ADDRESS

       BY
C, EVERETT KOOP, MOD,
   SUXGEON GENERAL

U,S, PUBLIC HEALTH SERVICE

         AND

  DEPUTY ASSISTANT SECRETAZY FOR HEALTH
U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

   PF~ESENTED AT TKE PANEL ON SMOKING AND HEALTH

JOHN F, KENNEDY SCHOOL 8~ GOVERNMENTAARVARD UNIVERSITY
        CAMBRIDGE, MASSACHUSETTS
           SEPTEMBER 4, 1986


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

  I AM DELIGHTED TO JOIN YOU THIS AFTERNOON TO PLAY A SMALL PART IN
THIS HISTORIC CELEBRATION OF HARVARD'S 35gTH ANNIVERSARY AND THE
KENNEDY SCHOOL'S 50TH ANNIVERSARY,

   IT ALL SOUNDS LIKE SUCH A LONG TIME, BUT HARVARD HAS BEEN HERE
FOR ONLY 7 GENERATIONS, ,,BACK TO THE TIME OF OUR

GREAT- GREAT- GREAT- GREAT- GREAT-GRANDPARENTS,

  THAT'S NOT SO FAR BACK, MANY OF YOU PROBA3LY KNOW OF TWO OR
THREE GREAT-GRANDPARENTS IN YOUR OWN FAMILY OR IN YOUR COMMUNITY
TODAYvMEN AND WOMEN WHO'VE LIVED A LITTLE BIT M3RE THAN A CENTURY,
                                                                  *


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  THEY HAD TO HAVE BEEN BORN IN THE AGE OF BRAHMS AND TOLSTOY,,,AND
LOUIS PASTEUR,,,AND ROBERT KOCH, AND THEY MIGHT HAVE HEARD STORIES

TOLD BY THEIR OWN GRAND-PARENTS OF THE DELIGHTS OF MOZART AND
GOETHE,, ,AND THE WONDERS OF LAVOISIER AND- EDWARD JENNER,

SO IT'S NOT SO LONG AGO,

  BUT A LOT HAS HAPPENED IN MEDICINE AND HEALTH ACROSS THOSE
GENERATIONS, AND WE'VE LEARNED A GREAT MANY THINGS THAT CAN HELP OUR
OWN GENERATION BE A LITTLE BIT HEALTHIER AS WE LIVE A LITTLE BIT
LONGER,

  THAT'S WHAT THIS SMOKING PROBLEM IS REALLY ALL ABOUT, WHAT MY
PREDECESSORS AND I HAVE BEEN DOING IS TELLING PEOPLE THAT SCIENCE HAS
COME UP WITH NEW AND IMPORTANT INFORMATION -- SOMETHING SCIENCE HAS
BEEN DOING SINCE ARISTOTLE -- THAT PROVES THE LETHALITY OF CIGARETTE

SMOKING,


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  OVER THE PAST 30 YEARS ALMOST A GENERATION OF BIOMEDICAL
RESEARCHERS, PHYSICIANS, AND PUBLIC HEALTH PERSONNEL FROM MORE THAN 80
COUNTRIES HAVE GENERATED THE HARD EVIDENCE LINKING CIGARETTE SMOKING
TO ABOUT TWO DOZEN SERIOUS DISEASE CONDITIONS,

THE \lORLD MEDICAL LITERAiJRE HAS AN INVENTORY OF MORE THAN 50,000
STUDIES ON SMOKING AND HEALTH,  THE OVERWHELMING MAJORITY OF THESE
STUDIES CLEARLY IMPLICATE CIGARETTE SMOKING EITHER AS A CONTRIBUTING
CAUSE OR AS THE PRIMARY CAUSE OF ILLNESS AND DEATH:

WE KNOW THAT A PERSON WHO SMOKES HAS A RISK OF SUDDEN CARDIAC
DEATH THAT IS 3 TIMES THE RISK OF A NON-SMOKER,


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WE KNOh' THAT ABOUT 85 PERCENT OF ALL LUNG CANCERSJN 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 25 TIMES
GREATER THAN THE DEATH RATE FOR NON-SMOKERS,

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 AMGNG .OLDER PEOPLE
WHO'VE SMOKED, BUT IT'S RARELY FOUND AMONG OLDER NON-SMOKERS,
DOESN'T THAT TELL YOU SOMETHING?

