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Full text of "False and misleading advertising (filter-tip cigarette) : hearings before a subcommittee of the Committee on Government Operations, House of Representatives eighty-fifth Congress, first session July 18, 19, 23, 24, 25, and 26, 1957"

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JULY 18, 19, 23, 24, 25, AND 26, 1957 

Printed for the use of the 
Committee on Government Operations 


{6846 WASHINGTON ;: 1957 

Lory ANY 

SJORE / 20590 



WILLIAM L. DAWSON, Illinois, Chairman 

JOHN W. McCORMACK, Massachusetts R. WALTHR RIEHLMAN, New York 
EARL CHUDOFF, Pennsylvania CECIL M. HARDEN, Indiana 

L. H. FOUNTAIN, North Carolina GEORGE MEADER, Michigan 
JOHN BH. MOSS, California EDWIN H. MAY, Connecticut 

DANTE B. FASCELL, Florida H. ALLEN SMITH, California 

HENRY S. REUSS, Wisconsin 
ELIGABETH KEE, West Virginia 
ORVILLE S. POLAND, General Counsel 
JAMES A. LANIGAN, Associate General Counsel 
HELEN M. Boyer, Minority Professional Staff 

JOHN A. BLATNIK, Minnesota, Chairman 

OVERTON BROOKS, Louisiana H. ALLEN SMITH, California 

PORTER HARDY, Jr., Virginia 


CuRTIS E. JOHNSON, Staff Director 

HAL M. CHRISTENSEN, Associate Counsel 
JEROME SONOSKY, Associate counsel 
STANLEY T. FISHER, Accountant-Investigator 
JOHN L. ANDERSON, Investigator 

ANN DOMINEK, Assistant Clerk 


Statement of— 
Burney, Surg. Gen. LeRoy E., Public Health Service, Department of Page 

Health, Education, ACG IE 2 cae Ut tate papleamincls Bae halts 0 134 
Greene, Harry S. i, chairman, ep of pathology, Yale 

University pP Pree SONS VE MIELE ee een Wee eee Pree ere ee her PEP peg Yr) 204 
Greenhouse, Max, certified public accountant and_ statistician, 

| OLE) TERE ORL ehh SOO eer ae GAPE a rt eae TENE rp ee nes, ey AMR 261 
Hammond, Dr. E. Cuyler, director of statistical research, American 

CIC DOCIOUY, 2 aus ae heccaue hele A cen r ged bao ane td Fe ee et ca 3 
Heller, Dr. John R., Director, National Cancer Institute___....._-- 136 
Kimball, C. 8., executive vice president, Foster D. Snell, Inc_______- 184 
Little, Dr. Clarence Cook, representing the Tobacco Industry Research 

CC ONAN EC Cc se eer ie OE OE eke ae eA heme Eo 34 
Macdonald, Ian G., M. D., University of Southern California______- 224 
Michelson, Irving, special projects division, Consumers Union_-_-_--_- 164 
Norr, Roy, publisher and editor, Norr Newsletter About Smoking 

2) ale (OS) i] | a OSA Oy SP, MER inca Oe, ember eon 0p Seer eae 267 
Rand, James; accompanied by Dr. Ahmed Burhan; and Dr. 8. Cardon, 

representine Rand Development Corp.............-.-.-..d su 240, 247 
Rigdon, Dr. R. H., professor of pathology, School of Medicine, Uni- 

VCR NO eOl LOKAG Re ae ee ELE SEE Rae i ere a eal I 114 
Secrest, Robert T., Acting Chairman, Federal Trade Commission___ 273 
Wolman, Walter, director of the chemical laboratory, American 

WESTICa A ScOCIAtION ager Kite Pie cy et era Sat eee ee 180 
Wrather, Stephen E., Director, Tobacco Division, Agricultural 

Marketing Service, Department of Agriculture..___________.___- 188 
Wynder, Dr. Ernest L., Sloan-Kettering Institute for Cancer Re- 

LOSER GI, Nan 2 RE ANE CET ss RE ee Mah | LNA NY nes Pa RR ele AY ME SENE 63 

Letters, statements, etc., submitted for the record by— 
Blatnik, Hon. John A., a Representative in Congress from the State 
of Minnesota, and chairman, Legal and Monetary Affairs Sub- 

Excerpt from article in Cleveland News, February 17, 1956, by 
S. Severino entitled, ‘Study Rand Paper for Cigarettes’’_ ____ 246 
Excerpt from book by Eric Northrup entitled, ‘‘SScience Looks at 
ma Oe er Rey eRe a ee ee Ba ee 57, 216 
Excerpt from joint Report of Study Group on Smoking and 
da Ge2M fA ERR De OOS ek SM eM 2 cake ge ge See ee me CO RE Cr Ne es 158, 159 
Excerpt from statement of Dr, E. Cuyler Hammond___-_..-- 214, 215 
Letter from Robert N. DuPuis, vice president, research, Philip 
Morris; Inc, to,Curtis:..Johnson, July 18,1957... 2 ba 200 
Greenhouse, Max, certified public accountant and statistician, Roch- 
ester, N. Y.: Siatcnlonte mies ge eters on Oa) eben eais te 262 

Hammond, Dr. E. Cuyler, director of statistical research, American 
Cancer Society: Smoking habits of men and women 18 years and 
over in the civilian population outside institutions, United States, 
MSO He Onuary., lOOOr +... = ieee a Cee ee i Sele Ge 2 31 
Jobnson, Curtis E., staff director, Legal and Monetary Affairs Sub- 
committee: Excerpt from cigarette advertising: 

CCS i AES Bs TRA el Ben eb TY le OPUS yl SN pte ee wr a Pte ft! ap) 289, 290 
RO Gla Gy OL ace ya, one oe ae es SO Sa ee ane 2 291 
1 We SN STE ges mae Paar eae Lan Eee aN UMVMN ENORT CANE Nia MONO Pipa s ay urn 292 
@hestenmeld aime c ly SoM 2 iia ei te kere ea ep ale 293 
Philip: NLORIS endeWlarl bono: to. c eee 2 ee ee 293 
Oamels “VW imeston, iain ivy ei Ae IY tee VES SE a as 295 
iocky. Strike; Hit. Parade, and.Pall, Malle... 8 oe .sieeueti es 296 
Chart—Comparison of claims and performance_-__.__---------- 298 
Little, Dr. Clarence Cook, representing the Tobacco Industry Research 
Committee: Excerpt from statement of Dr. Ernest L. Wynder__-_- 38 

Macdonald, Ian G., M. D., University of Southern California: 
Excerpt from observation of Dr. Paul EB. Steiner, professor of 

paviolosy. University OlsChicago. neta 2 hes toe. ee 232 
Excerpt from remarks of Dr. Berkson, biometrician at the Mayo 
TRAM oes ps ece bes bal osm > Sige &' 11 I A grea a Ne ape OTE 225 


Letters, statements, etc., submitted for the record by—Continued 
Meader, Hon. George, a Representative in Congress from the State of 

Michigan: Page 
Excerpt from statement of Dr. Clarence Cook Little_.___ 111, 146, 218 
Excerpt from statement of Dr. Ernest L. Wynder_---.------_-- 219 
Excerpt from’statement of Dr: LeRoy EH. Burney____--.----- 146, 147 

Michelson, Irving, special projects division, Consumers Union: 
Excerpt from Consumers Union tests report on cigarettes_____-- 169 
Except from summary statements or conclusions of Consumers 
Winion: tests reports. 2 - ee kee = eee, See ae 177 
Summary, history of cigarettes, by brand, 1953-57, re tars and 
WIGOUINE MIS Shs 2 SS ae ol ee et he: es eae epee 171 

Minshall, Hon. William E., a Representative in Congress from the 
State of Ohio: 
Excerpt from statement of Dr. H. Cuyler Hammond_--_---_-~-- 31 
Translation of an article published in Le Journal du Dimanche, 
Paris, Sunday, June 30, 1957, entitled, ‘“The Noncancerigenous 
Cigarette Is Born—Five French Scientists Have Given It the 

Final Touch—Two Smoking Robots Used for Tests’”________-_ 60 
Norr, Roy, publisher and editor, Norr Newsletter About Smoking and 
Claims made for filter-tip advertising on the air during the past 
DEY, COMER one ee A re RE Ne Ne et a ae ee 271 
Excerpt from statement by a former president of a tobacco com- 
feiny: LestChevistOMi leet oe ee a oe ee ee 271 
Excerpt from statement made by Louis Pasteur_______-_-_--~-- 269 
Excerpt from statement of Dr. Hugh Lennox-Johnston, noted 
authority on: cigareite seciction. -. Se ee 269 
Excerpt from statement issued by the American Association of 
Advertising Agencies more than 20 years ago_______-___-_-- 273 
Plapinger, Jerome §S., counsel, Legal and Monetary Affairs Subcom- 
Excerpt from book entitled, ‘‘Cancer, a Study for Laymen”___ 61, 224 

Excerpt. from Report of Study Group on Smoking and Health, 
sponsored by American Cancer Society, American Heart Asso- 
ciation, National Cancer Institute, and National Heart Insti- 

Sve (Ex MnO Gy te Nee ee eee te em es 129, 223 
Excerpt from quotation attributed to Dr. Clarence Cook Little. 61, 224 
Excerpt from statement in Consumers Reports of March 1957___ 189 
Excerpt from statement of Dr. R. H. Rigdon —=_=_2.----__..-- 160 
Tests of cigarettes for nicotine and tar—Consumers Union 

Dak 2) SUG gi ppc Ma raat ALNG Mp iN Joy ees le hand hale Me we eid ol coos ey 173 

Rand, James, representing Rand Development Corp.: Article in 
Cleveland News, February 17, 1956, by S. Severino entitled, 
Study: Ptamd “Paperntor Cisarettes, "ocak eee eee 246 

Rigdon, Dr. R. H., professor of pathology, School of Medicine, Uni- 

versity of Texas: 

Excerpt from statement of &. Schrek im 400 it 2s ee 118 
Excerpt from statement of Dr. Downes in 1931 re frequency of 

ES CGI te Si eS eee a ee ge Re ee) ye Oke ee ee 116 
Excerpt from statistical studies made by Wynder and Graham 

AEs OO) a oo afi eee ee ne ee 117 

Excerpt from vital statistics office of the United Nations in 1955. 116 
Secrest, Robert T., Acting Chairman, Federal Trade Commission: 

Cieavette-adventisine onidéd > -2-2< 22> 2k ee ee 299 
Excerpt from an article in the New York Times, July 21, 1957, 
entitled, “Huge Tobacco Industry Again on Defensive’’___-___ 280 

Excerpt from annual report of the National Better Business 
Ube aT For LOR eect ee eee ee en ee ee ee ee 280 


Letters, statements, etc., submitted for the record by—Continued 

Secrest, Robert T., Acting Chairman, etc.—Continued 
Excerpt from recent publication of the American Cancer Society - 
Excerpt from Surgeon General’s announcement, July 12, 1957___ 
Excerpt of letter suggesting to producers of cigarettes ‘to adopt 
standards for advertising, September 14, 1954_____.__._____-- 
Wolman, Walter, director of the chemical laboratory, American Med- 
ical Association: Table showing percent reduction by filter in the 
mainstream smoke of nicotine and tars in cigarettes_.__._.__...---- 
Wrather, Stephen E., Director, Tobacco Division, Agricultural Mar- 

keting Service, Department of Agriculture: 

Burley prices, loan receipts and holdings by grade groupings, 
Ea OMFClLONS 6s OSES ht A Stee tote tT eek cet hd oa 
Flue-cured prices, loan receipts, and holdings by grade groupings, 
MOO 2 IO CROMES 2 se ee Owe a 8 eee coe he 
oa stocks, duly, LOO. ot Ie ake bata 8 he ced opine tee h- 2G 2 
Table, production of cigarettes annually, 1951-56___._._.._..-_- 
Wynder, Dr. Ernest L., Sloan-Kettering Institute for Cancer Research: 
Excerpt from a report by the British Ministry of Health_______ 
Excerpt from statement of an American study group, American 
Gancer DOGICLY <¢ joc ned 3- oy p= eH S -bredsG~+aeed acc ae Ce 


Exhibit 1. Smoking in Relation to Death Rates, by E. Cuyler Hammond 
and Daniel Horn (a paper read at the annual meeting of the 

en Medical Association in New York City, June 4, 

1A (a Bie ow eis hal lm mo anes it cae ul Jato NA 

Exhibit 2. paredule of lung cancer grants awarded by the American Cancer 
op aa ie. Seep amar selon av Ne Sot Utne RR er ee 

Exhibit 3. Letter from the Tobacco Industry Research Committee to Hon. 
John A. Blatnik, dated August 1, 1957, with the following 
ERUUALOUIMIG UNG 5 re erat ener aE emery ee aera cena wa ieee eae 

Attachment A. Statement concerning the origin and pur- 

DOSS OF. Vie, COMMUTES. 2a ee ie 

Attachment B. Statement of policy concerning conditions 

and terms under which the Scientific 

Advisory Board awards grants-in-aid___ 

Attachment C. Statement of the research program___--_-_- 

Attachment D. An interim progress report dated May 16, 

OD peer ete drole bee a oe eter ee 

Attachment E. First report of the scientific director issued 

HORE Res ale ae ata ey fame fearbanter a  psares 2 OP Sieh ns 

Attachment F. List of original and renewed grants show- 

ing, as of July 1, 1957, the recipient, his 

institution, the amount of the grant, 

and the date the project was initiated _ - 

Attachment G. Abstracts of papers published in scientific 

journals on research work supported in 

whole or in part by grants approved by 

the Scientific Advisory Board__..___-_- 

Exhibit 4A. Study on Tobacco Carcinogenesis I]—Dose Response 
Studies, by E. L. Wynder, P. Kopf, and H. Ziegler; A 

Study on Tobacco Carcinogenesis IiJ—Filtered Cigarettes, 

by Ernest L. Wynder and Jona Mann (from the section of 

epidemiology, division of preventive medicine, Sloan 

Kettering Institute, New-York, N: Y.)2 20222 

Exhibit 4B. Toward a Solution of the Tobacco-Cancer Problem, by E. L. 
Wynder, M. D., British Medical Journal, January 5, 1957_ 

Exhibit 5A. The Relationship of Smoking and Cancer of the Lung, by | 

srs Beart M. D., the American Surgeon, June 1955 
(De il Ae) ede nat ani asec: otha Suna ah bill ele ieion esiia GS 
Exhibit 5B. Relationship of Cigarette Smoking to Lung Cancer, by Alton 
Ochsner, M. D. (presented before the annual session of 

the Colorado State Medical Society at Colorado Springs, 

Pepvemoel 22 Peloo eee ee RO Ge ee ee 

Exhibit 5C. The Influence of Smoking on the Respiratory Tract, by 
Alton Ochsner, M. D., the New York Journal of Dentistry, October 1954 
OO ee ee es ke lee ele aaa 
















Exhibit 6. Report of Study Group on Smoking and Health____________~ 
Exhibit 7. Tobacco Smoking Patterns in the United States (Public Health 
IMOnOsTapNS INO ED) = t2 ce) enc. ee ake ome eet nee ee ee 
Exhibit SA. Public Health Service release of July 12, 1957, on cigarette 
smoking and lung cancer with statement of Surg. Gen. Leroy E. 
Burney atpachodtys: h2 eee eee a ae ee ee eA 
Exhibit 8B. Statement of Tobacco Industry Research Committee of same 
aate on aboversublecton feo. fe ae cerns en eee ae. ee ee eee 
Exhibit 9. Interview with Dr. John R. Heller, Director, National Cancer 
Institute, U.S: News & World-Report; July 26, 195722. 3 os es 
Exhibit 10. List of research projects and research grants supported by the 
National Cancer Institute for period July 1, 1952, to June 30, 1957____ 
Exhibit 11. Article on tobacco industry by William M. Blair from the 
New -York=Pimes Sully ie 106 fas os oo oa ee eee eee ee Ee ceed 
Exhibit 12. Consideration of the Relationship of Smoking to Lung Cancer; 
With a Review of the Literature, by R. H. Rigdon, M. D., Southern 
Medidal-Jounmal “April oa Ap 0c 4)e 2 ee oe eee eee 
Exhibit 13. Material on British, Dutch, Swedish, and Norwegian govern- 
mental action in connection with lung cancer and cigarette smoking___- 
Exhibit 14A. The Facts Behind Filter-Tip Cigarettes, by Lois Mattox 
Miller and James Monahan, The Reader’s Digest, July 1957_________ 
Exhibit 14B. Wanted—and Available—Filter-Tips That Really. Filter, 
by Lois Mattox Miller and James Monahan, The Reader’s Digest, August 
Exhibit 14C. Report from Foster D. Snell, Inc., consulting chemists, on 
methodology employed in determination of tar and nicotine content of 
cigarette smoke-for the INeader’s Digest. oe ek See oe 
Exhibit 15A. February 1953 article from Consumer Reports on cigarettes. 
Exhibit 15B. February 1955 article from Consumer Reports on cigarettes_ 
Exhibit 15C. March 1957 article from Consumer Reports on cigarettes_-_ 
Exhibit 16. Articles from Journal of the American Medical Association, 
A study of Cigarette Smoke and Filters: 
Attachment A. Filter-Tip Cigarettes, July 4, 1953 (p. 917)________-_ 
es B. Special Low-Nicotine Cigarettes, July 11, 1953 (p. 
EOD ee ay et ae RR Se > EP Bs ie tk Ge IE Ws ni a Se Ns 
Attachment C. Cigarette Holders, February 20, 1954 (p. 677)_____- 
Exhibit 17. Report on Kent cigarettes by Consumers Union, attachment 
to statement before subcommittee of Irving Michelson, head of the special 
projects *Givision of Consumers Union. ease. ee et a ee ee 
Exhibit 18. Technical details of analysis for nicotine and tars in cigarette 
Exhibit 19. Bibliography of references on advertising, marketing, chemical 
analysis, and medical aswects-of -cisanreuyes..- = Oo ee 
Exhibit 20. Report on Type 31—Burley, of the Agricultural Marketing 
Service, Tobacco Division, United States Department of Agriculture__ 
Exhibit 21. 3,4-Benzpyrene in the Smoke of Cigarette Paper, Tobacco, and 
Cigarettes, by 8. Z. Cardon, E. T. Alvord, H. J. Rand, and R. Hitchcock, 
Rand Development Corp., the British Journal of Cancer, 1956 (p. 485) - 
Exhibit 22. The Inhibition of Formation of 3,4-Benzpyrene in Cigarette 
Smoke, by H. T. Alvord and 8. Z. Cardon, Rand Development Corp., 
the British: Journal of Cancer; 1956p. 498) 22 ee. ok eo 
Exhibit 23. Quantitative Determination of 3,4-Benzpyrene Formed by 
Combustion of Cigarette Paper and the Tobacco, by Raymond Latarjet, 
Jean-Louis Cuzin, Michel Hubert-Habart, Bernard Muel, and Rene 
Royer; translation from article appearing in Bulletin du Cancer (1956), 
page 180 
Exhibit 24. A list of medical development projects completed by Rand 
Developmen Cony. zee oe Mos wees ete ale ie eth oc ucleeey Fgh 
Exhibit 25. Norr Newsletter about smoking and health (June-July 1957) __ 
te ee Cancer by the Carton, by Roy Norr, Reader’s Digest, Decem- 
OY LOD et ae enter iim ce) ed he sph ae ee ee eo ec lo eS 
Exhibit 27A. Excerpt from the Congressional Record, January 17, 1957, 
of remarks of Hon. Richard L. Neuberger, of Oregon, containing article 

tere Filter-Tip Hoax, by Roy Norr, Christian Herald, September 
195 : 

Exhibit 27B. Now Everybody’s Getting Scared, by Roy Norr, Christian 
Herald, January 1954 













Exhibit 27C. Smokers Are Getting Scared, by Roy Norr, Christian 
RCE ere OceODer ostream en ee le 
Exhibit 28. Article from the Wall Street Journal, July 9, 1957, concerning 
cigarette company profits, filter cigarettes, with reference to effect on 
Boles Oh coumeen lnk (reponte sie so! 2 ks oe ee 
Exhibit 29. Letter to Hon. John A. Blatnik from Hon. John C. Watts, 
dated July 25, 1957, with attachment letter dated July 15, 1957, to the 
Surceon General. from Dr. Milton,B; Rosenblatt_.. 2. .20 22222 0..20_- 
Exhibit 380A. Letter to Hon. John A. Blatnik, dated July 21, 1957, from 
Dr. Joseph Berkson, Mayo Clinic, Rochester, Minn., with attached 
article, The Statistical Study of Association Between Smoking and Lung 
Cancer, from proceedings of the staff meetings of the Mayo Clinic, July 
OREO O Ou MOrevL Oh. 2 2a aenieinae wether Camels eel eos ce weet h ST ot 
Exhibit 30B. Letter to the editor, Washington Post and Times Herald, 
July 14, 1957, on smoking and cancer, from Dr. Calvin T. Klopp, 
director of the George Washington University Cancer Clinic__________ 
Exhibit 30C. Article from the Washington Daily News, July 18, 1957, 
concerning American Tobacco Co., The Reader’s Digest, and Batten, 
barton, Durceines Osborne ine. 2.20.2 ee ee 28 
Exhibit 30D. Cigarette Scare: What’ll the Trade Do? Business Week, 
Wecemiper sO Pe OO)e ox be ei a ERE Sey i A ae Oe 
Exhibit 30K. Letter to Hon. John A. Blatnik, dated July 15, 1957, from 
Booxbaum & Booxbaum, New York, concerning cancer causative agents 
MR CN GAT OOUE OACL 22 mio ne 5 oe ae ee gs eke ae Se oe a 
Exhibit 30F. Statement of Dr. V. Stefan Krajcovic on use of flexible 
GanGIB Me tanel eter thee he eS eS aes oad ete hae 5 Secs 








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In 2021 with funding from 
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a —-—~ - 

(Filter-Tip Cigarettes) 

THURSDAY, JULY 18, 1957 

Hovsr or ReEpreEsENTATIVES, 
Washington, Ds C. 

The subcommittee met, pursuant to notice, at 10:15 a. m., in room 
100, George Washington Inn, Hon. John A. Blatnik (chairman), 

Present: Representatives Kilgore, Griffiths, Brooks, Hardy, Meader, 
Minshall, and Smith. 

Also present : Jerome S. Plapinger, counsel; Curtis E. Johnson, staff 
director; and Elizabeth D. Heater, clerk. 

Mr. Buarnitx. The Legal and Monetary Affairs Subcommittee of 
the House Government Operations Committee will please come into 
session for hearings on matters pertaining to fraudulent and mis- 
leading advertising. 

I have a brief opening statement. This is a meeting of the Legal 
and Monetary Affairs Subcommittee, opening today what we hope 
will be the first of a series inquiring into the effectiveness of Federal 
agencies charged with protecting the public against advertising claims 
which may be false or misleading. 

Congress has assigned this responsibility to the Federal Trade Com- 
mission, the Post Office Department, and the Food and Drug Adminis- 

As the art of advertising has been refined and as its influence has 
grown through newspapers, periodicals, radio, and television, the 
responsibilities of these agencies have grown accordingly. 

Our hearings today are concerned with the advertising of ciga- 
rettes—particularly filter-tip cigarettes. This year Americans will 
smoke over 400 billion cigarettes. The cigarette industry has spent 
enormous sums to promote its products. On a number of occasions, 
the Federal Trade Commission has found it necessary to proceed 
against some of this advertising—principally with respect to claims 
that a particular brand of cigarette was less irritating to the human 
APP UBLOLY tract, or that it “had less nicotine and tars than other 


Cigarette smoking and its effects on health have been a matter of 
major public concern now for over 5 years. This concern has grown 
principally from reports that cigarette smoking is a contributing cause 
to lung cancer. Other reports have suggested that it may also con- 
tribute to cardiovascular diseases. 



May I state at this point that the committee does not and cannot 
go into the medical aspects of any possible relationship between any 
serious diseases and smoking as a subject in itself, or make any medical 
determination in this connection. But we feel it is necessary to know 
or be informed by the best possible sources from a professional level 
representing all points of view, in order to have a better backdrop upon 
which we superimpose this problem of the claims which are being 
made through advertising for the effectiveness of the filters in cigar- 

These medical reports were first highly publicized about 5 years ago, 
in 1952 and 1953, and they had a very adverse effect on cigarette sales. 
The industry then countered by introducing filter cigarettes promoted 
by a tremendous advertising campaign, some of it featuring health 
protection or less nicotine and tars. The fears of the public were 
thus quieted, sales climbed again and are now at an alltime high. 

About 5 years ago, of the total cigarette sales, only about 1.2 percent 
of all cigarettes sold and consumed were of the filter-type variety. 
Today it is estimated—and we shall verify this—that over 40 percent 
of all cigarettes sold are of the filter-tip variety. 

The subcommittee has arranged for the appearance of scientific and 
medical witnesses who will present various points of view on the rela- 
tionship of cigarette smoking to health in the opening phase of these 

This testimony will be followed by representatives of testing labora- 
tories, the tobacco industry, and the Federal Trade Commission. 

May I state here—I know I speak for the committee—our intent is 
a positive and a constructive one. We are not here, either directly 
or indirectly, to cast any reflection or do any harm to any economic, 
professional, or social group or to any individual in the study of 
something which affects and concerns, and certainly is of interest to 
millions of American people. We hope to be informed and to learn 
from men who have spent years of study and research in this field all 
that is possible to learn as laymen, and then to check and to inform 
ourselves on the effectiveness and the efficiencies of governmental agen- 
cies that are directed by laws passed by Congress in protecting people 
from fraudulent and misleading advertising. 

As I stated, this is the first of a series. We hope later on to get into 
medical products. The first one suggested as the next subject is the 
reducing field in which it is estimated that hundreds of millions of 
dollars are extracted from the consumers of America for products 
that are worthless and in some cases even harmful. 

We hope to get into the so-called tranquilizing drugs that are merely 
old common drugs sold often not only in drugstores but over the soda 
fountains—again extracting hundreds of millions of dollars from the 
consumers of America for purposes that are questionable. 

This briefly is the nature of the series of hearings. We pick on no 
one commodity. We pick on no one group or no one individual. We 
may now proceed. 

We have as our first witness Dr. E. Cuyler Hammond, of the Ameri- 
can Cancer Society, who will present his testimony on the observa- 
tions and the findings of his organization here on the influence of smok- 
ing on the death rate. 

Dr. Hammond, will you please take the chair. 


Dr. Hammond, would you give your full name, your official capac- 
ity, and a brief summary of your professional background and major 
field of interest ? 


Dr. Hammonp. My name is Edward Cuyler Hammond. I am 
director of statistical research of the American Cancer Society and I 
am professor of science at Yale University at the present time. 

I obtained my doctor’s degree in the field of science in the year 
1938. From there I went to the Public Health Service in industrial 
hygiene. During the war I was in the Air Force, part of the time 
in Washington and part of the time head of the Statistics Department, 
School of Aviation Medicine, at Randolph Field. 

At the end of the war I worked on medical aspects of the atomic 
bomb and I got out of the Air Force and went to the American Cancer 
Society. Since that time I have been largely engaged in research on 

Mr. Buatnix. Will you please proceed with you statement, Doctor? 

Dr. Hammonp. Mr. Chairman, I want to apologize. I think I had 
better read this because there are somany pagesinit. IfI doit from 
memory I might make an error. | 

Mr. Bratnik. Please proceed. 

Dr. Hammonp. Evidence that smoking is a serious health hazard 
has been accumulating slowly since about 1915. However, research on 
the subject has increased enormously during the last 8 years. The 
impetus for this was the alarming trend in the death rate from lung 
cancer. The reported number of deaths from this disease rose from 
2,500 in 1930 to 18,000 in 1950 to an estimated 29,000 in 1956. 

I should like to interject here that we are not certain that all of 
that rise is really a true rise. <A part of it is probably due to better 
medical diagnosis, and a part of it is due to the aging of the population. 

Nevertheless, it was alarming. 

I would first like to give a brief description of the state of knowl- 
edge in 1950; then describe the results of a study we started in 1951 
and just completed last month; and finally discuss the meaning of our 
findings in the light of other evidence. 

As early as 1915, it was reported that cancer of the mouth occurs 
most frequently among people who smoke or chew tobacco. This has 
since been confirmed by several independent investigators. In 1928, 
Lombard and Doering of the Massachusetts Health Department found 
smoking to be more common among patients with various sorts of 
cancer than among people free of cancer. 

By the end of 1950, nine independent groups of investigators in this 
country and abroad had reported a much higher percentage of smokers 
among men with lung cancer than among other groups of men. In 
1936, an English scientist found an increased number of lung tumors 
among mice exposed to many different inhalants, including cigarette 
smoke. ‘Three years later, an Argentinian scientist produced cancer 
on the skin of rabbits with tar distilled from tobacco. The tobacco 
wasn’t smoked. It was distilled tar. 

In 1938, Raymond Pearl, of the Johns Hopkins University, pub- 
lished the results of a study on smoking in relation to the life expec- 


tancy of men. Among men in the middle age groups, the death rate 
of heavy smokers was found to be about double that of nonsmokers. 
Pearl made no mention of the causes of death. 

However, such a large difference could hardly have occurred unless 
the death rate from cariovascular disease was higher among smokers 
than among nonsmokers. That is so because cardiovascular diseases 
make up such a large proportion of the total death rate. : 

In 1940, a group of doctors at the Mayo Clinic reported smoking to 
be more common among patients with coronary artery disease than 
among people in a suitable control group. This was again found in a 
study reported from a veterans’ hospital in 1950. It has also been 
reported by at least two or three other investigators. 

Investigators had reported that smoking has an acute effect on the 
circulatory system including (a) an increase in heart rate, (6) an in- 
crease in blood pressure, and (¢) a constriction in peripheral blood 

Clinical studies had shown that smoking has an extremely serious 
effect on patients with Buerger’s disease, a rather rare circulatory dis- 
ease which causes gangrene of the extremities. 

Clinical studies on patients with peptic ulcers indicated that it is 
very difficult to cure this disease unless the patient gives up smoking. 

In spite of all the evidence collected up to 1951, a number of investi- 
gators, myself included, were not convinced that smoking was an im- 
portant factor in lung cancer. I was smoking two to four packs of 
cigarettes a day myself at that time, and I didn’t like to believe it. 

The major reason for my skepticism was doubt as to the validity of 
the method which had been used in studies showing an association 
between smoking and this disease. In all of the studies made up to 
that time, patients with lung cancer were not questioned about their 
smoking habits until after they developed the disease. For this reason, 
there was a theoretical possibility that illness biased the responses of 
the patients. 

By 1951, the mounting evidence on smoking, together with the great 
increase in lung cancer, made it imperative to determine beyond rea- 
sonable doubt whether the total death rate as well as the lung cancer 

death rate was higher among smokers than among nonsmokers. 

For this reason, two large-scale followup studies were started that 
year. One was conducted, and is still being carried on, in England 
by Doll and Hill under the auspices of the Medical Research Council. 
The other was conducted in this country by Hammond and Horn 
under the auspices of the American Cancer Society. 

(See appendix, exhibit 1, p. 310.) 

Dr. Hammonp. I will now describe our study. 

After designing and pretesting a smoking questionnaire, we trained 
over 22,000 American Cancer Society volunteers as researchers for the 
study. Each researcher was asked to get a smoking questionnaire 
filled out by about 10 white men between the ages of 50 and 69 whom 
she knew well and would be able to trace. 

The researchers were told not to enroll a man if he was seriously ill 
or if they knew he had lung cancer. Once a year thereafter they re- 
ported on each man as “alive,” “dead,” or “don’t know,” and recorded 
all changes of address. A copy or abstract of the death certificate was 
obtained on each death reported. 


Whenever cancer was mentioned on a death certificate, further in- 
formation was sought from the doctor, hospital, or tumor registry. 
The study area included 394 counties in 9 States: California, [linois, 
Iowa, Michigan, Minnesota, New Jersey, New York, Pennsylvania, 
and Wisconsin. 

A total of 187,783 men who filled out smoking questionnaires be- 
tween January and June of 1952 were traced through October 31, 
1955. Eleven thousand, eight hundred and seventy deaths were re- 
ported during this period of time and the total experience covered 
667,753 man-years. 

I have some lantern slides and with your permission I would like 
to show them. 

Mr. Buarnix. Doctor, for the record, these slides which you are 
to show us now are the same slides you also have reproduced and at- 
tached to the copy of your report? 

Dr. Hammonp. That is correct, sir. May I say, sir, what I am 
about to show is an abridged version of a longer report I read at the 
American Medical Association. I have cut it in length so as not to 
take up too much of your time. 

| f | only 

: 3600 oo # |and OTHER 
: | CIGARS only 
& 3000} oie" PIPES only 
g ' | SMOKED 
S 2400) 
a 1800 
Se ge gate ae 
<< zn 
2.) ee 
a 2 
<= 600) 

f = | 

Age Age Boe fey 

50-54 55-59 60-64 65-69 

Slide 1, Total Death Rates by Type of Smoking (Lifetime History) and by Age at Start of Study 

This slide (1) shows death rates per 100,000 man-years by type of 
smoking for each of four age groups. Age, as shown here and else- 
where in this report, refers to the ages of the men at the time they 
were questioned in 1952. Of course the men were growing older. 

Note that in all four age groups, by far the highest death rate 
was that for men with a history of regular cigarette smoking only. 
Men who never smoked had the lowest death rate. Men with a 
history of regular cigarette smoking who also smoked cigars and 
pipes—that is the dotted line labeled cigarettes and other—had death 
rates somewhat lower than the death rates of men who smoked 
cigarettes only. The death rates of men who had only smoked pipes 


were just slightly above the rates for men who never smoked. The 
death rates of cigar smokers were slightly higher than those for pipe 


a 6 
Bem i 

© (ie = pee eee aes eee: 

Smoked Only Only Only Only & Other 
Observed 1644 646 925 774 4406 2910 
Expected 1644 595 76) 694 2625 2028 

Slide 2. 

In order to summarize these findings, we computed the number of 
deaths which would have occurred among men in each smoking cate- 
gory if their age-specific death rates had been exactly the same as 
that for men who never smoked. 

This will be referred to as the “expected” number of deaths. The ex- 
pected number is shown on the bottom line of the figures on the 

The observed number of deaths divided by the expected number 
is called the mortality ratio. By definition, the mortality ratio for 
men who never smoked is 1.00. In other words, the death rate of men 
who never smoked is taken as a contro] against which the death rate 
of men in various smoking categories is ‘compared. 

Four thousand, four hundred and six deaths occurred among men 
with a history of regular cigarette smoking only. Just 2,623 of these 
men would have died between January 1952 and October 1955 had their 
age-specific death rates been the same as for men who never smoked. 
The mortality ratio is 1.68. In other words, the death rate of these 
cigarette smokers was 68 percent higher than the death rate of a com- 
parable g eroup of men who never smoked, age being taken into consid- 

The mortality ratio was 1.43 for men with a history of regular 
cigarette smoking who also smoked cigars or pipes. It is interesting 
that these men with mixed smoking habits had somewhat lower death 
rates than men who smoked cigarettes only. This is partly due to the 
fact that there were fewer heavy cigarette smokers among those with 


mixed habits than among those who smoked cigarettes only. However, 
this does not entirely account for the difference. 

The mortality ratios were 1.22 and 1.12 respectively for men with 
a history of cigar smoking only and for men with a history of pipe 
smoking only, as shown by the blue bar and the yellow bar on the 

In both instances, the difference between the observed and expected 
number of deaths is statistically significant. However, the effect of 
pipe smoking seems to be small as compared with the effect of cigarette 

Six hundred and forty-eight deaths occurred among men with a 
history of occasional smoking only as compared with 595 expected. 
This difference is not statistically significant. Therefore, it appears 
that occasional smoking has little or no effect on death rates. 

The men with a history of regular cigarette smoking only were 
classified by their current amount “of cigarette smoking at the time of 
questioning in 1952. In all four age groups death rates increased 
markedly with amount of cigarette smoking. 




d/2 172-1 ia 

Pack Pack Packs Packs 
Observed 470 1833 1063 263 
Expected 350 1081 541 118 

Slide 3, Mortality Ratios by Number of Cigarettes Smoked per Day 

This shde (8) shows the same data summarized in the form of 
mortality ratios. The mortality 1 ratio rose from (a) 1.00 for men 
who never smoked, (0) to 1.34 for under one-half-a-pack-a-day ciga- 
rette smokers, (c) 1.70 for one-half to 1 pack a day, (d@) 1.96 for 1 to 2 
packs a day, and (e) 2.23 for 2 pack or more a day. 

In other words, the death rate of men smoking regularly at a rate of 
less than one-half a pack of cigarettes a day was 34 percent higher than 
the death rate of men who never smoked. The death rate of men smok- 
ing | to2 packs of cigarettes a day was 96 percent higher than the death 


rate of men who never smoked. The death rate of men smoking 2 
packs or more of cigarettes a day was 123 percent higher than the death 
rate of men who never smoked. That is, more than double. 

Mr. Buatnix. Doctor, excuse me, Congressman Hardy has a 

Mr. Harpy. Before you leave that chart, I would just like to know 
whether those figures relate to all age groups or whether there was any 
distinction made as to age groups with respect to the quantity of 

Dr. Hammonp. Sir, I left out one slide which I will be glad to show. 
you here. Those relationships were true in the four age groups studied. 
We divided the men into age groups 50 to 54, 55 to 59, 60 to 64, and 65 
to 69. This type of relationship, not the exact figures but this relation- 
ship, is true in all four age groups. 

Mr. Harpy. The relationship was practically the same in all. 

Mr. Buatrnix. We will recess for 15 seconds for a picture. 

(A short recess was taken. ) 

Mr. Biarnrx. The committee is back in session. 

Mr. Harpy. Mr. Chairman, that response answered the question I 
had in mind. I just didn’t know whether there might have been a 
greater increase in the older age groups than in the younger age 

‘ se Hammonp. I cut that chart out for brevity. This shows it for 
each individual age group. When you reduced the number of cases by 
dividing it into age groups, the figures are naturally not the same. 

Mr. Harpy. If I read this right, the percentage increase did go up 
some in the older age group ? 

Dr. Hammonp. There is variation in it, sir. As I recall, you are 
looking at the chart there, sir. 

Mr. Harpy. I don’t know whether I understand the chart. 

Dr. Hawnonp. I should point out, sir, that I don’t mean literally 
the association is exactly 1.34 there. Any sample has a certain amount 
of variation in it. 

Mr. Harpy. Just one other question, if I might, Mr. Chairman. 

This question as to the rate of smoking, I take it, was determined 
in the beginning of your survey. Was there a subsequent check to 
determine whether or not the rate of smoking had increased ? 

Dr. Hammonp. Yes, sir; we did a survey. The study ended as far 
as this present report is concerned on October 31, 1955. That day we 
started requesting the subjects to see the change in smoking habits. 
We can’t do it very often because people don’t like to answer ques- 
tionnaires very often. 

Mr. Buarnix. Please proceed, Doctor. 

Dr. Hammonp. I should point out that the corresponding rates for 
men with mixed smoking habits were somewhat lower than those 
shown on this slide. 

Ten thousand and ninety-five men with a history of regular cigarette 
smoking only said that they had stopped smoking, that is, they had 
stopped at the time they were questioned in 1952. These men were 
classified by the length of time since last smoking and by their maxi- 
mum previous amount of cigarette smoking. 


Slide 6, 


IN 1952 <T YR $16 VAS. 104YRS. 



IN 1952. €TYR 1-10 YRS, 10+ YRS. 




een MISE earn psomeene 




1644 2303 Si 159) 14 14) 1326 Cpe Pemeee Ko = eae = 
1644 1431 25 122 130 658 ig 74 #458 

Those who said that they had stopped smoking cigarettes less than 
a year before they were questioned had higher death rates than those 
who were still smoking. In our opinion, this reflects the effect of 
health on smoking habits, rather than the reverse. That is, some 
people give up smoking only because they are ill. It is probable that 
there were some such men among the short-time ex-smokers. This 
would account for the high death rates in this group. 

Mr. Pruarrncrer. Was this factor checked, Dr. Hammond ? 

End Hammonp. As to whether they gave it up for their health? 

O, Sir. 

Note the mortality ratios for men who once smoked regularly but 
less than one pack of cigarettes a day. 

Could I go back and answer that question, sir. What I said a 
moment ago was an interpretation of ours—that is, that it resulted 
from some people giving it up because they were sick. The alternative 
explanation which I doubt is that there is a severe withdrawal effect 
from giving up smoking. 

It is true that in some very serious habit-forming drugs when a 
person is taken off of it, 1t has serious effects. That may be so with 
smoking, but I have no information or no guess that it is so. Perhaps 
someone else will have something to say on that. 

Note the mortality ratios for men who once smoked regularly but 
less than one pack of cigarettes a day. The mortality ratio for those 
who had given up smoking 1 to 10 years before questioning was 1.30 
as compared with a mortality ratio of 1.61 for men who were still 
smoking at this level. The death rate of those who had not smoked 

96946—5 7——_2 


for 10 years or more was not significantly different from the death 
rate of men who never smoked. 

The mortality ratios for one-pack-or-more-a-day cigarette smokers 
did not drop so rapidly after giving up smoking. Nevertheless, the 
mortality ratio of those who had not smoked for 10 years or longer 
was only 1.50 as compared with a mortality ratio of 2.02 for men still 
smoking a pack or more of cigarettes a day. 

It is interesting that even 10 or more years after giving up smoking 
the death rate of the ex-pack-or-more-a-day cigarette smokers was 
higher than the death rate of men who never smoked. Such ex-smok- 
ers include both people who stopped smoking permanently because of 
bad health and people who did so for other reasons. 

Since people in bad health have an above-average death rate, their 
presence among the long-time ex-cigarette-smokers would keep the 
death rate relatively high. This meant that the effect of giving up 
smoking is probably greater than these figures would seem to indicate. 

Cigar smokers who had given up the habit for less than a year also 
had very high death rates. The rate dropped after a year of ab- 
stinence, but remained relatively high. The picture for pipe smokers 
was roughly the same. 

Having found a high degree of association between cigarette smok- 
ing and the total death rate, as well as some association between cigar 
and pipe smoking and the total death rate, we next sought to determine 
what diseases were involved. The 11,870 deaths were divided into 5 
broad categories as shown on this slide. 




and Cancer 
1.97 All Other 
Accidents, Diseases 
Violence, 157 
Suicide Pi 


— <a o & —— ie 

Smoked Smoked Smoked Smoked Smoked 

OBSERVED 123 363 1058 4593 258 1460 SOM 25) L755 3662: 

EXPECTED 123 385 1058 2924 298" 1741 SO} 6B 7S 2520 

Slide 5. Mortality Ratios by Major Causes of Death. Cigarette Smokers Compared with Men who Never Smokedy 


Mr. Mraper. Mr. Chairman, might I ask a question at this point? 

Mr. Buatnik. Yes, Mr. Meader. 
~ Mr. Meaper. I would like to know what efforts were made in-your 
survey to exclude other factors that might bear upon the death rate? 
Did you, for instance, consider the rural person as contrasted with the 
city person, whether some of these men that were interviewed, most 
of them were in occupations that brought on tension or in concentrated 
areas where there were perhaps fumes in the atmosphere that were 
not present in the country air, and that kind of business ? 

What effort was made to eliminate other factors besides the smoking 
in your study of the effects of smoking upon longevity ? 

Dr. Hammonp. This study was made primarily—our major motive 
was to study lung cancer. I was personally interested in the total 
death rate, partly for this reason. If the lung-cancer death rate had 
been much higher among smokers than among nonsmokers, but the 
total death rate had been no higher, then I wouldn’t have been worried 
about the high lung-cancer death rate, and I would have even doubted 
that it was true—if I make myself clear. 

That is one of the main reasons I was interested in the total death 
rate at the start of the study. 

Since we were seeking to find out about lung cancer, we had to look 
at those factors which anybody suggested might have an influence on 
lung cancer, and there was only one, and that was exposure to atmos- 
pheric air pollution and occupational exposure. 

As I will describe in a moment, we studied the rural-urban differ- 
ence in considerable detail. As far as occupation is concerned, we did 
not ask it on the original smoking questionnaire primarily because 
studies of that are very hard to do and if you ask too many questions, 
people refuse to cooperate. 

However, we did get the occupation of men after they had died 
from the death certificate, and the distribution by occupation of smok- 
ers and the nonsmokers, there was hardly any difference at all. 

The survey made by the Census Bureau shows there is very little 
occupational variation in smokers and nonsmokers. 

Mr. Muaprer. Do you have any way of telling of the 187,000 men 
interviewed, how many were city dwellers and how many were rural? 
Dr. HammMonp. Yes, sir. I will give those figures in a moment. 

Mr. Mraper. Thatis all, thank you. 

Mr. Buarntk. Please proceed, Doctor. 

Dr. Hammonp. If you would like, sir, I have some slides showing 
this urban and rural effect, which I don’t have in the record. But I 
have them here to answer just those questions. I can do that later, if 
you wish, sir. 

The death rate from accidents, violence, and suicide was almost 
exactly the same for men with a history of regular cigarette smoking 
as for men who never smoked. That is, accidents and violence and 
suicide grouped together, heart and circulatory, cancer, pulmonary 
diseases other than cancer, and all other causes. 

In contrast, 1,460 cigarette smokers died of cancer compared with an 
expected of only 741 deaths had their age-specific cancer death rates 
been the same as for men who never smoked. The mortality ratio was 

The deaths of 4,593 cigarette smokers were attributed to diseases of 
the heart and circulatory system as compared with 2,924 expected; a 
difference of 1,669 deaths. The mortality ratio was 1.57. 


Only 338 of the 11,870 deaths were attributed to pulmonary diseases 
other than lung cancer. They showed a very high degree of associa- 
tion with cigarette smoking. Two hundred thirty-one deaths of cig- 
arette smokers were attributed to these pulmonary diseases as compared 
with only 81 expected. The mortality ratio is 2.85. 

The 338 deaths included in this category consisted of 124 attributed 
to pneumonia or influenza, 41 to pulmonary tuberculosis, 76 to asthma, 
and 97 to other pulmonary diseases, including bronchitis, abscess of 
lung, pneumoconiosis, and bronchiectasis. 

Seventy-eight men with a history of regular cigarette smoking died 
of pneumonia or influenza compared with 20 expected, the mortality 
ratio being 3.90, as shown by the red and green bar on the left of the 
chart. I should say to make it clear, the green bars are the relative 
death rate of the men who never smoked and the red are the cigarette 
smokers. ‘The green is an index figure. 

Twenty-six cigarette smokers died of pulmonary tuberculosis against 
12 expected giving a mortality ratio of 2.17, based on a rather small 
number of cases. 

Fifty-one cigarette smokers died of asthma against 29 expected, 
giving a mortality ratio of 1.76. 

Other pulmonary diseases accounted for the death of 76 cigarette 
smokers compared with 21 expected, the mortality ratio being 3.62. 

Deaths attributed to all other causes combined—including cause of 
death uncertain or unknown—accounted for less than 10 percent of the 
11,870 deaths. Taken together, this group showed some association 
with cigarette smoking as shown by the mortality ratio of 1.29. As 
will be shown later, a few diseases 1n this category account for most of 
this relationship. 

Four hundred and forty-eight deaths were attributed to primary 
cancer of the lung. Only 15 of these were men who never smoked. 
Including these 15, only 51 had never smoked cigarettes regularly, 
whereas 397 had a history of regular cigarette smoking. 

(All Reported) 

. EY Shuey oy a 
} sf e acres ‘ Pare 

Smoked Only Only Only Only & Other 
15 8 Us ig 249 148 
S2,90e 11,703 14,483 12,109 63,632 44,136 

Slide 6. 


This slide (6) shows the age standardized lung-cancer death rates 
by type of smoking. The three lung-cancer deaths of men with a 
aerly of both pipe and cigar smoking are not shown on this lantern 

The figures at the bottom of the slide indicate the number of men 
enrolled im the study and the number of lung cancer deaths. The 
rates were very low indeed for men who never smoked, occasional 
smokers, and cigar smokers. 

Pipe smokers had an appreciably higher rate. The rate for men 
with a history of regular cigarette smoking only was nearly 10 times 
as high as the rate for men who never smoked. 

I should add that was not a statistically significant difference. 

Of the 448 deaths, 82 were microscopically proved adenocarcinomas 
of the bronchus. 

Mr. Piaprncrr. Dr. Hammond, on page 4 you said that the general 
mortality rate of cigar smokers is higher than that of pipe smokers. 
Is that right? 

Dr. Hammonp. That is right, in general. There is a slight dif- 

Mr. Praprncer. I just was curious as to whether there was any 
out there, whether you could draw any conclusions from these 


Dr. Hammonp. As I can show later, sir, these figures on pipe and 
cigar smokers are not dramatic at all. It isn’t enough difference to 
get me to smoke a pipe or a cigar, but I have to present the findings. 
As you will see a little later, pipe smoking does some harm as far 
as lung cancer is concerned—not a great deal, but some. However, 
that seems to have no relation practically speaking, with coronary 
or heart diseases. With cigar smoking, it is the reverse. 

It seems to have very little—no effect as far as I can see—on lung 
cancer, but it does seem to have some effect on heart diseases. Heart 
disease is so much more common than lung cancer that the overall 
effect of cigar smoking is a little bit worse. Frankly I wouldn’t worry 
about it, but the figures are shown here. 

Of the 448 deaths, 32 were microscopically proved adenocarcinomas 
of the bronchus. I will have to explain a little bit on this. The only 
way to diagnose cancer to any certainty is to look at a piece of tissue 
under the microscope. In a lung there are two principal types, and 
they look at it in a microscope and they see there are differences 
between them. There are two principal types. One type which is 
called adenocarcinoma has something of the appearance of blood. 

The other type called epidermoid carcinoma, to put it in the sim- 
plest terms, looks more like the skin. It is a flattened cell. That is 
called epidermoid. ‘The epidermoid is much the more common type, 
particularly in men. 

The adenocarcinoma is a rarer type. A good many pathologists 
think the only form of lung cancer that has increased much is the 
epidermoid type. That is not proved but it is the opinion of a good 
many pathologists. 

Back some years ago Dr. Evarts Graham, who performed the first 
operation that cured lung cancer, gave as his opinion that adeno- 
carcinoma of the lung and epidermoid were two different diseases. 
They had two different causes. He thought one might be related to 


smoking and not the other. It was for this reason that we separated 
them according to what pathologists and certain surgeons said. 

Mr. Puaprncer. Is this then the procedure in all of these studies? 

Dr. Hammonp. To separate the two ? 

Mr. Puaprncer. Yes. 

Dr. Hammonp. I think most workers have done so wherever they 
have had the opportunity. JI abridged this report in order not to take 
up too much of your time. I should have explained more fully that 
whenever cancer is approved on a death certificate, we then wrote to 
the doctor who signed the death certificate to get ‘all the details we 
could, and wherever possible, we got the report ‘from the pathologist. 
We classified these accor ding to what the pathologist said. 

As I will say ina moment, there are few cases in which there were 
an appreciable number in which it wasn’t observed microscopically 
until we analyzed it separately. We made the separation only 
because many pathologists thought it important and we wanted to 
get the data for them. 

I have shown it here both ways and everybody can draw their con- 

Mr. Meraper. Mr. Chairman, may I ask a question on that? 

Mr. Buatnik. Yes. 

Mr. Mraper. Dr. Hammond, in these cases where there was a path- 
ological examination, was the causative relationship found or was it 
merely assumed that because the person died and he had lung cancer, 
that lung cancer was the cause of death? Were other causes of death 
excluded ? 

Dr. Hammonp. That is what the doctor gave us as his opinion of 
what caused the death. It was a professional opinion on the part of the 
doctor. There are some instances in which the doctor is called into a 
hotel room after the man has died, and he has never seen him before. 
In those cases it is nothing more than a guess. 

Where a man has gone to a hospital, ‘been treated, and particularly 
tee they have done an autopsy afterwards, they are pretty certain 
of it 

There are instances in which there is a lot of doubt. There were 
quite a large number of people who died with cerebral hemorrhage— 
that is, stroke—and also with a heart attack. Either one of them 
would have probably killed the man. Both are written on the death 
certificate and we reported both. We have analyzed the figures. The 
doctor usually expresses an opinion of which killed the man. 

For cancer, however, to be sure of it you have to look at the other 
end of the microscope. In 79 percent of the cases of cancer reported 
on the death certificate, it was proved microscopically—79 percent. 
The remaining 21 were not proved microscopically since some of them 
probably were not cancer. But the evidence is pretty good in most 
of the cases. There are few in which it was not good. 

Mr. Mraper. And in these cases where lung cancer existed, the 
relationship between the existence of lung cancer and a death was 
determined by the pathologist, was it ? 


Dr. Hamnonp. I can’t give you the exact number. About 10 per- 
cent of these were verified by autopsy, which is as good evidence as 
you can get. In the other cases it was the opinion of the doctors and 
in 79 percent of the cases it was also the opinion of the pathologists. 

Cause of death is not always certain. We had about 10 deaths of 
people who died in automobile accidents and also had coronary at- 
tacks. On some of them we got quite a report from an inquiry as to 
whether the man first had a coronary and that made him run into a 
ae or whether he ran into a ditch and that brought on the coronary 

That is a very small percentage of the total, but such cases do exist. 

I think I see what you are driving at, sir. Let me give you a case 
where I think there is a very real doubt. 

I showed on that first slide a high degree of association between 
smoking and deaths attributed to pneumonia and influenza. Pneu- 
monia is often a terminal cause of death. It happens simply when 
the person is dying, the lungs fill up. Unless they have done an 
autopsy, it is quite uncertain as to whether that was the real cause 
or whether it was simply the last straw. 

It is perfectly possible that that association was due to a misdiag- 
nosis of lung cancer—that is, some of those people who were not 
autopsied, where they didn’t do an exploratory operation, they might 
have been put down as deaths due to pneumonia, whereas actually it 
was lung cancer. 

There is no way of telling where the determination wasn’t good 
enough. Therefore I think there is really no effect of smoking on 
pheumonia at all, but that apparent effect was a further misdiagnosis 
of lung cancer. 

Mr. Meaper. Thank you. 

Dr. Hammonp. Of the 448 deaths, 32 were microscopically proved 
adenocarcinomas of the bronchus, the bronchus being the windpipe 
going down into the lung. These were considered separately since 
some investigators have expressed the opinion that this form of cancer 
may not be related to smoking habits. 

Twenty-six of the 32 cases has a history of regular cigarette smok- 
ing, 2 never smoked, 1 was an occasional smoker, 2 were pipe smokers, 
and 1 a cigar smoker. The mortality ratio for the cigarette smokers 
was 4.83, that being considerably less than for the group as a whole. 

Of the remaining 416 cases, 295 had microscopically proved cancer 
with good evidence of its being primary bronchogenic carcinoma. 
This answers your question, sir. ‘This is the slide showing the results 
after we excluded those in which some doubt was expressed or which 
we might have had some doubt as to the validity of the diagnosis. 




Well Established Diagnosis 



Smoked Only Only Only Only & Other 
4 G50 6 Lor 162 103 
o2,99e 11,703 14,483 12,109 63,632 44,136 

Slide 7. “Well Sstablished Cases of Bronchogenic Carcinoma #xclusive of Adenocarcinoma 

This slide (7) shows age-standardized death rates for. these 295 
cases. The picture is much the same as in the previous slide except 
that for these well-established cases the association with smoking hab- 
its is even more pronounced. 


{All Reported) 

Cigere? Smokers 

Ex- regular 95.2 

Never None Occasi. <i/2 \/2-1 i-2 2¢ 
Smoked Pock Pack Pecks Pecks 
15 18 2 24 84 (90 27 
32,392 10,095 1,322 7647 26,370 14,292 3,100 
Slide 8. 

This slide (8) shows the age standardized death rates by amount 
of cigarette smoking, that is, the amount they were smoking in 1952, 


for men with history of regular cigarette smoking only. Only 3,100 
men who entered the study said that they smoked cigarettes only and 
were currently smoking 2 packs or more a day. Within the ensuing 
44 months, 27 of these men had died of lung cancer. On the other 
hand, out of 32,392 men who never smoked, only 15 died with this 


Well Established Diagnosis * 

Ex- requior 
Cigaret Smokers 


Packs Packs 
4 i5 2 13 50 60 22 

32,392 10,095 1,322 7,647 26,370 14,292 3,100 

Slide 9, ‘Well Zstablished Cases of Bronchogenic Carcinoma Exclusive of Adenocarcinoma 

The slide (9) shows the figures for well-established cases of bron- 
chogenic carcinoma other than adenocarcinoma. In each case we first 
looked at the total group and then we looked at those that are more 
serious. ‘The age standardized death rate for the 2-pack-or-more-a- 
day smokers with this diagnosts was 217.3 per 100,000 per year. 

In contrast, the age standardized death rate for the 2-pack-or-more- 
a-day smokers with this diagnosis was 217.3 per 100,000 per year. In 
contrast, the age standardized death rate from microscopically proved 
cancer of all sites combined was only 177.4 per 100,000 per year for men 
who never smoked. In other words, among two-pack-a-day cigarette 
smokers, the death rate from bronchogenic carcinoma alone is higher 
than the total cancer death rate of men who never smoked. 

I mention that because no amount of confusion between primary 
sites can account for that finding, they being microscopically proved 
cases. There is uncertainty as to site sometimes. 

Those of us who are ex-very-heavy-cigarette-smokers have some- 
thing of a personal interest in the lung-cancer death rate of men who 
stopped smoking cigarettes. 

Men currently smoking a pack or more of cigarettes a day in 1952 
had a lung-cancer death rate—well-established cases— of 157.1 per 
100,000 per year. Those who previously smoked at this level but had 
given up smoking for from 1 to 10 years had a rate of 77.6, and those 
who had given it up for 10 years or longer had a rate of only 60.5. 



SMOKERS IN 1952 — 

IN 1952 <] YR. 1-10YRS. 10+YRS. 



IN 1952 <1 YR 1-10 YRS, 10+ YRS. 

576 56] : 60.5 

3.4 a 
NEVER Smoked Less Than Smoked | Pack 
SMOKED | Pack a Day or More a Day 

Slide 10, Well Established Cases of Bronchogenic Carcinom Uoxclusive of Adenocarcinom 

As you can see, the men who only smoked lightly to begin with and 
then had given it up for 10 years, had a range not especially different 
from those men who never smoked. 

Lung-cancer death rates as reported by the National Office of Vital 
Statistics are higher in cities than in rural areas. 

(Excluding Adenocarcinoma) 


<4 Never Smoked Regularly 
4 83 3 §9 

8481 28,270 9234 26,133 11,717 28,457 14,136 23,560 

Slide 11, 


However that may be, the lung-cancer death rate was low among 
men who never smoked cigarettes regularly and high among cigarette 
smokers in large cities, small cities, suburbs and towns, and rural 
areas. There were between 40,000 and 45,000 men in each of those 
areas. We deliberately went to rural areas in order to get an answer 
to this question. At the time the study was started, I thought it just 
as likely that the air-pollution factor was a major cause of lung can- 
cer—I was more inclined to think that was the cause than smoking 

Mr. Mrapver. Do I understand that 45,000 out of the 187,000 were 
from rural areas ? 

Dr. Hammonp. They were roughly equal numbers in those small 
groups, not quite as high in the rural as the other. I could give you 
the exact figures if you wish afterwards, sir. This just shows the 
men who never smoked and the cigarette smokers. I can show you 
these figures in really more detail but it takes quite a long time to 
study them. 

What it appears to show is, sir, that both the smokers and non- 
smokers, there is a higher reported lung-cancer death rate in the cities 
than in the country. That is so. But both in the city and in the 
country there is a tremendous relationship with cigarette smoking. 

Whatever the urban factor may be, its effect on lung-cancer death 
rates 1s small as compared with the effect of cigarettes as shown by the 
relative heights of the bars on this slide. 

Tobacco smoke—or saliva and bronchial secretions containing mate- 
rial from tobacco smoke—comes into direct contact with the lips, 
mouth, tongue, pharynx, larynx, and esophagus. The death of 127 
subjects was attributed to primary cancer of these sites. Only six of 
these men had never smoked and three were occasional smokers. 

The other 118 had a history of regular smoking. One hundred and 
fourteen of the 127 cases were microscopically proved and only four of 
these were men who never smoked. Considering microscopically 
proved cases only, the mortality ratio was 7.00 for men with a history 
of regular cigarette smoking; 5.00 for men who smoked only cigars; 
and 3.50 for men who smoked only pipes. 

Still considering microscopically proved cases: Out of 34 deaths 
from cancer of the esophagus, only 1 was a man who had never 
smoked; of 25 pharynx cases 2 had never smoked; and of 16 tongue 
cases, 1 had never smoked. There were no men who never smoked 
among 24 larynx cases, 14 mouth cases, and 1 lip case. 

I should say that the numbers are too small to be certain of this, 
but that it appears that for these sites of cancer, at least some of them 
pipe and cigar smoking and chewing of tobacco are probably as bad 
ae probably may be worse than cigarette smoking for these particu- 
lar sites. 





1.58 | 


OBS eile & 85 2077 Io 59 

EXP 8 22 “20 44 108 27 

Slide 12. 

This slide (12) shows mortality ratios for microscopically proved 
cancer diagnosed as primary in the genito-urinary organs. ‘The mor- 
tality ratio of cigarette smokers was 2.17 for cancer of the bladder, 1.75 
for cancer of the prostate, and 1.58 for cancer of the kidney. In most 
of these cases, cancer was present at death in two or more of these sites 
as well as in other parts of the body. That is when a person gets can- 
cer of the bladder, by the time he has died, it has spread to the sur- 
rounding areas into the kidneys and the prostate and in those cases it 
is not always easy to tell which of the particular sites it started in. 

While cancer was proved microscopically, the evidence as to the 
exact primary site was far from conclusive in many instances. 

J should interpose here that may mean that all of this association is 
due to one of the sites, perhaps cancer of the bladder, and the others 
are spread out. 

There was no association between cigarette smoking and micro- 
scopically proved cancer of the rectum. | 






1.50 ue 



oss 34 84 19 55 17 76 27 107 2 33 

EXP 34 108 7S SOcesails so AA LSCE). VI9D1 Pe 

Slide 13. 


The mortality ratio of cigarette smokers for cancer of the colon was 
0.77. In other words, less than that for men who never smoked, This 
negative association for cancer of the colon, based on 84 observed 
against 108 expected deaths, is not statistically significant. 

The mortality ratio of cigarette smokers was 1.61 for cancer of the 
stomach and 1.50 for cancer of the pancreas. In neither case was the 
difference between observed and expected deaths statistically. sig- 

Deaths from cancer of the liver, gall bladder, and biliary passages 
appeared to be highly associated with cigarette smoking. However, 
there was a reasonable doubt as to the primary site in many of these 
cases. I should have said “most.” I shall explain. 

Cancer kills most often by spreading to some other part of the 
body. The liver is the place to which it most frequently spreads. Ina 
very large proportion of all people who have cancer any place, it 
spreads to the liver and I make no assertion to what that means. 

Personally I think it is very likely metastatic from some place else 
rather than actually liver cancer, but of that we don’t know enough. 

Leukemia showed no indication of an association with cigarette 

Hodgkin’s disease as well as lymphosarcoma and reticulosarcoma 
appeared to be associated with cigarette smoking, but not to a statisti- 
cally significant degree. 


Coronary Artery Other Heart 

200 Disease Diseases 

Cordiac Foilure 
1.70 etc) 

Chronic Rheumatic Hypertensive 
Heort Disease Heart Disease 


Smoked Smoked Smoked Smoked 
Obs. 35a Ore 2 re. ge eS seein 56 _206 
Exp. 35 103 57 174 709 1973 56 148 

Of the 11,870 deaths in the study, 5,297—45 percent—were ascribed 
to coronary ‘artery disease. Three thousand three hundred and sixt J- 
one of these were men with a history of regular cigarette smoking 
whereas the expected number was only 1,97 3. This is a difference of 
1,388 deaths and a mortality ratio of 1.70. 

That is the high bar there for the coronary diseases. 

The death rate from chronic rheumatic disease was almost exactly 
the same for cigarette smokers as for men who never smoked. 

The mortality ratio for deaths ascribed to hypertensive heart disease 
was 1.13, this being based on 196 observed against 174 expected deaths. 
This difference i is not statistically significant. 

Deaths described as due to myocarditis, cardiac failure, cardiac de- 
generation, and similar terms showed a positive association with cigar- 
ette smoking. 









Smoked Only Only Only ‘Only & Other 
OBS. 709 259 420 312 2026 1335 
EXP. 709 257 329 302 1108 866 

Slide 15. 

The coronary artery disease death rate of pipe smokers was just 
about the same as for men who never smoked. However, the mortality 
ratio for cigar smokers was 1.28. This association is statistically sig- 

nificant. Men who smoked only cigarettes had by far the highest 
mortality ratio. 




. Smoked 

Observed 709 
Expected 709 


This shows the mortality from coronary artery disease by type of 
smoking. Coronary artery disease kills more people in the United 
States than any other single disease which is why we are particularly 
interested in it. 

The coronary artery disease death rate increased steadily with the 
daily consumption of cigarettes; the mortality ratios being 1.00 for 
men who never smoked ; 1.29 for less than one-half a pack a day smok- 
ers; 1.89 for one-half to one pack; 2.15 for one to two packs; and 2.41 
for two-packs-or-more-a-day cigarette smokers. 




(Not Hear?) a) 

Never Cigaret Never Cigaret Never Cigoret Never Cigoret Never Cigars } 
Smoked Smoked Smoked Smoked Smoked 
es 27 tee. Soe a SO 8 Be ee 
10 a7 164 428 7 41 8 25 ee 
w Buerger’s disease, aneurysm, varices, arteritis, etc. 
BSiide 17. 

On the basis of a small number of cases, hypertensive diseases showed 
no indication of an association with cigarette smoking. 

General arteriosclerosis, phlebitis, and embolism have been grouped 
together because of the small number of deaths ascribed to each. Al- 
though the mortality ratio was 1.46 for these deaths grouped together, 
no single one of these three diseases showed a statistically significant 
degree of association with cigarettee smoking. 

Sixty-eight cigarette smokers died of aortic aneurysm—described 
as nonsyphilitic in origin—as compared with only 25 expected, a mor- 
tality ratio of 2.72. 

A small number of deaths from Buerger’s disease, aneurysm, varices, 
and arteritis were grouped together. They showed a high degree of 
association with cigarette smoking, the mortality ratio being 4.50. 

A total of 1,050 deaths were ascribed to vascular lesions of the cen- 
tral nervous system. Five hundred and fifty-six of these deaths 
occurred among cigarette smokers against 428 expected, a mortality 
ratio of 1.30. 



3.00 Ulcers 
Duodenal Vv 
Cirrhosis Ulcers es All Other 
of Liver (Incl. cause 
of death 
216 not specified) 

2.00 1.93 a 



Smoked Smoked Smoked Smoked Smoked 
OBSERVED 33 73 8 88 8 S84 0 46 9 413 
EXPECTED 33 91 oe 25 ) 0 19 362 

Fifty-one deaths were attributed to gastric ulcers. Forty-six of 
these were men with a history of regular cigarette smoking, 2 had 
a history of pipe smoking only, and 2 had a history of cigar smoking 
only, and 1 smoked both pipes and cigars. Not a single one of these 
cases was a man who never smoked. 

Deaths attributed to duodenal ulcers were also associated with 
cigarette smoking but not to such a marked degree as gastric ulcers. 

Highty-three deaths attributed to cirrhosis of the liver occurred 
among cigarette smokers compared with 48 expected, a mortality 
ratio of 1.93. 

Deaths from nephritis and nephrosis showed no association with 

Diabetes deaths were negatively associated with cigarette smoking 
but not toa statistically significant degree. 




Coronary Artery Disease: 1, 388 | 52.1% 
Lung Cancer: 360 135 5% 
Other Cancer: 359 13.5% 
Other Heart & Circ.: 154 
Pulmonary (Exc. Ca.): 150 eee 5.6% 
Cerebral Vascular: 128 
Gastric & Duod. Ulcers: 75 ; Si 
Expected Deaths: 

Cirrhosis of Liver: 40 muvcaa Denthel 
All Other: st 

Total 2, 665 

Slide 19 

The relative importance of the associations just described is de- 
pendent upon the number of deaths attributed to each disease as well 
as upon their degrees of association with cigarette smoking. That 
is, a disease such as Buerger’s disease which causes very very few 
deaths. Even if there is an extremely high association, it still doesn’t 
make any appreciable effect on the overall death rate. 

Coronary-artery disease accounted for 52.1 percent of the excess 
deaths among cigarette smokers; lung cancer accounted for 13.5 per- 
cent; cancer of other sites accounted for 13.5 percent; other heart 
and circulatory diseases, 5.8 percent; pulmonary diseases—other than 
lung cancer—5.6 percent; cerebral vascular lesions, 4.8 percent ; gastric 
and duodenal ulcer, 2.8 percent; cirrhosis of the liver, 1.5 percent; and 
all other diseases combined, 0.4 percent. 

The data just described were checked in many ways to assure accu- 
racy. For example, we independently traced a sample of 38,583 of 
our subjects to make sure that failure of the volunteers to report some 
deaths had not biased the results. 

We requestioned a large number of the men about their cigarette 
smoking. We studied the time trend in the death rates and found 
that the results in the last 2 years of the study fully confirmed the 
early findings which we had reported in 1954. Since these and other 
checks have been described elsewhere, and will be described in much 
more detail in the report we are now publishing, I will not take your 
time to discuss them in detail again here. 

Tt would now like to discuss our findings in the light of other evidence. 


No less than six independent investigators have now produced can- 
cer experimentally with tar condensed from tobacco smoke. Cancer 
has also been produced with tar distilled from tobacco. Another in- 
vestigator has shown that tobacco-smoke condensate acts as a cocarcino- 
genic agent when applied together with a known carcinogen to the 
skin of mice. I should say none of us know whether a mouse is any- 
thing like a man in this respect. 


Two investigators have noted an increase in lung tumors in mice 
exposed to tobacco smoke. A well-known carcinogenic chemical, 
3, 4-benzpyrene, has been found in small quantities in tobacco smoke. 
Wynder and Wright have fractionated tobacco-smoke tar and reported 
that most of the material which is carcinogenic when applied to the 
skin of mice is contained in one small fraction of neutral tar. Note I 
said “in mice.” This was not a human experiment. 

Florescent substances present in tobacco smoke have been shown to 
enter the cells which form the lining of the mouth. That wasa human 

It was a puzzle how the amounts of material contained in tobacco 
smoke could cause cancer in the lungs since the action of cilia in the 
bronchial tubes ordinarily washes out foreign matter. Now it has 
been demonstrated in experimental animals: (1) That tobacco smoke 
tends to inhibit ciliary action and (2) that material from cigarette 
smoke accumulates at spots in the bronchial tubes where cilia have 
been destroyed or ciliary action inhibited. 

That has been demonstrated experimentally; not with men. 

Detailed microscopic studies of the bronchial tree of men indicate 
that a number of changes, such as are usually produced by carcino- 
genic materials, are encountered more frequently among cigarette 
smokers than among nonsmokers. 


We found lung cancer death rates to be extremely low among non- 
smokers and high among heavy cigarette smokers, the rates increas- 
ing with the amount of cigarette smoking. Doll and Hill have re- 
ported similar findings in their followup study of British physicians. 
No less than 19 independent studies of the smoking habits of lung- 
cancer patients have been carried out in the United States, England, 
Germany, France, the Netherlands, Finland, and Norway. 

In every instance a higher proportion of smokers was found among 
lung-cancer patients than among people free of this disease. The 
experimental and pathological evidence cited above supports these 
epidemiological findings. 

In my opinion, the evidence is overwhelming that cigarette smoking 
is a causative factor of great importance in the occurrence of lung 
cancer. ‘This does not imply that cigarette smoking is the only cause 
of lung cancer. 


Cigarette smoke or material condensed or dissolved from cigarette 
smoke comes in direct contact with the mouth, tongue, and other par*s 
of the buccal cavity as well as the larynx and esophagus. A num’ ~ 
of investigators have found an association between the smoking and 
chewing of tobacco and cancer of the buccal cavity. 

Pipe and cigar smoking and the chewing of tobacco may be more 
important than cigarette smoking in this respect. An association 
has also been reported between smoking and cancer of the larynx. 

We found the death rate from cancer of sites just named, as well 
as cancer of the esophagus, to be very much higher among smokers 


than among nonsmokers. The experimental evidence is consistent 
with these findings. 
In my opinion, smoking is a causative factor in the occurrence of 
cancer of these sites. 

‘We found death rates from cancer of a number of sites which are 
not directly exposed to tobacco smoke to be higher among smokers 
than among nonsmokers. This evidence is so recent that there has not 
yet been time for proper evaluation. More research on the subject 
is indicated. 


Experimental studies on human beings have shown that smoking 
produces a number of acute effects on the circulatory eve includ- 
ing: (a) A constriction of peripheral blood vessels, (6) an increase 
in blood pressure, and (¢) an increase in heart rate. 

It has been shown experimentally that cigarette smoking produces 
changes in the electrocardiograms and ballistocardiograms of some 
patients with coronary artery disease. There is some evidence that 
smoking has an effect on the flow of blood through the coronary arteries. 
Kisen and Hammond showed that cigarette smoking produces an in- 
crease in the red blood cell count and in packed cell volume. 

There is strong clinical evidence that smoking has a severe effect 
on patients with Buerger’s disease. 


We found that death rates increase markedly with the amount of 
cigarette smoking. Doll and Hill have reported similar findings... 
This is in agreement with the results of at least three studies on the 
smoking habits of patients with coronary artery disease. 

Considering the acute effects of smoking on the heart, circulation, 
and blood, I am of the opinion that cigarette smoking causes an increase 
in the death rate from coronary artery disease. This does not neces- 
sarily mean that smoking is a cause of atherosclerosis of the coronary 
arteries, a disease in which diet apparently plays an important role. 
Tt may be that smoking only increases the risk of death of those who 
are already suffering from this disease. 


Our evidence suggests that cigarette smoking increase death rates 
from aortic aneurysm and may increase death rates from cerebral 
vascular lesions. 

The clinical evidence leaves little doubt that smoking has a severe 
effect on patients with Buerger’s disease. Our data coincides with 
that. We had too few cases for it to have any great meaning. 


The clinical evidence, taken together with our findings, strongly in- 
dicates that smoking has a severe effect on patients with peptic ulcers. 


There is evidence that smoking has an effect on death rates from 
respiratory diseases other than lung cancer. 

The data suggest that cigarette smoking may be a factor in cirrhosis 
of the liver, but there is insufficient evidence on which to base definite 


Both our study and the study of Doll and Hill showed that lung can- 
cer death rates were lower among men who had given up smoking for a 
year or more prior to questioning than among men who continued to 
smoke. Our study also indicated that giving up cigarette smoking 
results in a reduction of the overall death rate. 

Mr. Buarnix. Thank you very much, Dr. Hammond. We will have 
questions. May I merely announce that we have another witness 
speaking for research—Dr. Clarence Little, appearing on behalf of 
the Tobacco Industry Research Committee. We would like very much 
to hear him today and not to inconvenience him by holding him over. 
With mutual aid coming up at 12 o’clock, I know all members are 
anxious to get to the floor as promptly as possible. So if we keep our 
questions to major points, other details that will be required can be 
furnished later. 

Are there any questions on my right ? 

Mrs. Grirrirus. Have these experiments been conducted only with 
men, or have women been included ? Py 

Dr. Hammonp. The two major studies are ours and the Doll-Hill 
survey, which were conducted by first questioning people and follow- 
ing them for a number of years. Both of these were confined to men. 
The Doll-Hill study was confined to physicians; all the subjects were 

The reasons we both took men—and in our study we took men in the 
older age group—is that because that is where the largest number 
of cancer deaths occur. We would like to study women, but we would 
have to study between 500,000 and 600,000, because fewer older 
women—and by old in this case we mean 50 and above—die from lung 
cancer, and that is shown by the Bureau of the Census. 

Two studies have been made on lung cancer in women—1 of them 
in Norway and 1in thiscountry. Both of them showed the same sort 
of relationship as in men, but both were rather small, and it is hard to 
get enough lung cancer cases among women to study. 

Mrs. GrirrirHs. Thank you very much. 

Mr. Harpy. I know with respect to some of these findings you dis- 
cuss smoking from a causative point of view. In lung cancer, for in- 
stance, you listed smoking as a causative factor, and you said, “It 
doesn’t imply that it is the only cause.” With respect to some of the 

other cancer sites it is given as a causative factor. 

But then when you get into the heart and circulatory diseases, you 
speak of it as having a severe effect on patients who already have the 
disease, rather than as a causative factor. 

Dr. Hammonp. The reason for the distinction is this. If it had 
been possible, I would have liked to study the onset of the disease as 
well as the deaths. But that would have required that we examine 
each man periodically by medical examination—which was not 


Therefore, the data from the study is confined to deaths. Lung 
cancer unfortunately has such a high death rate—95 percent of the 
people who get it die from it—that, practically speaking, what causes 
the disease is what causes death, since they all die. 

For heart disease, that is not so. Therefore, we cannot distinguish 
between something which causes death in a person who has the disease 
and what causes the disease. I want to make it clear that we did not 
have the knowledge. 

Mr. Harpy. That is the thing I was trying to understand. With 
respect to Buerger’s disease, you said there is strong clinical evidence 
that smoking has an effect on patients with the disease. 

Dr. Hammonp. That is right. 

Mr. Harpy. Is there anything to indicate that smoking may be the 
cause of Buerger’s disease ? 

Dr. Hammonp. That is disputed, sir. Almost all the evidence on 
the matter is concerned with the people who have Buerger’s disease. 
We don’t know the other answers. 

Mr. Harpy. If we might pursue it, then, with respect to circulatory 
diseases, you have the same observation to make with respect to peptic 
ulcer. I thought you had indicated earlier in your statement that 
there might be some connection from the standpoint of cause—smoking 
causing peptic ulcers. You don’t make that statement in your conclu- 

Dr. Hammonp. I wonder if I can make myself clear, sir, on this. 
From our study, the only thing we have is association between smok- 
ing habits and death. That is the only evidence we have. 

For lung cancer, the occurrence of the disease and deaths from the 
disease are practically the same thing, since they al] die—not all, but 
practically all. 

With heart disease, this is not so; and with peptic ulcers, the 
majority don’t die of it. Therefore, when it came to peptic ulcers, I 
based my summary statement not just on our findings but on clinical 
studies published in the Mayo Clinic and others. 

In many cases it is reported they have had great difficulty in curing a 
person with gastric ulcers. They often can’t cure him. We found 
they had higher death rates with those two tied together. Therefore, 
I was willing to draw a conclusion. 

But many people have gastric ulcers who don’t die of them. I have 
no evidence as to whether smoking causes gastric ulcers. Maybe it 
does; maybe it doesn’t. I didn’t want to go beyond that. 

Mr. Harpy. That is the thing I wanted to clear up. 

Dr. Hammonp. I say that smoking may cause heart disease, but I 
ith know. Not knowing, I wanted to make it clear that I didn’t 


Mr. Biatnirk. Questions on my left ? 

Mr. Mrnsuatu. I have one question, Mr. Chairman. 

Mr. Buarnrk. Mr. Minshall? 

Mr. Mrnsuauu. Projecting your statistics, what percentage of the 
overall population can be classed as smokers and what percent non- 
smokers? Have you got those figures ? 

Dr. Hammonn. IJ do have them in my briefcase here, sir. I can give 
you the whole breakdown on them. 

Mr. Buarntk. Can he furnish that for the record ? 


Dr. Hammonp. I would hate to do it from memory, sir, because it 
depends on how you define them. I would rather put it in the record. 

Mr. MinsHatyu. As long as you are doing it, would you be kind 
enough to do it as it relates to men and women? 

Dr. Hammonp. May I say, sir, the Bureau of the Census, at the re- 
quest of the Public Health Service 2 years ago, made a very good survey 
on this for the total population of the United States. They covered 
both males and females. The age, I think, was 20 up. So that survey 
answers your question with a high degree of precision. 

What they found was almost exactly what we found, but we only 
covered a narrow age group. So, concerning women and men in other 
age groups, I would have to give you the Bureau of the Census figures. 
They are just the same as ours. 

(These are as follows :) 

Smoking habits of men and women 18 years and over in the civilian population 
outside institutions, United States, as of February 1955 

Percent of Percent of 
total men total women 

ee eee 

INGER smoked: duninehitetimCss= 2.4 ue ee Ae ee ee ge ea Oe 22.9 67.5 
Smokeaiaurm'S lnfetimes 2! 2 Ass se bet Seb ed FI a ee Wis S2NO 
Smokedinesularivadnnimovhitetimes. "35 Ses ee eee 71.9 28. 2 
Smoked eccasionally during lifetime: -..23 #.0.2-Loc.ige: lassi iz as 5. 2 4.3 
INeversmokeducigarcttes durine lifetime: 4 522s. 20 See ee : 32.0 67.6 
Smokedicicarertesmuninewifetimers jk. os. ae So ce ee 68. 0 32. 4 
Smoked cigarettes regularly during lifetime_.2._..-2-2222-222.5--222.-2- 63. 4 28.1 
Smoked cigarettes occasionally during lifetime.__________________________ 4.6 4.3 
Current ivgnotsmokime Citarettes sess. sare ee ae ee eee 43.1 71.6 
CurnemblvyesmokMercicarehbesss «eee et ee eee Nees ORs ae eee 56. 9 28. 4 
Currenthyesmokine cigarettes recwmlatly= 2. 22s se oe 52.6 24.5 
Currently smoking cigarettes occasionally. ________.__..-_-_-_.--_-_-___- A 3.9 

Source: Haenszel, W.; Shimkin, M. B.; Miller, H. P. Tobacco Smoking Patterns in the United States, 
Public Health Monograph No. 45, U. S. Government Printing Office, Washington, D. C., 1956. 

Mr. Minsyatu. In response to Mr. Hardy’s question you said there 
was some doubt, in your mind at least, as to whether or not smoking 
was the cause of cancer in certain parts of the body. 

However, on page 17 of your report in the next-to-the-last para- 
graph on that page you say: 

In my opinion the evidence is overwhelming that cigarette smoking is a 
causative factor of great importance in the occurrence of lung cancer. 

Dr. Hammonp. Yes, sir. 

Mr. Minsrauy. That is beyond any reasonable doubt in your mind? 

Dr. Hammonp. That is my personal opinion, sir. 

Mr. Minswatt. Is that disputed by any of your colleagues in the 
medical profession ? 

Dr. Hammonpn. I think there are some people who do dispute it, sir. 

Mr. Buatntrk. Doctor, who finances this statistical research work 
and other research of the American Cancer Society ? 

Dr. Hammonp. The American Cancer Society solicits contributions 
from the public, and those contributions are used for this and other 

In this particular study, the volunteers did work on it that would 
have cost, I estimate, up in the millions of dollars. Before using 


volunteers, I went to some of the public-opinion-survey people and 
asked what they would charge to question the subjects for us. They 
wanted $10 to $15 per subject. Now they would want more. That 
would have been $2 million right there. So I think, in this case, what 
was essentialy the cost of the study was contributed 1n volunteer work 
rather than in money. 

Mr. Biarnix. Doctor, is your society carrying on any other re- 
search in addition to the statistical analyses? Are you conducting 
any biological or laboratory medical experiments? 

Dr. Hammonp. The American Cancer Society is supporting a very 
great deal of research in the field in lung cancer; that is, laboratory 
research, clinical research, pathological research. 

Mr. Buarnrtx. Can we have an example—not necessarily all, but 
the major types—of the research which you are supporting and where 
they are conducted, later on for the record ? 

Dr. Hammonp. I can send it in. 

(See appendix, exhibit 2, p. 333.) 

Mr. Buatnix. My last question: You had quite a long series of 
bar graphs showing very significant differentiations between non- 
smokers and smokers. But in the smokers of cigarettes, you never 
differentiated between those that used filter cigarettes and those that 
used nonfilter cigarettes. 

Did you have any information on that ? 

Dr. Hammonp. At the time the study started in 1952, according 
to all reports, very, very few filter-tip cigarettes were sold—so few 
that we didn’t even ask the question. I think one brand accounted 
for almost all the sales. 

Later, we did question the men again in 1955; right at the end of 
the study. I do have the information. It was that about 28 percent 
of those who were then smoking cigarettes regularly were using filter 
tips—of these particular men, of course. 

Mr. Buatnrk. Is there any indication of any significance in your 
death rates between non-filter-tip smokers and filter-tip smokers? 
In short, is there anything to attract the interest of your organiza- 
tion to continue further statistical gathering of evidence and research ? 

Dr. Hammonp. I frankly doubt that this method of study could be 
applied to the study of filter-tip cigarettes—at least in the near future. 
Certainly, from the information we got in requestioning our own sub- 
jects, and from everything I have heard, I think it is in a state of flux 
ee now, with people switching from one to another and back and 


I don’t know quite how one would study it by this method. If people 
settle down to one particular type of filter tip and smoke it for the next 
15 years, then maybe we could answer it by a study of this sort. But, 
otherwise, I believe it would be impossible to get human information 
on the effect of filter tips, as far as cancer is concerned. I don’t think 
there would be any way to do it. 

Mr. Harpy. Just one other question. Doctor, have you attempted 
to make any determination as to the basis on which cigarette smoking 
has the effect that these statistics have pointed out? For instance, re- 
lated to tar, nicotine, or anything else that could be removed by 
filters or otherwise ? 

Dr. Hammonp. Sir, our own study showed nothing on it. If you 
would like, I can briefly review what is known on the subject. I can 


speak only from having reviewed the literature and from the very 
little bit of experimental work. 

Mr. Harpy. That will be all right. We can get that from another 

Dr. Hammonp. May I mention one thing, since you asked me, sir. 
Almost all of the attention has been centered in the experimental work 
on the neutral tar—that is, the tar in the cigarette smoke that is neither 
acid nor base. One of the components has practically not been studied 
at all except by Cornell, in England, and that is carbon monoxide. 

I have some reason to believe, from statistical studies and from at 
least one experimental study, that that should be investigated before 
definite conclusions are reached on the subject. 

I hope I have made myself sufficiently vague. I am not asserting 
that it had anything to do with cancer. 

Mr. Harpy. That is quite allright. I think that probably is a phase 
that we may discuss with some other individuals. But your study has 
been primarily in gathering statistics and evaluating statistics. Is 
that right ? 

Dr. Hammonp. I made one study—experimental study—of the effect 
on the blood; and I have preliminary data from another study on it. 

ee But still it was a statistical study rather than a medical 
study ¢ 

Dr. Hammonp. No, sir; it was strictly an experimental study on 
human beings. 

Mr. Harpy. Was that based on medical determination ? 

Dr. Hammonp. It was both experimental and medical. The study 
I referred to was done jointly by Dr. Eisen and myself. Dr. Eisen is 
a physician and did the actual handling of the patients. 

Mr. Harpy. What I was trying to get at, you haven’t been making 
medical analyses yourself, have you, thinking in terms of this statis- 
tical study ? 

Dr. Hammonp. On the study I described here ? 

Mr. Harpy. Yes. 

Dr. Hammonp. No. On this other study, on the effect of smoking 
on the blood, with a collaborator I did. And on this statistical study, 
I didn’t do all this caleulating-machine work. 

Mr. Harpy. The reason I asked the question was that, in your per- 
sonal information which you gave, you didn’t indicate that you were 
a medical doctor. 

Dr. Hammonp. Oh, no; Iam nota physician. 

Mr. Harpy. So your major work in any event would be the compila- 
tion and evaluation of statistics and results of various tests that might 
be run and medically evaluated by others? 

Dr. Hammonp. Well, sir, I am not sure that I say that. A very 
large proportion of the advances in medical science have been brought 
about by people who didn’t have to be physicians. Dr. Hill, as far as 
I know, is not a physician. 

Mr. Harpy. I don’t question that at all, but I was just thinking of 
the medical evaluation that has been made, not necessarily made by a 
medical doctor, either. 

Dr. Hammonp. As a matter of fact, the clinical trials which are 
being carried on in England, for example, for vaccines, for drugs, to 
see that they are effective, are being carried on by Dr. Hill, who is the 
associate also in this other study. He is one of the most prominent 


persons in the whole clinical trials procedures and he is a statistician. 
He evaluates the medical work of the doctors for the British Medical 
Research Council. He is the most prominent person in the world in 
that field, I would say. 

Mr. Harpy. To clear up my point, what I was trying to establish 
isn’t too clear, but I was thinking primarily of all of these determina- 
tions as to the cause of death, which were based on statistics that you 
gathered, rather than in the determination which you and your asso- 
ciates did yourself. 

Dr. Hammonp. I am sorry. No; I didn’t look at a single one of 
these men who died—if that is what you mean. I got reports from 
doctors and pathologists who had examined them. 

Tam sorry, I didn’t understand your question. 

Mr. Buarnix. Thank you very much, Dr. Hammond, for your very 
comprehensive and detailed report. 

Our next witness is Dr. Clarence Cook Little. 


Dr. Lirrir. I will try to make the best time I can. 

Mr. Bratrnitx. Doctor, you have a prepared statement ? 

Dr. Lirrrn. Yes, sir. That is in the hands of the committee, I 

Mr. Buiatnix. Doctor, would you please proceed; give your full 
name and your title and a brief summary of your professional back- 

Dr. Lirruz. My name is Clarence Cook Little. I am director 
emeritus of the Jackson Laboratory at Bar Harbor, Maine. For 16 
years I was managing director of the American Society for the Con- 
trol of Cancer, which is now the American Cancer Society. 

In 1954 I became chairman of the scientific advisory board of the 
tobacco industry research committee and scientific director of the 
tobacco industry research committee. I am not a doctor of medi- 
cine. I earned a doctor of science degree in my graduate work at 
Harvard. I am a biologist interested in the origin and nature and 
future prevention of cancer. 

Mr. Mraper. Mr. Chairman, might I say that Dr. Little was presi- 
dent of the University of Michigan when I graduated from that in- 
stitution in 1927. 

Mr. Harpy. Dr. Little, can I have a httle private conversation with 
you after the session ? 

Dr. Lirrir. Yes, sir. I might say that the experimental mice went 
along with me, both to Maine and Michigan, and I spent my evenings 
studying and doing research on them, so it was unbroken, even though 
T did commit the sin of being the university president. 

Mr. Biarntk. Please proceed, Doctor. 

Dr. Lirrin. My chief interests in the problem of tobacco and health 
are two: First, to help the pioneer coordinated efforts of a very 
creat industry to allow a group of scientists to plan and support re- 
search. This is pioneer work, and if those of us on the scientific 
advisory board of the TIRC can do a good job, can be patient, intelli- 
gent, and work without bias, we may be able to contribute to setting 


up a precedent of support of basic research that will have tremendous 
influence on the country later on. 

This will be because in a democracy it is very desirable to have 
an intelligent attitude in industry and the citizenry as a whole toward 
basic research. 

The announced purposes and cbjectives of the Tobacco Industry 
Research Committee are to aid and assist research in tobacco use and 
eae and to make available to the public factual information on this 

Without at all feeling the need of being defensive, I think it will 
be well to outline my own relationship. My appointment is annual, 
and it is clearly understood with the Tobacco Industry Research Com- 
mittee that if, as, and when the slightest pressure as to what type of 
direction we should take in research or what the publication of the 
research should be, is evident, that my resignation takes effect immedi- 
ately. I can say truthfully and honestly that, during the period that 
T have worked on this problem, there has not been the slightest effort 

“pull punches,” to select evidence, or to limit objectives for re- 

I want to make that clear, because when one is supported in his 
activities by an industry, it is quite natural for some people to ask 
how much is this man dependent on the industry and what is his 
attitude toward it. 

Secondly, after 50 years of research on the cause and nature of 
cancer, I have a tremendous respect for this disease and for its com- 
plexity. Most people don’t realize that an early cancer is a terrifically 
vigorous, virile, healthy biological unit, more healthy and more vigor- 
ous than the body i in which it originates. That is why it “outeats” is 
outlasts it, and eventually kills it. If you remove a cancer from the 
body and culture it in a test tube, or if you transplant it from animal 
to animal, it is essentially immortal. There are mouse cancers alive 
today 30 years after they were discovered, and the Methuselah among 
mice isn’t more than 3 years old. 

Therefore, this original mouse tissue, this cancerous tissus, has lived 
10 times as long as the oldest living mouse, yet it was a part of a mouse 
and isa part of a mouse. 

I mention that because the origin of cancer is a biological pheno- 
menon. It is fascinating. It is natural. It is going to occur, no 
matter how long mankind exists, because it is the. opposite side of a 
sheet of paper that means “control of growth.” 

Therefore, from this point of view, I feel that it is very important 
that openmindedness and interest in "further study—a willingness to 
be convinced too fast by any line of evidence as to causation—is an 
extremely important thing. We have got to have an open road. We 
have got to have scientists and people realizing that this problem is 
nowhere near solved—whether it is the etiology of lung cancer or any 
other type of cancer, we are a long, long way from home. 

During each of these 50 years I have thought I knew a little more 
at the end of each year. But I am certain of what I don’t know, and 
what I don’t know has increased, I regret to say, much faster than 
what I know, and therefore, perhaps, it is Just as well that I have 
reached the retirement age and can let somebody else do that kind of 



The scientific advisory board has been given a completely free hand. 
T should like to talk, if I might, for a moment on some of the com- 
plexities of lung cancer causation to show why I feel that it is so 
necessary to keep openminded and not to go off on the trail of the 
first “fox” that you come on. It is very desirable to keep a lot of the 
pack of research workers looking for other “foxes” that may be causing 
the trouble. 

Genetic constitution: There is a great difference in the reaction of 
different individuals of the same age, sex, and environment to the 
formation of lung cancer. According to four independent investiga- 
tions on the probability of lung cancer, the vast majority of even 
excessive smokers do not develop the disease. 

