence that this is the result of the chronic or even acute smoking by the mother. James E. Allen,'M.D., pediatric surgeon, ACS volunteer, Snyder, N.Y., before NCSPP forum, 6/16 Phila., Tape 2, side 2, rev. 767. (Asked by Baltimore about hypothesis of Ryser at Boston forum that indicators of carcinogens in smokers' urine, higher at night than in the morning, might cause mutations in the babies of smoking mothers) There's absolutely no reason why that can't be. I think that it's up to us in the scientific world to prove this, because the smoking product in the blood and urine of people, nicotine and nicotinic acid, are certainly toxic agents. James E. Allen, M.D., pediatric surgeon, ACS volunteer, Synder, N.Y., before NCSPP forum, 6/16 Phila., Tape 2, side 2, rev. 777. ...During my wife's two pregnancies, I had a deep concern about the health of our children. Thank God both did turn out very healthy. But my wife did cut down during those pregnant months, because she realized the dangers of pregnant women smoking cigarettes. Nick Joe Rahall,(D-W. Va.), U.S. Congress, Beckley, W. Va., 6/16 Phila., Tape 1, side 1, rev. 404. CONI+'IDENTIAL: TIMN 288750 MINNE5OTA TOBACCO LITIGATION

PREGNANCY (pagefive) I'm not trying to get people to stop smoking. I do believe that smoking is harmful to smokers, I believe it is harmful to nonsmokers and, most importantly, in my condition right now, I believe it is harmful to unborn children of mothers who inhale smoke. Sherry Martschink, former member of S.C. House of Reps., Charleston, S.C., 6/14 Atlanta, Tape 1, side 1, rev. 66. -231- ...the inhaled smoke of expectant mothers and its effect on the unborn child presents the greatest health hazard of all. Not only because of the risk that the expectant mother takes with her on .(sic) health but with the health of an unborn defenseless child. Patricia E. White, health educator, Clayton County Health Dept. Jonesboro, GA., 6/14 Atlanta, p. 2. CONFIDENTIAL: TIMN 288751 MINNESOTA TOBACCO LITIGATION

P R O M O T I O N R E S T R I C T I O N S OBJECTIVE #3: seek regulations of tobacco companies' sponsorship of sports events...Thi.s should be attacked from three directions: through the government, through the tobacco companies, and through strong appeals to the athletes themsleves to refuse to participate in events that give public recognition to the cigarette brands...We recommend that the proper government agencies be induced to approach the tobacco industry with regulations concerning the companies' sponsorship c5f tennis, racing and all major sporting events, especially those events that are carried on television and radio. Melvin A. Jensen, L. A. advertising agency executive, Mormom spokesman, 3/2 LPA statement, pp. 3-4. Active efforts must be made to prohibit promotion of this insidiously addicting habit. Ernest W. Johnson, M.D., Chairman, Dept. of Physical Medicine, Ohio State University School of Medicine, Columbus, Ohio, 5/25 Chicago, p. 3. The Virginia Slims tennis tournament has to be renamed and responsored. No responsible athlete, professional or amateur, should be able to capitalize by fostering the use of a human poison. Blake Cady, M.D., surgeon, Lahey Clinic, Boston, Mass., 6/2 Boston, p. 4- CONFIDENTIAL: TIMN 288752 MINNESOTA TOBACCO LITIGATION

-233- QUrT SMOEING 2fETHOD S Should smoking-cessation be publicly financed, or is it strictly a matter of individual responsibility? Dale Houghland, chairman, Calif. Interagency Council on Smoking and Health, 3/22LA statement, pp. 1-2. Should public medical assistance programs, such as aedi-Cal and Medicare, reimburse smoking prevention and smoking cessation activities? Dale Houghland, chairman, Calif. Interagency Council on Smoking and Health, 3/22LA statement, p. 2. ...drugs, such as nicotine substitutes (particularly lobeline) and tran- quillizers, are not effective in assisting smokers to give up the habit. Ann Hammond, Executive Dir., Health Education Center, Palo-Alto, Calif., 3/22LA statement, p. 2. In discussing non-medication clinics or the group therapy approach Bern- stein concludes, "Most clinic procedures result in an immediate quitting rate of from 30Z to 85%, which begins to deteriorate substantially over time as soon as the formal meetings are terminated." Douglas A. Bernstein, "Modification of Smoking Behavior: An Evaluative Review," as quoted by Ann Hammond, Executive Dir., Health Education Center, Palo Alto, Calif., 3/22LA statement, p. 3. In discussing anti-smoking drugs Bernstein says, "In spite of the weight of generally negative evidence apparent...in the literature, various forms of lobeline still enjoy widespread use, both commercially and in private practice. The picture presented by lobeline research is not improved when one examines the available publications on other types of drugs. Tests ob benzedrine sulfate, methphenidate--Ritalin--and diazepam--Valium--and hydroxyzine failed to establish the effectiveness of any of these as smoking deterrents." Douglas A. Bernstein, as quoted by Ann Hammond, Executive Dir., Health Education Center, Palo Alto, Calif., 3/22 LA statement, p. 3. In reference to "other behavior-modification techniques" which include hypnosis and behavior therapy, Bernstein says, "Chaos prevails." Douglas A. Bernstein, as quoted by Ann Hammond, W @ Executive Dir., Health Education Center, Palo Alto, ~ E C) C) ~ Calif., 3/22 LA statement, p. 3. It has been stated that the mass media plus face to face interpersonal instruction is very costly, perhaps as much as $500 per person. But I submit that it is too costly not to do it. Ann Hammond, Executive Dir., Health Education Center, Palo Alto, Calif., 3/22 LA statement. p. 6. TIMN 288753

-234- QII'LL' SKOKLIYG H-S"2H.0D.S- (page.twc) ...biofeedbac?c research by Dr. Barbara. Brown ("New Mind, New Body") shows how important deep relaxation is as a tool for habit control. Francis F.- Randall, Hawaii, 3/22La submitted s tatement, p-.. 7. There are essentially two ways of stopping smoking: seLf-car€ techniques and organized programs,.. Tfzee self-care techniquess can be information, drug store preparations, books, cassettes, records, or advice. The smoker usese these aids or advice to quit.on his own.. Most smokers who have quit have done so with self-care or self-devised methods - Jerome L. Schwartz, M.D.r Ph.D., Chief, Health Care• B,esearch,. Calif. Dept.. of Health. 3/22LA statemeat, p... 5. Groups may be Ied by- professionals, lay volunteers, or paid.paraprofes- sionals;. results generallp do aot differ, regardless of whether the group is Led by s, nurse, psychiatrist, psychoZ.ogist, or a lay ex-smoker. Success• has been =ouad to imarove as. the- counselor becomes more experienced with handling smoking groups. Success is also higher-,when maintenancee support is incorporated into the method.. Jerome L. Schwartz:, M.D., Ph.D., Chief, HeaLtft Care Research,. Calif. Dept.- of Hea1.th:.. 3/ZZ LA statements p.. 6 .. Educational groups simply provide information through lectures, both about the hazards of smoking and ways to stop.: these groups are generally large and of limited duration. Attendees do not get to know each other, and there is little time for discussion or handling individual problems. The Five Day Plan, developed by the Seventh Day Adventists Church as an educational approach, has been conducted in a variety of settings: commuter trains, prisons, TV hospitals, offices and factories. Medical and spiritual lectures, displays of diseased lungs, information on balanced diet, prohibitions on coffee, tea, cola and alcohol, and a buddy system are part of the method. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif., Dept. of Health, 3/22 LA statement, pp. 6-7. Commercial methods have spread throughout the country. A recent survey I did of city telephone directories revealed several quit programs in al- most all major and many small cities. Most of the programs offered were local. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif., Dept. of Health, 3/22 LA statement, p. 7. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288754

Q II I T S M 0 R I Y G HH-T B 0 D S (page three) Electric shock, smoke satiation, contingeiit punishment, imagining noxious thoughts, roLe playing, self-monitoring, and signal devices have been used by psychologists with only Limited success. Jerome L.-Schwartz, K.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health. 3/22 LA statement, pp. Most organized. ((quit-smoking)) programs show excellent initial results; four out of five persons generally give up smoking. 3bout•nalf of those who succeed retuzn to smoking, however,, reducing the long-term rates to 25 to 40 percent. Jerome L.. Schwartz, M.D., Ph.D., Chief, Health Care Research,. CalLE.- Dept. of Health. 3/22 LA statement, .p.. 9.. Other efforts that offer promise are- the cessation programs of myocardial infarction.and chest clinics,, the development of nicotine chewing gum in Sweden, the- one-session self-hypnosis approach, and the increased involvement of nurses, sociologists, physicians, dentists, and psycholo- gists in counseling efforts. There appears to be great interest and promise in techniques based. on meditation, yoga, relaxation, and exercise. Jerome- L.. Schwartz, K.D'., Ph.D., Chier, Health Care Research,. Ca1,if.. Dept. of Health. 3/22 LA st$tement,, p- LL.. With the proliferation of commercial methods, it is critical that some group--preferably disinterested cessation experts--be given the respon- sibility of setting guidelines and evaluating the success of methods sponsored by both profit and nonprofit groups. If we are going to ask physicians, voluntary agencies, and health departments to make referrals to smoking clinics, then we must protect the public by providing advice on the value of available withdrawal methods. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health, 3/22 LA statement, p. 13. Recommendations ... 3. State Medicaid programs, prepaid health plans, and insurance companies should either sponsor or pay the cost of smoking withdrawal methods for beneficiaries. Employers should be encouraged to support and sponsor smoking cessation methods for their employees; costs could be partially deductible from income tax. 4. Smoking withdrawal programs, whether voluntary, commercial, or university sponsored, should be required to disclose meaningful, relevant information concerning the effectiveness of their methods. Programs should be required to commission evaluations of their methods and a one-year followup to be conducted by disinterested investigators. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health, 3/22 LA statement, p. 14. TIMN 288755

QU IT SMOKING ME THOD S(page four) Employers should be encouraged to support or sponsor smoking cessation methods for their employees and the costs should be partially deductible from their income tax. Dr. Jerome Schwartz, as cited by ACS LA Film, 3/22LA. Although I think cessation programs, cessation clinics and so on, are a fine thing, they're not going to even begin to solve the problem. In the first place, most people who smoke cigarettes no matter how much they want to quit, wouldn't be caught dead going to a cessation clinic... So what people want to do is to get into a closet at home, close the door and practice giving up smoking, so if they fail nobody,will see them doing it. Daniel Horn, M.D., Director, NCSH,3/22 LA Tape 6, rev. 463. At least a third of those coming to the how-to-stop-smoking clinics are coming because their children have encouraged them to do so. Sidney Ottman, Ph.D., Santa Barbara, California Congress* of Parents and Teachers, 3/22LA Tape 4, rev. 318. Bubble gum has been proposed as a substitute for the oral gratification associated with smoking, but it is unlikely to succeed as a symbol of maturity, so that we still urgently need a social substitute for smoking behavior. William Morton, Professor, Dept. of Environmental Medicine, Univ. of Oregon, 5/I7 Seattle, p. 7. 6. Hundreds of "break-the-smoking-habit" clinics should be formed. The clinics would be an adjunct part of respiratory disease sections now in community hospitals. These clinics should be administered by the private sector but subsidized by H.E.W. funds. Stanley Stein, Pharmacist, Colo. Pharmacal Assn., 5/12 Denver, pp. 3-4. (2) Funding which will allow professional groups to develop quality effective withdrawal and maintenance programs, not just "skimming the cream off the top" by commercial advertising. L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 4. MINNESOTAO T BACCO LIT IGATION TIMN 288756

QU IT SMOKING METHODS (page five) ...this is not to indicate that aversive consequences for smoking should never be employed or that regulations limiting smoking should never be enacted. However, over reliance or exclusive reliance on such measures is likely to be counterproductive, provoking more resistance than healthy behavior. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., 5/19~St. Louis,_ pp. 11-12. ...there is much agreement that the major problem is not encouraging smokers to quit but encouraging ex smokers not to return to smoking (Hunt & Matarazzo, 1973). Nevertheless, the solution to the maintenance problem has not been found. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington'Univ., 5/19 St. Louis, p. 7. ...consider what might be the effects of making repeated spirometry tests of cessation program participants starting before cessation and continuing throughout follow-up. Authoritatively demonstrated, tangible improvement in lung capacity might prove to be an important consequence. Similarly, a manual which informs individuals of various ways they may notice improvement in their daily functioning as a result of smoking cessation, in combination with group discussion of such issues, might be an effective maintenance procedure. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., p. 10. 5/19 St. Louis, Modification of the Helping Smokers Quit program to reach other ethnic groups can be as easy as training a facilitator of that particular ethnic or racial background. SP/5.5. D. Bates, Behavioral Science Specialist, Dwight D. Eisenhower Army Medical Center, Box 715, Fort Gordon, Georgia, 6/14 Atlanta, p. 5. WBAL-TV's four-week QUITTERS CLUB campaign was a tremendously satisfying project from the station's point of view. Lawrence M. Carino, Vice President & general manager, WBAL-3*V, 6/16 Philadelphia, p. 1. CONFIDENTIAL: - MINNESOTA TOBACCO LITIGATION--- TIMN 288757 --- - -

QUIT SMOKING METHODS (pagesix) Working populations should be able to attend smoking clinics as part of the work schedule and the time should be counted as part of the permitted sick day. Ernst L. Wynder, M.D., Naylor Institute for Disease Prevention and the Health Maintenance Institute, P.merican Health Foundation, 6/16 Philadelphia, p. 7. Something is gained by the person who attends the clinic even if he stays off for a short interval and later returns to smoking. He has educated himself a bit about the insidious nature of the tobacco habit. He may have discovered for the first time he has been able to get along for a short while without this crutch. Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, pages 4 and 5. ... For some people, just the knowledge and perhaps some minimal scare tactics, they do stop. But for many hard-core smokers, just that knowledge does not work and we have to provide smoking withdrawal programs for those kind of people. . . L. Loring Brock, M.D., Director of Heart-Lung Center, Denver; 5/12 Denver, Tape 1, rev. 366. We are trying to get local health, boards of health and health officers, interested in this area, because traditionally they haven't at all. They've been more concerned with problems of sewerage removal and garbage, or rats someplace or other and people getting immunized. And I think that this switch that I think is happening in Dept. of Public Health, not only mine but others,.... Jonathan Fielding, M. D., Commissioner of Public Health of Massachusetts; /2 Boston, Tape 1, side 1, rev. 223. ...because of our feeling about the astronomical increase in smoking behavior in young women and the increase in mortality in women in general, we have applied and are part of the community-based cancer program in Connecticut funded by the NCI, we believe that Connecticut will be get- ting an implementation grant. Part of that will be to set up some programs for smoking behavior modification and for smoking education. These will be federal funds. Douglas S. Lloyd, M.D., M.P.H., Connecticut Commissioner of Health, 6/2 Boston, Tape 1, side 1, rev. 579. CONFIDENTIAL: TIMN 288758 MINNESOTA TOBACCO LITIGATION

QUI T S MOKI NG ME THODS (page seven) I know when I was trying to quit smoking, activities such as cross- country skiing helped me suppress the urge. Alexis A. Parker, teacher, Manchester, N. H., Boston 6/2/77, p. 5. Whatever your church or creed, to gain a complete and lasting victory over the smoking habit, make up your mind to ask for and receive divine aid. Elder P. Daniel Bakker, SDA minister, Merrimack, N. H., Boston 6/2/77, p. 3. Many untold, perhaps millions of individuals have stopped smoking without the aid of specific help, without clinics, without particular techniques, and as a response to information. ...those individuals who simply stop, who are able to stop smoking on the basis of inedia, and media information.... Brendan A.,Maher, Ph.D., Professor of the Psychology of Personality and Chairsman, Department of Psychology and Social Relations, Harvard Univ., Cambridge, Mass., 6/2 Boston, Tape 1, side 2, rev. 969. I think peer pressure is the reason that most people start smoking, so we separated our employees into four groups. We have an equal number of smokers in each group and we give everybody in that group, smokers and non-smok'ers, a$25 bonus if all the smokers in that group quit. We also agreed to give everybody, every employee a one-hundred-dollar bonus if all of the smokers in the plant quit. Yank Dean, president, Allied Sports Co., Eufaula, Ala., 6/14 Atlanta, Tape 1, side 1, rev. unknown. z I Among the aversive events ((at some cessation clinics)) that have been used are rapid smoking, foul odors, electric shock, and vivid presenta- tions of the possible medical hazards resulting from long-term smoking. Douglas 0. Draper, Ph.D., clinical psychologist, Jackson, Miss., 6/14 Atlanta, p. 1. A retrospective study of 1,862 subjects who practiced Transcendental Medi- tation for an average of 20 months showed a significant reduction in the . reported use of alcohol and cigarettes. Transcendental Meditation has been shown to provide deep relaxation to the entire nervous system (Charts 1 and 5) and remove tensions (Chart 13), giving rise to a more calm, restful and creative functioning of mind and body. These effects may be taken to explain the gradual decrease seen in the need for alcohol and cigarettes. Annie Bigelow, Transcendental Meditation teacher, Boston, Mass., 6/2 Boston, p. 6. I There must be a lasting and universal motive for people to avoid or quit the smoking habit. I would like to suggest that the best motivation is the motive of love. Robert H. Farley, Seventh Day Adventist pastor, Berlin, N.H., 6/2 Boston, p. 2. TIMN 288759

-240- S A F E C I G A R E T T E ...the average cigarette being consumed today produces significantly less harmful material than previously, largely because of public demand for less harmful cigarettes. Daniel Horn, Ph.D., Director, National Clearinghouse for Smoking & Health, 3/22 LA statement, p. 3. However, there is no "safe" cigarette, just as there is no "safe" radiation. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22 LA statement. p. 2. O Jonas: In your opinion, is there such a thing, or is there soon possible to have such a thing as a safe cigarette? Aronow: No. Jonas: Is that because of the carbon monoxide elements in Cancers (?)? Aronow: Well, first of all, let's say, if you're going to burn a cigarette,, you're going to get imcomplete combustion. If you get incomplete combustion, you're going to get substances such as carbon monoxide. And so consequently there are in fact over 1000 substances in`tobacco smoke. Most of these have not been tested. Investigators such as myself have tested carbon monoxide and have tested nicotine and found that both are harmful in patients that have cardiovascular disease. There are numerous other substances which have not been tested. For example, what would the oxides of nitrogen do -- etc.? But if you burn anything, you're going to produce carbon monoxide and so I don't think you can produce a completely safe cigarette. Jonas: Now it's one of those problems that beset those of us in the Ameri.can Cancer Society and since smoking is not a moral thing with us -- it's a health thing -- I guess if someone were to propose -such a safe cigarette, we would stop our opposition to it. You say that's not likely to happen. Aronow: Well, let's say there are so many substances that are released by smoking that are going to be irritating to the lungs. There are so many things we know and of course you need a tremendous amount of harm before you can pick things that we're probably just seeing the tip of the iceberg. And since carbon monoxide is produced by incomplete combustion, I just cannot conceive of, without producing carbon monoxide by anything you burn. ((sic)) And so consequently, what you're talking about is--a safe cigarette would be one that would not be smoked, would not be inhaled. Allan K. Jonas, Los Angeles, chairman, ACS National Tobacco and Cancer Committee and Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22 LA statement, tape 3, Rev. 610-633. ~ ~ Due to pressure from the American Cancer Society and other important groups, tobacco tars have been reduced by 60% over the past 20 years and are 30% lower than 10 years ago. Melvin A. Jensen, L.A. advertising agency executive, Mormon spokesman, 3/22 LA statement, p. 4.

SAFE C IGARETTE (page two) Priority should be given to determining the responsible agent and the mecha- nism of cancer induction in smokers and to the development of a safe ciga- rette...Despite repeated suggestions that alpha radioactivity from polonium-210 present in tobacco, cigarette smoke, and smokers' lungs may be involved, the several agencies responsible for tobacco and health research have given no consideration to this important possibility. Such negligence is all the more surprising in view'of the fact that alpha radiation is well established as an effective agent of human cancer...The measured concen- trations of radioactive lead-210 and polonium-210 at the bronchial tumor sites of cigarette smokers range up to thousands of times that found in nonsmokers. Edward A. Martell, National Center for Atmospheric Research, Boulder, Colo. 5/12 Denver, p. 1. If it is confirmed that cancer in smokers is alpha radiation induced, then it will be relatively straightforward tb make safe cigarettes at modest cost and effort. Changes can be made in tobacco fertilizer use and in cured tobacco storage practices which will reduce the radioactivity of tobacco trichomes...Personally I am confident that the tobacco alpha radio- activity, together' with the influence of several important physical and chemical cofactors, will soon be shown to be the agents responsible for cancer and other health effects of cigarette smoking, and that safe ciga- rettes are not far in the offing. - Edward A. Martell, National Center for Atmospheric Research, Boulder, Colo., 5/12 Denver, p. 2. Efforts should be made to find better ways to help people deal with stress, tension, and boredom, and to assist them in changing their lifestyles rather than expending large sums of money in attempts to develop a "safe" cigarette. . Avery Harvill, P.E.D., Clayton Junior College, Morrow, Georgia, 6/14 Atlanta, p. 2. The tobacco industry should be continuously abetted and encouraged in its efforts to produce "safer" cigarettes. J. E. McDowell, President, N.C. Div. of ACS, & General Agent, Southern Life Insurance, Greensboro, N.C., 6/14 Atlanta, p. 2. CONFIDENTIAL: TIMN 288761 NIINNESOTA TOBACCO LITIGATION

S A F E C I G A R E T T E (page thrae) I In terms of carcinogenesis, the ("less harmful") cigarette must be low in tar as well as specifically low in tumorigenic agents. Ernst L. wiynder, M.D., Naylor Dana Institute for Disease Prevention and the Health Maintenance Institute, American Health Foundation,6/16 Philadelphia, p. 8. Low tar and low nicotine cigarettes I think are a partial answer to this problem and the ACS preliminary data, released in September, seemed to bear this out. However, with respect to heart disease in particular I am concerned that we have not produced a safer cigarette, at least that is available for widespread public use. And that in fact smoking filter- tipped cigarettes with respect to the risk for heart disease may not be doing any good and indeed may be doing some harm. Evans (?): Cohen: Jerome Cohen, M.D., Clinical Cardiologist, St. Louis University Hospital, 5/19 St. Louis, Tape 2, side 2, rev. 552. In your judgment, Dr. Cohen, is there any real hope that further research in these agents can actually produce cigarettes that are not harmful? lettuce leaf cigarettes, which has been done -- non- tobacco cigarettes -- the CO yields are basically what we see when we smoke tobacco products. So with respect to CO and its relative risks for development of athero- sclerotic diseases I do not think there is such a thing a completely safe cigarette. I do however think that we can develop a relatively safer cigarette. No. I do not think that there is such a thing as a non-harmful cigarette, under the best of conditions, and let me tell you why. Carbon monoxide is a product of incomplete combustion. Every time you light a match -- just lighting a match, there is CO produced as a result of that. When you smoke any kind of cigarette, including Jerome Cohen, M.D., Clinical Cardiologist, St. Louis University Hospital, 5/19 St. Louis, Tape 2, side 2, rev. 552. ...permit me to comment on the quest for a "safer" cigarette, which in my opinion is only holding out false hope to the addicted. What is a "safe" cigarette? This unlit cigarette is safe; an unlighted stick of dynamite is safe. Put a match to either one and you have death and destruction for the igniter and varying harmful effects to the spectators. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 11. TIMN 288762 as

-243- S A F E C I G A R E T T E (page four) Past governmental policy (and health interst groups efforts) has oversimplified the problem and ignored important questions of brand introduction, product change and their implications for public health. Such a simplified strategy including elimination of TV and radio cigarette advertising and the FTC's 10-year moratorium on advertising of tar and nicotine content, has probably slowed the tar and nicotine reduction that might have occurred with greater brand competition. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 1. Policy is needed which is much more sensitive to the reduction of the health consequences of cigarette smoking, rather than the much more difficult elimina- tion of a social habit. Such a policy would shun basically symbolic gestures (such as package warnings), which have almost no impact on the problem, and would focus on obtaining more fruitful cooperation from the tobacco industry in reducing the tar and nicotine dosage of its products. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page l. Opportunities for creative cooperation and dialogue between the medical community and the tobacco industry appear to have the possibility of a very high payoff as measured by reduced morbidity and mortality. Recent scientific findings by Cuyler Hammond, et. al. and discussion by Gio Gori indicate the possible public benefits of more rapid switching to low tar and nicotine brands, and while the American Cancer Society has not yet acknowledged the fact, it appears that innocuous cigarettes already exist, if s.moked in moderation. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. ...reducing tar and nicotine dosage will more likely produce much more successful health consequences than the apparently symbolically satisfying, but relatively ineffective, "war against cigarettes." Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. Reduced tar and nicotine brands appear to be less harmful. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 5. CONFIDENTIAL: TIMN 288763 MINNESOTA TOBACCO LITIGATION

-244- SAFE C I G A R E T T E (page f3,ve) I don't see that one can condone in any fashion a hope that is yet un- established as the only approach and that hope is that there will be a safe cigarette. . . [A]s far as I know, there is no proof that there is a safe cigarette today. . . I would not invest a great deal of our re- sources that could be used otherwise effectively toward that goal. Charles A. LeMaistre, M.D., Chairman, ACS, Texas Division, Study Committee on Tobacco and Cancer, and later. a NCSPP patiellist; 5/12 Denver, Tape 2, rev. 328-330. The National Cancer Institute, the American Cancer Society, the Agricultural Research Service, and the tobacco industry all have neglected serious re- search in this area [a safe, low-radioactivity cigarette]. Edward A. Martell, Ph.D.., National Center for Atmospheric Research, Boulder, Colo.; 5/12 Denver, Tape 3, rev. 281. Obviously, the tobacco people have conned the public into thinking that if you put something between the tobacco and your mouth, namely a filter, that's going to take'care of your problem. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 95.• I think the tobacco industry ought to be willing partners with all agencies concerned with finding the causal factors or elements in cigarette smoke which are a threat to our national health and well being. They should be encouraged and abetted in trying to produce a safe cigarette. Properly certified reduction in tar and nicotine, carbon monoxide vapors in a particular brand of cigarettes ought to be publicized and say "This is the safest cigarette that we've been able to come up with so far" and then perhaps the other companies would try to emulate that to get part of that market. J. E. McDowell, general agent, Southern Life insurance, Greensboro, N.C., pres. N.C. ACS Div., 6/14 Atlanta, Tape 1, side 1, rev. 937. aa , d O U , a in the years since the first ((Surgeon General s)) report was issue great deal has happened, in terms of the smoking public. We have people smoking primarily filter cigarettes now. The average tar and nicotine content has decreased by over 60 percent and 50 percent, respectively. So that the cigarettes that people are smoking today, even though the per capita consumption has not gone down significantly, the cigarettes that people ~ i 1966 t d th t ki d d i f h , t e ea ra e s nce Q d, are smo ng are less hazar ous an , .n ac t__ ~~ for coronary heart disease and since 1968 for emphysema'and chronic 00 Q bronchitis has levelled off or decreased. This means that the kinds of Op ~ cigarettes that people are smoking are less hazardous. N Jesse Steinfeld, M.D., former surgeon general, now dean of the Medical College of Virginia, VCU, Richmond, at ACS 2/1/77 news conference, NYC, rev. Ey 216.