AND 't/E KNOW THAT PREGNANT WOMEN HAVE AN INCREASED RISK OF
DELIVERING THEIR BABIES PREMATURELY ,,,OF ABORTING THE FETUS
SPONTANEOUSLY ,,,OF DELIVER,ING A STILLBORN CHILD,,aOR OF GIVING

BIRTH TO A CHILD WHO SIMPLY WON'T HAVE THE ABILITY TO SURVIVE MORE
THAN A FE'vJ DAYS OUTSIDE THE WOMB,


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  THOSE ARE THE FACTS OF A CASE THAT IS SCIENTIFICALLY
CONCLUSIVE:

SMOKING IS THE LEADING PREVENTABLE CAUSE
OF DISEASE AND DEATH IN TtiIS COUNTRY,

  THAT VERDICT OF SCIENCE HAS BEEN RENDERED EVER SINCE THE FIRST
"SURGEON GENERAL'S REPORT ON SMOKING AND HEALTH," RELEASED IN 1964 BY
THEN-SURGEON GENERAL LUTHER L, TERRY,

  BY THE TIME I ASSUMED THE POSITION OF SURGEON GENERAL IN 1981,
ANOTHER DOZEN REPORTS HAD BEEN RELEASED BY THREE MORE SURGEONS
GENERAL: DRS, STEWART, STEINFELD, AND RICHMOND, BY THE TIME DR,
JULIUS RICHMOND LEFT WASHINGTON AND RETURNED HERE TO HARVARD, THE
SCIENTIFIC CASE AGAINST CIGARETTES WAS AIR-TIGHT,


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  NEVERTHELESS, SINCE 1981 WE'VE PRODUCED 4 MORE REPORTS, THEY
DOCUMENT THE RELATIONSHIP BETWEEN SMOKING AND CANCER, SMOKING AND
CARDIOVASCULAR DISEASE, SMOKING AND LUNG DISEASE, AND, THE MOST RECENT
ONE, ON SMOKING AS AN ADDITIONAL OCCUPATIONAL HAZARD,

  I MIGHT ADD THAT THIS PROCESS OF RESEARCH AND PUBLIC EDUCATION
HAS CONTINUED THROUGH 5 PRESIDENTS -- TWO DEMOCRATS AND THREE
REPUBLICANS -- AND THROUGH 10 SESSIONS OF THE UNITED STATES
CONGRESS,

   IT HAS CONTINUED THROUGH LAVISH BUDGETS AND THROUGH TIGHT BUDGETS
AND IS STILL GOING, ,,GRAMM-RUDMAN-HOLLINGS NOT'dITHSTANDING,

  THE GOVERNMENT'S LATEST STEP HAS BEEN TO REQUIRE XGARETTE
MANUFACTURERS TO PUT NEW AND STRONGER WARNINGS ON THEIR PACKAGES AND
IN ALL THEIR ADVERTISING,

THERE ARE 4 VERSIONS AND THEY MUST BE ROTATED EVERY 3 MONTHS,


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THERE'S NOTHING FANCY OR VAGUE ABOUT THESE WARNINGS:

+   ONE CATEGORICALLY-SAYS THAT "1, LiMOKING CAUSES LUNG CANCER,
HEART DISEASE, EMPHYSEMA, AND MAY COMPLICATE PREGNANCY?

+

   ANOTHER IS MORE SPECIFIC AND 'dARNS THAT ',,,PREGNANT WOMEN
'dH0 SMOKE RISK FETAL INJURY AND PREMATURE BIRTH,"

*

  A THIRD MAKES IT CLEAR TO EVERYONE THAT 'LCIGARETTE SMOKE

CONTAINS CARBON MONOXIDE,'

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  THE FOURTH WARNING SAYS THAT 'LQUITTING SMOKING NOW GREATLY
REDUCES SERIOUS HEALTH RISKS,' IN OTHER WORDS, IT'S NEVER TOO
LATE TO QUIT, IT'S NOT EASY TO DO, SINCE NILOTINE IS THE MOST
ADDICTIVE DRUG IN OUR SOCIETY, BUT IT'S NEVER'TOO LATE TO DO,


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  THEY AREN'T :JHAT YOU'D CALL "NSHY-WASHY" MESSAGES, THEY'RE TttE
BLUNT TRUTH AND ARE FIRMLY IMPLANTED IN FEDERAL LAWwCHAPTER 15,
SECTION 1331 OF THE UNITED-STATES CODE, TO BE EXACT,

THAT, IN ABBREVIATED FORM, IS THE CASE AGAINST CIGARETTES SO FAR,

   BUT THE INFORMATION GATHERED SO FAR MAINLY CONCERNS THE HEALTH OF
PEUPLE 'dH0 SMOKE,  HOWEVER, THAT'S BEGINNING TO CHANGE, SINCE WE NO;/
KrJOW THAT BEHIND EVERY CLOUD OF MAINSTREAM SMOKE, JS A CLOUD OF
SMOKE,
SIDESTREAM

'/{HAT DOES THAT MEAN?

