C,

ORIGINAL

SMOKING AND CANCER

     BY
EVERETT KOOP, MD, ScD
SURGEON GENERAL

    OF THE

UI S, PUBLIC HEALTH SERVICE

DUBLIN, IRELAND


(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,)

  DURING MY TIME AS SURGEON GENERAL, I'VE BEEN GIVEN A NUMBER OF
COMPLEX ASSIGNMENTS, HAVING TO DO WITH THE TREATMENT OF HANDICAPPED
CHILDREN, THE TRANSPLANTATION OF MAJOR ORGANS, THE IMPROVEMENT OF THE

NATIONAL BLOOD SUPPLY,, ,AND NOW, AIDS,

  BUT ONE ISSUE WAS WAITING FOR ME WHEN I FIRST TOOK UP MY POSITION
AND IT'S BEEN PART OF MY DAILY AGENDA FOR THE PAST 6 YEARS

THAT ISSUE IS,, JMOKING,

  DURING THE PAST 6 YEARS, I'VE BEEN IN THE FOREFRONT OF THE

CAMPAIGN TO REDUCE THE LEVEL OF SMOKING IN OUR SOCIETY -- IF NOT

ELIMINATE IT ALTOGETHER,


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  AT FIRST, I HAD THE ASSIGNMENT SIMPLY BECAUSE IT BELONGED IN MY

OFFICE, I HAD NO CHOICE IN THE MATTER, BUT NOW, AFTER BEING IMMERSED

IN THE ISSUE FOR A NUMBER OF YEARS, AND AFTER CLOSELY OBSERVING JUST

HOW THE CIGARETTE INDUSTRY WORKS, I'M KEEPING THE ASSIGNMENT BY

CHOICE,

  IN FACT, IN ADDITION TO MY OWN ANNUAL REPORTS ON SMOKING AND

HEALTH, I ANNOUNCED THE GOAL OF MAKING THE UNITED STATES A SMOKE-FREE

SOCIETY BY THE YEAR 2000, AND SINCE THEN, I AM PLEASED TO REPORT,

OTHER HEALTH MINISTERS IN OTHER ENLIGHTENED NATIONS HAVE VOICED THE

SAME HOPE FOR THEIR PEOPLES AS WELL,

I ANNOUNCED THAT GOAL 3 YEARS AGO, AND FRANKLY I WASN'T SURE IF

IT COULD BE ACHIEVED IN MY COUNTRY,


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  BUT I FEEL MUCH MORE SECURE ABOUT IT TODAY, THE RESPONSE FROM

AVERAGE AMERICANS -- THE PEOPLE AT THE "GRASS ROOTS," AS WE SAY -- HAS

BEEN VERY POSITIVE AND VERY STRONG,

  MANY VOLUNTARY AND PROFESSIONAL ASSOCIATIONS -- INCLUDING ALL THE

MAJOR ONES IN MEDICINE AND PUBLIC HEALTH -- PLUS LITERALLY MILLIONS OF

ORDINARY CITIZENS HAVE TAKEN UP THE CHALLENGE OF MAKING AMERICA SMOKE-

FREE BY THE YEAR 2000,

HOW COULD THIS HAVE HAPPENED?

  THE ANSWER LIES IN THE MASSIVE FOUNDATION OF RESEARCH,, ,AN

ACCUMULATION OF 30 YEARS' CJORTH OF SOLID DATA ON THE HAZARDS OF

SMOKING,


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  BIOMEDICAL RESEARCHERS, PHYSICIANS, AND PUBLIC HEALTH PERSONNEL

IN OVER 80 COUNTRIES HAVE GENERATED MORE THAN 50,000 STUDIES ON

SMOKING AND HEALTH, ABOUT 2,000 MORE ARE ADDED EACH YEAR,

I CALL IT OUR "EMBARRASSMENT OF RICHES,"