S AFE C I GARE TTE (page six) ...we don't want to know how to make a better cigarette, we want funds to help eliminate cigarette smoking by making the public aware. Jeanne A. Cunnius, vice president, Business Careers, New York City, 6/16 Philadelphia, p. 2. it is possible to produce a less harmful cigarette. Tobacco companies must be forced to cut their profit margin and work with us to eliminate lung cancer. Jeanne A. Cunnius, vice president, Business Careers, New York City, 6/16 Philadelphia, p, 5. All histological types of lung cancer have increased in terms of actual numbers but adenocarcinoma in our experience has increased to a greater degree proportional to any other histological type, while squamous cell carcinoma is becoming less prevalent. The explanation for this obser- vation may involve a number of factors but one is lead to wonder if changes in the smoking habits or recent design modifications of the filter and contents of cigarettes have changed the characteristics of the smoke to the point that it might influence the type of cancer now being produced. If, with all of these modifications we have succeeded only in diminishing squamous cell carcinoma in order that adenocarcinoma may take its place of prominence, we have created for ourselves a disservice in the sense that the one, two and five year survival for adenocarcinoma is significantly less than squamous cell carcinoma of the lung. Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, pp. 3-4. The American Health Foundation's Division of Environmental Carcinogenesis has accumulated chemical and biological evidence suggesting that a reduction of harmful smoke constituents by various means can be achieved. It remains the task of the epidemiologist to determine whether such product modifica- tions are indeed leading to reduced disease risks for the smoker. Dietrich Hoffmann, Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., 6/16 Philadelphia, p. 3. The formation of organ specific carcinogens during tobacco curing, their partial transfer into the smoke and their formation during smoking provide a framework for intervention towards their reduction in the smoke. Dietrich Hoffmann, Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., 6/16 Philadelphia, p. 5. CONFIDENTIAL: TIMN 288765 MINNESOTA TOBACCO LITIGATION

S A F E C I G A R E T T E (page seven) Flavoring agents derived from tobacco, from synthetic compounds and/or mixtures of plant extracts, enhance consumer acceptance. Such nontobacco flavor additives and their combustion products require testing with respect to their biologic activities. We have emphasized the importance of such testing for a number of years since there is a dearth of information in this area. Dietrich Hoffmann,Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., ' 6/16 Philadelphia, p. 7. incorporating all available techniques in cigarette manufacturing and assuming that none of the flavor additives induce additional toxic effects, we propose certain limits for smoke components for a less harmful cigarette (Table IV) ((see page 14 of his testimony)). Dietrich Hoffmann,Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., 6/16 Philadelphia, p. 8. In summary, we wish to stress that cessation of smoking'is the best option, but a less harmful cigarette must be realized for 55 million current cigarette smokers, for millions of future smokers, and for those who do not want to give up smoking. Dietrich Hoffmann,Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., 6/16 Philadelphia, p. 8. ...the general problem...is that we have enormous experience with the cigarette that has existed in its changing forms over the last seventy years...If we start changing it won't we need another 20 years of experience in order to know whatever really we've done what we think we've done? Because we're dealing with different components, that although you may get everything down as low as you can in the process you may create unseeen problems. I certainly would not want to disagree with you that decreasing the levels of those things we can identify to the absolute minimum in the fact of being unable to change people's habits is a beneficial thing. But I do wonder how far you think we can really push the idea that a cigarette is safer because we've reduced those things that we have decided to focus on, on the basis of animal testing and rationality. Hoffmann: They are all data and certainly associated with the experimental setting, and enhance inhalation studies or mouseskin bioassay. There is nothing what oppose at this moment. I cannot say for certain that is not so. But that's the best we have. Panellist David Baltimore during testimony of Dietrich Hoffmam.,. 6/16 Philadelphia. Tape 2, side 2, Rev. 877. CONFIDENTIAL: TIMN 288766 MINNESOTA TOBACCO LITIGATION

SAFE CI GARE TTE (pageeight) What I'm really asking is by working to lower the parameters that you described in Tables 3 and 4, how sure are you that you're going to have any measure of success along with the human population and why chance kidding people by saying a cigarette is less harmful, when it might turn out that when the data is in 20 years from now, 40 years from now, that a new set of problems has arisen. How sure can you be that you are really helping people? I know that the existing data suggests that we're moving in the right direction and that's extremely helpful. And some of the problems that we worried about, like the CO levels increasing heart disease that hasn't happened. But in the long range, in the long run, how sure can you be that you are really doing what you think and to what extent may you be giving people undue hope and in fact, increasing the number of people smoking, by developing the quote less harmful cigarette? Hoffmann: Obviously to give you an absolutely yes that would be unscien- tific and you don't expect this from me. However, by logical reasoning, have a three-faceted approach not just education, and adult education, but epidemiology, done by the cancer society, done by the AHF. Panellist David Baltimore during testimony of Dietrich Hoffmann, 6/16 Phila., Tape 2, side 2, rev. 877. If you produce a low-tar and nicotine cigarette, you make it much easier for the beginning smoker to start smoking. Laurence H. Bates, M.D., Meridian Medical, Indianapolis, Ind., 5/25 Chicago, Tape 2, side 2, rev. 273. High tar and nicotine cigarettes should have a very prohibitive tax and low tar and nicotine cigarettes less tax because they are less dangerous, not that they are safe. David T. Carr, M.D., Assoc. Director for Cancer Control, Mayo Comprehensive Cancer Center, Rochester, Minn., 5/25 Chicago, Tape 1, rev. 395. ...low tar is good business. So that if you look at the percentage distri- bution of cigarettes in the low tar category, which I must say I think is just a terribly arbitrary number, and it could be 10 milligrams as well as 15 and some people argue it ought to be 20. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 2. You may not have a safe cigarette, but certainly, according to Gio Gori, there are cigarettes on the market which, if smoked in great moderation, appear to be only minor hazards. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 68. CONFIDENTIAL: TIMN 288767 MINNESOTA TOBACCO LITIGATION

SAFE C IGARETTE - (pagenine) , At the moment our data indicate that the kind of total tar reduction has been very beneficial to lung cancer rates. I would believe that the reduction in mortality from coronary deaths may well relate to the reduc- tion in nicotine in American cigarettes, and I would feel that...we must not discontinue these studies ((the less hazardous cigarettes)). We must pro- vide more funds to these studies because when the final history of tobacco- related diseases is written, it may well turn out that the less harmful cigarettes will have played perhaps one of the most important roles in this simply because of the fact that I recognize that our society will not and perhaps should not ban smoking simply because I recognize that most of us think these things cannot happen to us. Ernst L. Wynder, M.D., President, Amer. Health Foundation, 6/16 Phila., Tape 1, side 2, rev. 34-38. Room #3. -248- ...there are now several long-term studies in the literature that have ~ verified our findings, both retrospectively and prospectively, that benefits do result from low-tar cigarettes and that our data also indicate that the lower the tar level the relatively safer the smoke. Ernst L. Wynder, M.D., President, Amer. Health Foundation, 6/16 Phi1a., Tape 1, side 2, rev. 48. Room #3. ..as we understand what the specific carcinogens are and understand what the precursors are, let's say in the tobacco leaf...we can then make sugges- tion on how to modify or genetically change the tobacco plant itself, so that fewer of these carcinogens arise. Ernst L. Wynder, M.D., President, Amer. Health Foundation, 6/16 Phila., Tape 1, side 2, rev. 59. Room #3. I think we won't know really what the lowered tar levels are going to do in regard to health for years. Because you know the latency period for lung cancer, for example, is 15 or 20 years ... Cuyler Hammond has some pretty good data on this. It looks like it's going to make a difference... Weingarten: Dr. Hammond told this commission last fall that he believes there were new carcinogenic substances in some of the new low tar and low nicotine cigarettes, but because the industry has no accountability there's no way to find out. Can you comment on that? Green: I don't know...There's no way of knowing when we don't know what constituents in the smoke are really causing the various diseases. So you can take out a lot of constituents and put in some, but you just don't know. Dorothy Green, Ph.D., psychologist, consultant to NCI and former employee of NCSH, Arlington, Va., 6/16 Phila., Tape 1, side 1, rev. 287. TIMN 288768 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

SAFE C IGARETTE (page ten) I was dismayed a few months ago to find that the excellent work and the reputation of Cuyler Hammond and the ACS was questioned in a sense in some media articles which reported that there existed statistics showing that there were safe cigarettes. Now I'm not saying that Dr. Hammond was responsible for using the word safe cigarette. I don't think that was his intent and having talked with him, I'm quite sure it wasn't. But it was unfortunate that a clear warning was not indicated as to the difference between a safer cigarette and a safe cigarette... (rev. 848.) And as long as the combustion process is present in this kind of context, carbon monoxide will be produced. The effect of carbon monoxide is to greatly accelerate the rate of atherosclerosis. Therefore, even if cigarettes can be made safer from the point of view of lowering the carcinogenic content it seems very unlikely that as long as cigarettes burn that they will be safe from the point of view of cardiovascular disease. (rev. 857.) Ovide F. Pomerleau, Ph.D., Director, Center for Behavioral Medicine, Univ. of Pa., 6/16 Phila., Tape 1, side 2. I'm in favor of the reduction of the tar content of the particulate phase by any means known. But I am concerned that we are oversimplifying the effect that we expect to achieve by doing it. Ronald G. Vincent, M.D., chief pf thoracic surgery, Roswell Park Memorial Inst. and former pres., Erie County ACS Unit, Buffalo, N.Y., 6/16 Phila., Tape 2, side 1, rev. 603. Some people say to me, why you and your colleagues work on a less harmful cigarette? Shouldn't that be the job of the tobacco industry? Well, it should be our job, outside of the tobacco industry, because we have the better biological, chemical and epidemiological knowledge combined to see what this kind of cigarette should be and how best to monitor it...the tobacco industry has succeeded in reducing tar and nicotine levels, has succeeded in reducing the specific carcinogenic activity of today's cigarettes compared to 20 years ago, when compared on a gram for gram basis of smoke condensate. (rev. 1038.) (Asked by Weingarten if he would recommend that a safer cigarette so far as we know now is one that is lower in tar and nicotine, although Hammond has indicated that there may be carcinogenic agents added to the cigarettes as the tar is reduced) Well, at the moment, for better or for worse, you've gotta rely on people like Dr. Hoffmann and myself, and my colleagues. And I say nearly virtually on ourselves because there are very few people -- and this really is a remarkable situation -- very few private investigators and I'm sure the tobacco industry is very much working in these areas -- but there are very few private institutions that for one reason or another are working in this area. And obviously we are concerned. And obviously we are monitoring for new flavoring agents and their combustion products. But a problem that we have is to convince the NCI and others that these are areas that require support. (rev. 1122.) Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2. Room #1.

-249a- SAFE CIGARETTE (pageeleven) The low-tar, low-nicotine cigarette does not seem a reasonable alternative as carbon monoxide levels in the smoke are unchanged. Although complete cessation should be the goal, conversion to non-inhaling cigar or pipe smoking, if really adhered to, might be an acceptable, though lesser victory. Laurence H. Coffin, M.D., thoracic and cardiovascular surgeon, and professor of surgery and Director, Division of Thoracic and Cardiac Surgery, Univ. of Vermont College of Medicine, Burlington, Vt., 6/2 Boston, pp. 6-7. ...work must be directed both at producing a safer cigarette and towards educating the smoker as to different ways of modifying current smoking patterns in order to decrease the dose and hence response, to tar and nicotine. (p. 6.) The search for the "so called" safe cigarette should be pursued but certainly not without at least an equal dollar commitment from the Tobacco Industry. Again, taxes from the sale of cigarettes could be made available for this purpose. (p. 7.) Jonathan Fielding, M.D., Mass. Commissioner of Pubic Health, 6/2 Boston. CONFIDENTIAL: TIMN 288770 MINNESOTA TOBACCO LITIGATION

S A L E S C U R T A I L M E N T We may not be able to, or want to, outlaw tobacco entirely right now-- but we can make it difficult for them to find it and smoke it. If it means that colleges can fill their social responsibility by curtailing the sale of tobacco, then "Let them walk a mile for a camel." Bennett Arnberger, Pre-law student, UC-Berkeley, 3/22LA statement, p. 5. Legislation should be encouraged also which would ban all cigarette vending machines... Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif. Dept. of Health, 3/22/LA statement, p. 4. r-~ ~ ~ 00 00 N One may ask - What has the City of Manteca vending machine ordinance accomplished? The answer thus far is probably not a great deal. However, the Manteca City Council upon the inception of this local ordinance ac- knowledged that young people within the community would continue to obtain cigarettes from older friends, vending machines outside of the city limits, violators who continue to sell over the counter to individuals under the age of 18 and, sad as it may seem, even parents will continue to supply their children with cigarettes. Trena Kelley, Vice-Mayor, Manteca, Calif., 3/22LA statement, p. 2. Finally, I hope it does not sound too pessimistic for me to say that although our best methods may have a gradual and slight effect on the incidence of smoking, the consensus among our respondents at Arizona is that nothing short of legislation curbing the production and distri- bution of tobacco products--with all its Prohibition-like ills--will significantly alter smoking patterns in the United States in the fore- seeable future. Salvatore V. Zagona, Assoc. prof. of psychology, Univ. of Arizona, Director-Center for Research on Smoking & Health, 3/22LA statement, p. 7. ~ I feel cigarettes should be banned by the Federal government. If they condemn saccharin, why can't they ban cigarettes? But we shouldn't wait for the Federal government to do our job for us. We should take the initiative on the local level in small ways, but in any way, to help eliminate cigarette smoking. Trena Kelley, as cited by ACS LA Film, 3/22LA. But we have a practical problem ((in outlawing cigarette vending machines)). Many of our hospitals are rural institutions and they might, by site, rest anywhere from a mile to two miles from a vendor of cigarettes. And where employees or patients, in a private room, for instance, have a great desire for cigarette smoking, it's going to cause a major problem for that hospital if they can't store it. W. Kevin Hegarty, board chairman, California Hospital Assn., 3/22/LA Tape 8, rev. 174.

-251- SALE S CURTA ILMENT (page two) It is very difficult for me to understand our government and the controls that are applied. Being a diabetic, I find it a real problem to think that saccharin may be taken off the market...All of this because they found bladder cancer in mice after being fed large doses of saccharin. Why is it that with all the evidence of crippling diseases and death in human beings because of smoking, are cigarettes still allowed on the market? Shirley Hunter, R.N., Children's Memorial Hosp., Oklahoma City, Okla., 5/12 Denver, p. 3. Perhaps the American Cancer Society and other concerned voluntary or governmental bodies might institute a study of how, over the next twenty years, the manufacture and sale of tobacco for profit may be phased out of our economy without the loss of a single job of any American. The goal of such a phasing would be a system in which cigarettes would continue to be manufactured and sold, but not for profit and only on a regulated basis, perhaps through liquor stores or pharmacies. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis, p. 17. Clearly, there is as much justification for governmental interference in the manufacture and distribution of tobacco products as there is for governmental intervention in and regulation of the sale of foods, drugs, and alcohol. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis,.. p. 18. Weingarten: Do you have any strong feelings one way or another about the need for more government regulation of the cigarette industry? Morton: Well, I'd say the best thing that could be done would be to remove some of the governmental financial support of the tobacco industry rather than actually put it down by coercive manner. I think that would fit more with the beneficial part of our government and it would avoid the problem we got into with Prohibition. If we could simply take away some of the artificial supports that should--and continue to develop the information we have been developing over the years, that should hopefully take care of the problem. William Morton, professor of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, Side 1, Rev. 1248. CONFIDENTIAL: TIMN 288772 - MINNESOTA TOBACCO LITIGATION

SALE S CURTA ILMENT (page three) Weingarten: We received testimony in LA from the mayor of the city called (sounds like Encino, but he must mean Manteca), California, which found that most of the school students were blowing their lunch lmoney at cigarette vending machines. And they received a ruling from the state attorney general which they proceeded and they have now banned the vending machines from their city, except in bars, and a minor caught buying cigarettes from a vending machine in a bar causes revocation of the liquor license, which they felt was highly enforceable and recommended that approach to other communi- ties. That has not been challenged in the California courts, inci- dentally. Victor Weingarten, executive director, Natl. Commission on Smoking & Public Health, 5/17 Seattle Tape 1, side 1, rev. 470. First, pertaining to the dangers of cigarette smoking, there has been enough time, effort, and money spent. There has been enough talking, meeting, discussing and writing. There has been enough research, studies and reports to convince anyone that the samllest amount of smoking is harmful. And secondly, as long as cigarettes are present in any form, at any price, people will smoke them. Therefore, unless the growing of tobacco and/or the production of cigarettes is abolished, we will be in this war forever. Richard Marks, Jr., M.D., Charleston, S. C., Dept of Radiation Therapy, Univ. of S. C., Charleston, S. C., 6/14 Atlanta, p. 9. Selling cigarettes in vending machines is like selling alcohol in vending machines. Vending machine sales must be stopped. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 5. At the end of the ten years of increasing taxation on tobacco products, private sale of tobacco should be discontinued. Tobacco could then be made available through licensed pharmacies and sold on a prescription basis only to those people who are addicted.' Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, page 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288773

S A L E S C U R T A I L M E N T (page four) If you have a demand ((for tobacco)) you're going to have tobacco produced in North Carolina, or as Steve suggested, perhaps Mexico. J. E. McDowell, general agent, Southern Life Insurance, Greensboro, N.C., president N.C. ACS, Atlanta 6/14/77, Tape 1, side 1, rev. 937. My hat's off to Manteca, California, the first city in the nation to ban cigarette vending machines. Why not in Atlanta or Jacksonville as well as Manteca? This is essential to any realistic program to solve the problem of teenage smoking. Ashbell C. Williams, M.D., former ACS president, now honorary life member, ACS, Jacksonville, FLA., Atlanta 6/14/77, Tape 1, side 1, rev. 1162. Another means of controlling cigarette distribution to minors is by prohi- biting or restricting vending machine sales. The town of Windsor, which is near my district, explored this possibility several years ago. Since a vending machine as an inanimate object cannot distinguish to whom it sells its product, towns like Chicago and Seattle have had ordinances prohibiting vending machine sales which have been upheld in court. To reduce smoking, particularly among young people, states and municipalities can consider removing vending machines for cigarettes from government property or then regulating their use. James A. Swomley, State Assemblyman & Executive Director, Conn. Lung Association, Boston 6/2/77, p. 5. Prohibition of tobacco use or smoking is obviously not an acceptable or politically or socially feasible solution. Blake Cady, M.D., Surgeon, Lahey Clinic, Boston, MASS., Boston 6/2/77, p. 1. . The time has come to limit ((cigarette )) production to the absolute requirements of those addicted to nicotine. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., Boston 6/2/77, p. 1. ...Michigan youth are receiving and purchasing their cigarettes from vend- ing machines. And if we could just ban the sale of cigarettes from vend= ing machines, we might take one good step toward limiting the easy access that youngsters have toward cigarettes. William Sederberg, Ph.D., director of research, program section, Mich. House of Reps. GOP Caucus, and president, Mich. Lung Assn., 5/25 Chicago, Tape 1, side 2. rev. 252. CONFIDENTIAL: TIMN 288774 MINNESOTA TOBACCO LITIGATION

-254- SALE S CURTAI LMENT (page five) The finding of my ((survey of 130 students)) indicate that 6% of those stu- dents bought cigarettes while themsleves (sic) under the age of 18, from stores, and 7% bought from vending machines when under the age of 18. The rest got their supply from an older member of the family or by paying an older person to buy them. This explains the methods of obtaining tobacco in its different forms. Kevin Young, high school student, Holland, New York, Philadelphia 6/16/77, p. 3. I think we can do much if we recruit the pharmacists and get them to give up selling cigarettes in drug stores. Impress on them that they are health agencies... It's difficult because when a person comes in for a package of cigarettes, he may go out with a twenty-dollar order, three enema bags, and so on before he leaves, but it is very much worth doing. Saul R. Kelson, M.D., cardiologist and President, Toledo, Ohio ACS, Toledo, Ohio, 5/25 Chicago, Tape 2, side 2, rev. 576. Recently, we had a visitor from an eastern European country. And as you know, in all eastern European countries all tobacco industry is a monopoly... I said to him after some vodka, "Why don't you outlaw smoking in your country?" And he said, "We had one revolution; that's enough." So in other words, facing reality, you cannot and I guess the United States will not go for outlawing smoking. Dietrich Hoffmann, American Health Foundation, Valhalla, N.Y., 6/16 Phila., Tape 2, side 2, rev. 910. I would suggest the following: 5) More public informati.on and preparation should precede the control of smoking areas in public places, the placement of cigarette machines, and so forth. Premature control induces resentment. As an instance: in my place of business (I own and operate the oldest and finest Italian restaurant in Arizona), I removed the cigarette machine out of anti-smoking zeal. The public reaction was an angry one, and within a short time I was forced to return the machine. I then placed a small sign on the machine which said, "proceeds of this machine are donated to the American Cancer Society." I could not have anticipated the violent reaction, and today the machine rests in its usual place, withDut a sign, doing a good business--a symbol of my defeat as an anti-smoking missionary. Salvatore V. Zagona, Assoc. Prof. of Psychol., Univ. of Arizona and Director, Center for Research on Smoking & Health, 3/22 LA, p. 7. I feel that more could be done to delay the start of smoking by children by instituting a program to eliminate the vending machine dispensing of cigarettes in public places than any other single program. Carl Sturm, D.M.D., Louisville, Ky., 6/14 Atlanta, p. 3. CONFIDENTIAL: TIMN 288775 MINNESOTA TOBACCO LITIGATION

