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ADDRESS

BY
C. Everett Koop, M.D,
SURGEON GENERAL
U.S. PuBLic HEALTH SERVICE
AND
DEPUTY ASSISTANT SECRETARY FOR HEALTH
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CRESPO

PRESENTED AT THE CONFERENCE ON SMOKING IN THE WORKPLACE
GLEN ELLYN, ILLINOIS
May 22, 1986
1

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

I AM DELIGHTED TO JOIN YOU THIS MORNING. AS YOU FOCUS YOUR
ENERGIES TO SAVE THE LIVES OF MILLIONS OF YOUR FELLOW CITIZENS, I'M
DELIGHTED THAT YOU INVITED ME TO BE A PART OF THIS PROGRAM, AND I AM
DOUBLY DELIGHTED TO SEE THE BROAD BASE OF SUPPORT FOR THIS
CONFERENCE...MY GOOD FRIENDS FROM THE LUNG AND HEART ASSOCIATIONS...
FROM THE CANCER SOCIETY...AND FROM THE PRIVATE BUSINESS AND INDUSTRY
AS WELL,

PUBLIC HEALTH IS THE PROPER CONCERN THE PUBLIC. IT’S NOT THE
SPECIAL PRESERVE OF THE SURGEON GENERAL AND IT’S NOT THE PLAY-THING OF
CHARITY. IT’S EVERYBODY’S BUSINESS, IN OUR KIND OF SOCIETY IT’S NOT
POSSIBLE FOR SOME TO BE ILL AND A FEW OTHERS TO BE NEGLIGENT WITHOUT
ALL OF US PAYING THE COST OF THAT ILLNESS AND THE PRICE OF THAT
NEGLIGENCE,
2

MAKE NO MISTAKE ABOUT THE SIGNIFICANCE OF THIS CONFERENCE FOR
METROPOLITAN CHICAGO:

YOU'RE HERE IN SUPPORT OF A VITAL NATIONAL CAMPAIGN
AGAINST ILLNESS AND DEATH

T HAVE TO EMPHASIZE THAT FACT, BECAUSE YOU WILL BE CHARGED -- AS 1
HAVE BEEN CHARGED -- WITH DISRUPTING OUR FARM ECONOMY. WITH THROWING
TAXPAYERS OUT OF WORK, AND WITH SPREADING TERROR AND ALARM THROUGHOUT
AN OTHERWISE SERENE NATION...AND DOING ALL THAT MISCHIEF ON THE BASIS

OF SOFT SCIENCE AND THIN SUPPOSITION,

I DON’T BELIEVE THAT STUFF. AND DON’T YOU BELIEVE IT EITHER,
3

OVER THE PAST 30 YEARS BIOMEDICAL RESEARCHERS, PHYSICIANS. AND
PUBLIC HEALTH PERSONNEL FROM MORE THAN 80 COUNTRIES HAVE GENERATED ALL
THE HARD EVIDENCE WE NEED TO PROVE THE CAUSAL RELATIONSHIP BETWEEN
CIGARETTE SMOKING AND ABOUT TWO DOZEN DISEASE CONDITIONS.

THE MEDICAL LITERATURE NOW HOLDS 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,

 
4

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

AND WE KNOW THAT WOMEN WHO ARE PREGNANT HAVE AN INCREASED RISK OF
DELIVERING THEIR BABIES PREMATURELY...OF ABORTING THE FETUS
SPONTANEOUSLY... .OF DELIVERING A STILLBORN CHILD...OR OF GIVING
BIRTH TO A CHILD WHO SIMPLY WON’T HAVE THE ABILITY TO SURVIVE MORE
THAN A FEW DAYS OUTSIDE THE WOMB,
5

THOSE ARE FACTS. THEY ARE PART OF THE INDICTMENT OF CIGARETTES
WRITTEN BY MEDICAL RESEARCHERS HERE AND AROUND THE WORLD OVER THE PAST
THREE DECADES, IT’S A CASE THAT IS SCIENTIFICALLY CONCLUSIVE.

IF YOU ARE AT ALL FAMILIAR WITH ANY OF THE MEDICAL LITERATURE OF
THE PAST 30 YEARS YOU KNOW THAT THE VERDICT IN THE CASE OF “THE PEOPLE
versus CIGARETTES” IS QUITE CLEAR;

SMOKING IS GUILTY OF BEING THE LEADING PREVENTABLE CAUSE
OF DISEASE AND DEATH IN THIS COUNTRY.