  SMOKERS ENGAGE IN "MAINSTREAM" SMOKING-THAT IS, THEY INHALE THE
SMOKE DIRECTLY INTO THEIR LUNGS FROM THE CIGARETTE'AND NOT FROM THE
AMBIENT AIR AROUND THEM, BUT THE "SIDESTREAM" SMOKER INVOLUNTARILY
INHALES THE CIGARETTE SMOKE THAT'S IN THE AMBIENT AIR,


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  ABOUT 10 YEARS AGO :ilE BEGAN TO PERCEIVE THIS NEW ASPECT OF THE
SMOKING ISSUE, WE BEGAN TO LEARN ABOUT THE EFFECTS OF CIGARETTE SMOKE
UPON THE HEALTH OF NONSMOKERS, ,,THE SO-CALLED "SIDESTREAM" SMOKERS,

FOR EXAMPLE, THE CHILDREN OF PARENTS WHO SMOKE HAVE A MUCH HIGHER
RATE OF COLDS AND OTHER UPPER RESPIRATORY INFECTIONS, COMPARED TO
CHILDREN WHOSE PARENTS DO NOi SMOKE,

WE'VE ALSO LEARNED THAT THE NONSMOKING WIFE OF A SMOKER RUNS A
HIGHER RISK OF LUNG CANCER THAN DOES THE NONSMOKING 'dIFE OF A
NONSMOKER, BEFORE LONG, WE EXPECT TO HAVE CLEAR EVIDENCE THAT THE
SAME IS ALSO TRUE FOR THE INCIDENCE OF HEART DISEASE, EMPHYSEMA,
AND CONGESTIVE LUNG DISEASE AMONG NONSMOKING WIVES OF SMOKERS,


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AND "SIDESTREAM" SMOKERS EXPOSED TO OTHER PEOPLES' HEAVY SMOKING
IN THE SAME ENCLOSED WORK-SPACE ABSORB AS MUCH SMOKE AS IF THEY
THEMSELVES WERE "MAINSTREAM" SMOKING TWO OR THREE CIGARETTES PER
DAY,                                              *

  JUST WHAT fi IT IN CIGARETTE SMOKE THAT'S SO HARMFUL FOR
EVERYBODY, SMOKER AND NON-SMOKER ALIKE?

  WELL, FOR STARTERS BOTH THE "SIDESTREAM" SMOKER AND THE
"MAINSTREAM" SMOKER BREATHE IN THE SAME 4,000 OR SO CONSTITUENTS OF
CIGARETTE SMOKE, THEY BOTH INHALE THE SAME TARS, THE SAME NAPTHALENE,
THE SAME PYRENE, AND THE SAME BENZOPYRENE, THEY ABSORB THE SAME
CARBON MONOXIDE, METHANE, AMMONIA, ACETYLENE, AND HYDROGEN CYANIDE,


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ODDLY ENOUGH, SCIENTISTS HAVE DISCOVERED THAT SOME OF'THESE TOXIC

AGENTS ARE FOUND IN GREATER CONCENTRATIONS IN SIDESTREAM SMOKE THAN IN
MAINSTREAM SMOKE:

0  T&, FOR EXAMPLE, THE SUBSTANCE THAT IS THE MOST CARCINO-
GENIC, IS 70 PERCENT MORE CONCENTRATED IN SIDESTREAM SMOKE THAN IN
MAINSTREAM SMOKE, , ,

0   CARBON MONOXIDE IS TWO AND A HALF TIMES MORE CONCENTRATED IN
SIDESTREAM SMOKE THAN IN MAINSTREAM SMOKE,,,

0   NICOTINE IS 2,7 TIMES GREATER IN SIDESTREAM SMOKE,,,

0   AMMONIA IS 73 TIMES MORE CONCENTRATED IN SIDESTREAM

SMOKEmAND SO ON,


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  THIS OUGHT TO BE ALARMING NEWS FOR TWO-THIRDS OF THE AMERICAN
ADULT POPULATION,,,THE PEOPLE WHO DO NOT NOW SMOKE,,,OR WHO THINK THEY
DO NOT NOW SMOKE,

  THEY MAY HAVE SAVED THEMSELVES FROM THE "STINK" AND THE "MESS" OF

SMOKING, mm BUT THEY ARE NOT COMPLETELY PROTECTED FROM ALL THE HEALTH
HAZARDS OF SMOKING, THOSE HAZARDS ARE IN THAT SAME AMBIENT AIR k/E
NON-SMOKERS SHARE WITH SMOKERS,