S M O K I N G R E S T R I C T I O N-- E M P L O Y M E N T There are public policy issues focused on the non-smoker, who is exposed to the smoke of others. Is public policy for his situation best expressed through legislation? Should public policy be implemented on private premises, such as work places? Is public policy developed on the basis of annoyance and inconvenience, or on the basis of demonstrable public interest? Dale Houghland, chairman, Calif. Interagency Council on Smoking & Health, 3/22LA statement, p. 2. Smoking should be banned from all work places. The amount of carbon monoxide in a cigarette is 600 times greater than we will consider safe at a work place. George Crawford, Ph.D., Weber State College, Ogden, Utah, 3/22LA statement, p. 3. I think all smoking should be banned from all public schools, including faculty lounges. First, we should hire teachers who are good examples for our kids and this includes non-smokers...I don't think the market is so tight and good teachers so scarce that non-smoking could not be a qualification for teaching in our public schools. George Crawford, Ph.D., Weber State College, Ogden, Utah, 3/22LA statement, p. 4. People are being forced to work in environments where tobacco pollution exceeds the Federal Air Quality Standards. Herm Perlmutter, founder & co-chairman, Californians for Clean Indoor Air, 3/22LA statement, p. 2. Teachers are smoking in classrooms yet. Maybe they don't smoke when the lessons are going on, but right after the lessons are through they light up one. There is no rule or mandated regulation or law that says they cannot. There is one that says they may smoke in their private office, and their classroom is to them their private office. So maybe some legislation on that. Dexter T. Suzuki, Student Activities Coordinator, Ka.ilua High School, Honolulu, 3/22LA Tape 4, Rev. 668. It's very hard to enjoy life when you want to go to a place of enter- tainment or when you are trying to do a good job at your place of business and you can't because of the pollution levels in that area. The federal air quality standards are often violated as far as places of employment. Herm Perlmutter, LA, founder and co-chairman of Californians for Clean indoor Air, 3/22LA Tape 7, rev. 590. CONFIDENTIAL: TIMN 288776 MINNESOTA TOBACCO LITIGATION

SMOKING RE STRICTION --EMPLOYMENT (pagetwo) During the past several years we have made giant strides in protecting the rights of non-smokers to breathe pure air in elevators, planes, buses, etc., but we have made very little progress in protecting the rights ofsworkers to breathe pure air while on the job. Oscar Austad, President, Austad Co., Sioux Falls, S.D., _.__5/19 St. Louis, P• 1• It is important to note that the OSHA legislation confers the necessary authority to that agency to deal with many work-related health problems, including toxic material protection. This is significant in the light of the President's Report on Occupational Safety and Health in 1972 which identified a toxic substance as "one which demonstrates the poten- tial to induce cancer, to produce long-term disease or bodily injury, to effect health adversely, to product (sic) accute (sic) discomfort, or to endanger life resulting from exposure to the respiratory tract, skin, eye, mouth,." Furthermore, OSHA is empowered through the Secre- tary of Labor to set and provide effective enforcement for occupational standards within these broad guidelines. So far OSHA has abdicted (sic) its responsibility in this regard. Oscar.Austad, President, Austad Co., Sioux Falls, S.D., 5/19 St. Louis, pp. 3-4. Employers have a common law duty to their employees which is generally unaffected by statutory schemes. This duty has been stated in these terms: It is the general duty of the employer to see that the place at which the employee is to work is reasonably safe, and to furnish suitable and safe instrumentality with which to work." (53 AM. JR. 2d "Master and Servant" S121). Oscar Austad, President, Austad Co., Sioux Falls, S.D., 5/19 St. Louis, pp. 5-6. Since the common law duty focuses on the pre-injury period, an employer can be enjoined from permitting unsafe working conditions. This use of the injunction makes the common law duty an ideal tool for use by an employee seeking a smokeless working environment. The risk and bad effects of passing smoke inhalation as noted above are clear and I feel convincing. Their presence does make a work site unsafe and unreasonably so. Accordingly I believe that under the common law duty and (sic) employer could be enjoined from permitting fellow employees to smoke on the job. This injunction can be permanent and therefore is an "ultimate" solution for any particular employee's place of work. Oscar Austad, President, Austad Co., Sioux Falls, S.D., 5/19 St. Louis, pp. 6-7 CONFIDENTIAL: TIMN 288777 MINNESOTA TOBACCO LITIGATION

SMOKING RESTRICTION --EMPLOYMENT (page three) Workers compensation laws make sure the worker is protected for medical expenses and loss of earnings for injuries or illnesses sustained in the course of employment and growing out of that employment. However, this only protects the employee after the injury or the illness has occurred and takes care of the financial end of it. This gives the employee no protection to change the working conditions prior to that time. However, it could be used in that way if enough employees were to file claims for treatment of health conditions resulting from working in a smoking area. If it were expensive enough, workmen's compensation insurance companies of self-insured employers would realize the advantages of creating a more healthful environment in the first place. Oscar Austad, President, Austad Co., Sioux Falls, S.D., 5/19 St. Louis, P• 6• It seems odd that OSHA, which goes to great expensive lengths to make a big issue of some hazard that is not likely to cause an accident in 100 years, will not lift a finger to protect the right of an employee to breathe pure air while on the job. In a discussion with one of the OSHA officials, and he will not permit us to quote him by name, he indicated that the problem is political. Apparently the tobacco lobby is too strong in Washington. The OSHA officer indicates that Congress should be pres- ' surized to strengthen the law. I suggest that this is simply "passing the buck" as they already have all the authority they need. Why should it be necessary for us to have to wait for Congress to pressure an agency to perform a job that they were already set up to do and so authorized. (sic) I understand that there is a possibility that another fine and effective non-smoking agency called Action on Smoking and Health may file suit against OSHA for failing to perform their duties in this important area. Oscar'Austad, President, Austad Co., Sioux Falls, S.D., _,5/19 St. Louis, P• 5• In light of the vast amount of scientific evidence linking smoking with premature death and disease, there is an appalling lack of evidence of the effect that working in an environment contaminated with tobacco has on the nonsmoker...No evidence could be found linking nonsmokers with pre- mature death and disease as a result of breathing air contaminated with tobacco smoke. FAA grievance case, 4/3/75, cited by Jimmy Spradley, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, p. 3. (FAA grievance case cited) CONFIDENTIAL: TIMN 288778 MINNESOTA TOBACCO LITIGATION

S M O K I N G R E S T R I C T I O N -- E M P L O Y M E N T (page four) The habit of smoking originates in an individual's search for contentment. The act of smoking is basically a psychological and social stimulation rather than a physiological dependency. As such, the significant bene- ficial effects of smoking occur primarily in the area of mental health. Unfortunately, the benefits derived from smoking are not measurable; and, therefore, there is no basis on which to compare the relative benefits of smoking to the smoker against the hazards of breathing tobacco polluted air to the nonsmoker. FAA grievance case, 4/3/75, cited'by Jimmy Spradley, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, p. 3. Since smoking does contribute to the possible progression and development of many illnesses such as emphysema, chronic bronchitis, and lung cancer, I feel that an employer should have the right to enforce no smoking in their businesses. Lori Weisbeck, Senior, Alden Central High School, New York, 6/]:6 Philadelphia,P. 11. Although it would be better for their health if teachers joined the anti- smoking crusade willingly, it is not practical or possible to mandate that they refrain from smoking. Maurice Bleifeld, former principal, Martin Van Buren High School, 6/16 Philadelphia, PP. 8-9. Employees also deserve the right to working in ea nonsmoking atmosphere. John Dean, high school student, Mamaroneck, New York, .6/16 Philadelphia,P. 2. Everyone knows I'm kind of a fanatic on the subject ((of "sidestream" smoke)). Oscar Austad, President, Austad Co., Sioux Falls, S. D., 5/19 St. Louis, Tape 1, side 1, rev. 945. The tobacco Industry is fighting bitterly to prevent any curtailment of smoking in the workplace and is hustling about the country buying TV time, conducting misleading surveys, and corrupting the health of our young people. Donna Shimp, Executive Director, Environment Improvement Associates, Salem, N.J., 6/16 Philadelphia, p. 6. R CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288779

-259- SMOKING RE STRICT ION--EMPLOYMENT (page five) there is little logic in tolerating smoking at working places at a time when considerably less hazardous emissions have been limited and certain harmful substances have been banned. Millions of dollars are being spent to eliminate emissions that we know are less hazardous to health than cigarette smoking. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 5. I would like to see each Board of Education adopt a position against all smoking in the schools -- not only among students but among the faculty as well. Richard J. Martwick, Supt. of Schools, Educational Service Region, Cook County, Illinois, 5/25 Chicago, page 4. ...it is hoped that teachers who are viewed as role models by their students would refrain from smoking while on the school premises. Paul Q. Peterson, M.D., Director, Illinois Dept. of of Public Health, 5/25 Chicago, page 4. We should pressure industry not to permit smoking on the job because of fire hazards and never to permit machine operators, automobile or truck drivers or airline pilots to smoke at all as a safety measure. The carbon monoxide levels in smokers' blood is high enough to impair reaction time and judgment. Robert L. Schmitz, M.D., Mercy Hospital and Medical Center; Board Member of Illinois ACS; Chicago, Ill.; 5/25 Chicago, page 2. ...I do not believe that the American Cancer Society or the American Heart Association should employ anyone or accept any volunteer who smokes. If we don't believe in our message how can we convert others? Just adopting such a policy would cause many such employees and volunteers to stop. Robert L. Schmitz, M.D., Mercy Hospital and Medical Center; Board Member of Illinois ACS; Chicago, Ill.; 5/25 Chicago, page 3. ..[I suggest] that in all of the schools, it be a requirement that no teacher, principal, or any employed person on the school property be permitted to smoke during school hours, or at any school-related function when pupils of that school are present. Martin G. Swaney, Public Health Educator, City of Milwaukee Health Dept., Milwaukee, Wisconsin, 5/25 Chicago, page 5. TIMN 288780

SMOKING RE S TRI CT ION -- EMP LOYMENT (page six) ... I think we teach both by the word and by doing it ourselves and I really think teachers, if they're going to smoke, should smoke away from work. . . L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo.; 5/12 Denver, Tape 1, rev. 394. We have as a corporate policy banned smoking in persons exposed to potentially hazardous agents. . . I think this represents an example of a corporate commitment. . . [B]asically we don't win brownie points with unions when negotiation time comes up when you abridge what they choose to call their God-given right to kill themselves any way they want. Paul Kotin, M.D., Medical Director for Johns-Manville Corp, Denver; 5/12 Denver, Tape 3, rev. 72-76. Newton: If smoking is such an addiction, as we heard from the previous speaker, how could you forbid teachers to stop smoking on the school . grounds unless you also request them to quit their teaching job? Biasco: That might be. There would be some withdrawal pains undoubtedly. But as with other kinds of drug addiction, they can seek treatment or they can terminate. Frank Biasco, Ph.D., Escambia (Fla.) School Board member, Associate Professor of Psychology, University of West Fla.; 6/14 Atlanta, Tape 1, side 2, rev. 194. If this is termed discriminatory then I protest that my right to fresh air is severely violated by those who choose to exhale a pollutant that is proven to do my body harm. I contend--and contend strongly--that ANY employee has the right to spend her or his forty-hour work week in an environment that is as free of pollutants as is humanly possible. (p. 2.) Smokers spread their health-destroying actions to each of us. We, as non- smokers, have our unalienable rights also. The human being--the employee-- must be granted the choice of a non-smoking work environment. (p. 2.) Carrie Nelle Thompson, Director, UNICEF, Atlanta, Ga., 6/14 Atlanta. If such a ((no smoking in the workplace)) rule or regulation were enforced, it would deprive the employee of eight hours of smoking, leaving eight hours for sleep, and another eight hours for him to do whatever he chooses to do. This, I am convinced, would cut down on smoking. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 17. CONFIDENTIAL: TIMN 288781 MIN-;ESOTA TOBACCO LITIGATION

SMOKING RE STRI CTION--EMPLOYMENT (pageseven) My second policy recommendation to the Cancer Society is that they themselves set a proper example. They can take two actions immediately that will be consistent with their objectives. First, ban smoking in all regional and national society offices. They should request, respectively, that all eiaployees of the Society abstain from smoking when any other person might see them. Employees of any health agency should not condone cigarette smoking practice in public. In a country with high unemployment and where the majority of the adults are non-smokers there should be no problem in recruitment. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., Boston 6/2/77, p. 3. ...extend the no smoking policy to all recipients of grants-in-aid from the Cancer Society. Hospitals should ban smoking on their premises any- way. Individuals in research institutions who receive support to fight cancer should protect their own health and be simultaneously prime exemplars. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., Boston 6/2/77, p. 3. Almost four out of five people believe that management has the right to prohibit smoking in its place of business. Now it is possible for busi- ness and industry to exercise that right. Dorothy E. Green, Ph.D., consultant to NCI, Arlington, Va., Philadelphia 6/16/77, p. 4. Weingarten: Do you believe that smoking should be banned in the schools entirely? - Parker: I do.... Weingarten: Do you think that's enforceable? Parker: I don't know; there are a lot of hungry teachers.... There are so many teachers out of work; that could be one of the criteria to hire the teachers. Alexis A. Parker, teacher, Manchester, N.H., 6/2 Boston, Tape 1, side 2, rev. 1122. I think that the trade unions do need to be educated more in regard to smoking. Unions tend to be self-indulgent. If there were some way we could get to the unions to be more cognizant to this real serious problem that the unions themselves might use it as a bargaining method to demand or ask for nonsmoking rights. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, Tape 2, rev. 119. CONFIDENTIAL: TIMN 288782 MINNESOTA TOBACCO LITIGATION

-262- SMOKING RESTRICTION -- EMPLOYMENT (page eight) ...we have to be very careful that the tobacco issue is not misued by uncaring persons in industry to penalize the worker that has been permitted to indulge in his habit with his employer's blessing. We can't give him a weapon to all of a sudden withdraw the benefits, but we have to then go to the employer and show him the dollar bottom line benefits of absolutely having no smoking in the workplace. Donna M. Shimp, Exec. Director, Environmental Improvement Associates, 6/16 Phila., Tape 1, side 1, rev. 148. ...if the employer is going to permit someone to harm their health on the job, then they are to bear the burden ((referring to the case of Fuentes vs. Workmen's Compensation Appeals Board et al.))... Donna M. Shimp, Exec. Director, Environmental Improvement Associates, 6/16 Phila., Tape 1, side 1, rev. 155. ((Referring to the general duty clause of OSHA)) The mechanism is there. My case is there for them to hang their hat on if they want a legal premise. Donna M. Shimp, Exec. Director, Environmental Improvement Associates, 6/16 Phila., Tape 1, side 1, rev. 184. (Huff asked if school boards will have problems in hiring nonsmoking teachers) That is the other side of the sword. If the labor ralations board upholds that we can set a policy in the school district of no smoking that must be adhered to by students as well as adults, it will be then a fact that we cannot smoke in buildings, but whether or not we could legislate against ((a teacher)) smoking is a different story. Now whether or not the courts would uphold us if we said, "You may not smoke in any school building or on any school property." --it may work, I don't know. It will have to be a test case for us to really know. Robert J. Beard, administrative assistant to Supt. of Schools, Chambersburg, Pa. Area School District, 6/16 Phila., Tape 2, side 1, rev. 1063: (Weingarten quoted figures from government showing a large amount of time lost from work because of cigarette-related illness and said the commission had been unable to find the medical director of any major company who had recommended or taken any action at all to limit smoking in work places. He asked if Burbank's professional group, the N.Y. State Society of Industrial Medicine, had taken any position on this) Not to my knowledge, as a unified body. (Would it be possible to make such a recommendation, Weingarten asked) One of the difficulties, speaking for myself, is the figures you quote, along with figures on alcoholism and how much time is lost -- I know alcoholism is bad and I know smoking is bad. But I can't say I can honestly believe the (cont.) CONFIDENTIAL: TIMN 288783 MINNESOTA TOBACCO LITIGATION

SMOKING RE STRICTION -- EMPLOYMENT (pagenine) (cont.) figures like that...this type-of persuasion, if that's what it is -- has been used ((with)) management for a number of years, particularly to justify medical programs...and I think we're a little jaded with that. It's not hard enouch evidence. We need harder evidence. Bernerd (sic) Burbank, M.D. Medical Director, McGraw-Hill, 6/16 Phila., Tape 2, side 1, rev. 10. (Asked by Weingarten if in her job she would recommend someone for a job if he was a smoker) ...I must say that I have to be honest with you. I feel that one's ability, in my instance, has to come before the fact that they smoke...We've placed store presidents, and they're bright guys and some of them smoke. Jeanne Cunnius, Vice President of Advertising and Sales Promotion, Business Careers, New York City retail execu- tive search firm, 6/16 Phila., Tape 2, side 2, rev. 661. You know that Franklin National failed six years after I retired. ((News' stories then spoke of bad loans.)) And I might say that to no little extent I believe that that failure was due to a breakdown. I might say that Loews Incorporated bought a working 24 percent interest in the bank. And Loews owns one of the major cigarette companies in America. And as soon as that happened, there was smoking in the bank. The ban ((instituted by me)) was off, and, of course, with that smoking, productivity lessened, discipline went out the window and to no small extent, in my mind, that failure was due to just that. Arthur T. Roth, former board chairman of Franklin National Bank, Rockville Center, N.Y., 6/16 Phila., Tape 2, side 1, rev. 1256. ' ...Obviously, you don't want every conceivable place in an office building or in the state office buildings covered...because then you're invading the workplace and the privacy of private offices... Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2, rev. 155. I am very bothered by smoke. I have now started taking tobacco allergy shots every two weeks and they hurt. I'm also allergic to dust and mildew. ...and now I've found out at thirty that I'm allergic to one-half of my favorite foods and drinks...taking shots ... regular allergy shots...they don't really hurt. The tobacco shots hurt...I suffer. Why should I quit my job? It pays well and has terrific benefits that I can share with my parents. Diana Brown, flight attendant, GASP and Ga. ALA volunteer, Marietta, Ga., 6/14 Atlanta, Tape 2, side 1, rev. 354. CONFIDENIIAL: TIMN 288784 MINNESOTA TOBACCO LITIGATION

..-.-,~. -- - S M O K I N G R E . _---- - T R m: I C T I O N E M PL O Y M E N T (page ten) I think if you want to reduce the amount of smoking or get smoke-free environments, you need to get businesses involved and people involved on a voluntary basis. I think if you can show a business that by eliminating or cutting down smoking that they can also cut absenteeism, that they can obtain higher production, better employee morale, in fact...perhaps...free advertising for the campaign, which all adds up on the bottom line to more profit. I think you will have much more success than trying to go to the government for additional legislation or controls. (rev. unknown.) I know of no government program that has managed to cut smoking in any group by 44%. I think if this program ((at my plant)) can be adjusted effectively for any business or at least a program similar to it, and we have certainly seen good results and we did it without getting the government involved. (rev. unknown.) (Asked how he enforced nonsmoking within his plant) We fire them if they smoke in the plant...we have not had to fire anybody. (rev. unknown.) Yank Dean, president, Allied Sports Co., Eufaula, Ala., 6/14 Atlanta, Tape 1, side 1. It was a very direct consideration in the hiring,of personnel as to whether or not they were smokers, not necessarily the fact that they themselves choose to smoke but the fact that we are involved for a lot of hours in a very close proximity and I did not want to be exposed to cigarette smoke for a long period of time. Fred Herren, head football coach, Newberry College, Newberry, S.C., 6/14 Atlanta, Tape 1, side 1, rev. 349. I'm supervisor of my area and I let my feelings be known about smoke. They don't smoke around me. Roger Setters, Pres., Louisville Chapter, GASP, Louisville, Ky., 6/14 Atlanta, Tape 1, side 1, rev. 290. -264- An air quality survey was conducted at the Ft. Worth Air Route Traffic Control Center (ARTCC) by the FAA Aeronautical Center Industrial Hygiene Section, ACC-162, as requested. Carbon monoxide gas and smoke particulates generated by smoking employees in two work areas were measured and compared with standards for such contaminants. It was determined that the levels of both were far below the workplace standards and consequently can only be considered an annoyance to the nonsmoking employee. Jimmy Spradley, citing Air Quality Survey by FAA on a grievance complaint, 9/23/74, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, attachment. CONFIDENTIAL: TIMN 288785 MINNESOTA TOBACCO LITIGATION

SMOKING RE STRICTION--EMPLOYMENT (page eleven) We do agree that, to the nonsmoker, particularly the hypersensitive one, smoking by others in the same areas can be extremely annoying and distracting. However, if smoking is to be prohibited in workplaces, it should be a deci- sion not based on the hazards to health of nonsmokers. It will have to be predicated on other factors such as morale, performance, fire hazard, etc. Jimmy Spradley, citing Air Quality Survey by FAA on a grievance complaint, 9/23/74, FAA aircontroller, ATCS Atlanta ARTC Center, 6/14 Atlanta, attachment. FAA's solid rejection of my suggestion and petition for adequate ventilation leaves the controllers no other alternative but to demand a majority rule vote to ban smoking from the control room. Votes have been taken in the past but they were rigged. For instance I, as a well known nonsmoker, have never been allowed to vote and I have worked here since 1964. (p. 1.) In December 1976, I submitted a written report'that I had been assigned to work among eight other controllers of which seven were smokers...I refused on that day and the next day to subject the flying public and myself to an air traffic control situation where the controller was so abused and angered that a hazard to air safety existed. (p. 1.) No FAA official has dared to mention the fact that there are a few ego-moti- vated smokers who use their smoke as a tool of coercion, intimidation and hateful spite. (p. 1.) To expect union leaders to fight management on the smoking issue is absurd. There is so much friction within the union membership on the smoking issue that if union leaders take a strong stand for either side, the opposing fac- tion could be disrupting to the unity of purpose that keeps any voluntary dues paying organization in existance (sic). (p. 2.) 1/24/77 letter from Hilliard, Fla., Air Traffic Controller Edwin Brock to Sen. Chiles and Rep. Bennett, submitted by Brock at NCSPP forum, Atlanta, 6/14/77. In occupancies where management controls employee smoking, fire caused by smoking is greatly reduced. For example, in industrial occupancies where strict control is instituted, only 4% of the fires in this type occupancy are caused by careless smoking. (p. 2.) t For the past several years...the Atlanta Bureau of Fire Services has had numerous requests... to enact ordinances ((prohibiting)) smoking in hospitals, office buildings, restaurants, night clubs, schools, department stores and elevators ((but)) we feel that such a request is without justification to enact ordinances regulating smoking in the various types of businesses men- tioned. In effect, it would put the City of Atlanta in a position of regu- lating policies of private business. (p. 4.) James B. Gossett, Chief & Fire Marshall, Atlanta Bureau of Fire Services, Atlanta, Ga., 6/14 Atlanta. CONFIDENTIAL: TIMN 288786 MINNESOTA TOBACCO LITIGATION