THAT’S NOT JUST THE VERDICT OF SCIENCE. IT’S ALSO THE VERDICT OF
YOUR GOVERNMENT, WHICH HAS TAKEN ITS CUE FROM THE SCIENTIFIC RECORD.
6

YOU’RE AWARE, I’M SURE, THAT FOR 20 YEARS CIGARETTE PACKAGES AND
ALL CIGARETTE ADVERTISING HAVE CARRIED THE LITTLE BOXED WARNING
SAYING, “THE SURGEON GENERAL HAS DETERMINED THAT SMOKING IS DANGEROUS
TO YOUR HEALTH.” THAT LABEL WAS ONE RESULT OF THE FIRST “SURGEON
GENERAL’S REPORT ON SMOKING AND HEALTH.” RELEASED IN 1964 BY ONE OF MY
PREDECESSORS, 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. THE SCIENTIFIC CASE
AGAINST CIGARETTES WAS BY THEN AIR-TIGHT,

NEVERTHELESS, SINCE 1981 WE’VE PRODUCED 4 MORE REPORTS. THEY
HAVE DOCUMENTED THE RELATIONSHIP BETWEEN SMOKING AND CANCER. SMOKING
AND CARDIOVASCULAR DISEASE, SMOKING AND LUNG DISEASE. AND, THE MOST
RECENT ONE, ON SMOKING, CANCER. AND CHRONIC LUNG DISEASE AMONG WORKING
PEOPLE.
7

THE CONCLUSION OF EACH REPORT HAS BEEN UNEQUIVOCAL: SMOKING IS A
MAJOR CONTRIBUTOR TO THE INCIDENCE OF THESE DISEASES AND IS ALSO A
MAJOR REASON WHY PEOPLE DIE FROM THESE DISEASES.

AND 1 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 NOTWITHSTANDING,
8

THE LATEST STEP BY THE CONGRESS IS EXTREMELY IMPORTANT IN THIS
REGARD. UNDER THE TERMS OF THE “COMPREHENSIVE SMOKING EDUCATION ACT
OF 1984,” PUBLIC LAW 98-474, THE MANUFACTURERS OF CIGARETTES MUST PUT

NEW AND STRONGER WARNINGS ON THEIR PACKAGES AND IN ALL THEIR ADVERTIS-
ING,

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

THERE’S NOTHING FANCY ABOUT THESE WARNINGS. AND THERE'S NOTHING
VAGUE ABOUT THEM EITHER:

*

ONE CATEGORICALLY SAYS THAT ”...SMOKING CAUSES LUNG CANCER,
HEART DISEASE, EMPHYSEMA, AND MAY COMPLICATE PREGNANCY.”
9

* ANOTHER IS MORE SPECIFIC AND WARNS THAT ”...PREGNANT WOMEN
WHO SMOKE RISK FETAL INJURY AND PREMATURE BIRTH.”

* A THIRD MAKES IT CLEAR TO EVERYONE THAT “...CIGARETTE SMOKE
CONTAINS CARBON MONOXIDE.”

* THE FOURTH WARNING SAYS THAT ”... QUITTING SMOKING NOW GREATLY
REDUCES SERIOUS HEALTH RISKS.” IN OTHER WORDS. IT’S NEVER TOO
LATE TO QUIT. BUT QUITTING IS NOT EASY TO DO -- I KNOW THAT --
BECAUSE SMOKERS ARE ADDICTED TO NICOTINE. WHICH IS THE MOST
ADDICTIVE DRUG IN OUR SOCIETY. THAT’S NOT POLITICAL RHETORIC.
THAT’S SCIENTIFIC FACT.

THEY AREN’T WHAT YOU’D CALL “WISHY-WASHY” MESSAGES. THEY’RE THE
BLUNT TRUTH,
10

THE FOUR NEW MESSAGES ARE NOW PART OF FEDERAL LAW.,.CHAPTER 15,
SECTION 1331 OF THE UNITED STATES CODE, 10 BE EXACT.

SO THIS WOULD BE A GOOD TIME TO OFFER A BIT OF ADVICE TO THE
TOBACCO INDUSTRY:

"FRIENDS, PLEASE RETIRE THOSE FULL-PAGE NEWSPAPER ADS THAT TALK
ABOUT, QUOTE, ‘THE CONTROVERSY,’ UN-QUOTE, THAT YOU THINK STILL
EXISTS AS TO WHETHER OR NOT SMOKING CAN HURT YOU. FRIENDS, I CAN
ASSURE YOU, SMOKING REALLY KILLS. AND THE CONGRESS OF THE UNITED
STATES THINKS SO, TOQ.”