Why does a small minority develop it, while the great majority 
does not? What type of person—physiologically, psychologically, 
and emotionally—is a bad cancer and health risk? Preliminary 
studies indicate that there are significant differences in these respects, 
and the taking up of excessive smoking may well prove to be an indi- 
cation of such differences, rather than the cause of them. 

I mention this to show how little we really know about what starts 
cancer in this tremendous and rather inspiring population of living 
units that form the human body, and we need to recognize that there 
are different risks, continuing risks as long as we live, and that to em- 
phasize any one risk is legitimate and proper, but it is only a part of 
the whole picture. 

Sex differences: It has already been pointed out that lung cancer 
is 6 to 8 times more prevalent in men than in women of the same ages. 
Why is this? There is a hormonal factor involved here which needs 
explanation. I might incidentally mention that spontaneous lung 
cancer in mice, although it is of the type that occurs less frequently 
in humans, also has a sex difference, and the males form more of it 
than the females. 

Why is this? This must have to be explained if we are to know 
the whole causation of the disease. 

Environment: A number of research workers have pointed out a 
clear relationship between industrial hazards of different types and 
the incidence of lung cancer. A number of investigators have pointed 
out the increased incidence of lung cancer among urban dwellers as 
compared with rural people. 

Why are these things? These facts are affecting the problem in 
which we are all interested, and these things must not be lost sight of 
by following any one lead. 

Inconsistencies evident concerning the claimed cause and effect re- 
lationship: Nonsmokers may and do develop lung cancer; the great 
majority of heavy smokers do not. 

There is lack of consistent correlation between various nations and 
among cities in the 

Mr. Buatnrx. I hate to interrupt you, Doctor. But, you are using 
two scales: When referring to nonsmokers you say they may develop; 
when you refer to smokers you say they did not develop. 

Dr. Lirrir. The vast majority do not, but some do. 

Mr. Buatntk. Would you also say, then, that the great majority of 
nonsmokers do not develop cancer ? 

Dr. Lrrrin. You mean cancer of any and all types? 


Mr. Buarnix. You say nonsmokers may develop lung cancer. Is it 
true that a great majority of nonsmokers do not develop cancer ¢ 

Dr. Lirrun. Do not develop lung cancer; that is true. 

Mr. Buatnix. Then you say that a great majority of heavy smokers 
do not develop cancer. 

Dr. Lirrtr. Yes; you can say it for both groups. In other words, 
lung cancer is a relatively rare disease, and there is no necessarily sim- 
ple cause and effect relationship with smoking habits. If there was,, 
you would get, instead of perhaps 1 out of 20, “1 out of 40, 1 out of 50 
heavy smokers developing it, as is often the case or perhaps 1 out of 
10 where it is at its very worst, then you would find a very much. 
higher correlation than that. 

It is not a simple single cause-and-effect proposition. The point is: 
that it is not a perfect correlation. It is not a thing on which you can 
rely. It is a serious problem as to what causes lung cancer, but it 
still remains true that it is not a simple cause-and-effect relationship. 

Mr. Buatnix. Would + be correct to say, then, to follow up further,, 
Doctor, of two equal groups, equal numerically and in other character- 
istics, of nonsmokers compared to smokers, that the percentage of 
those getting cancer is higher in the smokers ? 

Dr. Lirrrur. That would be correct, according to the present sta~ 

Mr. Brarnik. Would it be correct to say it would be considerably 
higher, the percentage would be considerably higher ¢ 

Dr. Lirriz. That would vary entirely on your methods of selecting’ 
your group and what you were looking for. If you are looking for 
the single relationship between the smoking, that represents one type 
of data. If you are taking an overall picture and considering other 
variables, some of which were mentioned earlier in this hearing, the 
results might not be anywhere nearly as clear cut. 

To establish a cause-and-effect relationship on statistical association 
without experimental evidence is not safe. It cannot be done. Yow 
may get an indication of something to look for, but to say that the 
case is finished, the evidence is all in, and that you can satisfy experi- 
mental scientists, all of them; that is not possible, because too many 
of us have seen too many statistical relationships which have not 
meant the “cause and effect” relationship. 

For example, the per-capita consumption of tobacco in England is: 
much less than in the United States, while the lung cancer incidence is: 
much greater. Similarly, in cities of the same size in the United States, 
where no local difference in tobacco use is known, there may be very 
different rates of incidence of lung cancer. These, I will admit, are 

The average life span has increased strikingly hand in hand with am 
increased consumption of cigarettes. Such general 

Mr. Buarnix. I apologize for interrupting, but the increase in the 
use of cigarettes—is that a per capita increase 4 

Dr. Lirrin. I am talking about a gross increase at the present: 
moment. I would have to look up the statistics to find out how that 
could be related to per capita, because the actual data on the use per 
capita of cigarettes is very interesting. If I have time, I will try- 

Mr. Buarnik. The life span is measured in per capita terms; isn’t 
it? Itissomany years added per person ? 


Dr. Lirrun. That is right; the average lifetime. 

Mr. Buarnix. So I was wondering if the smoke consumption per 
person per capita increased. That is why I asked the question. 

Dr. Lirrin. It has obviously increased. 

Such findings, I would say, definitely disprove a single cause-and- 
effect. relationship between cigarette smoking and lung cancer, and 
this, I think, is admitted by everybody. I think Dr. Hammond him- 
self said that he considered it an important cause, but that he also 
admitted that 1t was only a part of the story. 

The methods of assay of cancer-forming effects of tobacco products 
has been attempted by animal experimentation, The painting of 
known chemical cancer-forming substances on the skin of mice and 
other laboratory animals is one of the favorite methods. Dr. Ham- 
mond referred to this. It is a well-known, well-established method. 

In some experiments negative results have been obtained. In other 
experiments, various percentages of benign and malignant tumors 
have been obtained. There are marked differences in ‘susceptibility 
between different strains of mice and rats and other animals, and a 
very large number of chemical agents not related to tobacco can pro- 
duce the same or even more striking results. 

It 1s very interesting that there are, I believe, some 1,000 substances 
that can produce cancer on animals by painting. This means that 
we are using a method of evaluation which is subject to a lot of value 
as a temporary test, but in which, to extrapolate wholesale to man is 
a very dangerous procedure. To do this it gives us a false sense of 
security, and we may waste a lot of time following up leads on this 
basis which may prove sterile. 

Although certain chemists reported that they detected in tobacco 
smoke certain of the chemical substances which produce cancer on 
mouse skin, there is no evidence that these are present in tobacco in 
any form in sufficient quantity to produce this reaction even in mice. 

Dr. Wynder, whom I understand you are going to hear later, has 
made the statement that: 

There exists, therefore, so far, no evidence that a single known carcinogen in 
condensed tobacco tar can account for the established carcinogenic activity in 
mice and rabbits. 

I simply mention this because there is a great tendency and a very 
human one to grab at this animal evidence ‘and swallow it whole and 
transfer it to man in the hope that we have found a solution. 

I would be the first one to welcome it if that were true, but I have 
worked long enough with animals to know the need of very great 
caution in ceneralizing from them, or even in quantitatively taking the 
detailed individual experimentation. Very great danger exists in ‘both 
of these activities. Conservatism is the wiser course when you are 
dealing with a disease like cancer. 

Painting of the skin of monkeys—primates, these are—with known 
cancer- -forming chemicals which do produce cancer easily in mice has 
been uniformly negative, although the exposure may have continued 
for as much as 814 years. 

It is therefore probable that the cancer-forming reaction of mice 
does not accurately measure the cancer-forming reaction of primates, 
including man, because I am afraid that you would have to admit that 
the monkey, physically at least, and chemically, resembles man more 


closely than the mouse does, although I regret to say I have seen some 
men who acted more like mice. 

A large number of experiments involving inhalation of cigarette 

smoke by a total of thousands of animals have failed to produce a 
single lung cancer of the type most common in man. This is very 
important to me, because you have heard this morning of the 2 types of 
cancer, the 2 commonest types of the lungs of men. The type that is 
commonest in humans has not been produced by smoke-inhalation ex- 
periments in animals, as far as I know. The type which is relatively 
rare In man is not only hastened by inhalation in animals, but it is 
hastened by any process that you use, practically speaking, to ill treat 
these animals. 
__in other words, if you age these animals fast enough artificially, or 
if you can age them naturally and observe them, the percentage of 
cancer Increases, which is a very common phenomenon of almost all 
types of cancer. 

But as far as I know there is no evidence that repeated and intensive 
smoke-inhalation experiments with animals have produced the type of 
lung cancer commonest in man. This I think is very important if you 
are going to study cause-and-effect relationship. 

On the educational side of this work—in which I was very much in- 
terested, naturally, because of my past contact with the Cancer 
Society—for 16 years my associates and I worked to allay irrational 
fears and develop judicial attitudes by the public toward cancer. 

After 1945 there was a tremendous expansion of the program of 
education, service, and support of research by the American Cancer 
Society. At that time there was also initiated the development of its 
own statistical and investigative staff and program. 

The first major scale effort that division of the society was this 
collection of data on lung cancer. There were, as I understand, some 
20,000 lay workers trained and instructed to collect these data, and 
their purpose was to collect data for studying of the reported associa- 
tion between cigarette smoking and lung cancer. 

Drs. Graham and Wynder, in 1949, had definitely accused smoking 
as being of great importance in the causation of lung cancer; and the 
Cancer Society in this great big statistical study took that as an ob- 
jective—to see whether this was or was not true. ; 

This is important to remember. The specific definiteness of this 
objective, I think, was shown by the relatively small amount of infor- 
mation collected on other habits or previous health records of the 
population, or any information whatever, except smoke habit, place 
of current residence, and cause of death. 

A positive association is claimed now by the American Cancer Soct- 
ety between excessive smoking and some of the diseases of which you 
have heard today. I will go through them very rapidly. Mind you, 
this is not claimed by them as significant, because often the members 
are so small that a larger number would be needed in order to make 
the difference observed statistically significant. But these are all 
on the positive correlation side: Death from cancer of the lung, both 
bronchogenic and adenocarcinoma; larynx, pharynx; esophagus; 
tongue; mouth; lip; bladder; prostate; stomach; pancreas; liver; gall 
bladder: Hodgkin’s disease; lymphosarcoma: retinosarcoma kidney ; 
also with pneumonia; influenza; other pulmonary diseases; aortic 
aneurysm; duodenal ulcer; cirrhosis of the liver; asthma; coronary 


disease; myocarditis; cerebrovascular disease; hypertensive heart; 
nephritis; pulmonary TB; arteriosclerosis; and phlebitis embolism. 

In fact, I believe that the only diseases listed by this study in which 
no positive association of some degree is observed were cancer of the 
colon, rectum, and brain; leukemia; chronic rheumatic heart disease, 
and diabetes. 

There may have been 1 or 2 others, but, generally speaking, it is a 
difficult, if not impossible, scientific gymnastic feat to imagine a cause- 
and-effect relationship in this overall mixture of human ailments, es- 
pecially with a strikingly increased life span of our population and 
parallel increased national tobacco consumption staring us in the face. 

This is a hard thing to imagine on a cause-and-effect basis, I think, 
really. It is almost, not quite, reductio ad absurdum. It certainly 
makes one look for other factors in this situation than the statistical 
associations as meaning cause and effect. 

Narrowly focused emphasis on a causal relationship between smok- 
ing and lung cancer with powerful and continuous propaganda pres- 
sure has far-reaching results. 

1. It limits research objectives by setting off a large amount of in- 
tensive activity on but a single trail which may well prove a false one, 
or at best provide only a partial answer. 

2. It creates fear, mental and emotional disturbances, and a false 
sense of proportionate values in considering the whole complex prob- 
lem of lung cancer prevention and control. 

3. The definition of “smoking habits” is vague and is subject to the 
possibility of radical change when accurate information is obtained. 

4. Since a long—approximately 20-plus years—latent exposure 
period before cancer formation is required to explain the present un- 
favorable statistical results, supposedly preventive measures, even if 
practical, could not be safely evaluated for 2 decades. 

5. Should further knowledge force reversal, abandonment, or even 
radical modification of definite claims of the seriousness of the possible 
cause-and-effect relationship, research efforts not only in this particu- 
lar field but in many others may be discredited and progress toward 
eventual victory over cancer be seriously delayed. 

I should like, in closing, to make this one thing clear again. My 
interest in the fight against cancer is a very long one and a very in- 
tense one. I have given most of my active life to it. J want the pub- 
lic to realize the seriousness of the problem. 

I don’t want them to be misled by “apparent” victories, even partial 
victories, that might block continued research. An openminded at- 
titude is terrifically important in order to hasten the day—and I am 
afraid the day is still far off—when we can claim victory over the dif- 
ferent types of cancer. 

They are very much at home inus. As I have said, they are a part 
of us. They grow faster than we do. They outlive us. They are 
a much more effective biological unit, a much more effective living 
cell. The tragedy is when they occur in a limited human body and 
create the crisis. 

With all these factors, those of you who are in a position to main- 
tain sanity and balance and openmindedness and the zeal to get this 
knowledge as quickly as possible are, I think, in a terribly important 
position, perhaps much more important than the fellows who are in 


the laboratories or even the people who are on the fringe of education 
in this work. 

To keep an openminded attitude is the only way to conquer this 
disease. This doesn’t mean that we can’t let everybody who feels that 
he has got evidence give his evidence. By all means, yes. Let him 
interpret it in any way he wants. But remember that, in as compli- 
cated a subject as this, an open mind and great courage and great 
tenacity and great wisdom and great inventiveness are going to be 
needed for a great deal longer, I am sorry to say, than probably any- 
body sitting here in this room will live. 

I would be very glad to try to answer any questions. I have tried 
to hurry through this rather rapidly to keep you under your deadline 
of time. 

Mr. Biarnix. Questions on my right? 

Mr. Brooxs. I would like to ask the doctor one thing. You refer 
to painting animals, and all of that. Have you ever tried the process 
of the application of heat continued for a time ? 

Dr. Lirrriz. Yes. In some animals there has been evidence that 
around burns or around areas stimulated mainly by heat there is apt 
to be overgrowth of skin and cancer—an example is the forming of 
cancer of the lip following the excessive smoking of the old TD pipe, 
the old clay pipe that used to practically cook the lip. 

Chronic irritation, I think, is a bad risk any form of cancer. Heat 
is one type of chronic irritation if it is kept up long enough. 

Mr. Harpy. I take it, Doctor, that essentially your feeling about the 
statistics that were gathered and presented earlier is that it 1s pre- 
mature to make a final adjudication of what they mean ? 

Dr. Larrrn. I think that is true not only of these statistics but of 
all the experimental work of persons like myself and others who have 
tried to find the answer. I think we don’t know the whole picture 
by a long shot yet, and that an open mind and all kinds of courage 
and effort are the things to have rather than a precrystallization and 
a prejudgment which may turn out to be faliacious and block progress 
for years to come. 

Mr. Harpy. Then you would disagree with Dr. Hammond’s con- 
clusion that there is a causative relationship between smoking and 
lung cancer ? 

Dr. Lirriz. I would say that no evidence has yet been produced 
that has convinced me of that. I admit that he has an entire right 
to his own opinion and he has worked with these data and collected 
them. But from the point of view of somebody who has worked 
experimentally with the disease in animals, I am not convinced that 
this relationship is a real one yet; or, if real, is anything like as im- 
portant as it is now being made to appear. 

I think that it has become fashionable only because if you find a 
possible cause-and-effect “agent,” humanity is hungry for something 
to prevent cancer. It is a cruel, miserable disease, and, of course, it 
is a wonderful encouragement if you think you can put your finger 
on it. 

But it is an awfully tough disease, and it is ingrained right in the 
nature of the person himself. It belongs there. It is quite at home: 
just as much at home as the rest of his body. And I have great respect 
for it. 



Therefore, I cannot be driven to accepting the relationship with 
smoking, and especially with cigarette smoking, as being as significant 
as it is taken to be. 

Mr. Harpy. I would like to ask you a question comparable to one 
I asked Dr. Hammond. If there should be a relationship between 
smoking and lung cancer from a causative point of view, would that 
be due to some specific element in smoking that could be removed in 
your opinion 4 

Dr. Lrrrie. I wouldn’t want to estimate it—not because I wouldn’t 
like to be able to, but because I don’t know enough. I have too much 
respect for the different triggers that can set off cancer to be willing 
to evaluate any one until I had a better overall picture of the whole 
terrain in which this battle was being fought. <o/ff 

I don’t want to pick out one battleground and say that this is the 
whole campaign, and give a misleading effect that, if you solved the 
problem in that battle, you have won the war—because I don’t think 
that you have. : 

I think that it is very doubtful whether the chemical carcinogens 
which have so far been accused of being bad in this picture—they 
have been accused by some and abandoned by others—have a very 
ereat significance. I have a very great desire to get something defi- 
nite, but I have very great doubt whether the problem is anywhere 
near as simple as that. 

Mr. Harpy. Maybe I am getting ahead of the discussion that we 
are trying to develop, but it leads me to wonder whether I am properly, 
interpreting your statement there to mean that any idea that filters 
would remove the cause of cancer is fallacious or is certainly not 

Dr. Lrrriz. I wouldn’t want to go as far as to say that. I don’t 
know. First, I don’t know whether there is any cause in it. Second, 
T don’t know whether this cause is a chemical or a physical one. 

I don’t know whether minute particles of material that we inhale 
are bad—and we inhale much, much more of them from motor exhaust 
fumes than we do from tobacco smoke, and much more of the suspected 

I would like to see the efforts which the TIRC is trying to make 
progress on succeed, and see us get human lung cancer outside of the 
body where we can match what happens to it when we challenge it. 
Tt is hidden. 

Mr. Harpy. The reason I sort of got a little bit out of the line of 
the discussion we have had up to now was that actually the subject 
this committee is concerned with is possible misleading or false ad- 
vertising that has been going on. That is why I was interested in 
our reaction to the possibility that if cigarette smoking does have 
a causative effect on lung cancer, then whether or not a filter would 
veduce that cause or the extent to which it would reduce it is the sub- 
ject that we are immediately concerned with, and claims that it re- 
duces 1t, if such claims are made. 

That is the thing that seems to me is really the key to what we are 
eoncerned with, and I gather from your testimony that you don’t 
know of any reason to suppose that it makes any difference. 

Dr. Lirrin. It is very hard for me, when I don’t know the cause of 
a disease, to have opinions about what is supposed to prevent it. 


Mr. Harpy. I think that isa very reasonable reply. 

Mrs. Grrrritus. Mr. Chairman, may Lask a question ? 

Mr. Bruatrnrx. Certainly. 

Mrs. Grirrirus. If, in your judgment, smoking didn’t cause cancer, 
do you know why the cigarette companies came out with the filters? 

Dr. Lirriz. I don’t. Very fortunately, I couldn’t pass an examina- 
tion as to which company makes which kind of cigarette. And if I 
may say so, 1t is a matter of complete and enthusiastic indifference to 
me. Iam very much more interested in studying cancer than I am in 
cigarette companies. 

“Mrs. Grerviris. Are you interested in studying the connection be- 
tween cigarettes and cancer ? 

Dr. Lirriz. I am interested in studying either claimed or real asso- 
ciations between anything and cancer. 

Mrs. GrrerirHs. Have you ever studied whether or not the filters 
actually keep you from inhaling smoke ? 

Dr. Larris. No; I never have. I have been very much more in- 
terested in trying to study the nature of cancer itself. I am not at 
all interested in the economic or practical side of the problem. J am 
much more interested in the human being, the boy who is going to pay 
the billsif he has cancer. 

Mrs. Grirrirus. Perhaps it isn’t a fair question to ask you; perhaps 
you don’t know and couldn’t answer it anyhow. But if it were defi- 
nitely true that there is a real connection between cigarettes and lung 
cancer to the satisfaction of everybody, are the cigarette companies 
going to admit this? Are they going to stop selling cigarettes? Or 
are they going to advise the public? 

Dr. Lrrris. I couldn’t answer that. I suppose when you say asso- 
ciation between tobacco and cancer, you mean causative association ? 

Mrs. Grirrirus. Yes. 

Dr. Lirrre. Just a parallel habit or parallel incidence of the two 
may mean nothing. You mean if a causative effect is proved ? 

I would say that from what I have known in my brief contact 
with the committee of tobacco executives, they would do everything 
humanly possible to find out the truth about this. I don’t believe 
there 1s one of those men that wants to bluff for a minute. I don’t 
think there is one of them that is stupid enough to want to bluff for a 

It is now essential that they find out the truth. They want to find 
it out as much as anybody else. They don’t want to take a risk of 
producing a lethal or a semilethal agent. That is why they have 
come right up with the complete freedom they have given my asso- 
ciates and me, and some of the evidence that is coming from experl- 
ments may not be what they would ue It may raise questions. 
If it does, then they are prepared to continue to study in the face 
of those questions, because this accusation has been made and they 
are at grips with a very serious enemy. 

Mrs. Grirrrrus. But you don’t know whether the filters were put 
there for a bluff? 

Dr. Lrrrir. I have no conception of that at all. I really don’t. 
To tell you the honest truth. it would seem to me, from my point of 
view, to be more of a “sporting event” to try to find out the motives 
for something like that than it would really to have anything to do 


with the seriousness of the situation; for if they were put up for a 
bluff, nobody except the fellow who put them up that way is being 
as heavily fooled as he is, because he is building on an unknown situa- 
tion out of ignorance. 

I hope that they are too good citizens and too good businessmen 
to try to bluff the thing. I am not a cigarette smoker any more than 
I can help being, because my nose is so long that when they are half- 
way down it begins to be uncomfortable. 

Those that I have smoked with filters delivered less that I had to: 
remove afterward from my mouth than those without filters, and I 
found them cleaner and more comfortable to smoke. 

Mrs. GrirriruHs. Do you know whether in England more people 
who are heavy smokers die of lung cancer than those who do not 
smoke? I noticed you had some statistics. 

Dr. Lirrrn. I think that the Doll and Hill investigation was just 
a population of doctors and tended to show that association. I know 
that the per capita consumption of tobacco in England is far below 
this country, and that the lung cancer death rate is almost twice as 
high per capita. 

Mrs. Grirrirns. That would not necesasrily mean that there were 
not just as many heavy smokers in England as there are in this coun- 
try. Would that be right? If you are dividing cigarette sales by 
the people who live in England, I presume that is meant per capita. 

Dr. Lirrrz. I would rather see the statistics themselves in order 
to try to evaluate them, because sometimes you can set up a thing that 
looks perfectly reasonable and then by failure to include the borderline 
variables get a misleading result. 

All I get the impression of is, that there is no definite correlation 
that one can really arrive at between the amount of individual smok- 
ing and lung cancer death rate between nations. Whether this is 
the biological differences of the people who smoke, I wouldn’t know. 
But certainly there is no foolproof cause and effect correlation that 
goes through the whole gamut of variables and leaves you confident of 
it at the end. 

Mr. Harpy. May I ask just one question, Mr. Chairman? I be- 
lieve he has already answered it, but just so I can have a clear answer 
to it: Doctor, based on your own research and on your knowledge of 
the studies of others, do you know whether there is any health ad- 
vantage in smoking a filter-tip cigarette over one that doesn’t have a 
filter tip ? | 

Dr. Lirriz. I don’t know. 

Mr. Meaper. Dr. Little, as I appraise your statement, it is one of 
caution against jumping to conclusions from statistical associations. 
IT don’t find too much in here about the origin of the committee of 
which you are the director, nor the progress that your committee has 
made in its efforts, and precisely what the objective of the committee is. 

Dr. Lrrrir. The list of the scientists who are on my board, I think, 
should be or is appended there. 

(See appendix, exhibit 3, p. 337.) 

Mr. Mravrer. When was the committee created ? 

Dr. Lirrix. The committee was created in 1954. 

Mr. Mraprer. Was it a result of the public interest in the subject of 
the possible relationship between cigarette smoking and cancer? 


Dr. Lirrix. And also cigarette smoking and coronary and heart 
‘disease. In general it was, I think, a fine and honest recognition of 
the industry that the time had come when it would have to study these 
‘claimed cause-and-effect relationships and do its best to find out wheth- 
er they were true or not. It realized that if they were true something 
would have to be done to correct them, and if they weren’t true, the 
industry would like to know that so that they could go ahead and be 
‘about their business. 

Mr. Meapver. Let me ask you whether the financial support of your 
undertaking is derived solely from the manufacturers of cigarettes, 
or are the growers themselves involved in this and do they contribute 
to the financial support ? 

Dr. Lirrix. Subject to correction, it is my impression that the grow- 
ers and the various phases of the industry are involved. But I couldn’t 
possibly give you the list of the names because I don’t remember them. 

Mr. Mraper. Could you give us some idea of the magnitude of your 
research undertaking in terms of finances and employees and facilities 
‘and so on? 

Dr. Lirrir. Yes. We dono research of our own at all. We give two 
kinds of support—grants-in-aid to existing research centers, and to 
individuals on problems which they have submitted to us; and we 
‘also give very small summer scholarships to help medical students 
in any phase of research that they want. 

These fellowships are not at all confined to the field of tobacco and 
health. The grants we give have also been very, very broad, because 
‘we have some question about reactions of tissues that may not have 
any immediate obvious relationship to the problem. 

Since we are left alone to decide whom we shall support, and there 
is no industry pressure whatever, we have tried to look at it from a 
longtime point of view. 

Mr. Meaper. Could you submit for our record the budgets of the 
committee by years? 

Dr. Lirrus. I will be very glad to do so. 

Mr. Meaper. With some breakdown as to the grants made and the 
purposes of the grants and the individuals to whom the grants were 
made for research purposes in this field. 

Dr. Lrrrur. Yes. The committee has made available about $2,200,- 
000; and my impression is that we have appropriated $1,800,000 of 

Mr. Mraper. Since the beginning? 

Dr. Lrrrnz. Since the start of it; yes. Also, I have a very definite 
feeling that the industry would increase its support 1f those of us who 
were responsible for the program asked it to do so. 

But I have believed that it pays to proceed with caution and sound- 
ness rather than to try to make a splurge and to try to get results 
rapidly but superficially. I think that the problem of cancer is one 
that brings you right up on your haunches with a warning to you— 
“Tjon’t fool with me. If you mean business, you take hold of me and 
stay with me and don’t try to hurry things, because I am the boy that 
is going to fool you if you try to do that with me.” 

Mr. Buarnix. Not to interrupt you, but on one point, Doctor, I 
don’t quite agree on “hurrying’—not that I am a scientist. I grant 
you my undergraduate work was all in chemistry and mathe- 


matics. The only way we solved the atom bomb was by a crash pro- 
gram. We solved it in about 214 years. That is a very complex prob- 
lem. We stepped up the second stage in the race for the hydrogen 

The only reason we were successful in solving that problem was by 
an all-out crash program. I don’t quite follow you when you say we 
should not increase and intensify and broaden this all-out accelerated 
research work. 

Dr. Lrrrie. I don’t blame you for questioning me on that. I would 
be very dumb if that is only what I really meant. What I mean is, 
you should not proceed any faster than genuine opportunity offers it- 
self. You should not go through the motions of asking for a lot of 
money that you can’t wisely spend, and then having to explain how 
you spent it afterward. 

To take the atomic bomb problem—without going into the technical 
side of it—the groundwork by which the all-out drive was possible 
had been laid over a long period of years by a lot of men who had gone 

Mr. Brarnik. It wasall theoretical on three sheets of paper. There 
wasn’t even a laboratory assembled of the items we are talking about. 

Dr. Lirrin. You probably know much more about that than I do, 
but I had the general impression—I still do—that great discoveries 
had previously been made. Certainly in biology—which I must con- 
fess if I know anything at all, I know more than I do about the atomic- 
energy program, about which I know nothing—in biology you are 
dealing with an awfully tough proposition. ‘You are dealing with 
all the delicacies and balances of life processes. You are dealing 
with a population of living units, and a human being probably has 
more living units than there are people in any census anywhere today. 

All of these units are coordinated into a perfectly wonderful 
balanced system. The wonder is that more errors like cancer don’t 
happen, that more cells don’t break loose, that the control is so perfect ; 
and because the control is perfect, there are any one of a great number 
of agents that may break it or that may threaten it. 

So I would say that great caution was necessary, and I think that 
just spending money for the sake of spending money oftentimes 
boomerangs because the people who have been giving it say, “What 
have you oot ? a” 

Mr. Mraper. That was a question I was leading up to, Dr. Little. 
I have one preliminary question. Are your research orants in the 
field of cancer confined to the effect of the use of tobacco 1 upon various 
types ¢ 

Dr. Lirrin. Some of them are in the field of cancer generally. Some 
of them are in the field of heart or other circulatory disturbances. 
Some of them are in the field of stomach uleers—things of that kind. 
They are not confined to the effects of tobacco or any tobacco product. 
Some of them are, but some of them are not. And there is no fixed 

Mr. Mraper. Now I would like to ask the question you just asked: 
What progress have you made? 

Dr. Lrrrir. We have found some interesting leads, and these are 
all being published by the investigators who found them in regular 
scientific journals when and how they want. We have no influence on, 


and never shall attempt to exert even the tiniest influence on, pub- 
lication or interpretation of results. 

They are coming out in the journals now. I don’t know whether 
my associate, Dr. Hockett, here would know how the publication is 
progressing, but obviously there was a timelag after we began sup- 
porting research because you don’t just press the button and get scien- 
tific results. But there is an encouraging growth in first-rate scien- 
tific communications coming out. 

If you knew how exciting that is to me—realizing that a big indus- 
try is willing to get back of that, and what that may mean—before 
so many years we may be able to go to a lot of industries and say, 
“Come on now, boys, you get back of free research. Go at things, 
and we may be able to speed up discoveries in biological sciences and 
chemical sciences a great deal.” 

Mr. Meaper. Are there any discoveries which a layman could under- 
stand which you could mention as an example of the progress of your 
research program / 

Dr. Lirrin. Well, that is pretty hard for me to do. I would much 
rather give you the abstracts of them, give the whole committee the 
abstracts and let you form your own judgment, because if I tried to 
tell them to you in a condensed way, I am very much more likely to 
run the chance of overemphasizing something that is of particular in- 
terest to me. 

I hope you will give me the time to let you have the abstracts on: 
them and let you skim over them. Some of the things that do in- 
terest me are the relationship of stomach ulcers and cancer, things: 
of that kind, the discovery that it was not a simple cause-and-effect 
relationship, that smoking doesn’t change the chemical content of the’ 
material which is in contact with the ulcer, so that it doesn’t do any 
good, it doesn’t do any harm apparently. 

Smoking is a neutral factor as far as the analysis of the gastric 
secretion of stomach ulcer patients are concerned. 

We are just getting some very interesting results in the field of the 
types of people who are health risks. This factor of psychological 
strain and stress and the person’s reaction to it—I don’t know that 
Dr. Hockett has a list of materials here, but Dr. Brosek’s work 1s in- 
teresting in that it shows a correlation between smoking and certain 
health behavior which may lead to more enlightenment and more 
knowledge as to what is good and what is bad in this picture. 

That there are some at least supposedly beneficial effects of a habit 
that has been long used I suppose would have to be taken for granted. 
The question is, are these effects real ? 

Mr. Mraper. I understand you can supply the committee with a list 
of the grants that have been made and a list of the publications? 

Dr. Lirrir. Yes; we will be glad to supply you with a list of the 
grants and the names, and these will be supplied you also with a 
résumé—an author’s summary—of what he thinks he has found. 

(See appendix exhibits, pp. 361, 364.) 

Mr. Prarrneer. Is Dr. Brosek included in this list ? 

Dr. Lirrir. Yes; heis. 

Mr. Minsuat. Doctor, you have no staff, then, of medical men who 
are actually conducting experiments or research along this line? 


Dr. Lirrin. That’s right. We don’t hire a single person to do re- 
search, and we have no control over his research or the conclusions 
coming from it. 

We give him grants-in-aid exactly the way the Rockefeller Founda- 
tion does or the Carnegie Foundation. We kiss the money goodby 
when we give it to an investigator and hope that he will find something 
for the good of humanity. 

Mr. Mrnsuauu. The Roscoe B. Jackson Laboratory in Maine: Is 
that where you are headquartered? Does that have anything to do 
with the Tobacco Institute in any way ? 

Dr. Lirrirn. We have a grant from that group—the laboratory does. 
JT am no longer active with the laboratory. But we have a grant by 
which we try to produce animals which can be used by other grantees. 

You see, the Jackson Laboratory, in addition to its own, is the one 
supply research center of the standardized animals which are so uni- 
form due to inbreeding that a person can buy 5 or 5,000 or 50,000 of 
them and be working on a population that 1s essentially as alike as 
identical twins are in humans. 

In other words, it is the standardization and production of uniform 
biological material. That is besides our own research, but we are the 
service station for the whole country and really, practically speaking, 
for the world in that type of material. 

This grant is to enable the laboratory to have readily available for 
people doing research on the effect of tobacco on health to get this 
material as quickly and effectively as possible. We are not doing any 
experiments to test the efficiency of tobacco there at all. 

Mr. Minsuatu. In other words, you are just a breeding station ? 

Dr. Lirrir. We aresuppliers; yes. That is practically what we are. 

Mr. Minsuaur. You sell these animals to anyone 

Dr. Lirriz. Any legitimate person. I mean by that, any legitimate 
person who has a connection with an established laboratory, institution, 
or university. We do not sell them to individuals who appear to be 
irresponsible and are likely to be crackpots and who might produce a 
false sense of scientific achievement. 

We would do that—not about the tobacco thing, but about the use 
‘of the mice in general. We just wouldn’t let them have them if they 
wanted to see whether they got indigestion from eating grapefruit or 

We just wouldn’t let them have them, period. 

Mr. Minsuarx. Doctor, based on your association with this institute 
for the past 3 years, and the wealth of information that has certainly 
come to your attention, do you still believe that there is no connection 
‘between smoking and cancer ? 

Dr. Lirrir. No; I have never stated a belief of any kind onit. Iam 

Mr. Minsuartyi. What is your belief ? 

Dr. Lirrin. My belief is that I would like to get more facts before 
I am able to say whether there is any relationship; and if any relation- 
ship, where and how that occurs. Whether it is a cause-and-effect 
relationship, or a correlation that doesn’t mean anything, I don’t know. 

IT am very, very much from Missouri about this, because the greatest 
mistakes in the world that can be made when you are dealing with an 
enemy like cancer is to play your cards before you know the kind of 
.2 fellow you have to deal with. 


Mr. Minsuatu. Based on your progress so far, or lack of progress, 

when do you think you will know? Ten years? Twenty years? 
Fifty years? 
_ Dr. Lirrriz. I will say that I hope we will know more each succeed- 
ing year. But when a man will ‘be able to sit up and say, “Yes” or 
“No” about a type of cancer, when he will be able to do that, I wish I 
did know. 7 

Mr. MinsHatyi. You know more now than you did at the end of the 
first year ; do you not? 

Dr. Lirriz. Yes; we know some of the complexities that exist and 
some of the dangers in oversimplification. 

Mr. Minsuatu. Based on that experience, when do you think it 
might be? Do you think it will be in 5 years; 10 years? When do 
you think you will be able to definitely formulate some conclusions ? 

Dr. Lirriz. I think we will be forming tentative conclusions fairly 
rapidly for specific questions. But for an overall sweeping condemna- 
tion of any human habit or any human structure in the cancer problem,, 
I doubt whether we will be unwise enough to make a statement that 
gives a false sense of values. 

Mr. MinsHauy. What kind of tentative conclusions do you think will 
be formed and when will they be formed ? 

Dr. Lirrix. I couldn’t answer that. I wish I could. I honestly do. 
How can a fellow tell what new trails are going to come to him? Not 
even the prophets were too good at that, and certainly I am not a 

All one can do is to keep plugging honestly and courageously and 
without fear and without favor, and that is what this particular group 
is trying todo. The vast majority of people everywhere are trying to 
do this about this cancer problem. When somebody crystallizes or 
somebody states a belief, that doesn’t mean that those who don’t share 
that belief think little of him. 

If Dr. Hammond, whom I respect tremendously, has a belief, he 
has a perfect right to that belief; and it may be right and mine may 
be wrong. But to keep an openminded attitude is the one way of 
being sure that the best final judgments will be reached. 

People get convinced at different stages along the line. Some 
people will take evidence as final that other people are skeptical about. 
Maybe it is just because I am a “damn Yankee” that Iam very skeptical 
about things. Maybe it is just because I have worked with cancer for 
so long that I respect it terrifically, and know my own shortcomings. 

Mr. Minsuatu. In other words, then, as far as you are concerned 
there is no goal in sight when you might reach some definite con- 
clusions ? 

Dr. Lirrie. Yes; I think there is. I think there will be methods of 
testing. I think there will be more methods of doing this. 

Mr. MinsHatyt. You have me confused now. First you said you 
didn’t know, but now you say there is a goal. 

Dr. Lirriz. If I may just take a second and single out one sort of 
problem. You can’t see what happens in lung tissue when it is in the 
body, and you can’t reach it very successfully in any controlled way. 
Tt is beautifully hidden and protected because that is what it is there 
for—to do a very delicate job. 

Now, supposing we can get this lung tissue out into tissue cultures, 
and by giving it different nutritive medium and by challenging with 


different agents—including the products of tobacco—we can see what 
the changes are in relation to what the lung is doing in aging by itself 
without the other agents. 

Supposing we can take lungs that have had tuberculosis and compare 
them with lungs that haven’t; or lungs that have inhaled asbestos with 
those that haven’t. That is the kind of thing which isn’t visionary; it 
isn’t umpossible; and one of the things that we are doing on the TIRC 
is that we have got 3 young tissue-culture people learning all they can 
about lung-tissue culture under 3 of the very best men in the country, 
so that we can get the technique by which we can pull the lung tissue 
out of the dark and make it play the game where we want to play it 
instead of having to go and play on its terrain. 

I think that is a cardinal principle of scientific research—get your 
enemy out into the open. That is the kind of thing I mean. All I 
can tell you is that we are making progress toward it. 

I wish I could tell you just when we are going to turn the corner and 
begin to be able to do something, but it isn’t unhappy. I would say 
olive us 3 years, perhaps, for that, on a guess. 

Mr. Minsuauu. Three years is your best guess now. That is all I 

Dr. Lirris. On that particular problem; yes. I would say that 
by 3 years we ought to be able to be culturing lung tissue in a very 
much better way than at present, and making it obey, jump through 
some of the hoops that we want it to jump through instead of having 
to go to it. To get your enemy out in the open is a good principle, if 
you can do it. 

We may fail, but it won’t be because of lack of effort. And I am 
sure that if my scientific advisory board finds other places where 
trainees can be trained, we can go to the Tobacco Research Committee 
and say, “O. K., instead of 3 of these fellows working on this, we want 
53; we want 6.” 

But at the present moment it looks as though there were only three 
good centers of tissue-culture work where enough progress could be 
made on that to justify taking it. 

Mr. Mnaper. In connection with the material you are going to 
furnish the committee on the grants and the research and projects that 
have resulted from them, can you also furnish the committee with 
whatever charter there is for the committee ? 

Dr. Lirrie. Yes; I can. 

Mr. Meaper. And also any regular reports that you may have 

(See appendix, exhibit 3, p. 348.) 

Dr. Lirrir. We will be very glad to do that. This year’s annual 
report isn’t ready yet, but we can at least send you all the other mate- 
rial and, let’s say, a typed preview of the introductory part of this 
vear’s report, which will talk about the reasons for our programs and 
the philosophy of it, provided, of course, that you will take that not as 
a final documnet. We are very anxious to have you see our attitude 
while we are thinking about things and while we are in the formative 
stage as well as after we have come to a decision. 

Mr. Buatnrk. Mr. Kilgore? 

Mr. Kriicorr. Doctor, there is one thing that I am not quite clear 
on with respect to the functions of your committee. As I understood 


your testimony, you allocate grants to existing research foundations. 
But then in comnection with published findings of these organizations, 
do you maintain any evaluation procedure for the findings that are 
developed by independent research organizations? Do you, yWithin the 
committee, maintain any means for evaluating or correlating that? 

Dr. Lirriz. We review them, but the evaluation is purely personal. 
There is nothing official. We don’t rate them. We don’t put an official 
stamp of approval or disapproval on them. These men are just as 
free as they can be to find out anything they can. I think they have 
enjoyed that. We have had some scientific conferences. It has been 
very amusing. Some of the tissue-culture gentlemen are quite tem- 
peramental. We did have them come in to get their ideas as to how 
practical lung culture was. First it was largely a matter of their 
avoiding that rather than getting together. After that they got to- 
‘gether beautifully and they gave us some criticisms and ideas. 

Mr. Kincorr. Then the function of your committee would not en- 
vision or anticipate the publishing by the committee itself of any 
evaluation or compilation or comments ? 

Dr. Lirrtr. No comments on them other than a general introduc- 
tory comment which I, as the director, the chairman, would make 
trying to survey the whole field and point out the areas of interest 
and their relative development. 

But as far as singling out a piece of research and putting a stamp 
of approval on it; no. Ifa piece of research could be used as an ex- 
ample of encouragement or an example of something that we thought 
might be further considered, I think that would be quite right—the 
way the Carnegie Institute or the Rockefeller Foundation do. They 
give a report each year in which they pick out things that seem per- 
haps interesting to them. 

Mr. Kircorr. Then I have a specific question I want to verify my 
thinking on. If I remember your comment accurately, in response 
to a query made by Mr. Brooks with respect to the relationship of pipe 
smoking to lip cancer and the possible correlation of heat factor, I 
think you made a general comment to the effect that you would con- 
sider any chronic irritation asa bad risk insofar as cancer is concerned. 

Dr. Lirrin. Any chronic irritation—I take it you can say as a gen- 

ral principle—sets up an unbalance of some kind in the body and 
the body has to correct that. 

The body is amazingly efficient in correcting not 999 out of 1,000, 
but nearer 6 figures. It is a beautifully adjusted mechanism. Once 
in a while it cannot do that. Once in a while for some reason in the 
origin of cancer a cell becomes independent. 

It no longer will go back as it should and join the community and 
mind its own business. But it becomes independent with a terrific 
vigor, and with an increased vitality compared with the cells that 
reXe) ) back and obey. This is the awe-inspiring thing about it—the tre- 
mendous vigor of a cancer cell and the fact that all the pain, suffering, 
disaster, and death we have are the secondary and tertiary results of 
an overgrowth that the body can’t take care of, or of sepsis coming 
toa breakdown of tissue to blocka ge of a vital path. 

Mr. Kirtcorr. Doctor, that, of course, naturally raises the next ques- 
tion of whether or not "the regular or irregular inhalation of smoke 
wouldn’t properly be classified as an irritant to the lung tissue and to 
the larynx. 


Dr. Lirrin. I should say that any substance other than the actual 
material of the body itself in place has potential value as an irritant. 
For instance, the salt you eat has. For some people, milk might be. 
In other words, anything that you bring in contact with human tissue 
has a potential value that may differ entirely for the type of individual 
where this experience occurs. 

The old statement that what is one man’s meat is another man’s 
poison is pretty true biologically, not only of agents that you may 
single out and put a finger on but a whole lot of things, including too 
much water intake for certain people of certain chemical types, and 
so forth. 

Mr. Kircore. Would it be a fair evaluation of your answer, then, 
Doctor, to say that such an inhalation of smoke would be an irritant, as 
there are many other irritants ? 

Dr. Lirrtn. Yes. Anything inhaled into the Jung is a potential 
irritant; and I think that I would say that there is nothing unique 
that I can see in tobacco smoke that may not very well be possessed by 
hundreds of things that get into our lungs. 

Tt is visible and you can smell it, and that is a good kind of an enemy 
to chase because it gives you an immense sense of satisfaction. ‘Here 
isa guy I can knock out.” 

Mr. Kixcors. To some extent you can control it. That gives it an- 
other factor—in contrast to carbon monoxide from automobiles. 

Dr. Lirrix. I would be much more scared of the carbon monoxide 
from automobiles or from the colorless fumes that you are getting from 
diesel exhaust. lLet’s say I would be just as suspicious of them, 
and perhaps more so, because they aren’t so obvious or so easy to detect 
and to blame. 

Mr. Kitcorr. There was one other portion of your testimony with 
relation to this particular area that I thought was interesting, and 
perhaps related to the same thing. In discussing the failure of test 
animals to develop the type of lung cancer that man develops when ex- 
posed to the inhalation of smoke in smoking, I think you made a state- 
ment to the effect that any ill treatment of an animal is calculated per- 
haps to reduce the life span. 

I wondered if the use of that term “ill treatment” would indicate to 
you that the laboratory testing of animals by requiring them to in- 
hale smoke would necessarily be ill treatment ? 

Dr. Lirriz. It wouldn’t necessarily, but the ones that I have seen 
are—I think we have all done experimentally something we wouldn’t 
like to experience that had not very much resemblance to what we do 
when we smoke. 

These poor beasts are usually put in practically an airtight con- 
tainer, and smoke is pumped in and pumped in in such quantities that 
a white rat becomes yellow or yellowish brown, and their food is all 
covered with material and they have to inhale this perfectly ghastly 
stuff which—not because it is tobacco but because it is smoke—would 
choke almost anything. 

They give them this terrific beating and still the animal is not 
obliging enough to develop the type of lung cancer that they rather 
hoped that it would, because everybody hopes for positive results. 
Negative results are almost immediately buried. 

Mr. Kireorr. This is a ridiculous thing for a layman to conclude, I 
guess, but the prior differentiation you made between the biological 


structure of mice compared to man might be the factor which would 
cause the mouse to react differently to something induced into 

Dr. Lirriz. Yes; it might be. It isn’t only between mice and men. 
It is very, very difficult to induce any kind of a skin cancer on a guinea 
pig. I don’t mean by this that guinea pigs are any more like man, 
but in that respect they are. There are these literally hundreds of 
materials that you can paint on the skin of mice and you can get skin 
cancer in some mice. 

There, again, I could go back to the Jackson Laboratory and ask 
them to pick strain X and give it to an experimenter, and he would get 
perhaps only half of 1 percent, or 1 percent, skin cancer. I can say, 
“All right, give the boy a break and give him strain Y,” and he will get 
as high as 90 to 100 percent skin cancer with the same material and 
the same dosage. 

Mr. Kineore. Doctor, in commenting on the increase in the life 
span of man during the same period in which there has been a marked 
increase that there has been in smoking, would it be fair aiso to say— 
using the information presented earlier with respect to this controlled 
group of smokers and nonsmokers—that the increase in the hfe span 
of nonsmokers during this same period of time has been greater than 
has been the increased life span of smokers ? 

Dr. Lirritz. I am not sure about those data. I am honestly not. I 
could look them up. I don’t know whether any comparison has been 
made where the other factors of the environment have been equalized. 

You see, if one takes just the age and the smoking habit alone, he 
forgets a lot of other things. I shouldn’t be at all surprised if the 
type of person who was an excessive smoker is a bad health risk, not 
alone for smoking but for automboile accidents and violent death of 
different types. 

In other words, a person who reacts to life by excessive habits is 
apt to be a person off the normal and is not apt to be a good risk as far 
as well-adjusted participation in life is concerned. 

But when one gets to the cause-and-effect basis, then I think it is a 
great mistake to let these relationships have any lasting influence at 
all, because the cause-and-effect relationship is a tough thing to prove 
and has not been proven. 

Mr. Kincore. Just one last question. Somewhat in summary of 
your position, it would be accurate to say, then, would it not, that you 
do not challenge the existence of a higher incidence of death among 
smokers in comparison to nonsmokers insofar as many causes of 
death are concerned, but you do not see sufficient evidence to establish 
to your thinking the causative relationship to death and smoking? 

Dr. Lirrur. I have no reason to challenge the death rate figures in 
the statistics. I would say that I see no reason whatever to single out 
a single factor and look upon that as the key to this situation. I see 
no evidence yet that convinces me that, per se, smoking is a causative 
factor in this situation. 

Mr. Puarincer. Is the reverse true, Doctor? 

Dr. Lirrin. No; I don’t think it is. There are some figures in lung 
cancer incidence that are very, very interesting. As far as that 1s 
concerned, practically the age situation alone affects 1t importantly. 

There was actually a bigger percentage increase—percentage in- 
crease—in increasing age groups among the nonsmokers than there 
was in the smokers. In other words, if you take the death rate or 


death quantity at this age limit and take that as a unit and compare 
it with the next one, and then take this as a unit and compare it with 
the next one, you actually find a decreasing rate of death in the smok- 
ers from what you do in the nonsmokers. 

What this means I am not prepared to say, but I will go this far, 
that we do need to know an awful lot more than we do about this 
whole problem, in my opinion, before we become fixed or dogmatic 
about it. 

T am very much humbled by the power of cancer, by how much it 
feels at home in our body, and the fact that it can outlive us and out- 
last us. I think we have got hold of an enemy that is well worth 
a great deal of caution on our part before we attempt to say we know 
about it. 

Mr. Briatnix. Doctor, to wind up the hearings, we appreciate your 
sincere testimony here. I am still not clear now, but am I correct 
in saying that, as far as you know, smoking does not induce cancer 
of the lung or any other cancer ? 

Dr. Lirrir. As far as I know, in human beings the cause-and-effect 
relationship between smoking and lung cancer has not been estab- 
lished beyond question. This does not mean that I do not think it is 
an open question, because I think it is. 

I think it is one of the things that we ought to know more about. 
But if you were to ask me, am I satisfied with the evidence and am I 
ready to accept it as cause-and-effect relationship and begin to build 
for the future on that, I would say “No.” 

Mr. Buatrnik. But as far as you know now, it cannot be proven that 
smoking causes cancer. Is that correct? 

Dr. Lirrir. I think that is right. I also urge, please, if I may, 
that the study be continued, because I don’t say that it can’t. 

Mr. Buatnrx. I understand that, and I agree with you. Then, Doc- 
tor, are there any other harmful effects that you can ascribe to smok- 
ing or heavy smoking? 

Dr. Lirris. I can’t ascribe these. I have seen the correlations in 
Dr. Hammond’s paper. I would say that the lst of diseases, which 
is pretty impressive—which I read earlier—could, if the relationship 
continues and the figures get significant, some day be accused in the 
same way that it is now being accused for lung cancer. 

IT very much doubt personally whether it would show the cause and 
effect. any more than I think the present figures do. An association, 
yes; but an association is quite different from a proven cause-and- 
effect relationship. <A. lot of things may happen that don’t come from 
the same cause. 

Mr. BiatTnix. So a general conclusion would be that, as far as you 
know, findings available to date indicate there are no other harmful 
effects that can be ascribed to smoking, either ? 

Dr. Lirrix. I couldn’t go so far asto say that. I think that I might 
say that abuse of almost any human habit could lead to harmful ef- 
fects. I would include asceticism as one of the harmful human habits 
because I think that often kills more people than 

Mr. Brarnix. Would you have any idea, then, Doctor, why the 
industry which has created your most worthy research committee must 
have facts that impelled them to go to quite some special effort and 
additional expense to themselves and to consumers to produce filters 
in such a rapid increase in the past 4 years? 


Dr. Lrrrir. I wouldn’t know about the filters, but the attack on 
tobacco was so well organized, so well propagandized, and so profes- 
sional, that when it came first I think it stunned the industry wide 
awake. I think it suddenly realized, ‘The accusations that are being 
made now, we don’t intend to ignore any more. We are going to 
stay with this problem until we find out, if we can, what the facts are, 
because if they are true they have got to be corrected, if possible; and 
if they are not true, we have got to find out. We can’t go along any 
more subject to violent attacks by people without taking steps to 
do the best we can to find out whether these attacks are well founded 
or not.” 

Then at that stage of the game, when they came to me, I said, “Atl 
right, if you want me to do this, I would love to try this. There are 
probably better people. But this you remember, the important thing 
you said was we are going to try to find out the effects, whether they 
are good or bad,” and that is going to be true. 

The industry is prepared for that, because it is no longer going to 
be willing to go on with uncertainty and accusations or even comments 
without knowing if it can what the basis for those really is. 

IT think maybe the power of the attack on smoking may have been 
such that a very normal reaction might have been, “Well, is there any- 
thing that can be done or should be done while we are trying to find 
out what the fact is?” 

I have no opinion about, as I say, the filter at all. I don’t know why 
it was done, and I frankly—if you don’t think I am in contempt—care 
very little. I care less, really. 

Mr. Buarnix. I am curious now. You are conducting research. 
Have you asked your own people, your tobacco industry, why did 
they promote filter tips at such great expense / 

Dr. Lirtir. No. 

Mr. Buatrnix. You haven’t ? 

Dr. Lirruz. No. 

Mr. Brarnix. Are you interested in knowing why they doit? They 
are spending considerably more money for filter tips than they are for 
your research work. 

Dr. Lirrin. Personally I am not awfully interested in why they are 
doing it. I wish they would spend more money for the research work 
than they do for filter tips. Maybe someday they will. 

Mr. Buarntx. Do they have any other research facilities perhaps un- 
known to you in their own laboratories or any other financing of other 
foundations or any other sources ? 

Dr. Lirrir. I think it is generally known that some of the companies 
at least have had research laboratories working for years. The scien- 
tific advisory board visited at least two of these laboratories, but they 
have done absolutely nothing to suggest research to them; nor have 
they commented on or advised as to the types of research being done. 

It has simply gone in there to observe, and it would seem to me, 
frankly, that the question, about filters, Mr. Chairman, that that should 
be of much more interest to the industrial laboratory than it is to my 
committee or to me. 

It isn’t that we are pure. It is just that we have got hold of a lion 
and we can’t let him go. 

Mr. Bratnix. May I ask, do these tobacco companies then consult 
you on the effectiveness of filter tips? 


Dr. Lirrir. They don’t consult us at all. 

Mr. Buiarnix. They have not consulted you, not made any recom- 
mendation ? 

Dr. Lirrie. Not in the least. I think they are very wise because all 
I would say is I don’t know. : 

Mr. Buatnrg. You don’t know? 

This book was sent to the committee, I believe, either from your 
othee—Science Looks at Smoking. Are you familiar with this book ? 

Dr. Lirrie. It wasn’t sent you by the scientific advisory board. 
Whether it was sent from anybody connected with the industry or 
ge ae know. But it was not sent to you by the scientific advisory 


Mr. Biarnix. Somebody connected with the industry, then, sent 
this to the committee. This book was sent to the subcommittee by 
2 public-relations firm known as Hill & Knowlton, which I am in- 
formed represents the Tobacco Industry Researeh Committee, which 
is your committee. Is that correct ? 

Dr. Lirrir. Yes; it represents the public-relations phase of that. 

Mr. Buarnix. Would that include your research committee, or is 
this information 

Dr. Lirrir. It would definitely include the scientific committee as 
a subsidiary, you see. But that Hill & Knowlton has any effect on 
the scientific program would be absolutely negative. They not only 
don’t have any effect on it but they are not consulted about it and I 
don’t think they would have any advice to give about it. If they 
did, it frankly would not be of interest to my associates or to me. 
They are not scientists. 

Mr. Buarnix. Are they to release information prepared or com- 
piled by your research committee or by the tobacco industry ? 

Dr. Lrrriz. I don’t know what they are doing about the book. I 
don’t know what they are releasing about the book or what they 
aren’t. This book is not sponsored by the committee of which I am 
the chairman. We have no part in the preparation of this book beyond 
the fact that I was shown Dr. Greene’s introduction to it, which is 
a purely scientific evaluation, and Greene is doing research himself 
and I was interested in it as to his ideas about research. 

Mr. Harpy. Are you familiar with the book, Dr. Little? 

Dr. Lrrrir. With this book? I haven’t read it through. I am 
familiar with the fact that it exists; yes. 

Mr. BuatrntK. The reason I ask, Doctor, here is a book and I wanted 
to check this, I am informed and I may be in error, [ don’t want to 
present this as the final—this book was prepared by Hill & Knowl- 
ton, a public-relations firm which represents the tobacco industry, 1n- 
cluding your Tobacco Industry Research Committee. 

They have released a book called Science Looks at Smoking. Is 
this a scientific agency ? 

Dr. Lrrrin. Hill & Knowlton ? 

Mr. Buatnix. Yes, Hill & Knowlton. 

Dr. Lirrir. I don’t believe anybody would call it a scientific agency. 
T think it is a firm of public relations advisers and counsel. But per- 
fectly frankly 

Mr. Harpy. Let me ask a direct question. Is that propaganda or is 
it scientific ? 


Dr. Lirrir. As far as I know it is a fair statement of this man’s 
belief—what is his name—Northrup ? 

T believe that these are his honest 

Mr. Harpy. I haven’t seen it. I don’t known anything about it. 

Dr. Lirrir. There have been a number of pro and con statements 
as you know, that have come out on this problem and there will prob- 
ably continue to be. I don’t know that this could be called a pro, or 
whether it is just in the nature of an attempt at a review. 

Mr. Buarnitx. The reason I ask, here is a book distributed by Hill 
& Knowlton which is a public-relations firm for the tobacco in- 
dustry and your committee and they are releasing a book “Science 
Looks at Smoking,” and on page 183 referring to filter tips, of which 
you have no opinion, they state: 

On the other hand, there is no scientific evidence that filter tips provide a 
special safeguard in smoking. They merely reduce the smoking particle intake 
but not particularly selectively. 

This is not either the findings of your committee or the tobacco 
industry ? 

Dridaree.: Neo: 

Mr. Buatnik. But it is a book which was released by the public- 
relations firm of Hill & Knowlton 

Dr. Lirrix. Which represents the industry, yes. 

Mr. Mrnstratu. Doctor, it is difficult for me to believe you don’t 
know anything about the effectiveness of filter tips on cigarettes. 

Dr. Lirrier. I don’t. 

Mr. MrnsHatu. A man In your high position visiting these various 
scientific laboratories operated by the tobacco companies, haven’t they 
ever shown you any of the results of the abilities of these filters to re- 
move tars or nicotine ¢ 

Dr. Lirrin. No, they really haven't. 

Mr. MinsHatu. Have you ever inquired about it? 

Dr. Lirrir. No, I haven’t been in the least interested. 

Mr. Minsuaty. Why aren’t you interested ¢ 

Dr. Lirriz. Because I don’t believe they are the answer to the 
problem. The first thing to do is to find out what substance in 
tobacco, if any, causes the trouble. The question of removing them 
or possible manipulation of them comes after their identification, and 
they haven’t been identified. 

Mr. Mrnsuaurt. You have never seen any records or any data of 
any kind about the ability of certain kinds of filters to remove tars 
and nicotines from cigarettes ? 

Dr. Lirris. Only what I have read in the press. 

Mr. Minsuatyu. You have never seen any publications or any data 
supplied by the tobacco people ? 

Dr. Lirrin. I haven’t read a single paper on it. Very honestly, I 
am not interested. I have got too many other things of real interest 
in connection with the origin and nature of cancer, and any possible 
relationship that there may be, to get into the technical problems. I 
am not interested. 

Mr. Minsuaty. I thought you said your job was just to raise mice 
up there in Maine to distribute to these people, and all the scientific 
data was done by these grants and these fellowships. 

96946—57 5) 


Dr. Lrrrix. I happen to be chairman of the advisory committee to 
the industry. I am the ex-director of the laboratory. I have these 
associates who are listed in this material that has been given you. My 
job is to do everything I can to spend the tobacco industry money for 
good, sound, constructive research leading to the truth. | 

IT retired as director of the Jackson Laboratory last year, because I 
reached an age limit when I felt that was wise in the whole picture. 
But I am vitally interested in the laboratory because I helped found 
it and it is the place I wanted to work in. 

Mr. Minsiwaty. Your job right now then is—all you do is hand out 
the money to these various organizations ¢ 

Dr. Lirriz. That is all the job that I have in connection with the 
tobacco industry, yes, is to hand out the money, confer with the 
scientific associates that I have as to possible new leads that we should 
be investigating. 

Mr. Minsuarz. Don’t some of these people that you grant money to 
check the effectiveness of filters as part of their study ? 

Dr. Lirriz. Are any of them working on filters, Bob ? 

Dr. Hocxrrr. Not to my knowledge. They are trying to find out 
whether the typical cigarette of the type that has been smoked for 
the last 25 or 30 years does or does not do certain effects. ‘That ques- 
tion isn’t answered yet. 

Dr. Lirrriz. If you mean have we a program to try to justify filters 
or evaluate them; no. Fortunately we have been left absolutely clear 
of commercial impact of a single blessed thing we are studying. They 
are letting us study anything we want and you would be surprised 
if you saw some of the things that are being studied. They are about 
as far removed from tobacco and its possible effect on cancer as you 
can possibly go. When you see them, you will see the list and see 
what you think of it. 

Mr. Buarnix. Doctor, back to the filters and the cigarettes, you 
state as far as you know there is nothing in the cigarette that would 
induce cancer or be carcinogenic in nature. On page 16 of the testi- 
mony by Dr. Hammond, he refers to 3.4 benzpyrene. Is that substance 
or hydrocarbon in tobacco smoke ? 

Dr. Lirrie. That is carcinogenic on the skin of mice, if you give 
it to them in quantity. But the quantity in which it appears most 
radical in analysis by the biochemists, as I understand it, is such that a 
person would have to smoke 250,000 packages of cigarettes in a month 
or something of that kind. It is well known that benzpyrene also 
exists in the exhaust of any diesel engine or any of the common poly- 
cyclic hydrocarbon producing combustion products. 

Mr. Buatnix. Itis carcinogenic? 

Dr. Lirriz. It is for mice. 

Mr. Buatnrk It exists in extremely small quantities ? 

Dr. Lirrin. Yes. 

Mr. Buarnix. Is it cumulative ? 

Dr. Lirrin. There is no evidence of that. That isa hard question for 
me to answer because I am thinking hard now of the types of tests 
of accumulation that experimental people have made of it. I would 
say, not to a sufficient degree to expect a local effect from it. 

Mr. Brarnix. Has any research work been done on benzpyrene? 

Dr. Lrrrrx. It is being worked on quite hard at the present moment. 
The British are working on it, and there is a team over in Switzerland 


working on it. The moment a suspected thing like that comes up, 
the usual thing is to just give it everything you have got—drive it, 
find out what concentration will produce a cancer, find out what con- 
centration it exists in. : 

Mr. Buarnrx. You mentioned British and Swiss teams working on 
it. Isanyone in America working on it? 

~ Dr. Lirrin. They are working on it independently of tobacco. It 
is.a very common chemical used in most of the cancer laboratories to 
induce cancer in animals. | 

Mr. Brarnix. But it is the only substance that has been identified 
to be present, although in minute quantities, in tobacco smoke that 
is carcinogenic % 

_ Dr. Lrrrtz. I think that there have been claims by some that another 
polycyclic hydrocarbon related to benzpyrene , 
_ Mr. Buarntix. So there may be more than one? 
Dr. Lirriz. There may be. 
Mr. Buarnik. But this definitely is carcinogenic ? 
Dr. Lrrriz. If you get enough of it at the right place; yes, sir. 

Mr. Buarnrk. And you have run no tests on whether it is cumu- 

Dr. Lirrie. I don’t know of any evidence that would bear that out. 

Mr. Buatrnik. The reason I ask that question, Doctor—along about 
in the early thirties, if I recall the date correctly, when lead gasoline, 
high-test gasoline, was first coming out on the market, the amounts 
of lead were so minute that it was impossible, it was felt, to get lead 
poisoning. Yet there developed severe cases of lead poisoning in the 
industry, and the medical people felt it was incredible. They could 
not get this poisoning in the work they were doing with this lead gas, 
until they discovered 1t was cumulative. 

Over a period of years, like in smoking 10 or 20 years, here was this 
accumulation of lead poisoning, which was serious and in some cases 
fatal. Could that be possible with this carcinogenic? 

Dr. Lirrtr. I am not a good enough chemist to answer your ques- 
tion, but just from the point of view of trying to reason toward it, I 
wonder why, if this was retained by an organ like the lung, that any 
evidence which might be attributed to it occurs in such a minute loca- 
tion? It would seem to me more that the importance of the reaction 
was in the nature of the soil affected than it was the agent affecting it, 
because we know that cancer can be triggered by hundreds of different 

eee question is, why isn’t it triggered all the time by almost every- 
thing 4 

Mr. Mrnsyaiyi. Mr. Chairman, at this point I would like to put in 
the record an article that appeared in the Journal du Dimanche of 
Paris on Sunday, June 30, 1957, that relates to this benzpyrene re- 
search that the French scientists have been doing. 

Mr. Buarnix. Are you asking to put this in the record ? 

Mr. MinsuHatu. Yes. 

Mr. Buiarnrx. These are French scientists ? 

Mr. Minsuatt. Yes, sir. 

Mr. Buatnix. I thought we were talking about England and 
Switzerland where they have teams. Alsoin France? Is that correct ? 

Mr. Minsuatu. Yes. 


Dr. Lirriz. I think this is a different benzpyrene from the one you 
spoke of; I am sorry. 

Mr. Buarnix. This refers to 3,4-benzpyrene. Without objection, the 
article will be inserted in the record at this point. 

(The article is as follows :) 

[Translation of an article published in ees du Dimanche, Paris, Sunday, June 



French tobacco and cigarette paper made in France are the first in the world 
to be treated with a view to reducing considerably the risks of 2 types of 
smokers’ cancers—that of the lung and that of the larynx—2 ills which are 
becoming increasingly current, according to statistics published in various 

Two laboratories are from now onward bound to cooperate closely: that of 
the famous cancer specialist Dr. Raymond Latarjet of the Radium Institute, and 
that of the chemist Jean-Louis Cusin, attached to the Tobacco Government Ad- 
ministration. They are in fact working on two chemical processes, one applied 
to tobacco and the other to cigarette paper, intended to protect the health of 
heavy smokers. 

The various substances used in those processes, on an industrial scale, have 
already been selected. In order to prevent the formation of dangerous paper 
tars, ammonium sulfamate will be used and for tobacco certain nitrogenous 


Two robot smokers have been used for the experiments. The first has been 
put up at Quai Branly by Cusin and the other by Latarjet, Rue Pierre-Curie. 
The robot consists of a glass appliance, where combustion speed of the tobacco, 
the cigarette paper or the whole cigarette is controlled at the same time by the 
aspiration of a water pump and by the cramming into a tube of the sample to be 
burned and of a piece of glass wool. 

While the machine smokes, the tarry substances contained in the tobacco or in 
the paper adhere to the glass wool, rendering it increasingly compact. At the 
end of combustion these residual substances are dissolved by the washing of the 
whole appliance. The solution is then examined by the chemists. 

What have the tests carried out at the institute just revealed? 

Both in the paper tars and the tars of complete cigarettes, Messrs. Latarjet, 
Cusin, Hubert-Habart, Muel, and Royer have discovered a substance which they 
identify as the 3,4-benzpyrene. Now this hydrocarbon is, according to recent 
works, principally responsible for the cancerization of bronchial and laryngeal 

The French team have, on the other hand, definitely established that cigarette 
paper was far more cancerigenous than tobacco. 

The treatment of that paper with ammonium sulfamate by the French scien- 
tists prevents to a considerable extent the formation of dangerous substances. 


If we take the cigarette alone, the quantity of benzpyrene formed by the com- 
bustion of 100 cigarettes is only of the order of 1.2 thousandths of a milligram. 

Yet, here also, it is possible to lessen much the formation of tobacco tar. The 
Latarjet team have even discovered that the addition of certain nitrogenous com- 
pounds to the tobacco may lead to a lowering of the benzpyrene proportion, as im- 
portant as that of the paper treated with ammonium sulfamate. 

This is how the French scientific work will result in rendering noncanceri- 
genous the 450 milliards of cigarettes smoked annually in the world. 

Dr. Lirris. That is the 3,4. I don’t know about the quantity of it. 
It is an interesting suggestion. But I am not enough of a chemist 
‘to pass judgment on it. 


Mr. Puarrncer. I want to read a quotation attributed to you. I 
would like your comment on it. You are quoted as saying that— 

Any possible role of smoking in the etiology of lung cancer remains an unre- 
solved question. It cannot be said that smoking has been absolved from sus- 
picion. Neither have the charges been proven. 

Does that accurately reflect your position, sir? 

Dr. Lirriz. Yes. 

Mr. Puarincer. I would like also to cite to you a passage from the 
book, Cancer, a Study for Laymen, in which you are said to have writ- 
ten a chapter which states that— 

Although no definite evidence exists concerning the relation between the use 
of tobacco in the instance of lung cancer, it would seem unwise to fill the lungs 
repeatedly with the suspension of fine particles of tobacco products of which 
smoke consists. It is difficult to see how such particles can be prevented from 
becoming lodged in the walls of the lungs and when so located, how they can 
avoid producing a certain amount of irritation. One might also question the 
ultimate results of continued inhalation of the type of atmosphere which char- 
acterizes the lower levels of city streets. Experimental work with animals involv- 
ing these matters is still inconclusive, but it seems probable that the lung as an 
organ is not immune to the effect of chronic irritation and that it will in this 
respect resemble the other organs of the body. Such being the case, wisdom in 
avoiding unnecessary lung irritation seems to be established. 

Is that statement made in this 1944 book still applicable? 

Dr. Lirriz. To a large degree, yes. If you would be willing to con- 
sider it modified to the extent that any prolonged irritation 

Mr. Piarinerr. Not only of tobacco. 

Dr. Lirris. Not only of tobacco, but of any—that that would be a 
fairer statement, and that the reaction of different people’s lungs to 
different levels should throw out any sweeping generalization. The 
trouble with writing anything like that, as I did, or anybody does in 
a book, you have to put it down to a statement and trust to a chance 
to qualify it afterward, as I am now doing it with you, talking it 

Mr. Piarincer. Thank you, sir. 

Mr. Buatnrx. Doctor, we thank you very much for your patience. 

Dr. Lirriz. Thank you very much for your courtesy and your 

(Whereupon, at 1:30 p. m. the committee adjourned, to reconvene 
at 10a. m., Friday, July 19, 1957.) 

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(Filter-Tip Cigarettes) 

FRIDAY, JULY 19, 1957 

Washington, D. C. 

The subcommittee met, pursuant to recess, at 10:05 a. m. in room 
100, George Washington Inn, Hon. John ’A. Blatnik (chairman) 

Present: Representatives Blatnik, Kilgore, Hardy, Meader, and — 

Also present: Jerome 8S. Plapinger, counsel; Curtis E. Johnson, staff 
director; and Elizabeth D. Heater, clerk. 

Mr. Buatyix. The Subcommittee on Legal and Monetary Affairs 
of the Committee on Government Operations will continue in public 
hearings in further consideration of the question of possible fraudulent 
and misleading advertising in the matter of several products being 
advertised, the first of the series being the question of cigarettes— 
particularly filter cigarettes. 

On our second day of hearings we have with us and will hear first 
this morning Dr. Ernest L. Wynder, of the Sloan-Kettering Institute 
for Cancer Research. 

Dr. Wynder, would you please take the chair. 

Doctor, I see you have a lengthy prepared statement. Would you 
at the outset. identify yourself by name, title, and a brief summary of 
your professional background, particularly how long you were 1n your 
current work ? 


Dr. Wynper. My name is Ernest L. Wynder. I received my 
medical degree from Washington University School of Medicine in St. 
Louis in 1950. 

In 1947 I began to become interested in the problem of the etiology 
of lung cancer, together with Dr. Evarts A. Graham, at that time pro- 
fessor of sur gery at Washington University. 

I have been engaged in clinical and experimental cancer research 
since that time. T interned at Georgetown University Hospital here 
in Washington and had 3 years of residency at the Memorial Center 
for Cancer and Allied Diseases, and have been with Memorial Hospital 
since 1951. 



I am currently heading the section of epidemiology at Memorial 
Center and in this section we are interested in the cause or causes of 
all types of cancer and have during the past few years published re- 
ports not only on the etiology of lung cancer but also on the etiologic 
factors of other cancers of the respiratory tract as well as cancer of the 
cervix and are currently completing studies on cancer of the breast 
and stomach. 

The section also includes a laboratory section where we are in- 
vestigating the possible carcinogenic activity of tobacco tar and of 
other agents. 

I would like to present to you a summary of evidence which we 
believe demonstrates a causal relationship between smoking and cancer 
of the respiratory tract, and make a number of recommendations 
which we think can successfully overcome this problem, at least in 

a‘ As you know and heard in testimony yesterday, the primary reason 
why this problem has become so acute is because of the rather high 
prevalence of lung cancer today. More than 25,000 lives are lost 
in this country each year due to lung cancer alone. 

When we first began studying this problem, we were impressed that 
this was a real increase for two reasons: One, we felt that improved 
diagnosis, which so often has been mentioned as accounting for this 
increase, could not account for the difference in sex ratio because 
certainly improved diagnosis apphes to women as much as it does to 
men. In fact, it has been our experience in cancer detection work 
that women are more likely to come to a doctor than men. 

Secondly, frequently I hear somebody say “Well, there is more of 
cancer today because of an aging population.” First of all, the 
studies by the National Cancer Institute and others have shown that 
you can age-standardize your population group and you still have a 
marked increase in lung cancer, and secondly, lung cancer occurs in 
a younger age group than most other major cancers, in whom a simi- 
lar increase has not been noted. 

What is then the evidence that we believe demonstrates conclusively 
that smoking is a cause of lung cancer? ‘The first of these is what we 
will refer to as presumptive evidence. It is perhaps like in a trial 
where you say “Could this particular criminal have been at the scene 
of the crime?” 

In scientific research, or for that matter in any other research prob- 
lem, an investigator first considers the most likely answer to the given 
problem. What is the presumptive evidence with respect to lung 
cancer? Itisas follows: 

_ One, the increase in lung cancer has been more marked in men than 
in women. This is in line with the fact that males currently in the 
cancer age smoke more heavily than women in the same age group. 


I will demonstrate facts on this later. This fact would be difficult 
to explain on the basis of air pollution since the women in any given 
city area are as much exposed to polluted air as are men. 

Two, in countries in which there has been a sharp increase in the 
incidence of lung cancer there has also been a sharp increase in the 
consumption of cigarettes. By itself, of course—and we expressed 
this repeatedly—this factor means very little, because similarly there 
undoubtedly has been an increase in the sale of refrigerators and auto- 
mobiles, and as Dr. Graham often jokingly stated, in nylon stockings. 
However, in the absence of an increase in the consumption of ciga- 
rettes, it would have been difficult to incriminate this smoking product. 

Three, in countries such as Norway and particularly Iceland where 
the consumption of cigarettes is low and yet excellent medical facilities 
and reporting are available, the incidence of lung cancer is quite low. 
At the time when in the United States lung cancer accounts for the 
most common cause of cancer deaths in men, it ranks only ninth in 
frequency in Iceland. 

Four, contrary to most other cancers, the age distribution of lung 
cancer reaches a peak in the sixth and seventh decades and then de- 
clines. This is in line with recent data by the United States Census 
Bureau that there are more heavy cigarette smokers in the younger age 
groups than in men now past 65. 

Five, it has been a clinical experience among physicians astute in 
the taking of medical histories that patients with lung cancer are 
mostly excessive smokers. It has also been a repeated clinical observa- 
tion which is known not only to doctors but I am sure also to laymen, 
that a chronic cough, particularly in the morning, is much more 
commonly seen among heavy smokers than among nonsmokers, Cer- 
tainly the existence of a cough indicates an irritation to the bronchial 

Sixth, one of the established principles in carcinogenesis shows that 
pyrolysis of nearly all organic matter can create higher aromatic 
polycyclics which are of known carcinogenic activity. To the cancer 
worker therefore, it was not a surprise that tobacco, certainly an or- 
ganic matter, when combusted at such high temperatures that are 
obtained during smoking, reaching a temperature level of 880° C, 
can form such higher aromatic polycyclics. 

Ernest Kennaway, who is one of the leading cancer researchers in 
Great Britain, stated he was surprised that in view of the high 
temperatures reached in the combustion of tobacco, that tobacco 
wasn’t even more carcinogenic than evidence indicates. 

These points are our presumptive evidence. ‘They are presented 
to show that the other evidence which we want to present now is 
consistent with this presumptive evidence, thus strengthening both. 

Now there are two slides I would like to show you which add to 
this presumptive evidence. The first one is work reported by Dr. 
Drockrey from Germany. 


In the section No. 2 you see opaqual free benzol on which you 
shine ultraviolet light and see practically nothing there. (1) Section 
No. 1 cigarette smoke blown into optical free benzol without in- 
halation by the smoker and you will note there is a very marked 
fluorescence. In No. 3, the smoker inhaled and then exhaled into the 
optical free benzol and you will see that the fluorescence is much 
less than in No. 1, which indicates that of the fluorescent particles in 
the cigarette smoke over 90 percent are retained and therefore absorbed 
by the lung tissue. 

The next slide shows a very interesting study conducted by Dr. 
Mellors of our Institute with whom we are collaborating. (2) This 
comes from a patient who has developed leukoplakia which we think 
is also related frequently to excessive smoking. On the left are cells 
from his buccal mucosa, which makes up the lining of his mouth, 
when he had not been smoking. To the right the marked fluorescent 
cell is a buccal mucosa cell taken a few hours after he had smoked 
a cigarette. What does it demonstrate? It demonstrates that a 


fluorescence component of the smoke of a cigarette can invade the 
cell. So we do know, we have now ample evidence both from the 
work of Druckrey and Mezlors that cigarette smoke can enter the 
human epithelial cell. In other words, we can demonstrate that the 
suspected agent has been found at the scene of the crime. 

So much for what we call presumptive evidence. What about the 
other evidence? Let’s first see epidemiological evidence which in part 
was summarized for you yesterday by Dr. Hammond. The first slide 
on this evidence shows work that Dr. Graham and I presented some 

SO; SHE Lung cancer - 870 cases (males) 
General hospital population - 780 cases (males) 

Percentage of Cases 


eee 6: , tOrid.... 15-20. 7.21434 

than | 

Amount of Smoking Over 20 Year Period 
xeigarettes per day or equivalent in pipes or cigars) 

years ago. This is a retrospective study based on 870 lung-cancer 
patients, all of whom had histologically proved diagnosis. You will 
see when you compare these to matched controls there are much fewer 
nonsmokers in the lung-cancer group and many more heavy cigarette 
smokers in the lung-cancer group. 

To me the most impressive thing about this has been the rarety with 
which lung cancer occurs in nonsmokers. Yesterday you had testi- 
mony that lung cancer can occur in nonsmokers and we have never 
denied it. In fact, we have written a report on cancer of the lung in 
nonsmokers, summarizing our experience in over a thousand cases in 
which we could find only 20 who had never smoked. 

Similarly, Doll and Hill were so impressed with the rarity of non- 
smoking lung-cancer patients that they wrote a special report on this 
subject. It is that infrequent. In half of these patients we found 
occupational exposures which could account for their lung cancer. 

These studies now have been repeated in 7 different countries, 1 of 
them, and the most recent one was financed by the French tobacco 
monopoly. This study by Dendix and Swartz, and our studies have 
shown in this country a marked relationship between smoking and 
lung cancer. 




Relative Risks 

Cigarettes ——_—+ Cigars 

Smoking None 
no. per day 1-15 16-34 35+ 

The next slide shows what has impressed us most. As I am sure 
Dr. Hammond pointed out to you yesterday, there is an interrelation- 
ship between the amount of tobacco smoked and the risk of developing 
lung cancer. This can only be the result of a direct cause and effect 

One of these studies that Cornfield from the National Cancer Insti- 
tute and I published some years ago was based upon physicians. We 
had done this study because frequently a patient would say “Well, we 
can’t really believe it because look at all the doctors who smoke.” We 
did retrospective studies on doctors and found out that the doctor who 
smokes has the very same chance of developing lung cancer as the 
average layman. ‘To me, all this indicated that on these matters a 
doctor can be just as stupid as the average laymen. 

In other words, the point to be recognized from these retrospective 
studies is that without exception, in all studies that have had at least 
100 lung-cancer cases, the same relationship was seen that you see on 
this particular graph. In 1950 Dr. Hammond, who you heard yes- 
terday, came to see us in St. Louis, as I am sure he told you. He 
thought there was nothing to it because he thought that the retrospec- 
tive studies had certain faults and he therefore started the prospective 
studies which he reported to you yesterday. 

I say it because if there was anybody biased toward the other end, 
it was Dr. Hammond of the American Cancer Society. 

The next slide shows the study which he reported to you in detail 
yesterday, and the only reason I want to show it again is to demon- 
strate to you what has impressed me most—that is the enormity of the 


(Excluding Adenocarcinoma) 



Cigarette Smokers 

— a0 

wee OLS 
45 (or ba ef 
ort <i £-1 [2 2+ 
2 2 
Poiana Bon ee on Pack Pack Packs’ Packs 

In other words, the death rate of the nonsmoker from lung cancer is 
only 4.5, and that of the 2-pack-a-day-smoker is 278. Dr. Berkson was 
one of those who has criticized the Hammond and Horn study as pub- 
~ lished in 1954. Most of these criticisms have been taken care of by Dr. 
Hammond’s second report.. 

But what impressed me most was when you take all of Dr. Berk- 
son’s criticism and say ‘“‘All right, maybe they are all correct,” they 
could only account for 50 to 100 percent difference. Yet Dr. Ham- 
mond.shows a difference between 4.5 and 278, which is nearly a 7,000 
percent difference. To declare that this is on a statistical error or bias, 
you have to demonstrate an error of equal enormity. 

The next slide which Dr. Hammond also showed to you is marked 
‘»arallelism” for risk of lung cancer between city folk and rural folk 
if you standardize for the amount of cigarette smoking. 


(Excluding Adenocarcinoma) 

WZNever Smoked Regularly 
GRE Cigarette 




LA | V// ie O § 
City o City of Suburb Rael 

50,000 + 10,000 -50,000 or Town 

There is a slight increase among nonsmokers who develop lung 
cancer, in cities. But this is very minimal and it is entirely in line with 
our belief that there are probably other causes of lung cancer. 

Dr. Graham and I have written a special report on occupational 
influences of lung cancer. We feel that the same preventive measures 
have been directed against them as against tobacco. 

One of the criticisms to Hammond and Horn was that their cases 
perhaps did not represent the general population, and were artificially 

At the same time when Hammond and Horn published their data, 
Doll and Hill in England—the next slide—published a study on Brit- 
ish physicians. 



= 100 
© 50 

56° *\-1ay -24 264 

That was certainly not a matter of selection because every British 
physician was supposed to answer the questionnaire and the majority 
did. You will find the same very tremendous relationship of death rate 
to the amounts. Therefore, second prospective studies by Dr. Doll 
and Dr. Hill—and Dr. Hill, as you may know, is perhaps the leading 
statistician in Europe today—shows the same relationship in the 
British physicians as shown by Hammond and Horn and shows the 
same relationship we have demonstrated in physicians in this country. 

One of the most challenging things in this entire aspect was the ques- 
tion of lung cancer in women. You heard testimony yesterday that 
the female data could not be explained by smoking because, after all, 
there are so many female smokers today. Now, it makes very little 
difference how many women in the twenties and early thirties smoke 
today. What makes the difference is how much do women smoke who 
are in the cancer age? 

The next slide shows a comparison that we did on female and male 
control cases at Memorial Hospital, and it shows in the top line that 
a majority of females over the age of 30 and particularly over the 
age of 50 are nonsmokers, in contrast to the majority of males who 
are smokers. 













30-39 40-49 50-59 60-69 

At the same time we found, whereas about 40 percent of the males 
are rather heavy smokers, only about 2 percent of women in the age 
group over 45 smoke more than a pack of cigarettes a day. 

Somebody criticized us and said these are data from hospitals and 
they do not reflect the general population. We are very fortunate be- 
cause the United States Census data just came out at the same time— 
shown in the next slide—and they show a great similarity between 

our own data and that of the general population of this country, 

namely that the majority of females over the age of 50 are nonsmokers, 
and that very few of them are very heavy smokers. 







30} : 


20 30 40 Soe eo rd ain EY BO 
So we concluded, in line with a detailed study by Shimkin and 
Haenzel from the National Cancer Institute, that the present sex ratio 
of lung cancer was entirely comparable with the long-term smoking 
habits of the two sexes. 

What about women with lung cancer. The next slide shows that 
women with epidermoid cancer of the lung are much heavier smokers 

96946—57 6 



Epidermoid (4/ Cases) 
60 Cc] Adenocarcinoma (4/ Cases ) 
Game Contro/s (3/0 Cases) 
30 Fe BB rere 
: o i | ter 
Non Smokers 1-9 10-20 20-+ 

Cigarettes / Day 

than the control patients. Of particular interest to us was that women 
with adenocarcinomas of the lung didn’t smoke any more than did the 

In 1950 Dr. Graham and I first called attention to the differences 
between the etiology of the adenocarcinoma of the lung and this was 
borne out by the study. This at the same time took care of the 
criticism of Dr. Mainland who tried to demonstrate in a study that 
no one could possibly give you accurate information on how much 
they smoked, and that this was certainly influenced by the effect of the 
patient who had lung cancer. 

Now Dr. Mainland would have to go one step further and would 
tell me that the patient with epidermoid cancer of the lung would give 
you a different answer than one who had glandular cancer of the lung, 
and this is a difference which even the doctor can find out only after 
he has studied the lung tissue under the microscope. 

So we concluded in a study which I published together with Bross, 
O’Donnell, and Cornfield that the female heavy smoker reaching the 
cancer age has chances of developing lung cancer which are roughly 
the same as that of men. That is the only reason why the sex ratio 
is as it is today is that the majority of the females in the cancer age 
are nonsmokers or minimal smokers. 


To consider smoking as the major cause of lung cancer does not mean 
that we have ever said that that is the only cause of this disease. 
Obviously there is the effect of internal predisposition which must exist 
since not everyone who smokes develops lung cancer. Obviously, too, 
there are other exogenous factors that may produce cancer of the lung. 
Among these are certain occupational exposures. There is also 
evidence that general air pollution and/or motor exhaust fumes may 
be a contributing factor. 

However, with the possible exception of a few isolated cities such 
as Liverpool, air pollution is at best only a secondary factor. This 
belief is based on the fact that among nonsmokers lung cancer occurs 
but rarely; that the incidence of lung cancer among women, who are 
also exposed to city air, is low; and that the age distribution of epider- 
moid lung cancer with its peak in the sixth to seventh decade and its 
subsequent decline is more compatible with an exogenous factor to 
which only the younger population group was exposed some 30 to 40 
years ago rather than with air pollution, which would expose an entire 
population group at the same time. 

It is also taken for granted that not every smoker develops cancer 
of the respiratory tract, and that this disease may occur in nonsmokers, 
though, however, but very rarely. 

I would like to stress this point because it was emphasized in the 
testimony here yesterday, and because this observation applies to 
nearly every other disease. Not every person exposed to the polio 
virus will develop poliomyelitis, and pneumonia may be caused by 
other bacteria than the pneumococcus. 

Yet there can be no question that the polio virus can cause polio 
and that the pneumococcus can cause pneumonia. 

Let me give a specific example from the cancer field. I am sure 
there is not one investigator in this country who would doubt that 
radiation exposure increases the risk of leukemia. Many a study has 
been done, particularly among physicians who are radiologists, and 
it has been shown that the radiologist has a significantly greater risk 
of developing leukemia than, say, the general practitioner, though the 
risk isn’t anywhere near as great as the difference between the heavy 
smoker and the nonsmoker. Yet we know that not every radiologist 
will develop leukemia, and we know that leukemia occurs in people 
who have not been radiologists. 

_ So the same argument that Dr. Little presented yesterday, throw- 
ing doubt on the lung cancer-smoking relationship, would also throw 
out the fact that radiation could cause leukemia. 

Undoubtedly there are intrinsic factors which influence the cancer 
formation in man, but as long as these are unkown, we have to con- 
centrate on those extrinsic factors which are known. There are some 
additional carcinogenic agents to which man’s lungs are exposed in 
regard to which preventive measures should also be developed, but 
there can be no doubt that smoking represents by far the major ex- 
trinsic cause of lung cancer. 

While most students of the problem of the etiology of lung cancer 
admit to an association between smoking and lung cancer, some ques- 
tion whether this association also represents causation. Until proved 
otherwise, an association at least means a contribution toward, if not 
a causation of, a disease. 


For the patient it matters little whether a factor has contributed 
to or caused the disease. In either case the elimination of this factor 
will lead to a reduction of the disease. 

In respect to smoking, we have regarded smoking as an important 
factor in lung cancer and have stated that 80 percent of all lung cancer 
cases occurring in this country today could be prevented if it were not 
for smoking. This figure is in complete line with a similar figure 
presented by Dr. Doll in England, and to those who have stated 
again in testimony yesterday that lung cancer after all occurs so very 
rarely in nonsmokers, let me cite you the figures calculated by Cutler 
and Loveland of the National Cancer Institute that about 5.3 percent 
of males over the age of 25 who smoke in excess of 20 cigarettes a day 
will develop lung cancer by the age of 70. And in this line also im- 
pressive are the data of Dr. Hammond which show that among the 
two-pack-a-day smokers, lung cancer was the second most common 
cause of death. 

What about some of the other types of cancer? The next slide 
shows you the same correlation that we have found with lung cancer 
to exist with cancer of the larynx, with one major exception. You 
will notice that the risk becomes now slightly greater for the cigar 
and for the pipe smoker. 



Smoking ‘None | +————-Cigarettes Cigars 
no.perday I-15 16-34 35+ Pipes 
The next slide demonstrates this more clearly. It shows that the 

risk among cigarette smokers is about the same, but for cigar smokers, 
the risk of developing cancer of the larynx is greater. 



2.0 ae 
2 lLOF o-oo 

gy is rig 

Smoking None +——Cigarettes————4 Cigars 
no. per day I-15 16-34 35+ Pipes 

In the larynx cancer group, we found additional etiologic factors 
about which I don’t want to go into detail today because this would 
discourage you further. We demonstrated that excessive whisky con- 
sumption adds to the risk of larynx cancer. This is quite discouraging, 
I am sure, but this is only for people who consume seven shots of 
whisky or more a day. | 

The next slide shows the same thing for oral cavity, showing much 
fewer nonsmokers among patients with cancer of the oral cavity. This 
was a report published by Dr. Bross and myself on 543 patients with 
cancer of the oral cavity, again with more heavy smokers in the oral 
cavity group. 



W h oO 
oO Oo Oo 


NONE 1[-9 10-20-21 -34 356 

The next slide shows again the greater risk among cigar and pipe 
smokers to develop cancer of the oral cavity than among cigarette 




NONE | le (ease ae e Olen 

smokers. The next slide summarizes this, showing that the risk for 
cigarette smokers to develop cancer is greatest for the lung, then the 
larynx, then oral cavity. With cigar and pipe smoking it would be 
completely reversed. 





This, we believe, is due to the fact—just a physical phenomenon— 
that the cigarette smoker inhales and gets the stuff in hislungs. Cigar 
and pipe smokers do not as frequently inhale, and they keep the smoke 
in their mouths. 

I am presenting this, again, because it was pointed out to you 
yesterday that there was no increase in larynx and oral cavity cancer 
to compare with that of lung cancer, and it was considered very pecu- 
lar if smoking was a factor. But these data do show that the cigar 
and pipe smoker has a greater risk of developing oral cavity and 
larynx cancer. 

oF 5 
i rf 
2 lk 
2) ‘- 
zz 05 
Sn 0.055 —-— CIGARS 
aD Ft Pie 110908 ae, SMOKING TOBACCO 
2 0.02! —— CIGARETTES id 
rie ies | 1950 

“Sfo" “1920 1930" 1940 


The next slide shows what has happened with tobacco consumption. 
Recently there has been a marked increase in the consumption of ciga- 
rettes, but the overall consumption of tobacco hasn’t increased so 
markedly. In fact, there has been some decline in pipe and cigar con- 
sumption, and particularly i in tobacco chewing—which we also found 
to have some relationship to cancer of the oral cavity. 

Therefore, with the introduction of the cigarette, you would expect 
a marked effect only on the development of lung cancer. 

When you have all these data in, you say, “How do these tobacco 
data fit in with the epidemiological pattern of lung cancer?” You 
will find that in these population groups where the cigarette consump- 
tion is high, lung cancer is high; and in those in which the consump- 
tion is low, lung ¢ cancer is low. 



Males (U.S.A.) high | high 
Females (U.S.A.) low | low 
Males (Great Britain) | high | high 
Males (Iceland) low | low 
Males (Norwegian) | moderate! moderate 
Males (+70 years)(U.S.A) | moderate} moderate 

Males (Urban) | high high 

Males (Rural) | moderate | moderate 

Males (U.S.A. 1910-1920) low low 

So much for the statistical evidence. Dr. Berkson in the report of 
the Mayo Clinic stated: “Well, what about pathological evidence?” 
He said: “If smoking is effective in lung cancer, I would like to see 
some precancerous changes in the lungs.” 


At the time Dr. Auerbach and Dr. Percy Stout—Dr. Auerbach is 
with the Veterans’ Administration and Dr. Stout is the professor of 
pathology at Columbia—and Dr. Chang and Dr. Cowdry at Washing- 
ton University were working on this general problem. 

Percent Of Slides With 

(including borderline lesions) 

Never Less Than | Pack + Lung 
Smoked | Pack A Day Cancer 
Regularly A Day 

The next slide shows what Dr. Auerbach found. He had sectioned 
the lungs of smokers and nonsmokers to look for precancerous changes. 
To me, the two things most important to look for are basal cell layer 
hyperplasia and carcinoma in situ. 

Dr. Auerbach while reading all these thousands of individual slides 
did not know the smoking history of the patient. In other words, 
he read them blindly and he found that the precancerous changes were 
most marked in the heavy smokers and that they were directly related 
to the amount the patient smoked. 

In other words, he—a pathologist—has demonstrated precancerous 
changes in the lungs of cancer patients which are directly related to 
the amount they smoked. 

Chang and Cowdry found the same thing in St. Louis, and Dr. Ryan 
from the Mayo Clinic found similar evidence in studying vocal cords 
in which he showed that the thickening of the vocal cords was directly 
related to the amount smoked. 

So here we note that the pathologist demonstrates precancerous 
changes in the lungs of people directly related to the amount which is 

We have, therefore, presumptive evidence, epidemiological evidence, 
and pathological evidence. 

What about laboratory evidence? In 1948 Dr. Graham, Miss Cro- 
ninger and I began our experiments on animals. We did these not so 
much as to prove that smoking causes lung cancer, because we believe 
that this is proved primarily on the human epidemiological data. 
However, the animal data can strengthen the human data. 