S M O K I N G R E S T R I C T I O N-- H O S P I T A L S in dealing with patients as human beings, the smoking problem is compli- cated by medical requirements that may make it impractical in specific situations to be able to segregate smoking patients from non-smoking patients. W. Kevin Hegarty, chairman of the board, Calif. Hospital Assn., 3/22 LA statement. p. 3. If you're going to stop smoking anywhere in a public place, it's hospitals. That's where it should happen. Robert W. Jamplis, M.D., president, Calif. Division, ACS, Director, Palo Alto Medical Clinic, 3/22 LA Tape 1, Rev. 719-720. ((Doesn't know what the California Hospital Association policy is on smoking in hospitals)) I'd like to know. I think from all the hospitals that I work in, it's banned... ((Told that of the nation's 7200 hospitals, only 4 percent ban smoking)) Well, we'd better get the word to them, because that's the popular place to ban it, without a doubt. Robert W. Jamplis, M.D., president Calif. Division, ACS, Director, Palo Alto Medical Clinic, 3/22 LA Tape 1, Rev. 779-786. We have not favored total ban of smoking in hospitals simply because it becomes uncontrollable ... Total bans just seem to drive them underground and create a sneaky use, which adds significantly to the problem rather than solving it. Philip C. Favro, California State Fire Marshal, 3/22 LA Tape 2, Rev. 260. The California Hospital Association supports the concept that there be special smoking and nonsmoking sections in all public areas, including hospitals ... The basic thrust of the program of the California Hospital Association is to advise its hospitals to take the utmost care in an attempt to separate the smoking patient from the nonsmoking patient. Now I would only ask the commission to understand our problem in tihs regard. The state and the federal departments of health are screaming that our occupancy is too low and the vacant bed costs money and Medicare and MediCal are ekpensive for that reason, etc. If we overlay the smoking- nonsmoking over top of the diagnosis problem, the mix of sex and the rest of things, our occupancy is going to drop considerably, believe me. W. Kevin Hegarty, board chairman, California Hospital Assn., 3/22 LA Tape 8, Rev. 41. TIMN 288787 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

SMOKING RE STRICTION-HO SP ITAL S (page two) Hospitals have been involved in the issue of smoking for some period of time. Their original involvement probably related more to the areas of safety and concern about the safety of the patient than probably at least at that point in time the health associated with smoking. However, since hospitals have gotten involved from a safety point of view in the findings that we're now seeing coming out on smoking, we've seen the development of policies that go far beyond the areas of safety. .. Larry Wall, Colorado Hospital Association; 5/12 Denver, Tape 3, rev. 165. Dr. Shank: Why aren't hospital boards more effective in limiting smoking? Smith: It's a matter of personnel and time. The nurses say they just don't have the time to go around and tell everybody to stop smoking and the security guards are too busy handling the parking problem. A. Marshall Smith, Jr., M.D., head, respiratory medicine section, Eastern Maine Medical Center, Bangor, Maine, Boston, 6/2/77, Tape 2, side 1, rev. 266. The smoker must be made to understand' that freedom of choice is a relative thing. Kathleen Dooling, R.N., Watertown, N.Y., ACS - "Miss Hope '77," 6/16 Phila., Tape 2, rev. 441. For the past several years...the Atlanta Bureau of Fire Services has had numerous requests...to enact ordinances ((prohibiting)) smoking in hospitals, office buildings, restaurants, night clubs, schools, department stores and elevators ((but)) we feel that such a request is without justification to enact ordinances regulating smoking in the various types of businesses men- tioned. In effect, it would put the City of Atlanta in a position of regu- lating policies of private business. James B. Gossett, Chief & Fire Marshall, Atlanta Bureau of Fire Services, Atlanta, Ga., 6/14 Atlanta, p. 4. Any bill to prohibit smoking by visitors should contain some measures to give hospital security guards the right to issue summons for violation and fines sufficiently large to cover the cost of enforcement. Some of the money collected in fines should be returned to the hospital to help pay for the cost of guards. A. Marshall Smith, Jr., M.D., head, respiratory medicine section, Eastern Maine Medical Center, Bangor, Me., 6/2 Boston, p. 7. CONFIDENTIAL: TjMN 288788 MINNESOTA TOBACCO LITIGATION

-268- S M O K I N G R E S T R I C T I O N-- P U B L I C There are public policy issues focused on the non-smoker, who is exposed to the smoke of others. Is public policy for his situation best expressed through legislation? Should public policy be implemented on private premises, such as work places? Is public policy developed on the basis of annoyance and inconvenience, or on the basis of demonstrable public interest? Dale Houghland, chairman, Calif. Interagency Council on Smoking & Health, 3/22LA statement, p. 2. But with no law to back them up, they have no recourse with the one in a hundred smoker who insists on smoking no matter what the sign says. Herm Perlmutter, founder & co-chairman, Californians for Clean Indoor Air, 3/22LA statement, p. 5. Because smoking is readily accepted in this society, the protection of the non-smoker will progress too slowly without legislation. Increased smoking limitation laws are needed now to protect everyone in the public areas we must frequent. Herm Perlmutter, founder & co-chairman, Californians for Clean Indoor Air, 3/22LA statement, p. 5. The lack of non-smoking sections and limitation laws might be hurting the overall economy of the country. Herm Perlmutter, founder & co-chairman, Californians for Clean Indoor Air, 3/22LA statement, p. 2. The legislators in Arizona came to me and asked me to help them with getting legislation passed because they had tried just to get one law, no smoking in elevators, just about one of the smallest confined places you can go into in public. And they were unsuccessful. -They were laughed at, made a joke. So I went down to the state capital and received my baptism of fire. I spent the first year there and came home and said to my husband, "I shall never, never go near that frustrating place again, because they're just a bunch of crooks. And, a good many of them are. (emphasis supplied) Betty Carnes; anti-smoking activist, Scottsdale, Ariz., 3/22LA tape 7, rev. 83-95. We didn't succeed in getting that law passed because, you see, the passage of 1973 and 1974 had convincerid the tobacco people that something was happening in Arizona which wasn't going to be of much use to them. And they sent very fancy lobbyists into Arizona. (unintelligible) and kept a very careful record of all the things. I'm going to write a book one of these days that's going to blow the top off that state capital. Betty Carnes, anti-smoking activist, Scottsdale, Ariz., 3/22LA tape 7, rev. 138-145. CONFIDENTIAL: TIMN 288789 MINNESOTA TOBACCO LITIGATION

S M O K I N G R E S T R I C T I O N-- P U B L I C (page two ) (Explaining how she had originated the sign for use in private homes in 1966 because a simple "No Smoking" was too rude)...but you know it really killed me when they put that in the grocery stores, "Thank You For Not Smoking." And then they added to it, "Cooperation is Better Than Legis- lation." Now--we've tried two years to get that passed ((no smoking in grocery or department stores)) but we're getting it done because, with a "Thank You For Not Smoking" on a voluntary basis the majority of people will comply with the signs. The majority of people are polite and con- siderate and it's working very well in Arizona. Betty Carnes, anti-smoking activist, Scottsdale, Ariz., 3/22LA tape 7, rev. 169-175. The public is a difficult thing to really predict...how the people would vote. We have heard from Dr. Zagona that his people that he is checking on--and his people are all university students--are very unhappy about this kind of prohibition, or whatever, restrictions. I think that it depends very much on what type of people we are talking about. Now the general public in California--two-thirds of them don't smoke. So if we have a referendum we would find that the smokers would oppose it and the non-smokers would support it, I think. Dr. Elfreide Fasal, as cited by ACS LA Film, 3/22LA. Breathing air free of tobacco smoke should be a right available to all non-smokers. Therefore, either tobacco smoking should be prohibited in public places or special well-ventilated areas should be set aside in public areas for those individuals who w3-sh to smoke_ Dr. Aronow, as cited by ACS LA Film, 3/22LA. The public seems terribly receptive to their protecting the rights of non- smokers. The response was overwhelming in Michigan. The legislators all responded back that the public out there was supportive of the rights of nonsmokers. But the reverse side of that coin is that there is also the feeling that there are some rights of smokers. There is a feeling that we should not go so far as to ban cigarette smoking, that that would be a mistake; that people have a right to physically abuse themselves if they so desire. And we always had to deal with those two rights, the rights of nonsmokers and the rights of smokers. William Sederberg, Ph.D., director of research, program section, Mich. House of Reps. GOP Caucus, and president, Mich. Lung Assn., 5/25 Chicago, Tape 1, side 2, rev. 260. ~~ - - ---- _ ~ There's no question in-my mind that it's going to take a long time before we can take a society that is accustomed to smoking cigarettes any place they want to smoke to a society that goes back to what it was 50 years ago when you still Q had the smoking car on the train. It's going to take time...But we gotta keep Harvey Phelps, M.D., pulmonary specialist, Dem. state senator, Pueblo, Colo., 5/12 Denver, Tape 2, rev. 442.

S M O K I N G R E S fi R I C T I O N-- P U B L I C (page three ) Santa Barbara City passed an ordinance three weeks ago that said that there would be no smoking in any place where the public is, including restaurants, but in the case of restaurants they would have to provide 50 percent of the space for nonsmokers. One week later there was an election and of the seven councilmen--councilpersons, I should say-- three of those changed and today they are having a new hearing on this ordinance to see whether or not it's going to survive. And this is a bit frightening. ((It was passed, without the 50% stipulation for restaurants.)) Sidney Ottman, Ph.D., Santa Barbara, California Congress of Parents and Teachers, 3/22LA Tape 4, rev. 412. We do endorse the right of the smoker to smoke. We don't like smoke, but we don't care how much he smokes. All we care about is to protect our health from their habit...In public we feel the government has the right, the responsibility, the obligation to promote, to protect the health of its citizens. That includes setting up ordinances that would require separate sections for smoking and nonsmoking people. Herm Perlmutter, LA, founder and co-chairman of Californians for Clean Indoor Air, 3/22LA Tape 7, rev. 620. We have found that in restaurants that have voluntarily set up no-smoking sections their business has increased. There's no doubt about that...We have also found that many restaurant owners have stated, "We're all for you, however, we don't want to offend any of our regular smoking customers by setting up a no-smoking section." Yet they would comply very readily, very readily, with laws that would oblige them to-set up separate sections. Herm Perlmutter, LA, founder and co-chairman of Californians for Clean indoor Air, 3/22LA Tape 7, rev. 634. Z All kinds of ((stores)) are doing it ((banning smoking)) and they're ~ quite satisfied with the results. They are able to have a cleaner atmos- d+ phere, more comfortable shopping, reduced maintenance costs--this is a ~ definite advantage--less damage to stock. This is especially applicable H to department and clothing stores. And their fire insurance can go down " a in the future. I believe this could go down. ~~ Herm Perlmutter, LA, founder and co-chairman of U z U Californians for Clean Indoor Air, 3/22LA Tape 7, W ~ rev. 668. ~ The good thing about laws is that it applied equally to all places. Restaurants wouldn't have to fear losing business. Stores wouldn't have to feel they are offending anybody as long as the law applied equally to all places. Herm Perimutter, LA, founder and co-chairman of Californians for Clean Indoor Air, 3/22LA Tape 7, rev. 683. TIMN 288791

-271- S M 0 K I N G R E S T R I C T I 0 N -- P U B L I C (page four) We were all pleased two years ago when Alaska became one of the first states to pass smoking regulations in public places. However, since that time, this bill has proved worthless because of no apparent way to enforce peoples habits. But remember we have never been successful at legislating rules against popular human habits. Donald Rogers, M.D., Pathologist, Anchorage, Chairman, Alaska Division of ACS, 5/17 Seattle, p. 4. Wyoming introduced a "No Smoking In public Places" bill at the last session of its legislature. The bill was considered but was defeated...These legislators completely ignored the rights of the majority of people who do not wish to be bothered by tobacco smoke. Dr. Robert Taylor, M.D., Cheyenne, Wyo., 5/12 Denver, pp. 4-5. 1. Smoking must be prohibited in public places. Stanley Stein, Pharmacist, Colo. Pharmacal Assoc.,5/12 Denver, p. 3. Effective legislation to segregate the smoker - or the non-smoker,_which ever is your preference - to provide safe places for persons concerned with their health to live, work, play and take part in social responsibilities... . L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colo., 5/12 Denver, p. 4. In areas where people are unable to effectively protect themselves, government intervention becomes necessary. The time has come for a public mandate for greater social and legislative action at the National level to control cigarette smoking. For the health of the nation, we no longer have the right not to intervene nor the time to wait. Charles A. LeMaistxe, M.D., Chrm., ACS Texas Div. Study Comm. on Tobacco & Cancer, 5/12 Denver, p. 10. State legislators have moved rapidly into the area of public smoking where a decade before, such legislation would have been considered "tampering, meddling or legislating morality." Why this sudden surge? Very simple, a change in public awareness and attitude. If there is a common denominator that is readily understood and accepted by those who run for public office, it is popular opinion and trends of their constituency. Jack Ogg; Dem" state'senator; ITouston, Tex.; 5/12 Denver, p. 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288792

-272- SMOKING RE STRICTION' --PUBLIC (page five) As an agency committed to the promotion of good health, the Colorado Department of Health relegated smoking to "designated areas only" effective Monday morning, Jan. 10...We based our position on the fact that 1) smoking has proven bad effect upon the health of smokers and 2) that non-smokers can experience aggravation from prolonged exposure to smoke in the environment... We've set up a system which protects rights of non-smokers without greatly inconveniencing the smokers. Anthony Robbins, M.D., Executive director, Colo. State Dept. of Health, 5/12 Denver, p. 1. Two additional legislative areas which need emphasis, in my estimation, include restrictions on smoking in retail store, especially food stores, and smoke free areas in restaurants. Shirley Marsh, Nebraska State Senator, not delivered. 5/19 St. Louis, p. 2- ...no benefit accompanies the discharge of tobacco smoke into the air which I breathe, and I believe this represents an intrusion on my property rights. Since I am alive and breathe, I should have an implied prior right to the air. When someone intrudes on that property he should be liable under laws that cover the violation.of property rights and he should incur legal penalties as a result of this intrusion. Warren Bosley, M.D., pediatrician, Grand Island, Nebraska, 5/19 St. Louis, p. 6. Nebraska, among other states, has a law limiting or prohibiting smoking in certain public places. There is ample precedent for the role of the state's protecting the public health, and on this precedent I believe these laws can be expanded and strengthened to include all public places. It would appear that the American Cancer Society could make this an impor- tant part of its program, again, simulating local and state chapters to influence their legislators. Warren Bosley, M.D., pediatrician, Grand Island, Nebraska, .5/19 St. Louis, p. 7- ...this is not to indicate that aversive consequences for smoking should never be employed or that regulations limiting smoking should never be enacted. However, over reliance or exclusive reliance on such measures is likely to be counterproductive, provoking more resistance than healthy behavior. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in_ Psych. and Law, Washington Univ., 5/19 St. Louis, pp. 11-12. TIMN 288793 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

S M 0. K I N.G..12_.E__S T -R-I C_T Y' 0 N e-_- .P U B L I C (page 'six) While restrictive measures, such as increased taxes and laws limiting legal smoking, may be effective, care should be taken that they not be implemented in a manner likely to provoke black markets, open defiance, or other forms of subversion. Such reactions may negate particular measures as they tend to undermine the authority and respect of the campaign of which a given measure may be a component. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis,. p. 13. Another alternative would be for legislation to ban, or in some cases further restrict, smoking in public places. The lungs of those who abstain from smoking should not have to suffer as a result of other persons' habits. Of course, any action of this sort would have to be taken by state and local governing bodies. ('.harlea. E. _-Grassley_, . U. S. - Congress (R-Iowa) _ -delivered_by_-Stephen Roberts, • :5/19 St. Louis, po. 3-4. In the area of use, I think extension of no-smoking laws into all public places including public streets would be extremely useful. David B. Thomas, M.D.,aDr. P.H., epidemiologist, Fred Hutchinson Cancer Research Center, 5/17 Seattle, Tape 1, side 1, rev. 245. The whole climate here in the state of Washington has remarkably changed in the sense that the smoker is much more polite and I certainly have created an awareness. Georgette Valle, Washington State Representative, ~ Chairman, House Ecology Comm., 5/17 Seattle, Tape 1, 0 side 1, rev. 375. ~ I think that if someone wants to, as they say, pound another nail in his ~ coffin, why I think that's their privilege. I don't agree with it, and [.~ I think this (public smoking restriction) is pretty poor policy but whether " a we should interfere with his self destruction or not I'm not positive. ~ William Hutchinson, M.D., director, Fred Hutchinson W@ Cancer Research Center, 5/17 Seattle, Tape 1, Side 1, ^ ~ rev. 798. I told these people, many hundreds of them now, that I think as a physician ~~ it's my responsibility to educate people about the risks of smoking but U E-+ I don't think that government for example should prohibit smoking because ~ we've learned, especially with tobacco, that that doesn't work very well. Donald Rogers, M.D., pathologist, Alaska Hosp. and chairman of Exec. Comm. of Alaska Div. of ACS, 5/17 Seattle, Tape 1, side 1, rev. 1135.

-274- S M O K I N G R E S T R I C T I O N-- P U B L I C (page seven) Has the time come when society through governmental edict will have the right and maybe the obligation to protect the smoker from himself or at least to protect the non-smoker from the deleterious effects of smokers? Thomas McGowan, Judge, Buffalo, New York, 6/16 Phila- delphia, p. 3. If the Federal government can protect the rights of the handicapped by withholding money from SEPTA ((transit system)) for not considering special ramps in new construction to provide for wheelchairs, then Federal dollars should be denied SEPTA until they begin to protect the health of the majority of suffering non-smokers. Jerry Silverman, Philadelphia commuter, 6/16 Philadelphia, p. 1. It kind of bothered me at first, the idea of having to have legislation in an area of personal choice, because it kind of threatens the basic foundation of the U.S., that was built on freedom of the individual. There's no issue between the smoker and nonsmoker that can't be settled by just common courtesy and self-respect for others' rights, but people won't do it. So that's why I--that they're asking for ever-increasing governmental restrictions on their personal life. it's their own faults, really, but I do feel it's necessary. Christa Lira, high school student, Centerville, Iowa, 5/19 St. Louis, Tape 2, side 1, rev. 680. ...I, as a lay person, am opposed to any individual's infringing on the right of any other individual by smoking in public places. But I also recognize that in a realistic world, we cannot by fiat prohibit smoking and expect either addicted persons or young persons who unfortunately feel smoking equates with maturity to immediately desist. Rather, I feel that if we approach this acute problem in both an academic and logical manner, we can make measurable inroads toward our ultimate goal of persuading present smokers to quit and prohibiting would-be smokers from beginning. (p. 1.) ...I ani exceedlingly aware of the numerous health problems directly attributable to cigarette smoke pollution. Because I care for my husband and children, because I care for my fellow and sister human beings and because I care for myself, I am willing--indeed eager--to fight to restrict smoking to the privacy of one's individual home or office--or, in public, to a designated place that is clearly defined as a smoker's restricted area. (p. 1.) • I submit that we should:... Provide a smoking area on the individual campuses-- an area totally separate from classroom or student activity facilities ((and)) ... Assure that non-smoking rules ((in schools)) are ENFORCED, not just enacted. (p. 4.) Carrie Nelle Thompson, Director, UNICEF, Atlanta, Ga., 6/14 Atlanta. CONFIDENTIAL: Tj.MN 288795 MINNESOTA TOBACCO LITIGATION

-275- S M O K: L.N G R E S T R I C T I O N -- P U B L I C (page eight) (Mrs. Perkins asked her about the publicity she's gotten, how her smoking friends have reacted) Mrs. Perkins: What I was thinking about -- if this is successful in Iowa, if you can follow this through, get this man def eated((subcommittee chairman who won't support public smoking measures because he's a smoker)) and not let it go now, perhaps this is an example that could be followed all over the country. Because it's the young people who we're worried about. Mrs. Marlin Perkins, NCSPP Commissioner, during testimony of Christa Lira, high school student of Centerville, Iowa, 5/19 St. Louis, Tape 2, side 1, rev. 765. While the restaurants are worried about legislative action, I believe they are about my lowest priority. An increasingly conscious public has the ability to reward entrepreneurs who provide smoke-free dining and punish others who don't by informing them of our refusal to patronize them. Missouri State Rep. Carl H. Muckler, 5/19 St. Louis, Tape 3, side 1. The same industries that are now required to spend literally billions of dollars to eliminate air and water pollution (the steel industry alone has already spent $3 billion, and to meet current law will require the invest- ment of between $12 and $14 billion more between now and 1983) -- have yet to spend significant money toward limiting cigarette consumption. Jack L. Harris, M.D., Medical Director, Armco Steel Corp., Middletown, Ohio, 5/25 Chicago, page 8. Pipe and cigar smokers, while non-inhalers, have less significant personal health hazards but introduce more pollutants into the air for neighboring non-smokers. THESE MUST BE BANNED on many-peopled small spaces, e.g., planes, trains, and busses. Ernest W. Johnson, M.D., Chairman, Dept. of Physical Medicine, Ohio State University School of Medicine, Columbus, Ohio, 5/25 Chicago, page 2. Tobacco is the last remaining major pollutant and it too must be regulated by providing better ventilation and designated areas in every public place for smoking. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, Ill., 5/25 Chicago, page 2. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288796

-276- SMORING RESTRICTION -- PUBLIC (pagenine) DuVal: I happen personally to be one of those persons who believes that the regulation of a person's conduct when he's in private . . . is not a proper role of government:°"' What would be society's justification for taking a position with respect to the use of tobacco by someone who is off and alone? Brock: . . . I would say that when he is off and alone that it is not the same, you're right. .. DuVal: . . . I'm wondering how I could maintain in my own mind a consistent posture when I say I don't really care what two consenting adults do in their own home and then turn around and take a position and say, however you can't smoke. I find myself in a highly inconsistent posture were I to hold both of those views. . . I have to come back to the fact that their habit somehow impacts on me and I am simply looking and searching for a reason to take a firm societal position on why I as a member of society should dictate or regulate somebody else's behavior, unless it impacts directly on me and I wonder if you could help me reason my way out of that dilemma?. Brock: I really don't know that I can. . Merlin DuVal, NCSPP panel member, and L. Loring Brock, M.D., Director, Heart-Lung Center, Denver, Colorado; 5/12 Denver, Tape 1, rev. 377-383. We have many people who are not smokers who feel as legislators that this kind of law [a public smoking restriction bill] is an invasion of the privacy of the individual citizen. I think they . . . fail to agree ~ with the point of view that someone blowing a cloud of smoke in your face ~ is invading your privacy as well. ~ ~ Hugh Fowler, GOP Colo. state senator, Denver, Colo. 5/12 Denver, Tape 3, rev. 126. I however would like to urge you to endorse publicly proposed legislation in any state for legislation which has not been (sic) proposed or public policy statements which would limit smoking in public places. I think leg- islation is needed for two reasons:...Legislation, I feel, even in states where it does not pass, would make more people aware of the effects of smoke on non-smokers. Second, legislation would give something tangible to non-smokers to point to=• Many non-smokers-still feel awful about asking people not to smoke or even sticking up for their rights and I think they sometimes feel a little bit unsure of their rights. Sherry Martschink, former member of S.C. House of Reps., Charleston, S.C., 6/14 Atlanta, Tape 1, side 2, rev. 66. z O

-277- S M O K I N G R E S T R I C T I O N-- P U B L I C (page ten) The Minnesota law, ((Proposed law is not modelled after the Minnesota Law)) I feel, was trying to overly accomodate smokers in actually trying to grant equality to designated smoking areas. Roni Rechnitz, director, Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, Tape 2, side 1, rev. 1243. There is unfortunately among some of the health organizations a question of disagreement on policy. Now I had a disagreement with the president of the Mass. Division of the American Lung Assn., in which case their organization believes that there should not be restrictions in restaurants in smoking. They believe in designated smoking areas, which as I've indicated I don't believe is a proper concept. And as far as some of the health organizations are concerned, there is a difference in policy as far as the ACS is concerned. Roni Rechnitz, director, Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, Tape 2, side 1, rev. 1245. ...on an issue of this magnitude in which the tobacco companies will not-- if they can afford to spend $40 million on a six months introduction of a cigarette with no artificial ingredients, I'm sure they can afford to spend an equal amount to battle a political referendum question res- tricting smoking in publicly used buildings. Roni Rechnitz, director, Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, Tape 2, side 1, rev. 1265. Dr. Pool said he thinks it is wrong for the legislation to prohibit smoking in public. Z John L. Pool, M.D., thoracic surgeon, Norwalk, Conn., witness at 6/2/77 Boston forum--from Bridgeport Post, ~ 6/4/77. ~ ..get every state and at the federal level to rule against authorised (sic) smoking on tax supported public school premises. .. H y,..{ a Q U Bill Caldwell, newspaper editor & larynx cancer victim, Damariscotta, Maine, 6/2 Boston, p. 4. For the past several years...the Atlanta Bureau of Fire Services has had numerous requests...to enact ordinances ((prohibiting)) smoking in hospitals, office buildings, restaurants, night clubs, schools, department stores and elevators ((but)) we feel that such a request is without justification to' enact ordinances regulating smoking in the various types of businesses men- tioned. In effect, it would put the City of Atlanta in a position of regu- lating policies of private business. James B. Gossett, Chief & Fire Marshall, Atlanta Bureau of Fire Services, Atlanta, Ga., 6/14 Atlanta, p. 4. TIMN 288798

