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IVSMOKING AND HEALTH RESEARCH IN U .S .A.

iSG3~~B1078Smokingandhealthresearchis carriedout or supportedinUS.A. by

tobaccomanufacturers intheir ovalaboratories andunder contract wthoutsideresearchfirm by TheCouncil for TobaccoResearch- US .A., bytheAmericanMedical Association by theNational Cancer Instituteof theDepartment of Health, Education and :'lelfare . by the American Cancer Society,by Dr. EL. Wynder andhis Dvisionof theSoan-KetteringInstitute andby Drs . Bock and Moore at the Roswell Park Institute of New York StateDepartment of Health.

Aseparatereport anour discussions wthUS. research workers hasbeen prepared. Thepurposeof this sectionof our report is tosummarise-

(a) Thesmokingandhealthresearchpolicy of theUS .cigarette manufacturers .

(b) Their comments on TRC research policy(c) ThepositionregardingasearchinUS .A. for acigarettesmokewthless longtermactivity

A . Smoking and Health Research by U.S . ManufacturersSmoking and health research by U.S. manufacturers is largely

conditioned by two factors :1 . Thepersonal beliefs of thePresidents that nothingagainst

smoking has been proved, as mentioned in the Introductiontothis report.2 . The dilemma posed by the law suits. Themanufacturers have

to choose between -(a) Doingnosackingandhealthresearchandbeingrepresentedinlawsuits as negligent (although"tomeet pubicconcern",

they finance GTR and AMA research)(b) Doingsmokingandhealthresearchandbeingforcedtoadmt inlawsuits that their experiments havecaused

cancer in animals and yet that they have made no changesin tobacco smoke to eliminate the tumours .

The manufacturers have chosen (a), except for L & Ms researchthrough A.D. LittleCo., but competitionhas forcedthemtoadopt someshort termform of healthresearch

All themanufacturers aredci.igchemcal research. Mst of isfor commercial andquality purposes. Nevertheless, some of it is forsmokingandhealthpurposes - e.g. tounablethemtoalter quickly theconstituents of thesmokeif this shouldberequired

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All themanufacturers arealsobelievedtobedoingsomebiologicalresearchinrelationtotheir ownproducts. It must beaddedthat nooneactually knows of any suchresearchby Reynolds, but it is generallybelieved that Reynolds must be doing some. Theonly positiveevidenceabout this is astatement by Wynder toGFTthat Reynolds useBattelleforbological research but Wynder canfrequently get suchthings wrongWhile a remark made to us implied that one manufacturer might be doing somebiological researchinhis ownlaboratory, thepracticeis tocontract outthis work. Thefollowngarrangements arebelievedtohavebeenmade

American Tobacco Co. DLarson (Medical School of Virginia) .PhilipMorris Food&DrugResearchInc., of LongIsland

and another firm.Lggett &Mers AD. LittleCo., BostoLoillard BoResearch Inc, Boston, andDr . Dalhamn (Stockhdlm) .

Dr . Wynder also informed GFT that the Armour Research Foundation wasdoing biological research for some cigarette manufacturer .

Thebasicpoint is, however, that thebiological research exceptpossibly for some work by A.D. LittleCo. for L&M is short-termandnotcancer research primarily for thelegal reasons mentionedabove. Theshort termbiological researchis designedtoproduceasmokethat -

1. has mnimumresponseinatest (e.g. for ciliastasis) that sanberelatedinsometheoretical way toahumanreactiontosmoking without actually involving cancer .

2. that will carry medical or scientificsupport fromprivateindividuals (e.g. Fieser, Kensler) inafc-mthat canbeexploitedtobuildsalesBasically, therefore thesearchis for asuccessor toLark

Thedifferent Companies havedifferent ideas as tothebroadcharacter-istics of thesuccessor toLarkthat they areseeking. H. Harringtonthought that theflavour of Larkhadbeenanimportant factor inits success:hesaidthat Larkalsohadrelatively hightar andnicotinecontent, andhethought it important tokeepthenicotineup. Mr. Walker, inCarlton hadfollowed Dr. Yynders ideaof alowtar, lownicotinecigarette. Dr. Seeversinformedus that hehadspecifically toldDr. Harmer, Drector of Researchof A.T . Co., that it was important tokeepupthenicotinecontnent of thesmoke, while reducing anything that ought to be roducod. Dr. Seeversrecommendation was that A.T. Co. shouldaddnicotinetothecut tobaccoandthenreducebothnicotineandtar by filter andporous paper as inCarltonDr. WakehamdescribedPhilipMorris obectiveas a"highflavour/lor, delivery"

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cigarette but it was lowdelivery of somesmokeconstituent that con-tributedlargely toabiological reactioninsomeshort termtest .Mr . Galloway (RJR) thought that a reasonable amount of nicotine wasnecessary inacigarette. Mr. Blunt firmy heldtheviewthat peoplesmoked because of the nicotine.