In this controversy of the tobacco lung-cancer problem, the mouse 
has taken a tremendous licking. When I went to school—and partic- 
ularly when I trained in my freshman year at Dr. Little’s laboratory 
in Bar Harbor—I was impressed that the mouse was one of the most 
important factors in cancer research. In fact, I still believe so. 

I am sure Dr. Little believes so because his entire program in Bar 
Harbor is based upon mouse research. Then when we demonstrate 


that mice could develop cancer when you applied tobacco tar to them, 
all of a sudden the mouse lost all the significance that it apparently 
had ever had. 

This is our opinion, as I just stated: The mouse work by itself is 
not conclusive; but, together with the human data, it is important. 

For instance, in the chemotherapy program in the Sloan-Kettering 
Institute we carry out a major proportion of the screening program 
on mice. When it works on mice, we try it on men. It doesn’t mean 
necessarily that when you do something on a mouse that it will work 
on a man, but the chance is much greater; and though some dis- 
similarities have been found, a close corollation has been found in 
many instances. 

Let me say this, furthermore: Types of butter yellow which have 
been shown to produce cancer of the liver in rats have been taken off 
the market purely on that evidence. 

What is the evidence on the experimental animal? The next slide 
shows the smoking machine which we have used. It smokes 100 ciga- 
rettes of a popular brand, or different popular brands, at one time 
and it all condensates out in the cooled bottles which you see at the 






We collect about 50 grams of tobacco per thousand cigarettes. This 
we dissolve in acetone and apply to the mice. 

The next slide shows a study by Dr. Mezlors which shows that 
when you apply this tobacco Nee to a mouse, you get very much the 

same fluorescent absorption that we have previously demonstrated to 
you in man. 

The next slide shows to you the first cancer that we produced in 
St. Louis. It is a typical squamous cell cancer in a mouse. 



The next slide shows you the histologic section of a classical cancer. 

The next slide shows to you a summary of these data. They ap- 
peared in our first report in 1953, in which 44 percent of the mice 
developed cancer and 59 percent papillomas. 



Lesions 30 

SCE Ai, teens See LR BRB ee CA Mie A Re | 
e) 4 8 l2 i6 20 
Number of Months of Application 

ome=== CAF mice (8!) Cigarette tar/Acetone 
aman CAF mice (30) Acetone 

We have since repeated this work on at least four different strains 
of animals and found that we could produce cancer in all of them. 
They differ somewhat in the number of cancers you get, depending 
upon the susceptibility of the strain. 

It has been claimed that this work could not be repeated, and much 
fuss was made about a British study published by Drs. Hamner and 
Woodhouse and Passey in which they were unable to produce cancers. 
I was visiting in England at that time and found what the major 
difference was. We applied tar 3 times a week in a 50 percent con- 
centration, after shaving the mice to get the tar on the skin. Dr. 
Passey apphed the tar in a 20 percent concentration twice a week 
without shaving the skin at all and just applying it to the hair. Ob- 
viously he didn’t apply enough concentration to produce tumors. 

Since this time our work has been repeated in published reports 
by Dr. Sugiura from the Sloan-Kettering Institute, by Dr. Neukomm 
in Switzerland, Dr. Blacklock in England has injected tar into the 
lungs of rats and produced cancer, Dr. Oberling wrote to me a few 
weeks ago reporting that a study supported by the French tobacco 
monolopy had been made and he stated he has confirmed our work. 
These have also been confirmed by studies of Nelson at New York 
University and Buck and Moore at Roswell memorial. 

So there is enough evidence that condensed cigarette tar can produce 
cancer of the skin in mice. 

The next slide shows some new data on a study which we have 
just completed ; a production of carcinoma is rabbits using tobacco tar. 
This is a rabbit which has been painted for 3 years with condensed 
cigarette tar. 




The next slide shows the histologic section. 







It shows wide metastasis from 

This is the cancer in the ear. 



The next slide is of great 
the ear cancer to all organs. 


The next slide shows the cancer that has metastasized to the cervical 


The next slide shows the metastasis of this tobacco-induced cancer 
from the ear into the thoracic organ. 

Tt shows nodules in the lung. 


‘The next slide shows the metastasis into the lung. 


The next slide shows you metastasis into the liver, and you see 
normal liver tissue down at the bottom. 


The next slide shows you metastasis into the kidney. 


The final slide of this series shows you a metastasis into the heart. 


Having demonstrated that tobacco can produce cancer in the ex- 
perimental animal, we said to ourselves “Now what is the basic signif- 
icance? What are we going to do with it?” 

The first thing we did with this was to try to establish a dose level 
of the tar. 

The next slide shows a study which will be published in Cancer. 

GMS. 2 3 4 5 6 ie 8 q 10 

We varied the amount of tar given to the animal by either decreas- 
ing the concentration frequency of painting or the interval of painting. 
We find that if we go from 10 grams a year to 5 grams a year, a re- 
duction of 50 percent, We produce no cancer in our experimental ani- 
mal. The significance of the study is twofold. One, it shows why 
Dr. Passey produced no tumors in England because he applied less 
than 5 grams, and second, it shows that if we can decrease tar ex- 
posure by 50 percent or thereabouts, we could significantly reduce the 
chances of developing cancer. These dose response studies are quite 
in line with the human studies which we have previously shown in 
which we found the same relationship. | 
- The more one smokes, the greater the risk developing cancer. 
| What is the practical significance of this? It is twofold. One, 
tobacco types. The next slide shows a study which we published on 
tobacco types. 





We have found that the carcinogenic activity of Burley, Maryland, 
Turkish and Virginia tobacco on “two strains of animals is not sig- 
nificantly different. However, there is a significant difference in the 
amount of tar that you can oet from different tobacco types and from 
within a given tobacco type. Therefore by blending your tobaccos, 
and by using different tobacco types, it was clearly shown in studies 
published by Harlan from the American Tobacco Co., you can change 
the amount of tar that you get in the smoke. 


It seems perfectly feasible to me, and compatible with safe smoking, 
to choose tobaccos in such a way as to give you a relatively low yield 
of tar in line with the dose response studies I have just shown. 

From that point of view, studies on tobacco types and the tar yield 
are of great importance. What about filtered cigarettes, which ap- 
parently is one of the crucial matters that we want to discuss here? 
We become very interested in filtered cigarettes because we felt, on the 
basis of dose response study, that here was a possible answer to the en- 
tire problem. You know the filter story. 

One of the first ones to come out with a very effective filter was a 
manufacturer with a cigarette in which the filter was so good that all 
you could get through it was hot air. And though this was a per- 
fectly fine cigarette from our point of view, it was a very poor cig- 
arette from the point of view of selling it. And for that reason, I 
am sure, they tended to loosen the filter more and more. 

We recently did a survey in which we asked over 500 patients who 
had switched to filters why they had switched. We found that more 
than 70 percent of them had switched because they thought they were 
getting health protection, or because of advertising which indicated 
they got health protection. 

What happened? As soon as the concept of the effectivensss of fil- 
tration became a part of the person’s attitude toward filtered cigarettes, 
some manufacturers loosened their filters, increased the tar contents 
of their tobacco to a point where some of the smokers of filtered cig- 
arettes today get more tar and more nicotine than they did before 
when they smoked unfiltered, regular-size cigarettes. 

This was well demonstrated, I thought, in a recent study published 
by Reader’s Digest, representing data by Foster Snell, which entirely 
agree with our own information on this particular subject. 

What about filtered cigarettes? The next slide shows in a study 
which we conducted on filtered cigarettes that the carcinogenic activity, 
or tar coming through a filtered cigarette, on a gram-for-gram basis, 1s 
just as carcinogenic as that of an unfiltered cigarette, demonstrating 
that the filter is unable to selectively remove components from the 
tobacco smoke. 



(© CAF 
® swiss 
UR = Unfiltered Regular 
UK = Unfiltered King 
FR=Filtered Regulor 
80 FK = Filtered King 


A filter can have a function, however, in line with the dose response 
studies that we have presented, if it can reduce the tar exposure to the 
individual. That this can be done seems evident from a second article 
published in the August issue of the Digest in which they point out 
that a manufacturer apparently has now succeeded in producing not 
only a good filter, but by having a certain blend of tobaccos succeeded 
in exposing the smoker to significantly less tar and nicotine than he 
received when he was smoking the unfiltered cigarette. 

It is athing which can be done, and I will have specific recommenda- 
tions on this particular point. 


We have discussed animal experiments as they apply to cancer pro- 
duction. What about the chemical experiments that tie in with the 
animal experiments? The next shde— 


WHOLE TAR 1009. 

MeCl, INSOL. 14g. MeCi, SOL. 86g. 

60g. 14g. 

3 6.29. 


43g. l2g 
+++ + 


60g. 17g. 6.09. 21.59. 5.29. 1.0g. 
++++ - - - - 

And I do not really want to go into detail on this because it is strictly 
chemical. But in this work which was published by Dr. Wright and 
myself in the March-April issue of Cancer, we tried to find out which 
component of tobacco contains the carcinogenic elements. 

First of all, it is impressive that the components that are carcino- 
genic are mostly present in about 1.7 percent of the total tar. In other 
words, the major proportion of the tobacco tar is not carcinogenic. 
They are present only in a small group of substances. These we be- 
lieve—as I will point out to you in a minute—are higher aromatic 

We have therefore demonstrated the group of substances in which 
a major carcinogen in tobacco tar 1s present. 

The next slide shows you the application of this carcinogenic frac- 
tion by Mezlors which I previously showed to you and you see again 
the very marked fluorescence when you apply this to mice. 


The next slide shows you cancers, multiple cancers produced with 
this relatively small fraction of tobacco which proves to be highly car- 
cinogenic to the experimental animal. 


How are these carcinogens formed? The next slide shows to you 
that the formation of carcinogenic tobacco tar is directly related to the 

temperature at which tobacco burns. 













The average cigarette burns at about 880° C. If you raise the tem- 
perature higher you produce more carcinogens. If you burn it at pipe 
tobacco temper ature, the standard pipe tobacco burns at 767° C., you 
get fewer carcinogens. And if you have cigarette extracts which are 
not burned, you wet practically no carcinogens at all. 

So the formation of the carcinogens is a direct indication of the tem- 
perature condition. 

We have since demonstrated that if you reduce the temperature 
level from 880° to 800°, you get a marked reduction in the formation 
of the carcinogens, and if you reduce it to 700°, you get very few car- 
cinogens at all. So if we could modify pyrolysis in ‘such a way as to 
reduce the burning temperature of tobacco, we could reduce the for- 
mation of these carcinogens. 

The next slide shows a number of organic substances of which we 
have identified at least traces in tobacco and in tobacco extract which 
was pyrolyzed. 






In other words, as we have reported in Chicago in April, we have 
demonstrated with Dr. George Wright and Dr. Jergen Lam who 
worked with us the way in which these tobacco carcinogens are formed. 
If you take the waxes of tobacco and pyrolyze them at 880° C., which 
is the temperature at which tobacco burns, you form these substances 
in great quantity, and, in fact, the pyrolytic material obtained from 
pyrolyzing tobacco wax at 880° was one of the most carcinogenic mate- 
rials that I have ever had the chance to test in my laboratory. 

So we know the temperature at which they are formed and we know 
at least one of the precursors that upon combustion leads to these 
higher aromatic polycyclics. 

The last slide shows to you this very highly active pyrolytic ma- 
terial of tobacco wax and you see these animals are just littered with 


I have presented to you presumptive evidence, epidemiological evi- 
dence, pathologic evidence, animal evidence, and chemical evidence. 
What about the evaluation of this work ? 

Rather than citing to you the opinions of individuals, I thought I 
would just give you the opinions of some organizations and groups 
that have deliberated on this issue. 

As early as 1952 in a meeting at Louvain sponsored by the World 
Health Organization, they concluded that smoking was a major factor 
in the development of lung cancer. This has since been confirmed by 
the Public Health Service in Sweden and the Netherlands, by the 
American Cancer Society, and by an American study group which 
concluded that— 
the sum total of scientific evidence establishes beyond reasonable doubt that 
cigarette smoking is a causative factor in the rapidly increasing incidence in the 
human epidermoid carcinoma of the lung. 

A recent statement by Surgeon General Burney goes toward the 
same point of view. Similar positions have been taken in editorials 
of such well established medical journals as the New England Journal 
of Medicine and the Annals of Internal Medicine in the United States, 
and the British Medical Journal and the Lancet in Great Britain. 

Perhaps one of the most thorough statements was published by the 
Medical Research Council which was incorporated in a report by the 
British Ministry of Health. ‘They concluded as follows: 

1. A very great increase has occurred during the past 25 years in the death 
rate from lung cancer in Great Britain and in other countries. 

2. A relatively small number of the total cases can be attributed to specific 
industrial hazards. 

3. A proportion of gases, the exact extent of which cannot yet be defined, may 
be due to atmospheric pollution. 

4. Evidence from many investigations in different countries indicates that a 
major part of the increase is associated with tobacco smoking, particularly in the 



form of cigarettes. In the opinion of the council, the most reasonable interpre- 
tation of this evidence is that the relationship is one of direct cause and effect. 

5. The identification of several carcinogenic substances in tobacco smoke pro- 
vides a rational basis for such a casual relationship. 

If I were asked what are the three most important reasons why I 
think that smoking is a cause of lung cancer, I would say they are, 
first the enormity of the statistical relationship. As you know, your 
life insurance data, if you belong to a group which has a 25 percent 
higher risk than the normal, you pay a higher premium. [If it is 100 
percent greater than normal, you are going to have a hard time find- 
‘Ing someone to insure you. 

But here data both from England and the United States have shown 
-an Increase in up to 7,000 percent greater. 

Second, the relation of the response to the amount smoked in the 
risk of lung cancer, and third, this is entirely in line with presumptive 

The practical aspects are as follows: (1) Moderation in smoking 
habits; (2) effective filtration, (3) the removal of precursors which 
we indicated to you; and (4) modification of pyrolysis. 

The specific recommendations we would like to make are as follows: 
(1) In view of the dose response data established both for men and 
‘the laboratory animals, specific tar levels in the smoke of a given cig- 
arette should be prescribed. These tar levels should be at least 40 
percent lower than that of the average unfiltered regular-size cigarette. 
Standard procedure should be prescribed for determining the tar and 
nicotine values. 

(2) The amount of tar yield can be controlled with present know]l- 
edge of mechanical filtration and tar yield of different type of tobac- 
cos. The sooner this can be achieved, an achievement which should 
‘be entirely compatible with smoking pleasure, the sooner we will lower 
the health hazard of our smoking population. 

(3) Work has to be extended in the field of pyrolysis to determine 
ways and means of lowering the combustion temperature of smoking 
products and to determine whether materials can be safely added to 
tobacco which may interfere with the chemical reaction transforming 
organic substances into higher aromatic polycyclics. The field of anti- 
catalysts offers some promise in this direction. 

(4) ‘Precursors in raw tobacco which, upon pyrolysis, transform 
into higher aromatic polycyclics have to be studied further with the 
‘hope that by their reduction or removal fewer of the higher aromatic 
-polycyctics will be formed. 

(5) In addition to the available dose response studies in respect to 
cancer reduction, further work has to be done on the tolerance level of 

(6) ‘Phe practical aspects outlined above may not individually lead 
to a tobacco tar that will have less carcinogenic activity, but a com- 
‘bination of these factors will certainly lead to a safer smoking product. 

In summary, we believe that because of the presumptive evidence, 
epidemiological evidence, pathological evidence, and animal evidence 
and chemical evidence, that smoking represents one of the major causes 
of lung cancer, and that in its absence, 80 percent of all lung cancer and 
cancer of the oral cavity occurring in this country could be avoided. 
‘This opinion is shared by many responsible agencies in this country 
and ‘in “Eurepe. 3 | | 


We also believe that there is a practical solution to this problem. 
‘This problem, like any other problem, cannot be solved by depreciating 
its importance or by ignoring it altogether. 

It can be solved by facing it squarely. I believe that in line with the 
recommendations that we have outlined, we can give our public a safer 
smoking product, and, above all, we can save lives. 

It seems to me that the lives of all the people who died of respira- 
tory cancer in recent years and will die in years to come demand that 
we give this problem our fullest attention. 

Mr. Buarnirx. Dr. Wynder, we thank you and thank you most sin- 
cerely for the comprehensive statement, certainly a very sobering state- 
pes Do the members of the committee have any questions on my 
right ? : 

Mr. Harpy. The only question that occurred to me, Mr. Chairman, 
had to do with the causes which the doctor seemed to ascribe primarily 
to tars. 

Have you determined that the tar content of smoke is substantially 
the only cause of cancer ? 

Dr. Wynver. Mr. Hardy, “tar” refers to the whole brown substance 
that you condense out. 

Mr. Harpy. The total contents? 

Dr. Wynprer. That is right. That is made up of nicotine which we 
have already demonstrated is not part of the carcinogenic problem, 
and of perhaps thousands of other substances. In one of the slides 
I demonstrated that we have broken all this tar down to show that 
the majority of the tar components are not carcinogenic. 

Mr. Harpy. I couldn’t understand that chart. 

Dr. Wynver. The majority of the components of the tobacco tar are 
not carcinogenic, and I would estimate that the actual carcinogenic 
components in tobacco tar are certainly less than 1 percent of the total 

Mr. Buatnix. Have they been identified ? 

Dr. Wynper. Let me state this and I am sure this problem will come 
up repeatedly here. Much attention has been placed on benzpyrene. 
In effect this has become an issue. It happens to be one of the sub- 
stances that has been known and everybody tries to blame everything 
on that one substance. We have stated repeatedly there is not enough 
benzpyrene in tobacco tar to explain the animal results we have pub- 

However, we have also stated that there are numerous other sub- 
stances which are benzpyrene related which are more active than benz- 
pyrene and most likely account for the majority of the activity. 

These are, in particular, substituted benzpyrene derivatives. I think 
it is more or less academic whether it is benzpyrene or dibenzpyrene, 
or dibenzanthrene, or a substituted benzpyrene derivative because they 
all form in the same manner. 

If we can control pyrolysis and/or the precursors, we can reduce all 
of these substances at one time. 

Mr. Harpy. Of course I am not too concerned with being able to 
tie a name onto the particular factor. The thing that I am concerned 
with is whether or not we can get rid of it. 

Dr. Wynoer. As I stated, we can get rid of it probably in one or 
two ways. By modifying the combustion condition of the smoke, and 


second, by studying the precursors in tobacco, which we have been: 
studying. We have been extracting tobacco with various solvents. 
Initial results indicate that by extracting particularly the waxy por- 
tion you remove or reduce the higher aromatic polycyclics upon 
smoking this produces. 

Mr. Harpy. To what extent will the filters that are now being used 
actually remove these carcinogenic tars ? 

Dr. Wynper. As I stated and demonstrated in one slide, no filters 
currently in use—and I think no mechanical filter—can selectively re- 
move any particular component from within the tobacco smoke. 
These are all very small particles, and they move through the filter 
very rapidly. It is chemically and physically not possible to pick out 
certain substances from within the particles. 

But the filters do have a use in that they can reduce the overall ex- 
posure. If, let us say, a filter removes 40 percent of the total tar, it 
will also remove 40 percent of the carcinogen. 

Mr. Harpy. I am trying to think in terms of what is happening 
now. If I understand your analysis of it, if we use a proper filter and 
a proper tobacco mixture, then we could reduce the danger. 

Dr. Wynpvrer. That is absolutely correct. Whereas these studies on 
precursors and pyrolysis on which we are engaged—and I understand 
some of the tobacco companies are now eng oaged-—may give a practical 
answer a year hence, the problem you just stated could be solved today. 

Mr. Harpy. Then the question comes down to this, and this is the 
purpose, as I understand it, of what we are trying to consider here: 
Whether or not the filters that are currently in use actually do render 
the particular cigarette, or any of them, free of cancer-causing tars. 

Dr. Wynper. As I outlined to you, the field of filtered cigarettes, 
as I see it and as brought out in The Reader’s Digest story, shows that 
a majority of the filtered cigarettes give you more tar and more 
nicotine than you used to oret when you smoked a regular sized 

“Mr, Harpy. What you are saying, then, is that the cigarette manu- 
facturers have changed the mixtures to the point that they have more 
than offset the value of the filter ? 

Dr. Wynver. Therefore, in line with the dose-response study that 
we have demonstrated, any cigarette—filtered or unfiltered—that 
gives you more tar will increase your risk of developing cancer. 

Mr. Harpy. You don’t mean to say that the cigarette that is on 
the market today with a filter on it is more likely to produce cancers 
than when it was unfiltered a few years ago? 

Dr. Wynprer. You shouldn’t group all the filtered cigarettes to- 
gether because some of them are trying to do an honest JOD. SO 
don’t want to make a statement in general. 

Mr. Harpy. I am just trying to understand where we are. 

Dr. Wynper. I do want to say this. In the Digest story they made 
a certain comparison of changes within a given manufacturer—for 
instance, manufacturer A who used to produce a regular sized ciga- 
rette, A, now produces a filter, filter B. 

The Digest story shows that filter B now contains more tar than 
you used to get when you smoked cigarette A. That, in my opinion, 
1s going in the wrong direction. 


On the other hand, there are some other filter makers who have 
put on a better filter, used a better blend, to give less tars. This is the 
direction in which I believe the filter industry should go. 

I believe that the filter on the cigarette has a potentially great value, 
provided it is doing the job that it is supposed to do. I believe that 
a satisfactory smoking product can be produced by a good filter and 
by a proper blending of tobacco which will lower the tar content. 

I would lke to see regulations which would encourage or perhaps 
even require the filter cigarette manufacturers to reduce their tar 
and nicotine content to certain prescribed levels, or not permit them 
to use the term “filter.” 

Mr. Puaprincrer. What is the level you recommend, Doctor? 

Dr. Wynver. The level that we have recommended is a 40-percent 

Mr. Prarrncer. Forty percent at the top or forty-percent reduc- 
tion at the bottom ? 

Dr. Wrnver. Forty-percent reduction over and above the standard 
regular sized cigarette. | 

Mr. Piarrncrer. What does that mean, actually, in terms of tar? 

Dr. Wrnver. In terms of tars, it depends a little bit on the method 
that you use for tar determination. But let us say in the studies pub- 
lished by Snell, the tar content of the average regular sized cigarette 
is 830 milligrams, then it should be reduced to 18. 

Mr. Puapincrr. Suppose it is 40? 

Dr. Wynper. If it is 40, it means that this manufacturer has used 
specially heavy blends of tobacco, so we must arrive at the average 
norm that has been kept over the years. 

Mr. Puaprneer. But you would consider 18 the safety threshold. 
How much give one way or the other? Suppose it is 19? 

Dr. Wynoer. It is very difficult to put an exact figure on this. 
‘We chose 40 in part because we noted a drop off at about this level in 
our dose-response studies. This is the line that we like to encourage. 

J would never say that this cigarette would be safe, but I would say 
it will be safer. 

Mr. Harpy. Suppose you do reduce it to 18. Then it is up to the 
individual smoker to regulate his volume of consumption. If he con- 
tinues at a high rate of smoking, his total intake during a particular 
day a particular period of time could exceed what it had been pre- 

Dr. Wynvrr. You made a very good point there. In the studies 
that we did on people who smoked filtered cigarettes, we questioned 
this particular point: Do you now smoke more or less since you shifted 
to filter cigarettes? There are a certain number of people who smoke 
more and a certain number of people who smoke less. There was no 
significant number of people who said they smoked much more. 

Mr. Harpy. The encouraging thing in your testimony to me is ap- 
parently there is a solution to at least the critical serious effect of 

Dr. Wynper. That is right. 

Mr. Harpy. On the other side of it, you present a rather sad pic- 
ture to indicate that actually the intake of tars from smoking now is 
more than it was since before we started using filters. 


Dr. Wynper. This applies to some of the filtered cigarettes. I want 
to stress the fact that 1t applies to some of the filtered cigarettes now 
on the market. This is due to several reasons. 

One is that the filter has had to be made more porous. Two, tobacco 
blends have been used which are heavier in tar and nicotine yield. And 
three, the cigarettes have been lengthened. 

You can demonstrate that the longer the cigarette, the more tar 
you get as you smoke toward the butt end, because tobacco itself works 
as the filter. For instance, in the first 10 millimeters of the cigarette, 
you get only, let’s say, 4.5 milligrams of tar in the smoke and in the 
last 10 millimeters, 11 milligrams. 

Mr. Harpy. Then you might recommend that we buy only a king- 
sized cigarette and don’t smoke over half of it. That would increase 
the sale of cigarettes and reduce the risk of cancer ? | 

Dr. Wynper. That might make me very popular with the tobacco 
industry. But I don’t want to leave you with the impression that I 
think filters are bad, because I think they are one of the things that 
we must encourage. But we must encourage good filtration. 

Mr. Harpy. What you are saying is, though, it doesn’t make any 
difference if you use a filter which is good, if you offset its advantage 
by increasing the tars in your mixtures. 

Dr. Wynvber. Correct. 

Mr. Buatrnik. Doctor, in all of this discussion of your testimony, 
you have referred only to the tobacco in a cigarette as the source of 
tar. Have you considered, or do you have any knowledge of the paper 
used on cigarettes as a possible source ? 

Dr. Wynper. We did one study in which we took cigarettes and. 
wrapped them in a cigar leaf. We thought that that was a good way 
to find out what the paper does to the total product. 

We got just as many cancers with that product as we got with the 
ordinary cigarette with paper. We therefore believe that the paper 
contributes very little to the carcinogenic substances in tobacco. 

Mr. Bratrnix. After you ran these tests on cigarette tobacco 
wrapped in a cigar leaf, then did you shift over to use only a cigarette 
entirely with paper ? 

Dr. Wynper. No, we didn’t do that because we think it would be 
very hard to compare this—to take paper pulp, for instance. Dr. 
Wright published a study in which he compared the benzpyrene 
content of cigarette paper by burning it in a hollow shell. When he 
burned it as a pulp, he found some of these higher aromatic poly- 
cyclics, but when he burned it as a hollow shell he found nothing. 

It seems to me in all of these experiments you want to stick as close- 
ly as you can to the way humans consume a product. 

Mr. Buarnrx. You mentioned a filter as the possible way to reduce 
the total volume of intake of smoke, thereby cutting down by the same 
proportion relatively the intake of your carcinogenic material. Are 
there any other methods that are being examined or studied ? 

IT am thinking of the chemical! which may neutralize or alter or 
make into a neutral stable compound these carcinogenic compounds. 

Dr. Wynper. This isa very good point. As I outlined, at the Sloan- 
Kettering Institute we are engaged in research on filtration and dose- 
response. (See appendix, exhibit 4, p. 370.) We are interested in the 
pyrolysis of the material and how these compounds are formed. We 


are currently working in the field of anticatalysis in which we are’ 
adding substances to the tobacco to see whether the formation of these’ 
carcinogens can be reduced. 

This is very much in line with the statement that you just made. 
The third one which I outlined—the study of precursors—is to see 
whether we can remove potential carcinogen substances from the to- 
bacco. Incidentally, in this one study which we did where we ex- 
tracted tobacco with hot hexane, we did find that you get a marked 
reduction in the formation of some of these materials, and yet a very 
satisfactory smoking product comes out of that. 

So I think there are practical aspects to the problem short of im- 
proved filtration. The only reason I stress the improved filtration is 
because this is the kind of thing which we can do today. 

Mr. Bratrnix. Mr. Meader ? 

Mr. Meaprr. Dr. Wynder, were you present when Dr. Little testi- 
fied yesterday ? 

Dr. Wynper. No, I was not. 

Mr. Mraprr. You might say that scientists disagree sometimes, and 
I would like to stimulate that disagreement for just a minute. Dr. 
Little said in his prepared statement : 

Secondly, after 50 years of research on the origin and nature of cancer, I 
have the greatest respect for its vigor, versatility, and complexity. I therefore 
sincerely and deeply deplore premature and oversimplified conclusions and in- 
tensive publicity. 

Then somewhere else in his statement—I haven’t found it yet—he 
referred to the conclusion of the association of lung cancer cases and 
the amount of smoking—and deducing from the cause-and-effect rela- 
tionship. He characterized that as a gymnastic feat of some kind. 

IT would hke to have your comment on Dr. Little’s scientific attitude 
in saying we shouldn’t assume that there is a cause-and-effect connec- 
tion until there is more conclusive scientific evidence. 

Dr. Wynver. On the first statement that this is premature, I don’t 
think that in the field of etiology of cancer there has been ever such 
widely concerted efforts and research in the field of smoking and lung 
cancer. Everywhere I have been in Europe and in this country, people 
are working on it. 

As I pointed out to you, at least 16 separate retrospective studies 
and two prospective studies involving thousands of lung-cancer cases— 
have all confirmed the same thing. Special studies on women, animal 
studies, rabbit studies, isolation of known carcinogens in tobacco, 
plus all this presumptive evidence—this is about as conclusive as you 
can ever get it to be. 

J will entirely admit that there is no scientific subject, and I am 
sure you in Congress will recognize no political subject—on which 
you will get complete agreement at any time. 

One of my hobbies is history, and one of the things in history of 
medicine that impressed me most was in the last century when many 
women, particularly in Europe, died from childbed fever. Dr. 
Semmelweis, in particular, demonstrated this was due to the fact that 
doctors didn’t wash their hands. 

Today we recognize it as an obvious thing. But in those days there 
were many opinionated people, and he was laughed out of Vienna 
and died a brokenhearted man in Hungary. 


Yet, at that time all he thought was an opinion. It would have 
been very simple just to wash their hands. Today, unfortunately, we 
not only fight opinion; we fight a very important industry. 

I think Dr. Little, of course, has all the right to present his point of 
view, though I assume it would be very difficult for anybody asso- 
ciated with the tobacco industry to get up in front of you here today 
and admit that tobacco is a harmful product. 

Dr. Little has often said, “Now, you demonstrate association but 
not causation.” I thought ‘that by showing you all the evidence to 
find out how it fits in with the presumptive evidence, the causative 
relationship is the more direct one to assume. But from my point of 
‘view it makes very little difference whether we argue about the 
words “contributing to,” “initiating,” “causing,” “associate,” “relating 
to”—the important factor is that the person who doesn’t smoke rarely 
gets lung cancer. And the more you smoke, the more lung cancer you 
get. That is the important issue. 

I certainly admit there are numerous intrinsic factors of lung 
cancer about which we know very little. But if we were to apply the 
same argument of Dr. Little to the point of radiation—and I think 
it 1s a good example to use—we can rule out that radiation couldn’t 
possibly cause cancer in men. 

Yet I am sure that you will not find a single scientist in this 
country who will say that radiation cannot cause cancer 1n men. 
We have the evidence in men. We have the evidence in the experi- 
mental animal. The relationship is identical. 

In fact, I am sure that if we were dealing with spinach rather than 
tobacco, we would not be sitting here debating the point. 

The only thing that upsets me are really two points—and I was 
‘glad that the Public Health Service recently made a statement in this 
regard—one : I feel that the public ought to be entitled to know from 
the Government, from the Public Health Service, what the risks are 
when they smoke. I deal the same way with my own patients. I 
don’t say to the patient, ‘““Now, if you don’t smoke, I will never see you 
again.” I tell them the facts and let them lead their own lives, and I 
lead mine. That is all I can do as a doctor. 

The other point is, that I think there is a solution to this problem. 
As I pointed out in my last remarks, the solution can only come when 
we recognize we have a problem here and let’s go to it and do some- 
thing about it. 

Mr. Mraprr. The only other question I had, Dr. Wynder is this: To 
what extent are you familiar with the research conducted under Dr. 
Little at the expense of the tobacco industry ? 

Dr. Wynver. I am all in favor of the tobacco industry supporting 
research in this country. If they spent $2 million to further research 
in cancer or the tobacco-cancer problem, it is all so much the better. 

But I was a little discouraged if after 214 years Dr. Little pub- 
lishes his first report, after spending perhaps $2 million, and reported 
that they found very little. 

I am sure that the director of my institute, after I had spent that 
much money on research and after 214 years, and I had to report I 
found practically nothing, would be a little bit unhappy. 

The point is that I would like to find out what direction the tobacco 
industry research committee is taking. They say, “We cannot believe 


this animal work.” If they don’t believe you can demonstrate any- 
thing with mice, let’s not support any animal work because it doesn’t 
show anything, regardless. Then they think apparently very little 
of statistics. 

If you doubt statistics, why do human work, which is statistics. So 
actually you have already cut off every possible road to coming to an 
answer to the problem before you even start it. That is discouraging. 

Mr. Buatnix. Thank you, Doctor. The second bells have rung for 
a quorum call. If there are further questions of Dr. Wynder, I am 
sure he may be able to stay over until 2. We thought we would meet 
at 2. to proceed with Dr. Rigdon here then. 

Mr. Minswatx. Doctor, I have just one question. Do you know 
of any studies that have indicated that a virus might be a contributing 
cause of cancer ¢ 

Dr. Wrynper. This is a great controversy, as you know. Everyone 
has his own theory on cancer. I think it is conceivable that a virus 
could initiate a cancer, very much as a chemical carcinogen could 
initiate a cancer. I personally believe that the basic cause of cancer 
is an enzymatic deficiency within the cell itself, and that anything 
that can induce this deficiency—hbe it radiation, be ita chemical, be it 
a physical substance, be it a virus—could initiate cancer. 

Mr. Miystauy. The virus then in your opinion could initiate 
cancer ¢ 

Dr. Wynpver. It could, though I personally do not believe that it 
does. But certainly there are a number of theories that have been 
developed along that line; and as long as we do not know what the 
basic cause of cancer is, this is as likely a theory as anything. 

Mr. Minsuartz. Do you know Dr. Little? 

Dr. Wynper. Yes. 

Mr. Minsuarty. Have you ever discussed with him the merits or 
demerits of filters ? 

Dr. Wynver. No, I have not. Let me give you one final example— 
and sometimes examples are very good. There was a cholera epidemic 
in London—and apparently a lot of these good examples come from 

At that time Dr. Snow—who did the first major study on epidem- 
lology—got the idea this might have to do with a Broad Street pump 
where much water was consumed. He did a study and found out that 
the people who drank water from that pump got more cholera than 
consumers of other water. 

At that time they didn’t have the vaguest idea what the basic cause 
of cholera was. Yet he went to the board of governors one day and 
said, “Let’s try to remove the handle of that pump just on the basis of 
epidemiological evidence.” ‘They removed the handle and the cholera 
epidemic ceased. 

At that time the basic cause of cholera was not known. The same 
thing apples to the cancer problem. We do not have to find out or 
know the basic cause of cancer in order to prevent many of the cancers 
that occur in men today. 

Mr. Buarnix. Thank you very much. 

The committee will continue at 2 o’clock this afternoon with Dr: 


I have received several articles on the relationship of cigarette smok- 
ing and lung cancer written by Dr. Alton Ochsner, president of the 
Alton Ochsner Medical Foundation in New.Orleans, and, if there is 
no objection, I shall have them inserted in the record. (See appendix, 
exhibit 5, p. 391.) Dr. Ochsner, one of our most eminent surgeons, 1s 
chairman of the department of surgery, school of medicine, Tulane 
University, and a former president of the American Cancer Society, 
American College of Surgeons, and the American Association for 
Thoracic Surgery. 

(Thereupon, at 11:25 a. m., the committee recessed, to resume at 2 
p.m. of the same day.) 


Mr. Buarnix. The Subcommittee on Legal and Monetary Affairs of 
the House Committee on Government Operations will resume public 
hearings on the role of Federal agencies in the field of fraudulent and 
misleading advertising in the current series. 

The first is concerned with cigarettes, particularly with the filter 

We have this afternoon Dr. R. H. Rigdon, professor of pathology, 
School of Medicine, University of Texas. 

Doctor, we appreciate your bearing with us. You were scheduled 
to be on in the latter half of the morning session, which was interrupted 
by the House convening at 11 o’clock this morning instead of the usual 
12 o’clock. 

The mutual foreign aid program is in debate. It is a matter of con- 
siderable congressional interest and activity and we regret we have to 
run the hearings into the afternoon. Many of the members are tied 
down in debate on the floor who would like to have been here, and 
of course they asked me to express their regrets because of this unavoid- 
able conflict. It is literally impossible for them to be here. 

Dr. Rigdon, I notice you have a prepared, written summary state- 
ment of about three pages. Would you proceed with either reading 
your prepared statement or we will insert it in the record and you 
can give us an oral presentation. 


Dr. Riepon. I would lke to say that I am a pathologist, and a 
pathologist is one who is interested in the changes that occur in the 
body in disease. Cancer is one disease process. I teach pathology to 
medical students, and I am interested in research. 

I have been working on both, so my interest is in human diseases 
as well as in the experimental study of disease. 

T have prepared a summary of the problem as I see it, and I also 
have a copy of a recent publication which sums up my ideas on lung 
cancer and smoking. 

This problem of cancer of the lung is not a new problem. The first 
case of cancer of the lung was reported in 1810. Since this time there 
has been a progressive increase in the number of cases of lung cancer. 


dn fact, you can find a very good correlation between the number of 
increases relative to the introduction of new techniques for diagnosis. 

The X-ray was invented in 1895 and that was a very good technique 
to pick up more cases of cancer in the lung. And then the broncho- 
scope, where you go down and get out biopsies of the lung—has been 
a very important factor in this problem of an increase in the number 
of cases of cancer of the lung. 

As I see it, cancer of the lung is not something to itself. It is a 

part of the picture of cancer. So when we are talking about cancer 
of the lung, we must think about cancer as a disease process wherever 
we find it. 
_ I have been interested in this problem of cancer of the lung. The 
first publication was in December 1950, we started in this problem 
before this controversy arose. So it is of interest to note that in 1933, 
only 24 years ago, we had the first successful operation for cancer of 
the lung. This immediately brought into focus attention on this 

It is of interest to note from a statistical standpoint some of the 
problems referable to cancer. One of the first things that I did in 
this study was to check on the number of lung cancers that had been 
reported in the different States. When I speak of statistics, I refer to 
vital statistics and not to those that I got myself. I refer to vital 
statistics of the United States Public Health Service. 

We took the number of cases of cancer of the lung that had been 
reported, and the number of doctors practicing medicine in the different 
States, and the number of hospital beds. With these we were able to 
find out a correlation between the number of doctors, the number of 
hospital beds, and the number of cases of lung cancer. 

We had to conclude from this study that 1f you didn’t want to die 
from cancer of the lung from a statistical standpoint, you would have to 
go to a State with few doctors and few hospital beds, because they had 
fewer cases of lung cancer than other States. 

We realized at that time that there are some problems in such a 
statistical study. We then started to work on this problem referable 
to cancer of the lung and death certificates because we felt that the 
death certificate, which is a basis for vital statistics, is not an accurate 
record of whether you have lung cancer or not. 

We know that during the past 100 years there has been an improve- 
ment in diagnosis, and with this improvement, our vital statistics are 
better. All of those factors enter into this question of vital statistics 
and death certificates. We know that many men practicing medicine 
don’t have facilities to X-ray a patient, take a biopsy of the lung and 
do all of the examinations that are necessary. They do the best they 
can under the conditions in which they are working. 

If they are practicing medicine, in the back side of some county, they 
don’t have all of these facilities. They have to do the best they can 
and their diagnosis will not be as good as one who is in a teaching 

We therefore began to question whether these vital statistics were an 
accurate source for determining whether or not cancer of the lung is as 
frequent as it is reported to be. 

Tn this problem of vital statistics there has been a continuous change 
in the coding of cancer of the lung. I think there have been 4 or 5 
changes in the classification. At one time they just lumped cancer of 


the lung with all other cancers that occurred in the chest. Because of 
this you don’t have an accurate baseline. With the last revision which 
came in 1939, it is a more specific classification. 

Since 1939 we have had a tremendous increase in cancer of the lung. 
But I don’t think that you can actually determine how many cases of 
cancer of the lung that occurred preceding that time. As I see it, we 
really haven’t a base line to talk about. . 

If we change coding every few years, we don’t have anything really 
to base our opinion on. Those are some of the things that I am inter- 
ested in in this problem of the frequency of lung cancer. 

There are many people who have gone into this problem from a 
statistical standpoint, all these opinions are not my own about the value 
of statistics and the way they are changed. I might cite for you a few. 

In 1931 it was pointed out by Downes that— 

The general limitations of official mortality statistics as scientific data are 
already so well known that none save the tyro in statistics will fail to go behind 
the published figures in order to take into account their grosser faults. The full 
extent of their limitations will not be appreciated adequately by anyone, however, 

until he makes the attempt to ascertain what the death rate actually is from a 
given disease in a given area. 

The vital statistics office of the United Nations in 1955 said: 

All medically certified cancers are not equal in quality. The knowledge and 
skill of the physician in making the diagnosis, his willingness to report com- 
pletely, and the existence of facts for reporting certain diseases all affect the 
ultimate results. 

Mr. Prapincrer. Where are you reading from, Doctor ? 

Dr. Riepon. I am reading from the second page in the manuscript 
that I showed you—Review of Literature, the last paragraph. 

Mr. Puapincer. Thank you. 

Dr. Riapon. We question the statistics as being a satisfactory source 
to draw fine conclusions from. I personally have to be cautious in 
drawing conclusions from these data. 

We can find here—quoting from Gilliam, which is the last part 
of the paragraph on the first column on the following page, reported 
in 1900: 

I have previously stated that the rate of increase in recorded mortality was 
greatest in this country between 1914 and 1930 and it has been declining since. 

There are many references in the literature which emphasize this 
problem of statistics and the significance that one can attach to them. 

The second thing that we have been interested in is a survey with 
regard to the smoking habits of individuals. It was published in the 
Journal of the National Cancer Institute in 1955. I mention this 
only to emphasize the fact that we have been personally interested in 
gathering statistics on this problem of smoking and lung cancer. 

In this study we obtained the smoking habits of about 12,000 people. 
In this we began to learn something about the practical side of getting 
such data. We find that it is very difficult to establish a fact by ask- 
ing a man how much he smoked 20 years ago. They would usually 
come up with a statement, but it was always a question in my mind as 
to whether I could accept it as being correct. I don’t smoke; I have 
never smoked. So I find that it is difficult to establish exactly what 
aman did 20 years ago with regard to smoking. 

The next thing is, how much do they smoke? Because one man says 
he smoked 3 packages of cigarettes in a day, and another man says that 


he smokes 1 package. Statistically you would put them in two differ- 
ent groups. But really and truly, this man that smokes three packs 
may discard every cigarette when it is only a third smoked, while 
another will smoke it down very short—to a butt. 

We therefore have to be cautious about such data. It is not a 
matter of just collecting these data. They have to be critically 
analyzed. I don’t know how you are going to avoid a certain number 
of errors. 

So the question of smoking—how much you smoke—is hard to 
establish from a statistical standpoint. Then I find that there is a 
lot of difference in the division—whether you are a heavy smoker, 
if you smoke one pack; whether you are a heavy smoker if you 
smoke a pack and a half. So that is another difficult problem. 

Personally I have been very much disappointed in some of these 
surveys in which they have converted a cigar smoker into a cigarette 
smoker as far as the statistics were concerned. 

Mr. Puapincrer. Has the Cancer Society done this? 

Dr. Riepon. I don’t think the Cancer Society has, but the United 
States Public Health Service, and Doll and Hill in England did in © 
their studies. 

In other words, they say that 1 cigar is equal to 10 cigarettes. You 
can see what it would mean. If a man smokes three cigars, then he is 
really a heavy cigarette smoker ag far as statistics are concerned. Then 
if you smoke a pipe, it is 214 cigarettes. 

Personally I don’t follow that line of reasoning, shifting these 
cigar and pipe smokers over into cigarette smokers. Because of these 
conversions it becomes a difficult problem to arrive at data referable 
to this point. 

It has been of interest to me to note some of the data that have been 
given referable to the smoking habits and how much they smoked. 
I have one point that I would like to cal] your attention to, to em- 
phasize this point. 

In a study by Doll and Hill—these are English investigators, and 
they reported this in 1950—of 649 males with cancer of the lung, 
there was 647 smokers—a percentage of 99.7. In the control group 
of 649 patients with diseases other than cancer of the lung, there were 
622 smokers, a percentage of 95.8. 

My comment is, I can’t see much difference between 99.7 and 95.8 
in these statistics, especially when you have as many defects in get- 
ting these as I have mentioned. We have no argument at all with 
statisticians. They can take figures and do a wonderful job with 
them. But as far as I am concerned, their significance hes in the 
fioures that they used. 

So that is why I fuss and argue with them. It is not from what 
they have done, because they do a swell job. But these are the things 
that bother me, and therefore I have to consider them in interpreting 
the data. 

There have been many problems to arise with this smoking busi- 
ness. One of them, the argument is as to whether or not the inhala- 
tion is bad. Referable to this, it is of interest to observe—also in the 
statistical studies made by Wynder and Graham in 1950—that: 

The greater practice of inhalation among cigarette smokers is believed to be 
a factor in the increased incidence of the disease. 


Doll and Hill, English investigators, in 1950 in a similar statistical 
study state: 

It would appear that lung carcinoma patients inhaled slightly less often than 
other patients. 

There are two statistical studies. One says it influences causes of 
the lung, and the other one says it doesn’t. So I have to consider that. 

There have been several statistical studies made on this problem. 
I think 14 are frequently cited. But one of the interesting things in 
those data is the fact that one is by Schrek. In 1940 he says: 

This relatively low percentage of deaths by cancer of the respiratory tract 
as compared to the higher percentage of smokers indicates that smoking is at 
most only a weak carcinogenic agent. 

Now, that is included in these 14 studies, but they don’t emphasize 
that point, don’t you see? So to me, in trying to evaluate this prob- 
lem and form an opinion, I have to look at such points. That is the 
basis that I have to form an opinion. 

In these studies, then, there are certain things that come out, I 
think, as far as my personal opinion is concerned, that make me wonder 
about some of these things. 

Now I would like to go into another phase of this problem, and 
that is the experimental study of cancer. I have been studying cancer 
since about 1937. We did some work with viruses, and I might men- 
tion that there are many other agents that are said to cause cancer. 

If you want to really hear the argument in favor of virus, you 
should get that group of people together. They almost convince 
you that all cancer is due to virus. Then there are others who say 
it 1s due to chemical agents. Then there are others who say it is due 
to hormones. And then there are other problems referable to heredity 
and mutation in the etiology of cancer. 

So there are many theories about cancer. Experimentally is one 
of the ways to tackle this problem. I have been interested in the 
study of the experimental production of cancer. In this study I have 
used one of the most potent cancer-producing agents that is known, 
which is methylchlolenthrane. It is recognized as being an experi- 
mental agent only for the production of cancer. 

I have used a white Peking duck in this study. We have found 
several things that I think would be of interest to you in the overall 

We have put this agent on the skin beneath the wing of these birds 
and we get a variety of tumors. Then we put it on the web of the 
foot and we don’t get very many tumors. If you put the same agent 
into the trachea and down the lungs, we still don’t get the type of 
tumor that we get on the skin. 

Therefore, in one host, we get a variation depending upon where 
this same chemical agent is going. 

We have been interested in putting this cancer-producing agent 
on the skin, and then we plucked the feathers. That is the technique 
that we were using to produce trauma. We found that after having 
put this cancer-producing agent on the skin and the feathers were 
plucked, we got more tumors to develop in the skin than we did in 
those birds where we didn’t pluck the feathers. 


This observation suggested to us that this cancer-producing agent, 
plus the trauma, made this point more significant. This work has 
been published in the Archives of Pathology. 

That brings into the problem of cancer cocarcinogens—that is, cer- 
tain things acting together that may produce cancer. We have here 
a very important factor. That is, if you traumatize the skin and then 
put on a cancer-producing agent, that will be entirely different than 
just putting on the skin only the cancer-producing agent. 

That brings us to.a point that I think is very important in expert- 
mental cancer and that is, if you put an agent on the skin over a period 
of a year and traumatize that skin frequently during that time, you 
have a combination of things to worry about that produce the tumor. 

We are seeing this thing in Texas, in ranchers. They are exposed to 
sun. We are seeing these people develop skin cancer—we know that 
they develop skin cancer very easily because of the sunshine; the ultra- 
violet rays preduce some changes in the skin cells and trauma comes 
along and may be the immediate cause of producing it. Sometimes 
you get skin cancer without any trauma. 

There are many things that go into this problem of cancer rather 
than just one particular process. 

I believe in trying to evaluate this thing of experimental cancer, it 
would be wise to take several experimental hosts to work on. Since 
I was using the duck, I took the chicken and I put the same cancer- 
producing agent on the skin of the chicken and I got a different type 
of tumor. 

For a third host I took a turkey, I put this agent on the skin of tur- 
keys and I just don’t get anything to compare with the tumors I get 
in the duck. So in the skin of the chicken, the duck, and the turkey 
we have an entirely different situation referable to the development of 
tumors. I have to be cautious in concluding that what is going to 
happen in the skin of a mouse is what is occurring in the lungs of man. 

I can’t accept this theory. The reason I can’t accept it is because of 
my experience in the experimental study of cancer. 

I know that you can develop strains of mice that will develop cancer 
of the breast very, very quickly, or cancer of the lung very quickly, 
while another strain won’t. So if you select certain strains of animals, 
you can bring out many points, while you couldn’t if you used other 

Although the mouse has been used for a long time, I don’t accept 
observation as being conclusive evidence as to what is going to occur 
in man. So I have to be cautious about such conclusion. 

Mr. Mrnsuauy. Mr. Chairman, I wonder if I could interrupt at that 
point, please. Have you heard of any investigators who have at- 
tempted to grow a cancer on human skin ? 

Dr. Riepon. No; I have not. I don’t know. I developed one 
(squamous cell) on the ear, my ear, and somebody said it was due to the 
fact that I had been using methylcholanthrane. We got it out 4 years 
ago and it hasn’t recurred. 

But I don’t know any human investigation on human with this car- 
cinogenic agent that would throw light on the problem. I am not 
familiar withit. It may be. 

Mr. Minsuatu. That answers my question. You just don’t know. 

Dr. Riepon. I just don’t know. 


Mr. Puarrncrr. Doctor, have you experimented with tar after the 
fashion of Dr. Wynder on your turkey and your Peking duck? 

Dr. Ricpon. We are working on that now. The experiment has 
been in progress now fora year. After all, it has taken me 8 years to 
get a technique, and it takes me a year after I set up the experiment. 

This is nothing that you can do quickly. 

Mr. Puarrncer. Please don’t misunderstand me. I am not criticiz- 
ing. Iam just asking. 

Dr. Riepon. No; I just mentioned the time factor, and these ex- 
periments are not completed. But you asked me, and I will say that 
I am using tobacco tar. I do not make the tar. I obtain it from a 
commercial plant. 

We are putting it in the trachea of ducks, and we are comparing it 
with methyleholanthrane. 

Mr. Prapincer. Is there methylcholanthrane in tobacco ? 

Dr. Riepon. Not as far as I know, no. That is not in tobacco. It 
is an entirely different agent. 

So we may say we have been disappointed, if you want to look at it 
that way, that we haven’t found any tumors in the lungs. We mix 
this tobacco tar with mineral oil. That is not like you get it when 
you are smoking, but we are trying to work out a technique that may 
be of help to us later on. 

We have not been able to obtain any tumors so far with this tobacco 
tar. We find that it goes down into the lungs. It comes in contact 
with all the cells there. This brings up a very interesting problem 
because we can see that it gets all down in the lungs and the tumors 
alleged to be due to tobacco occurs at one site in the larger bronchi. 
That is hard for me to put together, but those are the facts the way 
we have them. 

We are studying lung cancer. We have found that tobacco tar is 
widely distributed through the lungs, and that brings up the question 
that, after all, as these agents go down into the lungs they go by the 
larynx, the voice box. There has been a lot of discussion about can- 
cers that occur here. 

The British have made a nice study on the frequency of cancer 
of the larynx over a period of the last 25 years, and they haven’t 
found a significant increase in cancer of the larnyx—nothing to com- 
pare with cancer of the lung. 

Now it is the same epithelium; it is the same individual. It is in- 
teresting, this variation, because the concentration goes right by the 
vocal cords and down in the lungs. That is another thing that is of 
considerable interest. 

Mr. Mrnsuaru. Doctor, one other question—a hypothetical one in a 
way. Assuming you took some of this cancer-producing agent that 
you have been talking about that is used on the Peking ducks, chtck- 
ens, and turkeys, and you put some of that on the arm of a human 
being or some other parts of his skin and it produced tumors or can- 
cerous tissue. Would you think that was significant ? 

Dr. Riepon. I would only say that it did produce it in man, but I 
would not conclude that everything that will produce it in a chicken 
you can transfer to man. 

Mr. Mrinsuari. Wouldn’t you think it was significant if they pro- 
duced cancer on human skin in numerous instances with this same 


agent about which you speak? Wouldn’t you think that would have 
some bearing on it ? 

Dr. Riepon. It would be an interesting observation, but I wouldn’t 
be able to conclude—just because they parallel each other—that this 
was “cause and effect.” In the skin of the duck we get one thing and 
in the trachea, we get another. 

Mr. Minsuaru. Even if it did 100 percent of the time in human 

Dr. Riepon. Yes. I would consider that as being a significant 
factor. But I don’t think it would prove that that is the thing, be- 
cause we don’t see too much difference between the skin of the duck 
and the skin of the chicken and the skin of the turkey and we find a 
different reaction, don’t you see, so that is why I am careful in draw- 
ing my conclusions. 

Mr. Mrnsuatu. I am talking about a human being now. 

Dr. Riepon. O. K., if you got it in a human being, I would say 
that this human being was acting like this particular animal. But 
I wouldn’t be able to say that it would act like all the other animals 

Mr. MinsHatu. We are not worrying about what it does to chickens. 
We are worrying about what it does to human beings. If it does this 
to a human being, wouldn’t you say that that is a cancer-producing 
agent on human skin especially if it produces cancer 100 percent of the 
time, don’t you think that is significant ? 

Dr. Rigpon. I certainly would. 

Mr. Minsuatu. That is the end of my question. 

Dr. Riepon. Sure, that would be the most important thing. If we 
could get some human beings to do this, it would be a wonderful ex- 

Mr. Minswary. I think some have. If you don’t think it would do 
it to human skin, why don’t you try it on yourself ? 

Dr. Rigpon. That is a very good point—for the simple reason that 
I feel hike, as a scientist, I could contribute more by trying to study 
and work out these things than to do something to myself and prob- 
ably cause death in the next 5 vears. 

So I don’t think it is a wise thing. 

Mr. Mrnsuatx. You have never tried to get any volunteers? 

Dr. Riepon. No; I never have. But I think it would be a swell 
thing to do. I don’t object. 

Mr. Minsuat. I am not volunteering. 

Mr. Kireorr. I would just like to inject here, as a fellow Texan, if 
the doctor seeks any volunteers, I would rather he would go to Ohio. 

Dr. Riepon. I have mentioned about the experimental procedures 
and some of the things you would have to watch out for. Then I 
would like to comment on the problem of the production of cancer in 
man and other pathological processes that might occur in man as a 
result of a carcinogenic agent—and to be specific we will talk about 
tobacco smoke. 

It is alleged that it is the cause of cancer of the ling. It is also al- 
leged that it produces heart disease. 

Since I am a pathologist and since I do autopsies and I look at peo- 
ple, examine tissues, I am a little critical of what we mean when we say 
heart disease. I know you have several things that produce heart 
disease. One of them is syphilis, another is a bacterial process, one 



is rheumatic heart disease, one is congenital heart disease, another is 
atherosclerotic heart disease, one is a heart disease you get with high 
blood pressure. ; 

When people say, “Well, it will produce heart disease,” I have to 
know what kind of heart disease they are talking about. So I think 
that it becomes a very important thing in evaluating this problem as 
to the specific disease processes that they relate to. 

It is very interesting to me to note that we have an agent that is 
alleged to produce cancer and any type of heart disease that you want. 
Cancer, as I know it—in man or the duck—is entirely different from 
heart disease. Here we have an agent that is producing both. We 
not only have that, but we have got it producing prostatic cancer. 

I just can’t see how you are going to connect this agent producing 
cancer in the lung, let us say, with a prostate. That is just too far- 
fetched for me, and that is why my conclusion has been that I don’t 
agree with what has been done. I can’t see that. I can’t see it by any 
stretch of my imagination. 

We know that hormones play a part in cancer. We know the age 
in which men get these cancers, and we know that women get cancers 
of the breast, and we know the effect of hormones on these things. 

So I can’t see how we can get all of this in tobacco to account for 
everything that we get, don’t you see. So that is the reason why I 
have difficulty in accepting these data. 

So, Mr. Chairman, I will close. I could go ahead and discuss this 
thing further, but I think this will give you the basis for my opinions. 

J understand that is what you would like to have. 

Mr. Buratrnix. Would you lke to have this report you have, Doctor, 
inserted in the record ¢ 

Dr. Riepon. It has been published in the Southern Medical Journal. 
(See appendix, exhibit 12, p. 583.) 

Mr. Biarnix. This is largely a résumé of other literature, is it not ? 

Dr. Rrepon. We have a review of that. We have an additional arti- 
cle which hasn’t been published yet, Cancer of the Lung From 1900 
to hte in which we review much more of the literature than what is 
in that. 

So that will give a basic idea of what we have, commenting on the 
observations of others. 

Mr. Buarnix. Any questions? Mr. Kilgore? 

Mr. Kizcorr. Doctor, I haven’t had an opportunity to go through 
this publication. It may answer the question. The study that you 
are doing, particularly with reference to what you described in the use 
of some of these agents on animals: Is that study carried on at the 
University of Texas branch at Galveston? | 

Dr. Riepon. It is, sir. 

Mr. Kincore. It is carried on under your direction, is it ? 

Dr. Riepon. Yes, sir. 

Mr. Kincorr. How many people have you associated with you in 
connection with this particular study ? . 

Dr. Riepon. I have in the laboratory of experimental pathology 
seven people. 

Mr. Kixcorx. In addition to the studies that you have made and are 
making in connection with the animal studies you describe, have you 
also made any evaluations on the incidence of lung cancer in patho- 
logical reports that have come to you in the hospital ? 


Dr. Riepon. Yes. In one of our earlier reports, we were studying 
the frequency of cancer in the white and colored. So from our study 
we found that cancer of the lung was less frequent in the colored than 
it was in the white. 

So we have made such studies. 

May I develop that point a little? 

Mr. Kincorr. Certainly. 

Dr. Rtepon. A few years ago the surgeons in the hospital got very 
excited about the number of cases of cancer they were seeing. So I 
said, “Well, now I am going to see what is happening here.” 

I began to check to see where these patients were coming from. I 
found out that—as you know-—-at the University of Texas we have a 
State hospital that brings in patients from all over the State. We 
were seeing that people were coming from a large area of the State 
into this particular clinic, don’t you see. 

It occurs in other clinics in the State. It occurs throughout the 
country in this way. We find that these doctors are the ones who 
write the papers for medical Journals, don’t you see. They are getting 
lots of patients concentrated there. This we figured results from a 
better cooperation between the University and the doctor out in the 
rural areas. It is better hospital facilities. It is better roads getting 
those patients into these clinics. 

That is one reason why we are concentrating these patients, we are 
seeing lots of them, in these centers. We have made a study that em- 
phasizes this problem. 

Mr. Kincorr. [ am certainly familiar with the fact that they fun- 
nel in—TI think it might be well to describe it—-the hopeless cases from 
many areas. 

Dr. Riepon. Yes, diagnostic problems that the men don’t have facili- 
ties to study. They send them m. We see them there, and it is an 
impressive thing. There is no two ways about it. 

Mr. Kricorr. In addition to the matter of affording them medical 
treatment, it affords clinical information to the medical students. 

Dr. Riepon. Sure. 

Mr. Kizcorr. What is the source of financing for your studies ? 

Dr. Rigpon. The sources of financing are this. In 1952 I believe 
it was the American Tobacco Co. gave me money for 3 years. Since 
that time the United States Public Health Service and the Tobacco 
Industry Research Committee have given me money. 

Now, let me say a word about how that is handled. That money 
comes to the University of Texas. I never see it. I draw on it, and 
when it is gone, it’s gone, don’t you see. I have to be responsible to the 
University of Texas for what is done. They send in a report on that, 
and I never do see the money. They fuss about the 15 percent over- 
head, you know, and they get that out of the grants. But I don’t 
ever see it. So that’s a very good point. It is a point that has caused 
considerable discussion because some people think it is a personal 
thing, that I get that money. I den’t get the money. It is just exactly 
like any other pharmaceutical house gives me money. I put it m the 
business office and I draw on it. 

That is the way the thing is handled. 

Mr. Mrnsnauu. Will the gentleman yield? How much money is 
that? How much is involved ? 


Dr. Riepon. It is just so little that I am ashamed to say. I got 
$7,500 from the American Tobacco Co. My grant for 3 years from the 
Tobacco Industry Research Committee is between $5,000 and $5,400, 
maybe. It is just in that area. 

Mr. Minsuani. What is the total amount that you received from 
them ¢ 
_ Dr. Riepon. I have received 3 grants for 3 years from the tobacco 
industry research committee. I believe it is either 2 or 3. I have 
got a new one that starts the Ist of July, and I no longer get the 
money from the American Tobacco Co. I have been getting money 
from the United States Public Health Service for several years. 

Mr, Minsiati. I am just concerned with how much money you 
have gotten from the tobacco interests in total. What is your best 
estimate as to how much you have received ? 

Dr. Ricpon. I can tell you exactly; $7,500 for 3 years, plus $5,000 
for 3 years. 

Mr. Minsnatyi. That is outright grants. Do they also give any fel- 
lowships out there ? 

Dr. Riepon. No; I don’t have any of that. 

Mr. Minsuaty. That represents all of the money you received ? 

Dr. Riapon. That is all the money I have received. 

Mr. Prarincer. Is the Federal Government any more generous 
with you? 

Dr. Riapon. Well, the Federal Government gives me a grant. It 
is about $5,000 or $6,000. I hope we get one of about $10,000 this 
September to carry on some of my work, don’t you see. So that is 
my budget, plus the money and the facilities that I have from the 
University of Texas, which 1s added to this. 

Mr. Kincorr. Doctor, on a little bit of a different subject, earlier 
when you were relating the increased incidence, or we will say the 
incidence of lung cancer, to the number of hospital beds and the 
number of doctors in the various communities, it occurs to me that 
that might also be related in an almost direct line to population, with 
minor variations, from one area of the country to the other. 

There would be, wouldn’t there, a pretty strong correlation between 
the number of hospital beds and the number of doctors and the 
population ? 

Dr. Rirepon. That is not a very good correlation, don’t you see, and 
that is why we are able to pick up this difference. In other words, 
in some of the Eastern States the ratio of hospital beds to population 
is different to what we have in Texas. So it is because of that that 
T can pick up that variation. Of course, you are aware of the fact 
that there have been many correlations made that go along with 
smoking. In 1925, it was automobiles. You correlated the cancer of 
the lung with automobiles. Then they said it is due to the tarring 
of the roads, and you can get a curve there. So it just depends upon 
what period of time you are in as to the correlation you use. 

Mr. Kireore. T think you mentioned that since 1939 the informa- 
tion contained on death certificates or the vital statistics with respect 
to the reports of deaths has contained a sufficiently detailed break- 
down on the types of cancer that you can get a pretty fair picture on 
the incidence of lung cancer. Assuming that situation, has there 
been any marked increase in the incidence of lung cancer since 1939? 


Dr. Riapon. We are seeing a tremendous number of cases of cancer. 
But now the question is: Is it an actual increase or is it an apparent 
increase? That is the thing that bothers me. 

Not having a baseline, don’t you see, I have difficulty in answering 
that problem. 

Mr. Kireors. It may be that there is an increase, and it may not be. 

Dr. Riepon. It may be, and it may not be. I don’t know any way to 
determine that. We just have to do the best that we can with what 
we have. But it does present that problem. 

Mr. Krucorr. One other question. You were discussing the produc- 
ing of skin cancer on these test animals after the trauma resulting 
from the plucking of the feathers; is it possible that the situation with 
respect to the relationship of smoking and lung cancer could be—I 
say is this possible, not is it probable—but is it possible that the exist- 
ence at repeated intervals or at repeated times of the cancer-producing 
agent on the lung tissues might combine with some sort of an inde- 
pendent traumatic condition in the lung very similar to the situation 
on the skin to explain the correlation between smoking and lung can- 
cer, making it a contributory rather than a causative relationship? Is 
that a possibility ? 

Dr. Ripeon. I think that that is a very definite possibility that 
should be explored. You are aware—or you may not be, not being 
familiar with this cancer literature—we have talked about influenza 
in the past. In 1919 they said, “We have got the answer to cancer 
of the lung, because it follows influenza,” and that was the idea at 
that time. Preceding that, along about 1890, they said, “It is due to 
tuberculosis.” You see, we were having lots of tuberculosis at that 
time. And you associate cancer of the lung with these things. 

That is an illustration of a change in the tissue, because you do get 
changes in the epithelium of what we might call metaplasia as a re- 
sult of infectious processes like influenza, and they felt that was the 
answer to the problem of lung cancer. | 

Silica was thought to be the cause of cancer of the lung; tuberculosis 
and influenza, aspirating the tar from the roads, and all those things 
have been one of the factors suggested. 

So, some people have felt very strongly that it was the chronic 
inflammation associated with tuberculosis that was the basis for it. 
That would fit in with your idea, as I see it. 

Mr. Kircorr. So, in general summary, your studies and your experi- 
ments have caused you to conclude that smoking may be a cause of 
lung cancer or it may not be? 

Dr. Riepon. That is right. We haven’t got the data to warrant the 
conclusion. That isthe way I see it. 

Mr. Krzcorre Thank you very much. 

Mr. Minsuaty. In other words, you don’t believe in statistics, but 
still you don’t want to become one yourself, is that it, by refusing to 
test this out on your own skin? 

Dr. Riepon. That is a very interesting approach to it. I think, if 
that could be arranged through legislation, that we could use these 
people in mental institutions for such as this; they absolutely are not 
going to be able to return to society. 

Mr. Mrinswauu. I don’t think you need any legislation. We out in 
Ohio have had volunteers in the Ohio Penitentiary who submitted 


themselves to medical science. I think in this case it would be a very 
worthy sacrifice to make. 

Dr. Riepon. I agree with you 100 percent. If that could be encour- 
aged, I think it would help us solve some of these problems, and we 
would know what 1s occurring in man and not mouse; don’t you see? 

Mr. Minsuat. I think we are going to have some testimony later 
on, Doctor, before this committee that will show that these cancer- 
producing agents will produce, with regularity, cancer on the human 
skin. You said that in itself would be significant. 

Dr. Riepon. It certainly would. But now you want to be sure to 
keep straight the different carcinogenic agents that you are talking 
about. I was talking about methylcholanthrane. You may be talking 
about some other chemical. 

Mr. MinsHauy. I am talking about the chemicals that are derived 
from cigarettes. 

Dr. Riepon. I have no information on that. 

Mr. Buatrnix. Doctor, did you use any carcinogenic substances from 
tobacco tars in your tests? 

Dr. Riepon. Yes; I used the entire tar. I didn’t try to break it 
down, because I am not in a position to break them down and get 
these different elements. I just used the whole tar. 

Mr. Buatrnix. What were the results when you used the whole tar? 

Dr. Riepon. We haven’t got any tumors. We haven’t found any 
irritation in the trachea of the ducks any different to those that used 
only the vehicle, which was mineral oil. 

Mr. Buarnix. Did you try it on any other animals? 

Dr. Riepon. No. The duck is the only one. I have put it on the 
skin of chickens, and I don’t get anything there. I discontinued that 
experiment. I haven’t tried it on any other animals. 

Mr. Brarnix. Did you write any report on that? 

Dr. Riepon. No. 

Mr. Brarnix. What is your conclusion, on the basis of your ob- 

Dr. Riepon. That experiment is still in progress. I want to repeat 
it. It will be, I think, 6 months or a year before that piece of work 
would be completed, so I feel that I can publish it. 

Mr. Bratnix. What I am trying to find out is, is there anything in 
cigarettes that could be considered as a source of cancer or inducing 
cancer? Is there anything at all that is deleterious or harmful in 
cigarettes, is what I am driving at? 

Dr. Riapon. I am no chemist and I can’t answer that. I can only 
say, upon what I have used in experiments that I have done, I haven’t 
been able to get anything out. But from a chemical standpoint, I 
am not in a position to answer that. I just don’t know. That is the 

Mr. Brarnix. The reason we are interested is because there is a lot of 
money in the American economy going first to produce and to promote 
the filters, and secondly, to purchase them. <A lot of money is in- 
volved in that alone. A lot of money is spent in advertising in imply- 
ing that it does serve some function—perhaps for protecting, that 
it does something. J am trying to find out why the filters. 

We have had two top witnesses—one for the tobacco industry, Dr. 
Little, who made a very fine presentation. But when it came to the 
subject of filters, he said, I forgot the exact language, but he indi- 


cated he was not at all concerned about them either positively or 

A lot of money is going then for the manufacture and the sale 
and the promotion and the consumption of something that a scientist 
of over 50 years’ experience, says, according to his “words, is of no 
consequence, either positively or negatively. 

Today we had another scientist who feels that filters could be of 
consequence if made efficient enough that they would reduce the vol- 
ume of smoke, and therefore the tars and nicotine; and that their sta- 
tistics show—I am referring to Dr. Wynder’s testimony of this morn- 
ing—that those who smoke less are least inclined to get lung cancer. 
If they smoke more, they are more inclined to get lung cancer. 

So you see, we are trying to find out some ‘basis for it. It may be 
perfectly valid. We would like to find some basis for the claims 
that are being made for filter tips. 

Dr. Riepon. As I see that problem, if we filter out, let us say, some 
tobacco tar, some is going on through. We don’t have any idea as to 
how much is necessary to produce cancer, even if it produces it, don’t 
you see. 

So suppose you filter out 50 percent. What are you doing? You 
don’t know the answer. 

Mr. Buatrnix. You say you have not been able to induce any cancer 
with the smoke containing the tars, without filters ? 

Dr. Riepon. That’s right. 

Mr. Biarnitx. Without any filters? 

Dr. Rrapon. That’s right. This is just the tobacco tar. 

Mr. Buatnix. You gave it full, without any reduction in volume, 
getting the full dose of the tars and all the condensed substances 
out of cigarettes ? 

Dr. Riagpon. Yes. So I think we should establish whether we have 
got anything there before we get so involved in this thing. I don’t 
know how we can get a quick answer to it. But that is a basic problem 
right there. 

Then we should know how much is going to be necessary to filter 
out. What would we accomplish if we filtered out 50 percent and a 
person smoked 2 cigarettes instead of 1% He would get the same 

So we have got to know some of these basic things before we can get 
the answer over here, it looks to me, as I see it. 

Mr. Buatnik. This is more of a side issue, but I am curious. It is 
true, if I have some understanding of what you are saying on the relia- 
bility of these statistics, that a man smoking three packs a day may 
smoke a third of the cigarette. But don’t you also think in terms of 
probabilities ? 

It is also likely that the man smoking one pack a day habitually 
smokes only a third of the cigarette. There is certainly probability— 
not specifically, you can’t say that— that every man will do it. 

Dr. Riapon. That is right. 

Mr. Briatnix. But in general if a man who smokes 1 pack versus 
a man with 3 packs, there is some sort of a measure—not absolutely 
precise, but not too rough—that the man who smokes 1 pack will be 
smoking only one-third the cigarette like the man who smokes 3 
packs, if you have a large group, or if your sampling is typical enough. 

So to protect you, we don’t know in either case, you see. 


Dr. Rigpon. But what about the large number that smoke and don’t 
get it, don’t you see. How are you going to figure those in? That is 
the thing that bothers me. There are a tremendous number of people 
who smoke three packs and they don’t develop cancer of the lung. 

So that must be evaluated into this overall problem as well as those 
that smoke three packs and get it. 

Mr. Buarnrk. Not to get into an argument, which I don’t want, but 
as a discussion to help clarify my thinking: If I recollect correcily, 
Dr. Wynder was not saying that all who smoke heavily—there will 
be many who smoke heavily who will never get cancer. There are 
many things they don’t know about it. 

But he did say emphatically there will be a larger number of those 
getting cancer who smoke the heaviest—a direct correlation. The 
less you smoke, the smaller the number that will get it. 

That was true of every group. It is true in the cities, it was true 
in the rural areas. It is true of every group if you tried a large 
enough sample. 

Dr. Riapon. I find this very interesting, on the next to the last page 
of the article that you have, to see many different diseases in which 
smoking is occurring. For instance, lots of people who have tubercu- 
losis smoked, trauma, a high percentage of those smoke, and benign 
tumors of the skin, lots of these smoke. 

J don’t know how to interpret that. 

Mr. Praprncer. How long did this study last, Doctor ¢ 

Dr. Rrepon. I started in in 1952, and it went to 1954, accumulating 
these data, compiled them. 

Mr. Prarrnenr. You mentioned on the previous page a clinical 
diagnosis on 12,000 hospital and clinical patients has been correlated 
with their smoking history and that “This will be reported more fully 
in a future publication.” Has that been done? 

Dr. Riepon. It hasn’t been done. There is a manuscript right there. 

Mr. Praprnerr. Can you tell us something about your results? 

Dr. Riepon. We are finding that a higher percentage of the people 
smoke regardless of what they have. We found a higher percentage 
of those with cancer of the lung smoking. Our results were just 
exactly what the others had. But we also found such a large number 
that smoke and didn’t have it until I have difficulty in evaluating that 
point, don’t you see. 

I don’t know what it means. The only thing that I can see is that 
there are some other factors that are involved in those cases that we 
don’t know. I think it would be important in evaluating the thing to 
learn something about that. That is the best I can do. 

Mr. Puarrnerr. I think almost all of the witnesses who have indi- 
cated that tobacco is a factor, have conceded that there are other 

Dr. Riepon. O. K. But the point is that it was alleged that 80 
percent of the apparent increase in cancer of the lung was due to 
smoking. That was Doll’s statement, and he got the ball rolling, 
don’t you see. And that is the thing that has occurred there. It is 
the tremendous number of cancers of the lung which are alleged to 
be due to tobacco with which I can’t go along on the basis of my 
knowledge of cancer and my knowledge of the statistical study. 

Mr. Prarincer. Incidentally, you say that the frequency of cancer 
of the lung is based upon records obtained from death certificates. 


Dr. Hammond yesterday citing his statistics, said that 79 percent were 
microscopically proven. He was addressing himself to this particular 

Dr. Ripon. That is a very good way. That is the only way we can 
get good data. It isa well-known thing that cancer of the lung is hard 
to diagnose. Dr. Weller, from the University of Michigan, has done 
an excellent piece of work. He died last year. He worked on this 
problem of cancer of the lung along in 1927 and 1928. So he was in- . 
terested in it and had done an excellent piece of work and commented 
on the necessity of doimg an autopsy, and a good autopsy, in order 
to establish the diagnosis. 

He wouldn’t even accept any of these diagnoses of lung cancer in 1927 
if an autopsy had not been performed. 

Gentlemen, at the time of death I have trouble making some of these 
diagnoses, to determine whether it is a primary tumor in the lung, or 
whether it has spread from some other point up to the lung. 

Mr. Puarrncer. I think Dr. Hammond conceded that point also, 

Are you familiar with the joint Report of the Study Group on 
Smoking and Health, Doctor? (See appendix, exhibit 6, p. 421.) 

Dr. Riepon. The only thing I know about it is what I have read in 
the paper. 

Mr. Puartnerr. Let me just cite the basis for their conclusions. 
They cite: 

At least 16 independent studies carried on in 5 countries during the past 18 

years have shown that there is a statistical association between smoking and 
occurrence of lung cancer. 

They say also that— 

epidemiological studies cannot always indicate that cigarette smoking cannot 
account for all cases of epidermoid cases of cancer of the lung. 

There are other causes, the most important of which are probably various at- 
mospheric pollutions ; as in other diseases, various others such as sex, nutrition, 
and heredity may modify its occurrence. 

Two prospective studies further suggest that cessation of smoking by chronic 
smokers decreases the probability that such individuals will develop lung cancer. 

They say that the— 

epidemiologic evidence is Supported by laboratory studies on animals. At least 
five individual investigators have produced malignant neoplasms by tobacco- 
smoke condensates, and they say that studies on pathogenesis of human-lung 
cancer also are compatible with the causal relationship, and fluorescent substances 
present in cigarette smoke have been Shown to enter the cells of the buceal mucosa. 

And they finally conclude that— 

the sum total of scientific evidence establishes beyond reasonable doubt that 
cigarette smoking is the causative factor in the rapidly increasing incidence of 
human epidermoid carcinoma of the lung. 

This study was sponsored by the American Cancer Society, the 
American Heart Association, the National Cancer Institute, and the 
National Heart Institute and was the basis for the Surgeon General’s 

To the untutored layman, that seems to be a pretty formidable array 
of evidence, and certainly is impressive. I just wondered whether you 
would care to comment on the basis for these conclusions by this joint 
study ? 

Dr. Riapon. Yes; J would. 


In the first place, in the United States Public Health Service there is 
a wide variation with regard to the role of cigarettes and cancer. You 
have certain ones that say it just can’t occur, and others who say that it 
might be, but it hasn’t been proven. So you have got a split in there 
from the people that I know in that organization. 

So you can’t disregard one group and say “Well the others are right, 
and we will base our opinion on that.” I personally have tried to take 
all this work into consideration in arriving at my conclusion. 

Secondly, there may be 5 studies, but I think it would be of value to 
check into it and see if this work on the mouse was confirmed and 
whether they got 50 or 75 percent cancers after treating the skin, or 
whether they got 1 mouse out of a group of 100 to produce a cancer. 

I think that factor needs to be evaluated—just how much—and then 
J think they should evaluate how many people repeated this experi- 
ment on mice and didn’t get the same results. 

They took the positive approach to it, and everything is positive 
there and no comment on the negative side. 

As I see it, they didn’t even mention about what Schrek said. They 
put him in the group, and he is the man who is really going along with 
us on it. But they didn’t quote him as saying if it 1s anything, it is 
certainly a poor agent. 

Mr. Puiaprinerr. Schrek is cited as a reference in the article. You 
are not suggesting that all of the evidence wasn’t considered in arriving 
at this conclusion, are you ? 

Dr. Rrepon. I don’t know what evidence they had. JI am comment- 
ing on the fact that in that report they didn’t bring out this other side 
of the situation. They just took the positive side and didn’t discuss 
the negative side of the thing. 

Had they come out with an equal study of the people who didn’t 
agree with that, to me it would have been a much better report. 

Second, I would like to comment on another point— 

Mr. Priaprneer. I understood you hadn’t read this, Doctor. 

Dr. Ricpon. But you read it to me. 

Mr. Puarrncer. But you didn’t read the rest of the report. There 
is an appendix here which is some 3 or 4 pages long. They discuss a 
number of other studies. 

Dr. Rrepon. That was published in Science, wasn’t it? 

Mr. Piarincer. That’s right. 

Dr. Riepon. I saw it in Science. Your comment on this regression 
is a very interesting thing. That brings up a basic problem in the 
consideration of neoplasms, and that is this, that in experimental 
work—and this was done by Andivant here at the National Cancer 
Institute, he put a pellet of methylcholenthrane into the subcutaneous 
tissues of the mouse and let it stay in, some animals for a week and 
took it out, and in others let it stay for 2 weeks and took it out. 

Then after a month, they took it out at other mice. What he found 
was that after it stays in there for a period of time, although you 
remove it, the animal goes ahead and produces a cancer. 

So it is an interesting point to me that if the mechanism of cancer 
due to carcinogen as alleged in tobacco acts differently because some 
say that if they cut down on the number, or if you stop smoking, the 
number of cancers will likewise decrease. This is different to the work 
on other cancer-producing agents, methylcholenthrane specifically. 
This is a very interesting point, I think. 


I don’t know how that fits into this report. 

Mr. Puapineer. In citing the various factors here leading up to their 
conclusion of the evidence that they have accumulated, they go on to 
say, as you may recall, there are a number of areas for a number of 
questions that are unresolved on which research is continuing. 

Dr. Riepon. Yes. 

Mr. Buatnix. Thank you very much, Dr. Rigdon. 

The hearings will be continued on Tuesday morning at 10 o’clock 
in the same room, so for today the committee is adjourned. 

(Whereupon, at 3:25 p. m., the committee adjourned, to reconvene 
at 10 a.m. Tuesday, July 28, 1957.) 

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(Filter-Tip Cigarettes) 

TUESDAY, JULY 23, 1957 

Washington, D.C. 

The subcommittee met, pursuant to recess, at 10 a. m., in room 100, 
George Washington Inn, Hon. John A. Blatnik (chairman) presiding. 

Present: Representatives Blatnik, Mrs. Griffiths, Meader, and Min- 

Also present: Jerome S. Plapinger, subcommittee counsel; Curtis 
E. Johnson, staff director; and Elizabeth D. Heater, clerk. 

Mr. Buarnix. The subcommittee on Legal and Monetary Affairs of 
the House Committee on Government Operations will continue with 
public hearings on the role of Federal Government agencies in the 
effective administration and enforcement of law and regulations per- 
taining to false and misleading advertising. 

This morning we have for the first time the Government witnesses, 
we have our two top medical authorities. 

We welcome you, Dr. Burney and Dr. Heller. 

We have Dr. LeRoy Burney, the Surgeon General of the Public 
Health Service, Department of Health, Education, and Welfare, and 
Dr. John R. Heller, Director of the National Cancer Institute. 

The first two hearings held on Thursday and Friday of last week, 
Doctor, we heard witnesses, pro and con, from the professional world, 
the object being not to go into the medical problem with a view of try- 
ing to make a medical determination. That is neither within the com- 
petence of the committee nor within its legal jurisdiction. 

Tlowever, we do feel it is essential and vital that we have, although 
in somewhat summary and general terms, a complete statement on the 
pros and cons of the problem of the effect on the health of the public. 

To do that more correctly, and in better perspective, we felt we 
should have a background of the latest available medical opinion on 
the subject, and against that we can get the true relative proportions 
of the nature of the problem and whether or not there is a Federal 
responsibility for you men in the executive offices, and for us in Con- 
gress in the legislative field, to do something about it. 

We will first hear Surgeon General LeRoy EK. Burney. 

Dr. Burney, we welcome you this morning. Will you please give us 
a brief introduction, which I am sure is well known to most of uw aout 
for the record a brief summary statement of your background and your 
record of experience, and then proceed with your statement. 




Dr. Burney. Thank you, Mr. Chairman, and members of the sub- 

I was appointed Surgeon General about 1 year ago. My previous 
experience has been almost entirely in the United States Public Health 
Service. I have been a career oflicer in the Commissioner Corps for 
26 years, coming into the Public Health Service in 1932, although I in- 
terned in the service in 1930. 

Following that I had a year at Johns Hopkins University in the 
School of Hygiene and Public Health, and then came into the regu- 
lar corps of the Service. 

I served in various assignments since then in the Public Health 
Service, and was detailed to Indiana as a State health commissioner 
of that State for 9 years. I came back to Washington in 1954, as an 
assistant surgeon general, deputy chief of the Bureau of State Serv- 
ices, and, as I say, last August was appointed by President Eisenhower 
as the Surgeon General. 

With your permission, Mr. Chairman, I would like to read this very 
brief statement, and will certainly be very pleased, together with Dr. 
Heller, who is much more of an expert in this area than I am, to an- 
swer any questions which members of the committee might have. 

The Public Health Service, Department of Health, Education, and 
Welfare, has participated actively in research on lung cancer since 
the establishment of the National Cancer Institute in 1937. This par- 
ticipation has included research at the Institutes, grant-supported re- 
search, in institutions outside the Federal Government, and close ad- 
ministrative and informational lhaison with organizations and with 
investigators concerned with the problem. 

Up to 1952, emphasis was placed on laboratory investigations on the 
genetic and other factors in lung tumors of mice and other animals, 
the histogenesis of lung tumors, and environmental carcinogenesis 1n- 
cluding the search for carcinogens in atmospheric dusts and in tobacco. 
A recent selected bibliography of contributions by the staff lists over 
75 titles. 

Since 1952, the emphasis has turned toward epidemiological investi- 
gations. One such retrospective study by the staff on smoking and 
cancer was published in 1953. Another one, supported in part by a 
grant, was published in 1954. A national survey of tobacco-smoking 
habits in the United States was conducted with the Bureau of the 
Census and published in 1956. 

Mr. Puarincer. May we have a copy of that for the record, please? 

Dr. Burney. I will be happy to supply you with a copy. 

(See appendix, exhibit 7, p. 431.) 

Dr. Burney. Several statistical analyses of available data on the 
subject were also prepared. | 

In light of these and other studies the Public Health Service stated 
on July 12 (see appendix, exhibit 8, p. 554) that it is clear there is 
an increasing and consistent body of evidence that excessive cigarette 
smoking is one of the causative factors in lung cancer. At the same 


time, we expressed our belief that heavy and prolonged cigarette 
smoking is not the only cause of lung cancer. 

Three major investigations on the relation between smoking and 
lung cancer are now in progress by the Public Health Service staff. 
The first is a large study in collaboration with the Veterans’ Admin- 
istration of the smoking habits of 220,000 veterans of World War I. 
The second is a national retrospective analysis of lung cancer in 
women, and its relation to smoking. The third is a national survey 
on the relation of occupation and lifetime residence, as well as smok- 
ing, to lung cancer. The method for this study has been tested in 
Pennsylvania and found to be feasible. 

Since 1952, the Public Health Service has not undertaken in its 
own facilities direct laboratory studies on tobacco. Close liaison 
with the American Cancer Society and many other individual investi- 
gators has led to the judgment that such studies are being pursued 
with sufficient resources, and that additional expansion is not required. 

Research work on tobacco products and on filters at present is being 
supported by a number of industrial concerns. A number of requests 
for grants also have been made to the American Cancer Society. 

Insofar as cigarette filters are concerned, research data available 
to the Public Health Service are insufficient to warrant a conclusion 
at this time. 

Modification of cigarettes so that their harmful effects would be 
reduced is of obvious importance to public health. It has been pro- 
posed, theoretically, that such modifications could be achieved in 
three ways: (1) by changing the tobacco leaf and other initial con- 
stituents of the cigarette, (2) by reducing the temperature of the 
burning cigarette, and (8) by the removal of certain constituents 
from the smoke. The last method, of filtration, preferably should 
remove harmful materials from the smoke and retain those materials 
that provide smoking pleasure. . 

It is apparent that further research, both on the general question 
of tobacco and its relationship to lung cancer, and on the question 
of filtration or other means of modifying cigarettes, is needed. The 
Public Health Service is prepared, of course, to play its part in this 
research, of importance to industry, to our economy, and to the health 
needs of the people of the Nation. 

Thank you, Mr. Chairman. 

Mr. Buarnix. Thank you, Dr.Burney. 

Dr. Burney, Dr. Heller’s testimony will tie in and give the scien- 
tific details to support the general statement you have made? 

Dr. Burney. Yes, sir. 

Mr. Buarnix. I suggest you proceed right on with the statement 
and then we can come back with our questions. 

Dr. Burney. That will be fine, Mr. Chairman. ' 

Mr. Buarntx. Dr. Heller, we welcome you to the committee this 
morning. Would you give us for the record a short biographical 
background of your professional background experience and then 
proceed ¢ 

Do you have a written statement, Doctor ? 



Dr. Hetier. I do not, Mr. Chairman. I am prepared to answer any 
particular questions you or the members of the committee may have 
and provide any additional information you or others may wish. 

Mr. Chairman, I am, like Dr. Burney, a career medical officer in 
the Commissioned Corps of the Public Health Service. I have been 
in the Public Health Service approximately 26 years. During that 
time my activities have been primarily in the field of preventive 
medicine and public health. Durimg the war I was Chief of the 
Venereal Diseases Division, which played a very active role in a very 
active program. 

In 1948 I was appointed Director of the National Cancer Institute 
and have served in that capacity since, up to the present. 

ITamalso an Assistant Surgeon General in the Public Health Service 
and have been primarily interested in medical research administra- 

Mr. Chairman, I might amplify, for the information of the com- 
mittee, one point which Dr. Burney mentioned; namely, the prospec- 
tive study among veterans of World War I, upon which no report has 
been made. This study, in my judgment, is a very important one and 
one which should elucidate many angles of.this problem generally. 

Mr. Prarincer. This is still a statistical study ? 

Dr. Heiter. It is a statistical study; that is correct. It is prospec- 
tive in the sense that we take a group of people and follow them to 
find what happens to them from the standpoint of health. 

There were approximately 290,000 men of World War I who had 
national service life insurance. Questionnaires were furnished them 
through the cooperation of the Veterans’ Administration. Part of 
the questionnaire incorporated smoking habits of this group. 

The questionnaire had other features, such as occupation and other 
elements which probably should be of usefulness and value in con- 
sideration of their health history. 

The reason that recipients of national service life insurance were 
included is that when they die, someone claims the insurance. We 
have knowledge of the death fairly promptly. Frequently they die 
in veterans’ facilities and frequently post mortem examinations are 
performed. We, therefore, have a fairly accurate medical back- 
ground upon which to append an analysis of these cases. 

These individuals, of course, at this age group are dying at an 
almost predictable rate, something on the order of perhaps 5,000 per 
year, with an increasing increment each year. 

This study has been progressing now about 3 years, or 3-plus years. | 
We have made some preliminary checks and the data which are de- 
rived from this study would seem, in general, to parallel other pro- 
spective studies for men of this age group. | 

The importance of this study is that these individuals are spread 
over the United States geographically and represent a variety of oc- 
cupations. Of the 290,000, some 260,000 answered the questionnaires 
and we have now about 220,000 whom we are studying because their 
questionnaires are complete and otherwise statistically significant. 

We hope to make a preliminary report on these data, these studies, 
probably next spring. This should give us considerable insight into 


the problems generally of smoking and health, among other things. 
It may give us some additional insight as to the types of individuals 
who die from whatever diseases, as correlated with their smoking 

This study, gentlemen, is another, but probably the best prospective 
study, and one upon which we are depending to give us additional 
information to enable us to understand better and more intelligently 
the entire problem so that additional programs might be implemented, 
if necessary. 

Dr. Burney has indicated the statement he presented on July 12, 
which reflects the best judgment that we of the National Cancer Inst1- 
tute and others of the Public Health Service are capable of rendering. 

We believe that this problem of smoking, particularly excessive 
cigarette smoking, is one which needs to be brought to the attention 
of the American public as being a health hazard, the magnitude of 
which we are not completely prepared to state at this time. 

Previous testimony before this group would indicate that it is 
enough, certainly, to direct our attention to the problem, and for us as 
health people to undertake every action that we know to take in order. 
to find out more about the problem leading toward possible remedial 

Mr. Chairman, I believe that is about all I have to comment upon at 
this particular time, since my role was that of being in a position to. 
assist in answering questions, or present any additional information 
which you or your committee members may wish to have. 

Mr. Buatnix. Thank you, Dr. Heller. 

Doctor, did you give this statistical study which you have under- 
taken with the veterans of the First World War—there is a larger. 
group than Dr. Hammond has in his statistical groupings. His 
was about 186,000 and yours is about 260,000. 

Dr. Heuer. Mr. Chairman, that is correct. Dr. Hammond said it 
was something like 186,000 or 188,000. Our studies from a statistical 
viewpoint will consist of better than 220,000, although we have re- 
ceived replies from 260,000. However, we had to eliminate some as. 
being not desirable to include in the study because of insufficient. 
information or data which otherwise would render them statistically 
invalid, so that our study will represent 220,000, but is pretty well 
distributed over the United States. 

The Cancer Society prospective study is an excellent study, and 
reflects a statistical sample of 9 States involving 394 counties. I 
wouldn’t say this isn’t statistically valid. I believe that it is. Our 
study in which we are very much interested, and which we believe 
will be significant, is a larger national study and comprises the entire. 
country, and we believe that its real significance will be the additional 
number of post mortem examinations we will have which will com- 
pletely define the diagnosis which is made. However, the Cancer 
Society study did have a very good sample of post mortem examina- 
tions to indicate that correct diagnoses were being made and, there-. 
fore, could be established as being statistically valid. 

Mr. Buatrnix. You feel that these statistical studies do have merit, 
and are positive in their findings? The reason I ask that question is. 
that it was indicated by some of the medical witnesses last week that 
Dr. Hammond’s study was merely a statistical study, and gave no. 



proof of smoking being a direct causative factor in the inducement 
of lung cancer. 

Dr. Henier. Mr. Chairman, I believe that statistical studies are 
worth while in the hands of ood statisticians, in the hands of compe- 
tent people, who interpret the studies. They are tools in the hands 
of the public health administrator and epidemiologists, and have 
proved exceedingly valuable in the assessment and management and 
control of other diseases, such as polio, syphilis, tuberculosis, and 
other diseases which for the most part are fairly well under control. 

We therefore believe that such statistical studies are extremely 

valuable and extremely significant, and it is our belief that on the 
basis of the studies which have been presented, and of which you have 
information from testimony of others, these studies reflect a situation 
of which we must take cognizance, and which considered in connection 
with laboratory studies, “br ought about the statement the Surgeon 
General made on July 12, 1957. 

Mr. BuaTnix. Doctor, as head of a very important Government 
health agency dealing directly and almost exclusively with cancer, 
its origin, nature, and possible cure, what would be your official recom- 
mendation, your official thinking on tobacco as a source of cancer- 
inducing substances ? 

Dr. Henier. Mr. Chairman, it is our belief, on the basis of the in- 
formation which is available to us—and we have indicated a mounting 
evidence that when cigarette tobacco is burned (pyrolysis is the 
technical name) at about 800° Centigrade, we believe there is a chemi- 
cal change in certain hydrocarbons in tobacco which produces certain 
cancer-causing compounds. We do not know which of these com- 
pound is the culprit. We do not know whether it is a combination of 
these compounds, but we believe from the best knowledge that we have 
at this time that the cancer-causing properties or agents are in the tar 
fraction in smoke condensates. There is reason to believe that these 
are some of the higher polyclic, many ringed, hydrocarbons, which 
are very complicated hydrocarbons, and about which we need to know 

At present much research is going on in several parts of the world, 
and in our own country, on these very important and very compli- 
cated chemicals, and we hope that they can be chemically character- 
ized, they can be identified more precisely, and their role or possible 
role in the production of factors in the causation of lung-cancer can be 
more precisely defined. 