S M O K I N G R E S T R I C T I O N -- P U B L I C (page eleven) S.O.S. is a registered non-smokers' rights organization recognized by ((state owned)) Virginia Commonwealth University and funded by Student Activities Fees. This student organization has programs within the University and works to a smaller degree off-campus in the Richmond com- munity. Students Opposed to Smoking has received a great deal of direction and support from the American Cancer Society. Keith Colonna, president, Students Opposed to Smoking, Virginia Commonwealth Univ., state-owned, Richmond, VA., 6/16 Philadelphia, p. 1. One activity will be a direct mailing to the academic deans requesting that professors enforce smoking restrictions in the classrooms. S.O.S. will meet with the Faculty Senate and ask that they take a stand to protect the rights of non-smoking students. Keith Colonna, president, Students Opposed to Smoking, Virginia Commonwealth Univ., state-owned, Richmond, VA., 6/16 Philadelphia, p. 10. The New York State Education Department ... has recommended legislation to prohibit smoking by students, faculty, other staff and visitors in school buildings housing students. Fred G. Field, Jr., N.Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., 6/16 Philadelphia, P• 9- Why not just come out and tell them they can't smoke-period and let them take the case to court if they are that concerned with their right to smoke. Fred G. Field, Jr., N.Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., Z 6/16 Philadelphia, p. 3. ~ H One of the unhappy things that's happening now is that as the two-thirds e~ of the population now that doesn't smoke becomes more agressive in trying ~ to protect itself against the nasty smell, there has become an increasing E-+ polarization between smokers and nonsmokers. a ~ U WU -0t C) E-+ O <C U O ~ Bernard Mausner, Ph.D., prof. of psych., Beaver College, Glenside, PA., 6/16 Philadelphia, Reel 1, Side 2, Rev. 446. ...is we're trying to approach it kind of on a general, gradual basis in that we're going to hit places where we feel like there's an obvious reason for ((banning smoking)) --grocery stores, hospitals, places of public gatherings. If we can get these through it'll give us something to work with, a foundation to build on. Roger Setters, Pres., Louisville Chapter, GASP, Louisville, Ky., 6/14 Atlanta, Tape 1, side 1, rev. 284. TIMN 288799

-279- S M O K I N G R E S T R I C T I O N -- P U B L I C (page twelve) ...one ((might search)) for lawsuits which would establish through the courts the principle that the norm in public buildings, for example, is a right to clean air. And the smoking invades one's right to privacy and that the failure of public facilities to protect those rights might subject such buildings to potential litigati.on...This kind of a construct, which places public policy on a base of high principles, of constitutional rights, of rights to freedom, I think is a context that has a likelihood for moving the public when its alternative, namely the context of a ban of a desired substance, raises many, many issues... J. Rich. Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. Weingarten: Do you believe that the present legislation efforts to limit smoking in public places are counterproductive? Friedman: No, I don't think they're counterproductive but I would certainly not encourage the American Cancer Society to devote much of its efforts to it. Mostly because I think again it's a symbolic type of activity. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 51. The central right by virtue of biologic existence in my judgment is to inhale fresh air... There are people obviously who enjoy smoking for one of many reasons and they have a right to do that, but in my judgment that should be in an area designed especially for those people with a maintenance staff and exhaust system which are underwritten by some fee to pay for it. Steven R. Homel, M.D., Director, Center for Health Educ., Phila., Pa., 6/16 Phila., Tape 2, rev. 78-80. We also made it very flexible. We didn't say that they had to have so many percentage (sic) for smokers, so many for nonsmokers in a restaurant. We said it had to be adequate to accomodate this relative preferences of the public frequenting those premises. Steven Sklar, Maryland House of Delegates, Baltimore, Md., 6/16 Phila., Tape 1, side 2, rev. 202. DuVal: In view of the fact that you've had experience with both the legis- lative and executive branches of government what, to the extent that you can define it, is the appropriate role of government in an issue of this kind? Bryant: Bringing facts to the attention of the public, one, and protecting non-smokers. Now, I make a distinction between imposing a restriction on an individual for exercising his freedom of choice on the one hand and on the other hand ... protecting society from abusive practices. Those two con- cepts may frequently conflict but democracy is a process of compromise and those who want to prohibit the smoking in public places, those who want to require smokers to go to the back of the plane, or the bus or whatever, it seems to me that they'are not without reasons for their point of view. And by doing things in this way, we can protect individuals who need to be pro- tected from the harmful effect of smoking without restricting their basic freedom of choice which is the American way of life--the right to do wrong (cont.) 9

-280- SMOKING RESTRICTION --PUBLIC (pagethirteen) (cont.) as long as we don't do harm to the other people in the exercise of that right. Farris Bryant, former Fla. governor and president, Voyager Life Ins. Co., Jacksonville, Fla., 6/14 Atlanta, Tape 1, side 1, rev. 187. I think the legislation needed from the standpoint of smoking is for pro- tection of the non-smoker. I don't think you'll ever affect the smoker through legislation other than restrict the area that he might smoke freely in. I'm reminded of the legislation we have concerning seat belts. We pay about $300 million a year for the privilege of sitting on top of our seat belts in our automobiles. Now I think legislation from the standpoint of restricting places in public areas and for the protection of non-smokers through an aggressive, positive approach that by virtue of the fact that you are smoking, you are hindering the non-smoker. This kind of legislation has a place and a possibility of passage... Barney Burks, Mayor, Pensacola, Fla., 6/14 Atlanta, Tape 1, side 1, rev. 234. ...a lot of people are advocating the government legislating smoking and non- smoking areas...I am against the government getting involved in anything that's not a government function. I think that this includes ... putting controls on business or getting involved in no-smoking advertising...I also think busi- ness has too many controls imposed upon them and I certainly don't think they need any controls in order to give nonsmokers a smoke-free env3.ronment or what- ever. As I see it, the nonsmoker has the freedom to change jobs or do what- ever he wants to do to find a smoke-free area...I was up in Minnesota a month or so ago, and in that area they have legislation which tells restau- rants that they have to have smoking and non-smoking areas...Everywhere I went people would complain -- they couldn't get seated at a restaurant. But on a voluntary basis it works, where on a forced basis, it doesn't work. Yank Dean, President, Allied Sports Co., Eufaula, Ala., 6/14 Atlanta, Tape 1, side 1, rev. unknown. ..I think the Cancer Society needs to strongly support legislation for restriction of smoking in public places...in addition to protect the non- smoker, however, I think that restriction in public places gave (sic) more impact on smokers in terms of some of the psychological things...I don't think ((you as a smoker)) can maintain ((your)) image as a suave, debonair individual in a restaurant if you're ((sitting)) in a corner of it.- Douglas 0. Draper, Ph.D., clinical psychologist, Jackson, Miss., 6/14 Atlanta, Tape 1, side 1, rev. 398. ~ I would strongly urge your Commission to promote non-smoking sections in restaurants. Some areas of the country are trying to accomplish this through legislation. Rather than doing that, I would hope that more and more diners request to be seated in non-smoking sections. Robert W. Butterfield, area supervisor, The Magic Pan, Atlanta, Ga., 6/14 Atlanta, p. 1.

-280a- SMOKING RESTRI CTION--PUBL I C (page fourteen) Citizens For Clean Air In Publicly Used Buildings feels one of the most effective solutions to many aspects of the problem is a statewide binding referendum question seeking the restriction of smoking in all publicly used buildings with the basic exception of restrooms. (p. 1.) ...the Minnesota Clean Indoor Air Act of 1975...is not good law. And it is not effective law. But it is significant law having been the first and thus opening the door for better, well thought out, and more enforceable legislation. (P. 1.) Citizens For Clean Air In Publicly Used Buildings believes anyone convicted of refusing to extinguish a lighted tobacco product in a publicly used building should be fined not less than $200 on a first conviction and not less than $500 on every conviction thereafter. Any proprietor refusing to enforce the law is subject to the same penalty. (p. 5.) Citizens For Clean Air In Publicly Used Buildings is dedicated to raising 3-5 million dollars for an effective media campaign capable of setting the issue squarely before the voters and answering any possible distortions, half-truths, or deceptions promulgated by the opposition's public relations strategy. (p. 7.) Roni Rechnitz, Dir., Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston. The non-smoker who is seriously bothered by exposure to smoke is effectively disenfranchised if smoking is allowed at public meetings. A. Marshall Smith, Jr., M.D., head, respiratory medicine section, Eastern Maine Medical Center, Bangor, Me., 6/2 Boston, p. 6. CONFIDENTIAL: TIMN 288802 MINNESOTA TOBACCO LITIGATION

-281- S M 0 K I N G R E S T R I C T I 0 N -- T V & F I L M S There are public policy issues involving the communications media... Should movies and television be monitored and censored, i.e., should Johnny Carson smoke on camera? Dale Houghland, chairman, Calif. Interagency Council on Smoking & Health, 3/22 LA, p. 2. Smoking should be banned from TV except for news and old movies. The pro-smokers say this interferes with the freedom of the TV personality, but, who is more important, the millions of viewers or the one person- ality? If this is going to be allowed we should be allowed equal non- smoking promo time. George Crawford, Ph.D., Weber State College, Ogden, Utah, 3/22 LA, p. 5. I would suggest the following: 3) Stronger appeals should be made to television and movie people to keep prominent figures 'from being shown smoking. Salvatore V. Zagona, Assoc. Professor of Psychology, Univ. of Arizona and Director, Center for Research on Smoking & Health, 3/22 LA, p. 6. The FCC should exert its authority to discourage radio and television programming and story content from depicting smoking as a positive aspect of a life-style. What's more, it should revive its previous stipulation that stations devote a certain amount of air time to public service spots, or better yet, develop special anti-smoking messages for children to be aired during the Saturday morning cartoon viewing time. Leonard Bachman, M.D., Pa. Secy. of Health, 6/16 Phila., p. 8. z ~ F~-+ Without question, having examined this with a number of my director friends, and writers, there is far less use of the cigarette as a prop today than there was a decade or two decades ago. (rev. 1000.) I cannot come before you and say that I'm now going to issue a new code of ethics and henceforward maybe a pipe and maybe a cigar or two but no more cigarettes. That's impossible to do in a freewheeling and untrammeled society like the community that I represent. (rev. 1011.) I'm not for one moment going to tell you that it isn't possible through friendships or whatever kind of tradeouts to do what we call a product advertising, where you make a picture and the Ford Motor Co. may say, "Look, we'll give you all Fords if you use Fords in the dar (sic)..." So I'm not going to for one moment suggest to you that the cigarette companies wouldn't be doing the same thing. But I'm merely saying that that is diminishing. The use of cigarettes. And also I think you will find in Hollywood, where people's fervor runs higher than in normal communities that there are a lot of people who are crusaders...for anti-smoking. And they make their in- fluences felt...even to the point that if you use cigarettes as a prop, you're being creatively crippled...because it shows that you don't have the ingenuity available to do something else. (rev. 1038.) Jack Valenti, president, Motion Picture Assn. of America, 6/16 Phila.. Tape 1, side 1.

-282- S M O K I N G T R E N D S Now that the girls have caught up with the boys, I suspect that they will no longer continue to increase at the rate that they have had in the past. Daniel Horn, Director, NCSH, 3/22 LA Tape 6, Rev. 289. What we have had is really a turnaround in the phenomenon that was taking place up to the year 1953, in which smoking was a rapidly growing habit and that has now changed to where we have had some stability, a constantly reducing proportion of smokers in the general population and even a stabili- zation of the total number of smokers. Daniel Horn, Director, NCSH, 3/22 LA Tape 6, Rev. 291. In 1977 we actually have fewer teenagers than we had last year and each year from now on we are going to have fewer teenagers than the year before. As a result, this is one case where we don't have to go so fast just to stay in the same place. If we can hold the line at the current level of 20 percent of teenagers smoking ages 13 to 19 by 1982 there will be 630,000 fewer smokers among teenagers than there are today. So that what we can say is that if we make no progress we're still going to have fewer smokers among the teenagers and this is the exact reverse of the problem we've been faced with. Daniel Horn, Director, NCSH, 3/22 LA Tape 6, Rev. 345. Most people simply don't want to stop smoking and stopping smoking is inconsistent with their style of life. Professor Salvadore V. Zagona, as cited by ACS LA Film, 3/22 LA. People do want to quit smoking, even smokers, by way of polls conducted by the American Cancer Society, and others have indicated that the vast majority that want to quit smoking--they want to do something to protect their own health; and it is perfectly proper, I think, indeed a responsible role for government, to urge that kind of action upon people. Larry Agran, (attorney, Community Cancer Control), as cited by ACS LA Film, 3/22 LA. I For some reason or another the principals of the two high schools that I contacted last Friday, both of them brought up this problem. Whereas they'd been able to get the boys to cooperate pretty well and confine their smoking either to walking across the street or at least not be such a pest that other people could not get into the restrooms. In the case of the girls there seemed to be no effective way of carrying this out. This was the chief complaint ... This is not peculiar to those two schools. Sidney Ottman, Ph.D., Santa Barbara, California Congress of Parents and Teachers, 3/22 LA Tape 4, Rev. 437. X TIMN 288804

-283- SMOKING T R E N D S (page two) Concerning the parents of our students, 35% of our students' mothers are smoking more than 5 cigarettes per day. Fathers show a higher rate at 47%. Robert W. Wandberg, Health Dept. Chairman, Olson Junior High School, Bloomington, Minnesota, 5/25 Chicago, page 1. Major reductions in smoking will almost certainly be achieved only with the aid of many measures. Increased taxation on tobacco products, the elimination of subsidies to the tobacco industry, the banning of tobacco advertising in whole or part, the extension of non-smoking regulations into a larger array of public places - including an absolute ban on smoking anywhere on school premises. These and other steps should be regarded as a part of a total effort in which media campaigns will play an important but not exclusive role. Brendan A. Maher, Ph.D., Professor of Psychology of Personality and chairman, Dept. of Psychology & Social Relations, Harvard University, 6/2 Boston, p. 10. ...women seem to find it more difficult now to quit than ever. It appears that the three basic reasons most women smoke are also the same three reasons why they find it harder to quit. Social pressure is on women to be smart, thin, and liberated. A survey of female smokers showed that most women began smoking because it was "smart." They also indicated their desires to lose weight and combat tension as the other reasons they took up the habit. Walter Kloss, president, Mass. ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, pp. 4-5. If recent trends in smoking pattens(sic) continue, it won't be long before women smokers outnumber men. Men are quitting at a faster rate than are women at the present time. Walter Kloss, president, Mass ALA & Director, 5-Day Plan, New England Memorial Hosp., Stoneham, Mass., 6/2 Boston, p. 4. CONFIDENTIAL: TIMN 288805 MINNESOTA TOBACCO LITIGATION

-284- S M O K I N G T R E N D S (page three) Two hundred years ago, no one had ever heard of Kant, Hegel, Marx, Darwin, Freud, and Lenin. Some people today still wish we had not heard of them. But what have these people to do with teenage smoking? They all had a philosophy that was contradictive to absolute thinking. By these philo- sophies society became more permissive. People are becoming more and more confused about how to bring up their children. Kevin Young, high school student, Holland, New York, 6/16 Philadelphia, p. 5. In the adult population as a whole, that segment of the population where most smokers are, we have seen a dramatic decrease in the proportion who smoke cigarettes. In 1964, a little more than one-half of the adult men were cigarette smokers; by 1975, this proportion had dropped to under for`ty percent. The change among women, from a little over thirty percent to a little under thirty percent, was not so dramatic. Dorothy E. Green, consultant to NCI, (Ph.D.), Arlington, VA., 6/16 Philadelphia, p. 1. While the proportion of boys who-sm4ke has remained-fairly constant, smoking among girls has grown to where it equals that of boys. There is some indication that this growth rate has slowed down and may stop, now that the girls have caught up with the•boys. Dorothy E. Green, Ph.D., consultant to NCI, Arlington, VA., 6/16 Philadelphia, . pp. 2-3. A disturbing trend in our nation is the increase in smoking which is occuring within this older age group. Accompanying the increase has been a corresponding change in death rates. As smoking has increased among older women, for example, one can note steep climbs in death rates among the age groups 45 - 54 and 55 - 64. Alice Van Landingham, president, American Ass. of Retired Persons, Wash., D. C., 6/16 Philadelphia, p. 2. During the past ten years periodic surveys and evaluations have been made in conjunction with health education programs in the school systems of Erie County, New York...A measureable influence can be effected in the student body with approximately 2% reduction in smoking among regular smokers but a 50% reduction among casual smokers ... Fewer students are finding smoking habits to be desirable and an increasing number are not using cigarettes even on a trial basis. Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, p. 4. CONFIDENTIAL: TIMN 288806 MINNESOTA TOBACCO LITIGATION

-285- S M O K I N G T R E N D S (page four) About 25% of the students are soing to become regular smokers inspite (sic) of having an understanding of the hazardous aspects of the habit. Characteristics that typify these students other than smoking habits are those of poor grades, unstable families, financial problems and personality deficiencies. Ronald G. Vincent, M.D., Chief of Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., Philadelphia 6/16/77, pp. 4-5. What we discovered was that the very first cigarette smoking is usually a result of an attempt to model the slightly older peer...It's the 18- year-old girl who smokes who gets the 15-year-old girl who smokes to smoke. Bernard Mausner, Ph.D., prof. of Psych., Beaver College, Glenside, PA., Philadelphia 6/16/77, Reel 1, Side 2, rev. 446. Question: Dr. Horn, if you'll come back just a minute to Mr. Jonas' question about the younger age, I think you're familiar with the . Yankelovitch survey and you'll recall that one of the findings there was that 6 out of 10 of the girls ((unintelligible)) commenced before they were 13. Is this a reliable statistics? Horn: No. Daniel Horn, Director, NCSH, 3/22 IA, Tape 6, rev. 530. The men have been at 23 cigarettes a day since 1964. Women have increased from 17 to 19. That's not a great huge increase. No, they're not smoking more cigarettes. In fact, we did a little study back in 1970 which looked at whether ((if)) they reduced their tar level, they would increase -- You know, this is the thing we keep hearing: Oh, well if you decrease your tar level you'll smoke lot's more cigarettes. What we found was not a really simple answer. It went like this: If you went 'way down, like if you went from a 30 mg cigarette to a 10, yeah, you did increase. But if you decreased the tar level gradually, you smoked about the same number of cigarettes. So no, I don't think people are smoking more cigarettes. Dorothy Green, Ph.D., psychologist, consultant to NCI and former employee of NCSH, Arlington, Va., 6/16 Phila., Tape 1, side 1, rev. 277. (Asked what percent of Congressmen smoke) I would guess roughly 80 percent...That's my own rough guess. When I think each day of the members of Congress that I'm around and there's very few if any that are not smoking. Nick Joe Rahall,(D-W.Va.), U.S. Congress, Beckley, W. Va., 6/16 Phila., Tape 1, side 1, rev. 432. CONFIDENTIAL: TIMN 288807 MINNESOTA TOBACCO LITIGATION

-286- SMOKING TREND S (page five) I guess we might sum this up by saying I think we're speculating too much about smoking. I think we need to know exactly how many people do it, when they begin and the differences in different geographic areas and different population groups. It's not safe to extrapolate from one part of the country to another, one population group to another in problems this size. William Morton, prof. of environmental medicine, Univ. of Oregon, Eugene, Ore., 5/17 Seattle, Tape 1, side 1, rev. 1244. For example, between 1970 and 1975, the proportion of smokers who reported smoking cigarettes with a "tar" level of 20 mg. or more dropped from 55% to 20%. There was a corresponding drop in nicotine level. Dorothy E. Green, Ph.D., consultant to NCI, Arlington, Va., 6/16 Phila., p. 2. The percentage of smokers who do not participate in athletics is substantially higher than the percentage among those who do. The percentage of smokers is higher among students who do not participate in any school activities. (p. 2.) Every day about 3200 youngsters'between the age of 12 and 18 take up smoking. This adds well over a million new smokers each year. (p. 3.) Gene Bridges, Supervisor of Physical & Driver Education, Escambia County, Pensacola, Fla., 6/14 Atlanta. Chewing tobacco has, according to teenagers questioned recently, become more popular with young boys and represents the first step of endoctrination into the tobacco habit. Billy E. Gober, Ph.D., Chairman, Comprehensive Health Education Project, Ga. PTA Health Commission and health and physical education coordinator, DeKalb County School System, 6/14 Atlanta, p. 2. The sources ((for cigarettes for children)) varied from members of family to friends and even clerks who were told that they were buying for their parents or even some adult relatives; but, by far, the most said that their source of cigarettes was the coin operated vending machine. Carl Sturm, D.M.D., Louisville, Ky., 6/14 Atlanta, p. 2. The problem with smoking cigarettes seem to be greater with the whites ((students)) than with the blacks ((students)). This is contrary to the National figure for adults. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 13. CONFIDENTIAL: TIMN 288808 MINNESOTA TOBACCO LITIGATION

-287- SMOKING TREND S (pagesix) ...teenage girls are smoking more than teenage boys, approximately 39% for teenage girls and 31% for teenage boys. Patricia E. White, health educator, Clayton County Health Dept., Jonesboro, Ga., 6/14 Atlanta, p. 2. ' The finding of my ((survey of 130 students)) indicates that 6% of those students bought cigarettes while themsleves (sic) under the age of 18, from stores, and 7% bought from vending machines when under the age of 18. The rest got their supply from an older member of the family or by paying an older person to buy them. This explains the methods of obtaining tobacco in its different forms. Kevin Young, high school student, Holland, N.Y., 6/16 Phila., p. 3. CONFIDENTIAL: TIMN 288809 MINNESOTA TOBACCO LITIGATION

-288- S 0 C I A L U N A C C E P T A B I L I T Y I think this is a saying (("Those poor devils aren't going to make it and obviously I am")) that this is the thing that we have to in some way combat. It's human nature. You don't want to take away all the crutches. But this is what I think. I think also--as an aside--that the way to do this is to make it socially unacceptable. I think we've warned them probably all we can, but when they have to sit in the back of the bus, they think twice. When they have to go outside to smoke it's more effective in my estimation. Robert W. Jamplis, M.D., president, Calif. Division, ACS, Director, Palo ALto Medical Clinic, 3/22LA Tape 1, rev. 672-378. Now, I must inject that smoking is rapidly becoming an unacceptable behavior in our society. • Art Cole, as cited in the ACS LA Film, 3/22LA. In schools, from the first grade on up, these motives ((social disapproval and health aspects)) are very effective. George Crawford, Ph.D., Business Administration „ ACS anti-smoking program advocate, 3/22LA statement, p. 7. The romanticism and sophistication that surrounds the smoking of a ciga- rette should be replaced by a feeling of disgust for a filthy habit. Stanley Stein, pharmacist, Colo. Pharmacal Assn., 5/12 Denver, p. 4. I feel we need to make cigarettes as holism. socially unacceptable as alco- Dr. Robert Taylor, M.D., Cheyenne, Wyo., 5/12 Denver, p. 4. 3. For an effective quit smoking campaign we must pull out the stimulus controls that support social smoking. By that I mean that we must make smoking difficult and socially unacceptable. By stringent anti-smoking legislation we will motivate more and more smokers to quit or at least decrease their intake. We must lobby to make smoking rough. Dr. J. P. Herter, Clinical psychologist, Jackson Hole, Wyo., 5/12 Denver, p. 3. (2) No longer should the adult cigarette smokers be allowed a comfortable conscience when in the presence of impressionable youngsters. Charles A. LeMaistre, M.D., Chrm., ACS Texas Div. S tudy Comm. on Tobacco & Cancer, 5/12 Denver, p. 10. CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION TIMN 288810 4

