ADDRESS

        BY
C, EVERETT KOOP, M,D,, Sc,D,
   SURGEON GENERAL

US PUBLIC HEALTH SERVICE

          AND

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

PRESENTED AS THE ANNUAL AARON BROWN LECTURE
TULANE UNIVERSITY SCHOOL OF MEDICINE
      NEW ORLEANS, LOUISIANA
        MARCH 17, 1987

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

   I'M HONORED TO BE YOUR CHOICE AS TO PRESENT THIS YEAR'S AARON
BROWN LECTURE, I'M ESPECIALLY DELIGHTED BECAUSE DRn BROWN WAS AN

ALUMNUS OF MY OWN MEDICAL SCHOOL,,,CORNELL,,,AND, OF COURSE, HE ALSO

FOUNDED OUR HOST ORGANIZATION, PHI DELTA EPSILON,

   WHAT A DIFFERENT AGE DR, BROWN LIVED IN, MEDICINE WASN'T THE BIG
STORY THEN,  IT WAS PHYSICS, wESPECIALLY RADIOACTIVITY AND ELECTRI-
CITY a  AND THE "BIG NAMES" OF HIS DAY, THE ONES THAT DOMINATED THE
WORLD OF SCIENCE, WERE ROENTGEN AND MAX PLANCK, ,,THE CURIES, MARIE AND

PIERREmAND MARCONIwAND EINSTEIN,

   BUT TODAY, THE WORLD SEEMS MORE DIVERSE AND THE DOMINATING "BIG
NAMES" MAY STILL BE IN PHYSICSwBUT THEY'RE ALSO IN MEDICINE AND
CHEMISTRY AND BIOLOGY AND PSYCHOLOGY,

   THE OPTIONS FOR YOUNG PEOPLE TODAY SEEM TO BE SO MUCH MORE
VARIED, BUT THAT MAY ONLY REFLECT THE DEGREE OF COMPLEXITY OF MODERN
LIFE IN GENERAL, AND, IN FACT, MY SUBJECT TODAY DEALS WITH JUST ONE

ASPECT OF THAT COMPLEXITY a ,,BUT A VERY DISTURBING ONE NEVERTHELESS:

  I'M GOING TO TALK ABOUT HABIT OF SMOKING CIGARETTES,


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  YOUR COMMITTEE SUGGESTED THAT TOPIC AND I QUICKLY AGREED, BECAUSE
SMOKING IS THE SUBJECT WITH WHICH I HAVE BEEN ASSOCIATED THROUGH THE
YEARS I'VE BEEN SURGEON GENERAL,

  WAITING FOR ME IN MY NEW OFFICE AS THE SURGEON GENERAL, BACK IN
NOVEMBER 1981, WAS MY OWN PERSONAL COPY OF EACH OF THE PREVIOUS 13
REPORTS BY FOUR SURGEONS GENERAL ON THE RELATIONSHIP BEWTWEEN SMOKING
AND HEALTH,

  DURING MY TIME AS YOUR SURGEON GENERAL, I'VE BEEN GIVEN MANY NEW
ASSIGNMENTS,,,THE "BABY DOE" CASE, ,,ORGAN TRANSPLANTS,, CARE FOR THE
AGED-NOW AIDS,


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  BUT ONE ISSUE WAS WAITING FOR ME AND HAS BEEN A PART OF MY DAILY

AGENDA FOR THE PAST FIVE AND A HALF YEARS: AND THAT ISSUE IS SMOKING,

DURING ALL THIS TIME, I'VE BEEN IN THE FOREFRONT OF THE CAMPAIGN TO
REDUCE, IF NOT ELIMINATE ALTOGETHER, SMOKING FROM OUR SOCIETY,

AT FIRST, I HAD THE ASSIGNMENT BECAUSE IT BELONGED TO MY OFFICE,

   BUT NOW, AFTER BEING IMMERSED IN THE DATA FOR A FEW 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 4 SMOKE-FREE
SOCIETY BY THE YEAR 2000,


