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February 18, 1964 SMOKING AND HEALTH SIGNIiFICANCE OF' THE REPORT OF THE SUiRGEON GENERAL'S COMMITTEE TO PHILIP MORRIS INCORPORATED Distribution: ~ 0 0 Mr. Hugh Cullman (10) 0 Mr. Mr. Mr. Mr. H. A. Atkins A. C. B'ritton J. E. Lincoin G. W. Macon, Jr. W W C!T O) F-i Dr. H. Wakeha.m (15) ~A

567 SMOKING'AND HEALTH (Significance of the Report of the Surg,eon General's Advisory Committee to Philip Morris Incorporated) INTRODUCTIONAND SUMMARY The Research Center has made an initial examination of the report of'the Surgeon,Genieral!'s Advisory Committee on Smoking and Health with the view to its proper influence on Research Center program and formulation of technical advice to Philip Morris management. This statement summarizes those preliminary views. The onus of proof has been moved by thie report from its usual position with the industry's accusers to the tobacco in- dustry itself. Meeting this challenge affords Philip Morris a splendidopportunity to gain a~ competitive edge through effective technical activity. Positive programs to cu~re ills cited in this report, wheth~er real or alleged'., are!recommended, as little basis for disputing the findings at this time has appeared. Among those programs whichideserve increased corporate support are~: 1. Expansion of Research Center knowledge through intelli- gence effort inlepidemiology, bioassay, lung cancer research, etc., and liaison with a medical school. 2. Increased laboratory study of: a. gas phase adsorption and selective filtration b, chemical carcinog,enesis of smoke c. cigar and pipe smoke chemistry d. pulmonary clearance mechanisms e. other physiological effects of smoke, particularly on respirationicharacteristtics and heart load. 3. Development by year end of a superior filter cigarette withiacceptable taste having high gas-phase absorption and very low TPM - to be based on Series T microfiber polyethylene tow and adsorbents of'surpassing adsorptivee qualities. The hoped'-for result of these efforts willl be cigarettes with, distinguishing new product properties which are biologically approved oniall major healthquestions,. Such products should be advertised vigorously on the basis of'studies so conducted. , ~

SIGNIFICANCE OF REPORT"S FINDI:`1GS'TQ TECHNICAL ACTIVITY The raising,of so many bogey-man issues over the centuries concerning the allegedly unhealthful effects of tobacco has no doubt Jaded the user's appetite for such rations. Consequently, the tobacco interests have successfully put their accusers in the position of proving their point, and as the latter failed, so the issue died. Now the findings of' the ten rruan panel of impartial scientists seem to have been taken rather as a verdict against cigarette smoking. Adoption of the Smoking and Health Report as "policy'r' of the U. S. Public Health Service, press treatment of the news, various proposed legislation, quick follow-up by the Federal Trade Commission and National Association of Broadcasters, and the beginning of negative action~s in the Defense Department, all suggest aishift in the onus of proof from the accusers to the tobacco industry. The professional approach of the Advisory Committee furthermore may serve to force future arguments to a more scientific basis. The proposed FTC Rule 2'cal!ling for more specific advertising,claims backed up by "substantial and reliable evidence to prove the accuracy and significance (to health)) of the claim" is in this vein. ~ O These early reactions to the Smoking and Health:R'eport under- COO score the increased importance of timely and effective R & D W activity, unfettered by non-technical restrictions to its inquiry, ~ to expand knowledge, upgrade present products, and introduce ~ pertinent new ones. Health impact will surely be an important, A perhaps the most important, basis for competition in the industry in the next few years. Competitive pressures suggest a break up of

C the commonfront approach of'the industry through TI and TIRC. While R. J. Reynolds continues to advocate a joint front, sit tight, status quo approach (it has the most to lose from any change in status quo), others like American and Liggett andMyers, sanguine for improved competitive positions, show signs of bolting and have capitalized with their new products on early reactions to the report. The greater the longer term market impact of the report, the more intense will there be healthicompetition, which is to say technical competition, among major tobacco companies. A special area of scientific activity receiving growing attentioniin the recent past and accorded emphasis in:the report is that of pulmonary cleansing mechanisms, particularly cilia function. This, together withirespiratory effects of smoking in general, is due for increased scientific inq;uiry in the future. EXCEPTIONS TAKEN TO THE REPORT'S'FINDING'S A careful review of'the report has so far disclosed no: vitiating errors of commission. There are the following exceptions/ comments, however, that are constructive: 1. No epidemiological or other evidence directly concerning the possible ameliorating effect of filters on the association of health and smoking was available for ~ consideration. This is an important omission, in virtue p of the fact that modern filters cut cigarette tar and' W nicotine deliveries up to one-half of'their former CJ CJ1 C? values. Th~e claim that people haven't been smoking N . filters long enough to:observe effects seem perfunctory ~ treatment of a major industry effort to meet objections

-C to its products. An~unfortunate impression at the committee's press conference that "filters do no good" was at least subsequently rectified by S'enator Cooper. 2. The report states (pi. 143) that no evid'er.de exists to indicate a smoking threshold, at rates below which no harmful effects occur. This conclusion is in the same situation as that relating to filters. Evidence does not prove the converse either, and, more importantly, the public at large has been left with the impression that it must eliminate, not moderate. If a threshold exists, the effect of filters must be cut by more than one-half (possibly eliiminate), any harmful effects that may obtain in the long term future. Actually Tables 8 and 10 of Chapter 10 do not give great encouragement for a threshold. However, these total mortality data are dominated by deaths due to cardiovascular disease whichimay mask any threshold effect on lung cancer mortality. A tabulation of lung cancer mortality ratio:versus smoking exposure would be more pertinent. 3. The report gives inadequate recognition (p. 61) to the selective adsorption of certain gas phase components from smoke whichiaffect pulmonary cleansing mechanisms a mucus flow, cilia activity). The statement that carbon O O filters previously employed do not have specific power W W to scrub the gas phase ignores pioneer work at American UT N . Tobacco reported in Tbbacco Science, Vol. 3, pp. 52-56, GO 1959.