-289- SOCIAL UNACCEPTAB IL ITY (page two) The principles guiding our adaptation of programs focus on the need for a long term, sustained effort to achieve through public under- standing a modification of the cigarette smoking habit. If a lessening of acceptance of the cigarette smoking habit can be achieved, the ' prospects for decreased taking up of the habit and for cessation of cigarette smoking are deemed brighter. Charles A.LeMaistre, M.D., Chrm., ACS Texas Div. Study Comm. on Tobacco & Cancer, 5/12 Denver, p. ? (said he thought social acceptability indicated the most significant aspect of the smoking problem). How do you reconcile the difference between the two rights in a democratic society -- the right of a person to smoke and the right of a nonsmoker to have nonpolluted air? It's a straight-out philosophical, social and political question. (said he-believed any reduc- tion in smoking would come about ultimately on the ground of moral beha- vior). It simply is not done by thoughtful, civilized persons. Dr. Merlin DuVal, Vice President, Univ. of Arizona Health Science Center, Tucson, former asst. secretary for HEW, NCSPP panelist, in interview with Denver Post's Joanne Ditmer, 5/18/77. The idea of all this is to make cigarette smoking socially less acceptable, sort of the way tobacco chewing is today--it's done not very much and it's not considered socially the in thing to do. And I think if our goal would be to make smoking of tobacco a similar kind of socially unacceptable thing that this would be useful. David B. Thomas, M.D., Dr. P.H.,`epidemiologist, Fred ~ Hutchinson Cancer Research Center, 5/17 Seattle,Tape 1, side 1, rev. 245. Smoking among youth is one of the most widespread "diseases" as I call it. Mahmood Ahmed, high school student, Beckley, West Virginia, 6/16 Philadelphia, p. 1. Smoking is a mal-adoptive way of dealing with personal, inter-personal and environmental stress. % Lewis R. Bigler, Director of Consultation & Education, Roswell Park Memorial Institute, Buffalo, New York, 6/16 Philadelphia, p. 10. Efforts at public education should attempt to create and reflect a negative social image for smokers. r Jonathan Fielding, M.D., Mass. Commissioner of Public .Health, 6/2 Boston, p. 6. CONFIDENTIAL: TIMN 288811 MINNESOTA TOBACCO LITIGATION

-290- SOCIAL U N A C C E P A T I B I L I T Y (pagethree) Portray the non-smoker as having all the characteristic qualities the cigarette ad models depict...plus the pride, determination and independence not to smoke. Portray the smoker as an outcast of society. Ann H. Dailey, vice-president, Torrieri-Myers Adver- tising, Inc., Baltimore, Maryland, 6/16 Philadelphia, p. 13. People who smoke have always come across to me as lacking-one or more of three things: intelligence, self discipline, or self pride. John Dean, high school student, Mamaroneck, New York, 6/16 Philadelphia, p. 1. I believe that now is the time to begin waging this all-out war on tobacco. Its time has come. Leonard Bachman, M.D., PA Sec. of Health, 6/16 Philadelphia, p. 5. ...the Federal government must take the initiative in'stripping away what remains of the aura of desirability of smoking. Leonard Bachman, M.D., PA Sec. of Health, 6/16 Philadelphia, p. 8. 2f, in any given population group, smoking is regarded as an acceptable social habit, such a habit can be eradicated much like the disappearance of the spittoon from the Waldorf Astoria, once this habit is no longer acceptable to the society. The principal thrust of our educational efforts, therefore, should be directed towards the unattractiveness and/or unacceptability of the smoking habit rather than the continued emphasis on its adverse health effects. Z O M [-+ Ernst L. Wynder, M.D., Naylor Dana institute for Disease Prevention and the Health Maintenance Institute, American_Healtlh Foundation, :6/16 Philadelphia, p. 4. The problem of smoking teenagers must be approached as one part of an !~ undesireable (sic) habit pattern which also involves alcohol, marijuana, and N ~ O rebellion. J. Mostyn Davis, M.D., P.C., Shamokin, PA, 6/16 Philadelphia, p. 6. ~ ~ Properly developed and implemented educational programs can very signifi- cantly and positively change children's attitudes towar.d smoking -- from O O 00 O ~ social acceptance to complete rejection and social unacceptability -- from the fourth through the seventh grades. Studies in Colorado schools between 1967 and 1970 fully verified this observation. Very marked attitudinal changes resulted from just one year of proper utilization of a standard curriculum guide covering the health hazards of smoking. N 9 H Ray G. Cowley, M. D., Director, Missouri State Chest Hospital, Mount Vernon. Mo.. 5/19 St- 7.m,; Q m- ,

S 0 C I A L U N A C C E P T A B I L I T Y (page f our ) They should regard the habit as dirty, degrading and deadly. Roger Secker-Walker, Director of the Pulmonary Division,"Dept. of Internal Medicine, St. Louis University School of Medicine, 5/19 St. Louis, Tape 2, side 1, rev. 375. ...cigarette smoking is one of a group of maladaptive behaviors with similar characteristics. They all involve activities whose gains, both short-term and long-range, arise from the basic values of our society. They all create costs which are tragically great. If we could solve the problem of cigarette smoking, we might be able to apply the solution to an attack on the attachment of Americans to the automobile, to reduction of the abuse of alcohol, to the elimina- tion of private firearms. Bernard Mausner, Ph.D., Professor of Psychology, 6/16 Philadelphia, p. 5. ...themes should be emphasized of the positive aspects of enjoying freedom from a cigarette, that it is youthful, attractive and sexy not to smoke. Christine Caffrey, student, ACS volunteer, Edina, Minnesota, 5/25 Chicago, page 4. Some people now compare an ashtray to a spitoon (si.c) - smoking is slowly becoming socially unacceptable. Patricia S. Stearns, Chairman, Alliance of Non-Smokers, Chicago, I11., 5125 Chicago, page 4. We must make.smoking the aberrant behavior, not nonsmoking. We need not no-smoking sections. 'We need smoking sections, to show that in fact normal behavior dictates that people shouldn't smoke and aberrant behavior is that of the smoker. Jonathan Fielding, M.D., Massachusetts Commissioner of Public Health; 6/2 Boston, Tape 1, side 1, rev. 121. It's just a constant pounding away in the various media -- TV, radio, newspapers -- and just making it to the point that anyone who smokes feels embarrassed to do so. A. Marshall Smith, M.D., Head, Respir$tory Medicine Seotion, Eastern Maine Medical Center, Bangor, Me.; 6/2 Boston, Tape 2, side 1, rev. 289. TIMN 288813 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION

-292- S O C I A L U N A C C E P T A B I L I T Y (page five) Themes and appeals to be employed in the activity will include appeals to the individual to live (life wish), that smoking is anti social, smoking is waste of money, authorities against smoking among all group interest s and interests groups (sic). E. L. Bernays, retired PR consultant, Boston 6/2/77, p. 3. Have well known hostesses and prestige women state they will refuse to serve cigarettes to their guests. E. L. Bernays, retired PR consultant, Boston 6/2/77, p. 4. A dramatic conscious-raising activity has been two massive poster blitzes of the campus. Creative posters supplied by the American Cancer Society as well as orginial (sic) psoters (sic) and information sheets were placed in virtually every classroom and general use bulletin board...There were two performance measures of this activity. Grafitti on the posters indi- cated that to a large inumber of students our message was unclear. Res- ponse was emotional and S.O.S. was accused of being "health fascists", "dictators of morals" and "petty and ridiculous". There was also much anti-smoking grafitti equally as emotional. There can be no doubt that the posters served to raise consciousness about the smoking issue. Vandalism was another indicator of effectiveness since many posters were removed. It is assumed that since the staples were meticulously removed and no tell-tale torn corners remained on the bulletin boards, that the posters were removed for souvenirs by persons sympathetic to the message. Keith Colonna, president, Students Opposed to Smoking, Virginia Commonwealth Univ., state-owned, Richmond, VA., Philadelphia 6/16/77, pp. 9-10. ...unfortunately, too many adults still consider smoking socially acceptable... Fred G.,Field, Jr., N.Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., Philadelphia 6/16/77, p. 8. We believe that the key to success in this whole area has to rely on the social acceptance, the social pressures. William Sederberg, Ph.D., director of research, program section, Mich. House of Reps. GOP Caucus, and president, Mich. Lung Assn., 5/25 Chicago, Tape 1, side 2, rev. 35. ...it seems to me that a very, very high priority ought to be placed on a search for ways of making nonsmoking attractive to people so that the general cultural drag, which we can't really fight, can be overcome. Bernard Mausner, Ph.D., professor of psychology, Beaver Coll., Glenside, Pa., 6/16 Phila., Tape 1, side 2, rev. 119. CONFIDENTIAL: TIMN 288814 MINNESOTA TOBACCO LITIGATION

-293- SOC IAL UNACCEPTAB IL ITY (pagesix) ((Smoking is being shown less in movies)), not because of any concerted effort on the part of Hollywood people to follow the precepts of the ACS -- but simply because people who construct programs on TV and movies for the theaters are following what is a trend in America today. And the trend is that smoking is no longer considered the thing to do. It is not fashion- able any more. Jack Valenti, president, Motion Picture Assn. of America, 6/16 Phila., Tape 1, side 1, rev. 966. Our groups have been very successful and why have we been successful? We've been hitting the very bed rock that smoking's been based on. We have been reversing the image of the smoker from a chic, socially acceptable sex symbol that the tobacco industry portrays them as to the dangerous public nuisances that they are. Roger Setters, Pres., Louisville Chapter, GASP, Louisville, Ky., 6/14 Atlanta, Tape 1, side 1, rev. 268. Our message must be grounded in a framework that solidifies confidence of the nonsmoker in resisting the temptations to be swallowed up in the aura of "everyone is doing it, so it must be right" philosophy. R Bruce Dunlap, Ph.D., Dept. of Chemistry, Univ. of S.C., Columbia, S.C., 6/14 Atlanta, p. 4. Social pressure will be the best means of.breaking the increase experienced in our youth, especially with girls, in smoking. Billy E. Gober, Ph.D., Chairman, Comprehensive Health Education Project, Ga. PTA Health Commission and health and physical education coordinator, DeKa.lb County School System, 6/14 Atlanta, p. 2. The college athlete is very discreet with his smoking habits. The exposure of being known athletes and pressure from coaches and teammates seem to be the deterrent in the case of college athletes. Fred Herren, head football coach, Newberry College, Newberry, S.C., 6/14 Atlanta, p. 2. We have been extremely impressed in the past 5-6 years with the research data that has been accumulated and published on the danger to nonsmokers being in the presence of smokers. We have found that this is a far more effective way of compelling people to consider stopping smoking through their own conscience and through peer pressure from nonsmokers about them who don't want to be subjected to the same danger. W. C. Payne, Jr., M.D., P.A., general & thoracic surgeon, Pensacola, Fla., 6/14 Atlanta, p. 1. CONFIDENTIAL: TIMN 288815 MINNESOTA TOBACCO LITIGATION

SOCIAL UNACCEPTAB ILITY (page seven) -294- ...we are starting to reverse the media image of the tobacco smoker from the chic, socially-acceptable sex symbol to that of the dangerous public nuisance that he is. (p. 4.) Don't be hesitant about using tactics such as slogans like "Kissing a smoker is like licking out a dirty old ashtray." Time and time again the tobacco industry has proven that this type of stuff works. They would not have been able to fight you and make all the money if it didn't work. (p. 6.) Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta. It is quite clear now that the problem is primarily a behavioural one, and one which must be approached in the areas of social acceptability. Essentially the conflict lies in the sphere of opposing social influences which determine personal and community behavioural norms. Norman C. Delarue, M.D., quoted by Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 5. At this point I am going to tell you about the boy who spat in the face of his friend: The boy was arrested for disorderly conduct and charged with spitting in the face of one of his friends. The judge asked him what happened. He said, "I spat in my friend's face because of the fact that I have had to endure his smoking for all of these years and I thought it was time for my friend to endure my alcoholic saliva." After this confession, the judge excused him. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 13. Advertising around the world has associated smoking with attractiveness, sexi- ness, youth, the well dressed, . people enjoying themselves and of all things health. Some of the best advertising minds have projected these positive images to the public. Not only this, smoking has been made a socially acceptable habit:: Smoking education must be approached from several different avenues. One of which is to make smoking socially unacceptable to the public (sic) particularly children. Patricia E. White, health educator, Clayton County Health Dept., Jonesboro, Ga., 6/14 Atlanta, p. 2. ...in 1940, prior to World War I, in one of the dormitories -- where smoking was banned, by the way -- a person was caught smoking and the fellow students hauled the person out of the dormitory and physically carried him to the river that went through the Michigan State campus and dumped him in the river. Now this kind of social pressure I think is what's really needed to convince people not to smoke and to convince people that it's less cool to smoke than it is to be a nonsmoker. William Sederberg, Ph.D., director of research, program sec- tion, Mich. House of Reps. GOP Caucus, and president, Mich. Lung Assn., 5/25 Chicago, Tape 1, side 2, rev. 287. CONFIDENTIAL: TIMN 288816 MINNESOTA TOBACCO LITIGATION

-295- TAR, NICOTINE & CARBON MONOXIDE Asswe are all aware, the new brand, NOW, is claiming only one milligram of tar and .1 milligram of nicotine in each cigarette. If one brand can do it, all can, possibly even to the total elimination of tar, nicotine and gases. Melvin A. Jensen, LA advertising agency executive, Mormon spokesman, 3/22LA statement, p. 4. Suppose you reduce the nicotine, which is the addicting substance. Let's say the person then starts inhaling more. If you reduce the nicotine alone and you start to inhale more, you'll absorb more carbon monoxide. And so you have a problem there. Wilbert S. Aronow, M.D., cardiovascular specialist, Long Beach VA Hospital, 3/22LA statement, tape 3, rev. 638. Again...it just stood out like a logical monolith that if chewing hot tar caused cancer, then smoking hot tar could do the same. Earl B. Flanagan, M.D., Carlsbad, N.M., 5/12 Denver, p. 2. One year ago a Wyoming newspaper ran an article concerning the huge numbers of one vehicle accidents involving 4-wheel drive pick-ups. 'They concluded that the reasons for this was the fact that 4-wheel drive pick-ups sit higher than a normal vehicle and this makes them unstable and must be the reason they tip over on the highways. I believe these accidents relate_to carbon monoxide in a small tight cab. We know that one part of carbon monoxide in 400 parts of oxygen results in the carbon monoxide being absorbed selectively over the oxygen. A small amount of carbon'monoxide could cause drowsiness which could contribute to the accident. The effects of carbon monoxide are greatly magnified due to the altitude of most of the state of Wyoming which is over the 6,000 foot level. I believe that this theory needs further investigation and study. Dr. Robert Taylor, M.D., Cheyenne, Wyo., 5/12 Denver, pp.5-6. If an athlete thinks that he can smoke cigarettes and still perform to the best of his ability, then he is leading himself into an evil habit. Smoking cigarettes denies the body of a sufficient amount of oxygen, because the tar builds up inside your lungs. David J. Yasgur, high school student, Mama.roneck, New York, 6/16 Philadelphia, p. 1. CONFIDENTIAL: TIMN 288817 MINNESOTA TOBACCO LITIGATION

-296- TAR, NI COTINE & CARBON MONOXIDE (page two) " he~fU.S. are of the low'tar and y ~ _. ,., - . ~a_ _ ~.__ l er in t ._ cenaage? _ _- _ _.~ __ ------ - nicotineltype.15Howfdo wec g increase3tiie p I feel that there are two ways in which we can accomplish this purpose. The first way is to give the Food and Drug Administration the authority to regulate tobacco, and the second is through a federal excise tax based on tar and nicotine content. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 5. An alternative approach to controlling tar and nicotine content is the federal excise tax based upon tar and nicotine proposed by Senators Hart and Kennedy. Under 'this proposal, a graduated tar and nicotine tax would encourage smokers to consider the additional risks of highly toxic cigar- .ettes and would provide an incentive for smokers to switch to less hazardous brands. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 6. Lower tar and nicotine cigarettes are good business for the tobacco industry. Competitive growth in the industry has taken place in those companies that' have been most successful in reducing the tar and nicotine contents of the cigarettes and in introducing new brands. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 3. Nicotine is a powerful stimulant and is clearly addictive, both pharma- cologically and psychologically. Ernest W. Johnson, M.D., Chairman, Dept. of Physical University, School of Me ic ne, Medicine, Ohio State Columbus, Ohio, 5/25 Chicago, page 2. If you're sitting in an enclosed car and two people are smoking, the carbon monoxide content goes up to 90 parts per million ... I'd like to see an analysis of the carbon monoxide content in cockpits of com- mercial airplanes. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 136-139. . . . Nicotine decreases libido. Alton Ochsner, M.D., founder of Ochsner Clinic, New Orleans; 5/12 Denver, Tape 1, rev. 207. CONFIDENTIAL: TIMN 288818 MINNESOTA TOBACCO LITIGATION

-297- T A R, N I C 0 T=I N E & C A R B 0 N M 0 N 0 X I D E (page three) There is no level of tobacco that is clearly in the interest of the general public health. Merlin DuVal, NCSPP panel member; 5/12 Denver, Tape 2, rev. 325. If you smoke a little over a pack of cigarettes a day every three months, you'll deposit about a half a pint of that tar in your lungs. We take .that same tar, paint it on the back of a mouse, and the mouse gets cancer. It's a carcinogenic agent. D. S. Bachman, M.D., Little Rock, Ark.; 5/12 Denver, Tape 4, rev. 143. Nicotine is the principal alkaloid of tobacco, and is effective as a contact insecticide for plants and control of insects on animals. Pure nicotine, C10H~~N2, is highly poisonous. Considering the problem of continued use of DDT and the ecology, it may be appropriate to study the potential usefulness and expanded application of nicotine in the fields of medical and veterinary entomology, and of agricultural and forest entomology xespectively. Contact poisons have been useful for controlling sucking insects and for killing adult flies, mosquitoes and similar flying species, and for destroying insects, eggs and pupae, perhaps there is a role for the tobacco industry to have a world-wide impact in major conversion effort to the production of insecticides. The effort to minimize such problems as malaria, world-wide, and to maximize food production, world-wide, are worthy objectives. John W. Turner, M.D., radiologist, Wesson Memorial Unit, Baystate Medical Center, Springfield, MASS., president, Mass. Div. ACS, 6/2 Boston, p. 2. For example, between 1970 and 1975, the proportion of smokers who reported smoking cigarettes with a "tar" level of 20 mg. or more dropped from 55% to 20%. There was a corresponding drop in nicotine level. These changes reflect the acceptance of the fact that cigarette smoking is harmful, and that some cigarettes are more hazardous than others. As people gain more knowledge of the effects of smoking, they take positive action on the basis of this knowledge. Dorothy E. Green, Ph.D., consultant to NCI, Arlington, Va.,6/16 Philadelphia, p. 2. CONFIDENTIAL: TIMN 288819 MINNESOTA TOBACCO LITIGATION

-298- TAR, N I C0T INE &-CARB 0N MONoX IDE (page four) I Vitami.n C in our diet may be high, but at the same time, there are many toxic substances which nulify(sic) its beneficial effects. Here is one report that may come as a shock. The eminent Dr. W. J. McCormick, who is a vitamin C specialist has determined by laboratory and clinical tests that "the smoking of one cigarette" reduces in the body approximately 25 mg. of vitamin C or the amount of one medium sized orange. it will thus be seen how difficult it is to meet the body requirements of the pack-a-day-smoker. A Dr. A. Borquin showed the effects of adding nicotine to the blood. An equal amount of nicotine to that inhaled by an average smoker in one day caused a reduction of vitamin C about 30%. Ernest M. Fidance, D.D.S., Wilmington, De., 6/16 Philadelphia, , p. 3. Medical evidence had made it increasingly clear that the risk of cancer from cigarette smoking increases with the amount of tar nicotine a smoker inhales. It is in fact, the presence of tars and nicotine in cigarette smoke which is responsible for most of the harmful effects of smoking. Nick Rahall, U. S. Congressman, (D-W. Va.), 6/16 Philadelphia, p. 2. Presumably the incidence of cancer of the lung should be reduced proportionately as the particulate phase of cigarette smoke is reduced. It is, however, by no means certain that the reduction of tar is the total answer to the cancer problem and that in all probability is not the answer to the cardiovascular and circulatory problems that are related to cigarette smoking. Ronald G. Vincent, M.D., Chief, Thoracic Surgery, Roswell Park Memorial inst., Buffalo, N.Y., 6/16 Philadelphia, p. 2. While the cigarette is changing, people's habits are also changing and there is also some evidence the type of lung cancer is changing. In a recent study completed at Roswell Park Memorial Institute, it was reported that patients who developed lung cancer since 1968 were more likely to be 2 pack a day smokers while patients who developed lung cancer prior to 1968 were more likely to be 1 pack a day smokers. The progressive re- duction of tar content of cigarette smoke during the past decade may account for the apparent need of increased exposure by smokers to cigarettes prior to the initiation of the lung tumor. Ronald G. Vincent, M.D., Chief, Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, PP• 2-3- It is also to be noted that as the tar is reduced in the cigarettes the pH range is increased. The more alkaline the cigarete smoke is the more rapidly the nicotine is absorbed. Whether or not this will result in additional physiological offenses is not at this time known. Ronald G. Vincent, M.D., Chief, Thoracic Surgery, Roswell Park Memorial Inst., Buffalo, N.Y., 6/16 Philadelphia, p- 3. TIMN 288820

-299- TAR, NI COT INE & CARBON MONOXIDE (page five) Incorporating all available techniques in cigarette manufacturing and assuming that none of the flavor additives induce additional toxic effects, we propose certain limits for smoke components for a less harmful cigarette. (Table IV) ((see p. 14 of his testimony)). Dietrich Hoffmann,Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., Philadelphia 6/16/77, p. 8. ...I'm all the way for graduated taxation. And I know that at least two in the tobacco industry who would not object to this. Dietrich Hoffmann,. Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., 6/16 Phila., Tape 2, side 2, rev. 877. Weingarten: As a professional pathologist and pharmacologist, would you have any difficulty in classifying nicotine as a drug...? Ryser: None whatever. It is discussed in the course of Pharmacology as a drug; it is actually a very important drug in pharmacology, because of its action on synapses. Weingarten: From a purely scientific point of view, would you have any problem with having it classified as a drug under the printed definition in the authority of the Food and Drug Administration? Ryser: No. I am very glad you raised the question. Because it is an extraordinary loophole and almost un-understandable state of affairs that ... cigarettes are not actually controlled by the same act that controlls the sale of drugs. Hugues J.-P. Ryser,M.D., Professor of Pathology and Pharma- cology, Boston Univ. School of Medicine, Boston, Mass., 6/2 Boston, Tape 1, side 1, rev. 513, East Room. There is no question in my mind that in my reading and my experience with patients that it is the nicotine that is addictive. I don't have any thought that the other components of the cigarette smoking have any real 'hang' to it type of hold on the smoker. I feel that it is the nicotine that is addictive. Laurence H. Bates, M.D., Meridian Medical, Indianapolis, Ind., 5/25 Chicago, Tape 2, side 2, rev. 270. Nicotine is basically a drug. It was in the U.S. Pharmacopeia up until 1906. Some of the people don't seem to know that it is an addicting drug. Ernest W. Johnson, M.D., Director of Physical Medicine, Ohio State Univ. School of Medicine, Columbus, Ohio, 5/25 Chicago, Tape 1, rev. 410. CONFIDENTIAL: TIIVIN 288821 MINNESOTA TOBACCO LITIGATION