It may be that there are combinations of such compounds, it may 
be that some promoting factor which interacts with another substance 
or compound is responsible. 

These are some of the things, Mr. Chairman, that we believe must 
be established before we can precisely put our finger upon all of the 

We do believe, however, that at this juncture enough is known and 
enough has been demonstrated from laboratory and from epidem- 
iologic investigations that we, as Federal health officials, should direct 
to the public information concerning these compounds and rely upon 
the laboratory, rely upon other investig ators throughout the country, 
and, in fact, throughout the world, for additional information in order 
that we may be better prepared to know what are the next steps that 
might be taken. 


Mr. Buarnrx. How would you reach the public to disseminate in- 
formation, especially when you have the competition of this terrific 
advertising encouraging all people to smoke? If you are fat, smoke 
and you will reduce. If you are weak and lethargic, smoke and it 
will pep you up and you can keep up with the athletes. 

Dr. Herter. With your permission, Dr. Burney can speak on that. 

Dr. Burney. Thank you, Dr. Heller. 

Mr. Brarnirx. Dr. Burney, please. 

Dr. Burney. 1 don’t know, Mr. Chairman, that we are competent 
to answer that particular question. Weare primarily a Federal health 
agency; naturally, we have a responsibility in health education, in in- 
forming the public as to health facts which influence their own indi- 
vidual health needs. That is the reason we felt a responsibility to put 
this statement out at this time. 

As Dr. Heller said, we felt that, as a result of the research we had 
done, and that others had done, at this time there was increasing and 
consistent evidence that this excessive and prolonged cigarette smok- 
ing was one of the causative factors. 

Now, we, as you know, have sent out this statement together with 
the backup information to the State and Territorial health officers, and 
to the American Medical Association, suggesting they pass that infor- 
mation on to their State medical societies and local medical societies 
and local health departments. 

We recognize that this may not be sufficient. On the other hand, the 
facts have been furnished to the public through the press, as a result 
of this statement, together with the facts brought out in your hearings, 
and the State and ‘Territorial health officers have definite responsibili- 
ties relative to public information and health education. 

I would agree with Dr. Heller that our position at this time, I think, 
relative to this whole matter, is that there is a lot that is unknown in 
this area, It is a controversial area in which some well-known sci- 
entists have opinions which differ from some of the other people whom 
you have heard in these hearings. 

Our position is that we have informed the public through the excel- 
lent coverage of the press, radio, and TV. We have informed the 
official health agencies in the States who are responsible for this area, 
and we have informed the American Medical Association, recognizing 
that many people will go to their own physicians for advice. 

We believe that is as far as we should go at this time until and 
when we have additional information. If, for example, next spring we 
have some definite findings coming from this survey, then I think 
we have an obligation and responsibility to make those facts known, 
and any additional information that may come out. 

Mr. Buarnirx. Doctor, the British, we understand, are circulating 
posters through local health authorities, samples of which are included 
in the July 26 issue of U. S. News & World Report, accompanying 
your interview, Dr. Heller, on the truth about smoking and cancer. 
(See appendix, exhibit 9, p. 558.) Would that be a proper function of 
the Government, in view of the concern expressed here as to the serious- 
ness of smoking ? 

Dr. Burnry. I don’t believe so, Mr. Chairman. In the first place, 
the British Ministry of Health is a centralized organization. In other 
words, the district health departments are really branches of the Minis- 


try of Health, whereas in this country the States are sovereign in mat-- 
ters of health, and we have certain interstate responsibilities, but are: 
not the directors or administrators of State and local health depart- 
ments; so, there is that difference. 

In other words, when the British Ministry of Health prepares post- 
ers and sends them out to their district health officers, they are sending 
those out to their own employees over whom they have administration. 
We have never in any of our public health programs, whether it is the: 
Salk program or the fluoridation program, prepared that type of post- 
er, and so forth, to send to the States for distribution. We have some- 
times helped them in the preparation of material, but they, in turn, 
do their printing and put their own byline on it and that sort of thing. 

Mr. Buatnrx. Would, perhaps, labeling on the package containing 
the articles itself help? For example, I notice rather innocuous sub- 
stances, such as “low salt content,” in articles purchased for saltless: 
diet, and I believe the bottle or the product is required to be labeled 
with a complete description saying there is a salt content of a certain 

figure. With regard to beer, they indicate 3.2 percent alcohol. 

Now, why are they compelled to label the contents of small amounts 
of things that are not really harmful? Do you think there is any 
validity to the recommendation that, perhaps, you ought to have a 
label on a cigarette package saying the total content does not exceed 17° 
milligrams of tar, or so much nicotine? Would that help in passing” 
on information to the people? If it is a filter-tip cigarette, should it 
contain a label saying, ‘This filter removes 10 percent of the tars, or 
removes 20 or 30 percent,” so the people have some idea of how much 
protection or how much filtration they are getting from the filtered 
cigarette? Would something like that, do you think, be a sound sug- 
gestion ? 

Dr. Burnry. We, as you know, do not have responsibility for label- 
ing, and that sort of thing, but if the Federal Trade Commission—in 
answer to your question, my thought would be, and Dr. Heller is able to 
add or subtract to this—we do not have sufficient evidence at this time 
in the identification of the agent, and the relationship of that agent 
to, perhaps, cofactors, whether it is air pollution or what else it might 
be, as the causative factor in this. In other words, even though I am 
firmly convinced that we were right in making this statement at this 
time, and in letting the public know that, in our opinion, we believe 
there is a relationship between excessive and prolonged cigarette smok- 
ing, I do not believe that we would be on firm ground in recommending 
such a warning sign at this time until-we have much more specific 

Mr. Puartnearr. This wouldn’t be a warning, Doctor; this would 
merely be a statement that “this cigarette contains blank milligrams 
of tar and blank milligrams of nicotine.” What would be your objec- 
tion there ? 

Dr. Burney. I, personally, wouldn’t see any objection to that. _ 

Mr. Buarntk. I notice along the same line, Doctor, many medicines 
for the common cold; many of them will have a label on them saying, 
“You take | tablet every 4 hours, not to exceed 6 in any 36-hour period.” 
That is just anexample. “One every 4 hours, not to exceed 6 in every 
36 hours.” Suppose you had a pack which said, “Not to exceed 18 or 
15 in any 24-hour period,” as a threshold? How will the people get 
these facts unless you have them printed on the package ?. 


Dr. Burney. I am not sure too many of us read too much of the fine 
print on anything when we buy it, as far as that is concerned. Also, 
I think there is a little difference between taking a medicine for a 
periodic ailment as contrasted to the matter of smoking, which most 
of us enjoy and which we do routinely. I enjoy smoking myself, al- 
though I smoke a pipe and have for about 15 years. I think there is 
a little bit of difference, Mr. Chairman, between labeling pills or other 
medicines, which we take occasionally for something, as contrasted 
to this. I would question whether too many people would read the 
fine print. 

Mr. Buarnix. Doctor, getting back to the main thing that concerns 
me, Dr. Little, speaking in opposition, more or less, on behalf of the 
tobacco industry—and we will have to get his exact quote, but, in es- 
sence, he said there was not only no evidence proving there was any 
substance in the cigarette, or in the smoke of a cigarette, that would 
induce or tend to induce cancer, but neither was there anything in 
the smoke of the cigarette which might be considered harmful to the 
body. That is his general position. 

Then he followed up in answer to my question, “Then why the fil- 
ters?” He said he doesn’t know; he is not interested in filters, and 
regards them as a thing so inconsequential that they are of no concern 
at all. That is his position. He is a scientist, a medical man, an 
adviser to the tobacco industry. 

What we are trying to find out, and we hope to do it before the 
week is over, is: Why the filters? If we accept your statement, that 
there is a rather substantial significance to the statistical relationship 
between heavy smoking and prolonged smoking, and the high incidence 
of deaths in lung cancer, if that is true, then how effective are the fil- 
ters? How effective are the filters? What do they filter? What do 
they remove, and how much do they remove? . 

What I am trying to get to, Doctor, What is the responsibility that 
falls upon those of us now representing the Government—you in the 
executive agencies, we in the legislative branch, in protecting the 
health of the people and discharging our responsibilities in protect- 
ing the health of the people, in this case from false or misleading 
advertising, that encourages them to smoke filter-tip cigarettes, that 
gives them some notion that they are being in some way protected 
or that something is being filtered. What is our responsibility, or 
is there any Federal responsibility there? 

Mr. Burney. May I refer that to Dr. Heller, Mr. Chairman ? 

Mr. Buatnix. Dr. Heller. 

Dr. Hetier. Mr. Chairman, as indicated in Dr. Burney’s opening 
statement, we have not ourselves undertaken any definitive research 
in filters. It has been our viewpoint that there is a desirability in 
elucidating the fundamental problems in this question of excessive 
smoking and lung cancer, which by no means depreciates the possible 
importance of filters. 

We do not know what in the tars cause, or represent one of the 
causes, in the producing of lung cancer. Filters, for the most part, 

are made up of cellulose acetate, and, as I am informed the tightness 
of the filter is the “gimmick” involved in filtering out the smoke. 
Obviously, since the tars, or the condensates from the smoke contain 
the material believed to be carcinogenic, anything that filters or strains 


these tars would prevent this material from getting down into the 
bronchi, or the tubes of the lungs. 

Now, "the original filters, I believe, were found to filter out some- 
where in the area of 40 to 50 percent of the smoke. I am informed 
that the company that originated this filter found that the cigarette 
was not as acceptable to individuals as they would hope because some- 
thing was wrong with the taste. They missed something. Therefore, 
as I understand it, there was a loosening up of the filters; the manu- 
facture was so adapted that smoke could get through more freely, and 
tars and smoke condensates would go through. 

I am informed at present that filters will eliminate something on 
the order of 15 to 20 percent of the smoke and, therefore, a propor- 
tionate amount of tar. 

Tt has also been stated, as you have heard from previous witnesses, 
that in order to compensate for the possible loss of taste and the loss 
of effectiveness of cigarettes, that some different types of tobacco were 
introduced, and in some instances, that result was an increase in 
amounts of tar as compared with that originally obtained in non- 
filter cigarettes. 

I do not know whether or not this is true. We have not done this 
work in our own laboratories, but I believe the work has been done 
by responsible individuals under circumstances which would lead one 
to believe the work is good. 

We do not know, Mr. Chairman, that any filter can selectively sort 
out that component or components in the tars which are responsible. 

As I related earlier, there may be a promoting factor involved which 
along with the tars is responsible, or partially responsible, for lung 
cancer in certain individuals. Therefore, as far as my knowledge goes, 
I would say that the important thing is to find out what is in the 
tobacco to chemically characterize those constituents which we be- 
lieve to be incriminated. If it is possible to filter them out, I think it 
is perfectly acceptable and proper. I do not know what is involved 
from the advertising viewpoint, where filters are concerned. I do 
not know the claims of companies for the virtues of filters, whether it 
provides a cooler smoke and that sort of thing. 

But I do know that we are intent, as scientists, upon obtaining the 
fundamental basic information concerning those things which cause or 
tend to cause lung cancers. Then the proper preventive steps can be 
taken, and we hope soon. We have no desire whatever to join the 
antitobacco league. As far as we are concerned, if people enjoy 
smoking, and can do it with little or no hazard, that is perfectly fine. 
We do feel, however, that as long as there is an agent which is pos- 
sibly causing lung cancer, or is one of the causative factors, we should 
undertake studies and to assist in supporting studies which will be 
directed toward finding out these compounds, or the compound in- 
volved in this process. 

Mr. Chairman, I am not sure your question can be completely, 
directly, and thoroughly answered, but that represents a reasonable 
attempt on our part. 

Mr. Buatnrx. You would, then, recommend further research on 
the part of the Government to find out more about what substances 
in the cigarette cause cancer, and perhaps how that substance may be 
removed or reduced to protect the people ? 


Dr. Hetimr. By Government, Mr. Chairman, by others who are 
interested, and by Government support of research, which as you 
know is one of our traditional roles. 

Mr. Buarnrx. How much is the Federal Government spending, it- 
self, either directly or through grants to other independent research 
groups, or universities in the form of erants for this cancer re- 
search ? 

Dr. Hetier. Mr. Chairman, I am unable to give you that figure. 
Tf you will allow me to, I will insert it in the record. . 

Mr. Prarincer. May we have that by year, Dr. Heller ? 

Dr. Henumre. Yes. 

Mr. Praptnerr. May we have the names of the grantees ? 

Dr. Herter. Yes. Would you like it for the last 5-year period ? 

Mr. Prapincer. That would be fine if it is not too much trouble. 

(See appendix, exhibit 10, p. 572.) 

Dr. Burney. These would include other causative agents that might 
produce cancer or lung cancer. 

Mr. Buarnix. Are other governments concerned about excessive 
smoking as a possible cause or source of cancer? Could you name the 
governments, give us a brief idea of what they are doing? 

Dr. Herier. Yes, Mr. Chairman. We have knowledge of sherills 
on the part of individuals in nine different countr les, such countries 
as England, Finland, Sweden, the Netherlands, France, and Italy. 
Four governments now have put out a national statement concerning 
their alarm, or I should say presenting information to the public con- 
cerning this question, and their alarm over the causative factors in- 
volved in excessive smoking. These four countries are Great Britain, 
Sweden, the Netherlands, and our own. 

Great Britain, I believe, was the first to come out in about 1954 edith 
a statement. Only recently the Medical Research Council of Britain, 
a very distinguished and authoritative body, has come out with a 
more definitive attitude toward this entire question, and this has 
resulted in the action on the part of the Ministry of Health to which 
you referred earlier. 

The Netherlands has put out an official statement saying they 
believe that excessive cigarette smoking should be brought to the 
attention of the public and individuals should be guided accordingly. 

Sweden has put ont a similar declaration. To the best of my knowl- 
edge, no other countries have come out with an official document, or a 
statement which reflects official attitude. | 

The work that is being done, Mr. Chairman, in other parts of the 
world to some extent parallels that going on in this country. They 
have approached the problem of the constituents of tobacco tars in a 
slightly different manner. In France, for example, Dr. Latarjet and 
his associates in Paris have been primarily concerned with how much 
benzpyrene may be formed from the burning of cigarette paper. 

Now, Mr. Rand, and his associates in Cleveland, in this country, 
have been similarly preoccupied. 

The group in England had been concerned with air pollution, with 
the correlation between excessive smoking and individuals subjected 
to heavy pollutants in the atmosphere. ‘They also have been working 
on 3,4-benzpyrene in tobacco tars. Their results, in general, confirm 
that of Dr. Wynder and his associates in this country, and also those 
of Arthur D. Little in Boston. 


There are 4 or 5 individuals in this country who have been working 
in this area, and we can expect in the future that additional good 
work will originate from these areas. 

I would say, Mr. Chairman, and members of the committee, that 
one of the very hopeful things about this problem is the willingness 
of the investigators throughout the world to share quickly their in- 
formation with us, and we in turn share with them. They recognize 
that this is a problem which is international in scope. As a matter 
of fact, the incidence of lung cancer in England is greater than in this 
country, and it is similarly true of certain other countries in Europe. 

Norway, for example, J am informed, has much less ling cancer, 
as has Sweden and Iceland practically no lung cancer at all. At- 
tempts are being made to correlate the smoking habits of the popu- 
lation of these countries with the occurrence of lung cancer, to deter- 
mine if there are factors there of which we have no knowledge in 
this country. 

We believe that the pooling of information which we get from in- 
vestigators throughout the world who are proceeding along lines which 
are believed by our scientists generally to be proper and productive, 
and we believe the immediate availability of these data will enable us 
to move much faster in meeting this problem from a preventive medi- 
cine standpoint. 

Mr. Buatnik. I have this last question: Doctor, just what is being 
done in America, then, to protect the people or inform them on the 
possible dangers from excessive smoking or just smoking ? 

Dr. Heiuer. There are several things being done, Mr. Chairman. 
One, as Dr. Burney pointed out, officially, there have been furnished 
to State health authorities for transmission down to local health de- 
partments in some three thousand-odd counties, information indicat- 
a: our official concern over this problem. 

imilarly, the American Medical Association, the spokesman for or- 
ganized medicine, will pass this information down to local individuals. 

Newspapers, radio, TV, and other media have done an excellent job 
covering this problem, and a very objective job. This is an exceed- 
ingly valuable way of informing the public. There has been an inter- 
pretation of the scientific literature by us, insofar as possible, by other 
interested agencies and groups, and there have been many discussions 
and additional discussions of planning in the future, of ways which 
are dignified and proper, that would not be productive of a scare to the 
public, and yet be consistent with the facts that we have. 

We wish to proceed in an orderly, dignified, and proper manner in 
order to present the facts as they become available to us, to the public. 

Mr. Buarnix. Have all those things been done to help inform or 
help protect the public from the possible dangers of smoking? Again 
I come back to what puzzles me most and that is that no one seems to 
know anything about the filters. The scientists representing industry, 
their own people—don’t know. We are spending, we will find out, 
literally millions of dollars to promote that one filter, and I will ven- 
ture to say, sight unseen, and I am open to correction—this is just a 
statement and I shall seek that information, I venture to say that in 
our country as a whole, more is being spent just to promote the smok- 
ing of filter-tipped cigarettes than is being done to find either the cause 
of cancer, or how much that filtration protects. I can’t understand 
why such a large expenditure is being carried out with no purpose. 


Here we have great difficulty in a congressional committee to find 
out wy there are filters. If we don’t know, how many people don’t 
cnow ¢ 

Dr. Little told us right here last Thursday, on the matter of filters, 
he said it was a matter of no interest to him. It might be of no 
interest to him, and he might have good reasons for saying that, 
but we would like to know where we can find this out. 

Could you advise us, Doctor? I know it is a little out of the field of 
your medical research. 

Dr. Hetier. Mr. Chairman, this, of course, comes completely into 
the field of developmental, industrial research. We know that physi- 
cally the filter simply removes certain constituents of the smoke. 
Now, whether or not it can do a complete job, we hope it can, if our 
plans continue to hold up as they have. Whether or not there are 
better filters that can be made, whether or not industry proposes to 
undertake additional work on filters, we do not know. I do know 
that individuals such as Dr. Wynder and others, some of whom are 
not known to me, are working on this problem. They are fitted by 
training, by interest, to undertake this sort of research and we are 
keenly interested in it. 

I, personally, Mr. Chairman, propose to go into this much more 
exhaustively and completely than we have in the past. - 

May I repeat again it has been our belief that it is eminently desir- 
able for us to elucidate the basic mechanism involved here and not 
necessarily introduce another variable. If we knew all of the con- 
stituents, if we could identify the particular tar or tars, then we 
could turn to such factors as filters, or washing of tobacco to remove 
wax before the cigarette is made, or whatever the remedial measures 
that should be instituted might be. But, since we do not know those 
things, we believe that it is desirable to find out all we possibly can 
about these other factors and then see where filters fit. 

After all, filters are merely mechanical strainers and, as far as my 
knowledge goes, there is no chemical action involved. Therefore, it 
is developmental research. 

Mr. Buatnix. Doctor, does the Federal Trade Commission seek 
medical information from either you or, perhaps, from the Surgeon 
General in their analyses and evaluation of the propriety and correct- 
ness of cigarette smoking? Could you give us some idea on that? 

Dr. Hetirr. Yes, Mr. Chairman. 

The Chief of the Division of Consultation of the Federal Trade 
Commission has been in constant touch with me concerning this item. 
He is very anxious to know what the Surgeon General’s attitude 1s, 
what the Surgeon General’s pronouncements are. I have been in touch 
with him. We have kept him informed. He has been, indeed, most 
cooperative and helpful and since this problem came to his and our 
attention, has indicated a desire to work closely with us, and to be 
guided by the medical facts which are developed and the medical 
opinions which may be derived from the scientific endeavors generally. 
I can only indicate our extreme pleasure at cooperation with this 
agency of the Federal Government. 

Mr. Buatnr«. Thank you very much. 

Mr. Meader? 


Mr. Mraper. As the chairman mentioned, we had Dr. Little before 
the committee last week. I don’t know whether you are familiar with 
his testimony originally given before this committee. 

Dr. Heiter. Yes, lam. 

Mr. Meaper. I would like to refer to a few passages from his testi- 

On page 2 of his prepared statement he said: 

After 50 years of research on the origin and nature of cancer, I have the great- 

est respect for its vigor, versatility, and complexity. I therefore sincerely and 
deeply deplore premature and oversimplified conclusions and intensive publicity. 

Then on page 6 of his statement he refers to the study of Dr. Ham- 
mond and says: 
A positive association is claimed by the American Cancer Society through the 

Hammond-Horn Study of 1957 between excessive smoking and death from cancer 
of the lung. 

And then he lists a whole lot of other organs of the body and diseases 
that are associated with excessive smoking. 

On page 7 he makes this comment : 

It is a difficult if not impossible scientific gymnatie feat to imagine a cause- 
and-effect relationship in this overall mixture of human ailments, especially with 

a Strikingly increased life span of our population, and increased national tobacco 
consumption Staring us in the face. 

Then on page 64 of the committee’s transcript, Dr. Little testified : 

To establish a cause-and-effect relationship on statistical association without 
the experimental evidence is not safe. It cannot be done. You may get an indi- 
cation of something to look for, but to Say that the case is finished, the evidence 
is all in, and that you can satisfy experimental scientists, all of them, that is not 
possible because too many of uS have seen too many statistical relationships which 
have not helped the cause-and-effect relationship. 

In the statement presented to the committee this morning, I quote 
from page 1—I guess the statement is in the name of Dr. Burney, the 
last paragraph: 

There is an increasing and consistent body of evidence that excessive cigarette 
smoking is one of the causative factors in lung cancer. 

Now it strikes me the comments I have quoted from Dr. Little and 
the comment I have just now quoted from your prepared statement 
seem to be in conflict. You say there is a causative relationship that 
is established by the evidence and Dr. Little says it is dangerous to take 
the statistical associations and from them deduce a cause-and-effect 

T would like your comment on what appears to be a conflict. 

Dr. Heurer. Certainly, Mr. Meader. 

Dr. Little is a distinguished and beloved scientist of the Nation. 
I think, perhaps, you may be aware of his accomplishments in the 
field of genetics. Dr. Little is indeed a very fine gentleman, both 
as a man and as a scientist. But there are differences in interpreta- 
tion among scientists as perhaps you are well aware. 

Dr. Little is sincerely of the opinion that these data do not warrant 
the inferences which we have indicated. 

We do believe, however, Mr. Meader, that while Dr. Little is en- 
titled to his interpretation and we respect him, still we feel on the 
basis of our background, our knowledge, our experience, and our 
information, that our stand is a proper one for us to take. We feel 


‘impelled to, after much study, and we believe that we respectfully 
‘disagree with Dr. Little in this matter. 

Mr. Meraper. I believe you do say, after saying that excessive 
cigarette smoking is one of the causative factors in lung cancer—your 
“next sentence says: 

At the same time we expressed our belief that heavy and prolonged cigarette 
“smoking is not the only cause of lung cancer. 

Let me see if this isn’t a reconciliation of what apparently is a 
conflict between the position you take, and Dr. Wynder, and Di 
Hammond, and so on, with that of Dr. Little. 

He asserts that there has been no logical demonstration of a causa- 
‘tive agent in the tobacco or in cigarette smoking which produces 
cancer, and I believe that is conceded by all of the rest of the scientists 
who testified. He takes the position that the statistical association, 
while it might show the direction in which to conduct research, might 
be misleading and, as he said, cause one to chase one fox instead of 
looking for some other foxes, ‘and might retard the discovery of the 
logical relationship between cause and effect in smoking and cancer, 
because it might discourage exploration of other avenues, if people 
are satisfied that they have the culprit already identified. So it seems 
to me that there isn’t really any too great disagreement on basic 
scientific attitude between Dr. Little and the other scientists who have 
testified—simply, perhaps, a greater question of causation on his part 
than on the part of the other scientists. 

Would you agree with that? 

Dr. HErier. Partially, Mr. Meader. I would say fundamentally 
it is a difference in interpretation. 

May I say, Mr. Meader, and members of the committee, that gen- 
erally in cancer causation there is a belief that there are certain 
products within the body—endogenous products—which may be re- 
sponsible for cancer. It may be hormones, it may be an anatomical 
anomaly, such as polyps, which we know in certain cases usually 
proceed on to cancer, or there may be exogenous factors, or things 
brought from the outside in contact with the body, or inhaled or in- 

What we say here is that we believe there is an exogenous product 
which is brought into the body, or in contact with susceptible parts of 
the body, which may interact with an endogenous factor or other exo- 
genous factors. Dr. Little does not quite interpret these products in 
the tars as being exogenous factors. We are led to the inescapable 
conclusion that we believe there is a causative factor, but we are unable 
to identify that particular factor. We hope that it can be identified 
and then we can proceed much more effectively. 

Therefore, truly as scientists, we are all seeking the facts, and 
there is always a difference in interpretation. I certainly give Dr. 
Little every respect and admiration for differences which he may have. 
But we believe that this subject is so important—and as protectors of 
the public health in general, or at least in our particular roles as 
protectors—that we feel compelled, nevertheless, to indicate our inter- 
pretation. This represents a consensus after long and careful study 
of our medical staff people who are working with it for the most part, 
and with others with whom we have talked. The advice comes from 
the outside and represents a body of opinion, and not just simply in- 


dividual personal opinions which may be correct but, therefore, might 
be considered only personal opinions. This represents a body of 

Dr. Burney. Mr. Meader, may I supplement this just briefly.. 

We would all like to have the ideal situation in any public-health 
problem, to know the causative factor before we proceed to: invoke 
preventive measures, but it has been our experience throughout the 150 
years of the existence of the Public Health Service that many serious 
public-health problems have been solved very largely before the final 
causative agent or its method of spread has been determined. 

In pellagra, for example, we didn’t know what the final dietary 
part was that prevented pellagra before certain remedial measures 
were carried on. We didn’t know the same about malaria, about 
yellow fever, and a number of things. We did have, however, statis- 
tical and epidemiological information which pointed up certain fac- 
tors, and upon which we could proceed to eliminate malaria, yellow 
fever, and pellagra before we could identify the specific cause. 

We would like to wait until we have the specific agent, and be able 
to identify it, and isolate it, before we pick any approach. On the 
other hand, it has not been our experience in public-health work that 
that has either been possible or has been a responsible course to follow.. 

Mr. Meaprer. Thank you. 

Dr. Heller, Dr. Little also told us about the $2.2 million that the 
tobacco industry has supplhed for research in this field. Are you 
familiar with the grants made under Dr. Little’s supervision, and what 
progress has been made as a result of expenditures of the tobacco in- 
dustry in research in this field ¢ 

Dr. Hetier. I have seen a list of the grantees and the titles of the 
grants. In general, those grants are basic, fundamental studies in 
what we call carcinogenesis; that is, those things which cause cancer. 

To the best of my recollection and knowledge, there are no studies 
in progress which are related directly to such things as filters or other 
applied-research components. I do know that the recipients of these 
grants are reputable scientists who are also recipients of grants from 
the Public Health Service, and from other grant-giving bodies. The 
work they do we can expect to be good work, and certainly, the re- 
search which is being conducted under the auspices of the tobacco 
industry research committee can be classed as good research. 

I do not know of any outstanding results which have come from 
these studies. Perhaps it is a little early, inasmuch as they have only 
been in operation, perhaps, a couple of years. So that, while my in- 
formation is not detailed, in general, I think that represents the 

Mr. Mraprr. Dr. Wynder commented that if he had spent $2 million 
on his cancer research, and had so little to show for it, he would re- 
ceive some very severe criticism from his superiors. 

Mr. Brarnitx. His superiors wouldn’t be very happy about it. 

Dr. Heiner. I don’t quite agree with that, Mr. Meader. I have 
been following cancer research, and have been responsible, for cancer 
research, generally, for a long time. It is a long, slow, laborious, 
heartbreaking, frustrating experience. Research, generally, in what- 
ever field, medical research, industrial research, or what have you, is 
expensive and time consuming. It is frequent that much money goes 


into something, and no results are obtained. If $2 million had been 
spent for cancer research, certainly, one would expect some results 
to come out of that. Probably some results are coming out of these 
studies. I just don’t happen to know of them. 

I would not be too critical of the results of research of $2.2 million 
worth of cancer research, on the basis of our experience in the Na- 
tional Cancer Institute over a period of years, in which much more 
than $2.8 million has been spent. Truly, I would certainly accept the 
proposition that any grant-giving group has a right to expect reports 
of progress and information as to the direction of the research, the 
accomplishments of research, attitudes of the investigators, as to 
whether they feel they are on the right track, and that sort of thing. 
I expect that is what Dr. Wynder is referring to, as well. 

Mr. Mraprr. Now, Dr. Heller, there was a comment on page 2 of 
Dr. Burney’s statement, the last paragraph: 

Modification of cigarettes so that their harmful effects would be reduced 
is of obvious importance to public health— 

and I think a similar attitude toward this question is expressed by Dr. 
Wynder and, perhaps, by other witnesses; that there isn’t any desire 
or any hope that tobacco smoking is going to be wiped out, but that 
the aim should be to identify the harmful agents in tobacco and see 
if they cannot be eliminated, and, thus, the bad effects of smoking 
could be reduced. 

That leads me to this question, which I haven’t heard explained in 
our record so far: Just what are the effects of cigarette smoking 
or the elements in cigarette smoking on the human body, the stimu- 
lating effect, how does it operate, and is it possible that whatever 
pleasurable effects derived from smoking can be separated from the 
harmful effects? In other words, that gets back to this question of 
the filters that filtered out so much of the smoke that nobody wanted 
to smoke filter cigarettes any more, and now the manufacturers ap- 
parently have put in cheaper tobacco with more tars and some of these 
elements that are suspected of being harmful. As a result, people 
get a kick out of the filter cigarettes, but they are getting as much 
of the harmful elements as they were before. 

Now can you, asa result of your research explain the operation of the 
elements in cigarette smoke upon body processes, and what element 
‘stimulates, and through what means there is a stimulation ? 

Dr. Hetier. Yes, Mr. Meader. My understanding is this: There 
‘seem to be three constituents, or major constituents, in cigarette smok- 
ing from which the individual derives the so-called pleasure of smok- 
ing. One is the effect of the nicotine on the individual. Now, nicotine 
is a very complex drug which has a complicated action on the human 
body from the standpoint of physiology. It brings about increased 
pulse rate, stimulation of what is called the parasympathetic nervous 
system, and involuntary nervous system, a stimulation of saliva, and 
a very complex train of physiological action which varies somewhat 
from person to person, but, in general, can be predicted. The second 
is in the tars, themselves. This is a mass of many hydrocarbons which 
haven’t been completely identified chemically, although 5 or 6 of them 
have been very definitely established as being present in tobacco tars. 
We happen to believe that the carcinogenic, or the cancer-producing 


elements, is in these tars, as we have indicated previously. The tars: 
apparently give the taste the individual gets from smoking a cigarette. 

Mr. Mraper. Rather than in the nicotine ? 

Dr. Herter. That is right. So far as we know, nicotine itself is 
not involved, even remotely, as one of the causative factors in lung 
cancer, as far as we know. 

Mr. Mnaper. The nicotine is tastless ? 

Dr. Hetier. It is tasteless, and produces a physiological action, 
both of which are associated with the taste, and they are indistinguish- 
able, as far as the individual is concerned. If he doesn’t get the slight 
stimulation from nicotine, then the cigarette doesn’t quite satisfy him. 
But the same token, as I understand it, when the tars are removed he 
doesn’t quite get the same taste, and it is, therefore, not what he is 
accustomed to. 

The third factor involved, as I understand it, is the psychological 
factor, which is doing something with the hands, or seeing the smoke 
curl up, or otherwise the satisfaction that one gets in release of his 
nervous tension, by merely holding a cigarette. 

Considerable work has been done by psychologists as well as physi- 
ologists as to what really constitutes pleasure in smoking, and I be- 
lieve that represents a consensus. Much more work needs to be done 
on the effect of nicotine, as far as the possible deleterious effect on the 
human body is concerned. We have reason to believe, for example— 
and I, certainly, am not expert in this field—that the action of nicotine 
does not have a beneficial effect upon certain cardiovascular diseases 
such as a disease called Buerger’s disease, or endarteritis obliterans. 

It is the technical name, in which the terminal arteries are con- 
stricted by the disease, and there seems to be a further constriction 
by the action of nicotine and, therefore, worsens the disease. 

Now, this has not been elucidated, and I do not claim that this is 
a particular factor in cigarette smoking, but it needs to be elucidated, 
and much more work needs to be done. But physicians generally 
will advise individuals with coronary heart disease not to smoke, or 
to moderate their smoking, and this is true in other similar cardio- 
vascular diseases. Nicotine probably has a much more direct action 
in cardiovascular diseases. 

Again, I repeat as far as my knowledge goes, nicotine is not involved 
in lung cancer except as it promotes the pleasure in smoking that the 
individual might have and, therefore, he is less likely to smoke mod- 
erately if he is accustomed to the effects of nicotine. 

Mr. Mraper. In other words, I take it that your research activities 
are reflected primarily toward the identification of elements in the 
tars, and their effect upon possible cancerous conditions? 

Dr. Hetier. I would say generally, Mr. Meader, that is correct. 
We by no means ignore the possibility of such things as arsenic on 
the tobacco when it is growing, the constituents of the paper in which 
cigarettes are wrapped, the waxy coating of the leaves which Dr. 
Wynder undoubtedly mentioned in his testimony, might be removed 
by hot hexane before the tobacco is processed for cigarette making. 

We believe as a very practical measure that the most direct ap- 
proach is toward these tars and particularly the neutral fraction, 
which comprises only about 2 percent of the total tars; nevertheless, 
we are not eliminating or ignoring any of the other possible factors 
involved. In fact, we pride ourselves that we keep an open mind, and 


that we are alert to every possibility in research which may be quite 
important in this entire question. 

Mr. Meraper. I believe you agreed to give the chairman a list of 
your cancer grants over a 5-year period. Could you give us an ap- 
proximation of the specific research on this problem of the relation- 
ship between smoking and cancer, in proportion to the total cancer 
ay pee program? How much of it is devoted to this particular prob- 
em ? 

Dr. Henier. From our work, or that of the Nation generally ? 

Mr. Menaver. I refer to your grants. 

Dr. Hetxier. It would be completely a guess. 

We do not support an awful lot of work, Mr. Meader, and fre- 
quently work may be going on in this direction in connection with 
certain other grants which we are supporting, of which we may not 
be aware until they report on it. I would say that several hundred 
thousand dollars are now utilized in support of this type of research, 
as of the moment. 

Mr. Meaprer. Probably not as much as the $2.2 million that the 
tobacco industry is spending ? 

Dr. Hretier. I would say not, Mr. Meader. We may be supportin 
as much as a half million dollars, depending upon the definition o 
what constitutes research in this area. 

Mr. Mraprr. Could you describe so that a layman could understand 
it, some of the avenues that you are exploring in this particular field ? 

Dr. Hetizr. Yes. 

In addition to the epidemiological investigations with which you 
are, I think, reasonably familiar—the veterans’ study and the study 
the cancer society is carrying on—we have engaged in studies to deter- 
mine the smoking habits of a cross section of the population. 

Mr. Mrapmer. I was thinking more in terms of the purely scientific 
rather than the statistical research. 

Dr. Heiser. All right, sir. 

In the purely scientific approach which the laboratory scientist can 
work at, we have been quite interested in finding out what are the 
earliest changes which occur in the epithelium or the lining of the 
bronchioles of the lungs. 

Two or three studies with which you may be familiar, as referred 
to by Drs. Wynder and Hammond, have indicated that since cancer 
of the lung occurs at a certain predictable rate, there would be reason 
to believe that early changes which precede the actual cancer lesion 
might be observed at autopsy. ‘These studies have indicated that there 
are very early changes, indicated by a diminution in the activity of the 
little cilia which propel waste material outward in the bronchial 
passages, in the nose and other parts of the bronchial system. There 
are varying degrees of change of this tissue, proceeding to the actual 
changes in some of the basic cells, and to what is called carcinoma-in- 
situ, or the very earliest stage of cancer that is clinically demonstrable 
before it becomes clinically recognizable. That is a very important 
approach, from our viewpoint, inasmuch as it enables us to know, 
or at least partially to know, how long it takes from the time that 
exogenous factors are applied to a sensitive epithelial or mucous 
membrane, until a fullfledged carcinoma of the epidermoid type is 


Mr. Mraprer. Are you financing any chemical research into the 
composition of the smoke in tobacco ? 

Dr. Hetrer. Yes, Mr. Meader. We have financed Dr. Wynder 
and Dr. Graham, who died last Mar ch, from lung cancer, incidentally. 

Their initial work was financed by. us and partially so continuing. 

We have financed work of the French investigators in 3,4- benz. 
pyrene. Some work has gone on in our laboratory in this regard but 
we don’t have individuals particularly interested in this field. We 
have financed some of the work at Sloan-Kettering. Of course Mr. 
Rand and his associates in Cleveland are independently financed, as 
is Arthur D. Little, of Boston, independently financed, and a group 
in Boston, I believe. 

There are only 4 or 5 workers immediately in this field, as far as 
my knowledge goes. There may be others of whom I do not. have 

We believe excellent work is going on and probably enough work 
is going on to give definitive results without blanketing the country 
with this sort of research. These investigators have to go through 
a very careful and quite complicated approach which, of course, re- 
quires considerable study and considerable knowledge. 

Mr. Mraprr. Mr. Chairman, I didn’t mean to monopolize so much 
of the time, but perhaps, since I made a personal reference to Dr. 
Little being president of the University of Michigan when I grad- 
uated in 1927, I might also mention that my brother, Ralph, has “been 
associated with Dr. Heller in the Cancer Institute. 

Mr. Brarnix. On the question of expenditures, Doctor. I recall 
quite well there was a special interest in medical research when ap- 
propriations were made by this Congress. 

The President asked the Congress for $46,902,000 for the National 
Cancer Institute for this coming fiscal year of 1958. Congress upped 
that by almost $10 million. The Congress voted $56,402 000 for this 

Now for this first quarter of fiscal year 1958, could you tell us at this 
time, or supply for the record upon checking up, whether the National 
Cancer Institute is spending one-fourth of the funds which the Presi- 
dent asked for, which is $46 million-plus, or are you spending one- 
fourth of the funds which Congress Saoby Ms ood which is over $56 
million ? 

In other words, are you spending a larger mend or a smaller figure ? 

Dr. Herter. Mr. Chairman, as of yesterday, to the best of my knowl- 
edge, the apportionment had not come down from the Public Health 
Service and the Bureau of the Budget, so I cannot answer that accu- 
rately at this time. I will be pleased to supply that for the record as 
of today or as of whatever day the apportionments are made. 

(Dr. Heller advised the subcommittee that the first quarter appor- 
tionment totalled $33,258,000. ) 

Perhaps Dr. Burney might have some additional information. 

Dr. Burney. I assume we will do the same as we did last year, Mr. 
Chairman. In other words, we received quite a sizable increase last 
year and there was no ceiling put on the amount of funds, and the In- 
stitute, through their advisory counsels and study secretaries were 
told that “We have this amount of funds and if we have the projects 
to go ahead and spend the money. We hope that the same quality of 
review and appraisal of project will continue, even though you have 


more money to spend,” and I would expect that the same policy would 
be followed this year. 

_ Mrs. Grirrirus. May I ask when did you first make a determina- 
tion that there was a relationship between lung cancer and excessive 
smoking ? 

Dr. Hetrer. It was brought to our attention in 1950 by the work 
primarily of Dr. Evart Graham and Dr. Wynder. However, part of 
that time in our own laboratories as early as 1939, some investigations 
had gone forward which were inconclusive, in attempting to establish 
a possible relationship between smoking and the production of lung 
cancer in animals. Not until 1950 did it come to our attention that 
there was a real problem involved. 

We recognized at that time that there was probably a statistical 

Subsequent studies were made in this country and abroad and in 
1954, an official viewpoint was expressed by the Surgeon General of 
the Public Health Service—I don’t think there was an official docu- 
ment put forth as has been, here, but simply a statement to the press 
and others that we believed there was a statistical correlation between 
excessive smoking and the occurrence of lung cancer, but we did not 
believe that there was a cause-and-effect relationship, as expressed at 
this time. 

Subsequent studies, and particularly laboratory studies, have 
brought us additional information, and the increasing weight of evi- 
dence caused us to recommend to the Surgeon General that we believed 
there was a desirability of calling to the attention of the public the 
information which had been derived from work, not only at the Na- 
tional Cancer Institute but in the world in general. 

Mrs. Grirrirus. When did you suggest that ? 

Dr. Hetrer. Just recently. 

Mrs. Grirritus. Within the last 60 days? 

Dr. Heiter. Within the last 6 weeks, I would say. 

Mrs. Grirrirnus. Is this the first written statement that has ever 
been issued by the Public Health Service, or have there been others? 

Dr. Hexen. In this regard the Surgeon General issued a statement 
on July 12, concerning the attitude of the Public Health Service, 
which I believe is the first written one that has been so formalized by 
the Surgeon General. 

Mrs. Grirrirus. May I ask you, had other countries made these de- 
terminations ahead of the United States ? 

Dr. Heiter. Yes, Britain in about 1954 came forth with an official 
statement by the Ministry of Health that there was at that time a 
statistical correlation, and they believed it to be a cause-and-effect rela- 

Mrs. Grirrirus. Have you already sent this information to the 
health departments in various States ¢ 

Dr. Burney. Yes, ma’am. This statement was given Friday, July 
12 and the material went out, I believe, the following Monday. 

Mrs. Grirriris. Have you notified the Federal Trade Commission ? 

Dr. Heuer: Yes. 

Mrs. Grirerrus. And have you notified the Department of Justice ? 

Dr. Hetier. I have notified officially the Federal Trade Commission. 
T have not officially notified the Department of Justice. 

96946—57 iG 


Mrs. Grirrirus. Did you consider doing that? Would that be part 
of your job? 

Dr. Hetire. Ordinarily, it would not be a part, Mrs. Griffiths. 
However, the Federal Trade Commission is directly concerned, and 
have been in touch with us quite closely as I have indicated to the 

Mrs. GrirrirHs. Have they asked you what you have found? Do 
you know of any official inquiry that the Federal Trade Commission 
ever made of you concerning lung cancer and smoking ? 

Dr. Heiter. Oh, yes. 

Mrs. Grirrirus. How long ago? 

Dr. Herier. Mr. Grandey, the Chief of the Division of Consulta- 
tion, I believe it is called, of the Federal Trade Commission, and several 
of his associates, visited me several months ago, 3 or 4 months ago, 
and we discussed at length this growing problem. I indicated we were 
studying this problem through a smoking and study group—which 
gave a report last June—and that probably we would recommend some 
action to the Surgeon General, but we were not completely sure of 
what it would consist. We have been in telephone conversation with 
them since then. 

Mrs. Grirrirus. They have never asked you to check filters or asked 
your advice on filters ? 

Dr. Hetier. No, only in a very general fashion. 

Mrs. GrirrirHs. Do you know if they are checking filters? 

Dr. Heimer. I do not know. 

Mrs. GrirrirHs. Would you consider it a wise expenditure of public 
funds to put this information that you have given us in every school 
in the country ? 

Dr. Hetier. As a part of a general health-information program, 
if the State health authorities approve of it, yes. Not as an official 
action on our part; as Dr. Burney indicated, the health authorities 
are sovereign. 

Mrs. GrrrritHs. Why don’t you think it is a wise official action ? 

Dr. Heutrr. Because, generally, we as a Federal agency do not 
indicate the way that health departments should approach their par- 
ticular problems. 

Mrs. Grirritus. But it has nothing to do with your conclusions? 

Dr. Hetrer. Oh, no. 

Mrs. GrirFirus. So if the Congress suggested this, actually you 
would feel it would be wise to warn children, would you? 

Dr. Heiter. I would say if the State health authorities, in view of 
their knowledge of their problems, and the situations with which they 
are confronted, believe that this information warrants a conclusion in 
such a program as they wish to make, then I think that is their 

Mrs. GrirrirHs. Have you or any official of the Public Health 
Service, ever appeared on a television program and announced your 
findings ? 

Dr. Hetuer. In this particular regard ? 

Mrs. GrirrirHs. Yes. 

Dr. Hetter. I have not. 

Mrs. GrirriryHs. On any others? Do you sometimes warn the public 
of various dangers? Is that one of the means that the Public Health 
Service has traditionally used since television has come into use? 


Dr. Burnny. I don’t believe we have ever asked, Mrs. Griffiths, to 
appear on any particular program, whether it is on polio vaccine, or 
anything else, but occasionally we are asked by a certain moderator 
of a program, radio or TV, to appear and discuss it. 

Mrs. Grirrirus. If you consider this a peril, and the Federal Gov- 
ernment controls the airways, would you consider it a legitimate use 
of those airways for the Public Health Service on a public-service 
program to announce their findings? 

Dr. Burney. I would be very pleased to present my statement on 
either TV or a radio activity. 

Mrs. GrirrirHs. Then I am going to ask for you to have some time. 

Have any States requested information on this problem ? 

Dr. Burney. I cannot answer that specifically, Iam sorry. I can 
find out for you. 

It just happens that. the executive committee on the State and Terri- 
torial health authorities was meeting with us the day before the state- 
ment was coming out—it had nothing to do with the statement; we 
did inform them that day of our statement coming out the following. 
day, and Dr. Heller gave them the background which he has given you 
all here this morning, and.told them we were sending this material to 
them. | | 3 ~ 
But, as far as I know, we have not received any specific requests. - 

Dr. Heiter. I don’t believe we have. ab 

Mrs. Grirrirus. When you were considering the relationship be-. 
tween lung cancer and smoking, what contrary evidence did you con- 
sider ? 

Dr. Hetier. The fact that there was no proved connection between 
the chemicals involved, and their ability to produce cancer in man}. 
the fact that prospective studies were preliminary, and as yet not de- 
fined as precisely as Dr. Hammond has defined it. Lack of know]l- 
edge of the processes of the pathology involved in lung tissue, which 
only in the last year or so has come to the public attention; I would 
say in general these represent the basis for our hesitancy before com- 
ing out—the fact that these particular factors were not elucidated 
properly to our satisfaction. Subsequently we believe that happened. 

Mrs. GrirrirHs. Thank you. : 

Mr. Buatnisx. Mr. Minshall. 

Mr. Minsuaryu. Mr. Chairman, at the outset I should like to ask 
unanimous consent of the committee to make part of the record a very 
excellent and concise article that appeared in the New York Times, 
Sunday, July 21, 1957, by William M. Blair, entitled “Huge Tobacco 
Industry Again on Defensive.” I think it has some background in- 
formation that would be of very much assistance to this committee. 

Mr. Buarnix. Without objection, it is so ordered. | 

(See appendix, exhibit 11, p. 579.) 

Mr. Minsuatu. Dr. Heller, you said you were familiar with Dr. 
Little’s testimony that he gave before this committee. 

Dr. Hexrier. In general, sir. 

Mr. Minswatu. Would you give us an opinion of his testimony—not 
as to whether or not you disagree with it, but of his findings ? 

Dr. Heiner. Well, Mr. Congressman, I would say that Dr. Little’s 
testimony reflects the attitude of a scientist who has been preoccupied 


Mr. MinsuHatt. Dr. Little is not a doctor of medicine? 

Dr. Hetier. That is right, he is a doctor of philosophy and partieu- 
larly noted for his work in genetics and as an educator. 

I would say that Dr. Little’s viewpoint is one of a very well-in- 
formed scientist who is interested in the basic components of research. 
He, by his own admission, was not interested in filters or the develop- 
mental research that is inherent in a discussion of this problem. 

Dr. Little’s testimony in general—at least the impression I reeeived 
from it, was that he simply did not believe that the epidemiologic and 
statistical evidence submitted was sufficient to allow an interpretation 
of a causative factor being involved in tobacco smoke. 

I think we agree certainly with Dr. Little that more research needs 
to be done. We disagree fundamentally in the interpretative aspects. 

T will not take exception to Dr. Little’s basic attitude, I think he is 
entitled to that. I differ with respect to his basic interpretation. 

Mr. Minsuatu. The question was also asked you, Dr. Heller, as to 
how soon you thought some definite findings might be made known 
to the public—whether it was just a manner of speaking but you 
said something about next spring. 

Dr. Heiter. I was referring primarily to the report which we hope 
to make of this very large prospective study among veterans. Now, 
as to what pronouncements might be made in the future would be 
dependent upon what findings emanate from the laboratories, or from 
the work of other investigators, and I do not know how to predict 
just when that might be. 

I can predict, because we believe that the initial reports will come 
out next spring on this prospective study which is a very important 
one, in our opinion. 

Mr. MinsuHatu. Your studies thus far are the results of analyzing 
the statistics of the World War I veterans. Am I correct that you 
said those studies thus far parallel] the reports and statistics as given 
before this committee by Dr. Wynder? 

Dr. Herter. Primarily by Dr. Hammond. 

Mr. Minsuautt. Dr. Hammond, yes. Pardon me. 

Dr. Heiter. The fragmentary reports dipped into the stream of 

Mr. MrnsHatu. What do you mean by fragmentary ? 

Dr. Hetirer. Well, in the sense that they take out a little piece of 
data and look at it, and see which way it seems to be going. This dip- 
ping into portions which they have examined seems to be consistent 
with results reported previously. 

The idea was, as we processed these data, to ascertain that they 
were consistent with existing ideas or findings which previously had 
been reported. | 

Now, obviously, one is unwise to make a dogmatic statement that 
this 1s going to be the same as any other statement. We are waiting 
until all the statements are analyzed, statistically interpreted, and 
studied by people who make it their business to interpret properly 
and put into a practical usage the results of such studies. 

Mr. Minsuatyi. Have you at any time conferred with the chemists 
or the doctors, other than Dr. Little, that represent the tobacco in- 
dustry ? 

Dr. Hetxer. I know most of the members of the tobacco industry 
research committee. I have attended a social gathering or so of this 


group. I know most of them personally, and we have discussed it in 
very general terms. I called Dr. Little, for example, before Dr. Bur- 
ney’s statement came out, to keep our haison. We are good friends 
and we have always enjoyed pleasant relationships which I hope will 

1 do not know of the work of the investigators who are supported by 
the tobacco industry research grants. 

Mr. MinsHatu. You, of course, have discussed, the general effects of 
smoking and cancer with these people representing the tobacco indus- 
try ; have you not? 

Dr. Hetier. Yes, sir. 

Mr. Minsuatu. Have you ever discussed the relative merits or de- 
merits of various kinds of filters that they have used ? 

Dr. Hetuer. No; I have not. The times at which I have discussed 
the problem with them, filters have not been introduced into the con- 
versation, and, as a matter of fact, there seems to be a lack of know!l- 
edge, generally, of the results. 

Mr. MinsuHatu. Well, the cigarette companies are making fantastic 
claims and have over the past several years as to what these filters do. 
Are you familiar with their laboratory tests ? 

Dr. Heuer. No. sir. 

Mr. Minsuautt Do you know that they do have laboratory tests? 

Dr. Heiter. We understand that tobacco companies have their own 
research laboratories. We do not not know the results of any work 
which they have done. 

Mr. MinsHauu. Have you ever requested that information from 
these research laboratories of the various companies? 

Dr. Hetier. No, sir; we have not requested it. 

Mr. Minsuatz. Don’t you thing that would be a good idea? 

Dr. Hetier. I think it probably would. 

From past experience with industrial laboratories, they traditionally 
or conventionally do not give out the results. 

Mr. Minsuatr. This is a different matter. This is in the interests 
of medical science. Like a gasoline company constantly sample tests 
the quality of its gasoline it puts in its service stations, and I am sure 
the tobacco people do the same thing with their tobacco as well as the 
filters. They test their filters periodically, do they not? 

Dr. Heiter. Yes; I presume they do. 

Mr. MinsuHaty. Have you ever discussed that matter with the 
tobacco people at all? 

Dr. Heiter. No; I have not, sir. 

Mr. Minsuatu. Where did you get the information that the filters 
were 40 to 50 percent effective when they first came out? 

Dr. Hetier. Primarily from the work of Dr. Wynder and his group, 
and also from the work—reported in the Reader’s Digest, of which L 
had some knowledge before it came out—done by Snell & Associates, 
which is believed to be good work. 

Mr. Minsuatu. From your knowledge of reading these various pub- 
lications, and talking with Dr. Wynder, are these filters as effective 
today as they were when they came out? 

Dr. Heutrr. The information I have from these discussions is that 
these filters are not as effective today as they were when they first 
came out. 


Mr. Minsuatu. Did you happen to see the New York Times article 
that appeared in last Sunday’s paper, where they stated that they are 
using all kinds of stems and roots in the tobacco that they put in the 
cigarettes now ¢ 

Dr. HetrEr. I did not happen to see that one, sir. I have heard 
that statement made by others, but I did not see this particular report. 

Mr. Minsuaru. Doctor, you also mentioned some statements put 
out by the health departments of foreign countries—Mr. Chairman, 
I think it would be also advisable if we had those statements put into 
the record. 

Dr. Hetrer. I will supply them, sir. 

Mr. Buarnix. Without objection, it is so ordered. 

(See appendix, exhibit 18, p. 593.) 

Mr. Minswatu. I have no further questions, Mr. Chairman. 

Mr. Buarnix. After a 3-day hearing we have come to this point: 

First, we have from the layman’s point of view a rather comprehen- 

sive picture of the extent, statistically, of lung cancer, and its high 
statistical relationship with heavy, prolonged smoking. 
- The medical witnesses representing more or less the point of view 
of the tobacco industry, say there is no direct evidence to show any 
causative factor in smoking that would cause cancer. Nor, as Dr. 
Little said, is there anything that he knew of in the smoke or in the 
cigarette that was harmful to the body. 

We have other testimony, and these two witnesses this morning state 
that there is something which justifies deep concern on the part of both 
official and private agencies and bodies, protecting the people from pos- 
sible medical harm from excessive smoking. 

Last year, in 1956, a study group on smoking and health was or- 
ganized including four organizations: The American Cancer Society, 
the American Heart Association, and the National Cancer Institute, 
and the National Heart Institute. 

Dr. Heller, were you involved in the forming of this joint Study 
Group on Smoking and Health ? 

Dr. Hetier. I was, sir. 

~ Mr. Buatnrg. In their report the statement is made— 
the sum total of scientific evidence establishes beyond reasonable doubt that 

cigarette smoking iS a cauSative factor in the rapidly increasing incidence of 
human epidermoid carcinoma of the lung. 

Does that statement hold as of this moment, Doctor ? 

Dr. Heturr. Yes. 

Mr. Buarntix. Is it correct, Dr. Burney, to say that is the basis, the 
combined collective judgment of these professional people who work 
in the field of cancer and heart disease, studying the smoking and 
health, that that would be the basis for this statement, the policy made 
by yourself, on behalf of your department ? 

Dr. Burney. That was the major factor, Mr. Chairman. In addi- 
tion, there was the report of Dr. Hammond and Dr. Horn; also the 
additional laboratory biological data that Dr. Heller discussed, the 
hyperplasia, the changes that occur in the cilia, and the bronchioles, the 
study group appraisal of existing evidence, and their comments—these 
constituted the major evidence upon which we based_our conclusions. 
~ Mr. Buarnix. In the conclusions of this joint Study Group on 
Smoking and Health it says: 


The study group concludes that the smoking of tobacco, particularly in the 
form of cigarettes, is an important health hazard. The implications of this state- 
ment are clear in terms of the need for thorough consideration of appropriate 
control measures on the part of official and voluntary agencies that are con- 
cerned with the health of the people. 

Would you say that statement sets forth the latest thing and the 
latest area of agreement on this important subject? 

Dr. Burnry. We believe, Mr. Chairman, that in that report we had 
this responsibility to express an opinion and make these facts known 
to the public, and our interpretation of the facts. | 

I would like to say again, however, that we do not believe the final 
answers have been secured and that there is a limit to what a responsi- 
ble, official Federal agency can or should do before they have all avail- 
able information. That is why I think we have stopped at a certain 
point, using our particular judgment, and that until such time as we 
have much more definitive information, we should not go all out on a 
campaign and put stickers on cigarettes and certain other things. 
Maybe our judgment is wrong in that, but I think we have gone as far 
as we should go at the present time. As new information comes out, 
as a result of what Dr. Heller is doing, or other things, we will make 
those facts known to the public and to our counterparts in the States. 

Mr. Puaprncer. But you said in your published statement “it is 
confirmed beyond a reasonable doubt.” It seems to me you are now 
saying, “on the one hand,” but, “on the other hand.” But you have 
said in the first instance that “it is confirmed beyond a reasonable 
doubt that there is a high degree of statistical association between lung 
cancer and heavy and prolonged cigarette smoking.” That is an 
unequivocal statement, Dr. Burney. 

Dr. Burney. That is right. We believe that, and Dr. Heller’s 
group agrees with that. 

Mr. Puarincrer. You are not prepared at this time to do more than 
make this information available to State agencies concerned with 
health. Having made this pronouncement, apparently that ends the 
public information-education phase, or is that a premature conclu- 
sion ? 

Dr. Burney. I would suspect this subject will be discussed this fall 
when the Surgeon General has his annual conference with the State 
and Territorial health officers. I would also suspect at the same time 
that we will discuss accident prevention in children, which is one of 
the very serious causes of death. 

This is not the only health hazard, and we certainly have some very 
definite information on those indications, and so there are other health 
problems that State health officers must consider. But, at the present 
time, yes, sir; I would say this is as far as I would intend to go, and 
which my scientific group have recommended. | 

Mr. Piaprncer. How about information in your own installations, 
such as the public-health hospitals, and among Federal Government 

Dr. Burney. This information has been pretty widely dispensed, as 
Dr. Heller mentioned. The press has given, I would say, very com- 
plete and very factual reporting on this. Recess 

T would also say that we are getting into an area here where individ- 
ual likes many times overcome one’s fears and prejudices. I have 
smoked a pipe for 15 years. If pipes were more seriously implicated 


in this, I think now that I might not stop smoking, but might not 
smoke so much. I wouldn’t swear to that, because I get a lot of 
pleasure out of smoking and, even though the threat is there, I might 
still continue. 

Mr. Piarrncrer. We have some evidence along that line from Dr. 
Hammond that I might turn over to you. Dr. Rigdon, the head of 
the department of pathology at the University of Texas, mentioned 
in his testimony that in the United States Public Health Service— 

there is a wide variation with regard to the role of cigarettes and cancers. You 
have certain ones who say it just can’t occur, and others say it might be but it 
hasn’t been proven, so you have a split in there from people who are now in that 

Now, I would assume that on any issue there is divergence of 
opinion—and I have been professionally trained to believe that there 
is such a thing as a 5-to-4 decision in the Supreme Court—but how 
wide is the variation of opinion within the Public Health Service or 
within the National Cancer Institute? 

Dr. Burney. I believe Dr. Heller should answer that, but I should 
say 1t was my understanding when we prepared this position that the 
consensus of the scientists at the National Cancer Institute were firmly 
behind this particular position. 

Dr. Hetrirr. That is true. 

Mr. Chairman, there are many scientists in the Cancer Institute, and 
many differences of opinion, scientists being scientists. However, I 
would disagree with Dr. Rigdon that there is a wide variation in 
attitude. Even a particular scientist who believes that air polution 
is much more of a factor, for example, than smoking, says, however, 
that there is no doubt that smoking is incriminated in this process and 
it is simply a matter of degree. 

There are others who are of the opinion that there might be such 
lung-cancer increases as has been stated, but that, through better 
diagnosis, it is coming to the attention of the medical profession and 
the people. We have better doctors, we are dagnosing more quickly, 
and so forth. However, I would say that the consensus in the Cancer 
Institute—I can’t speak for the entire Public Health Service, but 
certainly in the Cancer Institute and in the National Institutes of 
Health—the consensus is reflected in the statement which ‘the Surgeon 
General has promulgated. 

Mr. Puarincrr. Does that mean 51 percent, or is 1t overwhelming? 

Dr. Hetier. An overwhelming majority. I would say with the 
exception of only 1 or 2 who do not agree completely with this view- 
point, but the overwhelming majority of the scientists in the National 
Institute of Health agree. 

Mr. Puaprncer. With regard to the 1 or 2, what happens to their 
research that may have been going off in one direction or another 
as a result of this pronouncement of Government policy ? 

Dr. Hetier. They go right along, sir. It is not stopped. 

Mr. MinsHatui. You have mentioned what they do with it in the 
National Cancer Institute. Have you had the opportunity to discuss 
this with, for example, the Mayo Clinic, or any other private 
institutions ? 

Dr. Hetier. With individuals of the Ochsner Clinic, and the Mayo 
group, and so forth. I have discussed it with individuals. 

Mr. Minsuartu. And what was their feeling? 


Dr. Heturr. Taking the country as a whole, sir, and speaking of 
individuals whom I respect and who are responsible individuals, I 
would say the majority of them concur in this viewpoint. There are 
certain individuals, like Dr. Berkson at the Mayo Clinic, and others 
around the country, who do not agree. They agree, perhaps, with Dr. 
Little’s viewpoint. This 1s char acteristic of science in general, where 
there is a difference of opinion on many subjects. However, when 
one analyzes it to the utmost, there is not as much difference as one 
might think on the surface. 

Mr. Minsnauu. Can you give us a ratio among the private surgeons 
and cancer experts as to what the ratio would be? 

Dr. Hetier. It would be purely a guess on my part. 

Mr. Minsuatyi. What is your best guess ? 

Dr. Hetzer. My best guess is that 75 percent of the physicians or 
scientists who have knowledge and some competence in this area 
would concur with this formula. 

Mr. Puapincer. Dr. Heller, in an article that appeared in the July 
19 issue of the New York Times, there is a reference to the fact that 
a Dr. Smith stated that the National Cancer Institute, after protests 
from chemical companies, had abandoned a study aimed at determin- 
ing the extent to which chemicals might cause cancer. Would you 
care to comment on that, please ? 

Dr. Heir. Yes, sir. I am aware of that testimony. That is not 
a correct statement of action by the National Cancer Institute. The 
Public Health Service has not stopped any field or laboratory investi- 
gation into cancer at the request of any individuals on the outside. 
Such projects as have been terminated have been terminated because 
they logically had completed their course, or because we found it was 
fruitless, or for other reasons. I would say this is either a misunder- 
standing on the part of the individual or individuals who made the 
statement, and not founded upon fact. And we, in fact, have increased 
our studies in environmental cancer over a period of years. 

Mr. Buarnrk. In conclusion, we are certainly pleased and relieved 
to hear that our top medical agencies in the Government are working 
so closely and intimately on this important problem. Without trying 
to self-evaluate, would it be proper or correct to say that our Govern- 
ment officials, those of you in the top, executive positions, and those 
of us in the legislative. are doing about what is being done in other 
countries in Europe concerned with the problem of health and 
smoking, Doctor ? 

Dr. Burney. I believe we are Mr. Chairman. 

Mr. Buarnix. In terms of research and in terms of keeping the 
people informed, and in terms of keeping the Government agencies 
informed ? 

Dr. Burnny. I think we are. We are doing more than many coun- 
tries are doing, as Dr. Heller mentioned, and I would also point out 
that in addition to specific research on this particular area we have 
to recognize that some of the research in cancer, which is not directly 

aimed at this field, may have a bearing in giving some answer to 
this problem. 

Mr. Brarnix. Well, thank you very much. We appreciate your 
excellent cooperation, and your splendid assistance, and commend 
you for your straight-forward and forthright statements. 


The Chair wishes to announce that the hearings will continue to- 
morrow when we hope we will finally get some information on filters. 
I have never seen anything that has been advertised so extensively and 
persistently, and at great expense, about which I finally discover I 
k1iow so little about. 

The witnesses tomorrow will be Mr. Irving Michelson of the special 
projects division, the head of the Consumers Union. 

Dr. Walter Wolman, director of the chemical laboratory, American 
Medical Association, and Dr. C. §. Kimball, executive vice president 
of the Foster D. Snell, Inc., the research agency in New York which 
made the laboratory tests and the report for The Reader’s Digest, 
which is reported in their articles of this July and the coming issue of 

So until 10 o’clock tomorrow morning, the hearings are adjourned. 

(Whereupon, at 12:15 p. m., the subcommittee adjourned to re- 
convene at 10 a. m., Wednesday, July 24, 1957.) 

(Filter-Tip Cigarettes) 


Washington, D. C. 

The subcommittee met, pursuant to notice, at 10 a. m., in room 100, 
George Washington Inn, Hon. John A. Blatnik (chairman) presiding. 

Present: Representatives Blatnik and Meader. : 

Also present: Jerome S. Plapinger, subcommittee counsel; Curtis 
E. Johnson, staff director; and Elizabeth D. Heater, clerk. 

Mr. Buatnrx. The Subcommittee on Legal and Monetary Affairs of 
the House Government Operations Committee will come to order. 

We are proceeding with further public hearings on the effectiveness 
of Federal agencies in regulating advertising, restricting false and mis- 
leading advertising and in this case we are continuing with the hear- 
ings on cigarettes, primarily the filter-tip cigarettes. 

In announcing these hearings about a week ago, on July 15, I made 
a note that the cigarette sales declined for the first time in 21 years 
of uninterrupted growth following reports that cigarette smoking is 
a causative factor in lung cancer. Sales fell again in 1954, but the 
cigarette industry rescued itself through filter cigarettes promoted 
with a tremendous advertising campaign. Filter cigarette sales 
boomed and in spite of additional medical reports that cigarette 
smoking is a hazard to health, sales are greater today than at any 
time in history. Some reports we have received indicate that many 
filter cigarettes afford little, if any, protection to the public, although 
cigarette advertisers have emphasized the superiority and effective- 
ness of their particular filter. 

The testimony which follows will give us reports on the quantities 
of nicotine and tar in the smoke from various brands of cigarettes. 
Tobacco tar has been identified by medical testimony as the suspected 
cancer-causing agent. Nicotine has been linked with cardiovascular 

The protection afforded to the public by the filters on cigarettes can 
be measured roughly by the degree that the nicotine and tar are re- 

Our first witness today is Irving Michelson, head of the special 
projects division of Consumers Union. Mr. Michelson will be followed 
by Dr. Walter Wolman, director of the chemical laboratory of the 
American Medical Association. After Dr. Wolman, we will hear from 
Dr. C. S. Kimball, executive vice president of Foster Snell, Inc., the 



Jaboratory that conducted tests contained in the July and August 
issues of Reader’s Digest. (See appendix, exhibit 14, p. 604.) 

Consumers Union, in its publication Consumer Reports, published 
tests on cigarettes in 1953, 1955, and 1957. (See appendix, exhibit 15, 
p. 622.) . These tests affor dus an opportunity to observe the evolution 
of filter. cigarettes—their effectiveness or lack of it and also a com- 
parison of filters with regular cigarettes. 

I would like to note that the test methods used by Consumers Union 
and the American Medical Association, whose report will follow later 
this morning (see appendix, exhibit 16, p- 668), are the same and are 

Foster Snell, Inc., which conducted the Reader’s Digest tests, used 
a different laboratory technique in extracting tar which gives higher 
quantities and thus are not comparable to those obtained by Con- 
sumers Union or the American Medical Association. 

We will now proceed with our first witness, Mr. Irving Michelson 
of Consumers Union. Mr. Michelson, we welcome you to the com- 
mittee and appreciate your willingness to assist in gathering infor- 
mation for the committee on the effectiveness of filter cigarettes. 

Mr. Michelson, I notice you have a prepared statement with the 
printed reports of your three studies of 1953, 1955, and 1957. 

Mr. Micuetson. Yes, Mr. Chairman. 

Mr. Buarntk. Would you please give us a brief background of your 
technical experience and association with these Consumers Reports 
and then proceed with your statement ? 


Mr. Micuerson. My statement covers my background and associa- 
tion with Consumer Reports and I would like to proceed to read the 
statement with the chairman’s permission. 

Mr. Buarnix. Please proceed. 

Mr. Micuetson. My name is Irving Michelson. I am head of the 
special projects division of Consumers Union, whose laboratories and 
offices are located at Mount Vernon, N. Y. I have been a division head 
at Consumers Union for the past 10 years. Prior to that I was an 
analytical chemist in the laboratories of the United States Bureau of 
Customs at New York and Boston. 

To this introduction of myself, let me add a few words by way of 
explaining the work of the organization I represent. Consumers 
Union is a nonprofit organization, chartered under the membership 
corporations law of the State of New York. For more than 20 years 
it has been providing consumers with information and counsel on con- 
sumer goods and services. A major part of its work over these years 
has been in the field of comparative product testing—that is, it buys on 
the open market various brands of widely sold products, submits them 
to appropriate tests, and reports its findings in its monthly magazine, 
Consumer Reports. 

Consumers Union has no connection of any kind with any commer- 
cial interest, accepts neither advertising nor samples of products from 
manufacturers, and permits no promotional use of its test results. It 
derives its income from subscription fees and, to a lesser extent, from 


newsstand sales. At present the circulation of Consumer Reports is 
approximately 900,000—a figure which makes it, I believe, by far the 
largest publication of its kind in the world. 

Along with its product testing and publishing activities, Consumers 
Union has initiated and participated in a variety of other educational 
efforts related to the welfare of the public as consumers. Next month, 
for example, it is sponsoring jointly with Rutgers University, a con- 
ference on quality control and the consumer. In the past it has taken 
an active part in similar conferences held at other educational centers ; 
has cooperated with other consumer organizations, with the American 
Standards Association, with teachers, trade unions, and professional 
groups; and has worked with technical socities toward the end of im- 
proving test methods for consumer goods. Consumers Union has also 
cooperated with agencies set up by Congress in fields affecting the con- 
sumer interest—including the Federal Trade Commission, the Food 
and Drug Administration, and the United States Department of 

In short, my organization has been doing what it has been able to do. 
and what has seemed proper and useful to do, to contribute toward 
the development of that “intelligent and responsible citizenry” of 
which Dr. Clarence Cook Little spoke in his testimony here the other 
day. | 

With particular reference to the cigarette-cancer controversy, and. 
other health aspects of smoking, Consumers Union over the past 4 
years has made 3 sets of tests covering all leading cigarette brands 
along with a number of brands less widely sold. Our procedure has 
been the same for each test project. Consumers Union shoppers in 
various parts of the country have bought packages of various brands 
at retail; carefully controlled laboratory tests for nicotine and tar 
content have been run on the smoke of the cigarette thus purchased ;. 
and. the findings concerning each brand have been published in the 
pages of Consumer Reports. 

In the February 1953 issue of the Reports our findings covered 27 
brands; in the February 1955 issue, 37 brands; in the March 1957 issue, 
33 brands. (See appendix, exhibit 15, p. 622.) Our test results over 
the past years have convinced us that cigarettes vary considerably 
from brand to brand in the nicotine and tar contents of their smoke, 
and that an individual brand may vary considerably from time to 

It is therefore necessary to test many brands, and to retest the brands: 
now and then, to obtain useful information about the general situation,. 
about individual brands, and about trends. In this connection, at the 
request of this subcommittee we have Just completed another set of 
tests, this time on one brand—the Kent cigarette, which has recently 
announced a new filter tip described in its advertisements as revolu- 
tionary. Results of these newest tests will be published in the Septem- 
ber issue of Consumer Reports, but are summarized for the subcom- 
mittee as an attachment to this statement. (See appendix, exhibit 17, 

In fr: opinion, the Consumers Union test reports taken together 
constitute the most complete set of objective data available on the 
nicotine and tar content found in the smoke of cigarettes, and on the 
effectiveness of various filter tips to date in reducing such nicotine 
and tar content. Copies of the issues of Consumers Reports contain- 


ing these test results are also attached to this statement. (See ap- 
pendix, exhibit 15, p. 622.) 

On the average, we have found that filter-tip cigarettes give the 
smoker about the same amount of nicotine and somewhat less tar 
(about 15 percent) than cigarettes of the same size without filter tips. 
It is interesting to note also that the average tar content of the smoke 
of the filter-tip cigarettes reported on in March 1957 was no lower 
than the average found in cigarettes reported on in 1953. 

Mr. Puapincer. What kind of cigarettes are you referring to there 
in the last part, are they filter cigarettes, or nonfilter ? 

Mr. Micurtson. We are referring specifically there to the regular 
size without any filter and also to the king size with filter that existed 
in 1953. In both those cases there is no advantage in the present filter 
tips over the previous ones. 

Certainly, no filter tip of the many subjected to tests by Consumers 
Union can be considered in any sense to have eliminated whatever 
health hazard is presented by smoking. 

Without affecting the truth of this generalization, two brands in 
particular are worthy of special comment. The King Sano filter-tip 
cigarettes, covered in our 1957 reports, was found to give the smoker 
about 40 percent less tar than the average king-size filter cigarette, 
and about 50 percent less than unfiltered king-size cigarettes. 

Our recent tests on the new Kent cigarettes show that these also 
give the smoker about the same reduced quantity of tars as the King 
Sano cigarettes. 

For the information of the subcommittee, I submit the following 
notes on the methods used in the Consumers Union tests for tar and 
nicotine contents of the smoke of cigarettes. 

_ Mr. Chairman, would you want me to read these or should we just. 
put them into the record ? 

Mr. Buarnix. The three pages you have here ? 

Mr. Micuetson. On smoking, nicotine determination, and tar de- 
termination. Would the committee be interested ? 

Mr. Buarnix. Will you read them, Mr. Michelson ? 

Mr. Micuetson. Smoking: The apparatus and technique used were 
those described in the July 1936 issue of Industrial and Engineering 
Chemistry, in an article entitled “Technic of Experimental Smoking,” 
by Bradford, Harlan, and Hanmer. 

(See appendix, exhibit 18, p. 677.) 

Mr. Buatniz. Just to identify these people, the article was in July 
1936—I see—Bradford, Harlan, and Hammer were not men in your 
laboratories, they were men who developed this technique? __ 

Mr. Micueson. Yes, sir; the name of the laboratory in which they 
did their work I can provide. 

Mr. Buatnix. We can get that later. I am sorry to have inter- 
rupted you. 

Mr. Micuenson. The same apparatus and technique are widely used 
by laboratories in the United States working on this problem. In our 
tests, all cigarettes regardless of size were smoked to the same butt 
length (23 millimeters). The smoke was collected in an alcohol-water 
mixture containing a small quantity of acid. 

Mr. Meraper. Is this the same test made by the tobacco companies? 

Mr. Micuertson. I am sorry I did not hear the question. 


_ Mr. Meanper. Is the technique you use in making these determina- 
tions of nicotine and tar content, the same technique that is used by 
the tobacco companies themselves in any experimentation or test that 
they make ? 

Mr. Micuerson. I believe so. As a matter of fact, this test was a 
result of work by the American Tobacco Co., and these three gentle- 
men who wrote the article were working for the American Tobacco 
Co. at the time and so far as I know, all the laboratories in this coun- 
try are using this technique of testing modified only to the extent of 
making it more or less mechanical, or automatic, but in all cases the 
techniques are substantially the same in that they apply the same 
burning conditions of a cigarette, the same puff rates and the same 
technique for collecting the smoke. 

Mr. Mraper. Thank you. 

Mr. Micrerson. Nicotine determination: The nicotine was sepa- 
rated from most of the other smoke components by a method described 
in the Official Methods of Analysis of the Association of Official Agri- 
cultural Chemists, section 5.106. The quantity of nicotine present was 
then determined by an ultraviolet spectrophotometer, according to a 
method described in the March 1950 issue of Analytical Chemistry, in 
an article entitled “Spectrophotometric Determination of Nicotine” 
by Willits, Swain, Connelly, and Brice, of the United States Depart- 
ment of Agriculture. 

Tar determination: That portion of the collected smoke which was 
soluble in chloroform was separated from the water-soluble material 
by extraction of the smoke solution with chloroform; the chloroform 
was then evaporated and the residue weighed. 

The material obtained in this way is what we have been designating 
as “tar.” Because “tar” is a nonexact term, other definitions are pos- 
sible. There is no generally accepted definition for “tar,” so each 
laboratory is free to use any reasonable method it may choose. The 
chloroform extraction method was also used by the chemical labora- 
tory of the American Medical Association in preparing their reports 
(Journal of the American Medical Association, July 4 and 11, 1953, 
and April 9, 1955, see exhibit 16, pp. 668, 671), and by other labora- 
tories. If a different definition of “tars” is used, a different test 
method consistent with the definition is necessary. Direct compari- 
sons of results can be made only when the same definition, and, hence, 
the same test method, has been used. 

Another method used by some laboratories is to define tar as being 
the residue from the evaporation of all the trapped smoke—this may 
be designated as the “total smoke” method. The smoke is collected 
in the same manner in an alcohol-water mixture, and the solution 
is evaporated to dryness directly. This was the method used by the 
Foster D. Snell Laboratories in preparing their report for Reader’s 
Digest, and appears to be the method used in preparing the figures in 
the current Kent ads. Our tests on the current Kents were done both 
ways, to get comparisons with our previous work and with the 
Kent figures advertised. Both sets of figures are given in the attach- 

Consumers Unions’ tests were performed by the Fitelson Labora- 
tories of New York, acting as consultants to and working under the 
direction of the Consumers Union technical staff. Dr. Jacob Fitelson, 


an expert on analytical chemistry, was formerly a chief chemist of the 
New York district of the Food and Drug Administration. 

Attachment A gives the results of Consumer Union tests on Kent 
cigarettes over a 4-year period. A table is given which I believe 
would be difficult to visualize if read but, since everybody here has a 
COPY, I pass T can leave that, Mr. Chairman. (See appendix, exhibit 
TG Dei Gnt. 

Kent cigarettes are now available in 3 sizes, although in previous 
years they have been available in only 1 size, sometimes 2, and only 
in the last month or so they have become available in 3, so that, in 
order to keep the record complete, we are giving the figures on all of 
these different sizes and, where there are blanks, 1t 1s to be understood 
there either were no such sizes available at the time or we, for one 
reason or another, did not test them at the time. 

Mr. Maver. May I ask, Mr. Michelson, on this chart, are the milli- 
gram figures on just one cigarette ? 

Mr. Micuetson. In that sense, yes. The actual test was made on 
16 cigarettes in each case, but the result is in terms of milligrams per 

In 1958, the Kent regular size filter cigarettes had 8.5 milligrams 
of tar per cigarette, and 1 milligram of nicotine per cigarette. 

For 1955, the regular size had 12 milligrams of tar and 2 milligrams 
of nicotine. The king size had 15 milligrams of tar and 2.8 milli- 
grams of nicotine. 

The Kent cigarettes reported upon in our March 1957 issue: The 
regular size had 16 milligrams of tar per cigarette and 2.7 milligrams 
of nicotine. However, the current Kents now on the market have, 
according to our tests last week, 11 milligrams of nicotine per cigarette 
in the regular size, 12 in the king, and 10 in the long, and these same 
cigarettes have nicotine to the extent of 1.8, 1.7, and 1.6 milligrams, 
respectively. When we also tested by the total smoke method to 
compare their advertising with what we would find in the cigarettes 
themselves, we found 17 milligrams of tar in the regular and 22 milh- 
e@rams in the king size. They did not give any figures for their long 
cigarettes in their ads. They compare quite well with the current 
Kent ad figures which are listed in the last column, 17 and 21 milh- 
grams of tar, respectively. Similar agreement can be noticed 

Mr. Meaper. These are all filter cigarettes ¢ 

Mr. Micurnson. Yes. 

Mr. Mraper. And the tests were made, drawing through the filter ¢ 

Mr. Micuenson. Yes. 

Mr. Praprncer. Is it reasonable to conclude that the current Kent 
offers less protection than the 1953 Kent ? 

Mr. Micurtson. That isa valid conclusion. 

Mr. Buatnik. Are you suggestinge—the Kent and Sano are con- 
sidered the more effective filter cigarettes; is that correct? 

Mr. Micurnson. At the present time ? 

Mr. Buarnix. Yes. 

Mr. Micuerson. Yes. 

Mr. Buarnik. On page 4 of your testimony you gave 2 illustra- 
tions of the high percentage of total stream reduction; 40 percent of 
the fae were removed by King Sano, and the same for Kent; is that 
correct ¢ 


Mr. Micuenson. It may very well be that what I have said can be 
interpreted in that way, and I think it would be best if I were to 
clarify an important point here. In all of these tests that we have 
made—and we have made many on many kinds of filter-tip ciga- 
rettes—we have never tested the effectiveness of the filter, per se. We 
have always been testing only the amount of tar and nicotine which 
has come through the filter from the tobacco which was being smoked. 
We, therefore, have been careful to phrase our report in terms of, it 
I may be allowed to reread that paragraph: 

Without affecting the truth of this generalization, two brands in particular are 
worthy of special comment. The King Sano filter-tip cigarette, covered in our 
1957 reports, was found to give the smoker about 40 percent less tar than the 
average king-size filter cigarette, and about 50 percent less than unfiltered king- 
Size cigarettes. 

You will notice this statement does not say whether the filter is 
effective, because we do not know how much would have come through 
had there been no filter. We feel that the King Sano and the Kent 
cigarettes, as tested at the time we tested them, gave the smoker less 
tar and nicotine—less tar, particularly—than the average of other 
cigarettes, filtered and unfiltered. 

Mr. Brarnix. Isee. You didn’t test the cigarette without the filter ? 

Mr. Micuenson. Our comparison is made between other cigar- 
ettes—the tars delivered to the smoker by the other cigarettes and the 
tars delivered by these particular cigarettes. 

Mr. Mraprr. You say you never have made a test of the effective- 
ness of the filter, per se? 

Mr, Micuenson. That is correct. 

Mr. Meaper. In other words, you wouldn’t be able to tell from your 
experimentation whether or not a better filter was used but cheaper 
tobacco with harsher elements in it and more tar in the tobacco, All 
you get is a net result. You never made any examination of the 
components and the effectiveness of the filter ? 

Mr. Micusrson. That is correct. We felt that the sum total of 
these two factors, the kind of tobacco used and the filter, reacts on 
the smoker as a combination. To the smoker it does not matter 
whether he has a very effective filter and a terribly strong tobacco, 
or a very mild tobacco and a very ineffective filter. If he gets the 
same amount of tar from either combination, they are equivalent, so: 
far as he is concerned. And so we kept our tests on that basis. 

Mr. Mwaprr. I would like to ask about tar being a loose term and 
not identifiable. Have you, in your research and experimentation, 
sought to identify the various materials that are lumped together un- 
der the term of “tar” ? 

Mr. Micurison. No, we have not done that. There are many peo- 
ple in the tobacco industry and in other laboratories who have been 
working on that. Phere is very extensive literature on the subject. 
Dr. Wynder, I believe, testified to some of his efforts in separating 
various components and mentioned the fact that these components 
will change depending upon the burning temperature of the cigarette. 

If the committee would desire it, I could furnish a list of references. 
to articles bearing on the subject, none of which is definitive because 
nobody knows everything yet that 1s in cigarette smoke. 



Mr. Mrapver. Mr. Chairman, I believe it would be useful to have 
that bibliography on the components loosely lumped together under 
the term of “tars.” 

Mr. Micuezson. I can mail that to the committee. 

Mr. Brarntx. You will supply that for the record? We will ap- 
preciate it. (See appendix, exhibit 19, p. 678.) 

Mr. Buatrnix. Getting back to this ‘chart on your Kent cigarettes, 
let’s start off with your regular. The tar content of your regular cigar- 
ette, in 1953 there is 8.5 milligr ams; is that correct ? 

Mr. Micurnson. Yes, sir; corrected to the same basis as the later 

Mr. Buatnig. 1955 is 12? 

Mr Micurnson. That is correct. 

Mr. Biarnix. 1957, it jumped way up to 16 and only very recently 
within a few weeks in July, they put on a new filter—these are not 
filters, these are just regulars? 

Mr. Micurson. No. 

Mr. Buarnik. What does “regular” refer to? 

Mr Micuetson. The Kents are all filter cigarettes and the only rea- 
son I have not so specified in the left-hand margin is that these data 
are only on Kent cigarettes and Kent cigarettes do not come in any 
other form than with filter tips. 

Mr. Buatnix. We are getting them in 1957 with the total-smoke 
method and you have about twice the tar content out of the same type 
of cigarette that you had 4 years ago in 19538; is that correct ? 

Mr. Micurtson. Mr. Chairman, I believe that this comparison 1s 
the kind of comparison that I stated would not be valid. You cannot 
compare tar contents determined by two different methods. The com- 
parison between the 1953 results has to be made by basically the same 
method where figures are given as 11 for the most recent ones. 

Mr. Buiatnix. At any rate you have more tar and nicotine in the 
same cigarette with the filter than you had 4 years ago? 

Mr. Micuenson. That is correct. 

Mr. Brarnix. The reason I am trying to get this clear in my mind is, 
if I reeall the advertising—and we will go into all of them we possibly 
can, not just this one—but in 1953 this was called a micronite filter 
but now it is called “a new exclusive micronite filter” 

If I get this “new exclusive micronite filter” it reduces less tar and 
less nicotine than the original micronite filter did 4 years ago; is that 
correct ? 

Mr. Micuztson. Are you suggesting that the current advertisement 
would lead a reader to believe that this new current filter would be 
more effective than previous Kent filters? 

Mr. Buatnix. I couldn’t say what they are trying to do but it im- 
plies that it is new and exclusive. I can only speak for myself. I 
don’t know what the tobacco companies are trying to do, but it is a 
new and exclusive filter. I would expect when they say more efficient, 
it would be a newer model or up-to-date version but what you prove 
is that there is more tar and more nicotine getting in the 1957 Kent 
cigarette than we got in 1953? 

Mr Micuerson. That is absolutely correct. That conclusion is 
clearly shown by these data and it also appears to me to be clear that the 
current Kent ads can be interpreted to imply that they are actually giv- 
ing the smoker less tar and nicotine, even though they do not say so 


explicitly in comparison with the 1953 Kent cigarettes. Their 
advertisements do not compare their cigarettes with the 1953 Kents. 

Mr. Buatnrx. May I ask you why you just select Kent here? What 
is the pattern for other filter cigarettes? 

Mr. Micurrson. The pattern in other cigarettes in general is some- 
what similar, that they go up and they go down without any apparent 

If the committee is interested I have a chart which traces the his- 
tory of many cigarettes, brand by brand, in the same way as the 
Kent cigarettes have been studied in this chart. I have it available. 

Mr. Buatnrx. May wesee it? 


Tars Nicotine 


1953 ! 1955 1957 1953 1955 1957 

Philip Morris: 

ECPI AT eee aS ee Re, ee Rs eg en St 17 il 18 1.9 ay 2.8 

ISI OR GI7 Oneness Se a Sy eae sce ie: aad 20 ili 8 ere eee Sud | ee Be 

JI OTM ee Se ae ee eee Sa arg erase eR, Se Se ay Chae Ss ee ah Da ede aie opel es a sae Sl 

SECC Teg een eee ee PL Es ie iy Ge eh ee Re 2.8 eA lee 

GOA SAMI CG Eero mete te ee OE DAR Pere STEN Ss eee ae ltrs Sb A ee PAU Se 2 med 3.4 

AGN SFSIVC INCOR. 0 aS eet eee eh on er rele bie ts WO sles see ee = hoe ot aloe DeGuise Se es 
Ke cine Se CUlatees sn eee Me et ee eae 18 20 17 1.9 ane 3.2 
aera keimesst7 ee 22 st oo ee he oes 18 26 24 2.6 3.5 3.0 

Reo are eee eee ee eR EN RAE OS SN) 19 20 20 2-2 Bod! 2.9 

IMS: S17 Gree 2. ob ee ee. a Hee eee See ee Cd 23) We eels Aes bok ee Sass od Sat 

SGI OEST7 Oem pte are, UR Re ee ene oe oe oe ey ell eee LCG} a ec eat Sg ie 3.1 
Wuicky_ Strike sregulant S40 eee ee ease ee Persist 19 21 19 2.1 D7 2.6 
Vici Gieme Ou aieee ae Se ee Mile oe 2 le ae 20 21 7 al 1.8 1.8 
Cavaliers iime/size@x: <4453. g4ee ahs iste seer 23 26 26 2.8 3.9 3.8 
L & M: 

SHVIGC Gaeta nee na Ie kee eee Selo 11 355s alate 5 2.6 

KOIMe SIGs iiLers 2: 5. ey ats ees PPE Si es Dee F_Wike es 18 1 ON eae 22% O, |i 2.6 

TRG VAS Be Ne aie aoe ay | iene 3 ee 8 oe eee Pee ee 22 Ay BE $83 3.1 2.9 

GIMPeSI70 MUL OI. cake Sone a ee ER ele lh a 19 Olea eeees DAS 253 
EVOS CMG KUT OC SLZ OC. cll VO Maren te Meeenye em emp ns To, Ae 19 7 i el ay ea 2.4 3.1 
Wiartstomyrking sive: filter. 222. 2st eto 2 pee ore set Ss 20 222 eck Jc: 31 3.8 

FERC Sit Alen Ne te aes ee Se eee ee ye Se 12 Ii tire aes ge 1,2 1,2) eae ee 

GAG S17 Obl Oly ee Sos a eee ae ee Sys See hl Ses Ses 12 gal 3 pee ee 1.0 1.0 

GSA eres ees wy Mee ER or ee ie. me de ee 8 te 13 15 15 1.2 ills 1.8 

RATES VAS), St a ee Se | a 5 oii LAO, Beate a ee ees AED es sy pe cea 

RG CU Tere ee SE ee oe SS Ue a Pa 13 17 17 2.0 BS 201 

GIN ER STZ Ceres er. eee MNS Sw RAS 2 ee Pe rE 16 22 22 2.5 rf 3.0 
Wangs kiatoisi7eueapt st Fs ee shales pe ee a ct 13 20 Ales ee 2.3 20:9 Nw aces 
SOMA Ce Miashe SNA ess eae oo Sh a ene eae acta oe 14 16 21 .4 4 at 
Old Gold: 

FRCS Ul eA eyo pa eke oe ee EE rt elon a eS 15 18 18 2.0 2.9 207 

HECGTEAIS SIZ 0 ee pes tee eee Pte a Ne NS eet Ra rs es 25 POMS Rha 4.0 POY 

ksi sisi 7 6 salillter wars ha wares be See ee =e Peek reall ne eet 14 UO ore aes 2.9 3.1 

Restlaraeaeee Ae ATE TO EE AEE ON ae TS LORS IVES Se eee QuQUEd |e RE ER ek Cet 

SIGUA ORG UO Nera ok oak Lg a Ne kL a ite 25 Pay || ue ant 3.0 3.7 

IRGC G2 ae se ee en es ie fe ye he i IGS Ae te DEAS AG Seater rer ees 

RTT OAS IZC SeMNGE ee eee ye Rana tees eee ASN Seer ee 18 ip Shail oe ai aa 3.0 2.8 
AB ar Glin pe Kel a SG eee ey eats 2 ee 16 24 24 2.4 2.9 Sell 

1 Different methods were used for tar extraction in the 1955 and 1957 tests. The 1953 figures have been 
increased by 20 percent in an attempt to make them directly comparable. 

Mr. Micuetson. This listing, Mr. Chairman, that I have just given 
you, contains only those cigarettes which we tested more than 1 year. 
There are many other cigarettes which we tested one year and which 
either failed to remain on the market, or were changed to a different 


kind of cigarette the next year, or were so low in distribution that 
we did not feel it was warranted that they be tested by us again. 

So that these figures actually constitute a part of the whole picture 
but it gives you a complete picture so far as we have it, of every cig- 
arette which we have tested on more than on one occasion. 

For example, the first cigarette listed, the Philip Morris, under 
“tars” 1s found to vary, in 1955, it was higher than in 1953. In 1957 
it was back down somewhere in the 1958 level. 

Mr. Mxaprr. Mr. Michelson, might I ask, do you have any figures 
prior to 1953? 

Mr. Micurnson. We have no figures that would be comparable to 
these, Mr. Meader. 

Mr. Mraper. What I am wondering is whether this reflects a reduc- 
tion in tar content in cigarettes as a result of some publicity about pos- 
sible deleterious effects of the tar in cigarette smoke. 

Mr. Micuunson. I am unable to answer that question because I don’t 
the information that would be necessary to 

Mr. Mraprer. My thought was that in 1952 or 1953, the first adverse 
publicity of any importance on this subject came out? 

Mr. Micuezson. I believe that is so, yes. 

Mr. Mnaper. I wonder if the low figures in 1953 throughout the en- 
tire listed cigarettes could be connected with that adverse publicity 
and that perhaps prior to the adverse publicity the tar content had 
. been comparable to the 1955 figure ? 

Mr. Micuerson. Mr. Meader, I would be willing to make a guess 
that the cigarette companies had not been paying much attention to 
controlling, back then, the tar content of the cigarettes. It is my 
impression they were more interested in controlling the flavor which 
would appeal to smokers, but this is entirely a personal opinion of 
mine. I have seen no references in the technical literature to any at- 
tempts made prior to Dr. Wynder’s work on the waxes of tobaccos, 
of efforts to reduce tars by treating the cigarettes so I know of no at- 
tempt on the part of the cigarette manufacturers to control the tar 

Mr. Meaper. So far as you know, no similar figures exist with 
reference to periods prior to 1953, on tar and nicotine content of cig- 
arettes ? 

Mr. Micnetson. They may exist in the files of the tobacco com- 
panies or other laboratories who have not published them. So far 
as being in the public prints are concerned, there are none that I 
know of. 

Mr. Puarrncer. Mr. Michelson, in a study prepared by the staff, by 
company, not unlike your listing of tar and nicotine in the 3 years, 
the following was found. With respect to the American Tobacco 
Co., it was noted that in 19538, Lucky Strikes had 2.1 nicotine content 
and 16 milligram tar content. 

This is lower than all of the cigarettes produced by the American 
Tobacco Co., both with respect to tar and nicotine in 1957. That in- 
cludes Lucky Strikes, Pall Mall, king size Tareyton, filter king Tarey- 
ton and filter king Hit Parade. 

