Tobacco Documents Online

Inside: Sulfite food additives PAGE 3 Aerobic vs. anaerobic exercise PAGE 6 Are silver fillings harmful? PAGE 11 Nutritious snacks PAGE 12 VOLUME 7, NUMBER 3 outbreaks of the disease occurred in 10 loca- tions in 1985; Georgia, Hawaii, Indiana, Iowa, Minnesota, Oklahoma, Oregon, and three counties in Texas. Increased rates of the disease and decreased vaccination rates have been reported in other states as well. For instance, in Utah, the percentage of chil- dren fully immunized with DTP vaccine, the combination vaccine that prevents diphthe- ria, tetanus, and percussis (another name for whooping cough), has dropped'from 78 to 59 percent in just 4 years. Meanwhile, the number of pertussis cases in that state has reached its highest level in 20 years. CONTtNUED ON PAGE 2 MAY/JUNE 1986 PRICE: $2.00 NEWS & VIEWS PUBLICATION OFTHEAMERICANCOUNCILON SCIENCEAND HEALTH • 1995 BROADWAY • NEWYORK. NY 10023 (212) 362-7044 ~How Well Do American Magazines Cover the Health Hazards of Smoking? THE 1986 SURVEY By Lawrence White and Elizabeth M. Whelan Many cigarette ads - reiatively poor covernge of the itf effects of smoking. Helen Gurley Brown, editor of Cosmopolitan, said to the Wash- ington Post, "Having come from the advertising world my- self, I think, 'Who needs some- body you're paying millions of dollars a year to come back and bite you on the ankle'?" The Return of Whooping Cough By Kathleen A. Meister W HOOPING COUGH IS ON THE RISE IN THE UNITED S7ATES, at least in part because some parents' fears of rare side effects from whooping cough vaccine are leading them to make unwise decisions about their children's health. The federal Centers for Disease Control (CDC), which keep crack of the numbers of cases of important infectious diseases in the U.S., received reports of 2,258 cases of whooping cough in the first ten months of 1985, nearly double the cocal of 1,342 cases in all of 1982. The American Academy of Pediatrics says that local "near-epidemic" IN 19m IT tS FAIR TO SAY that smoking has been established as the number one prevent- able cause of death and disease in America. Most lung cancer and emphysema as well as a high percentage of heart attacks are caused by smoking. Scientists have learned that the cancer risk of smoking is not limited to can- cer of the lung. Many bladder, cervical, esophageal and pancreatic cancers are caused by smoking. Lung cancer has just replaced breast can~er as the number one cancer killer of women. It is now generally accepted that at least 350,000 Americans die each year of smoking related illnesses. Other estimates range as high as 485,000. Although 30 million Americans have given up smoking in the past 20 years, 50 million still smoke. These are not just loyal customers, they are, for the most part, addicted to cigarettes. Ironicaily, publicity about health hazards of smoking has kept new companies from entering the cigarette market and allowed the established six com- panies the great advantage of freedom from outside competition. With the huge profits generated from cig- arette sales the tobacco companies have begun to buy ocher large consumer goods companies. In 1985, R.J. Reynolds bought Nabisco, while Philip Morris bought Gen- eral Foods. Another use of tobacco industry Vogue's editor Grace Mirabella, when asked about possible pres- sure from ciclarette advertisers, said that this issue had never been brought up to her by the advertising department and that she was completely insulated from the work and concern of the advertising side of the busi- ness. CONTtNUED ON PAGE 6 T1MS~~031626

Survey CONTINUED FROM PAGE 1 cash is advertising. Cigarettes are the most advertised and promoted product in the United States - an estimated $2.7 billion per year. The facts about smoking and the tobacco industry are by any measure critically important news for the American public. ln a country that is deeply concerned about potential exposures to toxic chemicals and intensely worried about cancer, one would expect that news about smoking would be ubiquitous and that every new study of its harmful effects and the efforts of the tobacco industry to promote it would be front page news. Furthermore, the irony of the growing richness of the tobacco industry contrasted with the growing numbers of tobacco related deaths should provide grist for innumerable editorial mills. Yet the health hazards of smoking are rarely the subject of media scrutiny. While most Americans know that smoking can cause lung cancer, few know that lung can- cer is usually fatal, and fewer sti.ll know that smoking is implicated as a cause of at least five other types of cancer. Most Americans do not know that more people die of smok- ing-related heart disease than lung cancer. Coverage of the industry is so poorthat the media have never given significant attention to the fact that a company that makes most of its profits from cigarettes, the Loew's Corporation, bought a controlling interest in a major television network, CBS. There is nothing new about