TAR, NICOTINE & CARBON MONOXIDE (pagesix) -300- Our basic premise is that nicotine is a drug, and therefore we have incorpor- ated it into our department. George Browne, Commissioner, Dept. of Drug and Alcohol Addiction, Town of Hempstead, N.Y., 6/16 Phila., Tape 1, side 2, rev. 682. ...our data indicate...that using the mouse skin as a bioassay or using the larynx of a hamster, that the majority of carcinogens to epithitial tissue and that we have identified classical initiating carcinogens... We have identified tumor promotors ... and have identified ... tumor accelera- tors... In other words, we have shown much more in terms of a mechanistic answer to tobacco carcinogenesis than I'm sure we have to for many other agents. Ernst L. Wynder, M.D., President, Amer. Health Foundation, 6/16 Phila., Tape 1, side 2, rev.52-55. Room #3. You mentioned the toxic agents or nicotine is lower in the urine in the morning than it is at night. It's also in much larger amounts at cocktail parties, because alcohol acidifies your blood and nicotine is excreted much more readily from acidified urine and acidified blood. This has been one of the reasons posed why, potentially, people smoke more at cock- tail parties...because their nicotine level drops rather dramatically when they've had a drink or two. James E. Allen, M.D: pediatric surgeon, ACS volunteer, Snyder, N.Y., before NCSPP forum, 6/16 Phila., Tape 2, side 2, rev. 795. You can define ((low tar)) any way you want to...I define it as a tar level -- tar put in parenthesis, of course -- 19 and below ... Weingarten: Is there a scientific basis for... 19 or 20? Green: No. Itell you why I arrived at it... Back when I was smoking, there was a gap. Most cigarettes were 20 or more... And then the next ones were about 18, and I just took a nice break where the arithmetic came out. Dorothy Green, Ph.D., psychologist, consultant to NCI and former employee of NCSH, Arlington, Va., 6/16 Phila., Tape 1, side 1, rev. 210. ...where tar and nicotine...have been significantly reduced in the last 20 years, very roughly 50%, there is no...reduction of carbon monoxide. That has stayed as before, although there are ways to do it. Dietrich Hoffmann, American Health Foundation, Valhalla, N.Y., 6/16 Phila., Tape 2, side 2, rev. 936. CONFIDENTIAL: TIMN 288822 MINNESOTA TOBACCO LITIGATION

TAR, NI COTINE &. CARBON MONOXIDE (page seven) If you'll go to the tobacco industry tables on the pH ranges of their low tar and nicotine cigarettes,...you'll find that the alkalinity is increasing considerably with the reductions of tar. Now I don't mean to suggest that this would cause a different loading dose; what I do suggest is that the rate of absorption will increase much more rapidly, giving the person a greater jolt with the nicotine at an earlier possible moment in the cigarette smoking. This is like enriching the fuel mix- ture of a racing car; it's something you tolerate temporarily fairly well, but not over the long haul. So, it's a matter of concern, but it's not completely worked out yet. Ronald G. Vincent, M.D., chief of thoracic surgery, Roswell Park Memorial Inst. and former pres., Erie Country ACS Unit, Buffalo, N.Y., 6/16 Phila., Tape 2, side 1, rev. 579. ... it is my hypothesis that nicotine probably plays a key role in sudden death through ventricular atthythmia but not in arteriosclerosis. And next now we gotta determine if it does play a key role. And let's say it does this at 1.2 mg but not a .6 mg, then this we need to know because then, for terms of arteriosclerosis, for sudden death the safety limit would be .6. I don't say it is, but I'm giving an example... (rev. 1106.) Carbon monoxide, we gotta come to grips with the fact: Does CO play a role in arteriosclerosis? It certainly works in rabbits, but there's considerable doubt whether it works in man. (rev. 1110.) Ernst Wynder, M.D., president, Amer. Health Foundation, New York, N.Y., 6/16 Phila., Tape 1, side 2. Room #1. Great efforts are being expended to lower cigarette tar/nicotine content, however, we hear little about super heated air smokers inhale. Even if a no tar/nicotine cigarette were possible, smokers would still be affected by the inhaled hot air. Israel Cohen, President, WCAP, Lowell, Mass., 6/2 Boston, p. 2. CONFIDENTIAL: TIMN 288823 MINNESOTA TOBACCO LITIGATION

-302- T A X E S In "Modification of Smoking Rehavior: An Evaluative Review" dated 1969, Douglas Bernstein adds to the above-mentioned methods of smoking cessation the results of anti-smoking legislation, tobacco taxation and anti-smoking campaigns. He states, "There is little evidence at present that selective bans and health warnings on cigarette packs are effective in curtailing the continuing increase in cigarette consumption." In Great Britain where tobacco taxes have steadily increased since 1962, there is no measurable change in the behavior of that country's smokers." Douglas Bernstein as quoted by Ann Hammond, Executive Dir., Health Education Center, Palo Alto, Calif., 3/22 LA statement p. 2. A public policy also needs to be defined on the uses of funds derived from taxing tobacco products. Should they be earmarked for smoking education, control, and research? Should public policy lead to consumption control through taxation? Dale Houghland, chairman, Calif. Interagency Council on Smoking and Health, 3/22 LA statement, pp. 2-3. One way to raise money for smoking cessation is to tax 40 billion packs of cigarettes smokers use each year 1 cent tax per pack. This would raise $400,000,000 per year which could be used for mass media smoking cessation programs. Ann Hammond, Executive Dir., Health Education Center, Palo Alto, Calif., 3/22 LA statement, p. 6. I believe we must encourage and support federal legislation that w+ould require the United States Government to: 3. Substantially increase the federal tax on cigarettes and use the excess revenue to cover the subsidies proposed for farmers who switch crops. Such a tax increase can be expected to decrease cigarette consumption and recruitment, particularly among the young. Elfriede Fasal, M.D., Chief, Cancer Control Unit, Calif., Dept. of Health, 3/22 LA statement, p. 3. Recommendations: ... 6. States should be encouraged to use a portion of cigarette tax revenues for health education on nonsmoking, for mass media advertising, for smoking cessation clinics, and for research into the development of effective treatment programs. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, Calif. Dept. of Health, 3/22 LA statement, p. 14. CONFIDENTIAL: ~ZIl~TriE5OTA TOBACCO LITIGATYON TIMN 288824

T AX E S (page two) There have been studies that have shown that if the tax is quite a bit higher--it really does have to be a substantial increase--it will have an effect on--particularly young people who cannot afford the cigarettes. Elfriede Fasal, Chief, Cancer Control Unit, Chronic Disease Control Section, California Dept. of Health, 3/22LA Tape 4, Rev. 224. As a matter of reducing cigarette consumption by way of a tax increase, a one-cent per pack increase had a negligible impact of cigarette con- sumption in and of itself. But it does seem to me that with respect to alcohol abuse and with respect to the abuse of tobacco--or the use of tobacco--that funding programs to combat these very costly individual decisions should appropriately come from a user tax. Larry Agran, attorney, UCLA law instructor, director of NCI-funded History of Cancer Control Project, 3/22LA Tape 3, rev. 447. ((Cigarette bootlegging)) is a serious program on the East Coast, where you have close state borders--six states could be bordering on one another--and disparities in tax render it sometimes very profitable to cross state lines, to load up your automobile and move across state lines and black market the cigarettes, gray market the cigarettes. Larry Agran, attorney, UCLA law instructor, director of NCI-funded History of Cancer Control Project, 3/22LA Tape 3, rev. 455. 4. Tobacco farmers should be penalized by a severe tax for raising the tobacco leaf and subsidized generously for raising substitute crops. 5. An extreme tax of a dollar per pack should be levied against every cigarette purchaser. Stanley Stein, pharmacist, Colorado Pharmacal Assn:, 5/12 Deaver, p. 3. (RE: Colorado Tar Tax Bill on Cigarettes:) We proposed no tax increase on cigarettes with less than 10 milligrams of tar per cigarette...10 cents additional tax on cigarettes falling in the 10-20 milligram range...and 20 cents more per pack for those with more than 20 milligrams of tar... We're not hopeful about the bill's passage this year...One major hurdle is that our legislatorsswant to use the cigarette tax to replace the property tax. Anthony Robbins, M.D., Exec. Director, Colorado Dept. of Health, 5/12 Denver, p. 4. CONFIDENTIAL: TIMN 288825 MINNESOTA TOBACCO LITIGATION

T A X E S (page three) I recommend a CIGARETTE MORBIDITY TAX SCHEDULE AS PART OF OUR NATIONAL HEALTH INSURANCE SYSTEM. This would apply at both a federal and state level. A retroactive tax would be assessed against the cigarette industry on the basis of the costs of cigarette-caused diseases to all of the citi- zenry of the U.S. The costs would be a combination of those paid by Medicare, Medicaid, Veterans Administration hospitals, Eleemosynary health care centers, etc., for care of patients with disease that can be related directly to cigarettes in causation...Rather it would utilize existing and ongoing preventive medicine, health statistics, and health cost capa- bilities of the government. These would calculate the costs in the latter part of any given year. Costs covering the year 1979 would be calculated in 1980 with the tax payable in 1981 and prorated to the industry on the basis of cigarette sales. Dr. Paul Kotin, medical 5/12 Denver,{ pp. 7-8. - _ _.~.~ ...... director, Johns-Manville, While restrictive measures, such as increased taxes and laws limiting legal smoking, may be effective, care should be taken that they not be implemented in a manner likely to provoke black markets, open defiance or other forms of subversion. Such reactions may negate particular measures as they tend to undermine the authority and respect of the campaign of which a given measure may be a component. Edwin B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology &lecturer in Psych. and Law, Washington Univ., 5/19 St. Louis_,~ p. 13. For instance, setting life, auto and health insurance rates to provide economic incentives for not smoking can be continued and enlarged perhaps to include incentives for the control of other tax incentives to com- panies which employ such procedures and, in other ways, promote healthy lifestyles among their customers and employees. The government might, itself, provide incentives, perhaps through tax rebates, for individuals who act responsibly for their health. 31 E. B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ., St. Louis, Missouri, 5/19 St. Louis, p. 1. Government contracts, tax incentives, federal grants and aid are all powerful incentives which can be manipulated to increase activities of the private sector and of state and local governments to encourage not smoking. For instance, the practice of life and auto insurance premium reductions for non smokers could be encouraged and, thereby, expanded by tax incentives for corporations which implement such practices. Similarly, innovative state and local programs which encourage non smoking and other healthy behaviors might be encouraged through appropriate revenue sharing policies. It could be established that private carriers or a national health insurance system would provide lower premiums or a lower deductible amount for non smokers and those_who control other voluntary risk factors, such as obesity. E. B. Fisher, Jr., Ph.D., Asst. Prof. of Psychology & Lecturer in psych. and Law, Washington Univ., St. Louis, Missouri, 5/19 St. Louis, pp. 12-13. TIMN 288826

-305- T A X E S (page four) Employers should be encouraged to support or sponsor smoking cessation methods for their employees and the costs should be partially deductible from their income tax. Jerome L. Schwartz, M.D., Ph.D., Chief, Health Care Research, CA. Dept. of Health, TI "Target 5" film, ACS LA speakers, p. 15. One is that I'm not going to press my bill to increase the Missouri cigarette tax on high nicotine cigarettes which I filed the first of this year. A subsequent poll shows that only 43 percent of my constitu- ents favor this proposal... The cigarette tax finished first in increases, beating out even liquor and corporate income taxes. Seventy-three percent of the people wanted increase, 4 percent decrease and 23 percent no change. I feel that I would represent my constituents best by working for the same higher tax on all cigarettes. Missouri State Rep. Carl H. Muckler, 5/19 St. Louis, Tape 3, side 1. An alternative approach to controlling tar and nicotine content is the federal excise tax based upon tar and nicotine proposed by Senators Hart and Kennedy. Under this proposal, a graduated tar and nicotine tax would encourage smokers to consider the additional risks of highly toxic ciga- rettes and would provide an incentive for smokers to switch to less hazard- ous brands. Senator Birch Bayh (D.-Ind.), 5/25 Chicago, page 6. Place these enormous costs -- multiple billions -- on the smoker rather than on the citizen-at-large, through: Higher medical insurance premiums; Higher life insurance premiums; Higher disability insurance premiums; Higher Social Security premiums; Higher cigarette taxes-possibly triple David A. Penner, M.D., Thoracic and Cardiovascular Surgeon, Detroit, Michigan, 5/25 Chicago, page 3. ~ State and federal governments receive money from tax receipts on tobacco and tobacco products. It is interesting to ngte that in 1975, there was almost $6 billion collected from these taxes, yet over $11.5 billion spent on smoking related health care costs. Shouldn't the revenue from such taxes be available for research and treatment in tobacco related health problems? Douglas S. Lloyd, M.D., Conn. Commissioner of Health, 6/2 Boston, p. 3. TIMN 288827

-306- T A X E S (page five) There should be imposed an annual ten-cent per pack increase in the federal tax on cigarettes over each of the next ten years. Less severe tax penalties should be placed on all other forms of tobacco. Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, pages 1 and 2. ((Increased taxes)) would price the product out of range for many young people not yet addicted. It would provide for gradual dismemberment of the tobacco industry. Arthur Weaver, M.D., Northville, Michigan, 5/25 Chicago, page 3. President Carter has launched a program to cut down hospital costs. Get him to include a policy that smokers pay for those $4 billions. Impose a special dedicated tax on cigarettes which will funnel that $4 billion and more into those medical budgets; and which will take a $4 billion load off the backs of most non-smokers. T---- - _ Bill Caldwell, newspaper editor & larynx cancer victim, Damariscotta, Maine, 6/2 Boston, p. 5. Although I am primarily interested in discussing state and local controls on smoking, I think there is one area, taxation, that should be federalized. Varying prices of cigarettes because of different state or local tax rates, has led to making bootlegging low-tax cigarettes into high-tax states a very profitable venture, particularly for organized crime. James A. Swomley, State Assemblyman & Executive Director, Conn. Lung Association,6/2 Boston, p. 3. I do not think that a uniform federal tax necessarily should preempt the state's power to impose additional tax. Presumably what a uniform federal tax would achieve is minimization of the differential between tax rates so that smuggling would not be profitable. James A. Swomley, State Assemblyman & Executive Director, Conn. Lung Association, 6/2 Boston, p. 3. If a tax of 27 cents per pack were levied ((in Massachusetts)) and utilized to cover health care expenses, the cost of health care for all nonsmokers would decrease by 5%. Such a tax would save $29 a year for every nonsmoker or $116 for every family of four nonsmokers. Blake Cady, M.D., surgeon, Lahey Clinic, Boston, MASS., 6/2 Boston, pp. 5-6. CONFIDENTIAL: TIMN 288828 MINNESOTA TOBACCO LITIGATION

-307- T A X E S (page six) Another way the industry can be provoked into debate will be threat of a very high luxury tax. Such a tax should be at the federal level to minimize problems of bootlegging. A stiff tax, (a dollar or a dollar and one half per pack) would help to price cigarettes out of the reach of many school children. Richard H. Overholt, M.D., thoracic surgeon, Dedham, Mass., 6/2 Phila., p. 3. The tobacco industry has demonstrated that the technology exists to produce less harmful cigarettes and to sell them at a profit. It remains for the Federal Government to provide an economic incentive for consumers to switch to these less toxic brands. The most appropriate mechnism (sic) for such an incentive, is the Federal excise tax on cigarettes... Nick Joe Rahall, U.S. Congressman (D-W.Va.), 6/16 Phila., p. 3. On one hand we have the forces of the economy lined up against us reminding us that cigarette tax money supports a lot of government and on the other hand we have the medical profession telling us that cigarettes are killing us by the hundreds of thousands. Fred G. Field, Jr., N.Y. State Assemblyman, member of board of directors,N.Y. ACS Div., Albany, N.Y., 6/16 Phila., p. 2. We are also studying a proposal that would allocate one percent of our state's annual cigarette and alcohol tax revenues for the funding'of increased anti-drug and tobacco instructional efforts in our schools. More than $5 million would thereby be made available for educational programs. Fred G. Field, Jr., N.Y. State Assemblyman, member of board of directors, N.Y. ACS Div., Albany, N.Y., 6/16 Phila., p. 9. z ...we could have a shift in the concept of taxation of cigarettes, so that the H revenue collected would pay for the health cost of smoking. Instead of the ~ money going into the general treasury as now occurs let the money go to the DATW for reimbursement for Medicare and Medicaid or for whatever the appropriate ~ cost is which I'm sure could be actuary or computed to support the care of patients a with various diseases that result and for the support of research into cancer and ~ heart disease. If properly articulated, then one can give to such an idea an ~~ appeal of equity to the taxpayers that doesn't infringe on constitutional free ~ choice issues and in line with some of the other principles of the insurance Q~ industry and so on that we are used to seeing. 0 ~ I 0 ly J. Richard Crout, M.D., Director, Bur. of Drugs, Fed. Food & Drug Adm., 6/16 Phila., Room #3, Tape 1. ...I'm all the way for graduated taxation. And I know that at least two in the tobacco industry who would not object to this. Dietrich Hoffmann, Naylor Dana Inst., American Health Foundation, Valhalla, N.Y., 6/16 Phila., Tape 2, side 2, rev. 877. TIMN 288829

-308- T A X E S (pagL-`seven) We know that people are smoking more cigarettes because every state reports higher tax revenues from the sales of cigarettes.' Indeed, we ((New York)) are very much concerned over the $100,000,000 in tax revenue we are losing to cigarette smugglers. Fred G. Field, Jr., N.Y. State Assemblyman, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., Philadelphia 6/16/77, p. 1. There was more legislation ((in N.Y. State this session)) introduced regarding the possible evasion of paying the cigarette tax than there was in doing something about educating children not to smoke. Once more the almighty dollar reigns supreme. Fred G. Field, Jr., N.Y. State Assemblymen, member of bd. of directors, ACS N.Y. Div., Albany, N.Y., Philadelphia 6/16/77, p. 3. High tar and nicotine cigarettes should have a very prohibitive tax and low tar and nicotine cigarettes less tax because they are less dangerous, not that they are safe. David T. Carr, M.D., Assoc. Director for Cancer Control, Mayo Comprehensive Cancer Center, Rochester, Minn., 5/25 Chicago, Tape 1, rev. 395. I don't think that the graduated tax proposal of Kennedy and Hart is a good idea...it may lead to two things that would backfire, which I am sure you know. One is, of course, it's not very progressive for lower- income people; it discriminates against them. And second, the styles of smoking are incredibly important in terms of the risks that are involved. Kenneth M. Friedman, Ph.D., Asst. Professor, Dept. of Political Science, Purdue Univ., West Lafayette, Ind., 5/25 Chicago, Tape 2, rev. 72. ((Questioned about the impact of increased taxation on cigarette consumption))... I've noticed that every time the cost of cigarettes went up, I don't think it slowed down any smokers. Joseph Rizzo, Phila. Fire Commissioner, 6/16 Phila., Tape 1, side 1, rev. 927. ...we have data to indicate that taxes are a deterrent. Leonard Bachman, M.D., Pa. Secy. of Health, 6/16 Phila., Tape 1, side 1, rev. 27. The search for the "so called" safe cigarette should be pursued but certainly not without at least an equal dollar commitment from the Tobacco Industry. Again, taxes from the sale of cigarettes could be made available for this purpose. Jonathan Fielding, M.D., Mass. Commissioner of Public Health, 6/2 Boston, p. 7. CONFIDENTIAL: TIMN 288830 MINNESOTA TOBACCO LITIGATION

-309- T A X E S (page eight) (Asked if there would be any sentiment in the Congress for an increased federal tax on cigarettes to discourage anti-bootlegging measure, with a rebate to the states) I would hope there would be. I can't really say, though, just what the overall feeling is...This is the first time it's been brought to my attention. Nick Joe Rahall,(D-W. Va.), U.S. Congress, Beckley, W. Va., 6/16 Phila., Tape 1, side 1, rev. 476. I'm against smoking. But more than that, I am against the government getting involved in anything that's not a government function. I think this includes putting taxes on tobacco...Taxes should be levied to finance the government and should not be levied to control smoking, energy consumption, inflation or whatever. I think in many cases the government has used taxes to control various things, yet I know of no case where it's done much good, if any good. (rev. unknown.) Yank Dean, President, Allied Sports, Co., Eufaula, Ala., 6/14 Atlanta Tape 1, side 1. (Asked if he thought you drive an addicting substance out of the market by increasing its price) I don't think you can...it will have some effect on people if you drive up the cost of tobacco but what the psychodynamics of it happen to be, I don't know. Hoke Wammock, M.D., Enoch Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, Tape 1, side 2, rev. 106. We have a committee called the Georgia Cancer Management Network...This committee discussed a recommendation to a'sk the legislature to add to the cigarette tax money, earmarking it specifically for anti-smoking, anti-cancer activities. There's a philosophical problem here. Even those against smoking and willing to do something about cancer, they don't feel, some of them, that this is the democratic American way to go. Joe Wilbur, Ph.D., Director,of Young Adults Program, Div. of Phys. Health, Ga. Dept. of Human Resources, Atlanta, Ga., 6/14 Atlanta, Tape 1, side 1, rev. 107. ...I do think the next step in the State of Colorado is probably going to be a zinger of a tax on tar content. Harvey Phelps, M.D., State Senator, Pueblo, Colo., 5/12 Denver, Tape 2, rev. 126. Taxation on producing tobacco; make it very unprofitable to grow tobacco. Hoke Wammock, M.D. E och Callaway Cancer Clinic, LaGrange, Ga., 6/14 Atlanta, p. 20. CONFIDENTIAL: TIMN 288831 MINNESOTA TOBACCO LITIGATION

-310- W A R N I N G L A B E L In "Modification of Smoking Behavior: An Evaluative Review" dated 1969, Douglas Bernstein adds to the above-mentioned methods of smoking cessation the results of anti-smoking legislation, tobacco taxation and anti-smoking campaigns. He states, "There is little evidence at present that selective bans and health warnings on cigarette packs are effective in curtailing the continuing increase in cigarette consumption." In Great Britain where tobacco taxes have steadily increased since 1962, there is no measurable change in the behavior of tha country's smokers." Douglas Bernstein as quoted by Ann Hammond, Executive Dir., Health Education Center, Palo Alto, Calif., 3/22LA state- ment, p. 2. I was always for a health warning and I was always unconcerned really about the level of strength in the health warning, partly because if a warning is too strong it becomes counterproductive...I would not see it as an important source of education. Daniel Horn, Director, NCSH, 3/22LA Tape 6, rev. 578. 2) Warnings on cigarette packages should be bigger and possibly in front of the package so that people can read or take notice of it. Whenever I see the small print on the side of a cigarette package, I am reminded of those contracts where one party hides a clause in very small print so that the other party will overlook it... 3) Warnings should be put on cigarette vending machines which are more apt to be read than is the fine print on a cigarette package. This will allow warnings to be bigger and therefore more noticeable... Lupe Zamarripa, Special Counsel, Texas Secretary of State, Austin, Texas, 5/12 Denver, p. 7. (RE: cultural and social values) B) The extreme energy devoted to environmental hazards such as speeding and prescription drugs and to listing toxins in consumer products and giving cancer_warnings in the_workplace has an almost reciprocal laxness and ennui in the warning against smoking. The ineffectiveness of the pallid warning is more eloquently demonstrated by its lack of impact on cigarette consumption than by any comments I might make. Dr. Paul Kotin, medical director, Johns-Manville, Denver, 5/12 Denver, p. 4 There should be an informative warning, not necessarily including specific diseases but rather generic classes of disease (e.g. cancer, cardiovascular (heart) disease, and chronic obstructive pulmonary disease (bronchitis). Dr. Paul Kotin, medical director, Johns-Manville, Denver, 5/12 Denver, p. 6. CONFIDENTIAL: TIMN 288832 MINNESOTA TOBACCO LITIGATION

WARNING LABEL (page two) Warnings on cigarette packages should be more specific. "The Surgeon General Has Determined That Cigarette Smoke is Dangerous to Your Health and That of Your Children." Janith Stewart Kice, M.D. Garden City, New York, 6/16 Philadelphia, p. 5. What about the label on the package? Instead of the innocuous sounding names and the meaningless geometric designs, I submit that the package should have the universally recognized sign of poison, the skull and crossbones along with the word POISON in large letters. David T. Carr, M.D., Associate Director for Cancer Control, Mayo Clinic, Rochester, Minnesota, 5/25 Chicago, page 2. Policy is needed which is much more sensitive to the reductiori of the health consequences of cigarette smoking, rather than the much more difficult elimination of a social habit. Such a policy would shun basically symbolic gestures (such as package warnings), which have almost no impact on the problem, and would focus on obtaining more fruitful cooperation from the tobacco industry in reducing the tar and nicotine dosage of its products. Kenneth M. Friedman, Ph.D., Assistant Professor, Purdue University, Dept. of Political Science, West Lafayette, Indiana, 5/25 Chicago, page 1. ...I urge that the warning labels on cigarette packages should be made more prominent. Paul ~Q. Peterson, M.D., Director, Iliinois Dept. of Public Health, 5/25 Chicago, page 5. Obviously the advertisement on the cigarette package has been ineffective and now is practically ignored by all cigarette smokers. It may have been effective when it was first introduced, but now has become just part of the package labelling. Avery Harvill, P.E.D., Clayton Jr. College, Morrow, GA., I 6/14 Atlanta, Tape 1, side 2, rev. 1249. The reports to the stockholders ((of the cigarette mfgrs.)) mention the fact that the warning label on the cigarette add the microscopic portion in the advertisements ((T&N yield)) preclude any plaintiff from winning any of these actions due to the fact that our judicial procedures claim that when there is a warning there is contributory negligence on the part of the plaintiff. Louis U. Fink, retired businessman, Orlando, Fla., member of IUCC workshop on smoking & Health, 6/14 Atlanta, Tape 2, side 1, rev. 1112. TIMN 288833