THAT, IN ABBREVIATED FORM, IS THE CASE AGAINST CIGARETTES SO FAR.
1]

BUT YOU MIGHT HAVE NOTICED THAT THE INFORMATION WE’VE BEEN
ACCUMULATING MAINLY CONCERNS THE HEALTH OF PEOPLE WHO SMOKE. AND FOR
MOST OF THE PAST 20 TO 30 YEARS WE HAVE INDEED BEEN FOCUSING PRIMARILY
ON THE SMOKER.

BUT CIGARETTE SMOKING 1S A CLOUD WITH NO SILVER LINING. BEHIND
THAT CLOUD...1S ANOTHER CLOUD. BEHIND THE CLOUD OF MAINSTREAM
SMOKE...1S A CLOUD OF SIDESTREAM SMOKE,

 

WHAT DOES THAT MEAN?

SMOKERS ENGAGE IN “MAINSTREAM” SMOKING,...THAT IS, THEY INHALE THE
SMOKE DIRECTLY FROM THE CIGARETTE AND NOT FROM THE AIR AROUND THEM.
BUT THE “SIDESTREAM” SMOKER INVOLUNTARILY INHALES THE CIGARETTE SMOKE
THAT’S IN THE AMBIENT AIR,
12

ABOUT 10 YEARS AGO WE BEGAN TO GET THE FIRST GLIMMERS OF THIS NEW
ASPECT OF THE SMOKING ISSUE. WE BEGAN TO LEARN ABOUT THE EFFECTS OF
CIGARETTE SMOKE UPON THE HEALTH OF NONSMOKERS...THE “SIDESTREAM”

SMOKERS.

ITEM: TODAY WE KNOW THAT THE CHILDREN OF PARENTS WHO SMOKE HAVE A
MUCH HIGHER RATE OF COLDS AND OTHER UPPER RESPIRATORY INFECTIONS,
COMPARED TO CHILDREN WHOSE PARENTS DO NOT SMOKE.

ITEM: THE NONSMOKING WIFE OF A SMOKER RUNS A HIGHER RISK OF LUNG
CANCER THAN DO THE NONSMOKING WIVES OF NONSMOKERS, BEFORE LONG,
WE EXPECT TO HAVE CLEAR EVIDENCE THAT THE SAME IS ALSO TRUE FOR
THE INCIDENCE OF HEART DISEASE, EMPHYSEMA, AND CONGESTIVE LUNG
DISEASES AMONG NONSMOKING WIVES OF SMOKERS.
13

LTEM: “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.

BUT JUST WHAT IS IN CIGARETTE SMOKE THAT MAKES IT SO HARMFUL FOR
EVERYONE? IS IT REALLY SO BAD?

YES, IT 1S. BOTH THE “SIDESTREAM” SMOKER AND THE “MAINSTREAM”
SMOKER ARE BREATHING IN THE SAME 4,000 OR SO CONSTITUENTS OF CIGARETTE
SMOKE, THEY'RE BOTH INHALING THE SAME TARS, THE SAME NAPTHALENE, AND
THE SAME PYRENE AND BENZOPYRENE. THEY ABSORB THE SAME CARBON MONOX-
IDE. METHANE, AMMONIA, ACETYLENE, AND HYDROGEN CYANIDE.
14

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

MAINSTREAM SMOKE:

 

o TAR, FOR EXAMPLE, THE SUBSTANCE THAT IS THE MOST
CARCINOGENIC, 1S 70 PERCENT MORE CONCENTRATED IN SIDESTREAM SMOKE
THAN IN MAINSTREAM SMOKE...

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

o NICOTINE IS 2,7 TIMES GREATER IN SIDESTREAM SMOKE...

o AMMONIA IS 73 TIMES GREATER IN SIDESTREAM SMOKE...AND SO ON.
15

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

THEY MAY HAVE SAVED THEMSELVES FROM THE “STINK” AND THE “MESS” OF
SMOKING...BUT THEY HAVE NOT COMPLETELY PROTECTED THEMSELVES FROM ALL
THE HEALTH HAZARDS OF SMOKING, THOSE HAZARDS, WE HAVE DISCOVERED, ARE
IN THAT AMBIENT AIR WE SHARE WITH SMOKERS,

IT’S THAT RELATIVELY NEW INFORMATION THAT NOW LIES AT THE HEART
OF THE MOVEMENT BY NONSMOKERS TO BAN SMOKING IN VIRTUALLY EVERY PUBLIC
SPACE AND IN ALL PUBLIC TRANSPORT.