  AND THE OVERWHELMING MAJORITY OF ALL THESE STUDIES CONCLUDE THAT

CIGARETTE SMOKING EITHER IS A CONTRIBUTING CAUSE OR IS THE PRIMARY

CAUSE OF ILLNESS AND DEATH,

THANKS TO THE RESEARCH OF THE PAST 30 YEARS,, ,

WE KNOW,, ,THAT A PERSON WHO SMOKES HAS A RISK OF SUDDEN CARDIAC

DEATH THAT IS 3 TIMES THE RISK OF THE PERSON WHO DOES NOT SMOKE,


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WE KNOW,, @THAT ABOUT 85 PERCENT OF ALL LUNG CANCERS IN THE UNITED

STATES ARE CAUSED BY CIGARETTE SMOKING, PEOPLE WHO SMOKE A COUPLE

OF PACKS A DAY HAVE A LUNG CANCER DEATH RATE THAT IS AS MUCH AS 25

TIMES GREATER THAN THE RATE FOR PEOPLE WHO DON'T SMOKE AT ALL,

WE KNOW,, #THAT CIGARETTE SMOKING IS THE MAJOR CAUSE OF CHRONIC

OBSTRUCTIVE LUNG DISEASE, ESPECIALLY EMPHYSEMA AND CHRONIC

BRONCHITIS, IN FACT, EMPHYSEMA IS QUITE COMMON AMONG OLDER PEOPLE

WHO'VE SMOKED, BUT IT'S RARELY FOUND AMONG OLDER NON-SMOKERS,

AND WE KNOW,, ,THAT WOMEN WHO ARE PREGNANT HAVE AN INCREASED RISK

OF DELIVERING THEIR BABIES PREMATURELYmanOR OF ABORTING THE FETUS

SPONTANEOUSLY,,,OR OF DELIVERING A STILLBORN CHILD,,,OR OF GIVING

BIRTH TO A CHILD WHO IS UNABLE TO SURVIVE MORE THAN A FEW DAYS

OUTSIDE THE WOMB,


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  THOSE ARE FACTS THAT HAVE BEEN GENERATED SINCE 1964 BY FIVE

SURGEONS GENERAL AND ME -- THE SIXTH TO CARRY ON THIS WORK, THE FACTS

HAVE BEEN PUBLISHED IN 18 OFFICIAL REPORTS IN THE PAST 23 YEARS,

I SAY THAT THE SCIENTIFIC CASE AGAINST CIGARETTES IS AIR-TIGHT,

  AND I AM JOINED IN THAT OPINION BY THE VAST MAJORITY OF THE MEN
AND WOMEN IN MEDICINE AND PUBLIC HEALTH TODAY, NOT JUST IN THE UNITED

STATES,, #BUT AROUND THE WORLD,

  THE WORLD HEALTH ORGANIZATION HAS BEEN COLLECTING THIS KIND OF

DATA FOR SEVERAL YEARS, WHERE SMOKING IS PREVALENTwDISEASE IS
PREVALENT, ALSO, EVEN CUBA, OF ALL PLACES, WHERE TOBACCO HAS BEEN AN

IMPORTANT CASH CROP FOR CENTURIESmEVEN CUBA HAS REPORTED TO THE
W,H,O, THAT SMOKING-RELATED DISEASES ACCOUNT FOR 30 PERCENT OF ALL

PREMATURE DEATHS ANNUALLY,


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AND BY THE WAY, IT'S NO ACCIDENT THAT THE W,H,O, PROGRAM IS

CALLED AN "ACTION PROGRAMME ON TOBACCO & HEALTH,"

  AS I SAY, THE PUBLIC HEALTH CASE AGAINST SMOKING IS AIR-TIGHT,

BUT IS HAS SO FAR DEALT MAINLY WITH THE HEALTH RISKS OF PEOPLE WHO
SMOKE, THE SO-CALLED MAINSTREAM SMOKERS WHO INHALE SMOKE DIRECTLY FROM

THE CIGARETTE,

  HOWEVER, BEHIND THE CLOUD OF MAINSTREAM SMOKE IS NO SILVER LINING

BUT ANOTHER CLOUDwAND IT'S KNOWN AS SIDESTREAM SMOKE, THE CIGARETTE
SMOKE THAT NON-SMOKERS INHALE INVOLUNTARILY FROM THE AMBIENT AIR,