the under- reporting of the dangers of cigarettes. The bad news about smoking began to be estab- lished by scientists in the 1930s and with it came charges that newspapers, magazines, and, later, the broadcast media failed to ade- auately report about cigarettes. In the dec- ades that followed there were occasional articles about media suppression of the story of smoking and health. The Columbia Journalism Review twice (in 1963 and 1978) surveyed media coverage of the story and found it wanting. In 1982, ACSH conducted a survey of 18 magazines to determine how well they cov=- ered the hazards of smoking and to explore the role that cigarette advertising might play in editorial policy. The study showed clearly that, of the magazines surveyed, the best coverage of smoking and health was present in those which did not accept cigarette advertising. In January 1986. ACSH conducted another study of this type. The ooal of the study was to assess the reporting of smoking as a health hazard in a select group of 20 magazines, some of which accept cigarette advertising and some of which don't. One magazine, Parade, was dropped from the study and three were added. They were Glamour, The Saturday Evening Post, and Self. The readership of fourteen of the mag- azines is primarily women. The other maga- zines have a varied audience and range from 1986 ACE HOW WELL DO MAGAZINES REPO HOW MANY ARTICLES ON: SMOKING AS A CAUSE OF DISEASE/ BENEFIT OF HOW TO QUIT FOOD AND DISEASE STF AND MANAt (PERSC T`. Magazine a b a b a Reader's Digest' B S. 5 6 3 Good HouselCeeping' 6 10 7 10 Prevention' 7 9 47 29 11 Saturday Evening Post' 7 ' 3 9 1 1 Vogue 24 6 5 5 Seventeen 2 1 Harper's Bazaar 1 Glamour 2 14 2 11 4 McCall's 2 5 4 3 5 Self 5 0 7 50 P1us 4 9 6 1 Cosmopolitan 14 4 1 Redbook 11 3 10 Ms. 1 4 2 6 Ladies' Home Journal 1 - 2 1 Mademoiselle 2 2 3 2 3 Time 2 2 7 4 ~ Newsweek 3 - 2 1 U.S. News and World Report 1 4 1 KEY '- Does not accept cigarette advertising as a matter of policy. a - longer than 1/2 page. b - shorter than 112 page. the topical Reader's Digest to the hard news oriented U.S. News and World Report. Study Results Those magazines which did a good job of reporting on smoking can be determined by looking first at the number of stories they have devoted to the issue of smokine and its hazards. The numbers in columns a refer to stories longer than 1/2 page, the numbers in columns b to shorter stories. It is important to compare the number of smoking stories with the number of stories devoted to other health related topics. Of all the magazines surveyed, Reader's Digest has the best all around coverage of the hazards of smoking - as it has had for many years. Four other magazines also have excellent coveraee: Prevention, Sarurdav Evening Post, Good HousekeepiR, and 5Z TIMS00031627

' SURVEY: T ON THE DANGERS OF SMOKING? SS DRUGS (ILLEGAL, SKIN CARE RESS RECREATIONAL) 'v1ENT ALITY b a b a b 2 4 2 2 4 3 2 6 - 1 2 1 0 1 1 4 1 2 13 6 6 3 2 - 7 4 5 1 2 11 3 ` 1 1 1 10 3 3 3 32 6 2 3 2 1 1 2 3 1 7 1 1 4 2 1 - 4 1 6 4 5 3 5 0 a 14 2 1 3 COMMENTS excellent coverage excellent coverage excellent coverage excellent coverage has some of the best coverage on smoking even though it accepts cigarette ads. with 2 articles on smoking, it covered the topic better than any other health topic except skin care. relatively poor coverage relatively good coverage coverage may be improving relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage relatively poor coverage Vogue. Among these, only Vogue accepts cigarette advertisements. Coverage of smoking hazards by the Saturday Evening Post increased dramatically since 1983, when the ma¢azine stopped taking cigarette ads. Glamour had relatively good coverage of smoking, and there was evidence that McCall's coverage had improved. An article in December 1984, for example, correctly identit ied smoking as a number one risk fac- tor for heart disease in women. Both of these magazines accept cigarette advertis- ing. Among the magazines that had relatively poor coverage of smoking, the award for the worst coverage goes to Cosmopolitan. This magazine had no articles, even small ones, about smcking in the survey period, but had 14 articles about food and health. Further- more, some of the articles that did mention smoking were misleading. in the November 1985 issue, in an article entitled "Uncover- ing the Secrets of Health and Disease," the author asserts that reduction of smoking (as well as cholesterol levels and blood pressure) does not reduce the prevalence of heart dis- ease, which, he says, is caused mainly by stress. Cosmopolitan finally ended its silence on smoking in the January 1986 issue. Although this is outside the survey period, it should be noted as a low point of responsible reporting on the subject. Cos- mopolitan chose to make its only report on smoking a "good news for smokers" piece about a study that appeared to show that heavy smokers had a lower risk of endorne- trial cancer than nonsmokers. According to Cosmopolitan, female smokers can "take