B . US . Opinion of TRC ResearchWeoutlinedour researchobectives andprogrammetoall thePresidents

and Directors of Research that we met . There should now be a much widerknowledge and understanding of our research .

RJR, A.T. Co. andB&Wcriticisedour approachtobo-assay researchonthreegrounds -1 . It constitutedanimpliedadmssionthat tobaccocontainedhealth

hazards, andthis couldbedamaginginlawsuits inUS.A. Thishas beendiscussedintheearlier Sectionof our report onLawSuits2 . Mouseskinpaintingwthsmokecondensate accordingto

Dr. Little was scientifically unsoundandbasedonafallacy(though C.T.R. hadcontractedwthhio-ResearchInc. for researchofd type) . Against this bothL&MandLorillardscientists toldus quitebuntly that they consideredTRCresearchwas onthecorrect basis and CTRclargoly without value. It is unlikely thatCompany scientists wouldspeaksofrankly unless they wereprettysuretheir principals heldviews not greatly dissimlar.

3. It couldpresent theUS. manufacturers inabadlight totheU.S. publicsincethey couldberepresentedby hostilewritersas beingnegligent of pubichealthincomparisonwthUK .manuf acturers .

4

Wepointedout that wekept thepossibereactions inUS.A.continuously inmnd andfurther that Dr. ti W1'ynder had contended that U.Kmanufacturers were dragging their feet compered rith U .S. manufacturers .

Therewas particular interest inandapproval by Messrs. Gray, CullmanandCramer of researchintothecharacteristics of thesusceptiblemnoritiesbeingcarriedout for TRCby Prof. D.D. Reid and Dr. DM . Kissen. Mr Graysaid that obviously there were some people who should not smoke - e .g. thosewith emphysema.

Mr . Cullman, Mr . Cramer and others ren,rked that there was much morefirm direction and push behind TRCs research programme than CTRs .

Theonly criticisr.s in detail about TRC r esc rch wcre that 'RC wasyears behind the U.S. manufacturers inresearchintomucus flowandciliastasis,and that TRC was poscibly neglecting virus rescc .rch. Mr. Gay thought that"viral Activity mght :all uxplr.inth: st!ti.stics"

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C . The Search for a Cigarette -.ith Less Long Term ActivityWewerenaturally interested sincesomuchof TRCbological researchhadlongtermobectives, tofindout rhat researchinUS.A. was beingcarriedout toreducethelongterm-activity of cigarettesmokeOnly Liggett & Myers, th_-oui A .D. LittleCo., haveTorked on smoke

carcinogenesis. Someof their past workinthis fieldis detailedinourreport on research aspects of smoking and health, but we do not know whetherthey arestill carryingout r-orkinthis field. Dr. Darkis (L & M) believes( contrary totheviers of Dr. 1ynder and some others) that P. largepart ofthemouseskincarcinogeniceffect of cigarettesmokecondensatecanbefoundtobeconcentratedinthehigher polynuclors. L & Mwould remove thesepnlynuclears fromcigarettesmokeif they conveniently could. They haveworkedonthis probemfor anumber of years wthout success andstatethat they haverunout of ideas. They wouldliketofindaprecursor ofthe polycyclics in some particularly abundant compound in unsmoked leaf,but consider this very unlikely, as somepolynuclears ariseonpyrolysisof any organicmaterial andarenot specifictotobaccosmoke. Dr. Darkisis not particularly optimsticabout beingabletoproduceacigarettethat is satisfactory tosmokeandwill not producecancer onthebackofa mouse.

Inshort, therefore theL. S. cigarettemanufacturers arenot lookingfor means toreducethelongternactivity of cigarettesCouncil for Tobacco Research

Dr. A.B. Andervpnt of theNational Cancer Institute editor of theInstitutes Journal, andadistinguishedcancer researchworker, hadrecently been persuaded by Dr . G.C. LittletojoinCTRs ScientificAdvisory Board. Heis theonly persontohaveacceptedaninvitationtojointheBoardinrecent years. Dr. Andervant told GFT that he hadexpectedCTRtobeseekingabafer cigarette", as heClescribedit, as amatter of first priority As we know, CTR supports only fundamentalresearchof littlerelevancetopresent day problem.American Medical Association