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  RESEARCH IN SIDESTREAM SMOKE HAS EVOLVED SLOWLY BUT STEADILY OVER

THE PAST 10 YEARS SO THAT, BY NOW, WE HAVE A PRETTY GOOD IDEA OF ITS

EFFECTS, AND WE PUBLISHED THOSE DATA AND OUR CONCLUSIONS IN THE 18Tti

SURGEON GENERAL'S REPORT ON SMOKING AND HEALTH, WHICH WE RELEASED IN

DECEMBER OF 1986,

THAT REPORT INDICATES, FOR EXAMPLE, THAT,, ,

THE CHILDREN OF PARENTS WHO SMOKE HAVE A MUCH HIGHER URnI, RATE,

COMPARED TO CHILDREN WHOSE PARENTS DO NOT SMOKE,

"SIDESTREAM" SMOKERS EXPOSED TO OTHER PEOPLES' HEAVY SMOKING IN

THE SAME WORK-SPACE ABSORB AS MUCH SMOKE AS IF THEY THEMSELVES

WERE "MAINSTREAM" SMOKING TWO OR THREE CIGARETTES PER DAY,


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AND 'SIDESTREAM' SMOKE ITSELF CAN C>AUSE DISEASE, INCLUDING LUNG

CANCER, IN OTHERWISE HEALTSHY NON-SMOEKRS, FOR EXAMPLE, THE

RESEARCH SO FAR INDICATES THAT THE NON-SMOKING WIFE OF A SMOKER

RUNS A HIGHER RISK OF LUNG CANCER THAN DOES THE NON-SMOKING WIFE

OF A NON-SMOKER,
  AND THE NEW RESEARCH NOW IN THE PIPELINE WILL
UNDOUBTEDLY SHOW THAT NON-SMOKING WIVES OF SMOKERS ARE AT A HIGHER

RISK FOR HEART DISEASE, EMPHYSEMA, AND CONGESTIVE LUNG DISEASES AS

WELL,

THAT'S THE 'BAD NEWS,'  IS THERE ANY 'GOOD NEWS'? YES, THERE IS'

  WE CAN TAKE SOME COMFORT IN THE FACT THAT CIGARETTE CONSUMPTION

IN THE UNITED STATES IS GOING DOWN, AS A MATTER OF ACT, PER CAPITA

CONSUMPTION IS AT ITS LOWEST POINT IN ABOUT 40 YEARS,,,ABOUT 2,500

CIGARETTES PER CAPITA PER YEAR,


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  NOT AS GOOD AS IRELAND, I UNDERSTAND, WHICH HAS A LEVEL OF ABOUT
1,800 CIGARETTES PER CAPITA PER YEAR, BUT STILL, NOT BAD-AND IT fi

DECLINING,

  AND THAT DROP IN CONSUMPTION HAS OCCURRED DESPITE AN ENORMOUS
INDUSTRY BUDGET FOR ADVERTISING AND PROMOTION: WELL OVER 82,l BILLION