a modicum of comfort" from this study. There was no mention of the fact that lung cancer is far more deadly than endometrial cancer, nor of the great risk of other diseases incurred by women who smoke. Another magazine that had relatively poor coverage was Redbook. During the survey period this magazine had not a single article of any kind about smoking, while carrying 11 about food and disease, 10 about stress and seven about skin care. Ladies' Home Journal had very limited coverage of health issues, and in general a relatively poor coverage of smoking. One article in particular was a startling example of disinformation. In April 1982, an exten- sive article entitled "Family Doctor's Health Tips" purported to advise readers on how to have a healthy lifestyle - without mention- ing smoking. Under the topic of "Control- ling Hazards in Your Surroundings" the two main tips were: "Use seat belts when you drive and store weapons so they're neither stolen nor seized in a moment of anger." In another article about heart disease and working women, there is no mention of tobacco. Interestingly, there is a 1980 article on lung cancer that clearly warns women not to smoke, but a subsequent article in 1984 does not mention smoking in an article about lung disease. MS. had relatively poor coverage of the health hazards of smoking. In five years there were no stories longer than 1/2 page about smoking and only one shorter than 1/2 page. By contrast, there were four long stories on food and health and six on stress and health. When the facts about smoking start to creep in, they are underplayed. For example, in an article about heart disease and cancer, two sentences were devoted to lung cancer. They state accurately that "smoking causes about 35010 of lung cancer among women, who are, despite such evi- dence, starting to smoke at a younger age." There is no statement that lung cancer is usu- ally fatal. Nothing is said about the projec- tion that lung cancer is fast surpassing breast cancer as the number one cancer killer of women. A 1984 article entitled "Do You Jog Beside a Freeway?" advises wotnen to "limit CONTINUED ON PACF 10 TIMS00031628 9

Survey CONTINUED FROM PAGE 9 (L Of all the magazines surveyed, Reader's Digest has the best all around coverage of the hazards of smokin- . Four other magazines also have ercellent coverage: Prevention, Saturday Evening Post, Good ~ouszkeeping and Vogue. The award for the worst coverage goes to Cosmopolitan. » the intake of cigarettes, alcohol, and saccha- rine." A 1984 article advises "It makes no sense to smoke or take pills to lose weight." Self had relatively poor coverage of smoking, although it is owned by Conde Nast, which owns Vogue and Glamour, both of which had much better coverage. In six stories about how to have a healthy heart, smoking was not mentioned at all - a glar- ing omission. Harper's Bazaar also had relatively poor coverage. The most powerful mention of smoking ACSH could find was in an article entitled "Overcoming Infertility." It stated that "lifestyle and noxious influences including alcohol and nicotine can also interrupt a pregnancy." The most powerful argument Mademol- selte could muster 'against smoking was that nonsmokers have a better chance of being smoking can complicate pregnancy and adversely affect a fetus, since smoking was not even mentioned in any of the eight sto- ries that Time ran on subjects relating to human reproduction. Newsweek s coverage was the best of all the news magazines. Of six stories about cancer, smoking was mentioned in four and in two of these it was rated very prominently. Newsweek published a story about smoking and lung disease, which the other news mag- azines did not. Newsweek also carried three stories of more than 1/2 page on smoking and health and three shorter than 1/2 page. On the downside, ACSH's survey was unable to find in Newsweek the fact that smoking can adversely affect pregnancy and fetal health. A magazine that should be mentioned favorably is Vogue, one of the nation's most 11, 1985, p. A18), "Having come from the advertising world myself, I think, 'Who needs somebody you're paying millions of dollars a year to come back and bite you on the ankle?' " Most editors, however, deny that fear of offending their tobacco adver- tisers had anything to do with their decisions not to report extensively, or at all, about smoking. William Whitworth, editor of the Atlantic, was quoted in the same Washing- ton Post article as saying that he would pub- lish an article about smoking if it revealed something such as "smoking caused leprosy or something besides ... heart disease and lung cancer." Stories about smoking seem to have to pass a higher standard of news- worthiness than other topics. The survey noted that Vogue, although it accepts cigarette ads, covers the subject of tobacco relatively well. Vogue's editor, L G Lung cancer has just replaced breast cancer as the number one cancer killer of women. 