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  I ANNOUNCED THAT BACK IN MAY OF 1984 AND THE RESPONSE WAS
IMMEDIATE AND STRONG -- AND IT'S GOTTEN CONSISTENTLY STRONGER EVER
SINCE, TENS OF DOZENS OF VOLUNTAYR AND PROFESSIONAL ORGANIZATIONS,
INCLUDING ALL THE MAJOR ORGANIZATIONS IN MEDICINE, PLUS LITERALLY
MILLIONS OF ORDINARY CITIZENS, HAVE TAKEN UP THE CHALLENGE OF MAKING
AMERICA SMOKE-FREE BY THE YEAR 2000,

  AS A RESULT OF THIS KIND OF RESPONSE ALL ACORSS THIS COUNTRY, I
AM CONVINCED THAT MOST AMERICANS REALLY UNDERSTAND THE SIGNIFICANCE OF
THE ANTI-SMOKING CAMPAIGN,

AND JUST WHAT Is THAT SIGNIFICANCE?

  IN ITS SIMPLEST TERMS, THE ACHIEVEMENT OF A SMOKE-FREE SOCIETY
WILL INSURE THAT WE WILL HAVE RESCUED THE PEOPLE OF AMERICA FROM THE
PREVENTABLE BURDEN OF SMOKING-RELATED ILLNESS AND DEATH, ,.A BURDEN
THEY HAVE BEEN CARRYING FAR TOO LONG AT A FAR TOO HEAVY A PRICE,


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  AND I WANT TO EMPHASIZE THOSE KEY WORDS -- "PREVENTABLE BURDEN OF
SMOKING-RELATED ILLNESS AND DEATH" -- FOR TWO VERY GOOD REASONS:

FIRST, SMOKING IS A PERSONAL CHOICE, NO ONE IS REQUIRED TO

SMOKE,  IN FACT, ANYONE CAN -- AND SHOULD -- CHOOSE NOT TO SMOKE
AS THE FIRST AND MOST IMPORTANT ACT OF PERSONAL, PREVENTIVE HEALTH
CARE,

SECONDLY, THE SCIENTIFIC RECORD IS CLEAR ON THE RELATIONSHIP
BETWEEN CIGARETTE SMOKING AND ABOUT T'dO DOZEN SERIOUS DISEASE
CONDITIONS, MOST OF THEM WITH HIGH FATALITY RATES,


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  OVER THE PAST 30 YEARS BIOMEDICAL RESEARCHERS, PHYSICIANS, AND
PUBLIC HEALTH PERSONNEL FROM MORE THAN 80 COUNTRIES HAVE GENERATED
MORE THAN 50,000 STUDIES ON SMOKING AND HEALTH, ABOUT 2,000 MORE ARE
ADDED EACH YEAR, IT'S AN EMBARRASSMENT OF RICHES,

  AND INCIDENTALLY A GOOD DEAL OF THAT INFORMATION HAS BEEN
GENERATED RIGHT HERE IN LOUISIANA BY RESEARCHERS FUNDED NOT ONLY BY
THE NATIONAL INSTITUTES OF HEALTH BUT ALSO BY YOUR OWN STATE'S
MILLION-DOLLAR "CANCER AND LUNG TRUST FUND," DRAWN APPROPRIATELY
ENOUGH FROM CIGARETTE TAX REVENUES,

  ONE OF THE MOST IMPORTANT ON-GOING STUDIES FUNDED BY NtI,Ha IS,
OF COURSE, TULANE'S "BOGALOOSA HEART STUDY," WHICH IS A RICH MINE OF
BEHAVIOR-RELATED DATA ON SMOKING AND HEALTH, IF ANYONE IN THIS
AUDIENCE IS PARTICIPATING IN THIS RESEARCH, PLEASE ACCEPT MY PERSONAL
WORD OF GRATITUDE,


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  THOSE 50,000 STUDIES HAVE GENERATED A GREAT DEAL OF INFORMATION,

BUT THEY ARE INTERESTING FROM ANOTHER POINT OF VIEW, ALSO, THE OVER-
WHELMING MAJORITY OF ALL THE STUDIES THAT HAVE BEEN DONE 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 25 YEARS,,,