BUT THERE IS ALSO A STRONG GROUNDSWELL DEVELOPING TO BAN SMOKING
FROM PLACES WHERE PEOPLE WORK,
16

AND I WOULD LIKE TO THINK THAT I MAY HAVE CONTRIBUTED TO THAT
GROUNDSWELL WITH THE RELEASE THIS WINTER OF THE 18TH “SURGEON
GENERAL'S REPORT ON THE HEALTH CONSEQUENCES OF SMOKING,”

THIS REPORT WAS CONCERNED SPECIFICALLY WITH THE WAY SMOKING
CONTRIBUTES TO THE INCIDENCE OF CANCER AND CHRONIC LUNG DISEASE AMONG
THE MEN AND WOMEN OF THE AMERICAN WORKFORCE,

AS YOU MAY KNOW, 107 MILLION MEN AND WOMEN GO TO WORK EVERY DAY
SOMEWHERE IN THE UNITED STATES, ABOUT 38 PERCENT OF THAT TOTAL -- OR
SOME 41 MILLION WORKERS -- ARE CIGARETTE SMOKERS.

BUT WE KNOW THAT CIGARETTES ARE AN EQUAL OPPORTUNITY KILLER:
THEY’LL KILL YOU, REGARDLESS OF YOUR RACE, SEX, GEOGRAPHY,
INCOME... .OR OCCUPATION.
17

THAT’S WHAT 30 YEARS OF SOLID, PAINSTAKING, BIOMEDICAL AND
BEHAVIORAL RESEARCH HAS TOLD US.

THEREFORE, FOR MANY WORKERS CIGARETTE SMOKING MAY PRESENT A
GREATER HEALTH RISK THAN ANYTHING THEY MIGHT ENCOUNTER IN THEIR WORK
ENVIRONMENT. BUT FOR SOME GROUPS OF WORKERS IN HIGH-RISK OCCUPATIONS,
THE JOB-RELATED EXPOSURES ARE MORE HAZARDOUS THAN CIGARETTE SMOKING,
NEVERTHELESS, FOR THEM. ALSO, SMOKING MAY CONSIDERABLY ESCALATE ThE
LEVEL OF HEALTH RISK,

AMONG THE MOST DRAMATIC ILLUSTRATIONS OF THIS IS THE SITUATION
AMONG ASBESTOS WORKERS.
13

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

HOWEVER, IF YOU‘RE AN ASBESTOS WORKER WHO SMOKES A PACK OF
CIGARETTES A DAY, THE RISK OF LUNG CANCER THEN BECOMES 87 TIMES
GREATER THAN THE RISK AMONG PEOPLE WHO NEITHER SMOKE NOR WORK WITH
ASBESTOS,

THAT’S WHY BOTH ACTIVITIES -- ELIMINATING CIGARETTE SMOKING AND
REDUCING THE EXPOSURE TO HAZARDS IN THE WORKPLACE -- ARE SEPARATE BUT
NEVERTHELESS COMPLEMENTARY ACTIVITIES,
19

BUT I WOULD GO A STEP FURTHER AND SAY THAT ONE ACTIVITY OUGHT NOT
TO BE SEEN AS COMPETING WITH THE OTHER NOR SUCCEEDING AT THE EXPENSE
OF THE OTHER,

WE MUST NOT PRACTICE DISEASE-OF-THE-MONTH-CLUB THINKING... SWITCH-
ING OUR INTEREST, OUR ENERGIES, AND OUR RESOURCES FROM OCCUPATIONAL
SAFETY AND HEALTH TODAY TO THE ATTRACTIVE NEW ACTIVITY CALLED “SMOKING
CESSATION” TOMORROW,

WE’VE GOT TO DO BOTH AND WE‘VE GOT TO DO THEM WITH MAXIMUM EFFECT
. AGAIN, KEEPING IN MIND THE TOTAL HEALTH OF THE AMERICAN WORKER.