  IT'S THAT KIND OF INFORMATION THAT HAS BECOME THE FOUNDATION OF
THE MOVEMENT BY NON-SMOKERS TO 3AN SMOKING IN VIRTUALLY EVERY PUBLIC
SPACE AND IN ALL PUBLIC TRANSPORT ALL ACROSS THE UNITED STATES AND, I
AM PLEASED TO REPORT, IN A NUMBER OF OTHER COUNTRIES AS WELL,


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  IT'S A TREMENDOUS GRASSROOTS CAMPAIGN AND IT'S DIRECTED AGAINST
ONE OF THE MOST POWERFUL MEMBERS OF THE AMERICAN ECONOMY,

  YOU'RE AWARE, I AM SURE, OF THE ECONOMIC POWER OF THE CIGARETTE
INDUSTRY,  IT ACCOUNTS FOR 2,$ PERCENT OF THE NATION'S GROSS NATIONAL
PRODUCT, OR $63 BILLION,  IT SPENDS OVER $2 BILLION A YEAR JUST ON
ADVERTISING, THAT'S ABOUT $8 FOR EVERY PERSON IN THE UNITED STATES,,,
SMOKER AND U-SMOKER ALIKE,

  DESPITE THE BILLIONS OF DOLLARS THAT IT'S SPENDING, I STILL
BELIEVE THAT THE DAYS OF THE CIGARETTE INDUSTRY ARE NUMBERED,

  HISTORY IS ON THE SIDE OF THE NON-SMOKER, THE CIGARETTE INDUSTRY
AS WE KNOW IT, FOR ALL ITS ENORMOUS ECONOMIC POWER, WILL DISAPPEAR
OVER THE NEXT 20 YEARS AND WE WILL BECOME A SMOKE-FREE SOCIETY, WHICH
IS A GOAL I SET FOR OUR COUNTRY 2 YEARS AGO,


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  FOR EXAMPLE, I BELIEVE THE ANTI-SMOKING ATTITUDE IN THIS COUNTRY
WILL BECOME SO FORCEFUL THAT, WELL BEFORE THE TURN OF THE CENTURY,
SMOKERS WILL NOT LIGHT UP IN THE PRESENCE OF NON-SMOKERS WITHOUT
ASKING FOR AND OBTAINING THEIR PERMISSION

WE ARE ALREADY SEEING TH; DECLJNE OF PER CAPITA CIGARETTE
CONSUMPTION,, ,DOWN TO ITS LOWEST LEVELS SINCE 1944,, ,A TREND THAT

LOOKS LIKE IT WILL CONTINUE,

  DESPITE MERGERS AND BUY-OUTS INVOLVING FOOD COMPANIES, THE
CIGARETTE INDUSTRY IS NOT -- AND WILL NEVER AGAIN BE -- A GROWTH
INDUSTRY,

   I SINCERELY HOPE THAT THE MEN AND WOMEN WHO RUN THE CIGARETTE
COMPANIES ARE DOING THEIR HOMEWORK, I HOPE THEY'RE BEGINNING TO
"THINK THE UNTHINKABLE" 1, #THAT IS, I HOPE THEY'RE PREPARING THEM-
SELVES FOR THE KIND OF ROLE THEY ALSO CAN PLAY IN A COUNTRY THAT IS
SMOKE-FREE,


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   I CAN ASSURE THEM -- AND I WANT TO ASSURE THE AMERICAN PEOPLE AS

WELL -- THAT THE PUBLIC HEALTH SERVICE AND ITS SURGEON GENERAL WILL DO
WHATEVER WE CAN, CONSISTENT WITH OUR COMMITMENT AND WITH THE LAW, TO
HELP THOSE INDUSTRY LEADERS BECOME THE KIND OF EMPLOYERS AND THE KIND
OF CITIZENS WHO THRIVE IN A BUSINESS THAT ENHANCES LIFEwNOT THE KIND
THAT INVITES DEATH,

   SO I THINK THE AMERICAN PEOPLE ARE WINNING THE BATTLE AGAINST
SMOKING, THE SINGLE MOST SIGNIFICANT AND MOST PREVENTABLE CAUSE OF
DEATH IN OUR SOCIETY,

OUR MOTIVATION IS TO PROTECT AND STRENGTHEN THE PUBLIC HEALTH,

  AND OUR WEAPONS IN THIS BATTLE ARE BIOMEDICAL SCIENCE, maPUBLIC
EDUCATI3NmAND THE LAW,

THANK YOU,