WE KNOW, ,,THAT A PERSON WHO SMOKES HAS A RISK OF SUDDEN CARDIAC
DEATH THAT IS 1. TIMES THE RISK OF THE PERSON WHO DOES NOT SMOKE,

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,


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WE KNOWwTHAT 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
CJHO'VE SMOKED, BUT IT'S RARELY FOUND AMONG OLDER NON-SMOKERS,

AND WE KNOW, a ITHAT WOMEN WHO ARE PREGNANT HAVE AN INCREASED RISK
OF DELIVERING THEIR BABIES PREMATURELY a, ,OR OF ABORTING THE FETUS
SPONTANEOUSLY maOR OF DELIVERING A STILLBORN CHILDwOR OF GIVING
BIRTH TO A CHILD WHO IS UNABLE TO SURVIVE MORE THAN A FEW DAYS
OUTSIDE THE WOMB,

  THOSE ARE THE FACTS THAT HAVE BEEN GENERATED SINCE 1964 BY FIVE
SURGEONS GENERAL -- LUTHER TERRY, WILLIAM STEWART, JESSE STEINFELD,
JULIUS RICHMOND, AND I -- AND PUBLISHED IN 18 OFFICIAL REPORTS,

   I REGARD THE SCIENTIFIC CASE AGAINST CIGARETTES AS BEING AIR-
TIGHT, AND I AM JOINED IN THAT OPINION BY THE VAST MAJORITY OF THE
MEN AND WOMEN IN MEDICINE AND PUBLIC HEALTH TODAY,


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  THROUGH THE YEARS, THOSE REPORTS BY THE SURGEONS GENERAL HAVE
DOCUMENTED THE RELATIONSHIP BETWEEN, 8,

SMOKING AND CANCER,, n

SMOKING AND CARDIOVASCULAR DISEASE,, ,

SMOKING AND LUNG DISEASE, n,

SMOKING, CANCER, AND CHRONIC LUNG DISEASE AMONG
      WORK1 NG PEOPLE,

AND -- THE MOST RECENT ONE -- ON THE EFFECTS
  OF PASSIVE SMOKING,


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  THE CONCLUSION OF EACH REPORT HAS BEEN UNEQUIVOCAL: SMOKING IS A
MAJOR CONTRIBUTOR TO THE INCIDENCE'OF SIGNIFICANT FATAL DISEASES IN
THE POPULATION,

  AND I MIGHT ADD THAT THIS PROCESS OF RESEARCH AND PUBLIC
EDUCATION HAS CONTINUED, ,n

THROUGH 5 PRESIDENTS, T'dO DEMOCRATS AND THREE REPUBLICANS,,,

THROUGH 10 SESSIONS OF THE UNITED STATES CONGRESS,,,

AND RIGHT THROUGH GRAMM-RUDMAN-HOLLINGS,

  AND NOW, FOLLOWING THE MOST RECENT LAW PASSED BY THE CONGRESS AND
SIGNED BY PRESIDENT REAGAN, THE MANUFACTURERS OF CIGARETTES MUST PUT
NEW AND STRONGER WARNINGS ON THEIR PACKAGES AND IN ALL THEIR
ADVERTISING,


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  THERE ARE 4 VERSIONS AND YOU'VE PROBABLY SEEN ALL OF THEM BY NOW,
SINCE THEY MUST BE ROTATED EVERY 3 MONTHS,

  THERE'S NOTHING FANCY ABOUT THESE WARNINGS, THEY'RE IN THE SAME
PLAIN ENGLISH THAT ANY FAMILY PHYSICIAN WOULD USE -- AND SHOULD USE --
WITH A PATIENT WHO SMOKES, AND THERE'S NOTHING VAGUE ABOUT THEM

EITHER,

9

  ONE CATEGORICALLY SAYS THAT ' ,,,SMOKING CAUSES LUNG CANCER,
HEART DISEASE, EMPHYSEMA, AND MAY COMPLICATE PREGNANCY,"

*

  ANOTHER WARNS THAT fi an ,PREGNANT WOMEN WHO SMOKE RISK FETAL
INJURY AND PREMATURE BIRTH,"