RECOMMENDATIONS FOR COMPANY POLICY Any important new situation in an industry presents a:fresh opportunity for the smaller companies to compete with the leaders on a new basis. Since the issue has been joined, Philip Morris should embrace thehealthlarea as such~ an opportunity with the same agressiveness that it has shown in packaging innovation. At the same time severely reduced reliance on TIRC and TI seems indicated by the impact of the report in spite of those activi- ties. To promulgate this shift, and!for other purposes, the following recommendations are offered'to Philip Morris management: 1. Adopt as internal policy for technical purposes the view,that greater benefit will accrue from acce~pting the report's findings on face value and proceeding to the cure of'ills, real and alleged as they may be, than from engaging in disputation and refutation of these claims. Research effort should include very little of the latter. 2. Recognize the accelerated technical competition developing 3. in the industry through increased support of Research Center programs (details next section). Follow the prompt offering,of a new dual carbon filter product (Philip Morris Multifilter - 2), by leap-frogging the competition:with albetter engineered one (see below)e to:be developed by Research Center before year end~. 4. Nove promptly and effectively toward establishment of suitable biological approval specifications for all new smoking products. It may be expected that initime the P

Government will force the adoptionof such specification~s, in whichicase Philip Morris would be able to:influence the setting of the "uniform and reliable testing proced!ure" (p roposed!P'TC Rule 3) consistent with our own methodology. 5 Apart from possible legal requirements, such a policy would enhance advertising opportunities. Provide a substantive tising by publication literature. basis for vigorous healthiadver- of suitable articles IMPACT ON RESEARCH CENTER PROGRAM Consideration of the report's findings in the technical has resultedlin the following,influences on.the Research Center program, to be acted on promptly: 1. A broad review of bioassay techniques, through both literature search and personal contact of recognized contributors, will be undertaken to define optimum criteria for use iniphysiological studies, both at the Center and elsewhere. These criteria will include specifically a quick test for chemical carcinogenicity and best measu~res of pulmonary cleansing effectiveness (e.g. ciliastasis, mucus flow, phagocytosis, etc.), in -0 addition tolidentification of appropriate respiratory ~ parameters already under study. 2. A strong effort will be mounted toldevelop by year end a filter cigarette markedly better than any anticipated ~ from the competitioni. This will combine very low TPM delivery (less than 10 mg./cigt.), adequate gas phase scrubbing to permit satisfactory functioning of pulmonary

cleansing mechanism~s, and fliavor sufficient to attract a reasonabl'e market. The development will be based on Series T (new microfiber polyethylene tow) filter and~ adisorbents having qualities surpassing those now on the market. Technical participation of Manufacturing Depart- ment is important to success of this venture if we aree to manufacture by year end. 3. The chemistry of cigar and pipe smoke will be elucidated, and'deliveries to smokers determined. Clues will be sought as to possible differences which might help explain the much lower mortality ratios of these smokers versus cigarette smokers. Pipe smokers, even those smoking, (inhaling)~ more than 10 pipefuls per day for over 30 years, appear to have mortality ratios insignificantly different from non-smokers. 4. Present programs studying gas phase adsorption and tar fraction carcinogenicity will be emphasized, to improvee competitive posture inithese technical areas. 5. S'cientists will be assigned to expand the!Center's knowledge of'd~evelopmemts iniepidemiology, cancer studies (clinical as well as animal), etc., by current interpretive review, of'literature and personal visits to centers of such knowledge, as an aid to research planning and'competitive (technical)' analysis. 61. Liaison with a first class medical school should be A established a,s a further expansion of sources of knowledge.

This relationship:micnt be best initiatedithrough a grant to study possible effects of smoking on heart load. I NDUSTRY POSTURE VIS-A-VIS PUBLIC The health value of filters is undersoldlin the report and is the indlzstry's best extant answer to its problem. The Tobacco Institute obviously should foster the co mmunicationiof the filter message by all effective means. At the same time TIRC can profitably sponsor development of those areas where exceptions to the report's treatment have been made (listed'above)i. Specifically, a prospective survey of filter vs. non-filter smokers is appropriate. This study can be extended by correlation of filter smoking habits with examinationlof bronchial epithelium at autopsy (i.e. loss of ciliated columnar cells, presence of atypical cell nuclei), changes in which may occur some years before lung cancer, according to some (Scientific American, July 1962). An elucidation of the smoking,threshold question by further analysis of present data and new work is also desirable. If it is true that theonusof proof in the Smoking and Health issue has shifted to th~e tobacco industry, then the industry must come forward with evidence to show that its products, present and $ prospective, are not harmfu~l. Medical research must be done for . O O this purpose, as well as for jiudging the merit of work done outside W the industry. The industry should abandon its past reticence with w C1'i respect to medical researchi. Indeed', failure to do su~ch research TV. could give rise to negligence charges. Further, it is not enough to sponsor the work of third parties (e.g. ten millionidollar gift N -8 -

to AMA), though these moves are heartily to be d'esired. Individual companies must also do their owniresearch if they expect to develop proprietary positions for the health~competition.

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