A YEAR, I AM TOLD BY EXPERTS IN THE ADVERTISING INDUSTRY,

  WHILE THE SUCCESS RATE FOR QUITTERS IS NOT OVERWHELMING, THE

SMOKING POPULATION IN THE UNITED STATES HAS NEVERTHELESS DROPPED FROM

42 PERCENT TO LESS THAN 29 PERCENT OF THE POPULATION AS A WHOLE,


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  BUT MORE IMPORTANT THAN JUST THESE RAW FIGURES IS THE FACT THAT

THE TREND LINES ARE DOWN ACROSS ALL AGE GROUPS AND FOR BOTH SEXES,

I'M VERY ENCOURAGED BY THE CONTINUED DROP AMONG TEEN-AGERS, AND

THAT'S A VEYR GOOD SIGN, THAT'S THE FUTURE,

   THE ONLY DISCOURAGING SIGN IS THE FACT THAT THE DECREASE AMONG

WOMEN IS VERY SLIGHTwIN FACT, IT'S BARELY PERCEPTIBLE, AND THAT MAY

EXPLAIN WHY LUNG CANCER IS NOW THE LEADING CAUSE OF CANCER DEATHS

AMONG WOMEN,, ,NOT BREAST CANCER BUT LUNG CANCER,, ,AND IT WILL PROBABLY

CONTINUE TO BE THE LEADING CAUSE FOR MANY YEARS TO COME,

AND THAT'S A SHAME,

PEOPLE WHO SMOKE PLACE A LARGE BURDEN UPON THEMSELVES, THEIR

FAMILIES, AND THEIR SOCIETY,


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  FOR EXAMPLE, I WAS IN TEXAS JUST A FEW WEEKS AGO AND THE PEOPLE

IN THAT STATE ESTIMATE THAT SMOKING ADDS ABOUT $1.2 BILLION TO THEIR

OVERALL ANNUAL DIRECT COSTS OF MEDICAL CARE,

  THEY ALSO ESTIMATE THAT THE STATE COMES UP SHORT ANOTHER $1,7

BILLION AS A RESULT OF LOST INCOME AND PRODUCTIVITY BECAUSE OF

SMOKING-RELATED MORBIDITY AND PREMATURE DEATH,

  NATIONALLY WE PUT THE FIGURE NOW AT ABOUT $65 BILLION FOR BOTH

DIRECT MEDICAL COSTS AND THE INDIRECT COSTS OF LOST INCOME AND

PRODUCTIVITY, AS A RULE OF THUMB, WE NOW SAY THAT SMOKING ACCOUNTS

FOR ABOUT 25 PERCENT OF THE TOTAL DIRECT PERSONAL HEALTH CARE

EXPENDITURES RELATED TO NEOPLASMS AND DISEASES OF THE CIRCULATORY AND

RESPIRATORY SYSTEMS,

   SO THE TREND LINES FOR CIGARETTE CONSUMPTION MAY BE GOING DOWN,

BUT WE ARE FAR FROM THE DAY WHEN WE CAN FEEL SMUG ABOUT HOW WELL WE'VE

DONE, THERE'S STILL A VERY BIG JOB LEFT TO BE DONE,


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WHAT, THEN, ARE THE POLICY IMPLICATIONS OF ALL THESE DATA?

  I THINK THE FACTS ARE CONVINCING ENOUGH BY NOW TO ENCOURAGE US TO

TRY TO REACH THAT GOAL OF A SMOKE-FREE SOCIETY WITHIN THE NEXT 12

YEARS,,,OR AT LEAST COME VERY, VERY CLOSE,

  TO DO THAT WE SHOULD CLARIFY AND STRENGTHEN THE 4-ELEMENT

STRATEGY THAT HAS WORKED SO WELL IN OUR COUNTRY UP TO NOW, THEY ARE

RESEARCH, EDUCATION, ECONOMICS, AND NON-SMOKER MILITANCY.

  THE FIRST AND PRINCIPLE ELEMENT IS RESEARCH,
                    THE ANTI-SMOKING

PROGRAM IS, AFTER ALL, A PUBLIC HEALTH PROGRAM, AS SUCH, IT REQUIRES

A FIRM BASIS IN SCIENCE, WE HAVE SUCH A BASE ALREADY, AS I MENTIONED

EARLIER, BUT WE NEED TO EXPAND IT WITH NEW BIOMEDICAL AND

BIOBEHAVIORAL DATA,


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  THIS IS EXACTLY WHAT WE'RE DOING IN THE UNITED STATES, AS PART OF

OUR OVERALL NATIONAL RESEARCH AGENDA, AND WHAT MOST OF THE DEVELOPED

NATIONS OF THE WORLD ARE DOING AS WELL,

CIGARETTE RESEARCH HAS VIRTUALLY BECOME AN INDUSTRY UNTO ITSELF,

THE SECOND ELEMENT IS PUBLIC EDUCATION,

  SMOKING IS A SPECIFIC HUMAN BEHAVIOR,,,AND EDUCATION IS THE ONLY

SURE WAY TO CHANGE HUMAN BEHAVIOR OVER THE LONG TERM, THE ANTI-

SMOKING CAMPAIGNS PUT ON THUS FAR BY BOTH PUBLIC AND PRIVATE AGENCIES

HAVE BEEN VERY EFFECTIVE AND OUGHT TO BE CONTINUED, IT MAKES GOOD

POLICY SENSE TO CONTINUE THEM ON AN EVEN LARGER SCALE, IF RESOURCES

PERMIT,


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   I THINK ONE EXCELLENT ASPECT OF THE NEWEST EDUCATION CAMPAIGNS IS