9   A THIRD SAYS THAT n ,,,CIGARETTE SMOKE CONTAINS CARBON
MONOXIDE,"


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*   THE FOURTH WARNING SAYS THAT ",,,QUITTING SMOKING NOW GREATLY
REDUCES SERIOUS HEALTH RISKS,"  THIS IS A TOUGH ONE, BECAUSE WE
KNOW THAT NICOTINE IS PROBABLY THE MOST ADDICTIVE DRUG IN OUR
SOCIETY, STILL, SMOKERS MUST TRY, BECAUSE, AS THIS LABEL IMPLIES,
IT'S NEVER TOO LATE TO QUIT,

  THAT, BRIEFLY, IS THE CASE OF "THE PEOPLE VERSUS TOBACCO/' IN MY

OPINION, IT'S OPEN-AND-SHUT,

  BUT, AS YOU MAY HAVE GATHERED ALREADY, THE CASE THUS FAR HAS
DEALT MAINLY WITH THE HEALTH RISKS OF PEOPLE j&& 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 THAT DATA AND OUR CONCLUSIONS IN THE 18Tti

SURGEON GENERAL'S REPORT, WHICH WE RELEASED LAST DECEMBER THE 16Ti-1,

THAT REPORT INDICATES, FOR EXAMPLE, THAT-

THE CHILDREN OF PARENTS WHO SMOKE HAVE A MUCH HIGHER U,R,I, RATE,
COMPARED TO CHILDREN WHOSE PARENTS DO NOT SMOKE,

AND THE NONSMOKING WIFE OF A SMOKER RUNS A HIGHER RISK OF LUNG
CANCER THAN DOES THE NONSMOKING WIFE OF A NONSMOKER,
                       I BELIEVE
WE'LL SOON FIND THE SAME THING ALSO TRUE FOR THE INCIDENCE OF

HEART DISEASE, EMPHYSEMA, AND CONGESTIVE LUNG DISEASES AMONG

NONSMOKING WIVES OF SMOKERS,


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ALSO, "SIDESTREAM" SMOKERS EXPOSED TO OTHER PEOPLES' HEAVY SMOKING
IN THE SAME OFFICE SPACE OR WORKROOM ABSORB AS MUCH SMOKE AS IF
THEY THEMSELVES WERE "MAINSTREAM" SMOKING TWO OR THREE CIGARETTES
PER DAY,

AND SO ON,

  NOW, JUST WHAT Is IT IN CIGARETTE SMOKE THAT IS SO HARMFUL FOR
EVERYONEmWHETHER YOU'RE A "SIDESTREAM" OR A "MAINSTREAM" SMOKER?

  FIRST OF ALL, YOU BOTH BREATHE IN THE SAME 4,000 OR SO CONSTITU-
ENTS OF CIGARETTE SMOKE:

YOU BOTH INHALE THE SAME TARS, THE SAME NAPTHALENE, AND THE SAME
PYRENE AND BENZOPYRENE, mm


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YOU ABSORB THE SAME CARBON MONOXIDE, METHANE, AMMONIA, AND
ACETYLENE,, a

AND YOU INHALE THE SAME HYDROGEN CYANIDE,

  ODDLY ENOUGH, SCIENTISTS HAVE DISCOVERED THAT SOME OF THESE TOXIC
AGENTS ARE FOUND IN GREATER CONCENTRATIONS IN SIDESTREAM SMOKE THAN IN
MAINSTREAM SMOKE,

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

0   CONCENTRATIONS OF CARBON MONOXIDE ARE TWO AND A HALF TIMES
GREATER IN SIDESTREAM SMOKE THAN IN MAINSTREAM SMOKE,,,


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0   NICOTINE IS 287 TIMES GREATER IN SIDESTREAM SMOKE,,,

0   AMMONIA IS 73 TIMES GREATER IN SIDESTREAM SMOKEwAND SO ON,

  AND THE MOST RECENT RESEARCH IN THIS AREA INDICATES THAT
NONSMOKERS RETAIN THESE POISONS IN THEIR BLOODSTREAMS TWICE AS LONG AS
SMOKERS DO,