The same is true with respect to Liggett & Myers’ products, regular: 
size Chesterfield in 1953, it had a nicotine content of 2 milligrams, a. 
tar content of 11 milligrams. This is lower than the nicotine and tar 


‘content for 1957 of the regular sized Chesterfield, the regular filter, the 
L & M, the king size Chesterfield, the king size F atima and the filter 
king L &M. 

With respect to the Reynolds Tobacco Co., regular size Camel in 
1953 had 1.9 milligrams of nicotine and 15 of tar, This was lower than 
the Camel, king size Cavalier, filter king Winston and the mentholated 
filter king ‘Salem in 1957. 

With respect to Philip Morris in 1953 the regular size Philip Morris 
had 1.9 milligram nicotine content and 14 milligrams of tar. Lower 
than regular sized Philip Morris, king size Philip Morris and the filter 
king Marlboro in 1957. This is also true with respect to the regular 
sized Old Gold in 1953 with the 2 milligram content of nicotine, and 12 
of tar, as against the Old Gold regular size—not the Murad but the 
reg ular filter Kent prior to this new advertisement and the king size 
Old Gold and the filter king Old Gold currently. 

The filter king of Viceroy was 2.4 milligrams of nicotine in 1953 and 
16 of tar, as against 2.8, in 1957. The king size Raleigh was 2.1 of 
nicotine, and 16 of tar in 1953 as against 3 7 nicotine and 23 in tar in 

Tests of cigarettes for nicotine and tar—Consumers Union reporis 

[Numbers are quantities in milligrams] 

1957 1955 1953 

Firms and brands 

Nicotine! Tar {Nicotine} Tar |Nicotine| Tar 

uckyesurawes (reoulan) 7 C3751 5 i). peeap hear tis is 2.6 19 WT 21 oh 16 
anime (ain) a OS Ll es De ose 3.0 24 Bis 26. 2.6 15 
SR arenj Ome kan On sees 1 eee eee ee Se 2.9 22 3.1 Pa ia et cn a hh S er aa 
Mare vboms lCersklMg)) poo es eS Se peek 2.3 19 2.5 AQralietes ORs se Bie es — 
ehitpearade Giver Kine) oJ bee ee 3.0 DUN Nee mre ean Naeem eae ee oe eae, Meee 
Chestertieldbimesulir eel = 22 ee seh eta as 251 17 2.3 17 2a) 13 
Wiccan eoularimten) === aso oke oe ee eee 2.6 15 15 SOE Meter apee gereg| ee pee 
Whesvevtioldk(kima)| #255 55 ehe vee Ps BOL Te 3.0 22 257 22 205 16 
Brau rmnigy (RMON, ke ee oe sd te Boll 24 2.9 24 2.4 16 
Na Ge VI Cikbere kein oy. Bee = SSO ee SP eT eines 2.6 15 2.5 TSti? LE Es) Serta 
GWamiela(Trerulat, = ts ever acre lege Peas sa0s erty 5 ET 3.2 ly 3.3 20 1.9 18 
MO aivia lie Tas Gkehines ee LS SO se 3.8 26 3.8 26 2.8 19 
“Winston Giiverskerim) a4 «Poe ee) OSU Ee EBD 32 3.8 22 3.1 20M 2 SEE SOAR PALES 
HSalenae G7embGlWol tiers Kellie) = Beene ee ee ee Bo SYR: | sees ce eek GE Ge rie | SN Oe. a ee 
sehilip Wviorrisnieswlan 225-5 aoe 2 Sa ie ee eae 2.9 18 DE 21 1.9 17 
SBhilipeViorpissGeine)\ pk ee ee Ee Bell 21 3.4 CLR IO Se 8 A Obe Wane, oe 
Marlboro; (hlver=kane) £ Vs iie Cees ees 2.9 TSS eee ne ears Qn; 16 
‘Parhamennt Given iii) Pk ses sol eb ee a ee blige ce beh bce eee 2.4 14 Pas 17 
Old Gold" wegulan\s2 22 F838 Ee Ded 18 2.9 18 2.0 15 
Minad (Gestlary) 224 2.2.57 2. Aa ea ee een eee! Woe 1.8 17 1.8 2) la 17 
Kenty(regsularemlten) ==. ses eeye Le ke a 16 2.0 12 1.0 9 
@MldP-Gold cine Sees eet TL eeee sy Paes eh of pot 8x 312 19 4.0 AGG (ah we aes © SS, eT 
OLdKGOldaGhite naka) pa he Se As 3.1 19 2.9 pee Wee Ds. |e eee oe 
Wiceroys (alter kits)\ 2 fey ie fal si oer tei” ys 2.8 18 3.0 18 2.4 16 
TA ONS Mee ety eae irr A en BO pr ete, La pete Say 23 3.7 25 2.2 16 


Do those figures generally gibe with yours, or have I been reading 
too fast for you ? These are figures we correlated from the Consumers 
Union test by company. 

Mr. Micuetson. Can this be off the record ? 

Mr. Buatrnix. Off the record. 

(Discussion off the record.) 

Mr. Piarincer. I am citing the increases in nicotine and tar content 
between 1953 and 1957. It is interesting to note in every case in com- 
paring the regular size cigarette produced by a given company in 
1953, that the ‘nicotine and tar content is lower than all of the ciga- 
rettes produced by that company, regardless of whether filter, filter 
king, or regular, today. 

Mr. Micuxrson. I believe that your conclusion is well founded. 
The figures you have used to make that point, do make that point; but 
I believe that a further hypothesis is possible along the lines suggested 
by Mr. Meader, and that is, had we had more information going back 
before 1953 and had we had information, let us say, in between the 
ones we have in 1954 and 1956 for example, we might have found that 
there is generally a great fluctuation. 

The fact that when we tested our samples and reported on them in 
1953, we found fairly low—compared to 1955 and 1957—nicotine and 
tar, that this was just one point on a curve which we happened to hit 
in a low part of its swing. 

You will notice many of the figures in 1955 are somewhat higher 
than the 1957, as though the figures are beginning to go down again in 
1957. This indicated to me there probably is continual variation, 
from time to time, and that any figures used apply only to the cigarettes 
at the time the tests were made. 

The generalizations about what happened in intervening times are 
only guesses. 

Mr. Praprnerr. How marked is that variation, generally? Would 
it be as marked as a nicotine content of 1.9 to 3.2, for instance, over a 
period of 4 years? 

Mr. Micnenson. I believe that is easily to be predicted from varia- 
tions in nicotine of the same type of tobacco grown in the same field 
in a different year. The tobacco literature that I have perused has 
figures which indicate that a given tobacco type grown on any par- 
ticular field may vary by as much as 100 percent from year to year and 
in one particular case a thousand percent over previous occasions. 

So that it is my belief that these figures would show variations from 
year to year in the nicotine content of cigarettes and may be based 
on the fact that any given kind of tobacco will vary in nicotine content 
from time to time and that the cigarette companies may make no effort 
to control the actual amount of nicotine in the cigarette. 

Mr. Meaper. Now do you know anything about that, Mr. Michelson, 
whether cigarette companies do regularly in the production of cig- 
arettes, make periodical tests on each batch of cigarettes and each 
batch of tobaccos used in the cigarettes to determine the yield of tar 
and nicotine? 

Mr. Mrcnetson. I do not know that this is generally true except 
that a few companies are doing it on a regular basis. The Sano ads 
indicate they are doing that on a regular basis and the Kent cigarette 
ads indicate they are going it at present but to what extent other com- 
panies are doing it, I have no knowledge, at all. 


Mr. Mraprr. Have you ever sought information of this character 
from the tobacco companies, themselves ? 

Mr. Micuertson. No, I have not, sir. 

Mr. Bratnix. To sort of summarize what you are stating here, 
would you look at your March 1957 Consumers Report, which is the 
last of your three reports, on page 102. Perhaps this will help consoli- 
date this general summary picture. 

There you have tests for the average type of filter, regular size, no 
filter; king size, no filter, king size with filter. For the years 1953, 
1955, and 1957. Would you explain that chart ? 

Mr. Micnexson. In 1953, regular size, no filter cigarettes, which at 
that time was the common type of cigarette, had on the average, 2 
milligrams of nicotine per cigarette. In 1955, the average of the same 
type of cigarette had increased to 2.6 milligrams and in 1957, the 
average was 2.5 which is not significantly different from the 2.6. 

During the same period, the regular size with filters of which there 
were few, had 2.1 milligrams in 1953; in 1955 there was a distinct drop 
to 1.9 milligrams—this is on the average and does not apply neces- 
sarily to any particular cigarette—and in 1957 the average had gone 
up again—this time to 2.7. 

This figure, incidentally, included the Kent cigarette which was 
tested for this report but which has now been displaced by the new 
Kent, and so this figure, while true in March 1957, may no longer be 

Mr. Buarnix. Let’s stop right there for a minute. You have only 
regular size, no filter; with filter. In both cases we have more nicotine 
today then we had in 1953, regardless of whether it is a no filter regu- 
lar or a filter, is that correct? 

Mr. Micuenson. That is correct. | 

Mr. Buarntk. In the filter, regular size, you have a little more tar 
than you have in the nonfilter. Is that right? I mean nicotine. You 
had 2.7 nicotine in your regular size with filter, and 2.5 today, without 
the filter. 

Mr. Micuertson. Yes, sir, that is correct. 

Mr. Bratnrx. Am I correct in assuming as far as the nicotine con- 
tent goes in a regular filter, in fact I am better off if I buy a regular 
cigarette with no filter, is that correct ? 

Mr. Micurrson. In regard to nicotine. 

Mr. Buarnix. Now, with regard to tars—let’s stick to the filter 
cigarette. I have never seen anything advertised and publicized as 
much and that we know as little about as these filter cigarettes. It is 
somewhat exasperating. It is not directed at you because you are try- 
ing to help us. But look at the tars. On a regular cigarette—they 
have all this fancy business, king size, small, and we don’t know what 
they are—but the regular cigarette, in 1953, the tar content without 
filter is 17 milligrams, 1955, 18; and 1957, 18. So the regular has a 
little more tar than before. 

Mr. Micurison. That is correct. 

Mr. Buatrnix. The filter then does reduce the tars—14 in 1953, it 
dropped down to 12 and went right back up to 16. So on the tars, 
what is your conclusion on the regular cigarette? You have some pro- 
tection, you have 2 milligrams less in the filter regular cigarette than 
in the nonfilter, is that correct? 


Mr. Micuetson. That is correct, sir. 

Mr. Brarntx. How about the king-sized cigarettes / 

Mr. Micuerson. The king-size filter cigarettes’ advantage over the 
regular-size no-filter cigarette is absolutely none, by our figures, on the 
average. However, they offer an advantage over the king-size no-filter 
cigarettes to some extent. Whether this extent is significant, I would 

rather leave to the medical authorities in the field, but at best, according 
to our tests, the king-size filters at present give no less tar than a regu- 
lar-size cigarette without a filter, either for 1957 or 1953. According 
to this latter comparison, they offer no significant advantage for the 

Mr. Buatnrk. Repeat that again now. Do I understand that the 
king size with filter, which yields i in 1957 18 milligrams of tar, gives 
me just as much tar, no more, no less, as a regular-size no- filter 1957 
cigarette; is that correct ? 

Mr. Micrerson. That is absolutely correct, sir. 

Mr. Buatnik. So I get nothing here by way of reducing tar level 
in buying the filter on a king size—do I get any more tobacco in a king- 
size filter tip ? 

Mr. Micurnson. According to the Department of Agriculture, there 
is no more tobacco in a king-size, filter-tip cigarette than in a regular. 
In fact there may be even a little less. But the smoker smokes a good 
percentage more when he smokes a king-size cigarette, regardless of 
whether there is a filter present or not. 

Mr. Brarnik. Will you repeat that? By smoking more, you mean 
with a filter tip he smokes most, if not the entire part, of the cigarette; 
is that the idea? And without the filter tip he leaves a little ‘butt; is 
that it? 

Mr. Micuerson. Perhaps I would do best to give you some figures: 
If a regular-size cigarette is 70 millimeters long and a king-size ciga- 
rette is 85 millimeters, and a filter is 15 millimeters, the entire differ- 
ence in length between a regular cigarette and a king-size cigarette 
may be taken up by the filter. But when a smoker smokes down to 
about a 1-inch butt on a regular-size cigarette, he has only smoked 47 
millimeters of that cigarette; but on a king-size cigarette, by the time 
he has reached that 1-inch butt, he has smoked 62 millimeters, I believe 
it is, an increase of 15 millimeters more of tobacco that he has burned. 

It may very well be that he is getting more for his money in that 
sense, more smoking time; but if we compare the total effect on a per- 
pack basis, then he is getting just as much tar out of a king-size filter 
cigarette as he is getting out of a regular-size nonfilter cigarette, re- 
gardless of the difference in length between the cigarettes. He is actu- 
ally smoking more tobacco and getting the same amount of tar. 

There was a time when some cigarette companies made a virtue of 
the fact that their cigarettes were longer, they were king size and, 
therefore, there was more filtering by the tobacco itself. This we 
firmly believe, on the basis of test results, is fallacious because there is 
actually more tobacco burned in the longer cigarettes when smoked to 
the same size butt and that accounts for the differences in nicotine and 

tar found between regular-size cigarettes and king size. What the 
filter on the king size seems to have accomplished—and I say “‘seems to” 
because I don’t know whether it is a change in tobacco or the filter— 
it seems to have reduced the tar level of a king-sized cigarette to that 
of a regular size without a filter. Have I made myself clear? 


Mr. Buarniz. Yes; you have. The amount of tobacco is still the 
same in the king-size filter as it is in a regular but you smoke actually 
more tobacco in a king-size filter. 

Mr. Micuerson. In any king-size cigarette. 

Mr. Buarnix. On page 100 of that same report you state in the 
opening column there in the second paragraph, the left-hand side of 
the page: 

A number of interesting facts stand out from a study of the data obtained in 
this and previous tests. 

Would you read those or summarize those? Are those your con- 
clusions ? 

Mr. Micuertson. Those are conclusions. 

Mr. Buarnik. Of yourself and your organization after these cur- 
rent 1957 tests ¢ 

Mr. Micurrson. Yes; these were our conclusions at the end of the 
1957 tests. 

Mr. Biratnrx. Would you read those? 

Mr. Micuetson. I would like to point out before I begin reading 
these that some of the conclusions may relate to particular brands 
and as I said before, there are constant changes in the particular 
brands from time to time so that some of them may no longer be true 
at present. 

Mr. Buarnirx. We are not interested in individual brands at this 
time but those five general summary statements or conclusions. 
Would you read those ? 

Mr. MicHELson (reading) : 

King-size cigarettes produce more nicotine and tar in the smoke than the 
shorter regular-sized cigarettes, if both are smoked to the same butt length. 
As between filters and no filters there is very little to choose so far as nicotine 
content of the smoke goes. While the nicotine content is about the same, the 
average filtered cigarette smoke contains somewhat less tar than unfiltered 
smoke. So-called low-nicotine cigarettes do show low-nicotine content as com- 
pared with others, about a third as much on the average as the ordinary brands. 

Unfiltered cigarettes, both regular and king size, are remarkably similar in 
nicotine and tar levels to their levels of 2 years ago. In contrast, the average 
nicotine and tar levels of filter-tipped cigarettes have risen. 

Mr. Buarnix. Are there any further questions? 

Mr. Micuetson. Mr. Chairman, I would like to make a few general 

Mr. Buatnrk. Please do. 

Mr. Micurtson. The statement which I have presented on behalf of 
Consumers Union Laboratory has been confined to technical material. 
We did not want to editorialize in this factual presentation and we 
would like the committee to know that we have an interest in the 
general situation as well as the technical data. 

It is our feeling that the Federal Trade Commission can play an im- 
portant role in protecting the American public in this situation. We 
feel that they may have been less than the most effective organiza- 
tion in the world in this sphere, partly because of the procedural diffi- 
culties they may be operating under, partly because of budget diffi- 
culties, but whatever the difficulties that have beset them we feel 
that Congress would do well to try to find legislative remedies to give 
_them every possible help in this situation. 

The fact that the general cancer-cigarette problem has not been 
completely resolved to everybody’s satisfaction (as to whether ciga- 


rettes do or do not give people cancer of the lungs) does not warrant 
ignoring the situation. If there are misleading advertisements in the 
field of filter-tip cigarettes, we feel that action should be taken by 
the FTC. 

Our organization probably will have an editorial on the subject in 
one of our coming Issues. | 

I wonder whether it is your intention in this hearing to ask the opin- 
ian a Consumers Union any more extensively on the subject of the 

Mr. Meaper. Mr. Chairman, in the light of this voluntary statement 
made by Mr. Michelson, I would like to ask him whether his organiza- 
tion has taken any position on the question of whether the advertise- 
ments of the cigarette industry have been misleading to the general 

Mr. Micuerxson. The last time we took a position—in print, that 
is—was some time I believe around 1940 when there was a report by 
Reader’s Digest on cigarettes and I believe it was Old Gold came out 
lowest at that particular time. Reader’s Digest made certain limiting 
statements about this finding, they felt it didn’t have much significance 
because it was not much lower. Old Golds launched an advertising 
campaign on the basis of the fact that they were lowest in that par- 
ticular test and we called the attention of the FTC to this, I believe, 
and the FTC tried to take action but were unsuccessful because of the 
time involved. By the time they got to a cease-and-desist order, Old 
Gold had already switched to another advertising slogan and there 
was no effect in such a cease-and-desist order. The company wasn’t 
interested in using that advertising any more. 

Since then we have felt that the FTC needs prodding but under its 
procedures and other difficulties, there isn’t much possibility of effec- 
tive action. 

Mr. Mraper. Now we are getting off on the second question as to 
whether FTC has or has not discharged its responsibilities in protect- 
ing the public under its law. What I want to get at first was whether 
your organization had made any study of the advertisements of the 
cigarette companies and made a determination or at least formed an 
opinion as to whether or not those advertisements were misleading and 
misrepresented to the general public—the facts in the situation. 

Mr. Mrcnetson. We have studied the advertisements in our offices 
and laboratories. We have come to conclusions but we have not. pub- 
lished our conclusions in this field so far as I recall. 

If the committee would be interested in our feelings about these ad- 
vertisements, I would be glad to give you some examples or cite you 
some examples. 

Mr. Mraper. I think that is the subject matter of our hearing. 

Mr. Buatrnik. That is exactly what we want. 

Mr. Michelson, while I am not quite satisfied for the record—I don’t 
mean I am not satisfied with your testimony—because the three articles 
T have read, and I have read them carefully and one I have read be- 
fore, your March 1957 article, is about as good a report on the opera- 
tion and functioning and the purpose of the filter that I have come 
across anywhere. I think you have done as careful a job as was pos- 
sible and I believe you are fair, you are fair in your conclusions, you 
still leave it open, you suggest there is probable need for further test- 
ing on it. 


We are having great difficulty in trying to find out just what the 
filter does, so then we can proceed to see if it does what they claim for 
it and if you have any further material in your organization or any 
analysis you have made of claims—I believe you do study the claims 
made for a product and you run a test on a product, don’t you, to see 
if the test substantiates the claim, and Mr. Michelson, if you or your 
organization has any information on analyses of the claims made 
in advertising and see how it stacks up with what you find in a lab- 
oratory, we would certainly appreciate it and would like very much’ 
to have it. 

Mr. Micurtson. You already have in attachment A, an analysis 
of the calims of the Kent. The current Kent ads claim certain quan- 
tities of tar and nicotine for their regular- and king-size cigarettes 
and we have found that they are substantially correct. This, how- 
ever, is a type of case which I would like to come back to, if I may. 

There are, in our opinion, two kinds of false advertising, at least. 
‘With one the correct facts are given, the material presented to the 
public is absolutely correct, but through some manipulation of pos- 
sibly a copywriter—and a clever one, I might add—a very misleading 
impression can be given to readers. I can cite you one example which 
was startling to me when I first ran across it a few years ago. 
Parliament cigarettes were advertising that they had no more than 
one-quarter of 1 percent of nicotine in their smoke. We finished our 
tests and found that Parliament had about as high a nicotine content 
as any of the other cigarettes—higher than most of the others. 

‘That quarter percent was correct, but there was no comparison 
figure given to show whether others were higher or lower. They 
made no claim as to being higher or lower. Any implication that it 
was lower than other cigarettes was purely in the reader’s mind. 
And, by George, it was there in the minds of most people who read it, 
I believe. 

On the other hand, there are ads like Kents, where comparisons are 
given, and the figures are correct. There the danger lies in the im- 
plication that this gives complete protection. I believe Dr. Wynder 
had something to say about the quantitative aspects of reduction of 
probability of getting lung cancer depending on the quantity of tars. 
These figures in the ads are not given in the context of Dr. Wynder’s 
remarks and the reader is left to assume for himself any conclusion, 
to reach a conclusion on a basis of very limited knowledge but with 
great desire to continue smoking if at all possible and he may very 
easily delude himself into feeling that this gives him all the protec- 
tion that he needs. 

So again, there are data, there is some comparison, but again the 
implication in the reader’s mind may be misleading. I believe that 
even when a company does not make any other claim than that it has 
a filter tip on the cigarette, it can be a misleading advertisement. 

Mr. Buarnix. What does the word “filter” mean, Mr. Michelson ? 

Mr. Micnerson. A filter is a functional word in the sense that it 
does not define the materia] that is doing the filtering but it defines 
the function of filtering. A piece of felt can be a filter. A piece of 
paper can be a filter. A piece of steel with holes in it, a piece of sin- 
tered glass—all of these things can be called filters because they can 
remove from the materials passing through them undesirable mate- 
rials, or materials desired to be separated for one reason or another. 


Because of this, almost anybody who is told that a cigarette has a 
filter tip—just the very fact that it has a filter tip—is led to believe 
that things are being taken out of the smoke. At this particular time 
when the cancer scare has reached such proportions that officials of 
various organizations are being quite positive that there is a corre- 
lation, when the public mind is very much aware of the danger of 
cancer, when every time they read an ad of a cigarette, they have this 
in mind, the presence of the words “filter tip” even without any other 
claim will give the readers the idea that they are going to get protec- 
tion from this horrible danger. 

Mr. Buarnix. Mr. Michelson, will you furnish us further material 
for examination by the staff—our time is running out and we have two 
more witnesses. 

Mr. Micuerson. I will be glad to. 

Mr. Bratrnix. At this point, if there is no objection, I would just 
like to include in the record articles on cigarettes in your Consumer 
Reports of February 1953 and February 1955 and March 1957. (See 
appendix, exhibit 15, p. 622.) 

Our next witness is Dr. Walter Wolman, director of the chemical 
laboratory of the American Medical Association. 


Mr. Buarnix. Doctor, we welcome you to the committee. I am 
sorry we have run a little longer than we anticipated. You have a 
prepared statement with you, Dr. Wolman? 

Mr. Wotman. Yes, sir, I have. 

Mr. Buatnix. Will you give us a short background of your pro- 
fessional experience and proceed with your statement. 

Mr. Wotman. I obtained my bachelor’s degree in chemistry from 
the University of Wisconsin in 1938. I obtained a master’s degree from 
Michigan State College in 1940, and a doctor’s degree from the Uni- 
versity of Minnesota in 1943. The latter was in chemistry. | 

Mr. Chairman and members of the committee, I am Dr. Walter 
Wolman, director of the chemical laboratory of the American Medi- 
cal Association, in Chicago, Ill. I am a doctor of philosophy in chem- 
istry, not a doctor of medicine. I am here today in response to the 
request of this committee to discuss a series of studies made by our 
chemical laboratory on the nicotine and tars in the smoke of several 
types of cigarettes and the effectiveness of various filter devices in re- 
moving nicotine and tars from cigarette smoke. These studies were 
made during 1952, 1953, and 1954. (See appendix, exhibit 16, p. 668. ) 

The procedures and methods used were those generally recognized 
in the scientific literature as acceptable and accurate. The results 
of the studies were presented in four papers published in the Journal 
of the American Medical Association. Attached to my statement are 
copies of these articles with the published graphs summarizing the 
nicotine and tars contents in the mainstream smoke of the cigarettes 
and holders tested. 

Mr. Worman. My statement shall be a brief summary of these re- 
ports, No further work of this type has been done at our laboratory, 
and, as a consequence, we have no data on cigarettes and filters 
marketed since 1954. 


As you will note, the various cigarettes tested were not identified 
as to brand names in the articles reporting the results of these studies. 
Therefore, I have made available to the committee several copies of 
the key identifying the brand names of these cigarettes. 

Mr. Buarnr«. In showing your percentage of reduction, you don’t 
have a third column which would give the level of tar which passes 
through? That would be the important thing, wouldn’t it? 

Mr. Wonman. That is ri ight. 

Mr. Buarnikx. If you have a weak tobacco with low tar content and 
a very weak and ineffective filter that reduces 10 percent of this, the 
end product may be a low tar level? 

Mr. Wortman. That is right. 

Mr. Buatnik. If you have a high tar content cigarette and a more 
efficient filter—let’s say it reduces 40 percent of the tars—you may 
still end up with a higher tar level. 

Mr. Wotan. That is true, depending upon the original amount 
of tar-forming substances present in: the tobacco. 

Mr. Buatntk. Do you further clarify that? 

Mr. Wotman. I believe so. The statement explains that. 

Acceptance of laboratory smoking data demands that the procedure 
used must simulate human smoking and must be reproducible. These 
conditions were met to a considerable degree by the use of an auto- 
matic smoking machine. There are a large number of variables in hu- 
man smoking, including the rapidity, time, volume and number of 
puffs, the duration of smoking, and the length of the butt. With an 
automatic smoking apparatus, it is necessary to assign, arbitrarily, cer- 
tain values of these factors—values which are reasonably close to the 
conditions of human smoking. The results and data obtained will de- 
pend on these assigned values, but, as long as the conditions are 
cor a certain comparisons between cigarettes and filters can be 

The results of such laboratory experiments will depend also to 
a certain degree upon variables inherent in the cigarettes themselves. 
Variations are due to type, weight, cut, and tightness of packing. 
Some of these variations were minimized by using cigarettes that 
varied no more than 20 milligrams from the average weight of a lot. 
The weight of nicotine found in cigarettes and tars in their smoke 
can vary in different lots of the same type of tobacco. The nicotine 
content of tobacco is subject to a variation depending on growing 
conditions and cultural practices. 

Five cigarettes were smoked for each single determination and the 
smoking was done in a room kept at constant temperature and constant 
humidity. For the determination of nicotine, the smoke was collected 
in a flask containing a given amount of alcohol and acid. After the 
smoke deposited in the solution, it was made alkaline and then the 
nicotine steam-distilled into a dilute acid. The nicotine was then 
precipitated as the silicotungstate, ignited, and weighed. The amount 
of nicotine in the tobacco was also determined by the methods of the 
Association of Official Agricultural Chemists. 

Tars were determined by collecting the smoke over a given amount 
of sulfuric acid in a flask. The smoke was allowed to settle for 20 
minutes and then the contents of the glass smoke tubes and supple- 
mentary tubes were washed into the flask for chloroform. The ma- 
terial in the acid solution of the flask was extracted with chloroform. 


The chloroform was evaporated and the residual tars dried for 3 hours 
at 100° C. and weighed. 

Attached to my statement are two pages explaining in detail the 
methods used in analyzing the nicotine and tars in the cigarette 
smoke. (See appendix, exhibit 18, p. 677.) 

Our first report, published in J vl of 1953, dealt with the effect of 
the filters of the three largest selling filter-tip ‘cigarettes on the market 
at that time. They also represented the three types of filter tips 
available then, namley, paper, asbestos, and cotton. 

The efliciency of the filters in the removal of nicotine and tars was 
determined by smoking cigarettes with the filter mouthpiece and with 
the filter mouthpiece removed. The percentage reduction effected by 
the filter mouthpiece is based on the difference between the two 
values obtained. The values we reported actually favored the filter, 
because if the filter, after removal, had been replaced by an equal 
length of tobacco, the additional tobacco would itself act a8 a filter. 

During the course of the study, changes were made in the filters 
of each of the three brands and in order to avoid publication of data 
on obsolete filters, the work was repeated on the new filters. The 
results of the tests were as follows: 

Percent reduction: 
by filter in the 
smoke of— 

Nicotine Tars 

TES Ta ee tan, ihe net Sp ee gg i Se ie RS Se i emigre 9 5 
RAG VAU: Sere ees eee Cte, DOPE RS DEI L, LOO PRES AE ARON eo Mare Ne oe ee 14 17 
Bran Biles es BOs le 2 ee foe ge ie et Atel) rae er ele «ae es er Oe 60 55 
BAIR ee eee ee Be ae RR erp cc We a in ip oe a A 4] 44 
Brandeis eee pe ee ese ee Oe eT NEY OP Eee PE Ors ae Seat) EP 14 16: 
Doe Wa UG li OV eer ae ee ee, See Oe eee oer ee ee Reet oo es 27, 23 

Note.—Fig. 1 in 1st column refers to the original set of filters and fig. 2 to the set of cigarettes with the 
modified filters. 

Actually the filter of brand C2 trapped more nicotine than that 
of brand B2, but the percentage efficiency was smaller. This is a 
result of the fact that brand C2 has a larger nicotine content in the 
tobacco. The overall effectiveness of filters A and C was not large. 
The brand B filter was much more effective, although B2 was con- 
siderably less effective than B1 because of changes made in the original 

Our second report, also published in July of 1953, was concerned 
with special low-nicotine cigarettes. Two brands, E ‘and F’, were so- 
called denicotinized cigarettes, and the third, brand G, contained a 
tobacco bred for low-nicotine content. ‘The nicotine content for all 
3 tobaccos was less than 1 percent in contrast to the 1.8 or more percent 
found in the tobaccos of other types of cigarettes. Brand G had 
only about 0.3 percent of nicotine present, but it also contained 0.45: 
percent of another alkaloid similar to nicotine, called nornicotine. It 
also contained a significantly greater amount of tars. The tar content 
of brands E and F were about the same as for other tobaccos. 

The third report, published in February of 1954, covered our study 
on cigarette holders that contained filters. The efficiency of these 
were found by determining the amount of nicotine and tars remaining 


in the holders in-addition to that appearing in the mainstream smoke 
(that 1s, the smoke which reaches the smoker’s mouth in contrast to 
sidestream smoke.) Holders 1. and 2:used a metal trap such as those 
found in many pipes. .' The reduction of nicotine was 5 and 4 percent ; 
and in tars, 8 and .11 percent, respectively, for these two holders. 
Holder 3 used cylindrical paper filter containing a number of small 
paper bafiles. . It reduced the nicotine content of the mainstream 
smoke by 7 percent. and the tars by 9 percent. Holder 4 used a plastic 
cylinder filled with granules of silica as a filter. It reduced the nico- 
tine by 14 percent.and the tars by 21 percent. The most effective 
holder, No. 5, was one which used an inserted cigarette as a filter. 
It reduced the nicotine and tar content by about 41 percent. The 
efficiency of the holders dropped as additional cigarettes were smoked, 
although holder No. 5 maintained its efficiency even after the 20th 
cigarette was smoked. 

Mr, Buarnix. At that point, Doctor, could you give us, just on the 
holders—now—would I be correct in assuming from the testimony 
you have here, that the best filter is a cigarette, itself ? 

Mr. Wotman. In these particular tests, this showed up. best. 

Mr. Mrapmr. Is that because of the material in the cigarette or 
because it was a longer filter? : 

Mr. Woitman. I am.of.the opinion that it is largely a matter of 
the length of the filter. 

Mr. Prarrnenr. You say the: nicotine and tar was reduced 41 per- 
oat in, No. 5. Would this depend upon what cigarette was used as 
a filter 

Mr. Wortman. We didn’t make. tests to that effect, but I would im- 
agine that it would be fairly constant, depending on the tightness of 
the packing of the cigarette that is used as a filter and the length of 
the cigarette. 

The final report, published in April of 1955, covered regular cig- 
arettes, king-size cigarettes, and additional filter- -tip cigarettes which 
had appeared on the market since the work was done on the first re- 
port. In these instances, the same length was smoked in both the 
king-size and the regular-size cigarettes, but in a second test, king-size 
and regular cigarettes were smoked down to the same size butts. 

The attached reproduction of this fourth article summarizes the re- 
sults of these tests in table 2. Columns 4 and 9 of this table record 
the weight of nicotine and tars found in the mainstream smoke. Col- 
umns 5 and 10 show the percent reduction of nicotine and tars by 
the filter cigarettes. If a king-size cigarette is smoked, only the same 
amount as a regular cigarette, the longer butt will serve to filter out 
nicotine and tars. However, if the king-size cigarette is smoked to 
the same size butt as a regular cigarette, more nicotine and tars are 
in the mainstream smoke. 

That concludes my formal statement, Mr. Chairman. I will be 
happy to attempt to answer any questions that the members of the 
committee may have. 

Mr. Brarnrtx. Without objection, we have included with your state- 
ment, Doctor, the four reports you have submitted with the detailed 
information and tables. 

May I ask you if the method or the technique used for determining 
the percentage or the actual amount of tars and nicotine was similar 
to those used by Consumers people. 


Mr. Wotman. Yes, sir. There were some minor modifications but 
it is essentially the same. 

Mr. Buatnrx. And the results are the same? 

Mr. Worman. They compare very closely, yes. 

Mr. Buatnirx. Could you give us a summary statement in general 
terms of the advantage of using a filter ? 

Mr. Worman. A filter will reduce the amount of certain constit- 
uents of the smoke, or of smoke particles that pass through the filter. 

Mr. Prarrncrr. What is the effect of the filter on the nicotine and 
tar content of the cigarette if the nicotine and tar content of the cig- 
arette is stepped up ? 

Mr. Wotman. We didn’t make tests along that line, but I would 
imagine the efficiency would be pretty much the same. It might drop 
a little bit because of the volume that goes through but it would be 
pretty much the same. 

Mr. Buarnik. Doctor, you have brand A1, A2, B1, B2, C1, and C2, 
and so forth. Not for publication but for study of the staff to check 
with other tables we have which identify the brands, do you have a 
key we could have ? 

Mr. Wotman. I thought that had been presented to you. 

Mr. Buatrnik. I see we have the key here. 

I have no other questions, Doctor. Thank you very much for your 
cooperation and for your assistance. 

The next witness is Dr. C. S. Kimball, executive vice president of 
Foster D. Snell, Inc., Laboratories. We thank you, Doctor, for mak- 
ing a special effort to come down and give us information which I 
am sure will be of assistance to the committee. 


Mr. Kiweauy. Mr. Chairman and members of the subcommittee, 
may I state I am Mr. Kimball and I am not entitled to the doctor’s 

My name is Cyril S Kimball. I am executive vice president of Fos- 
ter D. Snell, Inc., New York, N. Y., consulting chemists-engineers. 
I reside at 80 Chittenden Avenue, Tuckahoe 7, N. Y. 

I am a chemist and I have been employed by Foster D. Snell, Inc., 
since the business was incorporated in 1931. We engage in a fairly 
broad spectrum of activities, largely centering on applied chemical re- 
search and development work for industry and the Government. It 
will be apparent to the committee that neither myself nor my firm are 
qualified to draw conclusions or express opinions on the physiological 
effects of smoking cigarettes. 

My first experience in carrying our work on tobacco smoke dates 
back to 1936. At that time we did some work in our laboratories which 
showed that an equal length of tobacco was a more efficient filter for 
tars and nicotine than the then current cellulose or paper filters. The 
following year three investigators at the Aluminum Company of 
America Research Laboratories confirmed our findings in an article 
published in the July 1937 issue of Industrial and Engineering 
Chemistry, a publication to do work on tobacco smoke from time to 
time up to the present. 


We recently carried out tests for Reader’s Digest and the results 
were published in the July issue of that magazine. (See appendix, ex- 
hibit 14, p. 604.) It is believed that you will be interested in knowing 
the technical details of the methods of testing we employed and, there- 
fore, | have turned over to counsel of the committee a report giving 
these details and literature references. (See appendix, exhibit 14, 
p. 619.) Copies of this same report have been made available to any- 
one requesting such information from our client, the Reader’s Digest. 

It is presumed that you are concerned with the reasons why the 
data published in Reader’s Digest is not in complete agreement with 
data obtained and published by others. We believe that the discrepan- 
cy is due to differences in methodology and in the case of data pub- 
lished several years ago there would be differences in the tobacco used. 

As regards the tar content of cigarette smoke, we think it is in order 
to define what is meant by tar content. We have never seen an official 
definition for the word “tar” as applied to tobacco smoke. Therefore, 
it seems logical to accept what I will call the classical definition for 
the word. We think it means a dark brown or black condensate ob- 
tained by the pyrolysis or destructive distillation of organic mate- 
rials such as wood, coal, shale, and petroleum. 

It has a variable composition depending upon the original material, 
the temperature and other conditions employed in producing it. Tar 
is a generic word describing a complex mixture of substances of uncer- 
tain composition. It is often possible to separate from tars, by ex- 
traction or distillation, pure substances of known chemical composi- 
tion, as for example phenol and naphthalene are derived from coal 
tar. Tar may also contain inorganic matter, that is to say mineral 
substances as well as organic matter or carbon compounds. 

According to the article published in Consumer Reports for March 
1957, showing the tar content of cigarette smoke, the figures are based 
upon a selective extraction with chloroform of the so-called smoke 
solution. This smoke solution was obtained by passing the smoke 
through acidified alcohol. We have determined that upon extraction 
of the acidified alechol-water solution containing the tar, with chloro- 
form, we obtain a fractionation with approximately 69 percent being 
soluble in the chloroform and leaving a residue of 31 percent remaining 
in the acidified alcohol-water solution. On evaporation of this residual 
alechol-water solution we obtain a dark brown tarry residue. I have 
with me some beakers containing residues which I would like to show 


No. 1 contains the tar from cigarette smoke as we determine 1t—for 
purposes of clarity I will call it total crude tar. 

No. 2 contains the chloroform extractable tar from an equivalent 
amount of cigarette smoke as in beaker No. 1. 

No. 3 contains the residue remaining in the acidified alcohol-water 
solution after extracting out the chloroform soluble tar. 

We cannot distinguish the residue in beaker No. 2 from that in 
beaker No. 3. We hold that our method of analysis measure the total 
tar in cigarette smoke whereas a chloroform extraction technique 
measures some unidentified portion of the total tar. It seems 
reasonable to us that if we are concerned with tars which may be con- 
densed or absorbed by a filter in a cigarette then the total tar content 
should be measured. 



The purpose for which an analysis is made is important in selecting 
a method of analysis. In this case, we are trying to find out what the 
average smoker gets in the mainstream smoke of his cigarette, whether 
it isa filter-tip or a plain-tip brand, and irrespective of any physiolog- 
ical effects. 

~The two important components we are familiar with are tar and 
nicotine. To have significance for human smoking, we think it is neces- 
sary to recover and weigh all—or as much as possible—of the tarry 
substances in the mainstream smoke. 

Until some recognized authority tells us which portion or fraction 
of this tarry substance has some particular significance, we cannot 
justify extracting selectively only some specific part of the total tar. 
We should extract and weigh all of the substance that the smoker 
would take in. 

In determining nicotine content of the smoke, we used the standard 
method of the Association of Official Agricultural Chemists, an organi- 
zation whose membership comprises workers in State and Federal 
Government agencies. We obtained good reproducibility of results. 
We have not had experience with ultraviolet spectrophotometric 
method of analysis for nicotine content, the method employed in the 
Consumer Reports data. We believe that the data we obtained for 
nicotine content is comparable with other data which was obtained by 
the same method of analysis. 

There is one additional point which may be of interest to the com- 
mittee. We smoked all cigarettes to the same butt length, namely 23 
millimeters or just under 1 inch. This has been the practice of most 
investigators in the United States and it dates back before the advent 
of king-size cigarettes. 

The 23 millimeter butt length has been applied in most published 
studies that since have included king-size cigarettes. 

However, there is the question of what is the average butt Jength 
tu which the average smoker smokes a cigarette, and does this average 
vary with regular- and king-size cigarettes. 

Frankly, we have made no statistical survey to try to establish these 
facts. Asan individual I find that when I smoke a filter-tip king-size 
cigarette I smoke it to approximately the same butt length as a regu- 
lar cigarette and my direct observation of other smokers indicates that 
this may be the general practice. 

That concludes my formal statement. 

Mr. Bratrntx. Without objection, we will insert in the record a 
2-page methodology employed in the interpretation of tar and nico- 
tine content of cigarette smoke for Reader’s Digest, signed by Mr. 
Kimball, who testified here this morning, and to include the two 
Reader’s Digest articles for July and August of 1957, in the July 
issue, The Facts Behind Filter Cigarettes; and in the August issue, 
Wanted: Available Filter Tips That Really Filter. (See appendix, 
exhibit 14, pp. 604, 612.) 

Mr. Brarnix. Doctor, some of us have gone over the two articles on 
filter cigarettes. Were those articles written under your direction or 
supervision or did the authors merely have access to the laboratory 
findings which you have made available to The Reader’s Digest? 

Mr. Krmpauu. We made the data available to The Reader’s Digest 
and had no connection with the article. 


Mr. Brarnix. Did you review the article? Were the conclusions 
justified ? } | 

Mr. Kimpatu. I read the article prior to publication but only for 
the purpose of making certain that there was no reference to our 
name in connection with same. } 

Mr. Buarnix. The interpretation or evaluation of your laboratory 
findings is entirely the responsibility of the authors and The Reader’s, 
Digest publishers ? 

Mr. Kimpati That is correct. 

Mr. Brarnrx. Would you have any comments to make from your 
experience and your laboratory work on the effectiveness of filters? 
In general what is their efficiency ? 

Mr. Kiweauu. Filters do remove tar and nicotine taken from the 
smoke. Now, I think we may be confused when we resolve this down 
to a per cigarette basis. Inasmuch as previous witnesses have pointed 
out that when you smoke an 85 millimeter cigarette, king size, and 
relate that to a regular cigarette of 70 millimeter size, you are smoking 
more tobacco in the case of the king size cigarette. You expect, there- 
fore, that you will find more tars and more nicotine when you smoke 
more tobacco. 

Mr. Meaper. Mr. Kimball, with respect to these beakers with the 
tarry content in the bottom, can you tell us how much cigarette smoke 
was used to produce the amount of tar you have in beaker No. 14 

Mr. Kimpati. I am not exactly certain but I believe that was from 
five cigarettes. This was made for demonstration purposes and it may 
have been more. 

Mr. Meapver. Do I understand that beaker No. 2 contains that por- 
tion of the tar which can be dissolved in chloroform ? 

Mr. Kiwpauu. Yes, sir. 

Mr. Maver. And the content of beaker No. 3 is the remainder that 
was in the acidified alcohol ? 

Mr. Kimpaty. That is correct. 

Mr. Meaper. You say you have no way of distinguishing as far as 
chemical composition is concerned from the chloroform soluble tars 
and the alcohol soluble tars? 

Mr. Kimpatu. That is correct. 

Mr. Meraper. You did not attempt to break down the chemical com- 
ponents of this tar? 

Mr. Kimpatt. We made no attempt, sir. In the first place, the tars 
have not been completely identified. They are of unknown composi- 
tion. Therefore, one would hardly analyze to determine whether or 
not you get all of the tars when you make an extraction with chloro- 
form. How to distinguish between the two when you are starting with 
something of unknown composition is impossible. 

Mr. Meaprr. It would be logical to assume that the tar contained in 
beaker No. 2, soluble in chloroform, would be of different chemical 
composition than the other which was not and remained in the acidified 
alcohol solution ? 

Mr. Krvearu. It would be logical to think there would be some dif- 
ferences in composition. We have made a selective extraction by ex- 
tracting the chloroform but we have not tried to identify exactly what 
the composition is that, was soluble in the chloroform. From appear- 
ances, the matter soluble in chloroform and the matter which remained 
in the acidified alcohol water solution appear to be the same. 


Mr. Meaprr. That is simply from examining it with the naked eye 
and not testing of any kind with scientific instruments ? 

Mr. Krupa, Yes, sir. 

Mr. PLapincer. Apparently your findings confirm that of the Ches- 
terfield, Lucky Strike, Camel, and Old Gold, each of those cigarettes 
have less tar content than the king sized filter tips made by the same 
company. Iam not sure I am correct there. 

The Chesterfield regular has 32.7 milligrams of tar. L & M king 
filter has 38.5. 

Pires Sl Strike regular has 31.5 milligrams of tar. Hit Parade has 

Camel regular has 31 milligrams of tar and the Winston king filter 
has 32.6 milligrams. 

Old Gold regular has 30.9. Old Gold filter-tip king has 39. 

Mr. Kimpatu. That is correct. 

Mr. Buarnix. Would that indicate that in each case the regular non- 
filter cigarette has less tar in the main-stream smoke than the king size 
with king-size filter ? 

Mr. Kimpauy. Yes, when both are smoked to the same butt length. 

Br. Buarnix. If there are no further questions, we thank you very 
much Mr. Kimball. Weappreciate your assistance. 

Mr. Stephen E. Wrather, Director, Tobacco Division, Agricultural 
Marketing Service, Department of Agriculture. | 


Mr. Bruarnrx. Will you please proceed with a brief biographical 
summary background? Do you have a prepared statement with you? 
Mr. Wratuer. I donot. Mostly statistical tables showing the price 
of tobacco. 
~I was born in Kentucky. I grew up on a tobacco farm and attended 
the University of Kentucky. I was on the staff of the Kentucky Ex- 
periment Station for about 6 years. I moved to Washington in 1940 
and have been here since then. I have been with the Department of 
Agriculture most of this time. I did serve a sentence of about 2 years 
in the OPA during the war. Currently I am Director of the Tobacco 
Division of the Agricultural Marketing Service. 

Basically as I understand the interest of your committee, we estab- 
lish and promulgate the grades for tobacco. After setting up the 
standards or the grade for tobacco, we proceed to inspect the tobacco, 
on the auction markets before it 1s sold. That is a matter over which 
the growers have jurisdiction in that before we move in and inspect the 
tobacco on an auction market a referendum would be held and if two- 
thirds of the growers voting approve the inspection, and along with 
the inspection goes the Market News Service, the quoting of the 
prices—then we would take it on asa regular operation. 

All of our auction markets are inspected. That includes our south- 
ern types of tobacco. All of our flue-cured, all of our burley, all of our 
southern Maryland, all the dark types of tobacco. This program does 
not prevail in the cigar-leaf producing districts largely because of the 
types of markets they have. They have no centralized market where 
tobacco is assembled for purchase, and so forth. In the cigar-leaf areas 


tobacco is bought by private treaty between the purchaser and the 
grower at the producer’s farm. 

As I indicated, I do not have a prepared statement. I would ap- 
preciate some indication as to what I could contribute to the Com- 

I would say to begin with that the inspection and grading of tobacco 
is an extremely complicated operation. We have in flue-cured and 
burley tobaccos, 120 grades. Actually we have more than that. We 
have some off-factored grades. We would make in flue-cured and 
burley tobacco perhaps 140 or 150 grades. So you can see when you 
arrange tobaccos into grades and have that many grades, it gets to be 
a rather involved grading system. I don’t know how far we can get 
into the grading system. I do have some pamphlets here that I 
thought if you were interested I might distribute and point out a few 
pertinent factors in connection with our grading system for tobacco. 
I thought it might help in the interpretation of the grade prices which 
I think you are interested in. 

Mr. Prarincrer. Mr. Wrather, I think some of the committee’s prin- 
cipal interest might be summarized in this statement from Consumers 
Reports of March 1957, and we would like to hear your comments on 
it. The last paragraph in the first column, page 104. It starts: 

What kinds of tobaccos are going into filter cigarettes these days seems to be 
largely each company’s secret. Manufacturers are reported to be switching 
from light-colored, light-bodied, flue-cured tobacco, to darker, leafier bodied leaf 
in an effort to compensate for loss of flavor that occurs as the smoke paces 
through the filter. In making this switch they are turning the tobacco market 
upside down. The price of low-grade darker leaves which used to be much 
lower than that of flue-cured leaf is climbing rapidly while high-grade flue-cured 
tobacco is bringing bids below Government support prices and going begging 
at that. At the end of last year, the supply of flue-cured leaf on hand had 
mounted to a record three and a half billion pounds, enough to last almost 3 
years. Even at the old rate of consumption. As a result, the Government, 
which in connection with the price-support program exercises strict control of 
the tobacco acreage, has ordered a 20 percent cut in flue-cured growing for 1957. 

Mr. Wratuer. Basically I will have to talk to you in terms of prices 
in the market place. JI would like to point out in general the situation 
that we seem to be facing. I think it is true that for the filtered cig- 
arettes, manufacturers are using a different blend from what they used 
im what we have called standard cigarettes. It also follows that as 
we approach the introduction of the filtered cigarettes, they had rather 
large inventories of leaf tobacco bought to put in standard cigarettes. 

Now, with their volume of standard cigarettes going down each day, 
their inventory of those tobaccos for those cigarettes durationwise be- 
comes longer each day without acquiring any additional tobacco. 

Té also follows that they were short inventorywise on these tobaccos 
they are using as a new blend for their filter-tipped cigarettes. 

We have had rather intense pressure in the market for this new blend 
of tobacco. 

Mr. Buarnrx. What is that blend? The tobacco that was used 
earlier was not used in the old quantities? Could you identify it more 
specifically than call it a new blend ? 

Mr. Wratuer. Largely they have moved up the stalk, I would say. 
As you begin with the lower part of the plant you have certain grades 
of tobacco which we classify as flyings, or lugs. As we go up the 
plant we get into cutters and then we wet into leaf tobacco. | 


Now, the leaves on the lower part of the stalk are extremely mild. 
They show ground injury and during the era when we were talking 
about a lot about a mild cigarette, those tobaccos were in tremendous 
demand because we were making milder cigarettes and then we made 
them milder and milder. 

In the meantime, plant breeders and agricultural experiment sta- 
tions bred tobaccos in that direction and they too got milder and 
milder tobacco until I wouldn’t be surprised, as far as the consumer 
is concerned, but what we somewhat overshot the mark. I think our 
standard cigarette boys were in trouble with a mild cigarette—I am 
talking now about consumer acceptance. I am not speaking from a 
health point of view. 

So when we began to introduce a cigarette which had a little dif- 
ferent blend of a little heavier-bodied tobacco 

Mr. Buatnrx. Was that a less expensive tobacco ? 

Mr. Wratuer. To begin with, Mr. Chairman, it was because there 
was a substantial supply of these tobaccos, including loan inventories, 
and they were immediately acquired. 

Mr. Meaprr. In loan inventory, do you mean in the Government 
warehouses ? 

Mr. Wratuer. The tobacco was collateral for loan under the Gov- 
ernment price-support programs. These tobaccos regularly are stored 
in commercial warehouses. 

Currently this price spread does not prevail. You take the burley 
market last year, there was very little difference pricewise in these 
tobaccos. Regardless of what quality you are thinking about. The 
fiue-cured markets are in progress now and I understand that in 
Georgia and Florida, these tobaccos are being bid up in the price 
ranges of the thinner tobaccos. 

Mr. Buatnrx. Would you repeat that last part? Your flue-cured 
tobacco is your lighter, finer, and is less in tar and nicotine content 
and in short, it is your more expensive and better tobacco ? 

Mr. Wrartuer. Historically those tobaccos brought the higher 
prices because our domestic manufacturers year after year were going 
back for their requirements for a mild popular standard cigarette and 
those tobaccos were bid up. 

I indicated earlier that manufacturers have large holdings of these 
tobaccos and I rather expect their requirements for these tobaccos are 
declining along with the sale of standard cigarettes. As a result of 
this inventory position, manufacturers are concentrating their pur- 
chases on the heavier bodied tobaccos. We must remember that manu- 
facturers carry or attempt to carry about 214 years’ supply of tobacco. 
Accordingly, 1f he has an annual manufacturing requirement of 10 
million pounds, the manufacturer would be in the market trying to 
buy 25 million pounds of tobacco. 

So with all manufacturers having success with filtered cigarettes, 
and in trying to accumulate an inventory of tobacco for these blends, 
tremendous price pressures have been exerted on those grades of to- 
bacco. Particularly in relation to the tobaccos which they are long 
on, inventorywise, due to falling off in consumption of standard 

T have some tables here showing the breakdown of tobacco in grade 
groupings and showing how the prices of these different kinds of to- 
bacco have behaved, beginning in 1952 and continuing through 1956. 


Mr. Buatnrx. Without objection, they will be placed in the record 
at this point. 
(The documents above referred to are as follows:) 

Flue-cured prices, loan receipts, and holdings by grade groupings, 1952-56 crops 

{Cents per pound] 

Market price Loan rates 
Grade groupings 

1952 | 1953 | 1954 | 1955 | 1956 | 1952 | 1953 | 1954 | 1955 | 1956 

——— ff Fs 

Thin and fairly thin bodied____-_______ 66 67 66 65 64 64 63 63 63 62 
Niediumr bodied@_ = ae. 222. Sek Meet 1 See: 63 64 62 61 62 57 56 56 57 58 
Fairly heavy bodied. :.2-.<._ 2 --sszke 50 48 51 54 53 42 40 40 40 44 
Darkrandroreent ss. oes) ks May Bae 34 32 32 40 40 29 27 26 27 31 
Loan receipts (percent of total) Current loan 
Grade groupings inventory 
(percent of 
1952 1953 1954 1955 1956 total) 
Mhinkanidetainkyminybodiedees sts ae youn ewe Boao 15.9 35. 4 50. 2 AB Ki 49,9 
IMieditmatpociedes 2. Bee oe ie Se 38.9 2652 o2nT 46.8 il) 46.7 
Haiplyaneavey-podied 220 = 62s bie aes 7.4 19.6 8.0 9 ie 1.1 
Darkeandkoneenl eae ee ae ad ee ae ids 18. 4 38. 3 23.9 20 3.0 2,3 
1952 1953 1954 1955 1956 
IMarnketspnrices(Cents per POUNd)2-. 2222255 A eee 50.3 52.8 5257 52.7, 51.5 
Overall loantlevels (cents per pound). 22225. < e S 50. 6 47.9 47.9 48.3 48.9 
Average value loan receipts (cents per pound)._______________- 37.6 Bile oi 41.6 Onl 49.4 
Hoanere cep ise mail OMe pO GS) ee ee eo ee 165.0 } 151.4 | 1380.3 | 298.9 319.9 
Woeanmeceipts (percemt- Of CrOp)) 2 ee = ee ee ee We 11.9 9.9 20. 2 22.5 

Source: Tobacco Division, Agricultural Marketing Service, July 1957. 
Burley prices, loan reecipts and holdings by grade groupings, 1952-56 crops 

[Cents per pound] 

Market price Loan rates 
Grade groupings BN OE 

1952 | 1953 | 1954 | 1955 | 1956 | 1952 | 1953 | 1954 | 1955 | 1956 
Main to medium, bodied2. 22. S< 2 68 66 65 64 66 65 64 64 63 63 
Wiedinmmebodiedias fo fee 56 54 51 58 65 50 48 47 47 49 
Medium heavy bodied_____-_-__--_-_-- 48 47 43 55 65 41 38 38 38 41 
Red dank oneeuk as. = Steen aap ps SE 2 te 30 29 28 46 61 27 23 22 22 26 

Loan receipts (percent of total) Current loan 
Grade groupings inventory (per- 

cent of total) 

1952 1953 1954 1955 1956 

Thin to medivumiubodied=----2---2--2 =. = 14.8 49.6 54.4 97.9 99. 2 84.0 
IVECO CIC Cees aes Sees a ee eee 18. & 15.2 BLS 2.0 .8 15.9 
IMiediuimubeavypOOGIeG@s- 5352. aoe Pe | 14.5 4.5 8.5 : Gl eee -l 
EVO Car aliey Sue Oleees senate SB aoe ee ee Sl) BOL Oe eee ee alee Be ees eee aya ot tere tates 
1952 1953 1954 1955 1956 
Market price (GeMmts per poumd) 2.4 oe Ses ts) a Ae a Tt 50.3 52.5 49.8 58. 6 63. 5 
Overallloanwdevel.(Cemtsiperpommd))s 528 S. 2 ys eke eee hes 49,5 46. 6 46. 4 46, 2 48.1 
Average value loan receipts (cents per pound) ________________- 34.9 46.0 Doel 6257 60.0 
Moansreceipts: Gmilliommpoum ds) is = seo ae ee ee 104. 0 102..0 2210) 73. 0 6.0 
A Oai RECEIP LS QOeCRCEM Ol CLOD) = = eee nee ee eee eee 16.0 18. 2 33. 4 one ee 

Source: Tobacco Division, Agriculture Marketing Service, July 1957. 


Mr. Mraper. May I ask for a description of the criteria through 
which they grade these tobaccos. I presume the tables are geared 
to those grades. 

Mr. Wratuer. That would be true. 

Mr. Meraper. We should have something in the record that 
describes the grading. 

Mr. Buatnix. Give us a greater description of the procedure and 
the method of grading. Do I understand that the United States 
apentey ous of Agriculture makes the final determination in the 

Mr. Wrartuer. That is true. 

Mr. Brarnrx. And the same procedure is used in all tobaccos in 
poteriainies the grade and thereby, their possible price on the open 

Mr. Wratuer. If you people will open that pamphlet on pages 6 
and 7—I wondered if we could discuss this pamphlet for a couple of 
minutes here without trying to put it in the record because I am 
afraid it won’t make very good reading in the record. It depends 
on what your interests are in connection with it. 

Mr. Buatnix. Off the record. 

(Discussion off the record. ) 

Mr. Buatrnix. Without objection, the statement, “Tobacco Inspec- 
tion, Market News, and Demonstration Services (Type 31—Burley)” 
will be included in the record. 

(See appendix, exhibit 20, p. 684.) 

Mr. Wratrner. We would have the same thing for the flue-cured 
and the other types but this is the pattern. 

Looking at pages 6 and 7—particularly 6—a grade of tobacco really 
has three symbols. The first one would indicate the group. We have 
on the tobacco plant, three groups of grades. The flyings, that would 
be X as far as our grade svmbol is concerned. 

If we had a flying of third quality in lemon color, the grade symbol 
would be X3L That means it is in the lug group, third quality and 
lemon in color. 

That would be true on up the stalk or in all groups. We get a 
large number of grades when you consider all groups, qualities, and 
colors. On page 10, the first column to the left, the long column, are 
the groups referred to. At the top of the column we have the B groups. 
That is leaf tobacco and reading across the page you will note you 
could have leaf tobacco in any of the five different qualities and in 
any of the different colors. So you get a tremendous number of com- 
binations of grade. 

Now historically 

Mr. Meraprr. Mr. Wrather, how do you determine this “choice,” 
“fine,” “good,” “fair,” and “low” ? 

Mr. Wratuer. We have spelled out grade specifications for each 
grade of tobacco. Maturity would be a factor, freedom from injury 
would be a factor, porosity would be a factor and for each of these 
120 grades, we have a description of the physical factors making up 
the grade. All of our grade work in tobacco is predicated on physical 
factors and characteristics which we can distinguish by an examina- 
tion of the tobacco. 


Mr. Maver. Now would they have any relationship to the chemi- 
cal composition or amount of tar or nicotine that would be produced 
by that leaf? 

Mr. Wratuer. I am afraid you are getting me in the wrong labora- 
tory as far as chemistry is concerned. 

I would say this and I am not prepared to discuss it because I am 
not a chemist, some years ago we initiated a project trying to relate 
our grades which were established on a physical basis, to chemical 
constituents in an effort to determine what relationships we might get. 

But we did that for a purpose I think quite different from your in- 
terest. If there is some better way of setting up tobacco grades, we 
would like to be aware of it. 

As I say, these physical standards sometimes seem rather crude. 
If you know tobacco, you know it is a pretty difficult commodity to 
judge and there is always a lot of—oh, some disagreement about the 
grading of tobacco. So in an effort to determine if there was some 
better or, more concrete basis for establishment of grades, we did ex- 
plore the chemical constituents of tobacco, on a Federal-grade basis. 

Relating chemical analysis to Federal grades is, I think, quite differ- 
ent from the chemical analysis that is done generally on tobacco. 

Mr. Puapincer. What does heavier-bodied tobacco mean, Mr. 
Wrather? You referred to that before. 

Mr. Wraruer. Just what the term indicates. That the leaf is a little 

Mr. Puaprncer. The physical characteristics ? 

Mr. Wratuer. That is right. If you look at this tobacco plant here, 
beginning at the ground and working up, you would generally have 
your thinnest tobacco near the ground and as you move up through 
your flyings, through your cutters, into your leaf tobacco, you get 
into a little heavier-bodied tobacco. 

Now historically, the stronger demand was in these flyings and 
cutter grades, these milder, thinner tobaccos. 

Mr. Prarrtnerr. Milder isn’t a visual, physical characteristic. Does 
“heavier bodied” mean stronger tobacco ? 

Mr. Wratuer. I think generally that would be true. I think these 
extremely thin, tissuey tobaccos are mild and as you get into a bodied 
leaf of tobacco you would have what we think of as stronger tobacco. 

Mr. Meapver. That would mean that it most likely would have 
greater tar content and greater nicotine content, the higher up the 
plant you go? 

Mr. Wratuer. I am really not prepared to say chemically what the 
relationships would be. 

Mr. Mraprer. I don’t know whether you completed this study that 
you made to see whether or not there was any chemical composition 
of the various classes that you have here of the tobacco plant, as re- 
lated to your grading. 

Mr. WrartHer. This would be a different category altogether from 
what you are talking about. For example, I don’t think we made any 
analysis on tar. I just heard a witness say he didn’t know what it was 

We are interested in nitrogen content, nicotine content, ash con- 
tent, and a few substances like that, rather than tar and some of the 
things I have heard discussed in this hearing. 


Mr. Praprncrr. Mr. Wrather, haven’t there been chemical analyses 
us py the Department of Agriculture, on the various types of to- 

acco $ 

Mr. Wraruer. Well, I know only of the work that we are doing 
and we have made rather extensive analysis on a grade basis of these 
burley tobaccos and of the flue-cured tobaccos. 

Mr. Piapincer. Chemical analyses? 

Mr. Wratuer. Yes. 

Mr. Praprncer. Would you tell us something about that, please? 

Mr. Wratuer. I could submit for the record the tables and the ana- 
lytical work that was done. As far as attempting to discuss the chem- 
ical properties of tobacco to you 

Mr. Praprncer. What are these chemical analyses directed toward ? 

Mr. Wraruer. In our work we are responsible for the develop- 

Mr. Praprncer. Incidentally, I don’t mean to foreclose your sub- 
mitting anything for the record. 

Mr. Wratuer. I understand that. 

We are responsible for developing tobacco grades. Any work we 
do we have to relate it to the development of tobacco grades. Now 
when it gets into the field of chemistry of tobacco, per se, or classical 
chemistry, we don’t have that kind of money, so to speak. We are re- 

Now the work we did as I indicated a while ago, was exploratory, 
trying to determine whether or not. we had a rather logical basis for 
establishing grades, in these physical standards which we have es- 
tablished, and whether or not we could find some other criteria that 
might help us in establishing grades of tobacco. 

Quite frankly, I don’t know how familiar you people are with the 
tobacco market. 

Mr. Prarrneer. I think we would like to be familiar. That is one 
of the things we would like to hear from you. 

Mr. Wratuer. It is lke a house afire. You are likely to get run 
over mighty quick at a tobacco sale. 

It moves on pretty rapidly, I would say. These tobaccos are placed 
on huge warehouse floors in baskets about 314 or 4 feet square and the 
tobacco is placed on the basket and arrayed in rows across the ware- 
house. We go in front of the sale and grade the tobacco. The sale 
moves very rapidly. Say 400 baskets an hour. 

We have got to have some system of grading tobacco where we can 
move on and get out of the way of the sale, or else the method of sale 
would have to be modified. As far as placing a chemical analysis on 
each basket of tobacco, you are talking about something we aren’t pre- 
pared to do. We haven’t explored it with that in mind. 

Mr. Buarntx. Not to interrupt but let’s get back to some things you 
might be able to help us on. Give us a better picture on what has hap- 
pened in the tobacco market, let’s say since 1952. Give me a picture 
in terms of the shift in the type of tobacco which is selling faster and 
on which the price has gone up, the shift in another volume of tobacco 
and so forth. 

Tn short, what has been the change in the price and the volume ? 

Mr. Wratuer. That is the information I have presented for the rec- 

T show that rather completely here for the two big cigarette to- 
baccos, and that is burley and flue-cured. 


Mr. Pxaprinecrer. Are manufacturers switching from light colored. 
flue-cured tobacco to darker, heavy-bodied leaf? 

Mr. Wratuer. In fiue-cured we have had a development that per- 
haps I should explain. As we were looking more and more for thin, 
mild tobaccos, the plant breeders kept breeding in that direction. Some 
3 years ago they introduced some varieties that were extremely light 
in color. They were mild to the extent that they have been referred 
to as neutral tobaccos. | 

The domestic buyers did not want this tobacco and bought very 
little of it. The importing countries said that they could not use this 
tobacco, since it was lacking in flavor or aroma and if they had to buy 
a neutral tobacco they might as well conserve their dollars and buy 
Rhodesian tobacco or tobacco from other countries. 

As a result of that, the Commodity Credit Corporation for this im- 
mediate crop reduced its price-support level on those tobaccos by 50! 
percent of the support on comparable grades of the varieties. So they 
are trying to discourage the production of these extremely light- 
colored tobaccos as far as flue-cured is concerned. 

Generally speaking as I have said, there has been more pressure on 
these medium, heavy-bodied grades in the past 8 or 4 years. 

Mr. Puarrncer. What do you mean by pressure, have there been 
more sales ? 

Mr. Wraruer. There is more demand for them and there is more 
interest in acquiring tobacco of that type by our domestic people than 
we had experienced prior to some 3 or 4 years ago. 

Mr. Prarrncer. Is flue-cured tobacco bringing bids below govern- 
ment-support prices 4 

Mr. WratHer. Currently ? 

Mr. Puapinerr. Yes. 

Mr. Wraruer. A very small percent. The market just opened last 
Thursday and less than 2 percent is moving under loan, which is a 
very low percentage but they have a short crop. 

As it is referred to in this statement here, the acreages were reduced 
20 percent. It is a short crop, the production is definitely below 
annual requirements so we don’t anticipate much tobacco moving 
under loan in flue-cured. 

Mr. Prarincer. Incidentally, is this statement accurate? Are there 
any inaccuracies in the statement ? 

Mr. Wratruer. I would tell the story differently from what he has 
told it. I think if he wants to give it that sort of a slant, he would 
have some basis for telling it that way. The thing he leaves out as 
far as I am concerned is the fact that you are really buying the market 
today, for two kinds of cigarettes. On the one hand you have exces- 
sive inventories. The manufacturers have excessive inventories of 
certain kinds of tobacco. 

Mr. Puarincer. The mild tobacco? 

Mr. Wrarner. For their standard cigarettes. So they are not buy- 
ing much of those tobaccos and they are rather choosy. 

On the other hand they are short of bodied or upstalk tobacco and 
their requirements for these tobaccos, because of sales of filter cigarettes 
is going up daily. So if you are going to build up an inventory of a 
21% year’s supply and your competitor is trying to do the same thing, 
you have tremendous pressure on the kind of tobaccos you are talking 


Mr. Puarrneer. But this has been truer since 1953 than it was before? 

Mr. Wratuer. That is true. 

Mr. Prarrneer. It wasn’t true before? 

Mr. Wratuer. That is right. 

Mr. Puaprncer. The demand in the period prior to 1952 and 1953 
was for the mild tobacco? 

Mr. Wraruer. That is right. 

Mr. Puarincer. Now what was determined to be an inferior grade 
is now in demand and in short supply ? 

Mr. Wraruer. I wouldn’t agree with the inferior grade. 

Mr. Buatnix. What word would you use, is it a lower grade? 

Mr. Wraruer. It isa heavier bodied tobacco. 

Mr. Buatrnrg. Perhaps it was cheaper in price before? 

Mr. Wratuer. It was because it moved under loans and the demands 
were for the other kinds of tobaccos. 

Mr. Buarnrk. Give us an example of what was the price in 1952 of 
this heavier grade? 

Mr. Wraruer. In flue cured in the table I have presented here, 
“Market prices in 1952,” are you following that? (Seep. 191, supra.) 

Mr. Buatrnix. Yes, I have it. 

Mr. WrarHer. Let’s move down to the table under 1952. Thin and 
fairly thin bodied, that was 66 cents a pound. Medium bodied, 63; 
fairly heavy bodied, 50; dark and green, 34. 

Mr. Buarnix. That is your flue cured ¢ 

Mr. Wratuer. That is right. 

Now move across the table to 1956 and come down in the same 

Thin and fairly thin bodied, 64; medium bodied, 62; fairly heavy 
bodied, 53; dark green, 40 cents. It moved up. 

Mr. Brarntx. In fact the lowest part in 1952 is your dark and 
green at 84 cents a pound and now that is up to 40 cents a pound? 

Mr. WratHer. That is true. 

Mr. Muaper. It has gone up 6 cents while your thin and fairly thin 
bodied has gone down 2 cents a pound. 
~ Mr. Wraruer. That istrue. That is true. 

Mr. Jounson. Mr. Wrather, wouldn’t it be correct to say that the 
cigarette manufacturing industry since the introduction of the filter 
cigarette has sought a “tobacco for the filter cigarette which would 
give to the smoker essentially the same flavor, the same strength of 
smoke that he would get with a regular cigarette ? 
~ Mr. Wratuer. I think that statement is true. I am not at all sure, 
Mr. Johnson, but what he has wanted to go a little further than that. 
I think we were in difficulty with our standard cigarettes in 1952. I 
think we had gotten them so darned mild they were having trouble 
peddling them. 

Mr. Jounson. With regard to filter tips as opposed to other types 
of cigarettes, in effect what the tobacco industry has done, while it 
puts a filter on the end of the cigarette because the public wants it, 
they have introduced a modified blend of tobacco so that essentially 
the consumer will get the same smoke whether he smokes regular or 
whether he smokes filters? Isn’t that right? 

Mr. Wratuer. I think that is true. 

Mr. Buatnrx. Mr. Wrather, let’s go to your burley prices. 


Mr. Wratrner. You get more contrast in burley. 

Mr. Buarnrx. Much more contrast. We start off with wh aah you 
call your prime part of the tobacco leaf, your thin to medium. In 
1952 it was 68 cents a pound and now it drops slightly to 66. It 
dropped by 2 cents. 

-In medium bodied in 1952 it was 56 cents a pound. And in 1956, 
65 cents a pound. Going down to your medium leafy bodied at 56 
cents a pound in 1952, today it is up to 65 cents, just a cent below your 
pyeuiaun quality thin to medium bodied. (See p- 191, supra.) 

Mr. Wratuer. That is right. | 

Mr. Buarnirk. Going down to your lowest grade, your dark green 
burley tobacco, in 1952 it was 30 cents a pound and now is 61 cents 
a pound, which is more than twice. 

‘Mr. Wratuer. That is right. We have this difference between the 
burley and fiue cured. For the past two seasons and for the crop com- | 
ing up, burley production has been running below disappearance. 
Where in flue cured it has been going the other way, very substantially. 

Mr. Biarnix. How much tobacco of all types does the Government | 
have in the warehouses stored as surpluses now? Do you have these 
figures ? | 

Mr. Wratuer. 1,040 million pounds held as loan collateral. 

Mr. Buatnix. We will correct that but it is approximately 1 billion 
pounds. Can you divide that between your burley and your flue 
cured ? 

Mr. Wratuer. I can give. that for the record. 

Mr. Buarnix. And compare it with 1952 to see if there is any shift. 

(The information is as follows:) 

Loan stocks, July 1, 1957 

[Million pounds, farm. sales weight] 

WEUWEG $0 ULE OC cer) seo oe ee Sm ee ae ee ep eee 643 

Od LE Ca eee aie ei aig Ol Gace pee oe A Mile San eee. Tees Se Ee 281 
MEMO OMG rete. ms be rere e US teeeee so E Se ee ee 116 
Meprlincie: wy liom Jojt aie coe ia OR ee WoL 1, 040 

Mr. Wratuer. I show that, in a way, in the tables I have presented 
here. Look at the bottom part of the table there. 

Mr. Bratnrx. On which sheet? 

Mr. Wratuer. Either one of them. It is in the same place, which- 
ever one you are looking at. 

Mr. Brarnix. I have the burley sheet now. 

Mr. Wraruer. It shows down here on the bottom portion of the 
table, the loan receipts in millions, the quantity they took out of each 
of those crops, 1952 through 1956. 

Mr. Muaper. That is not broken down with respect to these grades, 
is it, Mr. Wrather ¢ 

Mr. Wrarier. In the middle table if you will notice, the right-hand _ 
column of the table in the center, “Current loan inventory, percent. 
of total,” that will show you what their inventory holdings, what 
percent ‘are in these different grade groupings which we are talking. 

‘Do you see that, on burley ? Eighty-four percent is in the thin 
to medium bodied, 15.9 in the medium? 


Mr. Puaprnerr. In the middle, the red, dark and green, would be 
the heavier. 

“Mr. Wratuer. That is right. 

Mr, Prarrnerr. And there you have no inventory, is that right, 
no inventory. While in the mild you have 84 percent. 

Mr. Wratner. Eighty-four percent of their holdings in the burley 
would be in those grades. 

Mr. Buarnix. Mr. Wrather, years ago did the Department of Agri- 
culture participate in developing and encouraging the development 
and growth of these mild tobaccos? 

Mr. Wrarner. Yes. 

Mr. Biarnix. What is the purpose in encouraging that type of 
‘tobacco ? 

Mr. Wraruer. Well, I think it is rather obvious that we went 
through a decade, or perhaps more than a decade, of a rather standard 
product, a very mild, acceptable cigarette which seemed to get 
milder—the consumer wanted it milder year by year, and we had 
rather standard requirements as far as leaf was concerned. 

Naturally, the plant breeders tried to affect the crop composition 
as much as they could in that direction. So, all of our breeding and 
all of our educational work, not only with the Department, but through 
the experiment stations and the extension forces and everywhere, we 
thought we knew what we wanted, and we were encouraging people 
to move in that direction. 

It was a natural sort of a thing to do. I would like to add that 
there is a lot of confusion, I think, about quality of tobacco. For 
example, the tobacco you use in smoking or pipe tobacco, back over 
the years we would not have used that in cigarettes at all because it 
was a heavy-bodied tobacco. What constitutes quality in some meas- 
ure, particularly from a manufacturer’s point of view, depends on 
what he intends to use it for. 

Quality tobacco for a pipe is not quality tobacco for cigarettes. I 
am talking about historically, what we grew up on. If I may go 
back over a few years ago when we were just getting underway in the 
cigarette industry, these lower leaves here, which I have referred to 
as : flyings, were literally thrown away. They weren’t even marketed. 
They wouldn’t bring enough to justify the stripping and placing them 
on the market. | 

Mr. Buatnix. How far back was that? | 

Mr. Wratuer. I would say in the early twenties, and along in there. 
But then, as the cigarette industry developed and as we turned more 
and more in the direction of the mild cigarette, these darned_trashes 
that we used to throw away turned out to be, in your terminology, 
choice, fine, first-quality tobacco, because they brought the high 

Now it seems that we are turning in the other direction, where the 
manufacturers are making a little different product, and what he 
thinks will do the most for that product is not the tobacco that he 
has been using in his other product during this stable decade of mild 
cigarette production and consumption which we have experienced. 

Mr. Meaper. On this table of burley prices, in the center and to the 
left I notice that in 1952 the red, dark, and green, which in the termi- 
nology we have used is the lower orade ‘tobacco, represented 57.2 


percent of all of the burley tobacco that went into Government 

Mr. Wratuer. That is true. 

Mr. Mrapver. Whereas in 1955 none of it went in, and in 1956 none 
of it went in there. 

Mr. Wratuer. That is exactly what I wanted to show. 

Mr. Mraper. And the high-grade tobacco, on the other hand, in 1952 
represented only 14.8 percent of the burley tobacco moving into Gov- 
ernment warehouses but, in 1956, 99.2 percent oy an 

Mr. Wratuer. That i is another way of saying exactly what we have 
been saying. I wanted to go back far enough with my figures to latch 
onto the patterns which prevailed before the filter cigarette gained 
the momentum it now has. I thought 1952 would be far enough. So, 
in 1952, if you please, you can see from these tables where the demands 
were, what tobaccos were being bought, what tobaccos were moving 
under loan, and you can see currently, also. 

The fioure referred to by Congressman Meader is a good figure but 
it is like a lot of percentages; ‘it is a wee bit tricky—99.2 percent. 
However, in 1956, only 6 million pounds moved under loan, if you 
will notice in the bottom table, this burley table that you are ‘talking 
about; 99.2 percent were in those thin- to medium-bodied grades, but 
the takings under loan in 1956 in burley were almost nil. Burley 
production in 1956 was 506 million pounds, so 6 million pounds which 
moved under loan was neghgible. 

Mr. Mraper. That compared with 104 million in 1952. 

Mr. Wratuer. That is true. 

Mr. Buatnix. Mr. Wrather, we wanted to have the staff check these 
figures to get the complete story. We thank you very much for your 

Mr. Wratuer. If I may add, these are rather comprehensive tables. 
I think it will point out pretty clearly the direction in which we are 
going, and I know, from the questions you are raising, there are quite 
a few things reflected in the tables that you aren’t aware of since 
you have not had an opportunity to study the different parts of the 
different tables. 

Mr. Bratrntx. Do you have any other comments or statements? 

Mr. Wraruer. I could present for the record the production of 
cigarettes going back to 1951 and how that is broken down between 
the different kinds of cigarettes, regular, king-size, and filter ciga- 

Mr. Buarnix. Iamsorry. Would you please repeat that? 

Mr. Wratuer. I have a table here showing the production of ciga- 
ettes annually from 1951 through 1956, broken down by regular, king- 
size, and filter cigarettes, if you want it for your record. 

Mr. Buarnik. We would like that very much. Without objection, 
it will be included. 


. Cigarettes 
Domestic Type of cigarette (domestic) ! 
Calendar year Total pro- consump- = nee bis 
duction ,, tion: ; 
Regular King size Filters - 
Billions Billions Percent Percent Percent 
TOON sity. 22 ots oF Corky os 418.8 379.7 86. 6 12.7 0. 
LOS2 Re FA PRESSES ee 435.5 394.1 80.3 18.3 its 
1953S Y 240 ea ee eR es EE Sieg £98 423.1 386.8 69.8 26.9 5) 
nS Foy ie nt AUP 2h -<5 NE RR Re 401.8 368. 7 61.0 28.9 10. 
Ob bso 2s oe ee Sa ee 412.3 382. 1 Do. 2 iN 19. 
‘seer meee LE aR ree 424, 2 391.2 45.8 24.3 29. 


1 Estimates of Harry M. Wootten, Printers’ Ink. 
Source: Tobacco Division, Agricultural Marketing Service, July 1957. 

“Mr. Buarnix. Do you have any other tables? 

Mr. Wratuer. I may have some additional copies of those I have 

Mr. Buatnrx. Mr. Wrather, we thank you very much. We will re- 
check these tables and information we have here and get a more com- 
prehensive, chronological and more orderly picture of the problem 
with which you are thoroughly familiar and have the staff consult 
further with you. We would appreciate your further assistance on it. 

Mr. Wratuer. In terms of prices, I think we can give you any in- 
formation you want. 

Mr. Buarnix. Thank you very much. 

We have no further witnesses this morning. I would merely like to 
announce that thus far we have had people testifying on the filters 
and the type of tobacco in cigarettes that are not directly connected 
with the industry. 

We have hoped to hear from representatives of industry, in order 
to get a more complete and accurate picture to help us come to the 
point of just what is the function of the filter cigarette. To date we 
have had only one direct, formal accounting or reply. We had Mr. 
Robert DuPuis, vice president of research of Philip Morris who was 
tentatively scheduled to be one of the witnesses tomorrow speaking 
for the tobacco industry or for the cigarette manufacturing industry. 

I have a letter here addressed to Mr. Curtis E. Johnson, the staff 
director of the subcommittee, a letter dated July 18, and I would like 
to insert this in the record and briefly state that Mr. DuPuis will be 
unable to appear before the committee. I quote from the letter: 

I understand that no other tobacco industry technical man is scheduled to ap- 
pear. I do not feel that I alone could represent the entire industry. I hope 
you will understand my feeling in this. 

In view of the above, I feel that I must decline your kind invitation to appear. 

He had an appointment at some laboratory and there was a con- 
flict in date. 

(The letter referred to is as follows :) 
PHILIP Morris, INC., 
Richmond 15, Va. July 18, 1957. 
Mr. Curtis E. JOHNSON, 
Staff Director, Congress of the United States, 
House of Representatives, Legal and Monetary Affairs Subcommittee, 
Washington, D.C. 
Drar Mr. Jonnson: Thank you for your invitation of July 15 to appear 
before your subcommittee on Thursday, July 25. 


I understand that no other tobacco industry technical man is scheduled to 
appear. I do not feel that I alone could represent the entire industry. I hope 
you will understand my feeling in this. 

When I discussed my possible appearance with you on the phone Monday, I 
realized that I would have to cancel a week-long trip to the laboratory of one 
of our subsidiaries. This meeting had been planned for over a month. 

In view of the above, I feel that I must decline your kind invitation to appear 
and reactivate my original plans. 

I am sorry that I shall not be able to meet you next week in Washington. 

Rosert N. DuPUIs, 
Vice President, Research. 

Mr. Buarnix. Our job is to get spokesmen from the industry in the 
interests of trying to get a complete and fair record of all points of 
view. We do hope we will be able to succeed in getting testimony 
from the people who know most about this whole problem of the 
filter-tip cigarette and who are doing the most to promote its use. 

If there are no further comments, we will adjourn the meeting 
until 10 o’clock tomorrow morning. 

(Whereupon, at 12:45 p. m., the hearing adjourned to reconvene at 
10 a. m. the following day, Thursday, July 25, 1957.) 


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(Filter-Tip Cigarettes) 

THURSDAY, JULY 25, 1957 

Washington, D. C. 
The subcommittee met, pursuant to recess, at 10 a. m., in room 100, 
Sere Washington Inn, Hon. John A. Blatnik (chairman) pre- 

Present: Representatives Blatnik, Mrs. Griffiths, Meader, and 

Also present: Jerome S. Plapinger, subcommittee counsel; Curtis 
E. Johnson, staff director; and Elizabeth D. Heater, clerk. 

Mr. Buarnix. The Subcommittee on Legal and Monetary Affairs 
of the House Government Operations Committee will please come 
to order. 

We are in further continuation of public hearings on false and mis- 
leading advertising within the jurisdiction of the Federal Trade Com- 
mission and with special reference to filter cigarettes. 

Today the subcommittee begins its fifth day of hearings on cigar- 
ettes; their effect on health, the promotion of filter cigarettes, and the 
effectiveness of these filters. 

We expect to conclude these hearings tomorrow with an examina- 
tion of some of the filter-cigarette advertising and with testimony 
from Mr. Robert Secrest, Acting Chairman of the Federal Trade 
Commission. We have attempted to secure the most authoritative 
and complete testimony possible on all phases of this problem. 

Today we had hoped to hear the cigarette-industry people state 
their point of view and their thinking on the use of filters and on the 
heavy promotion of filter cigarettes. The cigarette industry, though 
vitally involved and affected by our inquiry, has to date been con- 
spicuously absent. Invitations have been extended to the industry. 
A representative of one company accepted but later withdrew. 

Testimony before this subcommittee from some of the most com- 
petent medical authorities in the country, including the Surgeon 
General of the United States, charges that excessive cigarette smoking 
is a contributor to the incidence of lung cancer. We have been told 
that this is the conclusion of an overwhelming majority of the medi- 
cal and scientific personnel who have conducted work in this field. 
They have identified tobacco tar as the suspected caustive agent. 
Nicotine has been named as a possible contributor to heart disease. 



We have received testimony that the cigarette industry has placed 
relatively ineffective filters on their cigarettes and in addition, have 
used stronger tobaccos to nullify the effect of these filters. 

We have been informed that in spite of the mounting medical evi- 
dence that tobacco tars and nicotine are deleterious to public health, 
the cigarette industry is marketing a product with as much or more 
nicotine and tar than ever. To date, the cigarette industry’s response 
to all of these charges has been, in effect, ‘‘no comment.” 

Without passing judgment on the charges that cigarette smoking 
is a causative factor in lung cancer—and may I note that the evidence 
to date is impressive—I find it difficult to fathom the behavior of the 
cigarette industry in deliberately flying into the face of this evidence. 

We have had testimony that the case against cigarettes has not been 
proved. However, even Dr. Clarence Cook Little, the scientific adviser 
to the Tobacco Industry Research Council, has stated here that “neither 
have cigarettes been absolved.” 

Dr. Ernest Wynder, of the Sloan-Kettering Foundation for Cancer 
Research, has stated his belief that a “safe” cigarette can be produced. 

We would like to know if the cigarette industry is conducting any 
research toward producing such a cigarette or whether they are just 
sitting out this controversy in the hope that it will blow over. 

In the hearings tomorrow, the subcommittee will give attention to 
specific examples of cigarette advertising which claim everything 
from “priceless health protection” toa “smoother, milder smoke.” 

I find it difficult to understand why this industry, which spends mil- 
lions of dollars to advertise its products, should remain utterly silent 
in these proceedings in which it is the central figure. 

In the hght of these observations, I again extend an invitation to 
leaders of the cigarette industry to appear before us in order that we 
may have a record which reflects all facets of fact and opinion on the 
cigarette question. Today we will hear from two very eminent medi- 
cal experts. 

We have first Dr. Harry S. N. Greene, chairman of the department 
of pathology of Yale University. Dr. Greene, will you please.take 
the chair? 


Mr. Buarnrx. Dr. Greene, welcome to the committee. We are cer- 
tainly honored by your presence here and we appreciate your coopera- 
tion in giving us the broader point of view from men of great pro- 
fessional standing and experience in the medical profession on this 
very serious problem which is of very deep concern to literally mil- 
lions of people in America. 

Doctor, do you have a prepared statement ? 

Dr. Greenn. Ido, Mr. Chairman. | 

Mr. Buarntk. Will you give us a brief background for the record? 

Dr. Greener. Mr. Chairman, members of the committee, and ladies 
and gentlemen, my name is Harry S. N. Greene. I was graduated 
from McGill University School of Medicine in 1930 with a degree of 
M. C., C. M. At the present time, I am professor of pathology and 
chairman of the department of pathology at Yale University School 
of Medicine. 


I have been intimately concerned with cancer research throughout 
the past 25 years and throughout this time have had a considerable 
interest in cancer of the lung. I thought today I would try to give 
you a brief presentation of my understanding of the lung cancer prob- 
lem and also some evaluation of present-day research. 

Now, there are several distinctive anatomical features of lung cancer 
that are quite suggestive from the point of view of ideology. ‘The 
function of the lung as a respiratory organ requires continued contact 
between its internal surfaces and inspired air. Thus, the lung, more 
than any other internal organ of the body, is brought into immediate 
association with the external environment. Generally, organs and 
tissues subjected to prolonged environmental contact are provided 
with a covering made up of cells of a special type, known as epidermoid 
cells. Such cells cover the skin, the tongue, the lining of the mouth 
and nose, etc., and being of special structure and present in a number 
of layers, supply a degree of insulation or protection. 

In contrast, the cells lining the tubules of the lung are of a different 
type, being columnar or glandular in structure and not stratified in 
multiple layers. It is from these cells that cancer of the lung arises, 
and their exposed surface as well as the type of cancer evolved are 
pertinent points in a discussion of causative factors. 

Now, this supposition is enhanced by another anatomical point and 
that is that cancer of the lung is an epidermoid carcinoma, similar in 
all respects to the carcinomas derived from the skin or the mouth 
or lips. 

Now, an epidermoid rather than an arsenal carcinoma is one that 
aia be expected from columnar cells. Elsewhere they produce an 

Now, before a glandular cell, a columnar cell can produce an epider- 
moid carcinoma, it has to undergo a change in cells. This change from 
a columnar to epidermoid type cell is known as metaplasia. Now, 
metaplasia is not an uncommon finding in the body and all evidence 
that we have suggests that it is due to chronic irritation. ‘Therefore, 
the suggestion is that preceding the development of cancer of the 
lung of an epidermoid type there must be a chronic irritation of the 
columnar cells to convert them into epidermoid cells from which the 
cancer then arises. . | 

‘Then we have two points. First, the intimate relationship between 
cells of the lung and the inspired air places them in immediate con- 
tact with all sorts of environmental agents that may be present in the 
atmosphere. And second, the vast majority of the lung cancers are 
epidermoid in type similar to those derived from the skin rather than 
glandular would be. 

Now, cancer-inducing agents, metaplasia-inducing agents, as judged 
from research are an extremely common contaminant of the everyday 
atmosphere in which we live. 

This has been very well expressed by Dr. William Boyd who used 
to be professor of pathology at Toronto. He said, “The trouble is we 
probably swim in a sea of carcinogens (cancer-inducing substances) .” 
He goes on to say that the task of tracking down any particular one 
is difficult. 

_Now I would like to say a word about the term “metaplasia”’ which 
appears to be so intimately concerned in lung cancer. Now, it is sup- 
posedly due to the action of chronic irritants, but not all chronic irri- 


tants would produce metaplasia. And surely not all metaplasia lesions 
are precancerous. Let me give an example. Some years ago people 
used to continuously wear stiff, starched collars which were a contin- 
ual irritant to the skin of the neck. Yet no cancers arose in the skin 
of the neck in that region. In contrast, cancers of the mouth is not 
associated with ill-fitting dentures. So that the nature of the chronic 
irritant 1s of extreme importance in the production both of metaplasia 
and precancerous relation. 

There is also considerable evidence that the constitutional makeup 

of the individual is very much concerned in the production of cancers 
in areas of irritation. 
_ Let me emphasize the fact that not all areas of metaplasia result- 
ing from chronic irritation are precancerous. Almost any individual 
in this room if subjected to a thorough post mortem examination would 
show areas of metaplasia, or areas that could be interpreted as pre- 
cancerous. It is obvious, however, that not all of us will die of can- 
cer. It is clear, therefore, that not all of these areas so designated 
are truly precancerous. 

How is the determination of a precancerous lesion made? First 
they are made from organs removed from human patients and sent 
to the surgical pathologist. He looks at them after the tissue has been 
killed and stained under microscopic slides. If there are certain struc- 
tural changes or changes in the relationship between cells, he says the 
lesion is metaplastic, shows cellular atypism, basal-cell hyperplasia, 
or many such terms as he considered to be precancerous. 

Now, how does he know it is precancerous? The lesion is not left 
in the individual to go ahead and develop. It goes in a can of formula 
and killed, where further development does not occur. 

In other words, the assumption that a lesion—the diagnosis of a 
lesion being precancerous is based purely on an assumption and not 
observation. One has, therefore, to be careful in interpreting these 

There have been many instances of that sort of thing at the present 
time and it apples particularly to cancer of the cirvex. There a lesion 
has been noted with some frequency recently and called a carcinoma 
in situ or a noninvasive carcinoma. 

Now that word, of course, is a complete absurdity. Carcinoma by 
definition is an invasive lesion. It is not possible, therefore, to use 
the term “noninvasive carcinoma.” In fact, all it means is the rela- 
tionship of the cells in a thin layer has been disturbed and its sig- 
nificance is not known. By many people, it is true, it is thought to be 
precancerous. There is some evidence, however, coming now that 
that is not true. A number of women who were subjected to cervical 
biopsies—some 5 to 6 years ago—refused treatment and the cervicis 
were not removed. Those women have recently been examined to see 
the outcome of this so-called precancerous lesion. 

Now, in some instances there has been a cancer present. These 
have been very few, however. In the majority of cases the same pre- 
cancerous lesion, so-called, is still present, or has completely disap- 
peared. So before we have some more, better observational data, one 
must take this business of precancerous relations with many grains of 

Another point in relation to metaplasia—I mention this specifically 
because there have been a number of papers recently, or one paper in 


particular, which has purported to show that smokers—cigarette 
smokers in particular—have many areas of metaplasia, and so on, in 
the lung. 

I would like to point out one point in relation to that, and that is 
that way back, following the great influenza epidemic of 1917, Dr. 
M. C. Winternitz, who was my predecessor at Yale, observed in the 
lungs of people who died with this disease an extreme degree of meta- 
plasia, and at that time said that, if this was a precancerous lesion, 
then all individuals who recovered from influenza would subsequently 
die of cancer. Now, that hasn’t occurred. 

I would like to also emphasize the fact that viruses are of great im- 
portance in the production of metaplasia. I have seen mouse lungs 
from mice which have been infected with influenza virus that, under 
the microscope, one could only with great difficulty distinguish from 
cancer because of this metaplastic lesion. If, however, these mice are 
allowed to live, or if a fragment of that lung is transplanted to another 
mouse, it never eventuates this cancer. 

Well, this has all been said simply to bring some doubt into your 
minds as to the significance of the term “precancer.” It is not of very 
great significance. 

Now, the frequency of lung cancer is thought by many to have in- 
creased during the past two decades and, on that basis, a search has 
been made for some environmental factor showing a parallel increase. 
It should be emphasized, however, that there is some question as to 
whether the purported increase is real or only apparent—that is, a 
question arises: Has the increase of lung cancer actually increased, or 
are we only now becoming aware of the true frequency of the disease ? 

This is an extremely difficult question, and let me emphasize that 
there is a great deal of doubt in critical minds as to whether or not a 
true answer is possible. 

The statistics that have been used in the recent studies, when based 
upon death certificates, are practically valueless. In the great ma- 
jority of cases, the cause of death is recorded in a death certificate and 
is a clinical impression and is as limited in value for scientific pur- 
poses as is the clinical diagnosis of a living patient. 

This applies particularly when the assigned cause of death is a 
popular disease, such as cancer, to which the attention of the attending 
physician has been directed by frequent reference. 

Acute gastritis was formerly a common, inclusive term employed 
when the actual cause of death was not obvious. But, as a result of 
the present widespread educational propaganda, the diagnosis of can- 
cer has been substituted. There is usually no greater basis in fact. 