THE EMPHASIS ON THE FACT THAT SMOKING NOT ONLY CAUSES LUNG CANCER --

WE ALREADY KNOW THAT -- BUT THE RESEARCH HAS ALSO SHOWN THAT CIGARETTE

SMOKING IS ALSO THE PRINCIPAL CAUSE OF LARYNGEAL CANCER, m ,A MAJOR

CAUSE OF ORAL AND ESOPHAGEAL CANCERS,,,AND A SIGNIFICANT CONTRIBUTORY

FACTOR IN THE DEVELOPMENT OF HEAD, NECK, BLADDER, KIDNEY, STOMACH, AND

PANCREATIC CANCERS,

  THIS, OF COURSE, IN ADDITON TO THE INFORMATION THAT SMOKING ALSO

CAUSES OTHER KINDS OF HAVOC IN THE LUNGS -- EMPHYSEMA AND CHTRONIC

BRONCHITIS, FOR EXAMPLE -- AND IS ASSOCIATED WITH MANY KINDS OF DAMAGE

TO THE DEVELOPING FETUS,

WHAT DO WE HOPE TO ACHIEVE THROUGH THESE EDUCATION CAMPAIGNS?


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  ACTUALLY, WE'VE SET SOME GOALS FOR OURSELVES, WE HOPE, FOR

EXAMPLE, TO ACHIEVE A 50 PERCENT REDUCTION IN THE CANCER MORTALITY

RATE BY THE YEAR 2000, THIS MEANS REDUCING -- ALSO BY 50 PERCENT --

THE LEVEL OF SMOKING IN OUR COUNTRY,

  IT ALSO MEANS BETTER DIET -- LES FAT AND MORE FIBER -- AS WELL AS

IMPROVED SCREENING AND CANCER DETECTION PROGRAMS AND, OF COURSE,

CONTINUED IMPROVEMENT IN CANCER THERAPIES,

  BUT THE KEY TO A MAJOR REDUCTION IS TO CUT THE RATE OF SMOKING,

AND THAT CAN ONLY BE ACHIEVED THROUGH EDUCATION,, ,EDUCATIONn, &AND MORE

EDUCATION,


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  THE THIRD ELEMENT OF OUR NATIONAL STRATEGY IS ECONOMIC, WHEN YOU

RAISE THE COST OF A PACK OF CIGARETTES, YOU LOWER THE RATE OF

CIGARETTE CONSUMPTION, IT'STHAT SIMPLE,

  A 10 PERCENT INCREASE IN THE PRICE OF A PACK OF CIGARETTES, FOR

EXAMPLE, WILL TRANSLATE INTO A 4 PERCENT DECREASE IN CIGARETTE

CONSUMPTION AMONG ADULTS AND A 14 PERCENT DECREASE AMONG ADOLESCENTS,

LAST YEAR, THE UNITED STATES CONGRESS RAISED THE TAX ON

CIGARETTES AND WILL DO SO AGAIN,

MEANWHILE, INDIVIDUAL STATE GOVERNMENTS ARE ADDING A FEW CENTS OF

THEIR OWN ON TOP OF THAT,  THAT ALSO IS AN IRREVERSIBLE TREND,

  ANOTHER ASPECT OF THIS ECONOMIC FACTOR IS THE SAVINGS THAT

EMPLOYERS MAY REALIZE IF THEIR EMPLOYEES DO NOT SMOKE, AND THIS IS AN

ASPECT THAT I PERSONALLY HAVE BEEN EXAPNDING ON WITH MANY AUDIENCES OF

BUSINESSMEN AROUND THE UNITED STATES,


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   IF A COMPANY INSTITUTES A "SMOKE-FREE" POLICY AMONG ITS EMPLOYEES