  I HOPE THAT MY LECTURE TODAY WILL CONVINCE AT LEAST THOSE
PHYSICAL CHEMISTS IN THE AUDIENCE WHO NOW SMOKE THAT IT REALLY IS TIME
FOR THEM TO QUIT,

  BUT THIS IS EXACTLY THE KIND OF INFORMATION THAT HAS SPURRED ON
THE MOVEMENT BY NONSMOKERS TO BAN SMOKING IN VIRTUALLY EVERY PUBLIC
SPACE AND IN ALL PUBLIC TRANSPORT,


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  IT'S THE KIND OF DATA THAT CONVINCED THE TOWN COUNCILS OF ASPEN,
COLORADO, AND BEVERLY HILLS, CALIFORNIA, TO BAN SMOKING IN PUBLIC
SPACES WITHIN THEIR RESPECTIVE JURISDICTIONS

  BUT THIS IS MORE THAN JUST A FIGHT FOR CLEAN AIR IN RESTAURANTS
OF EVEN MORE SIGNIFICANCE IS THE GROUNDSWELL THAT'S DEVELOPING TO BAN
SMOKING WHERE PEOPLE WORK,

  WE ADDRESSED THIS ISSUE IN OUR DECEMBER 1985 REPORT OF THE
SURGEON GENERAL, THAT REPORT DEALT SPECIFICALLY WITH THE WAY SMOKING
CONTRIBUTES TO THE INCIDENCE OF CANCER AND CHRONIC LUNG DISEASE AMONG
THE MEN AND WOMEN OF THE AMERICAN WORKFORCE,

  CLOSE TO 110 MILLION MEN AND WOMEN GO TO A FULL-TIME JOB EVERY
DAY SOMEWHERE IN THE UNITED STATES, UNHAPPILY, ABOUT 38 PERCENT OF
THAT TOTAL -- OR SOME 41 MILLION WORKERS -- ARE CIGARETTE SMOKERS


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   THE WORKERS MOST AT RISK, OF COURSE, ARE THOSE IN INDUSTRIES THAT

MINE AND PROCESS COAL, ASBESTOS, SILICA, AND RADIUM, FOR EXAMPLEwAND
THOSE THAT MANUFACTURE OR HANDLE TEXTILES, PETROCHEMICALS, PESTICIDES,
AND AROMATIC AMINES,,,OTHERWISE KNOWN AS THE "CLEANING AND DYING

INDUSTRY/'

  WORKERS IN THESE INDUSTRIES -- WHO ARE ALREADY AT RISK ON THE

JOB, WHETHER THEY SMOKE OR NOT -- MAKE MATTERS WORSE FOR THEMSELVES IF

THEY SMOKE, AND OUR 1986 REPORT GIVES THE DATA TO PROVE IT,

   AMONG THE MOST DRAMATIC ILLUSTRATIONS OF THIS IS THE SITUATION
AMONG ASBESTOS WORKERS,

  IF YOU'RE AN ASBESTOS WORKER WHO HAS NEVER SMOKED, YOUR CHANCES
OF GETTING JOB-RELATED LUNG CANCER IS 50 TIMES GREATER THAN IF YOU'VE
NEVER SMOKED AND HAD NEVER WORKED WITH ASBESTOS EITHER, SO IT'S
OBVIOUSLY A HIGH-RISK OCCUPATION,


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  HOWEVER, IF YOU'RE AN ASBESTOS WORKER AND YOU SMOKE A PACK OF
CIGARETTES A DAY, YOUR CHANCES OF GETTING LUNG CANCER IS 87 TIMES
GREATER THAN IF YOU NEVER SMOKED AND NEVER WENT NEAR ASBESTOS,

  THAT'S WHY BOTH ACTIVITIES -- ELIMINATING CIGARETTE SMOKING AND
REDUCING THE EXPOSURE TO HAZARDS IN THE WORKPLACE -- ARE SEPARATE BUT
NEVERTHELESS COMPLEMENTARY ACTIVITIES,