The point to be emphasized is that, in the absence of an autopsy, 
the cause of death is always in doubt, and death-rate statistics based 
on clinical evidence rather than on post mortem findings are entirely 
too unreliable for use in scientific investigation. 

At the present time, the diagnosis of cancer rests on microscopic 
examination and there is no acceptable substitute. Moreover, micro- 
scopic examinations must be performed on adequate speciments of tis- 
sue, and the desquamated cells found in a smear of sputum are not 
sufficient. Further, it must be shown that the tumor found represents 
a primary growth and not a metastasis. - 

Now, this latter point applies particularly to lung cancer, for the 
lung is an extremely common site for the location of secondary 


panes arising as metastasis from primary tumors elsewhere in the 

The common lung cancer, as I said, is an epidermoid carcinoma, 
and does not differ in appearance microscopically from epidermoid 
carcinomas originating in other bodily regions. 

Thus, microscopic confirmation of a lung cancer means confirma- 
tion not only of gross findings, but also an examination not only of 
the tumor, itself, but of the individual as a whole. Therefore, the 
loose term—the loose use of the term “microscopic confirmation” in the 
hands of statisticians is valueless without these qualifications. 

Thus, the only material available for analysis of the incidence of 
lung cancer are biopsy or autopsy reports. Figures so obtained—that 
is, from biopsies or autopsies—are necessarily based on a hospital 
rather than a general population and are, accordingly, biased, as 
they represent the incidence among people sick enough to be brought 
to the hospital. 

Now, the latter figure varies with many extraneous, unrelated fac- 
tors, including hospital facilities, which have been greatly augmented 
during the past 40 years. Nevertheless, the figures derived from such 
a population—that is, a hospital population—do indicate an increased 
incidence of lung cancer, but, again, one doesn’t know whether or not 
the increase is due to the coincident improvement in diagnositic facili- 
ties. These have advanced in a remarkable manner. 

Almost all hospitals now have one or more chest services, and these 
are manned by trained individuals who take X-ray pictures of one’s 
lungs, examine the cells in the sputum, look at the interior of the lung 
through illuminated tubes, snip off suspicious areas for pathological 
study, or even open up the chest wall for firsthand observations. 

Now, if such a screw failed to find an increase in the incidence of 
something or other, their diligence would be in doubt and their func- 
tion in hazard. 

Autopsy records would appear to be a better source of material for 
investigation, inasmuch as pathologists have been performing post 
mortem examinations according to the same technique and with little 
increase in facilities or imagination for well over 100 years. But, 
again, experience breeds suspicion. One sees what one knows, and this 
is as true at the autopsy table as it is elsewhere. 

The great pathologists, Virchow and Rokitawsky, fail to recognize 
the chronic areas in the heart characteristic of coronary occlusion, yet 
present-day, first-year interns, as a result of the increased emphasis 
on heart disease, spot the lesions with facility. 

Further, and more to the point, the eminent pathologist, Sir John 
Bland-Sutton, who was the dean of cancer pathology in his time, wrote 
a textbook on tumors and, in the 1922 edition, pictured the typical 
lung cancer over a caption bearing a completely wrong diagnosis o 
“mediastinal lymphosarcoma.” Let me emphasize the fact that this 
man was one of the best histologists of his day. 

If one goes through pathological museums at the present time and 
picks out old specimens labeled “Hodgkin’s disease” or “lymphosar- 
coma” and gets sections of these tissues, one finds in many cases they 
are not Hodgkin’s disease or lymphosarcoma, but epidermoid carci- 
noma of the lung. It was not, recognized at the time. 


And without accurate knowledge of the past incidence of lung 
cancer, which is of course impossible, it is obviously unreasonable to 
state that the present incidence represents an increase. 

Despite the evidence of definite proof of an increase, the assump- 
tion has generally been made that the incidence has increased, and 
this has been considered as a clue in the search for related environ- 
mental agents. 

Many factors in man’s environment have changed in the past 50 
years, and several of these pertain directly to the ‘lung. The atmos- 
phere has become polluted with the exhaust gases of industry and the 
automobile; tobacco smoking has become a universal habit. 

X-ray examination for early detection of tuberculosis has become a 
standard procedure to which many individuals are subjected at fre- 
quent intervals. There are many others, any one of which shows an in- 
crease in prevalence comparable to that thought to obtain in lung 

But for reasons which appear to me to be more subjective than ob- 
jective, major attention has been directed toward smoking. 

The statistical studies purporting to establish a causal relationship 
between smoking and lung cancer have been the subject of a barrage 
of propaganda both in the press and over the radio, and as the con- 
troversy has provided a great deal of free entertainment for the 

The arguments, of course, go on endlessly for, like the question of 
how many angels can sit comfortably on the head of a pin, there are 
no pertinent data on which to base a definitive answer. 

Several comments are required with respect to the published sta- 
tistics. Two points have been brought out in these studies that strong- 
ly suggest a conclusion contrary to that drawn by the investigators. 

Virst, the incidence of lung cancer has been found to be greater in 
cities than in the country and, second, the incidence is much greater 
in males than in females. 

The discrepancy here relates to the fact that country people smoke 
as much as do city people. I was brought up in the country. And the 
consumption of cigarettes by many females equals or surpasses that 
by many males. This latter discrepancy is further enhanced by the 
fact that there are more and more smoking females who reach the lung 
cancer age. 

The difference in cancer rate between males and females becomes 
greater rather than smaller. Let me say a word about statistical meth- 
ods and statistical associations. Statistical associations may means 2 
or 3 different things. The fact that two happenings appear to be re- 
lated may be purely on a basis of happenstance. It may be due to the 
fact that both have a factor in common. It is really extraordinarily 
rare in biology that it is a result of a cause-and-effect relationship. 

Let me illustrate what I mean. First, happenstance: There are cer- 
tain months of the year—November, December, January, and Febru- 
ary—that are cold. Other months—May, June, July—are warm. 

Now the cold months all have longer names than do the hot months. 
There are many more letters in November, December, January, and 
February than there are in May, June, and July. Asa matter of fact 
one can draw up a significant statistical association between the num- 
ber of letters in the month and the mean temperature. The months 
with longer names, more letters, being colder than the months with 


ie letters. But this, of course, is not a cause-and-effect relation- 

December is not cold because it has more letters and July is not hot 
because it has fewer letters. That is an association that is significant 
from a statistical point of view but obviously has no cause-and-effect 

Now as I said, this statistical association may be due to the occur- 
rence of a common factor. 

Now many years ago it was noted that the front row in a burlesque 
house was almost invariably occupied by baldheaded indviduals. In 
fact it was known as the baldheaded row. This occurred with such 
frequency that one might assume on statistical evidence that the con- 
tinued close observation of chorus girls in tights caused loss of hair 
from the top of the head and thus one could construct a nice cause-and- 
effect sequence relating the two. 

However, subsequent investigation has shown that in effect, bald- 
headedness and the desire to see chorus girls at close range are part of 
the same constitutional diathesis. Both are due to an excess of the 
male hormone testosterone. 

On the other hand this hormone in abundance brings about exces- 
am virility and, on the other, causes the hair on top of the head to 

all out. 

The point is to be made that if cigarette smoke and lung cancer 
have any relationship, it may well be of this variety and without any 
significance whatsoever from the point of view of causation. 

I hope I have made myself clear. Another illustration may help: 
If one questioned, in a State such as Connecticut, individuals who had 
jung cancer, about their political affiliations, I am sure that the vast 
majority would reply that they were Republicans. Now does that 
mean that this is purely happenstance or is it a cause-and-effect rela- 
tionship? Is there something in the tenets of the Republican Party 
that 1s carcinogenic ? 

This might well be a subject for future investigation. But you get 
what I mean. 

Now statistical methods are a natural adjunct in the everyday deci- 
sions of people who are outside of insane asylums. Correlations 
between various happenings determine most of our behavior from 
youth to old age. But an interpretation of the significance of the 
correlations is determined by judgment. 

For example, one recognizes the fact that corset covers have grad- 
ually disappeared as articles of female apparel, and one also observes 
that during the same period of time it has become increasingly difi- 
cult to get a good molasses cookie. One’s judgment immediately re- 
jects the possibility of a cause-and-effect relationship. 

The point to be made is that a determination of the nature of cor- 
relations as cause-and-effect sequences or merely phenomena associated 
by happenstance is a function of judgment, and judgment cannot be 
substituted for by statistical techniques. 

Now the basis of judgment is experience, and experience with new 
things is necessarily limited. Accordingly, the experience essential 
for evaluation must be attained and in research work, at least, that is 
done by means of experimentation. Associated phenomena are ob- 
served and the validity of a causal relationship is tested by controlling 
one variable and noting the effect on the other. 


This is known as the scientific method and its usage in one form 
or the other is responsible for the present age of medical discovery. 

According to this approach, an evaluation of the possible relation- 
ship between lung cancer and smoking rests on the results of experi- 
mentation. Asa matter of fact, the possibility of such a relationship 
has long been appreciated, long before the present statistical studies 
were made, and pertinent experiments were performed. They were 
performed by a number of different investigators utilizing various 
techniques, and no causal relationship was found. 

One of these studies was carried out in my laboratory. We had 
found that embryonic tissues were much more susceptible to cancer- 
inducing substances than were their adult counterparts. If, for ex- 
ample, one killed a pregnant mouse and removed the embryos and 
then dissected out of the embryo a specific organ, added to that organ 
a known carcinogen, such as methyl cholanthrene or dibenzanthracene, 
and then transplanted that organ subsequently in an adult mouse, a 
take occurred, the organ grew and survived, and at the end of that 
month if the material used was a carcinogen, one found a cancer 
in the transplanted organ. 

These embryonic transplants are much more susceptible to carcin- 
ogenic chemicals than are their adult counterparts and they offer a 
unique material for testing the carcinogenicity of various substances. 

In these experiments we used embryonic lung, embryonic mouse 
lung which we infiltrated with a variety of tobacco products. Tar—a 
great many different brands of cigarettes, cake and cleanings from my 
pipe, ash from cigarette paper, and soon. We used literally hundreds 
of animals and kept them for long periods of time, but not in one 
single, solitary instance did we find anything remotely resembling a 

I emphasize again that here we used a much more susceptible ma- 
terial than adult material and we used lung rather than skin. 

Now, despite such results we obtained, and so also did other investi- 
gators, the possibility of a causal relationship between lung cancer 
and cigarette products lingered in some minds, and the recent statis- 
tical studies together with the experiments of Wynder and Graham, 
have appeared to reopen the subject. 

The statistical data were obtained by a diferent method but the 
enumeration of individuals dying of lung cancer was based largely 
on death certificates without post mortem examination in the vast ma- 
jority of cases. The words were the words of Esau but the voice was 
Jacob’s voice and the conclusions derived from analysis were the 

Accordingly, there has been call for more experimentation. It is of 
some interest in this connection that the use of statistical methods in 
the prevalence of statisticians have shown an increase that corresponds 
as well with the assumed rise in lung cancer as does the consumption 
of tobacco. Yet the alternative conclusion has not been drawn. Why 
has cigarette smoking rather than the prevalence of statisticians been 
suggested as a cause of lung cancer? Perhaps some of us would have 
shown more enthusiasm in pertinent experimentation had that been 
the case. 

The coincidence of the reports of Wynder’s experiments in the 
tobacco statistics is probably a major factor in the extent of the present 


scare. Wynder extracted a tar from cigarettes smoked by machinery 
at a high temperature and painted this material, three times a week, 
on the skin of mice of a certain strain known as the CAF strain. Of 
the 62 mice so painted who survived for 12 months, 59 percent de- 
veloped cancer of the skin at the site of painting, and these results 
have been considered by some as sufficient investigative experience to 
validate the statistical suggestion. However, such a conclusion is un- 
tenable from a critical point of view. The experiments demonstrated 
that tobacco tar extracted by a special technique induces cancer in the 
skin of CAF mice, and nothing more. 

This point is of little significance to workers in the field who have 
found that under certain conditions a multiplicity of substances in 
everyday use will induce cancer in mice of highly susceptible strains. 

In certain animals, cancer has followed the injection of such material 
as glucose, sugar, and olive oil, but the interpretation of the experi- 
ments has been that something was wrong with the animals rather than 
that the materials were cancer-producing. The pertinence of this 
fact to Wynder’s experiments is brought out in a recent publication 
reporting more recent work in which he duplicated the technique but 
used other mouse strains. In one strain, Swiss, 14 percent of 86 
animals developed cancer, while in another, C57, only 2 percent of 89 
were so affected. 

It is apparent from this that the mice used in Wynder’s original 
experiment were not comparable to mice in general, but, on the con- 
trary, represented a strain bearing a constitutional factor which 
rendered the animals different from others in relation to cancer sus- 
ceptibility. The occurrence of such a high differential susceptibility 
among mouse strains would suggest the existence of an even more 
pronounced difference between species, and an extrapolation of the 
findings to man would be absurd. 

It should be noted also that the skin of the mouse rather than the 
lung of man was the object of study in these experiments. There is 
no surety that a substance capable of inducing cancer in mouse skin 
would also induce cancer in mouse lung—to say nothing of human 
lung. Asa matter of fact, in our hands, the same tar failed to pro- 
duce cancer in transplants of embryonic mouse lung, a material known 
to be highly susceptible to cancer-inducing substances. 

In any case, the human statistics purport to relate tobacco smoking 
with lung cancer not with skin cancer. It is not claimed that the 
incidence of skin cancer in man has increased despite the fact that 
the contact between the fingers and the burning cigarette is sufficiently 
intimate and prolonged to result in a yellow discoloration of the skin 
in that area. 

In summary, the methods employed in the statistical inquiry under 
question, particularly the type of data used for analysis, raise doubts 
that the results obtained can be interpreted as conveying a suggestion 
of a causal relationship between tobacco smoking and lung cancer. 
However, the results have been accepted by some investigators as 
sufficiently suggestive to warrant a direct experimental approach. 
The investigation has been reported as it progressed and, from my 
own point of view, has not succeeded in supplying confirmatory 

Thank you. 


Mr. Buarnix. Dr. Greene, thank you. Let me start off with just 
a few questions. 

Doctor, you state that the rather substantial increase in number of 
deaths caused by lung cancer are due largely to better diagnosis? 

Dr. Greene. I think that may be one of the important factors. 

Mr. Brarnix. Why wouldn’t increase be uniform for all people 
whether they smoke or not or whether they are male or female? Let’s 
leave out the female. Why wouldn’t it be uniform for all men, re- 
gardless of whether they are heavy smokers or nonsmokers? 

Dr. GrrenzE. Well, it is, isn’t it? There has been an increase in 
nonsmokers over what it was when I was a student in pathology. 
When I was a student in pathology, if I saw a lung cancer I called 
everybody around to see it. It was a rare occurrence in the autopsy, 
at least from my knowledge. But there is an increase over that in 
nonsmokers at the present time. 

Mr. Buatnix. But a greater increase in smokers? 

Dr. GREENE. But we don’t know, because we don’t know what the 
Tera was 25 years ago and we have nothing upon which to form 
a, base. 

Mr. Buarnix. Not that I am an expert at all, but I did have 4 years 
of mathematics, I majored in chemistry and mathematics—not that 
I don’t have some questions, and in fact quite some questions on the 
statistical material we have gone through. But the disproportionate 
ratio, running to hundreds of times more—in the bar group, this high 
rate [indicating| of lung-cancer deaths in heavy smokers, and a rela- 
tively low one for the others. How do you explain that? Repeatedly, 
over and over again, in the big city, in intermediate cities, in the vil- 
lage, on the farm, over and over and over again the pattern repeats. 

Would you say offhand there is at least something here to attract 
a second look at it or would you just ignore it? 

Dr. GreENE. We have got to examine the external environment for 
a possible agent in the increase in lung cancer. I think that is quite 
obvious. But I don ot believe that our investigation should be limited 
to tobacco smoke. As 1 say, many things have increased, significantly. 
X-ray of the lung is carried on routinely and it is known that X-rays 
are carcinogenical. Yet I haven’t heard any great furor about it as we 
have about smoking. 

Mr. Buarnix. I agree, Doctor, and I have nothing but the highest 
respect for your profession and you personally, but what concerns me 
is that repeatedly the same pattern, wherever it has been tried out, 
statistically, in England, Sweden, Switzerland, Germany, France—I 
hope it will be tried in other countries around the world—I can’t help 
but have a feeling that wherever you try it that that same pattern, with 
some variations, of course, will show up—that overwhelmingly the 
higher percentage of those dying of lung cancer are heavy and pro- 
longed smokers. 

Dr. Greenr. Yes. I would like to make a few points there. It might 
well be that here we are dealing with the operation of a common factor. 
There is much to suggest that, as a matter of fact, that people who have 
an unusual hunger for cigarette smoke, are people who are also sus- 
ceptible to lung cancer. Do you get my point? 

Mr. Buatnik. Yes, I do. 

Dr. Greene. And that they are not causally related but one follows 
along with the other. In fact, the statistics brought out an incidence 


of many other diseases completely unrelated to lung cancer among 
constant smokers and that might well be a factor. That is a constitu- 
tional affair, rather than restricting it to smokers. 

Mr. Buarnix. Again I will be frank and say I am in no position to 
challenge your statements, but I do have a little larger than the normal 
question mark, 

At the bottom of page 7 and page 8, you treated a little too gical 
the discrepancy in smoking between females and males. You passed 
it off with a statement at the top of page 8 that the consumption of 
cigarettes by many females equals or surpasses that by many males. 

That is true, but that is a limited statement. May I ask what per- 
centage of the male population smokes ? 

Dr. Greene. I can’t give you percentages lke that. This is the 
basis of my own observation. 

Mr. Brarnirx. Would you say more than half of the male popula- 
tion ? 

Dr. Greene. I couldn’t give you any data. Most of my friends 

Mr. Bruarnrx. Do as many women smoke as men smoke? 

Dr. Greens. Oh, I think so, certainly among my associates. 

Mr. Brarntrx. Many more? 

Dr. Greenr. Yes, and they smoke all day long. 

Mr. Buarnrx. My memory is not clear on this, and we can check it. 
As I recall, I think it is stated that over 70 percent of the men smoke. 
Over 70 percent, and perhaps around 383 percent of the women smoke. 
That means over twice as many men smoke, and most of the men have 
smoked for a much longer time than the women. 

You say there are many females who smoke more than some males. 
That is true, but why do you put that in testimony when it is so 
limited ? 

Dr. Greene. In my experience, and my experience is the only thing 
IT have to talk about. The experience of others is before you and 
has been put before you. Iam giving my own. 

The point I wanted to bring out is, despite the fact that more and 
more smoking females are reaching at the present time the lung- 
cancer age, the disparity in incidence between the males and females 

is getting 9 ereater instead of smaller. 

Mr. Bratnix. Getting back to the need for more direct medical 
evidence that death was due to lung cancer, I agree with you on that. 

T wonder if there wasn’t some misunderstanding, however—and this 
is just to clear up the record, Doctor—on page 10 1n the middie of the 
page you refer to statistical data, that the enumeration of individuals 
dying of lung cancer was based on death certificates without post- 
mortem verification in the vast majority of the cases. I wanted to 
clarify that. 

Dr. Hammond testified last week, and I quote him: 

In 79 percent of the cases of cancer reported on death certificates, it was 
proved microscopically that of the 79 percent, the remaining 21 percent were not 
microscopically tested. 

Ts there a conflict there between the two statements ? 

Dr. Greens. May I make a point there? Dr. Hammond is not a 
pathologist. He did not examine the microscopic tissues of these 
patients, and the question is, what does he mean by microscopic con- 


firmation? Does he mean these doctors examined adequate sections of 
the tissue, or does he mean that they looked at cells in sputum? Now, 
the latter is not acceptable to dying of lung cancer, and as I pointed out, 
epidermoid carcinoma of other parts of the body frequently masta- 
cizes to the lung, and microscopic confirmation is not sufficient. One 
has to have a thorough physical examination and an X-ray study to 
determine that the lung tumor is not a mastacyst or some other tumor. 

Further, there is a great discrepancy among pathologists as to 
what is called a lung cancer. I mean under the microscope. 

Mr. Buarnix. Mr. Meader asked: 

And in these cases where lung cancer existed a relationship between an 
existence of lung cancer and a death was determined by a pathologist, was it? 

Dr. Hammonp. I can’t give you the exact number. About 10 percent of those 
were verified by autopsy, which is as good evidence as you can get. In the 
other cases it was the opinion of the doctors and in 79 percent of the cases 
it was also the opinion of the pathologist. 

Would that answer it? 

Dr. Greene. No, it doesn’t. They would all have to be looked at 
by the same pathologist. Let me give an example of that sort of 
thing. Before I left to come to Washington yesterday, a pathologist 
from an adjacent hospital came to show me a section. This section 
had been obtained from the cirvex of a woman in still another hos- 
pital, and a diagnosis of epidermoid carcinoma had been made, with 
a recommendation that the patient return to her home and be treated 
in that hospital. This pathologist came from that hospital. He had 
looked at the section and could find no cancer in it. He sent this sec- 
tion to a pathologist in an adjacent town. There had been three 
diagnoses, epidermoid carcinoma, carcinoma in situ, and nothing 
wrong with the cervix. He therefore brought it to me for examina- 
tion. I looked at it and it showed a condition known as epidermoidiza- 
tion, a common occurrence in the cervix due to chronic inflammatory 
action. ‘There were four different diagnoses. 

Mr. Buarnrx. The same errors in diagnosis would also be made 
in nonsmokers who had died of lung cancer which would equalize it; 
but the overwhelming cases of lung cancer deaths are those who have 
been smoking. A 50 percent increase wouldn’t be bad but it is a 
200 and 3800 percent increase. 

Just to comment, I agree with you on statistics that you would 
attempt to prove that January and February were colder months be- 
cause they are longer words. The late Dr. Graham who worked with 
Dr. Wynder was a chain smoker himself, by the way. He earlier ex- 
pressed in conversation to Dr. Wynder and others the same thought. 
In fact, he ridiculed the statistical approach. At the outset, as I re- 
call, around 1950, he went to Dr. Wynder, close friends, with great 
regard for each other, but with completely different points of view. 
He said, “I prove that with the increase in the use of nylon stockings, 
there is an increase in lung cancer deaths in women,” and he did. He 
did prove it in actual tables. But the more he got into these other 
_ statistics with Dr. Wynder, the more he became impressed until he 
finally collaborated with him on it. 

Dr. Greene. I am sorry to say that I have little faith in statistics. 
I was intimately concerned in statistical work for 7 long years of my 
life and asa result of that study, I have far less faith in statistics than 
I have in the tenets of the Buddhist religion. 


Mr. Buatnix. Let’s get back to this. Here is a book entitled “Sci- 
ence Looks at Smoking,” by Eric Northrup, a writer of some repute, 
and you wrote an excellent introduction which I read which is essen- 
tially the same as the testimony presented here this morning. Did 
you read the rest of the book ? 

Dr. Greene. Yes. 

Mr. Buarnirx. I am getting to the pertinent point of the commit- 
tee’s inquiry on the effectiveness of filters, Doctor. Do you have any 
opinions on whether filters on cigarettes are necessary? Do they pro- 
tect? Do they serve any function as regards or concerns the health 
of the smoker ? 

Dr. Greene. Well, my feeling in this business is that there isn’t 
anything in tobacco that is carcinogenic, that is going to do the indi- 
vidual any harm and, therefore, it is difficult for me to see how a filter 
could take out something that doesn’t exist. 

Mr. Brarnrx. I share that hope because I have always smoked 
nonfilter cigarettes. 

Dr. Greene. I don’t know why they are used, they make a conven- 
ient mouthpiece and they perhaps remove some tobacco dust and in- 
haled material. 

Mr. Buarnicx. In Mr. Northrup’s book on page 183 he states that— 
there is no significant evidence that filter tips provide a special safeguard in 
smoking. They merely reduce the smoke particle intake, but not particularly 

There is nothing you believe that is cancinogenic in a cigarette that 
would harm a person, or anything else that is harmful. 

May I ask, is there anything beneficial about a cigarette ? 

Dr. Greene. I wouldn’t know. I haven’t seen studies on that, but 
I would like to see them. There is no question that the incidence of 
many diseases has dropped during the past 30 or 40 years when the 
consumption of cigarettes increased. That, of course, apples to upper 
respiratory disease which has dropped way down. 

I have heard no arguments on that side. I think it would be ex- 
tremely interesting if they were drawn up. I am sure they would be 
as significant as the present statistics purporting to show a causative 
relationship between lung cancer and cigarette smoke. . 

Mr. Buarnikx. Getting back to filters, now, you don’t see any pur- 
pose they serve outside of being more convenient and keeping tobacco 
particles out of the mouth ? 

This book to which you write a very impressive introduction states 
the same thing. 

May I ask, Doctor, and I do this not with any personal embarrass- 
ment, but did the tobacco committee or any tobacco people ask you 
to come down here to present testimony @ 

Dr. Greens. I don’t know, somebody called up, I think it was a Mr. 
Johnson, and asked me to come down. 

Mr. Buatniz. Mr. Curt Johnson? 

Dr. Greenr. I think that is who it was. I was glad to come down 
but I insisted that it be today, because I am going fishing tomorrow. 

Mr. Buarntx. He is the staff director of our committee. Was he 
the only person who asked you to come down? 

Dr. Greene. Yes; so far as I am aware. There were a number of 
telephone calls, Science Service, and things that day, but they didn’t 
specifically ask me to come down here. 


Mr. Buarnix. As I understand, representatives of the tobacco in- 
dustry asked Mr. Johnson if you couldn’t appear. I don’t know if 
they contacted you. 

Dr. Greene. It probably comes from the introduction to that book. 

Mr. Brarnix. The reason I am interested is that they have failed 
to produce any witnesses or themselves come here to explain the func- 
tion of a filter, or what would justify the expenditure of millions of 
dollars a year in merely advertising and promoting the sale of a filter. 

We want to know if they are misleading the people, if testimony 
such as you have presented—and we have had several other eminent 
colleagues of your profession join you in your point of view to dif- 
ferent degrees. We would like to know if there is so little or no danger 
in smoking, why the filters?) Why this great promotional campaign ? 

Why this great exepense to the manufacturer, to the advertising and 
to the consumer who spends as much as $15 a month to buy filters. 
And somehow or other we have not yet to date received any evidence 
that the filters are necessary or that they serve any function as con- 
cerns the health of the smoker. 

Dr. Greene. I have heard comments from people who have used 
filters on their cigarettes, people who have been troubled by cough 
from regular cigarettes. They have said that the cough has disap- 
peared after using the filter, but I have nothing to say about it. I 
don’t know anything about it. 

Mr. Buarnix. You have already said that smoking is not harmful, 
but that you would be interested in knowing what good it may do. 

In short, you don’t know how smoking affects the health of an in- 
dividual, either for the worse or for the better ? 

Dr. Greene. Only personal experience. If I have a bad cold com- 
ing on, I smoke a lot of cigarettes and usually wake up the next morn- 
ing without the cold. 

Mr. Buarnix. Before the cancer concern arose, years ago the tobacco 
people advertised that smoking would help in many ways, give you 
more energy, make you a more active athlete, it aids the T zone, and 
in fact it helps the health. 

Now they have switched and say it doesn’t hurt the health. I won- 
der whether they are entitled to go in this field of health unless they 
present a case, either one way or the other. 

Dr. Greene. I agree with you there. 

Mr. Buarnix. That is where we are trying to narrow down the 
findings in our hearings. 

Thank you, Dr. Greene. I am sorry I took so much time. Mrs. 
Griffiths ? 

Mrs. Grirrirus. I have no questions to ask, but did you say, Doctor, 
where you did your statistical work? 

Dr. Greens. The Rockefeller Institute. 

We were trying to correlate various constitutional differences in 
animals with their susceptibility to tumor transplantations. 

Mrs. Grirriris. What did you find out? 

Dr. Greene. I found out in the majority of cases when we relied 
on statistics we were throwing the baby away with the bath water. 

Mrs. Grirrirus. How many cases did you study ? 

Dr. Gremnn. Oh, gracious, innumerable ones. In this study we fol- 
lowed rabbits from birth to death over a period of some 10 years, and 

96946—57 15 


during that period there are a great many rabbits. I couldn’t tell you 
how many cases. 

Mrs. Grirrirus. But at least the rabbits didn’t prove anything? 

Dr. Greene. Not to me. 

Mr. Mraprer. Dr. Greene, I was quite interested in your discussion 
of philosophy and logic, on cause and effect relationship and so on. 

You appear to require a higher degree of proof than even Dr. Little 
who appeared here as our witness. Dr. Little seems to concede that 
the statistical association at least indicated areas where research might 
well be undertaken. 

I would like to quote from page 64 of the transcript of Dr. Little’s 

To establish a cause and effect relationship on statistical associaation with- 
out experimental evidence is not safe. It cannot be done. You may get an in- 
dication of something to look for, but to say that the ease is finished, the evidence 
is all in and that you can satisfy experimental scientists, all of them, that is 
not possible because too many of us have seen too many statistical relation- 
ships which have not helped the cause and effect relationship. 

Do I see some distinction between your attitude and his? 

Dr. Greene. I think not. I think that I feel about the same way 
about it. One has to use statistical associations in research work. One 
observes a series of happenings in mice-bearing tumors and on a basis 
of that observation you do experiments. 

For example one might find that a tumor was occurring with greater 
frequency in males than in females. That is a statistical observation. 
Then to find out whether or not it was significant, you would subject 
that to experimentation. 

Mr. Mraprer. Now we have in law a phrase known as a non sequitur. 
I was interested in your association of bald men and the burlesque 
show as a very picturesque example of a non sequitur, but I would 
like to ask you if you are contending that any of these other scientists 
who appear on the opposite side of this controversy have claimed that 
the association has proved a watertight cause and effect relationship. 

Dr. Greene. Now, they haven’t, but they have suggested that it was 
not beyond a reasonable doubt that such a cause and effect relationship 
existed, if my understanding of the Public Health Service statement 
was correct. 

Mr. Meaver. No one, I assume, could claim that a cause and effect 
relationship between lung cancer and smoking had been established 
until the cause of lung cancer, itself had been established, and I don’t 
think anyone in these hearings has claimed that they know the cause, 
of cancer. 

Dr. Greene. That is right. 

Mr. Meaper. I have gathered from your statement that until such 
a discovery is made, that we ought not to do anything. Am I to con- 
clude that from your statement ? 

Dr. Greene. I don’t know whether you are concluding that or not. 
I shouldn’t think so. If there was evidence, for example, that tobacco 
products produced cancer in transplants of embryonic human lung, 
I would be concerned. But there is no such evidence. I should per- 
haps emphasize the fact that I have tried that experiment. One can 
transplant embryonic human tissues to laboratory animals, where they 
survive and grow. 


If one obtains embryonic human organs or tissues before the fourth 
month of gestation and transplants them in certain sites—the eye or 
the brain, of laboratory animals—these organs survive and grow. 
They, therefore, offer an excellent material for the study of disease 
that man has, or for carcinogenic agents that might be effective in 

Now, we have infiltrated fragments of embryonic human lung with 
these tobacco products, including Wynder’s tar, transplanted them to 
adult animals, and let them go on, and there ‘have been no cancers 
formed in them at all. 

Mr. Meaver. I am interested that you brought that up, because I had 
a question as you were reading your prepared statement, on page 9 
where you say pertinent experiments were carried out and performed 
by a number of different investigators utilizing various techniques and 
no causal relationship was found. — 

Now, I am wondering if you are not, perhaps, at least apparently, 
guilty ‘of another fallacy of human reasoning, in leaving the im- 
pression that, because a particular experiment didn’t establish the 
casual relationship, therefore, there was no casual connection. 

Dr. Greent. No; I don’t mean that at all, of course. Experiments 
have to be continued; there is no question about it. The fact that 
a thousand experiments have been carried out and nothing has been 
shown doesn’t mean that No. 1,001 won’t show it. 

Mr. Mnaprr. Now, I wanted to draw your attention to Dr. Wynder’s 
comment on this point. I asked him about his difference in point of 
view from Dr. Little, and this is what he had to say, at page 170 of our 
transcript of Friday, July 19. 

Dr. Little has often said on the association : 

“Now, you demonstrate association but not causation.” I thought that, by 
showing you all the evidence to find how it fits with the presumptive evidence, 
the causative relationship is the more direct one to assume. But, from my 
point of view, it makes very little difference whether we argue about the words 
“contributing to, initiating, causing, association, relating to,” the important 
factor is that the person who doesn’t smoke rarely gets lung cancer, and the 
more you smoke the more lung cancer you get. That is the important issue. 

I certainly admit there are numerous intrinsic factors of lung cancer about 
which we know very little, but if we were to apply the same argument of 
Dr. Little to the point of radiation, and I think it is a good example to use, 
we can rule out that radiation couldn’t possibly cause cancer in men. Yet I 
am sure that you will not find a single scientist in this country who will say 
that radiation cannot cause cancer in men. We have the evidence in men. 
We have the evidence in the experimental animals. The relationship is 

Then, again, Dr. Wynder said: 

One of my hobbies is history, and one of the things in history of medicine that 
interested me most was in the last century when many women, particularly in 
Europe, died from childbed fever. Dr. Semelweiss, in particular, demonstrated 
this was due to the fact that doctors didn’t wash their hands. 

Then he gave the example of bubonic plague in London. 

At that time Dr. Snow, who did the first plague or study on epidemic con- 
trolling, got the idea that this might have to do with a Broad Street pump where 
there was water consumed. He did a study and found that people who drank 
water from that pump got cholera. At that time they didn’t have the vaguest 
idea what the basic cause of cholera was. Yet he went to the board of governors 
one day and said, ‘“‘Let’s try to remove the handle of that pump just on the basis 
of epidemiological evidence.” They removed the handle and the cholera 
epidemic ceased. 


T am reading these statements of Dr. Wynder because it seems to me 
he took a different attitude toward this question than you have, and 
that you and Dr. Little seem to require an almost perfect, logical indi- 
cation of proof before you believe anything should be done, and Dr. 
Wynder says we can’t wait that long, that something can be done 
before we find the basic cause of cancer. And he used these historical 
examples on which I would like your comment. 

Dr. Greene. Of course, Dr. Wynder has selected his examples. 
There have been other supposed cause-and-effect relationships derived 
from statistics that haven’t held. I think, actually, one of them was 
cited in one of the reports, and that was due to the statistical studies 
on pellagra in France, where it was found that the French population 
ate a great amount of corn, particularly among those people who had 
pellagra and, therefore, they assumed that the pellagra was due to the 
eating of corn. 

Well, that is known not to be true. It is not a cause-and-effect rela- 
tionship. ‘The occurrence of pellagra in those people is not because 
they ate corn but because they didn’t eat anything else but corn, and 
corn doesn’t contain enough tryptophan to manufacture an essential 

He has selected instances there very carefully. 

Mr. Mmuaprr. Let me see if I can clarify this: You do agree that 
the statistical studies and the association shown by the studies of the 
Cancer Society and others, and what experimentation there has been, 
do indicate areas where further experimentation and research should 
be conducted and in that sense you are in line with Dr. Little? 

Dr. Greens. Well, I think those areas were indicated long before 
the present statistical studies or the experimentation. Just from 
simple observation, that the surface of the lung was exposed to the 
environment and, therefore, environmental factors should be investi- 
gated as possible causes of cancer. I don’t think the present statistical 
studies, to my mind, have added much to that. 

Mr. Mraprer. You don’t take the position, I take it from the answers 
to my questions, although I got the impression from your statement 
that you did take that position, that nothing can be done until the 
basic cause of cancer is discovered ? 

Dr. Greene. No; the treatment for tuberculosis was effective, or 
comparatively effective, before we knew the cause. You don’t have to 
know the intimate cause of a disease in order to treat it effectively, or 
to treat it. 

Mr. Meaper. That is all, Mr. Chairman. 

Mr. Buatnix. Mr. Minshall. 

Mr. MinsHautu. Who requested or asked you to write the intro- 
duction for this book, Science Looks at Smoking, by Eric Northrup? 

Dr. GreENE. Eric Northrup. 

Mr. MinsHauu. Were you paid for that in any way? 

Dr. Greene. Yes. 

Mr. Minsuatu And who paid you? 

Dr. Greene. Eric Northrup. 

Mr. Minsuaut. Do you know anyone at the Hill & Knowlton 
public relations firm ? 

Dr. Greene. No. . 

Mr. Minsnatu. Have you ever talked with anyone over there? 


Dr. Greenn. I must have, but I don’t know their name. 

Mr. MinsHaty. What do you mean, you must have? 

Dr. Greene. People are continually calling me up on the telephone 
asking me questions. 

Mr. MinsHauz. Somebody called you from Hill & Knowlton; is 
that correct ¢ 

Dr. GreenE. Not to my knowledge. I couldn’t tell you. 

Mr. Minsuatu. You said they must have. Now, have they? 

‘ Dr. Greene. I said they must have, but I don’t know that they 

Mr. Minsuatu. You are not at all consistent. 

Dr. Greene. Well, I don’t know, then; let’s say that. 

Mr. Minsuartt. You have many acquaintances, don’t you, in the 
tobacco industry ¢ 

Dr. Greens. No; not many. 

Mr. Minswatyt. Have you discussed your testimony with anyone 
in the tobacco industry, or Hill & Knowlton, prior to appearing 
here today ? 

Dr. Greene. I tell you I don’t know anybody at Hill & Knowlton 
I have not been concerned with the tobacco companies, except in 
one instance where I acted as consultant in the case of some proposed 
litigation that was coming up. 

Mr. Minsuati. When was that? 

Dr. Greene. That was back several months ago. 

Mr. Minsuatyi. And what was that in relation to? 

Dr. GREENE. Some patient, some individual who had died of lung 
cancer and the wife I believe was considering suing the tobacco com- 
pany or something like that. 

Mr. Minsuaryt. And you were going to appear on behalf of the 
tobacco company ? 

Dr. GREENE. Yes. 

Mr. Minsuaux. Did you appear? 

Dr. Greene. No. 

Mr. MinsHaty. Hasn’t it come to trial yet ? 

Dr. Greene. No; the case was dismissed. 

Mr. MinsHatu. Settled out of court? 

Dr. Greene. No; it was dismissed. Let me emphasize a point 
with regard to this book that you are talking about. One time several 
years ago, Mr. Northrup called my laboratory about something en- 
tirely different, I have forgotten what it was, and we had a long con- 
versation. During the course of this conversation the subject of to- 
bacco smoking came up and that day I had seen a number of people 
who had given up smoking because of the tobacco scare and I was 
contacted and we discussed the question as to whether or not the 
public was sufficiently informed as to the basis on which these conclu- 
sions were drawn. 

Mr. MinsHay. How long have you know Eric Northrup ? 

Dr. Greene. I think that was his first visit. 

Mr. MinsHatyi. When was that ? 

Dr. Greene. Approximately 2 years ago. 

Mr. Minsuatyi. What was the occasion for him visiting your labora- 
tory, or your hospital, wherever it was? 

Dr. Greene. I think it had something to do with transplants of 
embryonic organs that he wanted to write about. I don’t really remem- 


ber. Or the transplantation of human cancer, or some such thing as 
that. In any case, after discussing this business, I told him that I 
thought it would be a great service to the American public if someone 
who was a good writer wrote a book about it, and he said he was going 
to do it and asked if he did, would I write an introduction and I con- 
sented to do it. 

Mr. Minsuaty. Do you know if anyone paid Eric Northrup for writ- 
ing this book and, if so, whom ? 

Dr. Greene. [assume the publishers. 

Mr. Mrnsuauu. Do you know who the publishers were ? 

Dr. Greenr. Coward-McCann, I believe. 

Mr. Minsiauu. Have you received any grants or other financial as- 
sistance from anyone associated with the tobacco industry ? 

Dr. Greener. None whatsoever. 

Mr. Minsuatu. You were paid for your testimony, or your advice 
to the tobacco people several months ago ? 

Dr. Greene. Yes; they paid for my time. 

Mr. Minsuaty. That is the only time they have ever used your serv- 
Ices ? 

Dr. GREENE. Yes; let me emphasize 

Mr. Mrnswaty. Let me ask you now, have you discussed this at all 
with anyone prior to testifying here today ? 

Dr. Greene. I discussed it with my associates at Yale, I discussed it 
with Dr. Macdonald, who is to testify next. I can’t tell you but I 
have been discussing this for a great many years. 

Mr. Mrnsuatu. When were you asked to testify here today, how 
long ago? 

Dr. GREENE. Some day last week. 

Mr. Minsuatu. And who have you discussed your testimony with 
since that time ? 

Dr. Greenr. Everybody that I came in contact with. 

Mr. Minsnatu. Did anybody get in touch with you? 

Dr. Greene. Yes. 

Mr. MinsHatu. Concerning who? 

Dr. Greene. Science News called me up the other day and asked 
for a transcript of my testimony. 

Mr. Minsuatu. Did anyone connected with the tobacco industry or 
any publishing firm or public-relations house get in touch with you? 

Dr. GREENE. No. 

Mr. Mrinsuatu. Did anyone assist you in writing your statement ? 

Dr. GreENE. There was someone who called me up and asked if I was 
invited to come here to talk, would I accept. I said I would first have 
to be asked. Now I don’t know who that individual was. He might 
have been from the tobacco committee, I don’t know. I didn’t catch 
the name over the telephone. 

Mr. MinsHatyi. When was that call made? 

Dr. Greene. A week or so ago. 

Let me emphasize the fact that I am an investor. The funds for 
my research come from the American Cancer Society, the Public 
Health Association, the Jane Hoffman Childs’ Fund and they haven’t 
got any ax to grind in this business and neither have I—except my per- 
sonal prejudice and I am prejudiced about tobacco. 

Mr. MrnsHatu. You see no reason then to use filters on cigarettes? 

Dr. Greene. I don’t know anything about filters on cigarettes. 


Mr. Minswaru. You have already testified to that effect that you 
see no reason for putting them on them? 

Dr. Greene. I see no reason for putting them on, if they are sup- 
posed to withdraw carcinogenic materials which according to my 
point of view are not present. 

Mr. Meapver. Wouldn’t it be better to say, Dr. Greene, not that the 
carcinogenic materials according to your point of view are not pres- 
ent, but there is no proof that they are present ? 

Dr. Greene. There is no proof that they are present. And whether 
or not these filters take them out or not, I am in no position to say. 

Mr. Mraper. If they are not there they can’t take them out. 

Dr. Greene. If they are present, I couldn’t tell you whether they 
will take them out. 

Mr. MrnsHauu. Just one other question, Doctor: You say you don’t 
believe in statistics. You made that pointblank statement. 

Dr. Greene. I don’t believe that a distinction can be used to draw 
out cause and effect relationships. 

Mr. Minsuaxu. Just for my own information, weren’t some sta- 
tistics used in resolving Dr. Salk’s now famous discovery # 

Dr. Greener. Yes, but aided by experimentation. 

Mr. Mrnsuatxt. Then statistics aided by experimentation are of 
some use ? 

Dr. Greens. Oh, of course, all experimental work, most all experi- 
mental work is based on statistical observation. Oh, yes; of course. 

Mr. MinsuHatu. Then statistics are of some value ? 

Dr. Greene. Why, of course. I didn’t say they weren’t. I said 
statistics could not be used to form judgments. The judgment has to 
be based on experience or experimentation. 

Mr. Minsuatz. That is all I have. 

Mr. Piaprtincer. When was the introduction to the Northrup book 
written / 

Dr. Greener. I would say I completed it about a year and a half 
ago. A long time ago. 

Mr. Prapincer. That was before the American Cancer Society re- 
cently published its statistical information ? 

Dr. Greene. Yes. 

Mr. Prapincer. Incidentally, in your testimony you pay particu- 
lar reference to Dr. Wynder. I am interested in that because in the 
joint Report of the Study Group on Smoking and Health (see ap- 
pendix, exhibit 6, p. 421). Under epidemilogic evidence as supported 
by laboratory studies on animals—it states that “at last five independ- 
ent investigators had produced malignant neoplasms by tobacco-smoke 
condensate.” That would indicate that there were investigations 
other than Dr. Wynder’s alone that confirmed the fact that there were 
carcinogenic agents. 

Dr. Greenr. Let me emphasize, this doesn’t say anything about the 
negative experiments. 

Mr. Priaprrincer. I understand that. Now, sir, on the negative ex- 
periments. You refer to the fact that there were transplants—unsuc- 
cessful as far as producing cancer were concerned. 

Dr. Greenr. Yes. 

Mr. Puarincer. Has this data been published ? 


Dr. Greene. It has not been published. If I attempted to publish 
all my negative results I wouldn’t be able to do any further research. 
I don’t publish negative results and I expect that has happened 
throughout the country. If people have tried this stuff and gotten 
negative results they have therefore not published it. 

Mr. Prarincer. Except that within an area that is literally im- 
mersed in such public interest, it might be to the benefit of the public 
and the scientific world at large, if this negative data were published. 

Dr. GREENE. I expect that could happen. 

Mr. Praprncer. When Dr. Little appeared here I questioned him 
concerning a quotation attributed to him as follows: 

Any possible role of smoking in the ideology of lung cancer remains an un- 
resolved question. It cannot be said that smoking has been absolved from sus- 
Ppicion. Neither have the charges been proven. 

Would you comment on that statement ? 

Dr. Greener. I would agree with that statement. 

Mr. Praprncrr. I quote another statement attributed to him: 

Although no definite evidence exists concerning the relation between use of 
tobacco and the instance of lung cancer, it would seem unwise to film the lungs 
repeatedly with the suspension of foreign particles of tobacco products of which 
smoke consists. 

Dr. Greene. I don’t think it is unwise. 

Mr. Piarrncrer. You would disagree with Dr. Little as far as that 
statement goes ? 

Dr. Gremne. As far as that statement goes. 

Mr. Puarrncer. Incidentally, he did not limit it only to tobacco 
smoke later on. This was a 1944 excerpt from an article that he had 
written. In his testimony, Dr. Little said this statement would apply 
not only to tobacco smoke, but to any irritant. 

Dr. Greene. Your question is, Do I think it unwise to fill my lungs 
with tobacco smoke ? 

Mr. Piarrncer. You answered that question. I was just explain- 
ing Dr. Little’s further statement before the subcommittee. 

Mrs. Grirrirus (presiding). Thank you very much for your testi- 
mony, Dr. Greene. 

Dr. Macdonald. 


Mr. Macponaup. I am Ian G. Macdonald, and I am a doctor of 
medicine. I received my doctor of medicine degree from McGill Uni- 
versity in 1928, and am clinical professor of surgery at the University 
of Southern California, School of Medicine, where I have also been 
coordinator of cancer teaching for the past 10 years. 

In addition to a number of national surgical and other medical so- 
ciety memberships I am a member of the American Association for 
Cancer Research. I have been engaged in the treatment of cancer and 
allied diseases since 1935, and am a surgeon slightly gone wrong in 
that I am certified by the American Board of Radiology in the area 
of radiation therapy. 

I also happen to be a member of the National Board of Directors 
of the American Cancer Society and am a past president of the Cali- 


fornia division of that society. I am also chairman of the subcom- 
mittee on cancer of the committee on research of the American Medical 

The constant reiteration of the claim that cigarette smoking is one 
of the important causes, if not the most important cause of lung cancer, 
has certainly persuaded many that a cause and effect relationship has 
actually been established. And I am sure I do not need to recite the 
results of a Gallup poll reported in the public prints of yesterday to 
the effect that some 50 percent of the general public now entertains at 
least a suspicion that cigarette smoking may actually be one of the 
causes of lung cancer. It seems to me many of those who so fervently 
advocate this relationship have an attitude that is almost evangelical 
and they are oblivious of the fact that virtually the entire basis on 
which this belief rests is statistical. 

One must say that there is an apparent association between cigarette 
smoking and lung cancer, but when one reviews the total evidence, I 
think it is not possible to establish a cause and effect relationship. 

I should like to offer some remarks made by Berkson, the biometri- 
cian at the Mayo Clinic, as follows. He said: 

I am not affected by the considerable number of statistical studies published, 
showing an association between smoking and cancer of the lungs. On the con- 
trary, undeviating consistency of statistical results all in support of the same 
conclusion is in some circumstances the hallmark of spurious statistical correla- 
tion. If correlation is produced by some elements of the statistical procedure 
itself, it is almost inevitable that the correlation will appear whenever the statis- 
tical procedure is used. 

It really shouldn’t be necessary but it probably is, to say that things 
which are connected by a cause and effect relationship will, of course, 
show a high degree of correlation satistically, but a high degree of 
correlation between two things certainly does not necessarily mean a 
causal relationship. 

Now, even at the risk of being repetitious, I should like to offer a few 
very general remarks about the nature of cancer as an extremely com- 
plex group of diseases of extremely disparate manifestations of abnor- 
mal growth of tissues of the individual in whom this disease arises. 
One should not refer to it as “this disease.” It isin fact a whole galaxy 
of diseases. 

A fundamental definition of cancer is that it is an abnormality of 
growth of cells resulting from a disturbance in an extraordinarily 
delicate system of check and balance which, under normal conditions, 
allows the body to replace worn out cells or to repair effectively the 
result of injury of various sorts. The possibility of a given individual 
developing cancer depends on two basic factors—this may be a little 
oversimplification : 

One: The capacity of the individual to respond to unfavorable in- 
fluences by developing cancer, or the lack of the capacity, 1s now ac- 
cepted by many as being genetically determined, that is, the ability 
of the individual’s tissues to respond or not respond to unfavorable 
influences was laid down at the time of fertilization. 

Mrs. Grirrirus. May I ask you at that point: Isn’t that statistically 
determined ? 

Dr. Macnonarp. The genetic potential to develop cancer in most 
humans cannot be statistically demonstrated. 


Mrs. Grirrirus. Cancer occurs, does it not, in families? That is, if 
your grandmother had it, you could have it, too? If one sister had 
it at 45, wouldn’t another sister possibly develop it at 45% 

Dr. Macponatp. That is true, and there are certain cancers such 
as breast cancer, for example, where there is a distinct traceable 
hereditary pattern by study of family groups. But referring to the 
larger problem of all cancer, it is the conviction of many and I am 
certainly one, that there has to be within the individual the capacity 
to respond abnormally and that in its ultimate expression is cancer. 

The second very general factor is the exposure of the individual to 
environmental factors which, in the susceptible individual, may even- 
tually result in the degree of abnormal growth finally resulting in 

Now, we don’t have too much information about some of the genetic 
factors. We do have considerable information about predisposing 
environmental influences which may lead to cancer, but we are still 
ignorant of the actual trigger mechanism that sets off the cancerous 
process in any individual. 

Now, in the next few sentences are offered a commonplace illustra- 
tion of this fact in that individuals who have sensitive skins and who 
are what I refer to as heliophobic—that is who are intensively and 
abnormally sensitive to sunshine—are candidates for the development 
of skin cancer, unless they exercise due care and caution in exposure 
to sun. 

At the same time, people who have a sort of average toleration of 
sunshine, if they overexpose to sunshine, they, too, will develop cancer 
of the skin. In either of these groups for every hundred people, 
either the sensitive variety or those who have overexposed themselves 
to solar radiation, there will develop the stigmata of skin damage by 
sunshine. The little erosions of the skin that break and heal and bleed 
a little occasionally. And in our part of the country where we rejoice 
In seven times more hours of sunshine than Chicago 

Mr. Puaptncer. This is a statistical analysis? 

Dr. Macpnonautp. Yes, and in California we happen to have about 
8 times more skin cancer than in Illinois. And yet of the hundreds 
of people one sees in their 60’s and 70’s in this area in which I live, 
with these areas of damaged skin, there are only 2 or 3 or perhaps 5 
at the most out of every hundred in whom these changes actually 
go on to be skin cancer. 

And we haven’t the slightest idea why two individuals with com- 
parable damage, one will go on to develop skin cancer, the other will 
live to be 92, not having developed any such change. 

Mr. Meaper. Madam Chairman, may I ask a question ? 

Dr. Macdonald, I wasn’t quite satisfied with the answer you gave 
the chairman a minute ago. It seems to me that these generalizations 
about cancer, as long as you do not know the trigger mechanism or 
the causation of cancer, must necessarily be based upon statistical 
studies. Isn’t that true? 

Dr. Macponatp. In a way sir, it ties into some studies in which 
I have been interested for many years, having to do with what I call 
the biologic potential of cancer. 

Not only is the individual either capable or not capable. of develop- 
ing cancer but having developed it, he develops a type of cancer which 


is either going to be highly unfavorable or very favorable type of 
growth, or any other spectrum of cancers in between. 

I do not have, sir, any statistical proof, I have no scientific proof 
that my concept of the capacity to develop cancer is correct. I be- 
heve it thoroughly. 

Mr. Muaprr. There are two factors, heredity and environment 
which have a bearing upon the person becoming cancerous, that seems 
to be based only upon a number of specific cases in which these two 
factors appear, isn’t that correct? 

Dr. Macponaxp. No, it is a little more complicated than the word 
“heredity” implies. It has to do with the capacities of the cells of 
the individual. 

Mr. Mraprr. What I am saying is that unless you have the definite 
scientific causative relationship, a foolproof perfect case showing the 
causation of cancer, what else do you have to rely upon except cases 
that have arisen and the statistical association about these factors and 
the occurrence of cancer? 

Dr. Macponaytp. Do you mean what do I rely on upon which to 
base this concept ? 

Mr. Mraper. What does anyone have to rely upon except a collec- 
tion of figures showing where these cases are present and a person 
has contracted cancer ? 

Dr. Macponatp. I base this on my study of and judgment concern- 
ing the behavior of cancer in the individual. I think it is so highly 
specific a process that it must be of genetic determination. 

Mr. Mravrer. What I am getting at, to be very plain about it, is that 
you and the witness who preceded you and Dr. Little have discounted 
this statistical association. Yet it seems to me that unless you have 
the actual cause of cancer, almost everything we know about cancer 
is based upon statistical association and I want to know whether that 
is correct or not in your view ? 

Dr. Macponaxp. I am sorry, sir, it is not, and again I will say that 
my belief about this genetic capacity is not provable by statistics. It 
is provable, if it is proof, and I believe it is, by a study of the behavior 
of cancer in individuals and not on a statistical, mass basis. 

Mr. Mraper. It may not be a survey such as conducted by the Can- 
cer Society of 187,000 men but it is based upon the observations of 
medical people over the course of the years and essentially it is based 
upon the facts found in individual cases from which you deduce that 
the occurrence of cancer has a relationship to these factors which you 
have stated, is it not ? 

Dr. Macponaxp. In some respects. My belief and my understand- 
ing of the cancerous process come from data which I have analyzed 
in a series of 800 to 1,200 patients with cancer of certain types, yes. 

Mr. Meanver. Is that not a statistical association, whether done by 
survey or questionnaire method or whether done by the collection of 
cases of cancer ? 

Dr. Macponatp. The kind of work I was doing was not an associa- 
tion, it was determining behavior within the cancer, itself. 

Mrs. Grirrirus. If 200,000 people move out to California and are 
exposed to sunlight over a certain period if time, can you predict the 
number of people who will have cancer ? 

e Dr. Macponatp. I could if I had the table to refer to that shows the 


Mrs. GrirrirHs. If those 200,000 people had remained in Iowa and 
not been subjected to that sunlight can you predict how many fewer 
people would have had cancer of the skin ? 

Dr. Macponatp. There are figures to indicate that. 

Mrs. GrirrirHs. Then are you saying to us that while it may be 
true that the sunlight will cause cancer in some people, that some 
people who are exposed to a given amount of sunlight will have cancer, 
many others will not have, and that this is also true of smoking and, 
therefore, there is no relation between sunlight and cancer, and smok- 
ing and cancer ¢ 

Dr. Macnonatp. No, I was not making that intellectual jump. 

Mrs. Grirrirus. Are you saying there is some relation between sun- 
Jight and cancer and smoking and cancer ¢ 

Dr. Macponap. I am saying, Madam, that sunlight is one of a 
number of factors which may act as predisposing factors to the de- 
velopment of skin cancer, but that we still have no fundamental un- 
derstanding of the trigger mechanism, the real, basic determinative 
cause of cancer. 

Mrs. Grirrirus. Because you don’t understand what causes it, are 
you saying that sunlight is not the cause and smoking is not the cause? 

Dr. Macponatp. Sunlight is a predisposing factor. My attitude to- 
ward smoking, if I may, I would sooner develop as we go along. 

Mrs. GrirriTHs. Very well, but we will remember it. Proceed. 

Dr. Macponatp. One further generalization I would like to offer, 
which I think is worth mentioning, to establish a general understand- 
ing of the cancerous process; factors which are found rather consist- 
ently in the backgrounds of certain individuals with a certain type of 
cancer may contribute directly to the initiation of the cancerous change 
or there may be evidence of some other factor which is actually and 
really the predisposing agent. For example, women who have their 
first child by the age of 18 and who complete childbearing by age 25 
have a distinctly greater hazard of developing cancer of the uterine 
cervix but these factors are far more common in girls who grow up 
in less favorable economic situations. 

And so the increased incidence of these cancers of the neck of the 
uterus may well be a reflection of poor nutrition rather than early 
childbearing and as of this moment we do not know which 1s the sig- 
nificant factor. 

In other words, the factor which is first discovered by statistical 
studies as being in excess, in the background of the individual who 
develops cancer, may simply indicate the presence or even the absence 
of some other factor entirely, which is actually of predisposing or 
causative significance. 

Now there is an increasing amount of evidence in the last 10 or more 
years to show that multiple factors are operative in setting the stage 
for a considerable variety of cancers. Again we are talking about 
predisposing factors. 

Commonly there are two or more separate factors frequently of en- 
tirely different nature which combine to increase the likelihood of 
cancer developing in an individual and this is referred to as cocarcino- 
genesis or the inability of a single agent to produce cancer by itself, 
but when combined with another, or other agents, it may lead to the 
development. of cancer. | 


_ Some of these factors are extremely weak carcinogens or predispos- 
ing agents to cancer. In experimental animals, some agents admin- 
istered in large excess cannot produce any semblance of cancer but 
their combination in a relatively modest degree with other agents may 
produce cancer in one who is susceptible. 

I would like to remind us all of prior errors concerning causation of 
disease due to statistical association. During the second or even the 
third decade of this century when I was a medical student, for ex- 
ample, medical textbooks referred to a certain form of cirrhosis of 
the liver as being ‘alcoholic cirrhosis,” simply due to the fact that 
some 9 out of 10 individuals with this type of liver disease could be 
demonstrated on history-taking, or an accurate knowledge of their 
background, as having been excessive users of alcohol over long pe- 
riods of years. 

It was also noted, however, even by those most convinced of the 
causative role of alcohol in this disease, that it. did occur at times in 
individuals who apparently had never been addicted, even in repre- 
sentatives of the clergy in whom a nonalcoholic history could be es- 

Well, for years now it has been established that what was formerly 
regarded as being alcoholic cirrhosis has nothing to do with the 
alcohol, per se, but to the nutritional deficiency, which is very fre- 
quently a concommitant of the unwise use of alcohol. 

A high incidence of primary cancer of the liver—that is cancer 
having its origin in the liver, in some natives of South Africa and in 
inhabitants of the Malayan Peninsula—was originally thought to be 
due to environmental exposure. Eventually it was shown with little 
room for doubt that the causative background or predisposing situa- 
tion was of dietary deficiency rather than from unfavorable environ- 
mental agents. 

In the later part of the last century there were dire warnings being 
issued about the rising incidence of cancer of the mouth and statistical 
evidence was being cited for tobacco as the principal offender and 
was, therefore, a causative agent, indicating nothing new, much, 
under the sun ever comes. 

Some of these individuals who correspond to the present evange- 
listic statistical exponents concerning lung cancer were advocating at 
that time a severe restrictive program on the use of tobacco in order 
that cancer of the mouth could be diminished. In the years that have 
followed it has been demonstrated that cancer of the mouth is attended. 
by a severe nutritional deficiency in the great majority of individuals 
with this group of cancers. Tobacco has now been relegated—that 
is except by the most feverish antitobacco apostles—to an extremely 
minor role, if indeed it occupies any position of causative significance. 

Mrs. Grirrirus. Does that mean you have discovered what causes 
cancer of the mouth ? 

Dr. Macponaxp. Dietary deficiencies, particularly of protein and 
vitamin B. 

Mr. GrirriTtas. How do you know about that? 

Dr. Macponaw. By a very thorough and excellent study of a large 
group of clinical patients done by Hays Martin & Associates and 
published in 1940. Work has been repeated by other observers, in- 
cluding our own group. 

Mrs. Grirrirus. And you accept that ? 


Dr. Macponat. I accept it, and I accept it, too, on the basis of 
now almost 20 years of seeing patients with cancer of the mouth. 

Mrs. Grirrirus. You accept the information, then, on smoking and 
lung cancer ? 

Dr. Macpnonaxp. I accept the information that the important back- 
ground situation in mouth cancer is nutritional deficiency. Second, 
if you should be interested, oral sepsis, or an unhealthy mouth, often 
with dental infection. 

Mrs. GrurrirHs. What do you consider to be the distinguishing 
feature between that work that you have cited and the work on smok- 
ing and lung cancer ? 

Dr. Macponarp. The work on lung cancer—I am sorry, I am afraid 
I did not grasp your question correctly. 

Mrs. Grirritus. If you agree with the work that says cancer of the 
mouth is due to a nutritional deficiency, then why do you not agree 
with those people—or maybe you do agree—with those people who 
say that smoking is causing lung cancer ? 

Dr. Macponarp. Because I think there are far too many contribu- 
tory factors in relation to the association of smoking and lung cancer. 

Mrs. Grirrirus. How did they isolate the factors in cancer of the 
mouth ? 

Dr. Macponarp. One is the clinical recognition by the trained in- 
dividual of abnormal changes in the mucus membrane of the mouth, 
throat, gums, and palate so often present. And a very considerable 
percentage of these people have never smoked. And investigation 
as to their history concerning diet, objective evidence in the form of 
blood tests as to the level of serum proteins and the various types of 
serum proteins in the blood—all of these form a contributory mass of 
evidence which makes this situation to me entirely valid. 

In particular I must say that I develop a little intellectual nausea 
when we are told nowadays in 1957 that pipes cause cancer of the 
tongue, cigars cause cancer of the larnyx and cigarettes cause cancer 
of thelung. This isa degree of specificity that just leaves me slightly 

Some years ago there was a rather fervent discussion in our teaching 
hospital which happens to be Los Angeles County Hospital, between 
several who were deeply impressed with the frequency of tobacco 
smoking in patients with cancer of the mouth, and some of us who 
were convinced that it was a matter of association, only. 

Mrs. GrirriTrHs. Excuse me. There has just been a quorum call. 
Could you come back at 2 o’clock? 

Dr. Macponaxp. I can. 

Mrs. GrirrirHs. Thank you very much and we are very sorry to 
interrupt you, but we have to answer the roll. 

(Whereupon, at 12:05 p. m., the committee adjourned to reconvene 
at 2 p. m. of the same day.) 


Mr. Buatnix. The Legal and Monetary Affiairs Subcommittee of 
the Government Operations Committee will resume public hearings 
regarding misleading advertising regulated by the Federal Trade 
Commission, with specific reference to filter-tip cigarettes. 


We shall continue with the interrupted testimony being presented 
by Dr. I. G. Macdonald, clinical professor of surgery, University of 
Southern California, School of Medicine, Los Angeles, Calif. 

I believe this morning, Doctor, you were on page 6. We had con- 
siderable questioning at that time which interrupted your testimony. 
Would you proceed from where you left off so that there wil be no 
break in your testimony ? 

Dr. Macponatp. I was about to comment at that time, sir, that 
some years ago at our teaching hospital, the Los Angeles County 
Hospital, because of some interest in the subject, consecutive histories 
of some 100 patients with cancer of the mouth and throat were ob- 
tained, along with similar histories of patients in the medical wards 
without cancer of any sort. 

Now, this survey revealed that 82 percent of the patients with 
mouth cancer had a history of steady smoking, while 80 percent of 
the patients on the medical services had the same sort of smoking 

What was much more striking was the fact that 92 out of 100 pa- 
tients with cancer of the mouth and throat had in their background 
various degrees of nutritional deficiency, some of them as a concom- 
itant to addiction to alcohol, some of them because of a past history 
of ulcer of the stomach or restricted diets, people who were food 
faddists, and so forth. 

One of the principal arguments that smoking is responsible for an 
assorted increasing mortality from cancer of the lung is based on the 
gradually arising mortality statistics for lung cancer generally quot- 
ed. I think it is more than proper, even though I am here repetitious, 
to offer some inquiry as to the validity of this alleged increase. It 
is certainly a striking fact that from the year 1900 to 1956 there has 
been a reduction in crude death rates from the principal respiratory 
diseases from 430 to 57 per hundred thousand, and there are, of 
course, United States Public Health Service, vital statistics. 

When you consider now that reasonably exact measures for diag- 
nosis of the lung cancer have become available only recently, it is ob- 
vious that many of the deaths in the earlier decades of this century 
were actually due to lung cancer were recorded in vital statistics as 
pneumonia, influenza, tuberculosis, and so forth. 

If you accept the fact that this error of past decades was as little 
as 5 percent, which in my opinion is reasonable, this adjustment would 
show that there has been no real increase in lung cancer during this 
century. There has been some degree of increase simply because of 
the survival of larger segments of our population to an older age at 
which time they become more apt to develop lung cancer. 

Now, there have been a number of investigators who have reviewed 
evidence of this sort and one I would quote is the investigation of 
Dr. Paul E. Steiner, who is professor of pathology at the University 
of Chicago. He is regarded generally in our profession as being one 
of the outstanding authorities in cancer research, he is a former presi- 
dent of the American Association for Cancer Research. 

Dr. Steiner says that an increase in the frequency of lung cancer 
is reported in most clinical studies and some mortality surveys, but in 


very few autopsy studies. His observations I believe deserve some 
quotation as follows: 

Great improvement has occurred in recent decades in the clinical diagnosis 
of lung cancer but accuracy in the autopsy recognition of the natural types 
has undergone little change, having started from a much higher level. These 
facts cast doubt on whether the increase is disproportionate to other cancers. 
Even in the autopsy studies, reported increases may not be real but represent 
merely a shift in the type of material that the clinical departments send to 
the autopsy room. 

Steiner remarks that in St. Louis in 1935 to 1950, in 12,400-plus 
autopsies, lung cancer had apparently increased from 1.5 percent to 
1.9 percent, to 2.5 percent of all autopsies in 38 successive 5-year 
periods, but there were 2 other types of cancer, those of the pancreas 
and breast that had increased nearly as much as that of the lung and 
that all cancers combined had increased from 16.8 to 20.6 percent 
during this same period under study. 

Summarizing this phase of the problem then I think it is proper 
to say that while most of the reports of studies made on clinical diag- 
nosis of lung cancer made during life do show an increase; that studies 
that are based on autopsies vary. Some of them do show an apparent 
increase, others show none at all. The accuracy of diagnosis at post 
morten examination has changed very little since 1900, but the ac- 
curacy of clinical diagnosis has tremendously improved. 

In view of these facts, then, an increase in lung cancer dispropor- 
tionate to that for all or selected types of cancer in my opinion has not 
been demonstrated in those geographical regions and perhaps even in 

_ Now, as to the evidence claiming that smoking causes lung cancer on 
this basis of statistical survey. There are a number of geographical 
disparities which I would call to your attention which in my opinion 
seem to suggest invalidation of the thesis of cigarettes as a causative 
factor in lung cancer. 

Australia, for example, 1949 to 1951, tobacco consumption averaged 
4.7 and then 4.9 pounds per capita, and this compared with 5 pounds 
per head in the United Kingdom. In Australia the incidence of lung 
cancer was 13.3 per hundred thousand as compared to 55.5 for the 
United Kingdom. 

Taking the age group 55 to 64, the Australians had 30.5 cases per 
hundred thousand, the United Kingdom, 111 plus. 

Let’s take an example closer to home. In a recent year in Idaho, 
there were 2,003 tax-paid cigarettes sold per person and, in New York, 
2,319 tax-paid cigarettes, but the lunge cancer rate in New York was 
4 times greater than that in Idaho. The difference in industrialization 
in New York and Idaho is too well known to require any mention. 

It seems appropriate here, perhaps, to inject a note concerning an 
experience in East Pakistan reported by the medical college hospital 
in that country. During an 18-month study involving 362 cases of 
pulmonary disease, 20 cases of cancer of the lung were found. The sex, 
age, and occupational distribution corresponded to reports elsewhere. 
That is the predominance in males, occurrence in adult lift, and a pre- 
ponderance of manual workers. 

To repeat, the findings emphasize the characteristics which I think 
are essential in cancer of the lung, and that is maleness, age, and ur- 
banization. All of these cases but two came from rural areas where 


alleged carcinogens from tarred roads and automobiles were conspicu-- 
ously absent. Even more striking, of the 20 cases there were 14 who: 
had never smoked, 4 were occasional smokers, and only 2 were heavy 
smokers. | 

This simply helps to add to the confusion of our lack of real knowl- 
edge about etiology. 

Now, the cause of lung cancer must be much more complicated than 
the oversimplified thesis of cigarette smoking. The data advanced by 
those who are mesmerized by statistics include the English findings 
offered by Doll and Hill. Their controls—that is patients without 
lung cancer, actually contained more subjects in the moderate smoking” 
group than there were lung-cancer patients in that moderate smoking” 
group. Their figures would just indicate that moderate smoking is 
actually commoner—speaking of the English sample now—in persons 
without lung cancer. Even these data may indicate smoking to be a 
harmless pastime up to 24 cigarettes per day. One could modify an. 
old slogan: A pack a day keeps lung cancer away. 

Still another interesting fact in the data collected by English investi-- 
gators concerns the individual! habits of inhalation of cigarette smoke. 
As you know, the proponents of the theory of cause and effect, ciga- 
rettes to lung cancer, have talked about the increase in inhalation by 
cigarette smokers as compared to the users of pipes and cigars. But 
Doll and Hill report that cancer of the lung was more common in 
cigarette smokers who did not inhale than in those who did. 

We have had to my knowledge no data on this subject in United 
States samples. 

Still another curious finding advanced by the advocates of cigarette: 
smoking in relation to lung cancer is the fact that the dilution of 
cigarette smoking by some use of cigars and pipes materially decreases 
the probability or the risk of lung cancer. This seems to be without 
reference to the degree of moderation or excessiveness with which the: 
individual uses cigarettes along with cigar and/or pipe. If cigarettes. 
are carcinogenic they surely should be so whether accompanied by 
tobacco in other forms or not. It is an insult, I think, to reason, to- 
believe that two men who indulge equally in cigarettes will have a dif- 
ferent chance of lung cancer simply because one periodically adds to: 
his cigarette smoking the use of tobacco in another form. 

Another fallacy in the theory that cigarettes have a casual relation- 
ship to cancer of the lung is shown by the differences in the relative, 
incidence of lung cancer in males and females. Long before cigarettes 
were suspect, the ratio of lung-cancer males to females was in the ratio. 
of 1.5 to 1 or in some parts of the country almost unity, or almost 1 
to 1. In the intervening period, disparity in incidence of lung cancer: 
has constantly increased until for the United States at large it is ap- 
proximately 5 males to 1 female. In some areas as upstate New York 
it isa ratio of 1 female to 7 males. 

During this period, cigarette smoking by females has constantly in- 
creased, as a matter of common observation. In a recent study of 
patterns of smoking by the United States Public Health Service, it is 
indicated that slightly over 40 percent of women smoke or have smoked 
since 1930. Thus, there has been at least a 25-year period during which, 
women have been exposed to the possible causative effects of cigarette: 
smoking, if there be any such effects, and nevertheless the disparity” 

96946—57 16 


of incidence of lung cancer as compared with males continues to widen 
instead of closing. 

An interesting pattern of incidence of lung cancer is shown by some 
racial groups and one outstanding example is the high frequency of 
lung cancer in Mexican women dying in the Los Angeles area as 
reported by Steiner. In autopsies performed at the Los Angeles 
County Hospital from 1918 to 1947, over 40,000 in number, parentheti- 
cally, the Caucasoid and Mexican were the largest of the various 
racial groups involved. Mexican men had only slightly more lung 
cancer than Caucasoid males, but Mexican females had significantly 
more lung cancer than Caucasoid females and nearly as much as their 
‘male counterparts. 

Nevertheless, when we did a rough survey of smoking habits among 
older Mexican women in Los Angeles, or those in the lung-cancer age, 
we found their use of cigarettes to be less than that of the correspond- 
ing Caucasoid, or actually non-Mexican groups. 

If cigarette ‘smoking were a real and distinct factor in lung cancer, 
the relative incidence in men and women should be approaching parity 

rather than being more disparate as is the actual situation. Knowing 
that lung cancer is predominantly a male disease, there should be a 
correlation in consumption of cigarettes with increase in incidence, 
if there be any, in lung cancer. 

However, much of the increase in cigarette consumption since 1930 
‘has been due to the i increasing use of cigarettes by women, and although 
there are no accurate figures available, tomy knowledge, we have tried 
-as best we can to evaluate this part of the problem and our semi-in- 
‘formed guess is that about one-half of the United States increase in 
cigarette sales has been due to their increased use by women. 

In addition, the actual increased use of cigarettes by men allowing 
for increased use by women is nowhere nearly proportionate to the 
-alleged increase in lung-cancer rates in men. 

Now, I think it is entirely proper to compare cigarette consump- 
tion and lung cancer in the United States with the same data in Eng- 
‘land and Wales. From 1920 to 1950, the consumption of cigarettes 
increased in pounds per capita, in England and Wales, from 1.6 to 
3.6 pounds, while lung cancer was increasing from 17 plus to 72 plus 
‘per hundred thousand. 

In the United States a vastly greater increase in cigarette consump- 
tion took place in this same 30-year period, or from 1.6 to 6.3 pounds 
per capita, but our lung-cancer rate increased only from 6.2 to 31.5 
‘per hundred thousand. 

Dr. Richard H. Sweet, who is one of the country’s outstanding chest 
‘surgeons, recently commented that the concentration of effort. being 
put forth to prove a causal relationship of cigarettes to lung cancer 
‘has resulted in neglect of other factors of equal or greater importance 
which have been studied and reported as showing an association with 
‘increased incidence in death rate from lung cancer. 

Hammond has published data on this “subject showing Increase in 
‘mileage of State asphalt highways and national consumption of motor 
fuel, both of which are consider ably greater in relative increase than 
cigarettes. Fuel-oil sales, motor-vehicle registrations also parallel the 
‘increase in lung cancer. 

There have also been similar sharp increases in the production or 
consumption of cancer-related industrial chemicals over the same 


period of time, such as carbon black, petroleum, coal tar, asbestos, 
arsenic, and chromite. All of these factors contribute to the greater 
degree of air pollution in urban areas and constitute, to me, the most 
reasonable explanation for the difference in the incidence of lung 
cancer in urban and rural areas. 

Some other associations of more estoeric nature can be offered. One 
is the fact developed by the English investigator, Dr. Percy Stocks, 
as quoted by Steiner, which shows a negative correlation between the 
mortality from cancer of the lung and the number of hours of sunshine. 
According to that criterion, we should have less lung cancer in south- 
ern California than we do. 

Several studies have demonstrated a relationship in social and eco- 
nomic status and lung cancer and I am inclined to think that this fac- 
tor is of some real importance. 

In New Haven, Conn., for example, Cohart reported the incidence 
of lung cancer was more ‘than 40 percent greater among the poor than 
among the more fortunate economic groups. Cohart concluded that 
unless one could assume that cigarette smoking is inversely related to 
economic status—and this seems to be an unjustifiable assumption—it 
is reasonable to conclude that important environmental factors other 
than cigarettes are contributory. 

Clemmenssen and Nielsen reported that there was a significant ex- 
cess of lung cancer in the male population of poorer classes in Copen- 
hagen. There have been several investigators who ascribe importance 
to the coexistence of old healed tuberculosis and lung cancer. Some 
observers suggest that as treatment of tuberculosis improved, those 
who were enabled to survive are now, years later, the persons highly 
susceptible to the development of cancer of the lungs as they reach the 
cancer age. 

On this theory one such investigator, Woodruff of Detroit, made 
the prediction in 1951, that the increasing incidence of lung cancer 
should reach a plateau, and within a few years actually begin to 
soi The present figures indicate that the prediction is proving 

Stocks also showed a positive correlation of beer drinking with 
increased rates of lung cancer, and a negative association between 
milk drinking and cancer. This may not be nearly as humorous as it 
sounds, because it may be a reflection of nutritional deficiency or nutri- 
tional advantages, respectively. 

Differences in lung cancer rates in the country and in the city are 
consistently found. Several investigators have concluded that resi- 
dence and employment in urban areas with constantly increasing 
industrialization constitute more significant and reasonable associa- 
tions with lung cancer than smoking. 

The adjusted mortality rate for cancer of the lung for white males 
in the United States, 1948 to 1949, was 22.3 per 100,000 in urban areas, 
and only 12.3 in rural areas. 

In the United States, individual cities offer confirmatory evidence 
of the importance of industrialization. For example, it needs no 
statistician or expert in sociology to realize that the smoking habits 
of the residents of Charlotte, N. C., are little different from those of 
other comparable communities in the eastern part of the country. 
Yet Charlotte has a lung cancer standardized mortality rate of only 


82 per 100,000. The national average on this SMR basis is 100, 
and this compares to various heavily industrialized areas that run as 
high as 187. It has been estimated that 6 tons of tarry material fall 
on each square mile of Manhattan every year, and walking down 
Fifth Avenue or Madison Avenue can well convince one of that fact. 
In English towns, various studies have shown that the number of 
lung-cancers deaths increases in proportion to the number of chimneys 
per acre in the towns studied. 

Now, to take up the experimental problem and in particular the: 
results reported by Wynder, which have already been described here 
today. Before I offer some attempt of my own to comment on this 
doubtful activity, I think it is proper to emphasize that mouse skin 
cancer bears no relationship to human cancer and this is admitted 
even by those who have done the experiments. The lungs and the 
skin have different origins in development of the animal and it can- 
not be assumed they will react to the same irritant. 

Still further, mice and men are completely unlike in their response 
or lack of response to many agents. For example, cancer of the breast: 
can be produced in a high percentage of mice of certain strains by the 
use of estrogens, or female sex hormone. But the intensive use of the 
same hormone over a long period of.years in female monkeys, has 
failed to produce a single cancer of the breast, or any other cancer. 

I think it is proper, therefore, to make these generalizations on this: 

(1) The demonstration of the production of cancer by an agent in 
a mouse cannot be accepted as valid evidence of a similar property 
in men, particularly if the experiment cannot be repeated success- 
fully in the higher mammals, which has certainly not been done in the 
instance of tobacco tars. : 

(2) No satisfactory approach to an equivalent of human lung can- 
cer has been produced in animals after exposure to concentrated doses: 
of tobacco smoke produced by smoking machines. In spite of the fal- 
lacies of this particular experimental approach, then, there are still 
other reasons for denying any real analogy to the situation of smok- 
ing in the human, as follows: 

(a) A certain English investigator exposed 160 mice for 18 months: 
to cigarette smoke. That is for about half of their life span. The: 
smoking mice actually lived longer than the nonsmoking mice. 

(6) Another British investigator, by name Campbell, observed an 
increase in lung-tumor rate in mice from 8 percent to 80 percent when: 
they were subjected to prolonged inhalation of dust from roads with 
a 2 percent content of tar. 

An attempt to compare the amount of cigarette smoking by humans, 
which would be required to equal the exposure of the skin of mice in: 
the Wynder experiments, I think points up the absurdity of the com- 


u Extrapolating the concentration of tar on the small area of the 
mouse’s skin to an equivalent concentration on the large area of the 
lung of men, and with the help, gentlemen, of one of our statisticians— 
we also use statisticians—I estimated that a man would have to smoke 
over 100,000 cigarettes a day to equal the dose that Wynder gave his: 

Now Wynder has told this committee that when his dose is cut in 
half no tumors result and thus on this further admittedly absurd 


extrapolation, a man could smoke over 50,000 cigarettes a day if he 
had the time and energy and not be in danger of developing cancer 
from smoking. 

Extrapolations such as this show the dangers of predicting results 
in man from results in mice and of predicting cancer-producing doses 
in men from mouse experience. To make an even further attempt at 
humorous comment, it would seem to me that all the mouse experi- 
‘ments indicate is that mice should smoke their cigarettes and not put 
the stuff on their backs. 

Wynder also said before this committee in his statement that he 
produced about 50 grams of tar per thousand cigarettes, or 50 milli- 
grams per cigarette. This raises a question whether the tar was 
produced under conditions that really simulated human smoking, 
since none of the figures presented to you Wednesday indicated that 
much tar content to be in the smoke of a cigarette. 

Finally, I offer with respect to experimental evidence, the work 
done by Kotin and his associates at our school of medicine in Los 
Angeles, in exposing mice to artificial and natural samples of atmos- 
phere, to show how potent the pollutants in air can be in their pro- 
‘duction of tumors—and, of course, the pollutants in urbanized, highly 
industrialized areas. Kotin applied various substances that con- 
tribute to air pollution on a quantitative basis and he used a lesser 
dosage in 1 year, weight for weight, than Wynder used in 1 week. 

When the material obtained from diesel exhaust fumes was so 
applied, 17 out of 20 animals so exposed bore tumors or 85 percent and 
11 of these 17 bore cancerous tumors. 

When a similar experiment was conducted again with a pure strain 
of mice using a concentrate from gasoline internal combustion engines, 
38 out of 86 mice developed tumors. There were multiple tumors in 
over 60 percent of the animals, or 44 percent and 22 out of the 38 
animals had tumors which were cancerous. 

Finally, when products simply filtered out of Los Angeles air were 
similarly applied, 13 out of 35 mice, or 42 percent developed tumors, 
and 9 of these 13 animals showed malignant tumors on microscopic 

None of this makes very consoling reading for the residents of our 
own Pueblo. It does, however, make obvious the fact that duplicating 
the Wynder type of experiment not only with diesel and gasoline 
engine exhaust concentrates, but also with samples of Los Angeles 
atmosphere, produce much more convincing evidence of carcinogenic 
ability in mice—for whatever this may be worth—than did the 
‘Wynder experiment. 

It should be noted, too, that Kotin’s observations have been dupli- 
cated readily by several other competent investigators. Wynder’s 
results to my knowledge at least have been rather difficult of repro- 
duction by other scientists. 

I would finally state then that the total evidence I have tried to 
review fails to establish any sound basis on which a causative in- 
fluence can be assigned to cigarette smoking in the production of 
cancer of the lung. 

As in the majority of human cancers, we have at hand an imposing 
list of predisposing factors, no one of which is of more than ephemeral 
status at present. The total problem of cancer in man, to me, remains 
about as much a mystery as it did hundreds of years ago. 


Mr. Buarnix. Doctor, thank you for your statement. I commend 
you for what is, obviously, a very carefully and well-thought-out 
statement, prepared with considerable special effort. Regardless of 
the point of view, we appreciate what, we are sure, was a verry serious 
attempt to submit before the committee a very well-thought-out state- 

Doctor, you make a rather convincing case here in allaying any fears 
one may have as to any substance in cigaretter smoking being carcino- 
genic. That brings us to the specific problem that we have, as to why 
the filters on cigarettes and the terrific effort and expenditure of time 
and money to promote them. In your opinion, is there anything 
that is or may be carcinogenic in tobacco smoke 4 

Dr. Macponaxp. I do not believe there is any evidence to so indi- 
cate, at present. 

Mr. Buarnitk. Could there be any other substances, to your knowl- 
edge, that you think might be harmful to the human body ? 

Dr. Macponaup. From a standpoint of production of cancer, I do 
not believe so. 

Mr. Brarnix. I am thinking of not only cancer, but other effects 
on the vascular system—carbon monoxide, nicotine? 

Dr. Macponaup. I would not venture to express an opinion on 
other diseases, sir. You know the person who specializes in cancer 
always fears heart disease, and the heart specialist is always dying 
of cancer. 

Mr. Briatrnix. Did I understand you to say that, in normal quan- 
tities of cigarette smoke—let’s say a pack a day—the amount of tar 
collected would be so insignificant that it is very unlikely that it would 
induce any cancer, even in mice—that your dose would have to be 
many times larger or heavier? 

Dr. Macponaup. Yes, sir, based on the Wynder experiment, at 
least. The concentration which he had to employ was so enormous 
that it was out of all resemblance to smoking habits. 

Mr. Brarnix. In recent months there has been more and more 
mention made of a substance calied 3,4-benzpyrene. Is that a very 
carcinogenic substance ? 

Dr. Macponab. 3,4-benzpyrene does have a distinct carcinogenic 
capacity for certain experimental animals. However, under the cir- 
cumstances of combustion, I am told by Dr. Kotin—and here I must 
quote his work—that the dissipation of benzpyrene during a process 
of combustion is so nearly complete that only an infinitesimal part 
of it is emitted to the stream of smoke emerging from the tip of the 

Mr, Buarnrx. Mention was made the other day about research being 
made by Latarjet and Cusin in France, that benzyprene was definite- 
ly present in cigarettes, and carcinogenic. You see, in France the 
Government owns a monopoly on tobacco. They have been carrying 
on research on benzyprene. Are you familiar with their research 
work, Doctor ? 

Dr. Macponatp. Only in a general way. Not sufficiently to offer 
any critical comment. 

Mr. Buarnix. On the basis of your testimony, would it be fair for 
the committee to feel that, as far as health is concerned, the filters 
serve little, if any, purpose or function in cigarettes? 


Dr. Macoonatp. I have no opinion about filters, Mr. Chairman. 

Mr. Bruatnix. If there is nothing to remove in a cigarette to begin 
with—I am talking from the standpoint of health now 

Mr. Macponaxp. My interests, sir, I have been concentrating in one 
area. My intense curiosity and desire is to know, is there some rela- 
tionship between smoking, in particular, cigarette smoking, and 
neoplasms, tumors, benign or malignant. 

Mr. Buatnrx. What is your opinion on it? 

q ee Macponarp. I do not think there is any sound basis for such 

Mr. Buarnrk. So, with or without a filter, a cigarette is not very 
likely to give you any tumor or cancer ? 

Dr. Macponap. In my opinion, no. 

Mr. Buarnix. That is all. Mr. Meader 

Mr. Mraprr. I have no questions. 

Mr. Buarnix. Mr. Minshall 

Mr. MinsHatu. Doctor, you have been specializing for how many 
years in the cancer field ? 

Dr. Macponarp. Since 19386. 

Mr. Minsuauy. Have you come to any conclusions of any kind as 
to what might be the cause of cancer ? 

Dr. Macponarp. Not as to the trigger mechanism—the fundamental 
basic factor that upsets an abnormal cell and starts it on its way to be- 
coming a cancer cell. No. I have learned a great deal over the years, 
sir, I hope, as to predisposing factors, and how many of them may be 
avoided, but nothing as to the actual 

Mr. Minsua. I don’t quite understand what you mean by how 
they may be avoided—how cancer may be avoided ? 

Dr. Macponarp. Yes, sir. For example, it is a curiosity to see 
cancer of the mouth in a person with a clean mouth and healthy 
mucous membranes and a good dietary background. That is one way 
of avoiding a particular group of cancers. But, again to be repeti- 
tious, one may have the same factors that lead to cancer of the mouth— 
namely, a dirty mouth and a bad diet, and one person will develop 
cancer and another will not, with equally bad situations. 

Mr. Mrinsuatu. Your specialty, then, is in skin cancer ? 

Dr. Macponaxp. Oh, no, sir. 

Mr. Mrysiautn. You specialize in all forms of cancer ? 

Dr. Macponatp. I specialize in the treatment of cancer, except that 
of the central nervous system and chest. 

Mr. Minsuatyi. What is the treatment that you use today for can- 
cer? What is your recommended procedure to your patients, de- 
pending, of course, on the degree and the stage of it? 

Dr. Macnonatp. It is highly individualized, sir? Surgery in some, 
radiation in others, and, added to that, some of the newer chemicals 
and isotopes that are now available. ; 

Mr. MrnsuHatu. From your studies, have you found out, Doctor, if 
any agents—say some of the tars; do they have any casual relationship 
to cancer ? 

Mr. Macponatp. Not that I can be sure of. 

Mr. Minsuatyu. Are you familiar with the British Government 
studies in allowing for compensation claims to their chimney sweeps 
over there for the past several hundred years—they have had studies 


and found out that it caused cancer of the skin on various parts of 
the body. 

Dr. Macponatp. Yes, sir. Tam. That, however, if I may suggest, 
is not an analogous situation. 

Mr. Mrnsyaty. What is that situation? I have just heard briefly 
‘about it. Could you explain it to us, please ? 

Dr. Macvonatp. I will try, sir. This is an example of direct con- 
tact of a known carcinogen-containing substance—that is, soot—on 
‘the skin. 

Mr. MinsuHatu. Soot isa tar, is it not? 

Dr. Macponat. It isa tarry substance containing 

Mr. MrinswHatu. In other words, this caused the cancer. You admit 
that, then? 

Dr. Macpon ap. Yes, by contact on the exposed skin, just as Wyn- 
der produced cancer of the skin by 

Mr. Minsuatu. Then tar has caused cancer; but a moment ago you 
said it hadn’t. 

Dr. Macponarp. Yes; it does, but not in the lung, to my mp lee 
lam sorry. I thought you were asking me, sir about the lung. 
the skin, yes. 

Mr. Mrnsuauu. Please tell us a little bit more about this situation 
we started to discuss. 

Dr. Macpvonatp. About chimneysweeps 

Mr. Minswatu. Yes, please. 

Dr. Macvonatp. The cancer-producing substances in soot are sev- 
eral in number. There is 3,4-benzpyrene, and several other hydro- 
carbons, such as dibezanthyacene and these are distinctly carcinogenic 
when placed upon the skin. 

Mr. MinsHauu. On the human skin ? 

Dr. Macponatp. Yes, sir. 

Mr. Minsuatu. In other words, there are tars that cause cancer on 
human beings? 

Dr. Macponarp. Yes, on skin. 

Mr. Minswatuy. That is all the questions I have. 

Mr. Buatnix. If there are no further questions, again Dr. Mac- 
donald, we thank you most sincerely. 

The next witnesses we have are from the James Rand Development 
Corp. of Cleveland, Ohio. We have with us Mr. James Rand and Drs. 
Burhan and Cardon. 


Mr. Buatnik. Please, first identify the men with you, Mr. Rand. 

Mr. Ranp. On my left is Dr. Burhan, a medical doctor of the Rand 
Development Corp. On my right is Dr. Cardon, a doctor of philoso- 
phy in chemistry who is with Rand Development Corp. I am presi- 
dent of the corporation. My corporation is a corporation for profit 
engaged in research and development work. ( See appendix, exhibit 
24. p. 730.) About 20 percent of our entire work is in the medical field 
and is directed toward cancer. We have spent over a quarter of a mil- 
ion dollars, 6 years of time and done literally thousands of experi- 


ments, consulted with the foremost authorities in this field and had our 
work checked by competent people. 

I would like first to have Dr. Cardon give the factual, chemical 
analyses that he has completed that have been confirmed by the French 
Government and others around the world. 

Mr. Buarnix. Dr. Cardon, will you give your full name and a brief 
summary of your technical experience and the work you are in and 
then proceed with your written statement which the committee has? 

Dr. Carpon. Mr. Chairman, my name is Samuel Z. Cardon. I have 
a bachelor’s degree from the University of Chicago and a master’s 
degree, 1941, University of Chicago, and doctor of philosophy, 1950, 
from Western Reserve University. My experience in this field has: 
all been with the Rand Development Corp. in the last 4 years. 

Recent statistical studies suggest a relationship between the increas- 
ing incidence of lung cancer and smoking. This implies carcinogenic 
activity by the smoke. Accordingly, for several years the Rand De- 
velopment Corp. has been investigating the nonvolatile fractions of 
the smokes of cigarettes, cigarette paper, and tobacco for possible 
known carcinogens. The statistical studies on the relation of lung 
cancer and smoking pointed especially at cigarette smoking and indi- 
cated little or no relation to cigar and pipe smoking. One major dif- 
ference between these types of smoking is, of course, the paper. Ini- 
tially, it was thought the carcinogenic activity might be wholly due 
to the paper, and we were thus stimulated to start with the paper alone. 

Indications of fluorescence, characteristic of the benzanthracene 
derivatives, was first noted by Carroll and Rand in the tars of cigarette 
paper smoke. The fluorescence was found by us to be due to a known 
carcinogen 3,4-benzpyrene, and related substances. The identification 
of 3,4-benzpyrene was based on 4 lines of evidence: The fluorescence 
spectrum, the ultraviolet absorption spectrum, indication of the pres- 
ence of the iodine derivative, 6-iodo-3,4-benzpyrene in iodinated puri- 
fied fractions of the tars, and the recovery of added quantities of 3,4- 
benzpyrene from the tars. In this method, the tar is condensed from 
the smoke, a known amount of benzpyrene is added to the tar and the 
analysis carried out. The amount of benzpyrene actually found was 
equal to the amount added plus that normally present. 

Subsequently, we found 3,4-benzpyrene in the condensed tars of 
smoke of tobacco, cigarettes, and cigars as well as from the paper. 
The cigarettes were smoked in a smoke sampling apparatus designed 
by the research laboratory of the American Tobacco Co., Inc., and 
manufactured by Phipps & Bird, Inc., of Richmond, Va. Cigarette 
paper and tobacco were smoldered in a glass tube and the smoke drawn 
through a plug of glass wool where the tars condensed. Our proce- 
dures and techniques for smoking, collecting the tars, and chemical 
analysis are described in the British Journal of Cancer (vol. 10, p. 
485 (1956)), in an article by Cardon, Alvord, Rand, and Hitchcock. 

(See appendix, exhibit 21, p. 696.) 

We found the following amounts of 3,4-benzpyrene: 

Cigarette paper: 1 microgram in 1.6 grams of paper 

Tobacco: 1 microgram in 8 grams of tobacco 

Cigarettes: 40 to 50 micrograms— 
that is two different brands of cigarettes—from 400 regular cigarettes.. 
32 micrograms from 400 filter-tip cigarettes. 