35 hired for a job than smokers. Among the thtee newsweeklies surveyed, U.S. News and World Report scored the worst. This magazine had only one story about smoking and health in the five-year period and that article was under 1/2 page. Although it is a hard news oriented pubGca- tion, it did manage to carry four stories on food and disease in the survey period, one about stress, 14 about the health effecu of illegal drugs, and even one about skin care. All of these were longer than 1/2 page. Most disturbing was a pattern of non-reporting about the hazards of smoking in articles where one would have expected it. Incredi- successful magazines. It had more articles about smoking and health, 24, than any other magazine. Unlike the magazines listed as having the best coverage of this issue. Irogue'sarticles were short ones, all under I/ 2 page, but they were relatively plentiful. Cigarette Advertising Revenue In the current survey, the dollar amount of advertising revenue attributable to tobacco sources for each magazine is not listed. Instead, it is simply noted whether a magazine accepted cigarette ads or not. Pre- vious studies have not found that there was a direct correlation between the percentage of Grace Mirabella•, when asked about possi- ble pressure from cigarette advertisers said that this issue had never been brought up to her by the advertising department and that she was completely insulated from the work and concerns of the advertising side of the business. She also said that her entire edito- rial staff was concerned about the issue of smoking and health and had a tendency to report on it whenever possible. This is cer- tainly commendable - and rare. The freedom of t%gue's editor to ignore the magazine's advertising needs is a privi- lege granted only to the most successfui and well established of magazines. Such privi- LL Cigarettes are the most advertised and promoted product in the United States - an estimated .52.7 billion per year. 5~ bly, in 18 stories about cancer, smoking was not mentioned even once: in 19 stories about heart disease, smoking was only mentioned one time. Time was also not very aggressive in cov- ering smoking and health. It did have four stories about the topic (two shorter than 1/2 page. two longer) but smoking was rarely mentioned in other heaith-reiated articles. For example, in a total of 22 stories about heart disease, smoking was mentioned in only one. In a total of five stories about can- cer, smoking was not mentioned at all. If one read only Time, one would never know that tobacco advertising in a magazine and its coverageof smoking. There was, however, a strong indication that the fact of acceptance of cigarette advertisements has a significant effect on the coverage of the hazards of smoking. In any case, the data show that magazines which accept cigarette ads are less likely than magazines which don't accept the ads to report on the hazards of smoking. A few editors have stated publicly that they do not want to offend their tobacco advertisers. Helen Gurley Brown, editor of Cosmoooli- tarr, said to thc Washington Post (December lege does not apply apparently to the maga- zine 50 Plus. In the first ACSH survey cov- ering the period from 1973 to 1980, this magazine was commended for its good reporting on the hazards of smoking. In reviewing the results of the 1986 study, ACSH was surprised to find that 50 Plus had a less admirable record of reporting about smoking - only four stories, ail of them less than 1/2 page, in five years. John Parker. the magazine's advertising director, ',Yfs. .btirabella is the wife of ACSH a civr- sor. Memorial Sloan-Kettering lurtgsurgeon Dr. William G. Cuhan. lo

confirmed the immediate suspicion - SO Plus began accepting cigarette ads in Janu- ary 1982. In conclusion, it appears that those maga- zines which accept cigarette advertising are much less likely to report about the hazards of smoking than those which don't. The rea- son for this appears not to be due to direct pressure from tobacco advertisers but rather self censorship imposed by editors who are fearful of offending cigarette advertisers. The presence of cigarette advertising seems to exert a "chilling effect" on the free flow of information about smoking and health. LL Newsweek's coverage was the best of all the news maga- zines. 55 Banning cigarette advertising along with cigarette company-sponsored athletic and cultural promotions may be a step forward in freeing the media from the threat of eco- nomic reprisals for reporting the story of the hazards of smoking, but it cannot guarantee insulation from the power of the cigarette industry. The year 1985 was a watershed one for the industry because the two largest ciga- rette companies, Philip Morris and R.J. LL While most Americans know that smoking can cause lung cancer, few know that lung can- cer is usually fatal, and fewer still know that smoking is impli- cated as a cause of at least five ether types of cancer. 