The Board of Trustees (which is the governing body) of the AmericanMedical Association drew up an"Charge" tobeusedby theScientificActivities Division of the A!-1A and by the Committee for Research on TobaccoandHealthinadmnisteringtheresearchfundof whichthe$10,000,000beingcontributedby thetobaccocompanies is themainpart. Beforebeingpassed to the House of Delegates for approv,r.l, this Chargewas consideredon behalf of the House of Delegates by a Reference Committee . TheChargwas amended by the Reference Cc.n-.itteeandpprovedby theHouseof Delegatesandreads as follows:-

"The Board (of Trustees) envisions c. study devotedprimarily todetermining Which signific-r.t human ailments may be caused or

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aggravated by smoking, how they may be -,sused, the particularelement or elements in smoke that may be the causal or aggrava-ting agent and methods f or the elimination of such agent" .Thephrase"andmethods for theelimnationof suchagent" hadnot

beenincludedinthedraft Chargepreparedby theBoardof Trustees butwas added by the Reference Committee .

Dr . Blasingame (Executive Vice rresident of the AMA) and Dr . Seevers(Chairman of the Committee for Research on Tobacco and Health) object tothedecisionthat theAMAshouldcarry- out asearchfor "methods for theelimnationof suchagent." Indeed Dr. Seevers considers that his Commtteeshouldnot support researchinfields inwhichtobaccomanufacturers havegreater competence suchas theconstituents of cigarettesmoke howtomodify them howtotreat tobactcinthefieldor factory. Todate theAMAhas not agreedtosupport any researchproect inthecancer fieldbut this is becausetheAMACommtteehas not receivedany applicationthatit consideredworthsupportingprobaby owngtothevolumeof funds alreadyavailabeinUS.A. for cancer research. Whatever theHouseof Delegatesmay haveresolved theAMAis not supportingresearchaimeddirectly toresult incigarettes withless longtermactivityNational Cancer Institute

Dr. Kotininformedus that theNational Cancer Institute as theappropriatedivisionof theDepartment of HER'., was preparedtounder-takeresearchwithavier toelimnatingthe:Long term activity ofcigarette smoke. But headdedthat -

1 . NC .I. wouldnot berushedintoearly action. They wouldrant time for example first toconsider therecommendationsfor futureresearchmadeby sub-commtteethat hadrecentlyvisited Euro;+;, including TRC

2, Their programme would form part of a comprehensive programmeby H.E.''i. that wouldincludeanti-smokingeducationas wellas research

3. It wouldbealongtermmulti-mlliondollar programmei} . Funds rouldhavetobeidentified(sothat other Government

Departments could not appropriate any of them) .5 . Satelaboratories wouldhavenoplaceintheprogrammUntil thetimeis ripefor this programmetogoforward Dr. Kotin

is remainingaloof a:=far as possiblefromresearchinthefieldof longtermactivity of cigarettesmoke. Indeed herecently callodoff someproerts plannedinthis field. TheNational Cancer Institutedoes not

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viewwthfavcuz theincurrenceof theDepartment of Agricultureinthefieldof smokingandhealthrese.u chbut this is somethingthat theNC.I.has toliveandco-operatewithfor thetimebeingCongress andtheUniversity of Kentucky

Arecent report (Report No. 1387) by theCommtteeonAppropriations(Dept. of AgricultureSul)-Commttee) of theHouseof Representativescontainedthefollowingparagraphs

"The Tobacco Problem"

"Tobacco has been a major agricultural commodity through theyears. it is producedin21 Sates aridiothefifthlargest income-producingcroptofarmers. It is anf8billionindustry withgrowersreceiving about 91.2billicnper year. It pays someA3.3billioneachyear intaxes toour Federal, Sateandlocal governments.

Duetotheimplications of theSurgeonGenerals report, it isessential that wefindtheansrrercthroughresearch. Inthis effortwe must have the o-operation of the Department of Agriculture, theDepartment of Health Education and1!elfare andprivateindustry,todetermnetheproperties of tobaccowhichmay affect thehealthof smoke--s and to develop a means to eliminate any harmful substancesfound.