  WE'VE GOT TO DO BOTH AND DO THEM WITH MAXIMUM EFFECT,,,-AGAIN,
WITH THE TOTAL HEALTH OF THE AMERICAN WORKER IN MIND,

   AND HERE, I BELIEVE, IS ONE OF THE MOST IMPORTANT CHALLENGES TO
THE FAMILY PHYSICIAN AND TO THE PRACTITIONER OF GENERAL MEDICINE,
YOUR PATIENTS, WHO WORK AND WHO ALSO SMOKE, NEED YOUR CONCERN AND YOUR

GUIDANCE -- AND YOUR TENACITY TO GET THEM TO QUIT,

   ASSUMING, OF COURSE, THAT YOU'VE ALREADY DONE THAT DONE FOR

YOURSELF,


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   AS I SAY, WE SHOULD DO WHATEVER WE CAN -- RIGHT NOW -- TO

ELIMINATE SMOKING AMONG WORKERS IN THOSE INDUSTRIES AND OCCUPATIONS
WHICH WE ALREADY KNOW PRESENT RISKS TO THEIR HEALTH AND WELL-BEING,

  AND NEXT, WE MUST MOVE AHEAD WITH SMOKING CESSATION PROGRAMS
AMONG THOSE OTHER INDUSTRIES WHERE THE HEALTH DATA MAY BE LESS CLEAR,
BUT WHERE THERE'S ENOUGH SUSPICION OF TROUBLE THAT THEY REQUIRE OUR

ATTENTION,

  AND HERE I'M TALKING ABOUT OCCUPATIONS THAT ARE RELATIVELY NEW
AND THE WORKPLACE HAZARDS ARE STILL NOT WELL UNDERSTOOD, FOR
EXAMPLE, 8,

9

   WORKERS IN THE COMPUTER INDUSTRY ARE POTENTIALLY EXPOSED TO
OVER 400 DIFFERENT TOXIC AGENTS, INCLUDING ARSENIC, NITRIC ACID,
AND FREON DE-GREASING AGENTS,


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+   THE NEW SEMI-CONDUCTOR INDUSTRY HAS SOMETHING LIKE 300
POTENTIALLY HARMFUL AGENTS PRESENT IN ITS WORK ENVIRONMENT, THESE
INCLUDE LEAD SOLDER, FLUXES, PHOTOCHEMICALS, AND HIGHLY TOXIC
DOPING COMPOUNDS SUCH AS HEXA-METHYL-DISILAZANE,

3   AND THE RADIO &lD- TELEVISION EQUIPMENT INDUSTRY IS ANOTHER
ONE, WITH NEARLY 400 AGENTS, INCLUDING EXOTIC METALS AND

CHEMICALS,

   AMONG THESE WORKERS, IT IS CONCEIVABLE THAT SMOKING IS THE MORE

SERIOUS HAZARD,,,WE DON'T KNOW THAT FOR SURE, BUT, EVEN WITHOUT
SUPPORTING DATA, WE KNOW ENOUGH TO GUESS THAT THE WORKER WHO SMOKES

ONLY MAKES MATTERS WORSE FOR HIMSELF OR HERSELF AND FOR OTHER CO-

WORKERS IN THE SAME CLOSE ENVIRONMENT,

   THAT5 WHY I BELIEVE THAT WE'VE GOT TO RE-DOUBLE OUR EFFORTS IN

TWO AREAS:


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  FIRST, WE NEED TO ESTABLISH SMOKING CESSATION PROGRAMS RIGHT
ACROSS THE SPECTRUM OF AMERICAN EMPLOYMENT, BETTER THAN 50 PERCENT OF
WORKERS IN BLUE-COLLAR OCCUPATIONS NOW SMOKE, JONSTRUCTION WORKERS,
TRUCK DRIVERS, MAINTENANCE MEN, AND SO ON, WE'VE GOT TO FIND A WAY TO
REACH THEM WITH OUR ANTI-SMOKING MESSAGE,

AND SECOND, WE NEED TO WORK WITH MANAGEMENT AND WITH STATE AND

LOCAL GOVERNMENTS TO NEGOTIATE THE ORDINANCES AND AGREEMENTS NECESSARY
BOTH TO ENCOURAGE SMOKERS TO QUIT AND TO PROTECT NONSMOKERS FROM THE
EFFECTS OF SIDESTREAM SMOKE IN THE WORKPLACE,