OR ON ITS PREMISES, THEY WIILL DISCOVER THAT THEIR FIRE INSURANCE

PREMIUMS WILL BE LOWER,,,THEIR FLEET AUTO INSURANCE BECOMES

CHEAPER,, ,THEIR HEALTH INSURANCE PREMIUMS WILL ALSO GO DOWN, ,,THE

RATES FOR EMPLOYEE ABSENTEEISM WILL TEND TO DECLINE, WHILE

PRODUCTIVITY RATES WILL TEND TO GO UP,, ,AND SO ON,

  ALSO, WE HAVEN'T SEEN THE LAST OF THE PRODUCT LIABILITY CASES

AGAINST THE CIGARETTE INDUSTRY, IN FACT, ABOUT 100 SUCH CASES ARE NOW

BEFORE THE COURTS, AND EACH PLAINTIFF IS ASKING FOR A LARGE CASH

SETTLEMENTmNOTHING LESS THAN A MILLION DOLLARS, AND SOME MANY ITMES

THAT MODEST AMOUNT,


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  THE SHEER COST OF DEFENDING AGAINST THIS MANY PLAINTIFFS IN

COURTS ALL ACROSS THE UNITED STATES IS PROBLEM ENOUGH FOR THE TOBACCO

INDUSTRY,  ADD TO THAT THE POSSIBILITY OF LOSING ANY ONE OF THEM, AND
YOU HAVE THE MAKINGS OF AN INDUSTRY NIGHTMARE, A PRODUCT LIABILITY

JUDGMENT AGAINST CIGARETTES WOULD BE AN ENORMOUS ECONOMIC BLOW TO THE

CIGARETTE INDUSTRY,

AND I BELIEVE THAT JUST SUCH A JUDGMENT WILL COME TO PASS,

SO MUCH FOR THE ECONOMICS OF THE ANTI-SMOKING STRATEGY,

  THE FOURTH ELEMENT IS THE RISING MILITANCY OF THE NON-SMOKER,

THE TOBACCO INDUSTRY ITSELF HAS COME TO RECOGNIZE THE MILITANT NON-

SMOKER AS THE MOST SERIOUS THREAT TO THE INDUSTRY SINCE THE FIRST

SURGEON GENERAL'S REPORT IN 1964,


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  NON-SMOKERS, CONCERNED ABOUT RISKS TO THEIR OWN HEALTH PRESENTED
BY OTHER PEOPLE WHO SMOKE, ARE THE ONES WHO ARE DEMANDING -- AND

GETTING -- THE NO-SMOKING ORDINANCES, REGULATIONS, AND LAWS THAT ARE

GOING INTO EFFECT DAILY ALL ACROSS THE UNITED STATES,

  THIS IS SERIOUS BUSINESS, HENCE, THE TOBACCO INDUSTRY IS TRYING

TO FIGHT BACK,  IT HAS MOUNTED A COSTLY PROPAGANDA EFFORT TO CONVINCE

THE WORLD THAT SMOKERS HAVE SOME SORT OF CONSTITUTIONAL "RIGHT TO
SMOKE," WHICH IS AN ABSOLUTELY PREPOSTEROUS AND INTELLECTUALLY

BANKRUPT IDEA,

  COULD ANYONE HONESTLY BELIEVE THAT SMOKING A CIGARETTE IS ON A
PAR WITH VOTINGnnSPEAKING YOUR MIND,,,OR WORSHIPPING GOD?

THE TOBACCO INDUSTRY WOULD SAY "YES,"