The drop in benzpyrene from regular cigarettes to filter tip cig- 
arettes of the same manufacturer was 25 percent, that is, from 40 
micrograms to 32 micrograms for 400 cigarettes. 

The interesting point here is that according to the Readers’ Digest 
article, the filter tip in question produced more tar than did the reg- 
ular cigarettes and yet the benzpyrene has been reduced. I would 
have expected that. Despite the comments that have been made here 
by previous witnesses that the amount of tar would be expected— 
that is the quantity of tar would directly influence the amount of bio- 
logical activity of the tar, that that isn’t necessarily true. The tar 
is a complex mixture and the active constituents of the tar are prob- 
ably only 1 percent or less of that mixture. It is easily conceivable 
that a proper filter tip will remove a certain proportion of that 1 per- 
cent and still leave the total amount of tar almost the same as it was 
before, or maybe even increase the tar in some way. ‘The filter tip 
won’t increase the tar but maybe a change in tobacco would increase 
the tar and still, as in this case, leave the benzpyrene which is the 
active ingredient, in smaller quantity. 

Therefore, while the tar might be the same or more than what it 
was before, the active ingredient would be less. That is what we find 
here. Actually it is analogous in some ways to our method of analysis 
of the tars. Our method of analysis that is in our paper depends to 
a considerable extent upon chromatographic absorption. In chromato- 
graphic absorption techniques we pass fractions of the tars through 
powders which are absorbents and we can see that the absorbents se- 
lectively remove one material and let the other materials pass through. 
That is the basis for our separation. 

In effect, the filter tip, itself, is an absorbent and could do the same 
thing. It can allow the active ingredient to pass through while re- 
moving most of the tar and, conversely, it can remove most of the ac- 
tive ingredient and allow most of the tar to go through, so that there 
is this distinct possibility that the filter tip could remove a part of 
the active ingredient of the cigarette smoke as the active biological 

The smoke of a popular denicotinized cigarette contained about half 
the benzpyrene of other regular cigarettes with a 40-percent drop in 
the corresponding filter-tip cigarettes. These results are based on 
only a few experiments and are to be considered somewhat tentative. 

We do have much more thorough experimental work planned under 
consideration and, once we get done with that, we will know a little bit 
more about the story of filter tips and cigarettes in general. 

Cigars varied greatly with the brand, giving from 1 microgram 
from 2 grams to 1 microgram from 8 grams of the cigar, based on 
the weight of the cigars smoked. 

We found no corresponding difference in the amounts of tar, which 
indicates that the amounts of time, while they might be the same, the 
active ingredient could be materially different in different cigars 
and different tobacco products. 

Considering that cigarette smoke might be carcinogenic due to the 
3,4-benzpyrene in the smoke, we went to work to attempt to eliminate 
this well-known carcinogen from the smoke. Our initial effort was 
with cigarette paper, and we added substances to the paper which 
would ae the combustion products so that less benzpyrene would 

e formed. 


Using a rapid-screening method described in a second article by 
Alvord and Cardon in the British Journal of Cancer, volume 10, page 
498 (1956) (see appendix, exhibit 22, p. 710), we were able to test 
many compounds and found one class, the ammonium salts of strong 
mineral acids, sharply reduced the production of benzpyrene in cig- 
arette-paper tars. This reduction is 95 percent or more for a 5-per- 
cent addition of ammonium sulfamate to the paper. The total tars are 
reduced and the characteristic fluorescence almost entirely eliminated 
from the oil-soluble fractions of the tar. This is especially significant, 
since any carcinogenic compounds of the benzanthracene type—benzy- 
pyrene is a benzanthracene compound; we would almost call it a benz- 
pyrene complex of compounds—would be expected to fluoresce in this 
spectral region, 395 to 465 millimicrons, and no fluorescence in this 
region is a good indication that not only has benzpyrene been almost 
completely eliminated but other similar compounds, possibly car- 
cinogenic, have also been greatly reduced or eliminated from the tars. 

The treatment was next applied to tobacco, and an 80-percent reduc- 
tion in 3,4-benzpyrene was effected in laboratory tests. Cigarettes 
made with treated paper gave 60 percent less benzpyrene than did the 
same cigarettes made with untreated paper. In preliminary tests, 
using treated paper and treated tobacco, only the 60-percent reduction 
was obtained. As yet unexplained is the low effect the treated tobacco 
had on cigarettes made with it as compared to the large effects of the 
treated paper. 

Our work has been repeated in France by Latarjet, Cusin, and their 
coworkers at the Pasteur Institute and the laboratories of the French 
tobacco monopoly, with verification of our results. heir work was re- 
ported in the French Bulletin of Cancer, volume 48, page 180 (1956). 
(See appendix, exhibit 23, p. 716.) Benzpyrene in cigarettes and in 
other tobacco products has also been found by Cooper and Lindsey in 

As a chemist of 16 years’ experience, I want to make this concrete 
statement. A known cancer-producing agent has been found in the 
smoke from cigarette paper, and a lesser amount from tobacco alone 
and in the composite smoke of cigarette paper and tobacco. This com- 
pound is known as 3,4-benzpyrene. It typifies a group of related com- 
pounds which has been demonstrated by Wynder, of the Sloan-Ket- 
tering Institute, and many others as being strongly carcinogenic. We 
have found that additives releasing ammonia at the approximate com- 
bustion temperatures of cigarettes can reduce by a large factor, or 
eliminate entirely, these compounds from the smoke of cigarettes. 

That concludes my formal statement. 

Mr. Buatrnirg. Dr. Cardon, you have made a very striking statement, 
which is the first testimony we have received indicating not only the 
positive identification of a carcinogenic substance in tobacco smoke—in 
this case you identify it as benzpyrene, which was indicated to exist 
in extremely minute quantities. Apparently, from your testimony 
here, you identify this substance as a carcinogenic substance and, also, 
you have measured it. 

I am not quite clear what you mean. What is a microgram; a 
millionth of a gram? 

Dr. Carpon. Yes, 


Mr. Buarnix. In talking about tars, we measure them in terms of 
miulhgrams; that is, a thousand ? 

Dr. Carpon. Yes. 

Mr. Briarnix. Other witnesses have testified that there was, or 
possibly was, 3,4-benzpyrene in cigarette smoke, but it was in such 
extremely minute amounts that it could not and has not induced 
cancer. Is that correct? 

Mr. Ranp. Dr. Burban can testify on the medical end. 

Mr. Buarnrx. The important thing is that we have identified a 
specific carcinogenic substance, and you have measured it. 

Dr. Carvon. That is right. The previous witness mentioned this 
cocarcinogenic effect, and I understand there is recent evidence that 
nicotine itself might be a cocarcinogenic agent. The statement that 
there isn’t enough benzpyrene here to cause cancer, which would de- 
pend on using a pure benzpyrene solution, in the presence of these 
possible cocarcinogen materials, like nicotine and other materials in 
the tar; I don’t think that is valid any more. We don’t know how 
much benzpyrene—we don’t know what the minimum amount of 
benzpyrene is that would produce a cancer in the presence of these 
cocarcinogenic agents. 

Mr. Buarntx. I have no further questions for the moment. 

Mr. Meraprr. I wanted to ask Mr. Rand—I notice in the second 
paragraph of your mimeographed statement it says part of the cost 
of your cigarette research was underwritten by a small tobacco 

Mr. Rann. Yes, sir. 

Mr. Meaper. That sounds as though it was prior to 1952. Are you 
still being financed in your research activities with funds from the 
tobacco industry ? 

Mr. Ranp. No; after we found 3,4-benzpyrene in the smoke, shortly 
after that, the funds from the tobacco company dropped out. 

Mr. Meraper. I understand that yours is a profitmaking institution. 
From what funds are your present research activities being financed ? 

Mr. Ranv. From our own funds. 

Mr. Mraprr. You mean you are not being 

Mr. Ranp. We have a number of proprietary projects. By pro- 
prietary means, we have bought the project, or we initiated it and we 
financed it ourselves. 

Mr. Bratrnix. And then market it? 

Mr. Ranp. Yes. License people to use our findings. 

Mr. Mraprr. If there is something here that is carcinogenic you 
will remove it? 

Mr. Ranp. That is right, and license the industry to use it. We 
bought the tobacco company’s interest out. 

Mr. Mraprer. You have no funds from anyone, either a charitable 
foundation or from an industry fund ? 

Mr. Ranv. Not to date. Ours is a publicly owned corporation. 

Mr. Brarnix. Mr. Minshall. 

Mr. Minsuatu. Mr. Rand, I believe you have said that your organi- 
zation was the first organization at least in this country, to separate 
and identify 3,4-benzpyrene; is that correct ? 

Mr. Ranp. That is correct. It was developed in Argentina in the 
middle thirties but at that time equipment didn’t exist to identify it 


properly and everybody criticized that, but we were the first in this 
country, certainly, to find 3,4- benzpyrene in products of cigarette 
smoke, and there is a very simple straightforward method of doing it 
now with proper scientific equipment. 

Mr. MinsHautyt. How soon after you made known your discovery 
to the tobacco people did the funds from the tobacco people disappear ? 

Mr. Ranp. About a year. 

Mr. MinsuHatyt. You have spent how much altogether on this par- 
ticular project ? 

Mr. Ranp. Over $250,000. 

Mr. Minsuatt. How does that compare to funds spent by other 
concerns either public or private, at least in this country on similar 
projects ? 

Mr. Rann. Tobacco industry altogether so far has spent $1,800,000. 
Whether it is on cancer or not, I don’t know. 

Mr. Minsizaty. The amount of money you have spent thus far is 
far in excess, is it not, of any other company of similar size? 

Mr. Rann. As far as we know, ours is the most concerted effort. 

Mr. Mrnsuatu. I have no other questions. 

Mr. Mmaper. Mr. Minshall’s question has suggested another to me. 
Do you know to what extent tobacco companies themselves are seek- 
ing information on possible carcinogenic substances in tobacco smoke 
and Ae seeking to find ways of reducing or eliminating them if they 

Mr. Ranp. No, sir; I do not. The only tobacco group that I know 
of that is seriously interested in our work is the French Government, 
the tobacco group, and there the Director of Research of the French 
Government tobacco group was the coauthor of the paper sub- 
stantiating our work. 

Mr. Meaper. If there were any activities on the part of tobacco 
companies in the field in which you are working, would there be any 
reason why you should know about it? 

Mr. Ranp. I don’t think so. I think if they did, if they repeated 
our experiments they would know they were true and would come 
around looking for a license. 

Mr. Maver. And there hasn’t been any activity in that direction, 
I take it? 

Mr. Ranp. None. 

Mr. Buatrntx. Has the tobacco industry research committee—are 
they aware of your work? 

Mr. Rann. Oh, yes. 

Mr. Bratnix. Have they contacted you for any further informa- 
tion ¢ 

Mr. Ranp. Oh, yes; we have had several meetings with them and 
privately they admit that a 3,4 benzpyrene is a dangerous substance 
and should be removed, if possible, if it doesn’t ruin the cigarette— 
the treatment to remove it. But they say they have no influence with 
the tobacco industry whatsoever and they have made a report on our 
findings. They questioned the way be burned our cigarettes, they 
questioned temperature. We answered every objection they have 
but they still won’t come out and admit 

Mr. Biarnik. You answered whose objections? 


Mr. Ranp. All the objections that were raised at the various visits. 
The first thing they questioned was whether we could find 3,4-benz- 

ee Meaper. You don’t mean Dr. Little? 

Mr. Ranp. Yes, Dr. Little and his group. 

Mr. Buatrnix. Mr. Rand, we have a copy, and we are certain this 
is correct and we will recheck it, a news item in the Cleveland News 
in Cleveland, Ohio, dated February 17, 1956, and it is a short news 
story report. “A visit made by Dr. Clarence Cook Little, Chairman 
of the tobacco industry’s advisory committee on its visit to Cleveland, 
made a visit to the James H. Rand Laboratories.” 

[Article in Cleveland News, February 17, 1956, by S. Severino] 

Cigarette paper made at the James H. Rand Labratories here impressed Dr. 
Clarence Cook Little, chairman of the Tobacco Industries Advisory Committee, 
on his visit to Cleveland. 

Dr. Little, who spent several hours at Rand Laboratories, said he will send 
two of his committee to Cleveland for a more thorough study of the work. 

Rand, Cleveland inventor and medical scientist, has developed researeh which 
showed that cigarettes when smoked give off a substance called benzpyrene, a 
known cancer-producing agent. 

A second research project by the Rand Laboratories was the development of 
a cigarette paper, treated with an ammonia compound, which prevents the 
formation of benzpyrene. : 

Dr. Little said he would ask Dr. Paul Kotin, chemical scientist from the Uni- 
versity of California, and Dr. McKeen Catell, professor of pharmacology at 
Cornell University, to study the Rand work. 

Dr. Little admitted being quite impressed by the research in the Bratenahl 
Laboratories. ; { 

Would you recall if that visit took place? 

Mr. Ranp. That was the first visit that he had made since he was 
chairman. He followed our work long before he became chairman 
of the Tobacco Advisory Committee. He encouraged it. 

Mr. Brarnirx. He encouraged your work before he came is as chair- 
man of the Tobacco Industry’s Research Committee ¢ 

Mr. Ranp. I am a trustee on his memorial laboratory and I know 
him very well. 

Mr. Bruarnirk. You are a trustee at his Jackson Memorial Labora- 
tory in Bar Harbor, Maine? 

Mr. Ranp. Yes. 

Mr. Brarnrx. We have this clipping which will be put in this 
record and it is something that can be checked if it is to be used as 
an authoritative document, but it shows the visit was made. 

The news item states: 

Dr. Little, who spent several hours at Rand Laboratories, said he will send 
two of his committee to Cleveland for a more thorough study of the work. 

Rand, Cleveland inventor and medical scientist, has developed research which 
showed that cigarettes when smoked give off a substance called benzpyrene, 
a known cancer-producing agent. 

A second research project by the Rand Laboratories was the development of 
a cigarette paper, treated with an ammonia compound, which prevents the 
formation of benzpyrene. 

Dr. Little said he would ask Dr. Paul Kotin, chemical scientist from the Uni- 
versity of California, and Dr. McKeen Catell, professor of pharmacology at 
Cornell University, to study the Rand work. 

Dr. Little admitted being quite impressed by the research in the Bratenahl 


Were Drs. Kotin and Catell ever sent to further observe and discuss 
your research ? 

Mr. Ranp. Dr. Catell never came out. He was supposed to come 
out with a group of five people. They never came out but wrote a 
report anyway criticizing our work. 

Finally I induced Dr. Little to come out and he subsequently sent 
Dr. Kotin, and Dr. Kotin said the same thing Dr. Little did. He said, 
“T am not sure 3,4-benzpyrene is carcinogenic but is a suspicious thing 
and should be taken out.” 

We are happy they would say that but in a subsequent report on 
Dr. Little he questioned our methods and the thing was dropped. 

Mr. Buarnix. Are there any further questions? 

Mr. Rand, will you later on give us more details of the work that 
you have been doing with the French Government? 

Mr. Ranp. Yes. 

Mr. Minsuatyi. When was it Dr. Little was at your laboratory ? 

Mr. Ranp. It is the date of that newspaper clipping, about a year 

enn. Mrinsuatyu. February 17, 1956, is the date of the newspaper 

Mr. Ranpv. That is the correct date. 

Mr. MinsHatu. How long was he in your laboratory ? 

Mr. Ranp. Well, he was in the laboratory I would say 3 or 4 hours. 

Mr. MinsHauyt. And during that length of time you had many con- 
versations with him and he asked many questions ? 

Mr. Ranpv. Thats right. 

Mr. MrnsHauu. Did you ever discuss the efficacy of filter cigarettes 
with him at that time ? 

Mr. Ranp. No, I never did. 

Mr. Minswatzi. You merely discussed the work you were doing, 
about 3,4-benzpyrene ? 

Mr. Rann. That is right. 

Mr. MrinsHaut. And explained how you derived it from cigarettes? 

Mr. Ranp. Yes. We put on a complete presentation with everybody 
involved in the project giving their own part, slides and pictures and 
diagrams and charts and the whole presentation. 

Mr. Minsuaty. What was his general comment again ? 

Did he give one at that time? 

Mr. Rann. He said, “This is very valuable work.” He said, “I 
think this should be pursued, and I think the tobacco industry should 
do something about it, because 3,4-benzyprene shouldn’t be in the 
smoke if you can get rid of it.” 

Mr. Mrinsuatu. Have you head anything from him since that time 
or had any discussions with him since that time ¢ 

Mr. Rann. I haven’t had any report except he sent me a copy of a 
letter that Dr. Kotin wrote me—I mean wrote him. 

Mr. Buarnix. Could we proceed now to get the medical end of the 

testimony ¢ 
If there are no further questions, we will proceed with Dr. Burhan. 
Doctor, will you give your full name and position with the Rand 
Development Corp. and a brief summary of your professional train- 
ing and experience and the work with the Rand Development Corp. 

Dr. Buruan. My name is A. S. Burhan and I hold bachelor of 
science and doctor of medicine degrees from the University of Istan- 


bul and a master in medical science degree from the Northwestern 
University Medical School. [am primarily a cytologist, which deals 
with physiology morphology, and pathology of cells. 

I have been associated with the University of Utah in Salt Lake 
City, the University of Oregon in Portland, Oreg., Northwestern Uni- 
versity Medical School and just before joining the staff of the Rand 
Development Corp. I was associated with the Cleveland Clinic Foun- 
dation and Frank E. Bunts Educational Institute. 

The following is my official statement on this subject. 

The successful isolation of a fluorescing polycyclic hydrocarbon 
from the cigarette smoke, in this country and abroad, and its identifi- 
cation as 3,4-benzyprene brings the efforts of correlating the in- 
creased incidence of lung cancer with heavy smoking toward a finite 

Upon identification and approximate quantitation of a universally 
recognized potent carcinogenic agent, like 3,4-benzpyrene and its pos- 
sible cogeners, and upon developing of a rather simple technique for 
the inhibition of its formation by the chemists of the Rand Develop- 
ment Corp., we were confronted with the problem of translating into, 
and reevaluating by means of biological criteria. Based on the initial 
promising findings by some outside consultants, a new department for 
biology was established. The following statements are the result of 
experiments performed on 1,402 animals, which I believe is the largest 
number of animals used for a certain kind of experiment, so far as I 

We felt that it was very fortunate to step into the problem at a 
stage when comparatively abundant leads were available for orienta- 
tion. The multitude of techniques developed for laboratory evalua- 
tion of carcinogens and the natural tendencies of an individual in- 
vestigator toward his favorite techniques is usually regarded as sub- 
ject to bias. For some, this needs corroboration of validity by others. 

Tn our case, the orienting leads were identification of 3,4-benzpyrene 
and the verification of it by fluorescence spectrum, ultraviolet absorp- 
tion, formation of 6-i0do-3,4-benzpyrene, and finally the recovery of 
an added amount of chemically pure 3,4-benzpyrene at the end of the 
process. This way one could base his experimental approach from 
Percival Potts’ observation on the cancer of the skin in chimney sweeps, 
to the systematic screening of all aromatic hydrocarbons at our times 
as accomplished by Japanese investigators. 

In 1915, two Japanese experimentors, Yamagiwa and Ishikawa, suc- 
ceeded in producing malignant tumors by application of coal tar to 
the ears of rabbits. Later, Tsutsui, another Japanese investigator, 
demonstrated a simpler method for biologic testing of carcinogenic 
material by merely painting tar on the back of the mice. This latter 
procedure finally developed into short-term application. 


A supposedly carcinogenic material is applied to the skin of the mice 
and the effects are determined in as short periods as4 to 5 days. Final- 
ly the isolation and identification of 1,2-benzanthracene, 1,2,5,6-diben- 
zanthracene, 3,4-benzpyrene, among others, in the coal tars as well as 
soot, et cetera, gave to this test a rather well-established place in the 
field of experimental carcinogenesis. 

Today we have two biologically accepted techniques for evaluating 
the carcinogenecity of any given material. These consist of short- and 
long-term cutaneous application of the compound under investigation, 
dissolved in a suitable solvent. In fact, one is the continuation of the 
other. A long-term experiment requires an average minimum of 6 
months latent period during which continuous close observation and 
fulfilling other necessary requirements are essential. 

The short-term experiment, on the other hand, is more suitable for 
screening, and provides sufficient information for the feasibility of 
more detailed studies, including long-term application. Due to the 
wide variety of compounds tested, and physical condition existing in 
our laboratory at that time, we based our biological evaluations prin- 
cipally on short-term application. Under close observation of prin- 
ciples of animal experimentation in general, and those of skin testing in 
particular (like age, sex, state of nutrition, state of health of the skin 
and its appendages) we have tested the following materials: Tars of 
the cigarette paper and ammonium sulfamate-treated paper, tars from 
cigarettes made of treated paper, treated tobacco, untreated paper, 
treated tobacco, and untreated paper, treated tobacco and untreated 
paper, untreated tobacco. The dosage applied to each animal was 1 
microgram per day as calculated on the basis of 3,4-benzpyrene as 
estimated spectroscopically. This amount corresponds to the tar 
obtained from 10 cigarettes. In the case of ammonium sulfamate 
treated components, tars derived from equivalent number of cigar- 
ettes—10--—were used to obtain a picture comparable to that of un- 
treated cigarettes. 

The results obtained were compared with those induced by known 
potent carcinogens like methycholanthrene and dibenzanthracene, and 
with those caused by chemically pure 3,4-benzpyrene. 

I would like for you to refer to figure 1, which shows a very sketchy 
picture of the skin of anormal mouse. Here you will see that the mouse 
skin is made up of two parts as in human beings, the dermis and the 
epidermis. The dermis is followed by the fat layer. 

There is shown here a large gland known as the sebaceous gland. In- 
stead of reading from the statement I would like to show you the 
ektachron photomicrographs. 



Figure 1.—Schematie drawing of the microscopic structure of the skin of 
normal mouse. 


Figure 2.—Microseopie picture of the normal skin. Large sebaceous glands, 
hair follicles are easily Seen. There is no thickening of epidermis. No infil- 
tration in any layers of the skin. 

Figure 3.—Microscopical changes taking place following application of 20- 
methylcolanthrene. Hyperkeratinization, thickening of epidermis, infiltration, 
and loss of sebaceous glands are characteristic. 


Figure 4.—Microscopical changes inducted by 3.4-benzpyrene (1.10—*° concentra- 
tion). Thickening, edema, infiltration of all layers with obliteration of glands 
represent principal changes. 


Figure 5.—Effect of 1,2,5 6-dibenzanthracene. In addition to the above note the 
necrotization and formation of keratin pearls. 


Higurer¢s—Tar of untreated cigarette paper. Thickening of the epidermis, 
massive infiltration, complete loss of sebaceous glands and hair follicles, oblit- 
eration of subcutaneous fatty layer. The dose applied corresponds to 1 micro- 

gram of 3,4-benzpyrene. 

Figure 7.—Tar of treated paper. Hairfollicles, sebaceous glands, and epi- 
dermis are intact. There is no visible infiltration of the dermis or subcu- 
‘taneous fatty layer. This picture is only comparable with figure 2 which 

represents the normal skin. 


Dr. Burnan. A quick look at the schematic drawing of the skin 
of a normal mouse reveals its very simplicity of structure. It will 
be easily seen that the top layer of the skin is made of a single- or 
double-row epithelial cells which extends into the second layer to 
merge with the cells of the hair roots. It will also be seen that the 
other layers of the skin are only sparingly provided with cells. One 
other important point to notice is the attachment of a glandular ap- 
paratus to each hair root or follicle, called the sebaceous gland. This 
orientation will help us in following the phenomena taking place upon 
local application of known cancer-producing agents as well as cig- 
arette smoke condensates. 

If we look at a histological section of the skin which has been sub- 
jected to paintings with 1—10° (1 to 1 million) solution of any one 
of the 3 potent carcinogenic materials, 1. e., 20-methylcholanthrene, 
1,2,5,6-dibenzanthracene, and 3,4-benzpyrene, we will be able to see the 
profound changes that took place in as short a time as 4 days. These 
changes are from top to bottom, hyperkeratinization, thickening and 
differentiation of epidermis, infiltration of all layers, swelling, disap- 
pearance of hair follicles and sebaceous glands, and finally new blood 
vessel formation. These are changes which are reproducible, and rec- 
ognized by every investigator; and have found their way into text- 

The skin changes induced by the comparable quantities of untreated 
tar are even more pronounced than those brought about by chemically 
pure agents. These are undoubtedly due to some other irritants 
present in the tar. 

The skin changes caused by the tars of treated materials, which are 
lesser in quantity, lower in viscosity, and lacking the normal pungent 
odor, are minimal. Lack of hyperplasia of the epidermis, absence of 
swelling and hyperkeratinization, and the intactness of the hair folli- 
cles as well as the glands characterizes the picture. From a purely 
morphological standpoint, the skin sections of animals subjected to 
paintings of tars from treated and untreated materials in placing the 
effect of the untreated tars with the carcinogens, and the effect of 
treated tars with normals. 

I would like to make this point very clear that my claim on haz- 
ardous effect of crude or untreated tar is not based exclusively on 
these morphological changes. However, here we have a tar which 
causes such profound morphological changes, and upon chemical 
analysis it proves that it contains a known amount of 3,4-benzpyrene. 
Inhibition of its formation, on the other hand, characterizes itself 
biologically, almost inert. In such a case, I believe, one could inter- 
pret these morphological changes in the light of its chemical compo- 

Although other studies, particularly those of acute and chronic tox- 
icity of tars, indicate the advantages of ammonium sulfamate treat- 
ment of paper and tobacco, we would like to stop at this point and 
recapitulate our findings based on animal subjects. 

Pyrolysis of cellulosic materials gave rise to some polycyclic hydro- 
carbons which present the physical and chemical characteristics of 
3,4-benzpyrene. The biological reaction to this material is identical 
with that of other known cancer-producing agents. The irritating 
power of this tar is obviously more pronounced than the pure chemi- 


cals. It is more toxic for animals in acute and chronic forms; and 
finally more tar is produced from the same weight of initial substance. 
The addition of ammonium sulfamate in the form of pretreatment of 
both tobacco and paper reduces the amount of tars produced; these are 
not toxic. The minimal toxic dose of tar from treated material is at 
least 10 times larger than for tars from untreated material. The 
physical and chemical characteristics of a known carcinogen like 3,4- 
benzpyrene is reduced from more than 90 percent in treated speci- 
mens; and there is almost no reaction in the skin, inflammatory or 
precancerous, whichever term is more attractive to the individual 

As a doctor with 17 years’ experience in both applied and experi- 
mental medicine, I wish to make this statement. The investigation 
shows that tobacco smoke contains an agent which has the same 
physiological activity as known carcinogenic materials, and that this 
agent can be largely, if not completely, eliminated by an additive 
which alters the combustion to prevent the formation of 3,4-benzpy- 
rene and similar condensed ring compounds. I believe that the mor- 
phological evidence which I have presented here should convincingly 
demonstrate the desirability of treating cigarettes by some means 
to reduce the irritation and also the potential carcinogenic properties 
of cigarette smoke. 

Mr. Buarnirg. Are these pictures, Dr. Burhan, hand drawn, or are 
they actual photographs ? 

Dr. Buruan. Yes, sir; they are photomicrographs taken directly 
from the microscope on Ektachrome films. 

ms Buatnik. Mr. Rand, would you proceed with your statement, 
please ? 

Mr. Ranp. Your committee has been hearing much about nicotine 
and tar and the need of eliminating them from tobacco smoke. 
Nicotine and tar are condensed smoke. To get tobacco smoke is the 
purpose of smoking. Therefore, to remove the nicotine and tar would 
be the same as removing alcohol from whisky or taking the substance 
out of milk. 

The job of Rand Development Corp. was to determine if there 
were any harmful chemicals in the smoke and, if so, to determine 
how they could be removed without changing the quality of the 
smoke in other respects. As one of our attorneys expressed it, “You 
want to do the same thing for tobacco smoke that pasteurization 
accomplished for milk. You want to remove the chemicals that ap- 
pear to open the door for cancer much as a cut on your foot might 
open the door for bacteria.” 

You have heard my associates in Rand Development Corp. tell 
you how we isolated the harmful chemicals and, when we knew what 
they were, how we added a neutralizer to prevent their formation. 
You have seen the results of comparative tests before and after. 

We had that solution in 1954. However, the attack on smoking 
seemed to run everybody into the ground. One gained the impression 
that we were attacking the tobacco industry instead of seeking to 
help it. Therefore, although our findings were substantiated here by 
other research people who went to the trouble to make the same tests, 
we could get no recognition from the industry. As a result, we ulti- 
mately went to England and France to obtain acceptance accompanied 
by action. 


I wish to make it clear to this committee what we and others found 
as a result of our experiments with mice is not conclusive evidence 
that we are right. We cannot, as Walter Reed did, use human beings 
as guinea pigs, even if the industry were to support such a project. 
Unless Dr. Little and some of the others want to be guinea pigs. 

However, if our neutralizer had been put on trial in 1954, the results 
would have shown us right or wrong in a matter of a year or two by 
the statistical methods employed by the American Cancer Society. 
In research, it is just as important to show wrong as it 1s to show right. 
The sooner we make the trial the more quickly we will know. 

We do not see anything wrong with smoking, and that goes for the 
tobacco industry, which includes the tobacco farmer. As a matter of 
fact, it is our belief, although we have made no tests in that direction, 
that smoking is beneficial. 

I might recall to some of the medical people who testified that the 
Public Health Service, Dr. Hueper, exposed animals to smoke and 
found that the respiratory-infection rate went down by about 50 

I say that to emphasize that we have not been showing sick mice with 
the intention of condemning smoking and we do not think that the 
others have shown them for that purpose. We merely desire to draw 
your attention to the only apparent cause—the less than 1 percent of 
harmful cigarette tar as testified by Dr. Wynder, as to which correction 

action can be taken. 

Mr. Buatnrx. Mr. Rand, in a new scientific development such as 
this, what is the usual procedure to verify, by having other independ- 
ent researchers in the same field, using the same techniques, using 
other techniques to check on that—in other words, to verify or to 
bring to light if there may be any of your own bias in your own 
research ? 

Dr. Burnan. We follow routine procedure in any scientific work. 
We leave out the bias. You repeat again and again until you reach 
a point where you have developed a firm opinion and then you expose 
your results to anyone who is desirous to do them. At that stage we 
put our cards down and say, “Here are our results and here is the 
material. If vou would like, we will send the material. If you want 
to see, we will send you the mice and you do it according to your 

Mr. Rann. We actually sent the boys to Paris to put on a demon- 
stration for the French Government and they went right down the 
thing and they said we were conservative in our findings. 

Mr. Brarnix. They carried out research and came to the same 
conclusion ? 

Mr. Ranp. Yes. 

Mr. Biarnrk. You say, though, your findings were substantiated 
here by other research people who made the same tests—does that mean 
you have had others in the United States? 

Mr. Ranp. There was a chemist sent to see us by one firm. Sir 
Ernest Kent, who first found 3,4-benzpyrene in coal tar and soot, put 
his boys to work on it and they confirmed the presence of it. 

Mr. Brarnitx. Did you attempt to get: the Tobacco Industry Re- 
search Committee interested in checking on the validity of vour 


Mr. Ranp. Yes, sir; I suggested they duplicate our work but all 
they did was to criticize it. 

Mr. Biarnix. To your knowledge, have they made any 

Mr. Ranp. Not tomy knowledge. These are facts. It 1s like count- 
ing pennies. There are so many pennies there and if you can count 
them you will always come out with the same number. 

Mr. Buarnrgx. Did you call this to the attention of Dr. Wynder, of 
the Sloane Kettering Institute? 

Mr. Ranp. Oh, yes. 

Mr. Buarnrx. What was his reaction ? 

Mr. Ranp. He is doing some work along the same line now. 

Mr. Buaxntk. He is interested in checking? 

Mr. Ranp. Yes; he is checking the treatment. 

Mr. Buatrnrk. How did you happen to go to France to look for 
further verification ? 

Mr. Ranp. Because we couldn’t get any interest of the cigarette 
people at all in this country and I went to most of the big ones. They 
just didn’t want to discuss it and that was that. I went to Mr. Kent, 
for example, and asked him to smoke one of the cigarettes and try it. 
He said his doctor had taken him off smoking. 

We just couldn’t get anywhere and I felt that perhaps a government 
that controlled cigarettes would certainly be interested in these find- 
ings so I went to see the director of research in Paris and he financed 
the whole works through Government funds and picked out the best 
chemists and physiologist he could find, the codirector of the Institute 
of Radium, and they have confirmed our findings and now they are 
working on ‘making experimental cigarettes. It has a black ash instead 
of a light ash which isn’t desirable apparently in the cigarette industry 
and they want to be sure it doesn’t change the taste. | 

Mr. Buarntk. This research work carried on by the French, to what 
part does the French Government participate? 

Mr. Rann. They paid for it all. It says right at the bottom, “Under- 
written by the Society”; that is the French term, the Government 

The second man on the paper is the director of research of the Gov- 
ernment monopoly. 

Mr. Buarnix. This brief you give us is the report of the French 

Mr. Ranp. Yes. In this report they confirm our chemical findings 
completely. I asked them why they wouldn’t do some animal experi- 
ments and Dr. Latarjet said, “My goodness, why monkey with it, every- 
body knows 3,4-benzpyrene is carcinogenic for animals and probably 
with men.” They weren’t interested. They just wanted to do away 
with the 3,4-benzpyrene. 

Mr. Buarnitk. They felt it was serious enough to remove it? 

Mr. Ranp. And members of the National Cancer Institute visited 
our laboratories and they felt the same way, that this was a good piece 
of work. 

Mr. Buarnrx. We have another publication, a reprint from the 
British Journal of Cancer, 1956, volume 10, pages 498. (See appendix, 
exhibit, 22, p..710.) 

Mr. Ranp. The reason we published it over there is because we 
couldn’t get publication anyplace in this country. Asa matter of fact, 


our work was confirmed by Cooper and Lindsay in England before it 
was ever published in this country. I don’t know why we couldn’t get 
publication in this country but we were turned down by several of the 
major publications. 

Mr. Buatrnix. Was this called to the attention of the National 
Cancer Institute and Dr. Heller? 

Mr. Ranp. Yes; and he was very helpful to us. 

Mr. Buarnirx. Has he done any work on this? 

Mr. Ranp. They are doing some work, I believe, now. 

Mr. Buatnix. They are doing work at the present time ? 

Mr. Rann. Yes. 

Mr. Buatnix. This is very striking testimony. You identify the 
carcinogenic substance, you measure it, you get sufficient amounts out 
of cigarettes to produce cancer in animals. At that point it has been 
repeatedly stated that it is not conclusive 

Mr. Ranp. May I correct your statement. We haven’t produced 
cancer in animals from 10 cigarettes, but this is a short-term quick test. 
The long-term test—we use approximately the same dosage per day 
but continue it longer. Carcinoma of the skin can be produced in this 
way from cigarette smoke. Dr. Sigura at the Sloan-Kettering Insti- 
tute produced 60 percent cancer from just the paper tar alone. 

Mr. Buatnix. It has been repeatedly stated here by other medical 
witnesses that tests on animals would not be sufficient, or conclusive 
of the same results being obtained on human beings. What would be 
your thinking on that? 

Mr. Ranp. We have a toxicity test on animals and we don’t use 
humans. If you are worried about arsenic, lead poisoning, radiation 
or anything, you test on animals. If it kills the animals you don’t 
use it, This is the first time I have ever heard anybody challenge an 
animal as a toxic test material. There has been so much evidence, 
anyway, on human experience when faced with polycyclic compounds, 
of which 3,4-benzpyrene is typical, that I don’t think any sincere 
scientist would question the fact that 3,4-benzpyrene has carcinogenic 
effects on man as well as animals. As far as the site is concerned, 
when you inject carcinogenic agents into the blood stream they can 
cause cancer all over the body. In the lung or any other place. If 
you inject it under the skin you get it very often. If you put it into 
the spleen and the bone morrow and so on, you often get leukemia. 
A carcinogenic material really just opens the door for cancer, where 
it is supplied. 

Mr. Buarnix. Mr. Rand, may I get your opinion as well as those 
of the scientists with you. Is there any carcinogenic substance in 
tobacco smoke in sufficient quantities to be a very likely or possible 
source of—is it very likely to be cancer inducing? 

Mr. Ranp. We wouldn’t have continued this work as long as we 
have if we all didn’t believe it. 

Mr. Buarntk. Did you do any work in trying to remove it with 
selective filtration ? 

Mr. Ranp. Just by accident. When we heard we were coming 
down here we went through our notes on filters and Dr. Cardon has 
some very definite indication that one cigarette filter has a selective 
capacity for removing 3,4-benzpyrene. That is a very important lead 
because if that is true, you should be able to develop a filter that will 


remove it. Another lead is that treatment of tobacco influences the 
amount of 3,4-benzpyrene because one cigar will have 10 times as much 
3,4-benzpyrene as another. One big cigar company sent us a number 
of cigars and finally they had a cigar with no 3,4-benzpyrene. They 
didn’t tell us what they did with it, but they were able to do that. 

Dr. Buruan. The tar from the filter-tip cigarettes causes less skin 
changes in the mice as compared to those of nonfilter cigarettes. 

Mr. Mrapnmr. This is the first time anybody has said filters were any 

Mr. Rano. If you face the fact that smoke tar contains irritating 
substances and you cut down the amount of tar, then filter tips are 
of value and I think Dr. Wynder brought that out very clearly. 

Mr. Mraprer. Now, I want to understand whether that is what Mr. 
Burhan is saying. That is why I want to go into this a little bit. 

Are you saying that where some of the tar is taken out by a filter 
and that there is less tar produced at the end of a filter cigarette than 
the regular cigarette that has this characteristic of less irritation to 
the mouse skin ? 

Dr. BurHan. As was pointed out the amount of tars produced 
might change from brand to brand depending upon the composition. 
However, it is our experience, although not so extensive as the other 
aspect of the whole project, that the filter cuts down the amount of 
tar in conjunction with the lessening of 3,4-benzpyrene. 

Mr. Maver. Suppose the same amount of tar comes out of a filter 
cigarette as comes out of a regular cigarette. You claim still there 
would be less carcinogenic results. 

Dr. Buran. In some instances. We have made only a preliminary 
investigation. We do not have extensive experience in the filter cig- 
arettes as in the case of the nonfilters. 

Dr. Carpon. In the specific example I had in the paper, here, the 
filter cigarette, according to Reader’s Digest produced more tar than 
the regular cigarette of the same manufacture. It was Camel and 
age Camel produces less than Winston, according to Reader’s 


According to the two experiments we made, Winston produces less 
benzpyrene by about 25 percent. Now, whether that is a function of 
the filter type directly or a function of the tobacco that is in Winston 
we are not sure. It would take a lot more extensive work on filter 
types used with the same tobacco before we could say definitely that 
the filter type is doing the job. 

There is indication though that just the fact the two cigarettes give 
the same tar does not necessarily mean that they will give the same 
amount of benzpyrene and Dr. Burhan’s experiments show they won’t 
have the same biological effect, either. There might be a reduced 
biological effect even though you have the same amount of tar from 
two different cigarettes. 

Mr. Meaper. In other words, what you are saying now is it isn’t the 
tar but it is the benzpyrene. 

Dr. Carpon. Chemically, yes. There is benzpyrene or there isn’t. 
There is evidence that the biological activity, even, is related to the 
benzyprene content. 

Mr. Brarnik. Your geneticist though, Mr. Rand, as I understand 
it, is one to—the point is to go thoroughly into all the research work 


and conclusively find out what substances in the smoke are injurious 
and then eliminate them? 

Mr. Ranp. That is right. 

Mr. Buarnix. Along the lines suggested by Dr. Meader. Have 
a type of tobacco that gives a lower tar yield, and nicotine yield, and 
improve the filter to keep those substances below the threshold of 
being injurious. 

Mr. Ranp. I think we have just scratched the surface on this in- 
vestigation. I think that a tremendous amount can be accomplished 
in the entailing of a mixture of compounds like tobacco smoke. 

Mr. Mraprr. May I ask about this ammonium sulfamate, or what- 
ever that is. Do you find any other chemical compounds that have 
the same effect on reduction of the amount of benzpyrene? 

Mr. Ranp. Yes. They always seem to be related to ammonia re- 
leasing compounds. In other words, if you put ammonia in the cig- 
arette, normally as it is found in the tobacco, it just comes off and 
volatilizes in a few hours. So Dr. Cardon found this stable form of 
ammonia, Which is ammonia sulfamate which at the combustion tem- 
perature of the cigarette volatilizes, and releases ammonia which in- 
terferes with the formation of these compounds and prevents their 

We found a whole series of them that will do that. 

Mr. Mraprer. Does your cigarette taste a little bit like ammonia, 

Mr. Ranp. No. You see, ammonia is normally found in tobacco and 
that accounts for the fact that only one-fifth as much benzpyrene 
comes in tobacco as in the paper. 

We looked for something in the tobacco that prevented that cellu- 
lose from forming benzpyrene when it burned. We were much amazed 
to find that just the paper alone, the additional ammonia affected even 
the formation of the benzpyrene by the tobacco. 

I think it reduced it 60 percent by treating the paper alone. 

Mr. Mraper. Did you ever smoke one of these cigarettes treated 
that way? 

Mr. Ranp. Yes. 

Mr. Meaprer. What do they taste like? 

Mr. Ranp. We can’t see any difference, but the French Govern- 
ment said the other day they did find a small change in the taste. 
They didn’t indicate whether it was better or worse. I suppose it 1s 

Mr. Buarntk. Mr. Minshall. 

Mr. Minsuatu. I have no questions. 

Mr. Buatntx. We thank you very much. 

You people have made-a special effort and have given us very 
well-prepared testimony. We commend you for the effort—even 
though it is a profit enterprise, it is directed at something that con- 
cerns millions of people. 

We thank you very much for your cooperation and assistance. 

Our last witness for today is Mr. Max Greenhouse, certified public 
accountant and statistician, from Rochester, N. Y. 



Mr. Buarnix. Mr. Greenhouse, before you read your statement, 
would you give a brief summary of your background, and whom you 
represent 4 

Mr. Greennovuse. That is all in the report, but I can state it separate- 
ly at the outset, if you prefer. | 

~ Tama certified public accountant, and have been such since 1927, in 
practice in the city of Rochester. I have my own office, and I am here 
in the private capacity of a citizen representing no one, and paying my 
own expenses and I am simply appearing, as it were, pro bono publico. 

Mr. Buarnix. Lam sorry. I have just been notified that there is a 
rollcall vote on the floor of the House, at this moment, which requires 
our personal presence on the floor. I know you have a 7-page state- 
ment, Mr. Greenhouse. Could you summarize it or would you prefer 
to come back tomorrow morning ¢ 

Mr. Greennouse. I could leave the whole matter until tomorrow 

Mr. Biarnix. We have scheduled a full morning with the Federal 
Trade Commission. That is our problem. 

Mr. GreenuHouse. Well, I could read this whole paper in about 5 
minutes. It might be faster than my trying to give you an informal 
summary. I shall attempt to. My purpose here is to call your atten- 
tion to what I consider a misleading report by the American Cancer 
Society, which has tended to frighten millions of people. My quali- 
fication as an expert witness here in the field of statistical study of 
unaudited reports, and the American Cancer Society report is such a 

They have omitted a number of essential points that would make 
their study untenable scientifically and fail to stand up statistically. 

Unfortunately, it was in this form of an unaudited report that it was 
received by the American Medical Association last month in New 
York at its annual meeting, and the report shows, as I say at the bot- 
tom of page 2 of my report, gives every indication of having been made 
to order in the preparation of which its authors set out to find some- 
thing they wanted to find and came up with results. 

Mr. Mraper. Mr. Greenhouse, your statement seems to criticize the 
statistical validity of the study made by the American Cancer Society 
and that is the substance of your statement as I gather. 

Mr. GreenHouseE. I wanted to call your attention especially to shde 
26, this chart, where they indicate an incidence of 52 percent in coron- 
ary disease and 27 percent in cancer where the actual percentage 
should have been three-quarters of 1 percent and 1 percent, respec- 
tively, if those figures had been compared to the total in the study 
instead of to the total shown. | 

Mr. Meaper. Mr. Chairman, I believe the comments of Mr. Green- 
house’s statement on the statistical study by the American Cancer So- 
ciety would be just as useful to the committee if it was inserted in the 
record in full, and I rather doubt that I would be concerned with going 
into the mechanics of the statistical study in too much detail in connec- 
tion with the purpose of these hearings, other than to have him point 
out what he believes are defects in the method they have used. 


Mr. Greennouss. My object here is twofold. One is to have the 
committee not rely on this report with regard to your policies and No. 
2, to “unfrighten” the American people who have been scared witless 
by.a report that to any experienced observer is misleading. 

Mr. Mraper. Your statement has been available to the press and 
to what extent that has that second advantage you seek will remain 
to be seen. 

Mr. MinsHatu. What prompted your interest in this matter? 

Mr. Greennouse. My duties as a citizen to protect his fellow Ameri- 
cans—a hundred million of them, primarily. 

(The statement of Mr. Greenhouse is as follows:) 


My name is Max Greenhouse, I am a resident of the city of Rochester, N. Y., 
and my profession is that of a certified public accountant. 

I came to Washington to testify before the House Government Operations 
Subcommittee hearings on the subject of hazards of cigarette smoking and 
merits of filters ; my purpose in asking to be heard was the desire, in the capacity 
of a private citizen, to petition this Congress, as it were, in a cause of public 
good and welfare, the welfare of 100 million people comprising cigarette smokers 
and their families in the Nation. Millions were made anxiety-ridden by the 
American Cancer Society’s statistical report of June 4 last, a report which 
ties in smoking habits with dire consequences of cancer, heart disease, and other 
illnesses. The report, in my opinion, is unwarranted statistically and untenable 
Scientifically. Furthermore, the fear it may spread can lead to a sort of cancer 
and coronary phobia that may cause more suffering than the diseases them- 

I was a voluntary witness and paid my own expenses to come here; I do not 
smoke, represent no tobacco-industry client, and do not own tobacco securities. 

My qualification as a witness attacking the ACS report is a lifelong experi- 
ence in the verification of unaudited statistical reports of various types, an ex- 
perience acquired in my profession of certified public accountant. 

The ACS’s report, prepared by laymen, is an unaudited statistical report; its 
findings have not been checked as to accuracy, for example, of the state of 
health reported by subjects at beginning of study and of the diagnoses listed 
as cause of the 11,870 deaths reported. Nor is there an explanation given for 
the report’s failure to include consideration of the adequacy of medical treat- 
ment as a factor in shortening or prolonging life, nor for failure to consider 
possible contributory effects of such carcinogenic agents as soot, engine exhaust 
fumes, asphalt, rubber products, etc., to which people are constantly exposed, 
despite the fact that these agents outnumber by far any of the possible carcino- 
gens in tobacco products. The last consideration is probably the most serious; 
it raises the question of the reliability of the entire ACS report, because the 
smokers in the study outnumber the nonsmokers 146,063 to 32,392, or almost 
5 to 1. Any errors and omissions are weighted heavily against the smokers. 

Yet it was in its unaudited form that the report was read last month at the 
annual meeting of the AMA, to be followed, unfortunately, by nationwide pub- 
licity and seare headlines. It is in the same unaudited form that the report 
has been accorded recognition by the Public Health Service and the Surgeon 
General. Its consideration by the subcommittee with which it has been filed, 
I feel confident, will be free from that intimidating influence upon intelligence 
which the report seemingly has exercised elsewhere. 

The ACS report gives every indication of having been made ‘“‘to order”; one, 
in the preparation of which its authors set out to find something they wanted 
to find and came up with results. For example, the study upon which the report 
was based was limited, to begin with, to men between the ages of 50 to 70, a 
period in life during which resistance to all types of illness is apt to be at its low- 
est. It is during this age that cancer most often occurs. In this respect I quote 
from one of the current ACS’s handout circulars: 

“The chances for developing cancer increases rapidly as people grow older. 
Below the age of 20 fewer than 10 people in 100,000. develop cancer in a 
year -* > *.” pat } ; 


And as to lung cancer and age-relativity incidence, the following quote is 
taken from an article by Prof. Paul E. Steiner, department of pathology, Uni- 
versity of Chicago: . 

“In 1950, 18,3138 deaths were attributed to lung cancer in the United States 
among 1,452,454 from all causes in a population of nearly 160 million. * * * 
The risk (of lung cancer) can be expressed in another simple form. Of every 
100 babies born in this country, nearly 2 will ultimately develop lung cancer, 
mostly between 50 and 80 years of age.” (My italic; Paul E. Steiner, M. D.; 
Ktiological Problem in Human Lung Cancer, Cancer, vol. 9, 1956, p. 664.) 

It is because lung cancer has been frequently mentioned in “spectacular associ- 
ation” with cigarette smoking that one can find considerable solace in what Dr. 
Steiner says above; Dr. Steiner does not mention cigarette smoking as a hazard 
in the etiology of lung cancer in the entire article. 

The smokers of the Nation have a reason to be grateful to the Public Health 
Service for not following the ACS’s report in its attempt to associate heart dis- 
ease with cigarette smoking. Here is what the Service says about it, in part, 
in its statement of July 12, 1957: 

“* * * there is no convincing biological or clinical evidence to date to in- 
dicate that smoking per se is one of the causative factors in heart disease.” 

Another audit item about the ACS report calling for corrective comment is the 
label frequently given it as a “massive statistical study” or a “major report” 
about 187,783 men “who have been traced for an average of 44 months.” 

It would be more accurate, in my opinion, to call the report an “enrollment” 
or a “registration” instead of a “study” of 187,783 men, judging by descriptive of 
procedure contained in the report itself. Also, ‘‘the tracing” of the men is 
explained to mean that the voluntary workers, once a year, reported on each 
man enrolled as “alive,” “dead,” or “don’t know.” Then, also, apparently once a 
year, “a copy or abstract of the death certificate was obtained on each death 

The entire ACS report, in the final analysis, once the subjects had been en- 
rolled, was concerned only with deaths, a total of 11,870 “bodies,” or about 6 per- 
eent of the total enrolled. This number was further reduced to 2,665 in order 
to reflect, in “slide 26” of the report, ‘“Excess deaths among men with a history 
of regular cigarette smoking.’ The reduced number, 2,665, is less than 1% 
percent of total “enrollment” of 187,783 men; this number of men and small 
percentage is what the whole “study” finally boils down to, a study the publica- 
tion of which has frightened quite needlessly and it seems, almost wantonly 
millions of people. 

It is a study, finally, that with properly punched IBM cards might have been 
completed in a matter of hours; it may take much longer to offset the harm 
it has done. 

Slide 26, incidentally, to which I have just referred, may be called the give- 
away piece of the whole ACS report. An experienced observer can spot it a 
mile away. It gives away what must be obviously, the ugly purpose of the 
report, the use of what Dr. Crile, famous Cleveland surgeon, in his book, Cancer 
and Common Sense, calls the weapon of fear. The chart on the slide, as the 
committee can observe, is in 14-inch heavy black lines, with a heavily lined 
“mourner’s circle,” resembling a tombstone, off to the right side. The figures 
on the chart, with percentages, are used in such way as to blowup an infinitesimal 
minimum of fact into an exaggerated maximum of frightening fancy. 

The “minimum of fact,’ as pointed out above, is that only 2,655 is the grand 
total of excess deaths from all causes, over a 44-month period ,or about 700 
per year, equal to an annual mortality ratio of less than one-half of 1 percent of 
the total number of 187,000 men in the study. Yet the chart on the slide confronts 
us with “52.1 percent” for coronary disease and “27 percent” for cancer; it does 
it by using a “provocative” and meaningless comparison of fractional parts of 
a total to the whole total. It is as if one would report the death of 3 people, 
2 of them by cancer, 1 by coronary, by stating 66% percent died from cancer and 
3314 percent from coronary, respectively, though the size of the figures in them- 
selves are entirely insignificant. 

I have made a calculation in the column on left of the chart, using the mor- 
tality figures of the report epidemiologically, that is, by comparing them with 
the total men in the study. You will observe the new percentages thus shown— 
34 percent for “coronary artery disease” against “52.1 percent” on the slide, and 
1% percent for “lung and other cancer” against “27 percent”’—indicating varia- 
tions of over 5000 percent between the two columns. The percentages in left 


column, as indicated, have been arrived at epidemiologically; the basis used 
on the report, in right column may be described as ‘inspired hysteriology.” 

We should be thankful to the Public Health Service for ‘‘knocking out” the 
“52.1 percent coronary line” by its reassurance, quoted above, that there is ‘‘no 
convincing biological or clinical evidence to date’ for associating heart disease 
with cigarette smoking. 

And as to lung cancer, we have the statement by Dr. Steiner, internationally 
recognized cancer authority, in another part of the article previously referred 
to, that the lung cancer risk in the Nation is about 20,000 to 750 million or 1 to 
about 4,000, smokers or not. 

If it is fitting to close with a prayer, I would entreat the Lord to entrust our 
Nation’s future health to doctors, test tubes, and microscopes, not to statisticians, 
adding machines, and calculators. I would also pray that in any future study 
of human habits, whether it be concerned with smoking, eating, or drinking, 
that human emotions are not isolated from consideration as they have been in 
this ACS study. For it is generally accepted that human beings, unlike animals, 
have a psychic life; they do more than just eat, drink, sleep, and smoke cigarettes. 

For all I know, it may be advisable for the committee, and I so recommend, 
that it table further consideration about filters until there is definitely estab- 
lished, by credible evidence, that there are hazards in cigarette smoking. Your 
committee may be already convinced that as yet no such evidence exists. 

May I close by repeating that my entire purpose of appearing before the 
committee is to help unfrighten the American people, to permit them once 
more, and for the time being, to smoke in peace themselves, and quit worrying 
about their loved ones who smoke. 







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We will print your statement in full, and if there are more questions 

Mr. Buarnix. Mr. Greenhouse, we thank you. 
we will certainly get in touch with you. 

The hear- 

the subcommittee adjourned to reconvene 

at 10a. m., Friday, July 26, 1957.) 


The members are notified to be on the floor immediately. 

ings are adjourned until 10 o’clock tomorrow morning. 

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(Filter-Tip Cigarettes) 

FRIDAY, JULY 26, 1957 

Washington, D. C. 

The subcommittee met, pursuant to adjournment, at 10:10 a. m., in 
room 100, George Washington Inn, Hon. John A. Blatnik (chairman) 

Present: Representatives Blatnik, Hardy, Meader, and Minshall. 

Also present: Jerome S. Plapinger, subcommittee counsel; Curtis 
E. Johnson, staff director; and Elizabeth D. Heater, clerk. 

Mr. Buarnix. The Legal and Monetary Affairs Subcommittee will 
continue its public hearings on the regulation of false and misleading 
advertising by the Federa] Trade Commission with particular refer- 
ence to the filter cigarettes. 

This morning our first witness is Mr. Roy Norr, editor of the Norr 
Newsletter About Smoking and Health. 

Mr. Norr, will you please take the witness chair. 

Mr. Norr, will you give your full name, title, and occupation to 
identity yourself and your connection and interest in this particular 

Mr. Norr. I have a statement which I presume I can read in about 
10 minutes. May I read that? It contains that information. 

Mr. Buarnrx. You may proceed. 


Mr. Norr. My name is Roy Norr. For almost 30 years, as a writer 
and publicist, I have been a student of the medical aspects of smoking 
and health, the advertising practices of the cigarette industry, the 
relation of tobacco abuse to other drug addictions, and the regula- 
tory problems which the sale of tobacco products raised here and 
abroad. I have visited and met or have been in correspondence with 
nearly every leading authority on these subjects here, in England, 
France, and other countries. 

Five years ago, due to the circumstance that Reader’s Digest picked 
up and published under the title “Cancer by the Carton,” my study 
on the subject previously featured in the Christian Herald, the stark 
facts I presented crashed the smokebarrier and brought the problem 
for the first time to the attention of many millions of people. Cancer 
by the Carton was not only published in the American edition but in 



10 other countries by Reader’s Digest. A copy is appended here- 
with, should this article prove of interest to your committee. 

My presentation of the mounting evidence that associated relent- 
less cigarette smoking with atrocious lung cancer brought a flood 
of requests that I establish a regular service of information on the 
latest medical developments, so | founded the monthly Norr News- 
letter About Smoking and Health, now entering upon its fifth year 
of publication. I am its editor and publisher. 

Mr. Buarniz. At this point, Mr..Norr, not to interrupt but just 
to elaborate, may this be called a business enterprise, your Norr 
Newsletter? (See appendix, exhibit 25, p. 730.) Is this your means 
of livelihood ? 

Mr. Norr. It is not. It is owned by my wife and myself who are 
out of pocket about $60,000 in the enterprise and I propose to continue 
it in the effort to make it self-paying. It will never be profitable be- 
cause I continue to lower the publication rates. I started at $25. I 
reduced the rate to $15, it is now $10 and some day I hope to give it 
away if I can afford it. 

Mr. Buatrnrx. What is the circulation, Mr. Norr? 

Mr. Norr. I would rather not tell that, sir, for important reasons. 

In brief remarks I have to make on the issues before you, I shall 
confine myself to the most important conclusions that bear upon the 
problem of cigarette advertising. 

The cigarette industry today stands with the albatross of cancer 
hung firmly around its neck. And cancer is the most anguished of 
all ways of life—anguish that 1s mental and physical, progressive 
and protracted, as Dr. Charles S. Cameron, former medical director 
of the American Cancer Society puts it. “We believe it to be the 
greatest curse levied by nature on mankind, in terms of human suf- 
fering, sorrow and economic loss,” concludes the annual report of 
the Sloan-Kettering Institute for Cancer Research. 

I quote this in stating what has moved me in starting the work and 
continuing it. 

Some 100 constituents have so far been identified in tobacco smoke, 
and of these, 5 have proved to be cancer-causing substances in animal 
experiments. This from the latest report of the British Medical 
Research Council. Take it that confident scientists will be able to 
remove the deadly carcinogens from tobacco smoke, when or if all are 
discovered, what will be left of tobacco flavor? Cigarette makers are 
in the tobacco business, not in the business of cabbage leaves or brown 
paper for smoking purposes. In the self-pollution that is smoking, 
there is no substitute for abstinence. 

The greatest discovery of the century in cancer research is the in- 
controvertible relation of chronic smoking to deadly lung cancer. 
There could be no finer crusade than the tracking down through re- 
search of the evil spirit of cancer throug the immense darkness in 
which it still hes. But let us gaze unflinchingly at every promise of 
cure. Despite the immense work being done with nitrogen mustards, 
hormones, contisone, radio isotopes, there is still no cure for cancer— 
nothing but the surgical removal of malignant growths and/or their 
destruction by radiation. The light that beckons is prevention—the 
prevention of preventable cancer. 

And we know today beyond any reasonable doubt, except the 
doubts expressed by the hired researchers of the cigarette industry, that 


smoking 1s a casual factor in cancer of the lung and in other cancers 
of the respiratory tract, not to mention the high association of smok- 
ing with cancer of the liver, gall bladder and certain other sites. 
Whatever alleged controversy ‘still remains as among independent 
scientists 1s as “to which of a number of inhalants or pollutants are 
major or minor contributors to the type of epidermoid cancer now 
generally known as Smoker’s Cancer. The great Pasteur said: 

When meditating over a disease, I never think of finding a remedy for it, but 
a means of preventing it. 

My interest in the subject, gentlemen, is the fact that I think there is 
a means of preventing preventable cancer that has been largely ignored. 

Incredible as these revelations seemed at the time, every laboratory 
determination since my article Cancer by the Carton unlocked the 
medical findings made before 1952, every report that has been 
written on the subject, every charge made in Congress fully confirmed 
the facts I had given (see appendix, exhibit 26, p. 737). 

The most significant finding, from the standpoint of the smoking 
population is that even heavy smokers who give up smoking for health 
protection—not because of ill-health—reduce their risks substantially. 

“The cessation of smoking by chronic smokers,” the study group of 
authorities appointed by the Government health institutes, the Ameri- 
can Cancer Society, and the American Heart Association found, “de- 
creases the probability of such individuals developing lung cancer.” 

The greatest bar to cancer prevention—again, the prevention of 
preventable cancer—lis the false, meretricious and misleading advertis- 
ing of most of the Big Six of the tobacco industry—six companies that 
control : appr oximately 98 percent of the business. 

The industry has adopted the techniques of the oldest profession in 
the world. The strumpet cry of cigarette advertising today is: 
Pleasure for sale! “Big, big pleasure’, 1f you smoke ’em king size. 
I quote from the advertisements. The myth of “flavor” and “aroma” 
has been effectively exposed by Dr. Hugh Lennox-Johnston, the noted 
authority on cigarette addiction. Smokers smoke mainly, he says: 

to obtain a satisfying dose of nicotine, just as smokers of opium smoke to obtain 
a dose of morphine, or hashish smokers smoke to obtain a dose of cannabis 

The most deadly gadget which the cigarette makers use is what I 
have described in my article, The Gre ate Filter Tip Hoax, the first 
publication of the facts which I made almost 10 months ago—in the 
September 1956 issue of the Christian Herald—and which was repub- 
lished in full in the Congressional Record of January 17, 1957 on the 
instance of Senator Neuberger, of Oregon. I submit a copy for the 
record of these hearings. (See appendix, exhibit 27, p. 740.) 

Five years ago Pope “Pius XII told a Eur opean tobacco group hold- 
ing a congress in Rome that a duty of conscience bound all those in- 
volved in the tobacco enterprise to reduce to a minimum the toxic 
and other harmful qualities of their products. But deliberately, 
studiedly and with the purpose, I charge, of binding scared addicts to 
their addiction, the leading American cigarette companies have set 
about to hold the carrot of “health protection” before the scared 
smokers of the Nation with filter tip cigarettes, while actually adding 
to the hazards of smoking by degrading filtration to the least possible 
effectiveness to the point where plain cigarettes often carry less 


nicotine and tars than filter tips—in fact, so patently ineffective that 
“vou don’t know the filter’s there,” to quote one of their slogans. The 
cigarette hucksters well know that it’s harder to wean a drunkard from 
100 proof whisky than from 3 percent beer, a dope addict from heroin 
than from marihuana. 

“Qne reason why Americans are smoking again more or less fear- 
lessly is that they see safety in filters”, says Time magazine. 

The greatest victims of the campaigns of tobacco-narcotic addic- 
tion are the youth of our Nation. I present copies of current advertis- 
ing where high school boys or younger are pictured as welcoming a 
new filter-tip brand, where male escorts light up cigarettes for early 
teen-age girls. 

I am in position to state to your committee that, when an investiga- 
tion of smoking in our schools is completed, the fathers and mothers of 
the Nation will find the most shocking proof of the success of the 
cigarette pushers. The sample is yet too small to be “statistically sig- 
nificant,” as statisticians say. 

But, if the vast number of cigarette addicts in the 10- and 12-year 
age groups among our school population should appear unbelievable, 
look now at what investigations among schoolchildren have disclosed 
abroad, where the economic position makes cigarettes harder to come 
by for children and adolescents. 

The Swedish Government has entered upon an extensive educational 
campaign since a survey of 5,000 schoolchildren in Stockholm showed 
an alarming spread of the habit. The Swedish tobacco monopoly has 
ceased all advertising, foreign companies have followed suit, and sub- 
stantial sums have been given by the tobacconists to aid educators in 
their work of protecting youth from the menace of death and disease 
from cigarette addiction. 

In Holland, following the report of a medical committee, the Gov- 
ernment has appointed an educational committee to cope with the 
problem. In England, health officers are finding that some children 
begin smoking as early as 7 years of age—I am referring to medical 
reports of their investigation—and that there are many inveterate 
smokers in the 13 to 14 year age-group. In Australia, the state govern- 
ment has inaugurated a poster campaign proclaiming: “If you smoke, 
cut down; if you haven’t taken it up yet, don’t.” 

The apparent accomplices of the evil cigarette campaigns are cer- 
tain leaders in the American television networks. I refrain from men- 
tioning names, because they may be unwilling accomplices; the cig- 
arette industry, with its huge advertising disbursements, may have 
them by the throat. On this issue, the three men who control the peo- 
ple’s air are usually found well hidden behind the baggy trousers of 
their innumerable vice presidents. 

The printed press advertising is relatively cold and lifeless puffery ; 
besides, the great newspapers of the Nation have broken their former 
silence. What the public knows of the menace of intemperate smok- 
ing it has learned from the press. Newspaper commentators do not 
end their columns with a fervent appeal that you smoke their brand 
of cigarettes, use their underarm deodorants, or take their favorite 

But look at the television screen. The people’s air has been handed 
over to the cigarette huckster. His weapon is the tainted testimonial. 
His targets are children and adolescents. 


The glamor girls who just love that cigarette, the smirking an- 
nouncers who blow clouds of “fragrant” smoke into the home, the 
baseball heroes who now train on “ciggies, not wheaties,” are not di- 
recting their fire at grandpa and grandma. They’re shooting at 
children and youth. They are even training lisping babies to repeat 
their singing commercials. And you can’t shut off a child as you can 
your television set. 

As I have indicated in various articles, no advertising hoax in the 
unwholesome puffery of cigarette advertising is so laden with evil 
promise to the health of the Nation as the present filter-tip fake. 
Here are some of the claims made for filter-tip advertising on the air 
during the past 2 years: 

High filtration to help you keep your smoking moderate. 

Effective filtration. 

Real filtration. 

Self-filtering action. ; 

Note that these claims followed on previous air commercials such as 

No other filter tip takes out so much nicotine and tar. 

For the greatest health protection in cigarette history. 

ge out so much harmful smoke that it also filters out the worry in every 
Dp 6 

I would like to interject something here: This is the cleverest cam- 
paign that has ever been conceived in the cigarette industry. The 
idea was, first, to run the series of ads that would make definite claims 
for the health protection through filtration, then, gradually, say 
nothing about health protection. In other words, the technique that 
the Russian, Pavlov, used with his dogs. 

He would ring a bell at feeding time and give them meat. Finally, 
he removed the meat and just rang the bell, and the dogs would rush 
in, salivating for the expected food. 

Mr. Buatnix. That is called the conditioned response; is that right ? 

Mr. Norr. Conditioned reflex. 

Thus, the smoker was brainwashed for the advertising that fol- 

The value which the cigarette industry puts upon its domination 
of the air could be not better stated than it was. by one of the Big 
Six presidents a few years ago: 

Here is a medium— 
he said about TV— 

that gets inside people as no other form of communication has done before. 
You hear it, you see it—you almost taste it. 

I am quoting from an address he made before a tobacco convention 
in Chicago. 

He added: 

The public gives us its faith that whatever words and pictures we send 
into their living rooms will be beneficial as well as entertaining, dependable as 
well as amusing. And it is our solemn obligation to keep faith with that trust. 

Suffice it to say he is no longer president, or even associated with the 
tobacco business. 

Never before in the history of broadcasting has such revolting 
hucksterism as the present cigarette advertising been allowed on 


the TV screen, and I have a had a good deal of experience in the in- 
dustry. I have been an adviser to television interests since the forma- 
tion of the first television network. 

But network leaders continue to accept medals, awards, citations for 
the public service with the greatest of ease. One, who deserves, per- 
haps, his honors more than most, has received nearly every award 
except mother of the year. 

Yet in huckstering a product that carries disease and death in its 
wake, cigarette advertisers who bestride the TV screen with the bless- 
ing of our radio bosses utter no caution, sound no warning, give no 
indication of the perils of tobacco abuse in relation to cancer or sudden 
death from coronary disease. 

The liquor industry, at least, has spent millions of dollars in saying, 
“Don’t take one drink too many.” 

We are a nation of sneezers, snifflers, coughers, spitters—and the 
greatest consumers of tobacco products in the world. Smoker’s cough 
has become the cough of the Nation. Time does not permit an exten- 
sive rundown of other health emergencies which medical research has 
exposed with regard to tobacco abuse. 

How many thousands have been crushed into a pulp due to sudden 
failure of sight suffered by a hard-smoking driver due to nicotine 
amblyopia causing a sudden spasm of the blood vessels of the eye? 
How many mysterious air disasters have occurred because the pilot’s 
vision and depth perception have been affected by smoking? It is only 
recently that aviation doctors have taken steps to warn pilots of the 
danger. Medical literature is full of papers on that subject. 

Tobacco apologists have cried out that the industry is the victim 
of a propaganda campaign engineered by medical headline seekers. 
If so, the headline seekers include the medical advisers who told Presi- 
dent Eisenhower, when they noted a marked pulse irregularity when 
he was president of Columbia University, that he ought to stop smok- 
ing. The President, then a cigarette chain smoker, quit on the instant, 
and many physicians believe that his fortunate recovery from an attack 
of coronary thrombosis was due to his self-discipline. 

Franklin D. Roosevelt’s physicians warned him to cut down on ciga- 
rettes and he tried bravely to do so before he died from a massive eel 
hemorrhage. He wrote ailing Harry Hopkins that he found it could 
be done. President McKinley, seriously wounded by an assassin, might 
have survived, according to his friend, Luther Burbank, the famous 
naturalist, if his strength had not been vitiated by heavy smoking. 

In my view, the following steps are essential with regard to the con- 
trol of cigarette advertising, if we are to do our duty to youth of the 
Nation. I am concerned about addicts created by the cigarette in- 
dustry. Medical history is full of cases where men have lost a leg or 
an arm due to Berger’s disease, but yet insisted upon smoking. 

In my view, the following steps are essential with regard to the con- 
igo} a4 cigarette advertising, if we are to do our duty to youth of the 

ation : 

_ 1. Action by Congress to declare tobacco a drug, which it inescapably 

It disappeared from the United States Pharmacoepia under mys- 
terious circumstances after the adoption of the Pure Food and Drug 

Act, with a note to the effect that it was no longer used in the treatment 
of humans, but that 1t was a very satisfactory bedbug poison. 


To the extent that an extract of tobacco leaves is still used in veteri- 
nary practice, it is under the discipline of the Pure Food Act, I believe. 

Thus, a hog would be protected by law from irresponsibility made 
tobacco preparations, but a human can be exploited without let or 
hindrance by the tobacco huckster. 

2. A demand by Congress that broadcasters in the public interest 
outlaw completely testimonial cigarette advertising. 

A bought-and-paid-for testimonial is inherently a lying testimonial. 

More than 20 years ago the American Association of Advertising 
Agencies issued a statement of principles declaring : 

We believe that making a practice of paying for testimonials is an unfortunate 
development in advertising. 

About the same time the Association of National Advertisers 
adopted a resolution expressing disapproval of insincere testimonials, 
i. er atuitous or paid for.” 

3. A labeling act, as already suggested in testimony before your 
committee, in which the claims for filter- -tip cigarettes with reference 
to the removal of nicotine and tars from the mainstream smoke could 
be clearly stated. 

If filters should prove some protection to the smoker, such an act 
might reverse the present trend to see which cigarette maker could 
produce not the best but the worst possible filter. 

4. A congressional mandate to the Federal Communications Com- 
mission to wake up and use its inherent powers to determine that ad- 
vertisers and broadcasters use the people’s air in the service of public 
interest, convenience, and necessity. 

The “scientific doubt” with regard to smoking and health, that the 
cigarette industry can keep alive forever through its hired scientists, 
poses this question: “Shall poison or people, smoking or smokers, 
money or men, be given the benefit of their ‘doubt??” There can only 
be one answer. 

Mr. Buarnrx. Thank you, Mr. Norr. Your statement is quite self- 
explanatory. Even your recommendations, which I was going to ask 
for, are listed very clearly. Your statement will be given most serious 
consideration by the committee. 

Are there any questions on my right? On my left? There are no 
further questions. Thank you, Mr. Norr. 

Our next witness, which will conclude our hearings on this first 
series, is the Acting ‘Chairman of the Federal Trade Commission, the 
Honorable Robert T. Secrest. 

Mr. Commissioner, will you please take the chair? 


Mr. Secrest. Thank you. : 

Mr. Birarnix. Mr. Commissioner, as a former highly eed 
colleague on both sides of the aisle and close personal friend of prac- 
tically all of us who knew you during your outstanding service in the 
House, we welcome you back to Congress. Itisa pleasure to get your 
thinking and your recommendations. 

I notice that you have a well-prepared statement here. How long 
have you been with the Commission? As I recall it is 2 or 3 years. 


Mr. Secrest. It will be 3 years this coming September. 

Mr. Buarnix. We welcome and appreciate your assistance and the 
conferences we have had with your staff assistants during these many 
past weeks. 

Mr. Harpy. Mr. Chairman, I would like to add a word of welcome, 
too, and make an obser vation that our former colleague seems to be 
living higher on the hog than he used to when he was up here. 

Mr. Secrest. Heavier. 

John Gwynne, our chairman, would be here today except for the 
fact that he is out of town. He served for 14 years as a member of 
the Judiciary Committee and I believe him to be one of the greatest 
men I have ever known in my life. I am pinch-hitting for him. 

The Commission has not met on this particular statement I am 
giving but it has been given careful consideration by our staff and 
by myself, We have worked on it diligently for at least 2 weeks, 
since we knew we were going to testify. 

If permissible, I would like to read it and then I will be glad to 
answer any questions I can to the best of my ability. 

Mr. Buatrntx. Please proceed. 

Mr. Secrest. I appreciate this opportunity to discuss with the Com- 
mittee the Commission’s administration of the laws regulating cig- 
arette advertising. 

At the outset I would like to point out that, whenever necessary in 
our consideration of matters in this field, we have consulted with 
and received the full cooperation of the Department of Justice and the 
National Health Agencies, including the National Institutes of Health 
and the Office of the Surgeon General. We have also been in touch 
with other scientific groups interested in the health aspects of the 

The Commission’s authority over cigarette advertising is governed 
by amended section 5 of the FTC Act, which declares unfair methods 
of competition and unfair or deceptive acts or practices in commerce 
to be unlawful. Under this act the Commission has authority to issue 
orders to cease and desist from specific practices it finds to violate 
section 5. Such orders become final after 60 days unless they are 
appealed, in which case the order is stayed until 30 days after its 
affirmation by the highest court to which appeal is taken. 

The cigarette industry, as you know, is a substantial one. Its retail 
sales are about $5 billion a year. It is also 1 of our biggest national 
advertisers, spending about $85 million annually. This advertising 
has been characterized by frequent changes in claims and themes. In 
addition, it has been reported that blends and filters of cigarettes have 
been changed rapidly, Also, new filter-tip brands have been con- 
stantly introduced. 

The Commission has proceeded in a substantial number of cases 
involving health claims for cigarettes. These include 7 formal com- 
plaint cases, beginning in 1934 and culminating in 4 final orders, with 
1 complaint still being tried. Each of these formal cases presented 
unusually difficult problems of investigation and trial and required 
a prolonged effort to obtain a final order. 

Typical of the direct and indirect representations concerning 
health in these formal matters were these: 


That the smoking of “X cigarettes” encourages the flow of digestive 
fluids or increases the alkalinity of the digestive tract, or that it aids 
digestion in any respect (D. 4795). 

That the smoking of X cigarettes relieves fatigue, or that it creates, 
restores, renews, gives, or releases bodily energy (D. 4795). 

That X cigarettes or the smoke therefrom will not harm or irritate 
the neha or will provide any defense against throat irritation (D. 

That X cigarettes or the smoke therefrom contain Jess nicotine, or 
less tars and resins, than the cigarettes or the smoke therefrom of any 
of the six other leading selling brands of cigarettes (D.4922). 

That X cigarettes will save * * * the nose, throat or mouth; con- 
tain no irritating properties; will not irritate delicate throat tissues 
(D. 4981). 

That X cigarettes are endosed or approved by the medical profes- 
sion (D. 4981). 

That X’s method of processing the tobacco—eliminated harsh irri- 
tants, and that its cigarettes contain no harsh irritants (D. 4981). 

In addition to its formal cases, the Commission settled 17 other 
cases by accepting stipulations from the cigarette companies to stop 
objectionable advertising. Through requiring less time than formal 
cases, the stipulations required protracted effort. 

Some of the typical health claims stopped by these stipulations 

Play safe or be on guard by smoking X cigarettes that said cig- 
arettes give extra protection (stipulation No. 3486). 

That X cigarettes may be smoked to the full extent of anyone’s 
desire without irritation or ill effects (stipulation No. 8021). 

That X cigarettes are safer for the throat, safer for the lungs, bet- 
ter for health (stipulation No. 8021). 

Because of the time required before the false claims involved in these 
24 cases could be stopped, the Commission sought to employ in injunc- 
tive power in a later case. This was in 1952 when it asked the United 
States district court under section 13 (a) of its amended act for an 
injunction to stop, among others, the claim, ‘Nose, throat, and acces- 
sory organs not adversely affected by smoking X cigarettes,” pend- 
ing the issuance of its complaint and its final adjudication. The Com- 
mission argued that cigarettes were a drug, under section 15 (c) of 
its amended act, which applies to food, drugs, devices, and cosmetics 
only. The district court, however, held that cigarettes were not a 
drug within the meaning of the statute or within the intent of Con- 
gress in enacting the amendment (108 Fed. Supp. 573). This hold- 
ing was affirmed on appeal by the Second Circuit Court of Appeals 
(203 Fed. (2d) 956). 

The Commission’s experience clearly indicated that prompt policing 
of cigarette advertising presented unusual difficulties—which were 
all the more serious because of the newly raised serious health ques- 

The Commission’s difficulties included the facts that: 

(a) Ithad no facilities to test cigarettes ; 

(6) Its burden of proof almost invariably required unassailable 
current, test data not only on the advertised brand but on all other 


brands with which the advertised brand was directly or indirectly com- 
pared ; 

(c) There were no uniform procedures for testing the smoke con- 
tent of cigarettes, and the Commission has no authority to establish 
such standards. As a result its test data were almost invariably the 
subject of vigorous, prolonged, and sometimes successful attack in 
formal cases ; 

(d) The blends of tobaccos in cigarettes or the composition of the 
filter used, or both, could be and were frequently changed. In addi- 
tion, new brands were constantly being put on the market. Claims for 
them changed frequently. All of these factors increased the Com- 
mission’s difficulty in obtaining adequate test data; and 

(e) Its burden of proving that claims were false—and you must 
remember, we must prove it—first by competent evidence of their 
meaning and second by competent scientific proof in light of that estab- 
lished understanding, was greatly complicated by some or all of the 
foregoing factors. 

To prevent deceptive cigarette advertising wherever possible and 
to obtain its prompt discontinuance—while scientific research resolved 
the newly raised question of serious health hazards—prompted the 
Commission to undertake an industrywide, unprecedented approach 
to the problem. 

On September 14, 1954, the Commission directed its Bureau of Con- 
sultation to confer with the producers of cigarettes for the purpose of 
adopting standards for their advertising. Adherence to these stand- 
ards would, the Commission believed, prevent deceptive claims. The 
Bureau of Consultation promptly sent a letter to each cigarette manu- 
facturer and enclosed a suggested set of standards for consideration 
and comments. This wasin 1954. That letter stated in part: 

Recent scientific developments with regard to the effects of cigarette smoking 
have increased the Commission’s interest in advertising claims made for such 
products and have increased its responsibility under the law to prevent the use 
of false or misleading claims. 

In our opinion, the scientific development referred to above have likewise in- 
creased the responsibility of the industry to eliminate voluntarily from its ad- 
vertising all claims and implications which are questionable in light of present 
day scientific knowledge. 

Full details were given the press and wide publicity followed. 

Then ensuing conferences were chairmaned by a representative 
of the Commission’s Bureau of Consultation. Each was attended by 
representatives of cigarette produces, a representative of the legal staff 
of the Commission’s Bureau of Investigation, and also by a representa- 
tive of that Bureau’s Division of Scientific Opinions. 

The industry was advised to bring its advertising into conformance 
with the law (expressed in the original and subsequent revisions of 
the suggested standards) while the conferences were in progress. 
During this period the discontinuance of most of the questionable ad- 
vertising was obtained through correspondence or personal contact 
with individual companies. 

The conferences culminated in the Commission’s. adoption, on Sep- 
tember 15, 1955, of Cigarette Advertising Guides for the use of its staff 
in evaluating cigarette advertising. A copy of the guides was sent 
to each cigarette producer, together with a request that he conform 
his advertising practices to the guides voluntarity. Facilities of the 


Commission’s Bureau of Consultation to aid them were offered. The 
whole procedure was fully publicized. 

The guides are consistent with Commission law and decisions. 
They were drafted after detailed consideration by representatives of 
all of the Commission’s staffs concerned with the problem. They were 
approved by the Commission’s General Counsel and were thought- 
fully considered by the Commission prior to their adoption. 

Prior to the adoption of the guides, typical cigarette filter claims 
involved health and extravagant comparisons with competing filters. 
Typical were these: 

Maximum filtration. 

Effective filtration. 

Superior filtering efficiency. 

Much less nicotine—the filter removes one-third of the smoke, 
leaves you all of the satisfaction. 

Filters out what you don’t want in 

Gain the real assurance you can only get with the greater protec- 
tion of—’s filter 

Just what the doctor ordered. 

No other cigarette approaches such a degree of health protection. 

And at the same time you'll be enjoying the greatest health protec- 
tion in ¢ garette history. 

Inhale to your heart’s content. 

Guarantees cleaner, milder, safer smoking. 

These were standard advertising practices by cigarette companies 
prior to the issuance of these guides. 

Mr. Buatnik. Just at that point, Commissioner, not to interrupt 
you, did you discuss these individual claims? In short, did the to- 
bacco representatives using these various claims, such as “a maximum 
filtration,” “effective,” and so forth on down the line, did they pro- 
duce any testimony or evidence to substantiate those statements ? 

Mr. Srcresr. They attempted in some cases—and the Commission 
was guided by what tests they had from outside sources and by the 
guides. And a reading of the guides—I will be glad to discuss them 
a little later—will show why these things were taken out. 

Mr. Buatnix. I would like to mention, Mr. Commissioner, what 
puzzles me, and I say this with all candor. The industry will spend 
millions of dollars with such statements, but for some reason won’t 
voluntarily come before us—a free, responsible public body in a pub- 
lic forum—tell us what is superior about their filters, or justify, at 
least in some measure, the claims they are making before the entire 
American audience here at great expense to themselves in promotion 
of the filter tips. 

Mr. Secrest. I assume they know more about their product than 
all of the other people put together, because they have their own 
laboratories and they certainly know what is in their own cigarettes. 
Some of it may be trade secrets, and undoubtedly is, but we operate 
within the current of all the knowledge we have, and we try to get all 
we can. 

- Our information at the time the guides were being considered and 

adopted indicated that the smoke of the filter cigarettes then offered 
to the public did, indeed, contain less tar and nicotine than. was present 
in the smoke of the same company’s nonfilter brand. Similar informa- 


tion during that. time and since has indicated that the filters do 
perform a filtering action. 

I don’t think anyone could question that. It would be possible to 
put in tobacco with twice the nicotine or tar content and the filter 
would not take out as much, possibly, as if the tobacco were weaker, 
but filters do filter. 

The Commission’s staff has reviewed cigarette advertising con- 
tinuously during and since the adoption of the guides. When claims 
considered questionable have been detected, they have been considered 
by representatives of the Bureau of Consultation and by both legal and 
scientific representatives of the Bureau of Investigation. The Bureau 
of Consultation has brought all such claims deemed violative of the 
guides to the attention of the company involved, and their discon- 
tinuance has been obtained as soon as possible, excepting, of course, 
for those matters currently receiving staff attention. And every day 
they are examining cigarette advertising. 

Tn the absence of its own continuing { test data on all industry prod- 
ucts, 1t has been necessary to rely upon reports of tests by private or- 
ganizations. Because of the different testing methods used and the 
absence of regularity in the testing of all industry products by the 
same organizations and methods over prolonged periods of time, it 
has been difficult, if not impossible, to evaluate accurately the tar and 
nicotine content of each brand of cigarettes offered the public. These 
factors also made it difficult to keep abreast of changes in either the 
blend of tobaccos used in, or the composition and efficiency of filters 
used on, the same brand of cigarettes. 

Notwithstanding these difficulties, the adoption and administration 
of the guides resulted in a marked improvement in the advertising of 
all cigarettes, including that of filter-tip cigarettes. 

Prior to the issuance of the guides, cigarette advertising generally 
involved health claims. Since their issuance, the theme of all such 
advertising, including that for filter tips, has centered around taste 
and flavor. 

Prior to and after the guides were adopted, the Bureau of Consul- 
tation obtained the voluntary discontinuance of over 75 objectionable 
claims for industry products. In the majority of those instances, the 
claims were discontinued within a brief time after their first. ap- 

Additionally, the Bureau of Consultation, as directed by the Com- 
mission, has in its administration of the guides consulted with ad- 
vertising agencies or officials of the industry member they represented 
on a voluntary basis whenever they were requested to do so concern- 
ing either specific claims or entire advertising programs prior to their 
use. And many agencies and people who propose to advertise will 
submit their copy to the Commission and, where that is done, it cer- 
tainly gives the Commission then an opportunity to do a more effec- 
tive job than if the advertising is put before the American people and 
we have to clip it out of the newspaper and go after it later, or get 
it from a television commercial. 

In that way the use of a great many other objectionable claims was 
prevented in the first instance. The high degree of public interest 
in all advertising of cigarettes within the Commission’s jurisdiction 
has thus been served to the fullest extent by its adoption and admin- 
istration of the guides. 


Although of lesser importance, under the circumstances, we believe 
your committee’s interest in efficiency and economy in Government 
operations warrants our commenting that these affirmative accom- 
plishments were brought about at a fraction of the cost the use of 
the Commission’s regular procedures would have required. 

On the basis of past experience, if we had issued formal complaints 
in each of these 75 instances where we have been able to get con- 
formance with our guides slowly, these claims could have been used 
perhaps for years before a Supreme Court or a final court would have 
ruled on whether we were right or not. 

Mr. Buarnix. Just one question, Commissioner. You said you 
have obtained the voluntary discontinuance of over 75 objectionable 
claims. Was in necessary to institute any formal proceedings during 
this same period and, if so, in how many cases? 

Mr. Secrest. It wasnot. I think there are some matters now pend- 
ing but in every case other than those that are now pending, we have 
secured voluntary compliance. If we had not, I can’t say what the 
Commission would have done until the complaint came before the full 
Commission and we discussed whether or not we could prove the alle- 
gations in the complaint. 

Additionally, the prevention of some and discontinuance of other 
claims by this means overcame the time factor which otherwise would 
have been involved. 

You see no doctors standing up lecturing the people. Since these 
guides, you see no claims that they are good for your throat or that 
they won’t irritate your throat. Some may say that the impression in 
instances may be given, but even there we are trying to stop any im- 
pression that might be given indirectly that the health of a person is 
affected, by cigarette advertising. 

Mr. Buarnix. Commissioner, may I ask you a question there? 
While you may have, and most likely have, succeeded in stopping any 
further advertising which may give an impression relating to health, 
is there any carryover, or residual mental attitude or mind set in 
the public after years of exposure to the other type of health claims? 

Mr. Secrest. I can discuss that a little later. 

Mr. Buarnix. The one word, “filter,” may give them a big connota- 
tion built up in the past. 

Mr. Secrest. But the Commission must prove that and the only 
way to prove that is to have a survey of consumers to see what con- _ 
notation they get. We can’t go in and say we believe the people think 
such and such with regard to filters. We have to prove it if we have 
a formal case, and I will discuss that just a little later in the statement. 

The Commission believes its industry wide approach to cigarette 
advertising and its adoption of advertising guides have served to 
eliminate completely all health implications from cigarette advertis- 
ing, thus achieving a marked and prompt improvement in the adver- 
tising of cigarettes. 

During the interim when scientists were conducting research into 
the more serious health aspects of cigarette smoking, the Commission 
believed that to achieve cessation of all health claims for all cigarettes, 
including filters, was highly desirable. It is of the firm conviction 
that its adoption and administration of the guides did more to prevent 
deceptive advertising of cigarettes and to fulfill the Commission’s 


responsibility to the public than it could possibly have accomplished 
by any other means. 

The headline of the Washington Daily News, September 22, 1955, 
issue, read: “ETC Tunes Out Health Claims in Cigarette Ads.” 

The annual report of the National Better Business Bureau for 1955 
made this significant comment: 


On the contrary, there have been many fields of national advertising which 
have been free of serious criticism during 1955 and others where substantial 
improvement has been effected. 

For example, the cigarette industry has long been a whipping boy for critics 
of advertising. Granting that much cigarette consumer complaint, that is not 
true today. 

7a September, the Federal Trade Commission made public a set of “guides” 
for evaluating cigarette advertising. * * * 

The Reader’s Digest, in its August 1957 issue, says that after adop- 
tion of the guides “the industry fell in line.” The same article, how- 
ever, warns of a possible “rash” of new claims soon. 

An article in the Sunday, July 21, 1957, New York Times (see 
appendix, exhibit No. 11, p. 579) commented on industry advertising 
as follows: 

The advertising has shifted with the public winds over the years. Previously 
the emphasis was on health, with such slogans as ‘‘Guard against throat scratch” 
and “safe for your T-zone.” Those catch phrases led to conflict with the Federal 
Trade Commission, which 2 years ago laid down a guide to its staff in judging 
cigarette advertising. The guide included cautions against claims of medical 
approval, references to the effect of smoking on nerves, noses, and other parts 
of the human body and claims on nicotine and tar content. 

This guide followed the first impact of the cancer controversy. The manu- 
facturers shifted tactics. Now the emphasis is on pleasure and taste. * * * 

We have been advised that since the guides were issued there have 
been continuous changes in the blends of tobacco used in particular 
brands of cigarettes and the filters attached to them. Also, it is a 
fact that there have been frequent entries into the market of entirely 
new and different brands concerning which little or no reliable tests 
or other data have been available. 

The Commission’s staff has noted in recent months a recurrence of 
some objectionable copy and in some instances the introduction of 
new and objectionable advertising themes. Upon detection, such ad- 
vertising has been challenged and in most instances actual or assured 
discontinuance has been obtained. The remaining instances of ques- 
tioned advertisements are continuing to receive expenditious attention. 

During this period the Commission has kept in touch with scientific 
development and reports concerning the effects of cigarette smoking. 
Particularly did it note the Surgeon General’s July 12, 1957, announce- 
ment that: 

In the light of these studies, it is clear that there is an increasing and consistent 

body of evidence that excessive cigarette smoking is one of er causative factors 
in lung cancer— 


While there are naturally differences of opinion in interpreting the data on 
lung cancer and cigarette smoking, the Public Health Service feels the weight of 
the evidence is increasingly pointing in one direction: that excessive smoking is 
one of the causative factors in lung cancer. 


That announcement by the public health officer, upon whom the 
Commission relied for a medical determination in this matter, calls 
for a fresh approach by the Commission in its regulation of cigarette 
advertising in the public interest. To this end, the Commission al- 
ready has directed and given high priority to a consumer survey that 
would reveal the public’s current understanding of the meaning of 
the terminology used for filter-tip cigarettes. 

The results of that survey will enable the Commission to take the 
necessary steps to protect the public from deception in the labeling 
or the advertising of cigarettes to the fullest extent of the laws the 
Commission enforces. 

The Commission also is giving serious consideration to additional 
steps 1t may take or suggest in light of this recent information from 
the Government’s chief public health officer. The Commission also 
is alert to the test data published by a private publication in late May 
which indicated that the tar and nicotine content of the smoke of 
many filter-tip cigarettes is approaching the tar and nicotine content 
of the smoke of the company’s same length non-filter-tip brand and 
in some instances is higher than the tar and nicotine content of the 
smoke of the company’s regular popular non-filter-tip brands. 

In speeding consideration of these serious problems, the Commission 
will consult, as it has in the past, with all Federal agencies concerned 
and with the staff of this committee. It will cooperate to the fullest 
extend in every effort to protect the public from all questionable ad- 
vertising and labeling of industry products in the light of present and 
developing facts and scientific conclusions. 

The Commission and its staff welcome the efforts of your committee 
to assist it and the other Federal authorities concerned in arriving at 
the proper solutions to this serious and mutual problem. We appre- 
clate this opportunity to apprise the committee and, through it, the 
Congress and the American people of our concern and continuing 
efforts to secure truthful advertising of cigarettes, and I want to point 
out that under the law that is our only obligation, our only legal re- 
sponsibility: to prevent misleading and false advertising. If it isn’t 
misleading or false or if we can’t prove it is, that is the end of our 

Mr. Harpy. Mr. Chairman, if I might be permitted, I would lke 
to compliment Mr. Secrest upon a very clear and understandable state- 
ment and on the obvious good work which has been done in the past. 

Since he referred to this accomplishment from an economy stand- 
point of working out these guidelines and assuring compliance, I 
would congratulate the Commission on having done that. but might 
ask why they haven’t done it sooner and whether or not they are ap- 
plying that same practice to other items. 

Mr. Secrest. The Commission acted, I think, as soon as there was 
any deceptive or false or misleading advertising. These formal cases 
brought against the big cigarette companies started in 1954 against 
claims that were made, compared with other industries—for instance, 
“smoke a cigarette instead of eating candy.” 

Mr. Harpy. We remember that, when you and I were a little 

” Mr. Srcrest. Yes, sir. The Commission discouraged that because 
it was disparaging on the part of another product. 



Mr. Harpy. The candy manufacturers led in that, too. 

_ Mr. Secrest. If they say cigarettes will not let you get fat, also that 
is not always true. | 

Mr. Harpy. I do think, Mr. Chairman, Mr. Secrest has made a very 
fine statement and obviously the Commission has given a great deal 
of thought and attention to this matter. 

_It would seem to me that this voluntary compliance he has empha- 
sized should work out very well and I am glad to observe that, in gen- 
eral at least, the cigarette companies have apparently been cooperating 
with the Commission in trying to clear this matter up. 

Would you say that is generally true? 

Mr. Secrest. [ would say there are probably right now pending 
discussion over 4 or 5 claims of cigarette companies that have not 
been resolved but in at least more than 75 instances in the past year 
or two where we have called their attention to advertising, they have 
voluntarily given it up. 