It is extroE:1y impo: 'ant ththis -researchbeginimmediatelyTheanswers tothis prob-ier must befoundjust as rapidly as possibetoprevent economcruinfor gov:ers, substantial losses of revenuetothefederal andloci). gcvernments, andpossibeinury tothepubichealth

The Commit':echearings disclosethat theUniversity of Kentuckyhas a Tobacco Research Laboratory built with .+ .5 mllionof Satefunds whichis nor. availabeandhas beenofferedtotheDepartmentof Agricultureby Univerr i ty andSateofficials for suchresearchIt is locatedadacent tothuNov Medical ResearchCenter at thisUniversity andis ideally situatedfor aco-ordinatedagricultural-medical researchprobemof this naturo Accordingly, the Committeehas included51,500,000 of Section52funds inthebill for 1965 toenabetheDepartment toimmediately initiatutobaccoresearchatthis locationincollaborationwiththeSateUniversity, Sateagencies, the Department of Health, Education and Welfare and otherpubicandprivateorganizations whichcancontributetoaconcertedapproachtothis urgent resorrchneed"Thebackgroundtothis is that Dr. Oswald President of theUniversity

of Kentucky, Lexington, -riti: theco-cp.raticnof theGovernor of Kentuckyandother politicians, cav, zr. or:ortunity of' obainingsomeFederal funds- II )

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The Department of Agriculture (Dean: Dr. W. Seay) hadbuilt alaboratorywhichwas carryingout researchintocornandother crops groininKentuckyIt was plannedtodevotesomespacetotobaccobut astart hadnot yet beenmade . FollowngtheSurgeonGeneral's .sport, Dr. Osv,aldhas offeredtopledgetheresources of theUniversity tothesmokingandhealthprobemincludingthefacilities of thechemstry aridphysics departments andofanew$12mlliont.1edical Centre if Congress mouldfoot thebll. Theresearch would cover everything from seed bed to smoke, including productresearch, and some model biological assay systems have already been preparedby theMedical Faculty towards asolutionof theprobem

Inthemeantime afight for control of theresearchprogrammeof thelaboratory and of any Federal money has developed:

1 . Asectionof theDept. of Agriculture wthFlaggerstat, SedmanandMood is tryingtocontrol theprogrammeof theLexingtonlaboratory

2 . A group from the American Cancer Society - Davies, Auerbach,Nelson- arearoundthis particular honey pot, tryingtoinfluenceits affairs, thoughinwhat precisedirectionis not clear ,3 . TheDept. of HE.k., instructedby theAppropriations Commttee

to co-opcrate,has nominated Dr . Kotin whois reluctantlyobeyingandhopingthat thewholeKentucky proect still foldup. As reportedabove hebelicvcs that smokingandhealthresearchis amatter for HE .V1. alone

4. Representatives of thecigarettemanufacturers attendedanorganisingmeeting withtheir la:~yers on6-7thOctober, tooffer Dr. Oswaldtheir co-operationif therescarchwas tobelimtedtothequestionwhether scokingcausedlungcancer.

5. Dr. Hockett of CTR ':as present at this meeti.ig toadviseontheprogrammeontheexpress invitationof theGovernor ofKentucky, but Dr. Littleintends that CTRshouldnot beinvolvedintheKentucky proect.

6. Dr. Oswaldintends that heandhealoncwill control theresearch programme .

Theodds arethat, after muchado theso-calledTobaccoResearchLaboratory at the University of Kentucky -.rill achievevery littleinthefieldof researchintothelongtermactivity of cigarettesmokeOther U.S. Researc

We know that Dr. Wynder is aimngtorroducccigarettewhosesmokehas mnimumlongtermactivity, thoughthat is not hc. hewoulddescribehis obectivo. Hs research ha-:ever, is ccir.gcarriedout r-ithout regardtotheappeal of theresultingproduct tcs ckcrs

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There is some research b Bing carried out in U. S . A. on fundamentalproblem inthefieldof smokingandlungcancer, but nothingas far aswe ]rno-., directly applicabletoour problem.Conclusion

Themainconclusionthat t drewis that theUS. researchwill notachievevery =uchat least inther,;ar future inmeetingtheobectiveofthe House Appropriations Committee "to determine the properties of tobaccowhich may affect the health of smo_kLrs and to develop means to eliminateany harmful subs : : :- yes found." Ontheother hand this isan very powerfulCommittee. It as recently ::ritten by heir. FrankSmth inhis autobiography,"Congressman from Mssissippi" -

"The Appropriations Sub-committtc;s of both Houses are goodexamples of subcommittee power . Thereports of thesub-commtteesarcoftenmoreimportant thanstatutory lat, because the Agencieswhosefunds they appropriateoftenoperatewththosereports asaliteral bible. Thereports arenot subect toamendment onthefloor, andthey frequently donot reflect majority opinion"The objective expressed in the Appropriations Committee report quotedabovereflects theinterest of hundreds of thousands of tobaccogrowers,

andtheSenators andRepresentatives representingtheseinterests inCongress areunlikely tobedeflectedinthelongrunfromtheir researchobectiveby lawsuits facingthetobaccomanufacturers. If this obectiveholds, thentheNational Cancer Institutemay corktohaveits tray