19 Reynolds bought the nation's two largest food companies, General Foods and Nabisco, respectively. The advertising budg- ets of food conglomerates are now under the control of tobacco executives. The advertis- ing industry was quick to note the new situa- tion. Magazine editors may already be start- ing to wonder if anti-smoking stories might lead to withdrawal of cookie or cracker ads. There are good reasons for banning ciga- rette advertising and promotion of athletic and cultural events. Certainly, it is anoma- lous in our health-conscious society to allow advertising for a product that is both useless and fatal to many consumers. : i_., Lawrence White is an attorney who is a fre- quenr contributor to NEWSd; VIEWS. Eliz- abeth M. Whelan, Sc.D., M.P.H., LsE.xecu- tive Director of A CSH. ARE SILVER FILLINGS HARMFUL? By Kathleen A. Meister LL ACSH has looked at the scientific evidence and discovered that the answer to this question is, 'No'. 59 ARE THE SILVER FILLINGS IN YOUR TEETH hazardous to your health? This issue has been raised in several recent news reports, including at least three network television programs. These reports have left viewers wondering about many questions. Is there real cause for concern? Should we all refuse to have new silver fillings? Should we even take the extreme step of having all our exist- ing silver fillings replaced with other materi- als? ACSH has looked at the scientific evi- dence on these questions and discovered that the answers are not as uncertain as the news media may have suggested. Here's what we learned. Mercury in Dental Amalgams The technical name for silver fillings is dental amalgams. Amalgams account for 75 percent of all fillings and they consist of a combination of metals including mercury. Mercury is the ingredient which causes the filling to harden after it has been placed in a cavity. It is also the ingredient that has aroused controversy. People who are concerned that silver fill- ings may be harmful have pointed out that mercury is a toxic element, that some mer- cury vapor is released from dental amal- gams, particularly during chewing, and that the released mercury may be swallowed or inhaled, thus reaching the rest of the body. All of these statements are correct. But do they add up to a hazard? Dental amalgams have been used with apparent safety for more than a century. Why is an alarm being sounded at this late date? The concerns about the use of mercury in dental amalgams seem to stem, at least in part, from improvements in technology. It recently became possible to detect miniscule amounts of mercury vapor in air, and the new techniques have been used to decmon- strate that tiny but measurable quantities of mercury are present in the air exhaled by individuals with dental amalgams in their mouths. - Well publicized charges that amalgams are linked to chronic diseases have also con- tributed to the controversy. There have been speculations that mercury in dental amal- gams might be linked to multiple sclerosis, epilepsy, mental illness, and a wide variety of other chronic and serious health prob- lems. Colorado dentist Dr. Hal Huggins, one of the principal proponents of this hypothesis, claims to have cured several people of longstanding chronic illnesses by removing their amalgam fillings. Recently, on the CBS Evening News with Dan Rather, a young woman described her dramatic recovery from a chronic illness that had resisted diagnosis and treatment until she had her silver fillings replaced. Such case reports, however, do not con- stitute proof of a cause-and-effect relation- ship. Many diseases, particularly neurologi- cal and emotional conditions, often have spontaneous remissions. Case reports can- not tell us whether a patient's improvement was a result of the removal of fillings or merely a coincidence. We need to look at other kinds of evidence to answer the ques- tions of whether mercury poisoning can cause the types of illnesses described and whether dental amalgams can cause mer- cury poisoning. How Much Mercury? Mercury poisoning can cause a wide vari- ety of symptoms, particularly neurological ones; this is why speculation about dental amalgams has focused on neurological dis- orders such as multiple sclerosis. But in order for mercury to cause poisoning, it must accumulate to dangerous levels in the body. 'I}ace amounts of mercury do not cause toxicity symptoms. "The amount of mercury emanating from dental fillings is extremely small," concluded a 1984 workshop on the biocom- patibility of metals in dentistry sponsored by the National Institute of Dental Research. "Mercury is introduced to the human system through a variety of other sources-including the air we breathe, the foods we eat, the water we drink and through the bad habit some of us have called smoking. ~`The mercury we receive each day from these nondental sources far exceeds the min- iscuk amount released from dental fillings " The amount of mercury in the body is most often assessed by measuring mercury (evels in urine. Mercury poisoning is associ- ated with urinary mercury levels of 500 CONTINUED ON PAGE 14 ~ a Y C Z ~ ~ > 0 ~ ~ ~ 0 0 0 tn 14 2 i z x ~ < 1I