Now “voluntary” means they may want to clean it up themselves, 
or it may mean that the Commission, if they didn’t clean it up, would 
issue a formal complaint. No one knows. I am only 1 Commissioner 
and there are 5 of us who would have to decide on proceeding formally. 

Mr. Harpy. You are keeping current as new advertising techniques 
show up, I gather? | 

Mr. Secrest. We have a bureau in the Commission that constantly 
checks advertising. They go through—we get 50 magazines every 
month, we get about 200 newspapers every month, not only for cig- 
arette advertising but every other kind of advertising. 

The 2 major networks send to the Commission every 2 weeks out 
of every month, every line of advertising they use so that we can check 
radio and television—television. 

Every radio station in the United States sends to us 4 days of its 
complete radio advertising each year and they don’t know what they 
are going to send. It is spot-checked. We say “Send in the advertis- 
ing that you used yesterday or that you have lined up for tomorrow.” 
There can be no shifting around of the advertising. We get that. 

In addition the Commission has a monitoring system now that was 
instigated, with money given to us by Congress, in which we have 
lawyers in every 1 of our 9 branch offices who take certain parts 
of their time to monitor television advertising. We do that on the 
theory of “what you say may be truthful but what you show the people 
could be a lie.’ And I can give you an example of it. The announcer 
might say, “You can buy this basket of fruit for $1 down at my store.” 
and then he can show a basket of fruit there that would hold 2 bushels 
of apples. When you go to a store, there are 10 apples in a little basket. 
By magnifying what you have can be a lie ina picture. That is why 
we have the monitoring system. 

There was great interest in Congress—Senator Magnuson and others 
were greatly interested in it and gave us money to do it and told us to 
do it and we are doing it. We have issued some six complaints already 
involving television advertising. 

Mr. Harpy. I am delighted to know that the Commission is pursu- 
ing that practice of monitoring all of this advertising. I am not just 
thinking now of cigarettes. 

I appreciate, Mr. Chairman, the very fine presentation that our 
former colleague has made to us. 


Mr. Secrest. Thank you very much. 

Mr. Buarnix. Thank you, Commissioner, for what I consider to be 
a very solid, thoughtful, and, more important, a very frank and 
straightforward and positive statement. 

I have just a few questions, Commissioner. First, on the testing you 
indicated that you were handicapped by lack of testing facilities. Is 
there any other Government agency which would be capable or ade- 
quate enough to do testing for you? Or would you require your own 
testing facilities ? 

Mr. Srcrrest. We have authority to ask any Government agency to 
test for us. We can ask them. The Bureau of Standards has made 
tests—none that I know of in connection with cigarettes, but we do 
have available practically all of the private tests made. We have those 
the Reader’s Digest has published and many other magazines have 
published them. I have one here showing a very complete listing with 
respect to the total advertising from Printer’ s Ink. If we get this 
compliance by calling them and saying, “You violate our guides and 
these guides are predicated on what we think the law requires,” and. 
we say to them, “You have violated our guides,” and they say, “We 
have not,” assume the Commission went on and issued a formal com- 
plaint. That has to be tried. We had 1 case where I think there were 
12 separate tests of the cigarette put into that case. We put a test: 
in, they would come back with a test showing that ours was wrong. 
We would come back showing theirs was wrong and back and forth 
and when it finally got to the court of appeals, our own attorneys said, 
“That case is so confused with conflicting laboratory tests, scientific 
tests, that we never could win it,’ and the Commission on its owm 
motion dismissed it. 

But we did get a voluntary compliance with most of the things that 
were charged in the complaint. So the lack of standards of testing is 
the first thing that you face and then the second thing, of course, we 
can get testing done but that takes funds and the Commission’s money 
for testing of ‘all the things that we must test is limited. 

We requested an additional amount this year, which we did not 
get and we asked for one more doctor this year that we thought we 
needed to go into these kind of claims and we did not get that doctor. 
Possibly next year the problem will be such that we will get additional 
funds but we use what we have in the testing of these cases. 

Even if you tested and found out that cigarette advertising was 
completely wrong, you still have the formal case to go through that 
at best would take a good many years, if it is fought all the way 

Mr. Buarnrk. Commissioner, do you have access to other facili- 
ties, or assistance from other governmental facilities # 

Mr. Sxcrest. We do in any kind of testing and we also have private 
testing done. We are having a test made at the University of Vir- 
ginia through arrangement with their facilities there. They seem 
to be in a position to make a very—and our tests must be accurate and 
complete, we don’t want any other kind, if they exonerate the re- 
spondent, we want that just as much as if we convict the respondent. 
We want the truth, that is all. 

Through private laboratories with any group we can arrange for 
testing of any of our products that involve scientific claims. 


Mr. Buarnrx, You feel getting voluntary compliance or insti- 
tuting formal procedures for enforcement aimed at a cease-and- 
desist order, the advertising can still continue? 

Mr. Secrest. Yes, sir. The advertising can continue until that 
case is completely settled. 

Mr. BuaTnrk. Give us some idea of how long the average case 
would take. 

Mr. Secrest. It would be impossible even to get a consent order in 
less than 150 days, if the respondents used all their time. We file a 
complaint, they are given 60 days to answer. If they have an answer 
in 10 days the case is hurried. If they want to wait the full 60, they 
can. At the end of 60 days they can ask for a 30-day extension. If 
we deny that 30-day extension and that case ultimately goes to a 
court of appeals, they may say, “You denied them due process 
and didn’t give them time to make their brief.” 

Our rules provide for so many days in every step of the way and 
then in addition, we grant other days if it 1s such a case that it might 
prejudice due process or might call for a claim of lack of due process. 

Mr. Bratnrx. How long would it be before you got through with 
the court action ? 

Mr. Secrest. It would depend on the amount of evidence they 
put into the case. 

In that one case of cigarettes where consumer evidence was put in, 
I think from both sides, I think probably 12 different tests, in a case 
like that if a company comes before a hearing examiner—and all our 
cases are held before him, not the Commission—if it goes before the 
hearing examiner and the defendant says, “I will need 6 months to 
adequately defend myself,” the hearing examiner rules on that ques- 

Mr. Buatnrk. How many cases are now pending or in process or 

Mr. Secrest. There is only one cigarette case. 

Mr. Biatnrk. How long has that been underway ? 

Mr. Srcrest. Since 1953; 4 years. 

Mr. Buatntik. Is this an unusual thing? 

Mr. Secrest. Yes; 4 years is unusual for our average case, of 
course. ! 

Mr. Buatnrx. What would be an average length of time for an 
average case ? 

Mr. Secrest. That would be hard to say, because the average doesn’t 
give the picture. We have 5 or 6 cases that took years. When you 
average, you have to include those. For instance, a case that I don’t 
think is finally settled yet, Carter’s Little Liver Pills, has been going 
11 years that I know of. It has been to the Supreme Court and back, 
‘and through the mill. When it will finally be settled, I don’t know. 

We had two cases involving brushes where they were putting in 
some, oh, maybe other fibers in the hog hair and such; those lasted for 

" These cigarette cases started in 1934. Now you get other things that 
intervene. During the war, the Commission practically suspended op- 
eration in many fields, especially if they involved candy and things 
“needed overseas, or that they thought were needed, and then the 
Commission’s personnel, itself, many of them were in the service. 


We have a board down there, with 100 or 200 names on it, of lawyers 
who left the Commission—there were delays there; a delay maybe for 
3 or 4 years, where no action was taken at all just because of the war’s 

I would say that 90 percent of our cases, or more than that, would 
be handled in 150 to 200 days, including everything, consent orders 
and all. 

Mr. Buarnrtx. No matter what the length of time is, the particular 
firm can keep on advertising and using the exact advertisement which 
you challenge and dispute until the final orders? 

Mr. Secrest. If it is cigarettes or any other product under the Fed- 
eral Trade Commission Act, we cannot stop the sale of that until 
the order is finally sustained in the final court of review. Now, if it 
involves foods, drugs, cosmetics, or devices under the Wheeler-Lea 
amendment—and I was in Congress when it was passed, and was 
interested in it—under that act we can go in and ask for an injunction 
and stop the alleged false advertising of it until the case is tried. | 

Mr. Bratnrx. Would you recommend that tobacco also be included ? 

Mr. Srcresr. I can say that the Commission already tried to get 
an injunction, and they certainly believed that the injunction was war- 
ranted, to stop that particular cigarette advertising. If we could get 
an injunction, it is obvious that 

Mr. Buatntk. Youtried that in court; yourequested the court? 

Mr. Secrest. We took it up to the court of appeals, and the court of 
appeals said it was not a drug, so we didn’t have the authority to 
get an injunction. | 

Mr. Buatnix. We could amend the law. | 

Mr. Secrest. The law could be amended by adding, I think, per- 
haps, the word “tobacco” under that section that deals with drugs, 
cosmetics, or devices, or could be amended by an act such as we have 
in wool, fur, and flammable fabrics, where the Congress allowed in- 
junction to stop advertising in the sale of the goods until the case was 
settled. . 

We can’t automatically issue an injunction, ourselves; we must go 
to court and prove grounds for that injunction, which, I think, is 
proper. There should be some authority above the Commission to look 
over its injunctive power. If we could issue an injunction against any 
false or misleading advertising where we thought the situation war- 
ranted it and the court would grant the injunction, the advertising of 
that commodity—and I will restrict it to advertising—the advertising 
of that commodity would stop until the case is decided. As it is now, 
it is continued until it is decided. 

Mr. Bratnrk. Does the Pure Food and Drug Agency have any juris- 
diction over any part of the cigarettes ? | 
Mr. Srcrest. Pure Food and Drug has jurisdiction over the labeling 
of many things. 

Mr. Bratntk. Including cigarettes? 

Mr. Secrest. No; they don’t. 

Mr. Prarincrr. That was the important fact in your injunction 
case; that cigarettes were not drugs. 

Mr. Secresr. The court said it was not a drug and we could have 
no injunction. 

Mr. Mraprer. You say it was appealed to the circuit court of appeals. 
Is that now on the way to the Supreme Court ? 


Mr. Secrest. It was not appealed. 

Mr. Buarnix. I know there are Federal regulations on such things 
as salt, for a salt-free-diet compound. A product may carry a label 
saying, ‘This contains not more than 0.08”—-whatever it may be—per- 
cent salt.” 

In the case of beer, it says, “Not more than 3.2 alcoholic content.” 

We have those things that are not too much concerned with the 
health of the public, and yet here is something that has nicotine and 
tar content and we have no label on it. 

Mr. Sroresr. I don’t think anyone would deny that Congress would 
have the right to require labeling. 

Mr. Buatnrk. We could standardize tests and merely state, without 
passing judgment on whether they are harmful or not—if we could 
just pass a law and say, “These king-size cigarettes contain 30 milli- 
grams of tar and 8—.” 

Mr. Secrest. You would have to leave some tolerance, because I 
don’t believe any testing could ever be devised that would come right 
tothe milligram, and there would have to be some tolerance. 

Mr. Buatntix. I agree with that. 

Mr. Secrest. They would say, “Not more than so much tar”; “not 
more than so much nicotine,” and let the company, itself, figure the 

Mr. Buarniz. Of the regular cigarettes on the market today, I 
know there are, perhaps, 15 milligrams of tar. That is a rough illus- 
tration. If I buy a king-size filter, there are approximately 22 milli- 
grams of tar, and so forth. If I buy a regular filter, it is so much, 
and so forth. I would be able to see it on the package, and I could 
depend on it, rather than these statements as to “supereffective” and 
so forth. 

Mr. Secrest. The reason I am not commenting on that, and am 
not even personally in a position to make a recommendation, is the 
fact that 1f you limited it to tar content, that would be predicated on 
medical and scientific opinion. 

In the first place, does the tar cause the cancer? The Commission 
can’t say. We are not in a position to say what happens. That isa 
medical question. And if the Public Health Service or the medical 
people eventually would reach a conclusion that there was a necessity 
that so much tar was dangerous and below that was not dangerous, 
that is purely medical, and we couldn’t comment on it. 

We could certainly comment on legislation introduced, to see that 
it was technically correct and that it would be enforcible by the Com- 
mission, and that is standard practice in Congress. 

If the committee receives any bill introduced, and intends to give 
it any consideration, that affects the Federal Trade Commission, they 
always send the bill to us for comment, and we send our comments 
back o to the drafting of the bill and any other suggestions we have 
to make. 

But the question as to whether or not labeling should be placed on 
cigarettes 1s one that is based on the medical requirements for it, and 
we are not in a position to discuss that—that particular thing. Now, 
the injunctive power, we certainly can. 

Mr. Buarnrk. What I am getting at—we hope later on to get a 
pretty good overall picture. For example, you buy a cold remedy, 



12 tablets in a box. It says “Take 1 every 4 hours, but do not exceed 
8 in any 24-hour period,” or something like that. Well you stop, auto- 

Why don’t you say, “Take all you want of these, but do not exceed 
20 in any 24-hour period” or 30, or 15, or something like that ? 

Why do we make it a point of a Federal agency enforcing a descrip- 
tion on one article and not on the other. 

Mr. Secrest. I think the law requires notice if it contains poison or 
something that can hurt you. 

The scientific testimony would have to go further probably than it 
has before you could—well you could require, I guess, anything which 
is based on that. 

Mr. Buatnix. I prefer this voluntary, positive method. 

Mr. Secrest. We have been able to get results quick. In some cases, 
3 days after we ask the cigarette company to quit using an expres- 
sion, within 3 days’ time they have stopped that advertising. 

Mr. Buatnik. Could you give us an example without identifying the 
ae We don’t want that, it wouldn’t be fair, but give us an ex- 

Mr. Secrest. Above all I don’t want to mention one firm or one brand 
of cigarettes because without mentioning all, it might imply this one 
was worse than the others. 

Mr. Brarnik. Give us an example of the advertising voluntarily 

Mr. Secrest. It might be general to a good many claims. “Effective 
filter.’ We don’t believe that the word “effective” filter is proper. 

“Superior filter, best filter, less nicotine, just what the doctor or- 
dered” —that was stopped January 11, 1956—“protect you from tar 
and nicotine, lowest on nicotine and tar, full old-fashioned flavor of 
X cigarette may have caused you to overlook the unique efficacy of 
the highly selective filter—it screens the smoke effectively but let’s 
the honest tobacco flavor flow through.” 

We have no objection to the reference to flavor but when you say 
a filter is effective, there has to be some kind of evidence in the form 
of tests to indicate that it is. Now every filter filters. We can’t 
deny that. 

Mr. Mraper. Mr. Chairman, would you yield to me? 

Mr. Buarnirx. Mr. Meader. 

Mr. Mraper. Commissioner Secrest, I assume what you are reading 
from is the list of 75 objectionable claims which you referred to on 
page 10 of your statement ? 

Mr. Secrest. That is true. 

Mr. Mraper. Has that hist been furnished to the staff? 

Mr. Secrest. It has not. The words “finer filter”’—the many claims 
that we have asked them to withdraw—advertising phrases we have 
asked them to withdraw, and in over 75 cases they have volunteered 
{0 doit, 

Mr. Mraper. Is there any reason why that list could not be fur- 
nished and made a part of the record ? 

Mr. Secrest. Here is why we didn’t furnish it along with the state- 
ment: This is an entirely voluntary operation. It 1s a highly com- 
petitive industry. If we call manufacturer A in and say “That claim 
we think is false and misleading,” manufacturer A may say, “Well 
JT will agree to take it out but don’t tell my competitor that you 

called me in.” It gives him a competitive advantage. His competitor 
ean say, “Well the Federal Trade Commission had him in and 
whacked him over the shoulder.” 

Mr. Mraper. I have no desire to embarrass the Commission or 
any company. 

Mr. Secrest. If the members of the committee care for a copy 
of this, you are welcome to have it. 

“Mr. Buatnix. I have gone over the list with him. We are not 
interested in that element. It is a voluntary, confidential matter. 

Mr. Secrest. I don’t think it is necessary to the question, because 
we have pointed out in all cases what the examples were. It would 
just give you the name of the brand or company. That would hurt 
us definitely, I think, in getting them to come in tomorrow or next 

A lot of that advertising was never used. They come in, in advance, 
and say, “We plan to use this,” and say, “Look, you better not.” 

We just felt to make it public we would certainly hurt what we are 
trying to do voluntarily because they could come in with advertising 
ahead of time and if that were made public 

Mr. Mnaprer. It did seem to me it would be appropriate for fii 
Committee, whether it was published or not, to have in its files the 
list referred to in his testimony. 

Mr. Secrest. The Commission operates on this theory. 

Mr. Briarnix. The suggestion is well taken. It will be treated 
confidentially and not be put in the public record, as least for the 
time being. 

Mr. Secrest. It can be furnished. 

Mr. Buatnix. Referring to the top of page 14 of your statement, 
you stated here that the Commission is alert to the test data published 
by private publications, and there are instances in which you have a 
higher nicotine content in a new, filter tip, longer cigarette than you 
have in your old, regular, standard cigarette. 

Mr. SEcREST. According to the tests. 

Mr. Biarnix. These things were brought up in open hearings and 
I say that we do not single out any company or any brand. There is 
testimony from several witnesses listing the brands they tested by 
name and the amount of tar and nicotine they got out by the process 
they used, which they explained. 

We have gone over some of these and we would like to check a few 
more of the current advertising—perhaps some has already been taken 
out—to give you an example of the thing that concerns us now. 

They are statements that we don’t see how they can be justified 
at what we know about it. 

Secrest. Any advertising claim that this committee or any 
ald of it or any Member of Congress or anyone thinks is false and 
misleading can be submitted to the Commission and we will welcome 

Many of the things we investigate do come from such sources, in- 
cluding the public, members of the public. Any statement you have 
that you think may be false or misleading, if you will submit them to 
the Commission, they will be checked and checked expeditiously, as 
we do everything that we find that we think is false and misleading 



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first introduced in 1952 and 

Mr. Jonson. Kent cigarettes has been one of the continuing ad- 

vertisers of the filter cigarette. They were 


while we don’t have test data for that time, I understand that it re- 
moved such a substantial portion of the nicotine and tar that the cig- 
arette was completely unsatisfactory commercially and was almost 
immediately modified. 

However, in tests that were made in 1953 by Consumers Union, 
Kents had 9 milligrams of tar, 1 milligram of nicotine. 

In 1955, this was stepped up to 12 milligrams of tar, 2 of nicotine. 

In March 1957 it was up to 16 milligrams of tar and 2.7 milligrams 
of nicotine. 

Then the Hammond-Horn report was presented to the American 
Medical Association in New York, June 4, 1957. Shortly thereafter, 
Kent announced a new micronite filter, a trade name which had been 
featured, incidentally, all the way through its advertising. It now has 
a tar reading of 12 milligrams and nicotine, 1.7 milligrams. How- 
ever, if you will note, this is a less effective filter and/or perhaps a 
stronger blend of tobacco than Kents had back in 1953. 

I think the advertising is rather interesting if we consider it with 
this test data. 

You will notice the one common element throughout all of this ad- 
vertising is the micronite filter. You find it in every one of the ad- 

Now in studying trade magazines we know that at least one tobacco 
company has tried through its advertising to create a character for 
each particular product or cigarette that they have. In other words, 
they identify in the public mind a certain type of cigarette with a 
certain name. And this would appear to have been done here by asso- 
ciating the micronite filter continually with the Kent cigarette. 

In 1954 you have—and these are excerpts from some of the ad- 
vertising : 

Kent’s micronite filter gives greater protection against nicotine and tars than 

any other cigarette on the market today. It is the greatest health protection 
in cigarette history. 

In 1955: 

Your voice of wisdom says, “Smoke Kent’, Kent with the micronite filter. 
Puts extra protection and extra pleasure in your filter smoking. 

In 1956—incidentally, this would represent the point at which the 
FTC’s ground rules were applied to cigarette advertising—now you 
find no reference to nicotine and tars. 

You will relax even more with Kent with a micronite filter for high filtration— 
actually smooths the flavor of Kent’s custom blend. 

In May of this year: 
Kent, the mild cigarette—the easy draw micronite filter—the full, rich flavor. 

Now with a new filter introduced very recently after the Ham- 
mond-Horn report on cigarette smoking and lung cancer they are 
back about to where they were in 19538: 

New exclusive micronite filter. Significantly less tars and nicotine. Easy 
draw, full, rich flavor. 

Now with respect to the element of price, I understand that Kents, 
until about a year ago, sold at 6 cents a pack more than the standard 
cigarette. The price differential now is 2 cents. I checked the prices 
yesterday at the House restaurant and Kents sell for 22 cents and the 
standard nonfilter brands at 20 cents. 


But we felt there is an element of deception in this sort of advertis- 
ing, because the micronite filter is still fixed in the public mind, and 
these changes make it quite a different product now from what it 
was in 1953 or 1955, or just a few months ago, and yet the public was 
in no way advised. 

l 9 5 T ye 


21¢ 22¢ 20: 22¢ 

Now here are some comparisons of P. Lorillard Co. Old Gold 
is their old standby, sold for many years as one of the big sellers. 
These were tests made in 1957. You will see the Old Gold here, 20 
cents, the Kent filter at 22 cents. The tar in the Old Gold is 18. The 
exclusive micronite filter gives you 16. The nicotine content of both 
cigarettes is identical. 

Then we can take Old Gold—and here again we have the matter of 
the standard brand. Now both of these cigarettes—Old Golds, king 
and filter king, are the same length cigarette. Only the filter distin- 
guishes one from the other. The tar content is identical and the nico- 
tine content is one-tenth of 1 milligram different. 

Mr. Buatnix. Mr. Johnson, just one question: Between Old Gold 
king and Old Gold filter king, though they are the same length cig- 
arette, there is more tobacco in the Old Gold king, is that correct ? 

Mr. Jonnson. That is right. 

Mr. Buarnik. And you pay more for the Old Gold filter king with 
a little less tobacco, and the same tar content? 

Mr. Jonnson. That is right. 

Mr. MinsHatu. Does it cost the cigarette manufacturers less or more 
to insert that filter ? 

Mr. Jounson. That is a debatable situation. We have read. the 
trade journals and there is speculation, based perhaps upon a study 
of financial reports of the tobacco companies that the filter cigarettes 
may be actually cheaper to produce than the regular. However, 
there are two elements involved. 

Tobaccos do account, I believe, for about 75 percent of the cost of 
the cigarette, but you do need an additional machine and an additional 


process to apply the filter. The filter may be cheaper but the extra 
process may result in about the same price or conceivably less. 

Mr. Minsuauu. The material in the filter costs less. 

(See appendix, exhibit 28, p. 751.) 

Mr. Jounson. I think that is correct. It is acetate cellulose, I be- 

I would like to point out in connection with the examples we have 
chosen here, that we intend them to be illustrative of the advertising 
in general and we have not attempted to pick out or select any one 
company as the victim or goat. 



~~ — 

Now here we again find the application and evolution of a common 
advertising term—in this case, the miracle tip. The L & M regular 
when originally introduced had 11 milligrams of tar, 1.5 milligrams 
of nicotine. Now, incidentally, this is comparable to the present im- 
proved micronite filter Kent cigarette—a reasonably effective filter or 
combination of filter and tobacco blends to produce a cigarette low in 
nicotine and tar content. 

The advertising in 1955: Miracle tip—for most effective filtration and much 
less nicotine. 

There may have been some justification for such a claim at that time. 
In 1957 we still have the common element in the advertising—now the 
“miracle of the modern miracle tip.” 

Tar however has now gone up to 15 milligrams, a 40 percent increase. 
Nicotine has gone up to 2.6 milligrams, a 70 percent increase and I 
believe the consumer could quite validly ask, “Where is the miracle of 
the modern miracle tip?” 


1987 a 


| | Mts Newacle of te Modan Made iyo 
20° 22¢ 

Here we combine the L & M with the Chesterfield regular. The 
Chesterfield sells for 20 cents, one of the old popular brands, and the 
L & M introduced since the cancer scare or whatever we wish to call 
it, and along with the promotion of other filter cigarettes. 

The Chesterfield has 17 milligrams of tar. You have 15 in the 
L&M’s. Slightly less. 

af the Chesterfield you will get less nicotine than you will get in the 
L & M filter tip, and again we have the question, “Where is the 
Secs of the modern miracle tip ?” 

- 1957 TEST 



Z20¢ 2O* a2? 



Here we make a comparison with the Philip Morris principal sellers. 
We have the Philip Morris regular, the Philip Morris king, and the 
Marlboro filter king. 

Now if you will compare the Philip Morris regular with the Mar]- 
boro filter, you will find they have identical tar. Now it is true this 
is a longer cigarette, though the total amount of tobacco is practically 
the same. The nicotine content is exactly the same. If you buy Philip 
Morris regular, or a Marlboro filter, you will get exactly the same thing 
in terms of tars and nicotines. 

The Marlboro filter king is slightly more effective than the Philip 
Morris king, which is all tobacco. 

Marlboro advertises : 

The unique efficiency of the highly selective filter. 

Now according to testimony which was presented by Dr. Wynder, 
of the Sloan-Kettering Foundation—and I believe they have conducted 
the most exhaustive published tests on this matter—he stated that they 
had been able to develop a filter, or had observed no filter which could 
exert selective filtration action. That is, the filter could take out the 
microscopic particles of tar which were intrained in the main stream 
of the tobacco smoke but it could not selectively remove any one por- 
tion of the smoke. 

Mr. Buatnik. Let’s take one last look at that: Your Philip Morris 
on the left side, your Philip Morris regular, that is the regular size. 
At the extreme right is your Marlboro filter king size. Am I correct, 
is there more tobacco in the regular Philip Morris on the left side than 
there is—there is less tobacco in the regular without the filter and you 
get just as much tar and just as much nicotine in a Marlboro king 
which has less tobacco and a filter ? 

Mr. Jounson. That is right. 

It has been estimated that in most brands of filter kings there is 
about 10 percent less tobacco than in the regular size, nonfilter ciga- 
rettes. This will vary from brand to brand and we have no data as to 
which those brands are. I think in terms of tobacco there will be 
approximately the same amount in these two cigarettes. 


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Mr. Jounson. Here we have the Reynolds Tobacco Co., the regular, 
which is the Camel, the filter king which is the Winston, and the 
Cavalier, which is the straight king size cigarette. 

Here you have the Camel which is a best seller and standby of 
Reynolds Tobacco. It has 17 milligrams of tar, 3.2 milligrams of 

In the Winston filter king you will get 22 milligrams of tar, 3.8 milli- 
grams of nicotine. 

In the Cavalier which is a straight king cigarette, you will get 26 
milligrams of tar and 3.8 milligrams of nicotine. 

These two cigarettes have identical lengths. The nicotine content 
is identical. The difference in tar content is 4 milligrams. 

The Winston has been advertised as: 

The cigarette which brought flavor back to filter smoking. 
With respect to the filter, it has been advertised as— 
the exclusive filter—works so effectively. 

That was in 1956. 
In 1957: 

Exclusive filter. Snowy white and pure. 

They are no longer speaking of its efficacy, but there is, I think, 
almost inevitably a certain continuity in thinking of the consuming 
public where they will remember back at least a little of the earlier 





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With American Tobacco we make a similar comparison and find their 
longtime best seller, Lucky Strike regular has the least tar and nicotine 
of any of the three large brands which they sell. The tar in the Lucky 
Strike is 19 milligrams. The nicotine is 2.6. The Hit Parade which 
was introduced about a year ago has 20 milligrams of tar—that is 1 
miligram more than the Lucky Strike. It has 8 milligrams of 

The Pall Mall has 24 milligrams of tar and 3 milligrams of nicotine. 
Again we can compare the two identical long cigarettes. The nicotine 
is identical. There is 4 milligrams difference between the 2 in tar so: 
you would have approximately 15 percent reduction in the tar content 
by the application of the filter, or perhaps the variation in the blend. 

Now the Hit Parade is currently advertised with the slogan “Your 
taste can’t tell the filter is there.” It would, I think, imply at least 
that maybe though your taste can’t tell the filter is there, the filter 
is there to perform some function. In view of all of the advertising 
which has gone to the public in recent years, it would seem reasonable 
to assume that the public believes they are getting less nicotine and 
less tar. 

Now as I pointed out, these are a few typical examples of the 
advertising. We feel they are fairly representative of the industry as: 
a whole. 

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Mr. Buarnrx. Whose tests are used there? 

Mr. Jonson. They are tests by Consumers Union. The reason we 
selected them is that theirs was the only source where we could get a 
series of tests over a period of time. That is, they made tests in 1953, 
1955,-and 1957. 

Dr. Wolman, director of the American Medical Association labora- 
tory appeared before the subcommittee a few days ago and testified 
that the method used by Consumers Union paralleled their own and 
that the results were remarkably close, so we assume that these tests 
for comparative purposes, should be accurate and valid. 

Mr. Buarnrx. So we are not so interested in the absolute figures 
because the type of tests will vary. You could get another test which 


is accurate and would run perhaps a few points higher, but the rela- 
tion would be the same. 

Mr. Jounson. That is right. 

In Dr. Wynder’s tests and also the tests performed by Foster E. 
Snell for Reader’s Digest, used a different method in extracting tar. 
They used the whole smoke condensate rather than just that portion 
soluble in chloroform, so they got a larger reading for tar. 

Mr. Meapver. I would like to ask the Commissioner a question or 
two on this statement. 

On page 7 you refer to the cigarette advertising guides. Have you 
furnished a copy of those guides to the committee staff for our record ? 
’ Mr. Secrest. I think the committee staff has it and I have copies 

Mr. Meaper. Is it anything very voluminous? 

Mr. Secrest. No. 

Mr. Meaper. Mr. Chairman, I would suggest we incorporate the 
advertising guide he referred to in the record. | 

(The document referred to is as follows :) 


The following guides have been adopted by the Federal Trade Commission for 
use of its staff in the evaluation of cigarette advertising. 

No representation, claim, illustration, or combination thereof, should be made 
or used which directly or indirectly : 

1. Refers to either the presence or absence of any physical effect or effects 
of cigarette smoking in general or the smoking of any brand of cigarette. 

Note.— Words, including those relating to filters or filtration, which imply the 
presenee or absence of any physical effect or effects are considered subject to 
this guide. 

2. Represents that any brand of cigarette or the smoke therefrom is low in 
nicotine or tars, or contains less nicotine, tars, acids, resins, or other substances, 
by virtue of its ingredients, method of manufacture, length, added filter, or for 
any other reason or without any assigned reason, than any other brand or 
brands of cigarettes when it has not been established by competent scientific 
proof applicable at the time of dissemination that the claim is true, and if true, 
that such difference or differences are significant. 

Note.—Words, including those relating to filtration, which imply lesser sub- 
stances in the smoke, through filter comparisons or otherwise, are considered 
subject to this guide. 

8. Refers to the effects of cigarette smoking in general or the smoking of any 
brand of cigarette on the (@) nose, throat, larynx, or other part of the respiratory 
tract, (0) digestive system, (c) nerves, (d) any other part of the body, or (e) 

4, Represents medical approval of cigarette smoking in general or the smoking 
of any brand of cigarette. 

5. Compares the volume of sales of competitive brands of cigarettes, or the 
purchase or use of particular types, qualities, or grades of tobacco in cigarettes, 
when such claim is not based on reliable information currently applicable when 

6. Relates to or contains testimonials respecting cigarette smoking or the 
smoking of any brand of cigarette unless (a) the testimonial is genuine, (b) the 
advertiser has good reason to believe it represents the current opinion of the 
author who currently smokes the brand named, and (c) it contains nothing 
violative of any of the other guides set forth herein. 

7. Falsely or misleadingly disparages other cigarette manufacturers or their 

Notres.—(a) Nothing contained in these guides is intended to prohibit the 
use of any representation, claim, or illustration relating solely to taste, flavor, 
aroma, or enjoyment. 

(b) Nothing contained in these guides will have the effect of modifying the 
‘provisions of any existing cease-and-desist order or stipulation or altering the 
responsibility of any party thereto to fully comply with the specific provisions 


of such order or stipulation affecting it. They do not constitute a finding im 
and will not necessarily affect the disposition of any formal or informal matter 
now pending with the Commission. 

(c) These guides will be altered, modified, or otherwise amended when and 
if the facts and circumstances warrant. 

Mr. Mnaper. Has this method of establishing advertising guides 
been established in other industries than the tobacco industry ? 

Mr. Secrest. We have what can be compared to them in what we 
call trade-practice rules which are guides on price discrimination, 
false and misleading advertising, the laws the Commission enforces: 
for 160 industries. "They are just industrywide guides. The metal 
awning people, the fountain pen manufacturers and 160 others. They 
are onides for them. That is a form of procedure. We hold public 
hearings and such and we did not do that in this case because 
that was time-consuming and we wanted guides as quickly as we 
could get them to put into operation. 

The other would have taken maybe a year or two. This was con- 
sidered in the Commission and we had the case law back of us in what 
we used in the guides. We went into nothing but advertising. In 
the other rules we go into every discrimination ‘of prices and the other 
things that the Federal Trade Commission has to deal with besides 
advertising. We have many other duties. 

Mr. Mraper. Let me see if I am clear about this: Your jurisdiction 
would be limited to the tobacco industry as contrasted to the press or to: 
the television and radio industries. You can’t issue any orders to 
ape television and radio industry ? 

Mr. Secrest. I think the Commission might be able to do so, but 
it is the advertising we are after. I don’t know if the radio station 
would ever today publish nothing but false and misleading advertis- 
ing and keep it up for a year, one after the other—I don’t know. I 
think we can proceed against the radio station, but as a policy we 
don’t. We are after the advertiser. 

Mr. Mraper. I am thinking of the possible conflict in jurisdiction 
between the Federal Communications Commission and the Federal 
Trade Commission. 

Mr. Secrest. Every order we issue, every stipulation we take, every 
proceeding we have against any manufacturer or against any ad- 
vertiser, that is all sent to the FCC, together with the call name of the 
station that put it out and the FCC then has that for its own guidance. 
I don’t know of any station that has ever been refused a license on false 
and misleading advertising or probably ever will, but they in turn 
send that to the station that is involved. 

Tf we issue a complaint against X company for false and misleading 
advertising, that complaint goes under our arrangements with FCC 
direct to them. They immediately send that complaint to the local 
radio station or to the television station. 

Mr. Mraper. In your formal proceedings your complaint is issued 
against a particular company ? 

“Mr. Secrest. Yes, for particular acts. 

Mr. Mraper. But others that may have had a part in distributing the 
false claims, if they are false, are not parties to your proceeding. For 
instance, you don’t enjoin all the newspapers ? 

Mr. Srcrest. We go to the source of the ads, 

Mr. Mraprer. You go to the manufacturer and don’t attempt to 
govern the media of distribution. 


Mr. Secrest. We do not. We go to the man who initiates the ad- 

vertisement, who has something to sell, a commodity or service to give. 

- Mr. Meaprr. You wouldn’t enjoin an advertising agency represent- 
ing the manufacturer of the product ? 

Mr. Secrest. We have in rare instances. It would just depend if 
the advertising agency drew up all the advertising and was responsible 
for it, I assume we could, but it is a rare instance. We always go to 
the man who is going to benefit from that advertising and that is the 
fellow with something to sell. 

Twelve claims on this list here have been discontinued and four 
of them within the last few weeks by our voluntary process. 

Mr. Maver. In the consultations that you had prior to the estab- 
lishment of the guides, was there any record maintained of those 
conferences ? 

Mr. Secrest. Just memorandum records. No stenographic record. 
Because it is all voluntary. Every one of these 75 claims that have been 
discontinued were discontinued voluntarily by the companies at our 

Mr. Mraprr. Now, on the whole from your statement I gather that 
you feel that the tobacco industry has cooperated rather well with you 
ona voluntary basis. 

Mr. Secrest. I would say it has worked exceptionally well con- 
sidering the conflict that exists in the medical testimony with respect 
to tar and nicotine. 

Now, if tomorrow morning they could say that “This tar, or this 
in tar causes cancer,” then Congress would be faced possibly with a 
national health problem and the Commission would have something 
upon which to pinpoint more definitely complaints or require adver- 
tising, but I think our proper procedure under these guides has been 
a miracle of achievement in stopping what might be false and mis- 
leading advertising in the cigarette industry. 

Mr. Buarnix. If the Commission had the voluntary injunctive 
power to order them to cease and desist immediately but on a tem- 
porary basis, would that further encourage this good start on proper 
policing of advertising ? 

Mr. Secrest. The injunctive power, as we have it now in drugs, 
on the theory if you keep on selling a medicine that might harm some- 
one, you better stop it now. We go to the court and can get an in- 
junction. If it is false and misleading advertising—drugs, cosmetics, 
food—any false and misleading food advertisement, we can ask for 
an injunction to stop it and, if the court agrees with us, we get the 
injunction. If they say, “You don’t need an injunction; that is 
too close a question,” you can’t have it. If that were given to the 
Commission, it would certainly make more effective, quicker, the 
regulation of false and misleading advertising in the cigarette field, 
or any field, for that matter. 

Mr. MinsHaru. At the outset, I would like to commend you on a 
very excellent, forthright, and, above all, a candid statement. I wish 
I could say the same thing for some of the other witnesses who have 
testified before this committee, but, unfortunately—I believe the 
rest of the committee agrees with me—I cannot. I notice on page 18 
of your statement that you said, in view of the Public Health Serv- 
ice’s statement, that it calls for a fresh approach by the Commission 


in its regulation of cigarette advertising in the public interest. Now, 
what do you intend doing in the way of a fresh approach ? 

Mr. Secrest. I can say this: that we considered, months ago, a 
consumer survey, and reached the conclusion that, until there was a 
more definite pronouncement on the subject of the relationship of 
cancer to cigarette smoking, we should hold it in abeyance. | 

Immediately after this statement by the Surgeon General, the Com- 
mission authorized our staff to prepare the questions—and that is 
very important; those questions have to be used as evidence to be used 
in a legal proceeding—to prepare the questions, to prepare the plans 
for a consumer survey. The whole staff, including our General Coun- 
sel, the Chief of our Bureau of Consultation, the Chief of our Bureau 
of Investigation, all of them will work the plans out for a consumer 
survey. ‘That will be presented to the Commission. That action then 
would give us some basis in the approach to the question of filter alone 
in cigarettes. What does a man think about when he buys a filter 
cigarette? Does he want to keep loose tobacco out of hismouth? Does 
he want to protect his health, or does he think he is protecting his 
health? Those are things the Commission needs to know to put in 
proof in the case of false and misleading advertising. 

That is not all the proof, but that is a part of 1t, and an essential part. 
So we are laying the groundwork for any future formal action that 
we might be compelled to take in the field of cigarette advertising. 

Mr. Minsnaui. How long do you contemplate it will take to make 
a survey like that ? 

Mr. Secrest. I should think that, at most, 2 or 3 months; by then 
they should have the questions. They have to be considered. There is 
no use to take a survey and leave one question out that is essential or 
find one question wasn’t worded so it could be used legally in the formal 
trial of the case. That will take some time. The survey itself must be 
broad; it must be broad enough so that it can be considered a cross 
section of what all the people think when they buy a filter cigarette. 

Mr. Puarrnerr. Are you familiar with past surveys that have been 

Mr. Secrest. Not exactly on this question, but we have made numer- 
ous surveys in the past. 

Mr. PLAPINGER. by other agencies. I understand the Bureau of 
the Census made one. There was reference during our testimony to 
one conducted by the Institute of Public Opinion, and also reference 
made to one by Sloan-Kettering. 

Mr. Secrest. You get certain delays. Now, in any surveys such as 
this, questions we send out we have to clear with the Bureau of the 
Budget under an act of Congress. That isso we won’t send out a ques- 
tionnaire at the same time another agency does and pester businessmen 
todeath. It isa goodlaw. We clear it with the Bureau of the Budget. 
Mr. Babcock will be responsible for that. What would you estimate? 

Mr. Bascock. Four to six months. 

Mr. Secrest. Four to six months for the actual survey itself. 

Mr. Mrnsatt. Would you consider it accomplishing any useful 
purpose to put the contents of tars and nicotine on the package of the 
cigarettes ? , 

Mr. Secrest. I don’t want to comment on the advisability of it, be- 
cause the advisability of it rests solely upon medical opinion. If tar 
doesn’t hurt you, there is no need for it. If medical opinion says tar 


is a causative factor and thinks that the health of the Nation requires 
it, it could be done. It certainly would be easy for us to enforce it. 
If the wording said, “Not more than so much tar,” all we would have 
to do would be to get some samples of cigarettes, test them by what I 
hope would be some standard procedure. If it is above that “not more 
than,” it is then false and misleading—substantially above. 

The law would have to outline the standard of testing procedures, 
but I think I have mentioned that several times. That law would be 

Mr. Minsuaty. Would you consider an alternative of that; to have 
the cigarette manufacturers submit to you, based on a standard method 
of testing at periodic intervals, the ratings of their cigarettes as to tar 
and nicotine ? 7 

Mr. Secrest. You get, then, back to the health question. Of course, 
the Commission hasn’t considered the answers I am giving, but I am 
giving them to you because I think they are right; that whether you 
required that to be put on a pack of cigarettes is a health matter. We 
are not the health agency, and we are not in a position to say what 
effect this has and, I think, from some of the material—I noted a 
recent publication of the American Cancer Society, whose officials re- 
viewed the various scientific data on the problem states: 

It would be gratifying if the Cancer Society could produce a neat, final answer, 
but it cannot. 

When the question of marking the package of cigarettes and such 
comes up, if tar doesn’t hurt you a bit—assuming that; that there is 
no connection between cigarettes and cancer—then there can be no 
false and misleading advertising with respect to it. 

— Mr. Buarnitx. But would it be helpful just to know how much tar 
is in there? For example, there is no question about the alcohol in 
beer hurting you, yet they mark it 3.2. 

Mr. Secrest. I don’t know how it would work out and, since it is 2 
medical question, my comments are merely incidental to that particular 
part of the question. It might be, if cigarette companies had to put on 
each package how much tar was in it, that there would then be com- 
petition in the industry to reduce the tar content of the smoke. The 
public might, “I want the one with the least tar.” If they wanted the 
one with the least tar, then the competition would see who could get the 
least tar in the smoke of their product to sell it. It might have that 
effect and it might not, depending on the test of the consumer. 

Mr. Mrnswatu. It doesn’t prove anything in alcoholic beverages 
when they put the proof on the bottle. 

Mr. Srcrest. I don’t know of anyone the proof ever stopped. 

Mr. Buarnrx. With regard to alcoholic beverages, what Govern- 
ment agency is responsible for supervising ? 

Mr. Secrest. The Alcohol Tax Unit in the Bureau of Internal 
Revenue, and here is what they do, as I told you: We get these news- 
papers and magazines, different ones every month, we get half of all 
the commercial broadcasting that is used by the two major networks 
sent to us voluntarily by them. We get one week a month from one 
of the smaller networks. We go through those advertisements. Every 
one that advertises alcohol that we see, we clip out and send over to 
this Aleohol Tax Unit. I think in the last weekly report I saw we sent 
them in a week’s time about 370 or 380 advertisements dealing with 


liquor. They have the control over it, and we send those to them and 
it saves them setting up a bureau—we have to look these papers through 
and get the ads anyhow, and it saves them setting up a bureau to dupli- 
cate the work. Every ad we get dealing with liquor we send over to 
the people who enforce it. 

Our haison with Justice and the other agencies of the Government, 
I think, has been very well perfect to the point where they get the 
most good out of what we do and there is the least duplication or waste 
of the taxpayers’ money. And, on this whole subject, I feel that we 
made the only approach that could be made on it, to get the best 
results in the quickest time, and I think that the fact that the Com- 
mission even issued guides as far back as 1955 indicates that we were 
well ahead of the field in this business of regulating advertising in 

Mr. Buarnrx. Now here you have two different agencies handling 
ee etter sh one alcohol and the other in tobacco and the cigarette in- 

My knowledge, such as it is, on the alcohol competition, it is a very 
-competitive field. 

Mr. Secrest. They have done much in the way of self-regulation. 

Mr. Buarnrg. There is a voluntary aspect about it, it is quiet, not 
much fuss or fanfare. J think the industry has done a good job and 
the governmental agencies have done a good job. They are not over- 
ballyhooing the liquor and what it is going to do to or for you. 

I wonder if we could find some lessons here for the cigarette in- 
dustry where a cooperative, positive joint effort might be worked out 
to have a little bit more of a realistic and a little better taste in all this 

Mr. Secrest. The greatest hope of getting results in any advertising 
field is the sincerity of the advertiser to try to advertise his product 
truthfully. If every advertiser in the country wasn’t trying to con- 
‘trol his advertising, you couldn’t appropriate us enough money to 
do the job that we are asked to do. Ninety-nine percent of all in- 
dustry and maybe more advertising just as honestly as they know 
how, and there is a difference here between the people who manufac- 
ture cigarettes and the Federal Trade Commission on many of these 
claims, because there is a difference in the scientific evidence that is 
before anyone, at this time. I think we moved well ahead of the field 
in our efforts to try to get this advertising. We prohibited health 
claims in 1955, the month of September, in these guides and that has 
been now almost 2 years ago—before we had anything like the tests 
that we now have available to us with respect to tar and nicotine con- 

Mr. Bratnik. Commissioner, you have done an excellent job. You 
have made great strides here with your guide and with your ground 
rules, so to speak, and the voluntary cooperation with the cigarette 

industry. But yet it is my feeling with the literally hundreds of mil- 
lions of dollars that have been spent by the cigarette industry in ad- 
vertising in the last 4 years, I don’t think the average consumer has 
much of an idea of just what he is getting—whether he is buying a 
“miracle tip,” or an “effective filter” or “superfilter,” in whatever 
brand he is buying. Why so little knowledge on a thing that has been 
so widely advertised is the thing that puzzles me. I think we are en- 


titled to know. The consumer knows about many other products which 
are far less important from a health standpoint. He doesn’t know 
whether 18 milligrams is bad for him, but I would like to know 
whether one has 30 milligrams or 18 milligrams. I know that an 18- 
milligram cigarette isn’t any safer than a 30-milligram cigarette if 
you are smoking 3 packs of one and 1 of the other. 

I am directing these comments more to the industry people, and 
you have contact with them. 

I think this thing can be resolved in a fair and a positive and con- 
structive way. 

As someone said, I think smoking is here to stay until something 
drastic ;comes up. But it has to be done in moderation. It is not 
the use of a bad thing, if you want to say cigarettes are bad. It may 
not be so much the use of a bad thing as the abuse of a good thing. 

I can only speak for myself, but I think we would make far better’ 
progress in reaching the people, by advertising in good taste and even 
going out in honesty and saying that you should use this in modera- 
tion. On certain occasions, the liquor industry says, “If you must 
have that last drink for the road, make it a cup of coffee.” 

It is a good feeling between the industry and the people and the 
industry and the Government agency, and I wonder if something 
along that line couldn’t be developed here with the cigarette industry. 

Mr. Secrest. In the guides we attempted to do it and we certainly 
would be happy if they could advertise in such a way that we would 
never be compelled to question it. It would save our time and our 
money for many other things that the Commission is supposed to 
be doing, and I hope they will. 

Our responsibility under the law, and our only responsibility as of 
right now, is to see that advertising in any field within our jurisdiction 
is not false and not misleading, and we will continue to question every 
claim of any advertiser—the cigarette people included—that we think 
is false and misleading. There are honest differences of opinion and 
above all we want to be fair to any segment of industry in the country. 
We have tried to do that, I think, as well as we could, but we haven’t 
stopped or rested just because we have guides. | 

Every day we are trying to get more and more compliance with 
those guides. When we get consumer testimony we will have some: 
ideas of what a man thinks when he buys a filter cigarette or when 
he says the word “filter” by itself, and if this committee has any 
advertisement that they deem to be false or misleading, just let us 
have it and it will be corrected. Maybe it will be found false and 
misleading and maybe it won’t. That depends upon the facts in the 

Mr. Buarnrk. Thank you, Commissioner. Any further questions? 

Thank you, Commissioner, for the splendid help, information and 
cooperation which you have given the committee. 

We have a letter from our colleague, Congressman John Watts of 
Kentucky, and enclosed is a copy of a letter by Dr. Milton Rosenblatt 
of New York, addressed to Dr. Leroy EK. Burney, the Surgeon Gen- 
eral, which we will include in the record. (See appendix, exhibit 29,. 
p. 752.) 

This closes the hearings as far as the Federal Trade Commission 
is concerned on the cigarettes, particularly the filter cigarettes, except 


that the Chair would like to ask unanimous consent or agreement 
with the members of the committee that he hold the record open for 
a week to complete the record with many exhibits we have asked for 
and give us time bs insert them in the record. I direct counsel to in- 
clude in the record at the appropriate places material that 1s necessary 
‘to complete the record. (Bes appendix, exhibit 30, p. 754.) | 

The only important ec we have not yet heard from is the ciga- 
rette industry, itself. We do not want to be arbitrary, nor do we want 
to be impulsive in this matter. Although we are closing the hearings 
we would be glad to hear from the cigarette people if upon further 
consultation amongst themselves or within their own industry they 
feel that in all fairness and to make the record complete they should 
be heard. 

Our main objective here in getting the medical background was 
to collect together in one reliable volume, all the points of view in 
testimony without imposing upon ourselves the responsibility of mak- 
ing a determination which is not within our jurisdiction to make. 

We hope that in a fair and positive and comprehensive open dis- 
cussion of all points of view on something that is unquestionably of 
great concern to literally millions of American people we have made a 
little contribution to a better understanding of the problem and spe- 
cifically we hope a more effective program of advertising of these 
particular products. 

In closing I want to commend the members of the subcommittee, 
particularly the gentlemen here. Knowing what an extremely heavy 
floor schedule we have had. the Chair is deeply grateful for the special 
effort made to be here in afternoon sessions as well as the many morn- 
ing sessions we have had. 

If there are no further comments or questions, the Chair ad- 
journs the 

Mr. GreenHouse. Mr. Chairman, may I 

Mr. Buatnix. Mr. Greenhouse, Iam SOrTy 

Mr. Greennouse. May I respectfully ask permission of the Chair 
to make a statement to the committee that will take about 5 minutes? 
You will recall that I was interrupted in my testimony yesterday by 
a rolleall. I came here a thousand miles at my own expense. I 
believe that what I have to say is very pertinent to your issue 
here, and of interest to 100 million Americans. May I have that 
permission, please ? 

Mr. Bratnrk. We do give you the permission. Will you please 
take the chair, Mr. Greenhouse ? 

Mr. Greennovuse. Thank you. 

Mr. Briarnix. I do want to emphasize this: We appreciate the 
special effort you made to be here 

Mr. Gremnuouse. Thank you. 

Mr. Briarnix. But I hope you do not feel or indicate here that the 
statement was not given or will be given the same consideration given 
to all testimony. 

Mr. Greennouse. I realize that. 

Mr. Buarntk. It is already properly and officially included in the 
official record of these hearings. We will be glad to hear whatever 
supplementary or additional information you may have to present 


Mr. Greenuouse. I qualify as a witness and I attach my com- 
ments entirely against the American Cancer Society report which 
has been put into your record and which has received nationwide 
publicity m the press and has appeared in scare headlines to an extent 
that it has filled the American public with anxiety about the dire 
consequences of smoking. I am addressing my remarks exclusively 
ito the statistical validity of that report because I am an expert on 
statistics and have spent my life analyzing all types of reports. 

I say to you that the American Cancer Society report is in many 
respects a phony from cover to cover; that the report was designed 
especially to impress upon the American people a certain point of 
view and in doing so it has violated all scientific procedures in ob- 
talning reports. 

To start with, they selected only men between the ages of 50 and 70 
who would have died anyway 25 years ago from natural causes; they 
have extended even today with the health improvements the age on 
pee report to 70, when 67 by actuarial science is the limit of a man’s 


No. 2, they have sent out 22,000 volunteer workers and with the best 
of intentions were told not to take any men who were sick, but it was 
deft to the research workers themselves to determine whether or not 
aman wassick. They could have very well gotten a doctor’s certificate 
for each case. 

No. 3, they did not look into the question of medical treatment in 
the case of a death. They dealt only with dead bodies, although they 
call it a study of 187,000 men. It is not a study, it is merely a census 
or a registration, an enrollment of 187,000 men who after they were 
enrolled were just checked up once a year by these workers. They 
turned in the question on each one, “alive or dead or change of ad- 
dress,’ and if they died, they followed the certificate. 

That, I submit, is not a study, it is merely an enrollment. 

Now, they overlooked the fact that cancer in many cases is heredi- 
tary, and they took no pains to determine whether any of the deaths 
resulted from hereditary traits. 

I am skipping a lot of other factors which should have been con- 
sidered by them in an honest study. Iam taking slide No. 26 of their 
own report. (See p. 265, supra.) In this slide they show that 52.1 
percent, in a great big line, die of coronary-artery diseases. ‘The first 
impression of that as a man looks at it is that smokers will die to the 
extent of 52 percent from smoking excessively, which would not have 
‘happened if they did not smoke. ( 

Now, I examined this chart. A statistician, a person who is ex- 
perienced in studying statistics can spot a chart of this sort a mile 

L ios comparative figures to the side to show what the chart really 
should have expressed if they desired a logical statistical report. 

Instead of showing 52 percent, my chart shows three-quarters of 1 
percent, and down below instead of showing 27 percent dying from 
cancer, when you compare the total to the total men in the study, 
187,000, the percentage is less than 1 percent. So there is a difference 
of 5,000 percent in 1 method of figuring which is more logical than 
the arbitrary method used here. It is as if they took 100 men who 
died in any locality and say 70 of those men died from coronary-artery 
disease and 30 from cancer or other causes. They draw a blank line. 


Seventy percent died from cancer; but they do not consider that the 
total deaths with which that part is compared, the total is only 144 
percent of the entire 187,000 cases. 

Mr. Buarnik. Just straighten me out in my thinking: Dr. Ham- 
mond’s testimony was not that this smoking caused 70 percent of all 
deaths. I thought the testimony was that of those who do die of 
lung cancer, or who have lung cancer when they die, that a high per- 
centage of them are heavy smokers. Isn’t that what they were trying 
to tell us? | 

Mr. Greenuousp. What they were trying to tell the committee is 
that there is a high intimacy of association between cigarette smoking 
and lung cancer. What they overlook is the fact- 

Mr. Buatnrx. No; what they were saying, as I understood it, and I 
want you to correct me on it, was that of all of those who die of 
lung cancer, the overwhelming number of those people were smokers 
of long duration and only a relatively small percentage of those people 
did not smoke. Isn’t that correct ? 

Mr. Greennouse. That is correct, but—— 

Mr. Brarnrk. I am lost now. I didn’t think they said 70 percent 
of all the people who die each year die of lung cancer. 

Mr. Greennouse. I say this chart is misleading and I tell you why: 
You can have this insignificant number of 3 people, 2 of them die of 
cancer and 1 of heart disease. 

Mr. Buarnrx. How many people die a year of cancer? 

Mr. Greennouse. Of cancer altogether, I would say about 200,000. 
Lung cancer is about 20,000. But Dr. Steiner, who was quoted here 
yesterday by Dr. Macdonald, states in his article on lung cancer which 
appears in Cancer magazine, a magazine published by the American 
Cancer Society, Dr. Steiner says that lung cancer is such that 2 out of 
every 100 babies born will develop lung cancer between the ages of 
50 and 80, smoking or no smoking. That number will be almost ex- 
actly, or approximately what they are giving you here. But why do 
they say that lung cancer is produced by cigarettes when it is a natural 
trait for persons to have it anyway @ 

I say that 100 million American citizens have been scared to death 
by this type of reporting which is inspired, statistical maneuvering 
to create an impression about a situation which does not exist and I 
am attacking this as a statistician against another statistician. I say 
as a statistician they are twisting figures to create a case. 

Mr. Brarntx. As the statistician, then, do you have figures that 
will prove that a given percentage of babies born will have cancer? 
Are there statistics collected on that? 

Mr. Greennouse. I only auote Dr. Steiner, who is an international 
authority on cancer. 

Mr. BrarntK. Is he a statistician? J thought you were interpret- 
ing statistics. 

Mr. Greennouse. He is a statistician to the extent that he says 2 
out of 100 babies born every year—that is statistics 

Mr. Bratnrx. Was that based on a survey ? 

Mr. Greennouse. That is based on Dr. Steiner’s survey which was 
in part subsidized by the American Cancer Society, itself, which is 
the sponsor of this report. They knew of Dr. Steiner’s statistics when 
they came out with this. 


Now, I am not employed by the tobacco interests. I don’t smoke. 
I have no other interest than to say 100 million American people have 
a right to be protected from this kind of specialized, what you might 
call inspired type of work—they wanted to show, I suppose, that they 
are doing something for the millions they checked. God bless them, 
I subscribe to them, but they ought to wait for laboratory findings. 
The adding machine and calculator should not replace the microscope 
and test tubes. It never can. 

Mr. Brarnix. Thank you very much, Mr. Greenhouse. 

The committee is adjourned. 

(Whereupon, at 12:25 p. m., the subcommittee adjourned to re- 
convene at the call of the chairman.) 



By E. Cuyler Hammond, Se. D. and Daniel Horn, Ph. D. 

Today we will present an analysis of death rates in relation to the smoking: 
habits of 187,788 men who have been traced for an average of 44 months. 

The first results of the study were presented when the subjects had been traced’ 
for 20 months. The major findings at that time were: 

1. The death rate of cigarette smokers was far higher than the death rate: 
of men who had never smoked cigarettes. 

2. Deaths ascribed to cancer accounted for about one-quarter of the excess. 
deaths among cigarette smokers; and deaths ascribed to coronary artery 
disease accounted for over one-half of the excess. 

The study was continued for another 2 years as a check on the earlier findings: 
and to obtain more detailed information on many points of interest, such as: 
the effect of giving up smoking. 

The new information fully confirms the earlier findings as outlined above. 

We will first describe the procedures; then the findings in relation to the total 
death rates; then discuss some of the checks we have made on the accuracy 
of the data; and then describe the findings in relation to specific causes of 


After designing and pretesting a smoking questionnaire, we trained over 22,000" 
American Cancer Society volunteers as researchers for the study. Each re- 
searcher was asked to get a smoking questionnaire filled out by about 10 white 
men between the ages of 50 and 69 whom she Knew well and would be able to 
trace. The researchers were told not to enroll a man if he was seriously ill or 
if they knew he had lung cancer. Once a year thereafter, they reported on each 
man as “alive,” “dead,” or “don’t Know” and recorded all changes of address. 
A copy or abstract of the death certificate was obtained on each death reported. 
Whenever cancer was mentioned on a death certificate, further information was: 
sought from the doctor, hospital, or tumor registry. The study area included 
394 counties in 9 States: California, Illinois, Iowa, Michigan, Minnesota, New 
Jersey, New York, Pennsylvania, and Wisconsin. 


The questioning of subjects began on January 1, 1952, and continued until the 
summer of that year. 'The follow-up procedures were started on November 1 
of each year from 1952 through 1955. The subjects still alive at the end of 
this time had been traced for an average of 44 months. 

1A paper read at the annual meeting of the American Medieal Association, New York 
City, June 4, 1957. 



A total of 204,547 smoking questionnaires were obtained, but we decided to 
exclude the 6,288 men enrolled after May 31, 1952, and an additional 8,405. 
questionnaires were excluded because of incompleteness of information, dupli- 
cation, or administrative difficulties. This left a net total of 189,854 subjects; 
187,783 of them were traced by the volunteers through October 1955 and 11,870: 
deaths were reported. The total experience covered 667,753 man-years. 

Sixty and five-tenths percent of the men in age 55 to 59 had a history of regu- 
lar cigarette smoking. As reported by Haenszel, Shimkin, and Miller, 58 percent 
of the men in age group 55 to 64 were found to have a history of regular 
cigarette smoking in a survey conducted by the Bureau of the Census in Febru- 
ary 1955. 

fh jonly 
= 3600 ¢ | and OTHER 
= (4 CIGARS only 
3 “| PIPES only 
a 3000 
S 2400 
a. /1g00 
Ze Wk206 
< 600 
Age Age Age Age 
50-54 55-59 60-64 65-69 

Slide 1, Total Death Rates by Type of Suoking (Lifetime Fistory) and by Age at Start of Study 


This slide shows death rates per 100,000 man-years by type of smoking fox: 
each of 4 age groups. Age, as shown here and elsewhere in this report, refers 
to the ages of the men at the time they were questioned in 1952. 

Note that, in all four age groups, by far the highest death rate was that for: 
men with a history of regular cigarette smoking only. Men who never smoked 
had the lowest death rate. Men with a history of regular cigarette smoking 
who also smoked cigars and pipes had death rates somewhat lower than the 
death rates of men who smoked cigarettes only. The death rates of men who 
had only smoked pipes were just slightly above the rates for men who never 
smoked. The death rates of cigar smokers were slightly higher than those for 
pipe smokers. 




— i om me oem so 




Smoked Only Only Only Only & Other 
Observed i644 646 925 T74 4406 23910 
Expected 1644 595 76) 694 2625 2028 
Slide 2. 

In order to summarize these findings, we computed the number of deaths which 
would have occurred among men in each smoking category if their age-specific 
death rates had been exactly the same as that for men who never smoked. 
This will be referred to as the ‘expected’ number of deaths. The observed 
number of deaths divided by the expected number is called the mortality ratio. 
By definition, the mortality ratio for men who never smoked is 1.00. In other 
words, the death rate of men who never smoked is taken as a control against 
which the death rate of men in various smoking categories is compared. 

Four thousand four hundred and six deaths occurred among men with a 
history of regular cigarette smoking only. Just 2,623 of these men would have 
died between January 1952 and October 1955 had their age-specific death rates 
been the same as for men who never smoked. The mortality ratio is 1.68. In 
ether words, the death rate of these cigarette smokers was 68 percent higher 
than the death rate of a comparable group of men who never smoked, age being 
taken into consideration. 

The mortality ratio was 1.48 for men with a history of regular cigarette smok- 
ing who also smoked cigars or pipes. It is interesting that these men with mixed 
smoking habits had somewhat lower death rates than men who smoked cig- 
arettes only. This is partly due to the fact that there were fewer heavy cigarette 
smokers among those with mixed habits than among those who smoked cigarettes 
only. However, this does not entirely account for the difference. 

The mortality ratios were 1.22 and 1.12, respectively, for men with a history 
of cigar smoking only and for men with a history of pipe Smoking only. In both 
instances, the difference between the observed and expected number of deaths 
is statistically significant. However, the effect of pipe smoking seems to be 
small as compared with the effect of cigarette smoking. 

Six hundred and forty-six deaths occurred among men with a history of oc- 
casional smoking only as compared with 595 expected. This difference is not 
statistically significant. Therefore, it appears that occasional smoking has 
little or no effect on death rates. 



4000 | 

2-1 Peck o 

ot om of 
we» eo 

oe? e 

Less Than 1/2 



Age Age Ags Age 
$0-54 55-59 60-64 65-69 
Slide 3. Death Rates ty Bamber of Cigarettes Szsoked per Day. Man with a History of Regular Suolring.Only. 


The men with a history of regular cigarette smoking only were classified by 
their current amount of cigarette smoking at the time of questioning in 1952. 
In all four age groups, death rates increased markedly with amount of cigarette 




1.0 F > — ~ gue —-—- — - 
) ome _____. Ma 
NEVER d/2 {-2 
Smoked Pack Packs 
Observed 1644 470 1063 
Expected 1644 S50 1081 541! 

Slide 4, Mortality Ratios by Number of Cigarettes Smoked per Day 



This slide shows the same data summarized in the form of mortality ratios. 
The mortality ratio rose from (a) 1.00 for men who never smoked, (6) to 1.34 
for under one-half-pack-a-day cigarette smokers, (c) 1.70 for one-half to 1 pack 
a day, (ad) 1.96 for 1 to 2 packs a day, and (e) 2.23 for 2 packs or more a day. In 
other words, the death rate of men smoking regularly at a rate of less than one- 
half pack of cigarettes a day was 34 percent higher than the death rate of men 
who never smoked. The death rate of men smoking 1 to 2 packs of cigarettes a 
day was 96 percent higher than the death rate of men who never smoked. The 
death rate of men smoking 2 packs or more of cigarettes a day was 123 percent 
higher than the death rate of men who never smoked. 

The corresponding rates for men with mixed smoking habits were somewhat 
lower than those shown on this slide. 

MORTALITY RATIOS bee ene woee, 

IN 1952 <1 YR 1-10 YRS. 10+YRS. 

SMOKERS IN 1952 . 

IN 1952 <TYR 1:10 YRS, 10+ YRS. 


ae 150 


1644 2303 51 159 141 1326 Leer eS i 
1644 1431 2> ‘l22 “130 658 i 74 58 
Slide 4, Mortality Ratios for Ex-Cigarette Smokers Compared with Men who Never Smoked and Men Still Smoking in 1952 


Ten thousand and ninety-five men with a history of regular cigarette smoking 
only said that they had stopped smoking. These men were classified by the length 
of time since last smoking and by their maximum previous amount of cigarette 

Those who said that they had stopped smoking cigarettes less than a year 
before they were questioned had higher death rates than those who were still 
smoking. Im our opinion, this reflects the effect of health on smoking habits, 
rather than the reverse. That is, some people give up smoking only because 
they are ill. It is probable that there were some such men among the short-time 
ex-smokers. This would account for the high death rates in this group. 

Note the mortality ratios for men who once smoked regularly but less than 
one pack of cigarettes a day. The mortality ratio for those who had given up 
smoking 1 to 10 years before questioning was 1.50, as compared with a mortality 
ratio of 1.61 for men who were still smoking at this level. The death rate of 
those who had not smoked for 10 years or more was not significantly different 
from the death rate of men who never smoked. 

The mortality ratios for one-pack-or-more-a-day cigarette smokers did not crop 
so rapidly after giving up smoking. Nevertheless, the mortality ratio of those 
who had not smoked for 10 years or longer was only 1.50, as compared with & 
mortality ratio of 2.02 for men still smoking a pack or more of cigarettes a day. 


It is interesting that, even 10 or more years after giving up smoking, the death 
rate of the ex-pack-or-more-a-day cigarette smokers was higher than the death 
rate of men who never smoked. Such ex-smokers include both people who stop- 
ped smoking permanently because of bad health and people who did so for 
other reasons. Since people in bad health have an above-average death rate, 
their presence among the longtime ex-cigarette smokers would keep the death rate 
relatively high. This means that the effect of giving up smoking is probably 
greater than these figures would seem to indicate. 

Cigar smokers who had given up the habit for less than a year also had very 
high death rates. The rate dropped after a year of abstinence, but remained 
relatively high. The picture for pipe smokers was roughly the same. 

Per !00,000 Per Year 



3000 PERIOD JAN. 52-OCT. 53 2755 



{1500 1286 
wien Peete 





AS previously mentioned, the findings in the last 2 years of the study con- 
firmed the findings previously reported when the men had been followed for an 
average of 20 months. This slide shows a comparison between findings in the 
two periods of time. The small differences in mortality ratios between com- 
parable groups in the two periods are well within the limits of sampling varia- 


We anticipated that some researchers might be inclined to assume that the 
subjects (most of whom were close friends or relatives) were alive until they 
heard to the contrary. This difficulty was most likely to arise in the case of 
subjects who moved. As a safeguard, we asked the researcher to record all 
changes of address. 

In order to make an independent check of the followup work done by the re- 
searchers, we selected a sample of 38,583 men from 8 groups: (@) A represent- 
ative sample of 60 percent of all the men who said that they had never smoked ; 
(b) all of the men with a history of regular cigarette smoking only who were 
currently smoking 1 to 2 packs of cigarettes a day in 1952; and (c) all of the 
men who were currently smoking 2 or more packs of cigarettes a day in 1952. 
For the sake of brevity, we will hereafter refer to these last two groups com- 
bined as “heavy cigarette smokers.” In the first week of November 1955, we 
mailed a brief questionnaire (asking current cigarette-smoking habits and date 
of birth) to all of these subjects except those whom we knew to be dead. The 


following request was printed on the face of the questionnaire: “If the man 
whose name appears on the other side of this card is dead, check here and re- 
turn this card.” In order to obtain as complete coverage as possible, five suc- 
cessive mailings were used, the last being certified mail requiring that the ad- 
dressee sign a receipt card, which was returned to us by the post office. By 
the end of this mailing process, we had obtained information on all but 2,135 
of the 38,583 men in the sample. Records on these 2,135 men were sent to the 
respective divisions of the American Cancer Society for further checking, and 
1,428 of them were found. Thus, 37,876 of the men were successfully traced, 
this being 98.2 percent of the sample. Entirely independently of this, the vol- 
unteers sent us routine followup: reports on these men, together with reports on 
all the other men in the study. 

We found that there was a time lag in the reporting of some deaths by the 
volunteers. That is, usually about 7 percent of the deaths were reported 1 fol- 
lowup later than they should have been reported. The volunteers missed less 
than 3 percent of deaths which they had had 2 or more opportunities to report. 
For the entire period, the underreporting of deaths by the volunteers amounted 
to only 5.1 percent. 

The most important finding of this checking procedure was that failure of 
the volunteers to report some deaths was unrelated to the smoking habits of 
the men. 


To make doubly sure that no error was introduced by underreporting of deaths 
by the volunteers, all of the subjects with New Jersey addresses were checked 
against the entire list of deaths occurring in the State of New Jersey in 1954 and 
1955.2, No deaths were found which were not either reported by the volunteers 
or discovered in the mail-tracing. 


PERIOD Jan.'52-Oct.'53 PERIOD Nov.'53-Oct.'55 2.10 






Smoked a Only Only Smoked & Only Only 
Other 1+ Packs Other 1+ Packs 

Slide 7. 

This slide shows the age standardized death rates of the men who never 
smoked and the heavy cigarette smokers included in the special sample traced 
by mail as previously described. The period from January 1952 through Octo- 
ber 1953 is compared with the period November 1953 through October 1955. Also 

2This was accomplished through the cooperation of Dr. Marguerite F. Hali, director, 
Division of Vital Statistics and Administration, New Jersey State Department of Health. 


shown are United States white male death rates in the same periods of time 
suitably adjusted for the aging of our study population. 

. In both periods, the death rate of the men who never smoked was about one- 
half the death rate of the heavy cigarette smokers. Actually, the mortality 
ratio—heavy cigarette smokers compared with men who never smoked—was 
somewhat higher in the last 2 years of the study than in the earlier period. 

In the first period the death rate of the heavy cigarette smokers in the study 
was 4.9 percent lower than the United States average. However, in the last 2 
years the death rate of the heavy cigarette smokers was 14.3 percent higher 
than the United States average. The death rates of both the smokers and the 
non-smokers in the study rose, with time, relative to the United States rates. 
We attribute this to the fact that the researchers were instructed not to enroll 
seriously ill men in the study. When a population is selected in this way, the 
death rate is very low for a few months, increases rather rapidly, and returns 
to normal within a few years. 

In the last year of the study, the death rate of the entire study population 
had risen to about 81 percent of the comparable United States rate. By that 
time, the effect of excluding ill men had probably almost worn off. It is doubt- 
ful if the death rate of the study population would eventually rise to quite the 
United States level for three reasons: (a). the subjects were selected from 
counties with slightly lower than average death rates, (6) relatively few of 
the subjects were drawn from the very lowest socioeconomic groups, and (c) 
men in institutions such as tuberculosis sanitoriums and mental hospitals were 

A study was made of socioeconomic status as indicated by occupations stated 
on the death certificates and it was found that the distribution by occupational 
level was about the same for the cigarette smokers as for men who did not 
smoke cigarettes. 

In connection with the independent tracing of the subjects, we asked them 
their date of birth. In some instances it was found that this did not agree 
with the age as stated on the original smoking questionnaire in 1952. An an- 
alysis of the data showed that such discrepancies as occurred in the statement 
of age may perhaps have resulted in a slight under-estimate of the degree of 
asociation between death rates and cigarette smoking. 

Change in Cigarette Smoking Habits of Subjects 
1952 Compared with 1955-1956 

% Not 
1% Smoking} Smoking | 
| Cigarettes | Cigarettes 
Regularly} Regularly 
1955-1956} 1955-1956 | 

Current Cigarette 
Smoking in 1952 

Never Smoked ___ Se ha ae 
3 = 

Smoked, But Not Cigarettes 2. 3% | a ee 
Meee (ex-Getoker) Go| bem | 92.8% | 
Occasional(Ex-Regular [2654 fs. 6% | 
Lee en bie Daye bee | 38.2% | 

E ee 2. 6% 

| 1/2tolPacka Day | 78.4% | 

| 1 plus Packs a Day zk 8 13.8% 
Slide 8, Cigarette Smoking in 1955-1956 Compared 
with Cigarette Smoking of Same Men As Reported in 




Between November 1955 and January 1956, we sent a mail questionnaire on 
current cigarette smoking habits to a sample of over 45,000 of the subjects 
(including all those traced by mail plus several other groups). 

Less than 1 percent of the men who in 1952 said that they had never smoked 
said that they were smoking cigarettes regularly in 1955-56. On the other 
hand, 7.2 percent of the ex-cigarette smokers who had stopped altogether and 
26.4 percent who had cut down to occassional smoking were again smoking ciga- 
rettes regularly in 1955-56; 36.2 percent of the men who previously had said 
that they smoked less than one-half pack a day of cigarettes in 1952; 21.6 per- 
cent of those who previously smoked one-half to 1 pack a day; and 13.8 percent 
of those who previously smoked a pack or more a day said that they were not 
smoking cigarettes regularly in 1955-56. 

Of those who were smoking cigarettes regularly in 1955-56, 28 percent said 
that they smoked filter tip cigarettes. 

It is possible that being subjects for this study had some influence on the 
smoking habits of these men. 


In retrospective studies of habits in relation to disease, the subjects are not 
questioned until after they become ill. Conceivably, illness could bias the way 
in which a person answers questions about his habits. In designing this prospec- 
tive study, we sought to avoid this possibility. It was for this reaosn that we 
instructed the volunteers not to enroll a man if they knew he had lung cancer 
or if he was seriously ill from any disease. As previously described, the trends 
in death rates indicate that seriously ill men were largely excluded in the 
selection of the subjects. 

Obviously, if a researcher enrolled, let us say, Seven or more men with lung 
cancer or other fatal diseases, it is highly probable that at least 1 of them would 
have died within the following 2 years. Conversely, if a reSearcher enrolled 
7 or more men and none of them died within the next 2 years, then it is improb- 
able that she selected seriously ill men. 

This fact gives us a means of eliminating men enrolled by researchers who 
might possibly have misunderstood instruction or deliberately selected sick men. 
Therefore, we made an analysis restricted to men enrolled by researchers who 
almost certainly did not select seriously ill subjects. The results were almost 
identical with the results for the study as a whole as previously described. 




and Cancer 
1.97 All Other 
7 Diseases 

Violence, 1.57 




Smoked Smoked Smoked Smoked Smoked 
OBSERVED 123 363 1058 4593 258 1460 30. «23! 175 669 
EXPECTED !23 385 1058 2924 258 741 30.~—s Bl 175 520 

Slide 9. Mortality Ratios by Major Causes of Death, Cigarette Cmcokers Compared with Men who Never Smoked. 



Having found a high degree of association between cigarette smoking and 
the total death rate, as well as some association between cigar and pipe smok- 
ing and the total death rate, we next sought to determine what diseases were 
involved. The 11,870 deaths were divided into 5 broad categories as shown on 
this slide. 

The death rate from accidents, violence, and suicide was almost exactly the 
same for men with a history of regular cigarette smoking as for men who 
never smoked. 

In contrast, 1,460 cigarette smokers died of cancer compared with an ex- 
pected of only 741 deaths had their age-specific cancer death rates been the 
same as for men who never smoked. The mortality ratio was 1.97. 

The deaths of 4,598 cigarette smokers were attributed to diseases of the heart 
and circulatory system as compared with 2,924 expected; a difference of 1,669 
deaths. The mortality ratio was 1.57. 

Only 338 of the 11,870 deaths were attributed to pulmonary diseases other 
than lung cancer. They showed a very high degree of association with cigar- 
ette smoking. Two hundred and thirty one deaths of cigarette smokers were 
attributed to these pulmonary diseases as compared with only 81 expected. 
The mortality ratio is 2.85. 

The 338 deaths included in this category consisted of 124 attributed to 
pneumonia or influenza, 41 to pulmonary tuberculosis, 76 to asthma, and 97 
~ to other pulmonary diseases including bronchitis, abscess of lung, pneumo- 
coniosis, and bronchiectasis. 

Seventy-eight men with a history of regular cigarette smoking died of 
pneumonia or influenza compared with 20 expected, the mortality ratio being 

Twenty-six cigarette smokers died of pulmonary tuberculosis versus 12 ex- 
pected, giving a mortality ratio of 2.17. 

Fifty-one cigarette smokers died of asthma versus 29 expected, giving a mortal- 
ity ratio of 1.76. 

Other pulmonary diseases accounted for the death of 76 cigarette smokers 
compared with 21 expected, the mortality ratio being 3.62. 

Deaths attributed to all other causes combined (including cause of death 
uncertain or unknown) accounted for less than 10 percent of the 11,870 deaths. 
Taken together, this group showed some association with cigarette smoking as 
shown by the mortality ratio of 1.29. As will be shown later, a few diseases 
in this category account of most of this relationship. 


(All Reported) 

19 eS 
12.8 13.1 Pe pre a 


Smoked Only Only Only Only & Other 
15 8 T ig 249 i48 
S299 11,703 14483 12,109 63,632 44136 
Slide 10. 

Four hundred and forty eight deaths were attributed to primary cancer of 
the lung. Only 15 of these were men who never smoked. Including these 15, 
only 51 had never smoked cigarettes regularly whereas 397 had a history of 
regular cigarette smoking. 

This slide ? shows the age standardized lung cancer death rate by type of 
smoking. The figures at the bottom of the slide indicate the number of men 
enrolled in the study and the number of lung cancer deaths. The rates were 
very low indeed for men who never smoked, occasional smokers, and cigar 
smokers. Pipe smokers had an appreciably higher rate. The rate for men 
with a history of regular-cigarette-smoking-only was nearly 10 times as high 
as the rate for men who never smoked. 

Of the 448 deaths, 32 were microscopically proved adenocarcinomas of the 
bronchus. These were considered separately since some investigators have 
expressed the opinion that this form of cancer may not be related to smoking 
habits; 26 of the 32 cases had a history of regular cigarette smoking, 2 never 
smoked, 1 was an occasional smoker, 2 were pipe smokers, and 1 a cigar smoker. 
The mortality ratio for the cigarette smokers was 4.33. 

8’'The three lung cancer deaths of men with a history of both pipe and cigar smoking 
are not shown on this lantern slide. 



Well Established Diagnosis’ 



Smoked Only Only Only Only & Other 
4 ao 6 13 162 103 
32,392 HLtOS 14,483 12,109 63,632 44,136 

Slide 11. ¥well Established Cases of Pronchogenic Carcinoma Exclusive of Adenocarcinoma 

Of the remaining 416 cases, 295 had microscopically proved cancer with good 
evidence of its being primary bronchogenic carcinoma. This slide shows age- 
standardized death rates for these 295 cases. The picture is much the same as 
in the previous slide except that for these well-established cases the association 
with smoking habits is even more pronounced. 


(All Reported) 

Ex- regular 
Cigaret Smokers Saki 




Never None Occasi. 41/2 1/2-1 1e2 2¢ 
Smoked Pack Pack Packs Pocks 
15 18 2] 24 84 90 27 

32,392 10,095 1,322 7,647 26,370 14,292 3,100 

splaicls) UZ 


This slide shows the age standardized death rates by amount of cigarette 
smoking for men with a history of regular-cigarette-smoking-only. Only 3,100 
men who entered the study said that they smoked cigarettes-only and were 
currently smoking 2 packs or more a day. Within the ensuing 44 months, 27 
of these men had died of lung cancer. On the other hand, out of 32,392 men 
who never smoked, only 15 died with this diagnosis. 


Well Established Diagnosis * 

Ex- regular 
A Smokers 

ennsnprcsse : 11] 

NEVER NONE OCCAS'L wie I72-| i=2 2+ 

Smoked Pack Pack Packs Packs 
4 15 2 13 50 60 22 

S2,o9e 10,095 322 7,647 26,370 14,292 3,100 

Slide 13. “Well Sstablished Cases of Bronchogenic Carcinoma Exclusive of Adenocarcinoma 

This slide shows the figures for well-established cases of bronchogenic car- 
cinoma other han adenocarcinoma. The age standardized death rate for the 
2-pack-or-more-a-day smokers with this diagnosis was 217.3 per 100,000 per year. 
In contrast, the age standardized death rate from microscopically proved cancer 
of all sites combined was only 177.4 per 100,000 per year for men who never 
smoked. In other words, among 2-pack-a-day-cigarette smokers, the death rate 
from bronchogenic carcinoma alone is higher than the total cancer death rate 
of men who never smoked. 



IN 1952 <1 YR. J-10YRS. 10+YRS. 



IN 1952 <1 YR_ 1-10 YRS. 10+ YRS. 

576 56.) 


5 a Gomme 
NEVER Smoked Less Than Smoked | Pack 
SMOKED | Pack o Day or More a Day 

Those of us who are ex-very-heavy-cigarette-smokers have something of a 
personal interest in the lung cancer death rate of men who stopped smoking 

Men currently smoking a pack or more of cigarettes a day in 1952 had a lung 
cancer death rate (well-established cases) of 157.1 per 100,000 per year. Those 
who previously smoked at this level but had given up smoking for from 1 to 10 
years had a rate of 77.6, and those who had given it up for 10 years or longer 
had a rate of only 60.5. 



Cae [43502| 50039 | 46,783, 
62.5% | 60.1% 56.9%] 50.4%| 
lung Cancer*Death Rate 
Sundntind rage | 58 | 46 | 43 | 34 | 
Rate Standardizea for Age 
and Smoking Habits 52 a | SEES 39 

“Well estoblished 

Slide 15. *Well Zstablished Cases of Bronchogenic Carcinoma Exclusive of Adenocarcinoma 


As expected, the lung cancer death rate (well-established cases exclusive of 
adenocarcinoma) was found to be higher in cities than in the country. The age 
standardized death rate was 34 per 100,000 in rural areas as compared with 
56 per 100,000 in cities of over 50,000 population. In other words, the rate was 
39 percent lower in rural areas than in large cities. However, cigarette smoking 
is more common among city dwellers than men in rural areas. Standardized for 
smoking habits as well as for age, the rate was 39 per 100,000 in rural areas and 
52 per 100,000 in cities of over 50,000 population. Thus, when standardized for 
both factors, the rural rate was still 25 percent lower in rural areas than in 
large cities. This difference may be due to some lung cancer producing factor 
associated with city life or to better case finding and diagnosis in cities than in 
rural areas. 

(Excluding Adenocarcinoma) 


: Gn ae yp 
City of City of Suburb or Town Rural 
50,0004 10,000 - 50,000 a 

Never Smoked Regularly ZA Cigoret 

4 83 3 §9 2 0 §2 
8481 28,270 9234 26,133 11,717 28,457 14,186 23,560 

Slide 16, 

However, that may be, the lung. cancer death rate was low among men who 
never smoked cigarettes regularly and high among cigarette smokers in large 
cities, small cities, suburbs and towns, and rural areas. Whatever the urban 
factor may be, its effect on lung cancer death rates is small as compared with the 
effect. of cigarettes as shown by the relative heights of the bars on this slide. 


Tobacco smoke (or saliva and bronchial secretions containing material from 
tobacco smoke) comes into direct contact with the lips, mouth, tongue, pharynx, 
larynx, and esophagus. The death of 127 subjects was attributed to primary 
cancer of these sites. Only 6 of these men had never smoked and 3 were occa- 
sional smokers. The other 118 had a history of regular smoking. One hundred 


fourteen of the one hundred twenty seven cases were microscopically proved and 
only four of these were men who never smoked. Considering microscopically 
proved cases only, the mortality ratio was 7.00 for men with a history of regular 
cigarette smoking; 5.00 for men who smoked only cigars; and 3.50 for men who 
smoked only pipes. Still considering microscopically proved cases: out of 34 
deaths from cancer of the esophagus only 1 was a man who had never smoked ; 
of 25 pharynx cases 2 had never smoked; and of 16 tongue cases 1 had never 
smoked. There were no men who never smoked among 24 larynx cases, 14 mouth 
cases, and 1 lip case. 





20 577. ie) 59 
20 44 10 27 


This slide shows mortality ratios for microscopically proved cancer diagnosed 
as primary in the genitourinary organs. The mortality ratio of cigarette smokers 
was 2.17 for cancer of the bladder, 1.75 for cancer of the prostate, and 1.58 for 
cancer of the kidney. In most of these cases, cancer was present at death in two 
or more of these sites, as well as in other parts of the body. While cancer was 
proved microscopically, the evidence as to the exact primary site was far from 
eonclusive in many instances. 






1.50 g 

1.00 1.00 94 

ous 34 84 919,55 ios, 27 ton 2 3 33 
EXP 34 108 19 59 17 SO 27 66 2 7 




There was no association between cigarette smoking and microscopically 
proved cancer of the rectum. 

The mortality ratio of cigarette smokers for cancer of the colon was 0.77. This 
negative association for cancer of the colon, based on 84 observed versus 108 
expected deaths, is not statistically significant. 

The mortality ratio of cigarette smokers was 1.61 for cancer of the stomach 
and 1.50 for cancer of the pancreas. In neither case was the difference between 
observed and expected deaths statistically significant. 

Deaths from cancer of the liver, gall bladder, and biliary passages appeared 
to be highly associated with cigarette smoking. However, there was reasonable 
doubt as to the primary site in many of these cases. 


Leukemia showed no indication of an association with cigarette smoking. 

Hodgkin’s disease as well as lymphosarcoma and reticulosarcoma appeared 
to be associated with cigarette smoking, but not to a statistically significant 


Coronary Artery Other Heart 

Disease Diseases 
Cordiac Foilure 
1.70 etc) 

Chronic Rheumatic Hypertensive 
Heart Disease Heart Disease 

00 100 60.98 



Smoked Smoked ~ Smoked Smoked 
Obs. 35 lot 57 196 709 _336I 56 _206 
Exp. 35 103 57 174 709 1973 56 148 
Slide 4. 


Of the 11,870 deaths in the study, 5,297 (45 percent) were ascribed to coronary- 
artery disease. Three thousand three hundred and sixty-one of these were 
men with a history of regular cigarette smoking whereas the expected number 
was only 1,973. This is a difference of 1,388 deaths and a mortality ratio 
of 1.70. 

The death rate from chronic rheumatic disease was almost exactly the same 
for cigarette smokers as for men who never smoked. 

The mortality ratio for deaths ascribed to hypertensive heart disease was 
1.13, this being based on 196 observed versus 174 expected deaths. This differ- 
ence is not statistically significant. 

Deaths described as due to myocarditis, cardiac failure, cardiac degenera- 
tion, and similar terms showed a positive association with cigarette smoking. 





(@) at 



Smoked Only Only Only Only & Other 
OBS 709 259 420 312 2026 1335 
EXP. 709 Zor $29 302 1108 866 

€lide <1. 

The coronary artery disease death rate of pipe smokers was just about the 
same as for men who never smoked. However, the mortality ratio for cigar 
smokers was 1.28. This association is statistically significant. Men who 
smoked only cigarettes had by far the highest mortality ratio. 

NEVE «1/2 1/271 ; 
Smoked Pack Pack Packs Packs 
Observed 709 192 864 486 118 
Expected 709 149 456 226 49 



The coronary-artery disease death rate increased steadily with the daily 
consumption of cigarettes; the mortality ratios being 1.00 for men who never 
smoked; 1.29 for less than one-half-a-pack-a-day smokers; 1.89 for one-half to 
1 pack; 2.15 for 1 to 2 packs; and 2.41 for 2-packs-or-more-a-day cigarette 






(Not Heart) 

1.00 4.00 



Never Cigoret Never Cigaret Never Cigaret Never Cigeret Never Cigaret 

Smoked Smoked Smoked Smoked Smoked 
10 27 164 556 ser 260) & 68 pes 1B 
O27 164 428 7 “a 8 25 2 4 
%& Buerger’s disease, aneurysm, varices, arteritis, etc. 
Slide 23 


On the basis of a small number of cases, hypertensive diseases showed no 
indication of an association with cigarette smoking. 

General arteriosclerosis, phlebitis, and embolism have been grouped together 
because of the small number of deaths ascribed to each. Although the mortality 
ratio was 1.46 for these deaths grouped together, no single 1 of these 3 diseases 
showed a statistically significant degree of association with cigarette smoking. 

Sixty-eight cigarette smokers died of aortic aneurysm (described as non- 
syphilitic in origin) as compared with only 25 expected, a mortality ratio 
of 2.72. 

A small number of deaths from Buerger’s disease, aneurysm, varices, and 
arteritis were grouped together. They showed a high degree of association with 
cigarette smoking, the mortality ratio being 4.50. 

A total of 1,050 deaths were ascribed to vascular lesions of the central nervous 
system. Five hundred and fifty-six of these deaths occurred among cigarette 
smokers versus 428 expected, a mortality ratio of 1.30. 

96946—57 22 



3.00 Ulcers 
Duodenal A 
Cirrhosis Ulcers All Other 
of Liver (Incl. cause 
of death 
not specified ) 
2.00 1.93 
1.00 1.00 1.00 
Smoked Smoked Smoked Smoked Smoked 
OBSERVED 33 7 15 83 s 54 Oo 46 9 413 
EXPECTED 33 91 15 43 8 25 o re) 119 362 

Slide 24 

Fifty-one deaths were attributed to gastric ulcers. Forty-six of these were 
men with a history of regular cigarette smoking, 2 had a history of pipe smoking- 
only and 2 had a history of cigar smoking only, and 1 smoked both pipes and 
cigars. Nota single one of these cases was a man who never smoked. 

Deaths attributed to duodenal ulcers were also associated with cigarette smok- 
ing but not to Such a marked degree as gastric ulcers. 

Highty-three deaths to cirrhosis of the liver occurred among cigarette smokers 
compared with 43 expected, a mortality ratio of 1.98. 

Deaths from nephritis and nephrosis showed no association with smoking. 

Diabetes deaths were negatively associated with cigarette smoking but not to 
a statistically significant degree. 

The limitations of time do not permit us to further discuss these findings. 
Moreover, we greatly regret that we cannot review the excellent work which has 
been done on this subject in this country and abroad. 


Our first concern was to study total death rates in relation to smoking habits. 
We found a high degree of association between total death rates and cigarette 
smoking; a far lower degree of association between total death rates and cigar 
smoking; and a small degree of association between total death rates and pipe 

Having found a considerable relationship between cigarette smoking and 
total death rates, we then sought to determine what diseases were involved. 
Our available source of information was cause of death as recorded on death 
certificates supplemented by more detailed medical information on cases where 
eancer was mentioned. 





Over 50 Less Than 50 
Cigaret Smoker | Cigaret Smoker 

Over 50 Less Than 50 
Cigaret Smoker | Cigaret Smoker 
Deaths Deaths 

31.00 —T Lung (Exc. Adeno) 

& Larynx, Pharynx 
= 7.00 Esophagus, Tongue 
ee Mouth Lip 
& 6,00 
~@ 5.00 
2 Liver-Gallbladder Buerger's Disease, 
is. denoca. Lung Varices,Arteritis, 
oO 4.00 Etc, 
= Pneumonia 
| Other Pulmonary 
8 3.00 
=) Hodgkin's Disease | Aortic Aneurysm 
g (Non-Syphilitic) 
= Bladder Duodenal Ulcer {Pulmonary 
3 2.00 Tuberculosis 
= °° Cirrhosis of Liver 
g Prostate Lymphosarcoma | Asthma 
Reticulosarcoma; |Coronary Artery 
Stomech ! 
1.50 Pancreas anes, Aortic Aneurysm 
yocarditis } Arteriosclerosis 
Cardiac Failure) {Phlebitis-Embolism 
Cerebral Yascular 
Hypertensive Heart 
5 Nephritis 
200 Other Hypertensim 
As Leukemia Chron. Rheum.Heart 
on Brain Diabetes 
Slide 25 

An analysis of the data showed the following relationships with cigarette 

(1) An extremely high association for a few diseases such as cancer of 
the lung, cancer of the larynx, cancer of the esophagus, and gastric ulcers; 

(2) A very high association for a few diseases such as preumonia and 
influenza, duodenal ulcer, aortic aneurysm, and cancer of the bladder ; 

(3) A high association for a number of diseases such as coronary artery 
disease, cirrhosis of the liver, and cancer of several sites; 

(4) A moderate association for cerebral vascular lesions. 


Coronary Artery Disease: 1, 388 52.1% 

Oe 13.5% 

Lung Cancer: 360 

Other Cancer: 359 ee 13.5% 

Other Heart & Circ.: 154 ; oe 15.8% 
Pulmonary (Exc. Ca.): 150 eee 5. 6% 
Cerebral Vascular: 128 fol 4.8% 
Gastric & Duod. Ulcers: 75 i 2.8% ae Ran nae 
i J : g Expected Deaths: 4,651 
Cirrhosis of Liver: 40 ae 1.5% Excess Deaths: 2,665, 
All Other: 11 ff 0.4% ; mee 
Total 2,665 
“Slide 26, 

The relative importance of the associations listed above is dependent upon the 
number of deaths attributed to each disease as well as upon their degrees of 
association with cigarette smoking. Coronary artery disease accounted for 
52.1 percent of the excess deaths among cigarette smokers; lung cancer accounted 
for 13.5 percent; cancer of other sites accounted for 13.5 percent; other heart 
and circulatory diseases 5.8 percent; pulmonary diseases (other than lung 
eancer) 5.6 percent; cerebral vascular lesions 4.8 percent; gastric and duodenal 
ulcers 2.8 percent; cirrhosis of the liver 1.5 percent; and all other diseases com- 
bined 0.4 percent. . 

We found little or no association between cigarette smoking and a number 
of diseases including: chronic rheumatic fever, hypertensive heart disaese, other 
hypertensive diseases, nephritis and nephrosis, diabetes, leukemia, cancer of the 
rectum, cancer of the colon, and cancer of the brain. 



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