AND THEY OUGHT TO BE ASHAMED OF THEMSELVES,


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  IN ANY CASE, STATE AND LOCAL GOVERNMENTS ARE RESPONDING WITH THE

CLEAR MESSAGE THAT THE SO-CALLED "RIGHTS" OF SMOKERS END WHEN THEIR

ADDICTION AFFECTS THE HEALTH AND WELL-BEING OF OTHER PEOPLE WHO DON'T

SMOKE, AND THAT'S ALL THERE IS TO IT,

  SO FAR, MORE THAN 40 STATES, THE DISTRICT OF COLUMBIA, AND

HUNDREDS OF COMMUNITIES HAVE LAWS PROHIBITING SMOKING IN PUBLIC BUILD-

INGS AND ALL FORMS OF PUBLIC TRANSPORTATION,, ,IN RESTAURANTS,, #RETAIL

STORES,, SPORTS ARENAS,, aTHEATERS,, ,AND MANY OTHER PUBLIC PLACES,

AND 9 STATES HAVE LAWS THAT RESTRICT SMOKING BY EMPLOYEES OF THE

PRIVATE SECTOR,


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  I'M PLEASED TO SAY THAT OUR DEPARTMENT OF HEALTH AND HUMAN

SERVICES BECAME VIRTUALLY SMOKE-FREE AS OF JULY 1, WHEN THE NEW NO-

SMOKING REGULATIONS TOOK EFFECT IN ALL OUR FACILITIES,, ,OFFICES,

LABORATORIES, CLINICS, AND SO ON,

   ONE STATE -- MINNESOTA -- HAS A LAW THAT SAYS YOU CAN'T SMOKE IN

ANY PUBLIC PLACE UNLESS THERE'S A SIGN POSTED THAT SAYS YOU MAY,

  THOSE, THEN, ARE THE FOUR ELEMENTS THAT ARE SHAPING OUR NATIONAL

POLICY IN REGARD TO SMOKING: RESEARCH,, ,EDUCATION,, ,ECONOMICS . , aAND

THE MILITANCY OF THE NON-SMOKER, TOGETHER THEY FORM A STRATEGY THAT

HAS BEEN SUCCESSFUL OVER THE PAST 20 YEARS, AND I BELIEVE THEY WILL

CONTINUE TO WORK FOR US, AS WE FORGE AHEAD TO OUR GOAL OF BEING A

SMOKE-FREE SOCIETY BY THE YEAR 2000,


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  I'M VERY OPTIMISTIC, OF COURSE,, 'BUT I'M NOT NAIVE, THE TOBACCO

INDUSTRY IS A FORMIDABLE OPPONENT, IT IS POURING MONEY INTO PRINT

ADVERTISING,,,BILLBOARDS, JULTURAL EVENTSwSPORTS EVENTSwYOU NAME

IT, THE LAST FIGURES I HAVE INDICATE THAT THE INDUSTRY SPENDS MORE

THAN $2 BILLION A YEAR ON ADVERTSING AND PROMOTION,, ,OR ABOUT $8 FOR

EVERY MAN, WOMAN, AND CHILD IN THE UNITED STATES,

  WE DON'T ALLOW CIGARETTES TO BE ADVERTISED ON RADIO AND TELE-

VISION, THIS YEAR, WE BEGAN THE DEBATE OVER WHETHER CIGARETTES SHOULD

BE ADVERTISED, a ,AT ALL,


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  I WAS INVITED BY THE CONGRESS TO GIVE MY OWN VIEWS ON THE MATTER
AND I HAVE SAID THAT I THINK ALL CIGARETTE ADVERTISING SHOULD BE

BANNED,

  THERE IS STILL MUCH TO BE SAID ON BOTH SIDES, I AM TOLD, BUT I

BELIEVE THE DAYS OF THE INDUSTRY ARE NUMBERED AND NO AMOUNT OF

ADVERTISING IS GOING TO CHANGE THAT FACT,

  BUT, AS I INDICATED BEFORE, THAT'S NO REASON TO BE SMUG, THE

INDUSTRY IS STILL CAPABLE OF DOING MUCH MISCHIEF WITH THE HEALTH OF

YOUNG PEOPLE, WOMEN, BLUE-COLLAR WORKERS, AND MINORITIES,, 'ALL OF WHOM

MAKE UP THE BULK OF THE REMIANING 53 MILLION OR SO SMOKERS IN THIS

COUNTRY,


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  WE MAY BE UPSET AT THEM FOR CONTINUING TO SMOKE,,BUT THAT'S NO
REASON TO ABANDON THEM, AND I, FOR ONE, CANNOT DO THAT, AND I ASK ASK

EACH AND EVERY ONE OF YOU TO REMAIN IN THE FIGHT TO RID OUR SOCIETY OF

CIGARETTES BY THE END OF THE CENTURY,

  I KNOW WE CAN DO IT, AND I WANT TO ASSURE YOU THAT THE USa
PUBLIC HEALTH SERVICE AND ITS SURGEON GENERAL -- I AND WHOEVER ELSE

COMES AFTER ME -- WILL DO WHATEVER WE CAN TO MAKE THAT DREAM OF A

SMOKE-FREE SOCIETY COME TRUE,


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  I INTEND TO LEAVE FOR MY SUCCESSOR NOT JUST THE 13 SMOKING-AND-
HEALTH REPORTS THAT 1 FOUND, BUT THE ADDITIONAL .$ REPORTS THAT WILL BE
MY CONTRIBUTION TO THIS COUNTRY'S LIFE-SAVING CAMPAIGN AGAINST

CIGARETTES,

AND I WILL ALSO LEAVE A NOTE INVITING THAT PERSON TO PLEASE

CONTINUE THE TRADITION,

THANK YOU,

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