-312- W A R N I N G L A B E L (page three ) I would be in favor of 1) total ban of promotion ((he means adv.)): 2) if the warning is to continue to appear, it must be exactly the same size as the name of the cigarette. Louis U. Fink, retired businessman, Orlando, Fla., member of IUCC workshop on smoking & health, Atlanta 6/14/77, Tape 2, side 1, rev. 1133. One of the things in Target 5 is that we want to see a more urgent warning on advertising and on the cigarette itself. We think it is warranted. We want to see that warning more prominent in the ads instead of a small piece, an unreadable piece of copy on a billboard as you zoom past. Allan K. J"onas, LA businessman, chairman, ACS Task Force on Tobacco and Health and NCSPP panellist, at ACS 2/1/77 News conference, NYC, rev. 687. ...the health warning is still not specific or blunt enough to provide the smoker with an accurate appraisal of the risk he or she takes in lighting up. The fact is that smoking can kill, and every cigarette package or advertisement should so state. Nick Rahall, U. S. Congressman (D-W. Va.), Philadelphia 6/16/77, p. 2. ...the current warning on cigarettes is grossly inadequate in comparison with current data and with the warnings that we usually deal with in a regulatory agency in relation to other consumer products. It's wholly lacking in candor and accuracy in terms of what the modern consumer deserves and needs. There.is no reason why the straight forward risks' couldn't be on the cigarette package so that the real message is there. J. Rich.Crout, M.D., Director, Bur. of Drugs, Fed. Food and Drug Adm., 6/16 Phila., Room #3, Tape 1. ...the warning label on the cigarette pack should be as big as the name of the cigarette... include all of the problems that we have rather than making the warning as simple and as easy as it is... Robert C. Eyerly, M.D., Geisinger Medical Center, Danville, Penn., ACS Volunteer, 6/16 Phila., Tape 2, rev. 506-509. ...The Surgeon General's warning should be more specific and much stronger. It is too feeble... that these cigarettes are not only damaging to you but ...more so to your children. Janith S. Kice, M.D., Garden City, N.Y., 6/16 Phila., Tape 2, rev. 219-222. CONFIDENTIAL: MINNE SOTA TOBACCO LITIGATION TIMN 288834

-313- W A R N I N G L A B E L (page four) (Asked by Huang if a stronger label would have any "permanent impact.") I think it would make quite a large impact. In other words, if I understand you correctly, if that legend on the cigarette pack said 80% of all lung cancers are caused by the contents of this package, and that 80,000 people will die this year as a result of it, I think it would have an impact, yes. Rodney P. Adair, lung cancer victim and Vice President- Finance, Interpol, New York, NY., 6/16 Phila., Tape 2, side 1, rev. 740. Perhaps you can get the problem out of the Congressional arena, which might be a gain. Perhaps instead of the Congress being the one that writes the label and having to deal with each issue, there could be an authority given to somebody. It probably fits better under the Toxic Substances Act or something like that -- the Consumer Product Safety Commission, because it's pretty hard to get cigarettes to be either a food or a drug by any definition, but it clearly is a toxic substance. J. Richard Croht, M.D.,Director, Bureau of Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 562. Room #1. (Re: warning label ineffectiveness) They might pay attention to it if it said this is the major cause of cancer and the major underlying risk factor for 300,000 cases of coronary disease... J. Richard Crout, M.D., Director, Bureau of Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 625. Room #1. (Asked about the prospects of "proper labelling") Not as bad as you might think. Because in my judgment we're seeing several substances today that the public seems to want that don't pass the health laws -- things like cigarettes, marijuana, saccharin, laetrile. For one reason or another, it's conceivable that society in its wisdom would say: we want some things around that don't pass the health laws, providing they can be properly labelled, providing there is an element of free choice, providing there's an administrative review to review that they aren't just absolutely and totally lethal or -- some level of risk is unacceptable. If that kind of a mechanism were available for things that don't pass the health laws, cigarettes would undoubtedly be labelled in a much more forthright way than they are now. J. Richard Crout, M.D., Director, Bureau of Drugs, Federal Food & Drug Administration, 6/16 Phila., Tape 1, side 2, rev. 628. Room #1. CONFIDENTIAL: TIMN 288835 M~SOTA TOBACCO LITIGATION

W A R N I N G L A B E L (page f ive) We want to see the warning label on cigarette packages to be amended to read as follows: "Warning: The Surgeon General has determined that cigarette smoking is hazardous to your health and to the health of nonsmokers in the immediate vicinity." ~ ~ Roger Dale Setters, President, GASP, Louisville Chapter, Louisville, Ky., 6/14 Atlanta, p. 5. -314- I feel efforts to gain stronger and more prominent warning labels on all ciga- rette packages, stronger controls of cigarette sales to minors, and mandated tar and nicotine levels would for the most part be a waste of time and energy. Roni Rechnitz, Dir., Citizens for Clean Air in Publicly Used Buildings, Brighton, Mass., 6/2 Boston, p. 7. CONFIDENTIAL: TIMN 288836 MINNESOTA TOBACCO LITIGATION

~ .~. . .... ,, C a t a 1 o g I n d e x NCSPP Witnesses I A Adair, Rodney P. 4, 13, 14, 200, 201, 313 Adams, Crawford, W. 119, 152 Adams, Roger J. 156 Agran, Larry 30, 190, 282, 303 Ahmed, Mahinood 289 Alevy, Mitchell 36, 73 Allen, James E. 55, 119, 230, 300 Alley, James W. 39, 85, 123, 149 Anderson, Gordon W. Anderson, Jean Anderson, Lloyd G. Arnberger, Bennett 209, 212, 214, 250 Aronow, Wilbert S. 8, 40, 62, 155, 156, 212, 214, 215, 216, 223, 240, 269, 295 Auerbach, Oscar 119, 198, 199, 203, 207, 208 Austad, Oscar 97, 98, 256, 257, 258 B Bachman, David S. 12, 94, 107, 129, 218, 244, 296, 297 Bachman, Leonard 10, 32, 136, 167, 281, 290, 308 Bakker, P. Daniel 226, 239 Barnes, S. Eugene 76 Bass, George L. Bates, Laurence H. 13, 161, 196, 247, 299 Bates, S. D. 28, 109, 237 Baxter, Suzanne 61, 154 Bayh, Birch 77, 78, 83, 102, 128, 139, 152, 158, 168, 176, 196, 206, 296, 305 Beard, Alexander 4 Beard, Robert J. 84, 262 Becker, Norman Benoliel, Jeanne Q. Berg, Jean C. 17 Bergmann, Harry J. Bernays, Edward L. 37, 292 Biasco, Frank 260 Bigelow, Annie 239 Bigelow, John 75 Bigler, Lewis 289 Biron, Robert E. 175 Blackford, Lilian St. C. Blalock, Fletcher E. Bleifeld, Maurice 76, 195, 258 Bloch, Sylvia Blum, Alan 26, 99 Borgaard, Kathy 95, 107 Bosley, War"ren 74, 97, 228, 272 Bridges, Arlene Bridges, Gene 14, 59, 85, 211, 286 Briggs, John V. 214 Brock, Edwin G. 221, 265 Brock, L. Loring 12, 36, 126, 134, 146, 150, 159, 193, 206, 236, 238, 260, 271, 276 Bronsdon, Mike Brown, Diana 29, 263 Brown, Robert J. Brown, Robert K. Browne, George 10, 100, 118, 151, 206, 300 Bruce, Robert M. 77 Bryant, Farris 85, 123, 143, 162, 184, 199 224, 279-280 Burbank, Bernerd 55, 138, 213, 219, 220, 262-263 Burks, Barney, Jr. 15, 280 Butterfield, Robert W. 58, 185; 280 C Cady, Blake 24, 111, 131, 232, 253, 306 Caffrey, Christine 78, 291 Caldwell, William J. 81, 131, 277, 306 Campbell, William W. 24, 81, 110 Carino, Lawrence M. 237 Carnes, Betty 62, 71, 268, 269 Carr, David T. 20, 83, 102, 103, 247, 308, 311 Caulfield, Pat 92, 126 Christian, Ed Clark, Lee Claseman, Wilma 156 Coffin, Laurence H. 249a Cohen, Israel 22, 125, 301 Cohen, Jerome 50, 101, 152, 242 Cole, Arthur L. 16, 30, 288 Cole, Carolyn 84, 108 Cole, Philip Colonna, Keith W. 67, 278, 292 Cousins, Tom 32, 136 Cowell, Michael J. 61a, 163 Cowley, Ray G. 46, 74, 168, 290 Crawford, George 8, 17, 71, 209, 255, 281, 288 TIMN 288837

Crout, J. Richard 25, 66, 67, 83, 117, 162, 174, 175, 177, 178, 279, 307, 312, 313 00 M 00 00 00 Cunnius, Jeanne A. 33, 112, 173, 245, 263 D Dailey, Ann H. 100, 290 Danaher, Brian G. Danzinger, Joanne Davidson, Alan B. Davis, J. Mostyn 10, 19 , 127, 128, 167, 228, 290 Dean, John 10, 258, 290 Dean, Yank 27, 58, 239, 264, 280, 309 Deignan, Joseph 133, 139 Deputat, Zenon DiBiaggio, John DiCara, Lawrence Dooling, Kathleen Draper, Douglas 0. Duff, William H. Dunlap, R. Bruce M. 25, 113, 132, 10 61a, 87, 148, 225a 172, 219 267 39, 239, 280 27, 60, 85, 293 N E Eyerly, Robert C. 312 127, 166, 167, F Fairbanks, Ellen K. ~ Farley, Robert H. 239 ~ Fasal, Elfriede, 17, 70, 134, 158, 164, 209, 240, 250, 269, 302, 303 ~ Favro, Philip C. 42, 43, 44, 141, ~ 142, 266 Fidance, Ernest M. 66, 112, 148, 219, 225, 298 O Field, Frederick G., Jr. 25, 82, 83, 174, 220, 278, 292, 307, 308 ~ Fielding, Jonathan E. 15, 39, 108, 125, W e~' 157, 158, 171, 222a, 238, 249, 289, ~ 291, 308 ~ Fink, Louis U. 23, 99, 109, 138, 311, 312 Fisher, Edwin B. 18, 31, 61, 97? O 146, 159, 160, 164, 165, 237, 251, ~ 272, 273, 304 Fisher, Samuel M. 26, 116, 119, 120, 133, 153, 178, 213, 220, 225, 230 Fite, Tom 96 Flanagan, Earl B. 94, 137, 150, 218, 226, 295 Catalog Index -2 Flynn, Bruce 168 Foote, Emerson 27, 125a Fowler, Hugh 189, 276 Franklin N r n , o ma Frelick, Jane H. 54, 82 Friedman, Kenneth M. 3, 5, 7, 20, 50, 51, 61, 137, 168, 296, 308, 311 Fuller, Peter 169, G 176, 243, 247, 279, Geyer, Milton 81, 13 0 Gilbert, Ruth E. 28 Gingell, George A. 23, 31, 33, 166 Gleaton, Thomas J. Glover, Elbert D. 74, 77, 96 Gober, Billy E. 85, 286, 293 Goldowsky, Seebert J. 110, 162 Goldsmith, John R. 8, 43, 93, 215, 227 Gordon, Mark 24 Gossett, James B. 60, 143-144, 211, 265, 267, 277 Grassley, Charles 135, 175, 193, 273 Green, Dorothy 56, 173 , 248, 261, 284, 285, 286, 297, 300 Guyton, Rick 36 H Hackney, Rufus R. Hager, Hans 76 Hammond, Hanson, Ann H. Doug 44, 70 , 88, 233, 302, 310 Harken, Dwight 37 Harner, Joseph 6, 122 Harris, Jack L. 51, 10 3-104, 117, 16 9, 221, 259, 261, 275 Harvill, Avery 36, 76, 241, 311 Hayden, John C. Hegarty, W. Kevin 44, 250, 266 6 26 2 3 Herren, Fred 8 , 4, 9 Herter, Heston, Jacques P. 9, 12, 17, 35, Charlton 91 28 8 Hoffmann, Dietrich 202, 24 5, 246, 24 7, 254, 299, 300, 307 Holmes, Frederick F. 3, 49 Homel, Steven R. 25, 119, 162, 279 Honorof, Ida 1, 155, 190, 191, 194 Hopkins, William A. 34, 60, 68, 86, 123-124, 157, 162, 185, 203, 222 Horn, Daniel 2, 8, 35, 43, 46, 70, 71, 72, 75, 134, 145, 236, 240, 282, 285, 310 Houghland, Dale 17, 142, 233, 255, 268, 281 302 , Howard, Charles 69, 87, 177, 186-187

Catalog Index -3 Hull, Bob Hunter, Shirley 251 Lloyd, Douglas S. 31, 33, 158, 172, 189a, 238, 305 34, 61a, 130, 137, Hutchinson, William B. 19, 45, 47, Lottes, Gayla 93, 192, 273 Lyon, Lou Hutter, Robert V. P. 67, 120, 133, Mc 203 I McAllister, Ray McCaffrey, Janet D M l Istas, Els Ivy, Livingston, Jr. 69, 86, 185 e cCarren, a McCord, David 160 McDowell, J. E. 2, 3, 48, 136, 138, 241, J 244, 253 McGee, Pam 228 27 Th F M G 4 t J b J 31 owan, omas . , c son, eanne te aco Jamplis, Robert W. 70, 191, 266, M 288 Jensen, Melvin A. 16, 70, 72, 98, 158, Macknick, Ed 232, 240, 295 Magel, Fred 210 Johnson, Ernest W. 11, 13, 104, 117, Maher, Brendan A. 13, 25, 37, 38, 81, 239, 218 232 275 148 299 296 283 , , , , , K Maloof, Edward C. 64 Manley, James C. 64, 173 Marks, Richard, Jr. 80, 108, 195, 197, Keeton, Norma 9 203, 252 Kelley, Trena 41, 250 Marsh, Shirley 217, 272 Kelly, John B., Jr. 34, 68, 120-121, Martell, Edward A. 193, 241, 244 179, 210 Martin, Kenyon Kelson, Saul R. 51, 78, 117, 147, Martschink, Sherry Shealy 184-185, 231, 276 224 254 149 Martwick Richard J 78 105 259 , , , . , , Kice, Janith S. 11, 14, 100, 101, Mathis, Jack L. 80 127, 142, 167, 224, 228, 229, 311, Mausner, Bernard 5, 38, 39, 117, 278, 285, 2 292 291 31 , Ki J h J Wi r 59 196 M i t 205 o n ng, , e . s e , gs, Kj elland, Trig Mims, Dorothy L. 22, 108 , 127, 137 Z Kloss, Walter 111, 112, 131, 132, 153, Modrall, M. A. 79, 8 0 ~ 207, 224, 229, 283 Molind, Samuel 13, 5 3, 1 75, 198, 225 @ Knight, Alice T. Morgan, Nola Mae 19 Knight, Norman Morton, Holly E Korson, Roy 53, 125, 197, 218, 219 Morton, William E. 4 7, 1 35, 192, 194, 195, ..y„{ Kotin, Paul 10, 18, 96, 126, 134, 150, 236, 251, 286 164, 170, 193, 206, 260, 304, 310 Krumel, Diane 124 I L Lair, Dolphin 8, 93, 158 Landrigan, Herbert 198 Leinbach, Earl LeMaistre, Charles A. See listing under NSCPP Panellists Lenihan, Patricia 147, 149 Leonard, Roy 104 Leone, Louis A. 37, 110 Lira, Christa 20, 77, 274 Muckler, Carl H. 49, 165, 275, 305 Murphy, John N Nealon, Thomas F., Jr. Nichter, Rhoda 0 Ochsner, Alton 52, 95, 107, 296 Ogg, Jack 171, 187, 271 Ogle, Mark David Ottman, Sidney 72, 236, 270, 282 TIMN 288839

CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION Catalog Index -4 Overholt, Richard H. 5, 6, 12, 54, Rotolo, Candi ___- 66, 111, 131, 198, 202, 207, 253, Rubel, Pat 261, 307 Overton, Dan . P Ryan, Michael Ryser, Hugues J.-P. S 109, 202, 205, 229, 299 Parker, Alexis A. Parks, Ralph D. 239, 261 Samuels, Paul Sandler, Sylvan 63 Patterson, John W. 05 Sapinsley, Lila M. 61a, 126, 189a, 222a, 224a 148 hil Alb Patterson, Pat 79, 1 Payne, Walter C., Jr. 14, 15, 122, ert ling, Sc Schmitz, Robert L. 6, 21, 105, 137, 259 293 149 e T Schneider Geor 45 224 227 229 , g . , , , , Penner, David A. 63, 118, 129, 161, 305 Schulz, Milford D. 66, 202 ffr B J S h t 209 159 88 89 . war z, e ey c L 30 J h t S 235 234 145 159 , , , Perlmutter, Herm , , , , , erome . , z, war c 214, 255, 268, 270 236, 302, 305 Peterson, Paul Q. 11, 21, 59, 92, Secker-Walker, Roger H. 11, 96, 97 , 101, 148, 169, 210, 213, 218, 259, 311 128, 156-157, 206, 227, 291 Petty, Thomas L. 52, 206, 207 Sedberry, Stephen 29, 81, 110, 219 Phelps, Harvey W. 95, 126, 129, Sederberg, William 83, 163, 186, 253, 269, 269 309 188 292 294 , , , Pines, Lois G. 110, 161, 175 Setters, Roger D. 6, 27, 123, 124, 125 , 185, Pomerleau, Ovide F. 14, 39, 67, 222, 223, 264, 278, 293, 294, 314 68, 249 Shaw, Don 10, 73 Pool, John L. 52, 157, 277 Shimp, Donna M. 28, 101, 102, 123, 128, 140, Poole, Richard E. 52, 53, 135 177, 217, 218, 220, 242, 258, 262 Pope, Harry H. 77, 101 Porath, Jerome R. 73 Preston, Ivan L. 18, 32, 52, 157 Shute, Robert E. 38 Silverman, Jerry 166, 274 Simone, Remegia V. 76 er Judith L Sin Q . g , Skaggs, Herbert V. 18, 19 Sklar, Steven 6, 26, 57, 121, 181-183, 210, 221, 263, 279 R Slavin, Raymond G. 216 Smith, A. Marshall, Jr. 61a, 125a, 224a, 267, Rahall, Nick Joe 113, 121, 173, 280a, 291 S ith B b 179-180, 230, 285, 298, 307, 309, 312 m , ar ara G. Ralston, John 31, 79, 135 Randall, Francis F. 88, 89, 92, 226, Smith, Jackie Sorensen, Kent W. 89, 190, 192 234 105 118 Harry 29 Spataro 177 Rechnitz, Roni 40, 158a, 185, 277, , , , , Splitter, Stanford D. 40, 150 280a, 314 Spradley, "Chip" Robert Reese, Raymond 94, 207 Spradley, Jimmy 48, 49, 60, 257, 258, 264, Rice, Joy 265 Rizzo, Joseph R. 54, 142, 308 Stearns, Patricia S. 21, 28, 106, 161, 218, Robbins, Anthony 52, 272, 303 252, 275, 291 Rogers, Donald 45, 146, 192, 194, Stein, Stanley I. 9, 17, 95, 140, 146, 236, 209, 271, 273 271, 288, 303 Rosenberg, Marvin Rossano, August 209 Roth, Arthur T. 114, 115, 130, 132, Stone, E. K. Straub, Richard F. Striker, Gary 139, 219, 263 Sturm, Carl B. 125, 254, 286 Roth, Janet 68, 123 Suttake, W. Bernard 100 Suzuki, Dexter T. 2, 40, 71, 255 TIMN 288840

Catalog Index -5 Swaney, Martin G. 79, 169, 170, 259 Swartz, Stanley "' Swomley, James A. 58, 172, 253, 306 T Taylor, Robert R. 3, 4, 9, 95, 271, 288, 295 Thomas, Bill Thomas, David B. 19, 94, 273, 289 Thompson, Carrie Nelle M. 60, 84, 86, 211, 222, 260, 274 Thorson, Nancy A. Thurmann, Manfred 46, 63, 151, 217 Togut, Allen J. Truelove, Edmund 19, 47, 75, 98, 99, 225 Tryon, William E. Turner, John W. 110, 130, 140, 198, 204-205, 297 Tyson, Debbie 29 Wandberg, Robert W. 21, 283 Warren, Sherwyn 12, 22, 36, 106, 129, 137 Weaver, Arthur 14, 22, 107, 118, 170, 238, 252, 306 Weinstein, Sheridan L. 89, 90, 91 Weisbeck, Lori 258 Weiss, William 65, 199, 200 White, Patricia E. 87, 231, 287, 294 Wilbur, Joe 59, 309 Will, Drake W. 41, 62, 91, 191 Williams, Ashbell C. 64, 109, 165, 197, 203, 253 Wilson, Ronald 50, 54, 61, 128, 153 Witte, John J. 127 Woodson, Stephen F. 80, 136, 140, 171 Woodward, Craig Wynder, Ernst L. 11, 49, 57, 100, 122, 149, 153-154, 162, 167, 183-184, 204, 238, 242, 248, 249, 290, 300, 301 X U Ulfelder, Howard V Valenti, Jack 26, 34, 84, 121, 281, 293 Valle, Georgette 94, 216, 273 Van Landingham, Alice 66, 132, 143, 207, 219, 284 Vincent, Ronald G. 56, 113, 174, 180, 201, 204, 245, 249, 284, 285, 298, 301 Vongsawad, Tum W Wall, Larry 267 Wammock, Hoke 7, 59, 61, 69, 86-87, 145, 186, 211, 222, 260, 286, 294, 309 CONFDENTIAL. MINNE5OTA TOBACCO LryIGATION Y Yasgur, David J. 295 Young, Kevin 25, 254, 284, 287 z Zack, Albert 36 Zagona, Slavatore V. 2, 35, 41, 42, 43, 44, 63, 71, 145, 250, 254, 281, 282 Zamarripa, Lupe 17, 22, 310 Zhorne, Hubert P. 107, 196 Zinker, Barbara TIMN 288841

Catalog Index -6 NCSPP Panellists Baltimore, David 53, 54, 202, 207, Maull, Baldwin 162 230, 246, 247 Byrd, Benjamin F., Jr. Charmot, Dennis 120 Newton, James Quigg 260 Owens, Cornelius W. DuVal, Merlin K. 12, 57, 107, 122, Perkins, Mrs. Marlin (Ca rol) 4 9, 275 170, 185, 188, 189, 276, 279, 289, Pollard, H. Marvin 297 l Ebersol, Charles R. 26 Russel , Harvey Evans, Marshall K. 55, 220, 24 2 Shank, Robert E. 8, 33, 45, 16 1, 267 Scott K 22 52 64 Simonds 148 156 Height, Dorothy I. W b . , , , , T M i , . Holley, Ro ert Huang, Alice 313 ree, ar etta Huff, Mrs. Robert W. 108, 138, 262 Jonas, Allan K. 1, 16, 42, 82, 240, 312 Kneeland, George Weingarten, Victor 23, 33, 47, 53, 55, 56, 66, 75, 98, 121, 135, 140, 156, 171, 176, 180, 194, 202, 204, 230, 248, 249, 251, 252, 261, 262, 263, 299, 300 Wendel, William H. White, Kerr Lee, Philip R. LeMaistre, Charles A. 59, 73, 108, 146, 196, 224, 244, 271, 288, 289 Luria, Salvador E. American Cancer Society Consultants Steinfeld, Jesse 12, 244 Terry, Luther 13, 172 American Cancer Society Press Material Pages 9, 13, 66, 93, 230 CONFIDENTIAL: TIMN 288842 MINNESOTA TOBACCO LITIGATION