  IN BOTH AREAS, THE COUNTRY NEEDS THE INVOLVEMENT OF ITS HEALTH
PROFESSIONALS, AS I SAID AT THE BEGINNING OF MY REMARKS TODAY,
SMOKING IS THE SINGLE MOST SIGNIFICANT AND PREVENTABLE CAUSE OF
DISEASE AND DEATH AMONG OUR CITIZENS, I'M NOT IMPLORING YOU TO JOIN
SOMEBODY'S ELECTION CAMPAIGN OR SIGN A PARKING PETITION, I'M ASKING
YOU TO BECOME PART OF A CAMPAIGN THAT IS VITALLY IMPORTANT TO THE
PRESENT AND FUTURE HEALTH OF THE AMERICAN PEOPLE,


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  THE ANTI-SMOKING CAMPAIGN NEEDS ALL THE INFORMED AND INVOLVED
ASSSITANCE IT CAN GET BECAUSE IT'S A TOUGH FIGHT ALL THE WAY, WE'RE
TAKING ON MORE THAN JUST DISEASEwWE'RE TAKING ON THE CIGARETTE
INDUSTRY,, ,AND YOU AND I KNOW THAT THE CIGARETTE INDUSTRY IS A VERY
FORMIDABLE ADVERSARY,

  THAT INDUSTRY ACCOUNTS FOR ABOUT 2,5 PERCENT OF THE NATION'S
GROSS NATIONAL PRODUCT, OR ABOUT $60 BILLION, EACH YEAR,

  IT SPENDS ABOUT $2 BILLION A YEAR JUST ON ADVERTISING ALONE,
THAT'S A LITTLE OVER $8 FOR EVERY PERSON IN THE UNITED STATES,,,SMOKER
AND NONSMOKER ALIKE,

  BUT SOME AMERICANS ARE GETTING MORE OF THIS ADVERTISING ATTENTION
THAN ARE OTHERS,


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  WOMEN ARE ONE SUCH TARGET GROUP, AND IT SEEMS TO BE EFFECTIVE,

WOMEN SMOKERS ARE ALSO GIVING UP CIGARETTES, BUT AT A MUCH SLOWER
QUIT-RATE THAN THE ONE FOR MEN, FOR EXAMPLE, MEANWHILE, LUNG CANCER

IS NOW THE LEADING CAUSE OF CANCER DEATHS AMONG WOMEN, SURPASSING

BREAST CANCER,

   I FIND IT QUITE DEPRESSING THAT THE EDITORS AND PUBLISHERS OF THE
MAJOR WOMEN'S MAGAZINES ARE HAPPY TO CARRY LAVISH, FULL-COLOR CIGAR-
ETTE ADS, BUT DECLINE TO RUN THE LIFE-SAVING, ANTI-CIGARETTE ARTICLES

THAT COULD HELP SAVE THE LIVES OF THEIR READERS,

  AND FRANKLY, IT'S BEYOND ME WHY ANY SELF-RESPECTING WOMAN TENNIS
STAR WOULD PLAY IN THE "VIRGINIA SLIMS" TOURNAMENT,

  YOUNG PEOPLE ARE ANOTHER MAJOR TARGET GROUP, AND WHY NOT, SINCE
90 PERCENT OF ALL PEOPLE WHO SMOKE STARTED THEIR HABIT WHEN THEY WERE
IN THEIR TEENS,


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  I'M ALSO TRULY CONCERNED ABOUT THE CONCENTRATED BARRAGE OF
CIGARETTE ADVERTISING AND PROMOTION THAT'S DIRECTED AT MINORITIES,
AMONG BLACKS, FOR EXAMPLE, IT TAKES THE FORM OF FULL-COLOR, FULL-PAGE
ADS IN ALL MAJOR MAGAZINES WITH A PREDOMINANTLY BLACK READERSHIP,

  THE INDUSTRY ALSO PUBLICIZES ITS DONATIONS TO BLACK AND HISPANIC
COMMUNITY SERVICE ORGANIZATIONS AND ITS SPONSORSHIP OF LAVISH
FESTIVALS, FASHION SHOWS, AND OTHER EVENTS FEATURING POPULAR MINORITY
ENTERTAINERS AND SPORTS FIGURES,

  I WISH THOSE ORGANIZATIONS AND PERSONALITIES WEREN'T SO WILLING
TO TAKE THE MONEY,  I WISH THEY KNEW -- JUST AS CLEARLY AS WE KNOW AND
AS THE TOBACCO INDUSTRY ITSELF KNOWS -- THAT THE RATE OF LUNG CANCER
AMONG BLACKS IS 119 PER 100,000 POPULATIONunOR ALMOST 50 PERCENT
GREATER THAN THE WHITE RATE OF 81 PER 100,000 POPULATION,


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  THE TOBACCO MONEY GIVEN TO THOSE COOPERATING BLACK ORGANIZATIONS
AND PERSONALITIES IS PART OF THE HIGH PROFIT THAT THE INDUSTRY IS
SQUEEZING OUT OF THE DISEASED LUNGS OF BLACK MEN AND WOMEN WHO SMOKE,

  IT'S A TERRIBLE SITUATION, FOR THE MEN AND WOMEN WHO DIRECT THE
FORTUNES OF THE CIGARETTE INDUSTRY, I SAY IT IS ALSO AN UNFORGIVABLE
SITUATION,

  BUT I EXPECT IT TO CHANGE, BECAUSE THE INDUSTRY'S DAYS ARE
NUMBERED,

  DESPITE THE BILLIONS OF DOLLARS IT SPENDS AND DESPITE THE MERGERS
AND BUY-OUTS OF FOOD COMPANIES AND REAL ESTATE AND BEER AND WINE, THE
CIGARETTE INDUSTRY ITSELF IS NOT NOW -- AND WILL NEVER AGAIN BE -- A
GROWTH INDUSTRY,


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  YES, IT IS A FORMIDABLE ADVERSARY TODAY, BUT IT BECOMES LESS AND
LESS FORMIDABLE WITH EVERY TOMORROW, PER CAPITA CIGARETTE CONSUMPTION
CONTINUES TO DECLINE AND THAT CURVE WILL NEVER AGAIN GO UP, WE KNOW
THAT,, ,AND THE INDUSTRY DOES, TOO,

  AND, DESPITE THE ADVERTISING PRESSURE, YOUNG PEOPLE IN GREATER
AND GREATER NUMBERS REALIZE THAT, IN THEIR JARGON, THE COMPANIES ARE
JUST "RIPPING THEM OFF,"  CIGARETTE SMOKING IS NOW RIGHT UP THERE WITH
SUCH OTHER TEEN-AGE DISASTERS AS BAD BREATH, PERSPIRATIONieAND
PARENTS,

  THAT'S WHY I PREDICT THAT THE AMERICAN CIGARETTE INDUSTRY, FOR
ALL ITS ENORMOUS ECONOMIC POWER, WILL VIRTUALLY DISAPPEAR OVER THE
NEXT 20 YEARS,


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   HISTORY, MY FRIENDS, IS CLEARLY ON THE SIDE OF THE NONSMOKER,
AND IT'S ON OUR SIDE, AS HEALTH PROFESSIONALS,

   THEREFORE, I BELIEVE THAT WE WILL INDEED ACHIEVE OUR GOAL, WHICH

IS TO MAKE OUR HOMES, SCHOOLS, AND WORK ENVIRONMENTS SMOKE-FREE BY THE

YEAR 2000,

   IT'S NOT AN IMPOSSIBLE DREAM, AND I WANT TO EMPHASIZE THAT THE

US, PUBLIC HEALTH SERVICE AND ITS SURGEON GENERAL -- I AND WHOEVER

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

SMOKE-FREE SOCIETY COME TRUE,

   I INTEND TO MAKE SURE THAT ON MY DESK, WAITING FOR MY SUCCESSOR,
WILL BE NOT JUST THE 13 SMOKING-AND-HEALTH REPORTS THAT I FOUND BUT
THE ADDITIONAL 8 THAT WILL BE MY CONTRIBUTION TO THIS COUNTRY'S LIFE-
SAVING CAMPAIGN AGAINST CIGARETTES,

THANK YOU,

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