CLEARLY, WE NEED TO ELIMINATE SMOKING FROM AMONG WORKERS IN THOSE
INDUSTRIES AND OCCUPATIONS WHICH WE ALREADY KNOW THREATEN AN
INDIVIDUAL’S HEALTH AND WELL-BEING:
20

THE ONES THAT MINE AND PROCESS COAL, ASBESTOS, SILICA, AND RADIUM,
FOR EXAMPLE...AND THE MANUFACTURING AND HANDLING OF TEXTILES,
PETROCHEMICALS, PESTICIDES, AND AROMATIC AMINES, OTHERWISE KNOWN
AS THE “CLEANING AND DYING INDUSTRY.”

AS OUR LATEST REPORT ILLUSTRATES, WORKERS IN THESE INDUSTRIES --
ALREADY AT RISK ON THE JOB, WHETHER THEY SMOKE OR NOT -- ONLY MAKE
MATTERS WORSE FOR THEMSELVES IF THEY SMOKE.

AND WE’VE GOT THE DATA THAT PROVES THAT CASE.

BUT WORKERS IN HIGH-RISK INDUSTRIES ARE STILL A MINORITY OF OUR
COUNTRY’S TOTAL WORKFORCE. ONLY AN ESTIMATED 4 T0 5 PERCENT OF ALL
AMERICAN WORKERS ARE EXPOSED TO ASBESTOS, SILICA, COTTON, AND IONIZING
RADIATION. THAT'S BETWEEN 4 AND 6 MILLION MEN AND WOMEN OUT OF THE
TOTAL WORKFORCE OF 107 MILLION,
21

I BELIEVE OUR FIRST PRIORITY OUGHT TO BE TO PROTECT WORKERS IN
HIGH-RISK INDUSTRIES FROM OCCUPATIONAL HAZARDS AND AT THE SAME TIME
PROVIDE THEM WITH EFFECTIVE SMOKING CESSATION PROGRAMS,

BUT WE ALSO OUGHT TO 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 ON BOTH COUNTS:

FIRST, FOR THE REDUCTION OR ELIMINATION OF OCCUPATIONAL HAZARDS
AND, SECOND, FOR THE ELIMINATION OF SMOKING,

 

AND HERE I'M TALKING ABOUT OCCUPATIONS THAT ARE RELATIVELY NEW OR
EVEN BRAND-NEW,..WHERE MOST OF THE HAZARDS ARE STILL NOT WELL
UNDERSTOOD,..AND WHERE THE INTERACTION BETWEEN THOSE HAZARDS AND
CIGARETTE SMOKING IS EVEN LESS CLEAR.
22

IN A PROBABILITY SAMPLE OF SOME 4,500 PLANTS AROUND THE COUNTRY,
OUR P.H.S, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH FOUND

THAT. 4.

* THE NEW SEMI-CONDUCTOR INDUSTRY HAS SOMETHING LIKE 300
POTENTIALLY HARMFUL AGENTS IN ITS WORK ENVIRONMENT, INCLUDING LEAD
SOLDER, FLUXES, PHOTOCHEMICALS, AND HIGHLY TOXIC DOPING COMPOUNDS
LIKE HEXAMETHYLDISILAZANE,

* AND WORKERS IN THE NEW COMPUTER INDUSTRY ARE POTENTIALLY
EXPOSED TO OVER 400 DIFFERENT TOXIC AGENTS. INCLUDING FREON DE-
GREASING AGENTS, ARSENIC, AND NITRIC ACID,
23

* AND THE RADIO AND TELEVISION EQUIPMENT INDUSTRY IS ANOTHER
ONE WITH NEARLY 400 AGENTS, INCLUDING EXOTIC METALS AND CHEMICALS,

AT THIS TIME OUR INFORMTION ON THESE AND OTHER INDUSTRIES IS
SOMEWHAT THIN. NEVERTHELESS, WE DO KNOW ENOUGH TO BE CONCERNED... AND
TO WANT TO KNOW A GREAT DEAL MORE.

SO FAR, I‘VE TALKED ABOUT AMERICANS WHO ARE IN INDUSTRIES THAT
PRODUCE A PRODUCT OF SOME KIND: A BOLT OF CLOTH. A CAR-LOAD OF COAL. A
T.V. SET, OR WHAT-HAVE-YOU,

BUT MOST AMERICAN WORKERS -- ABOUT 3 OUT OF EVERY 4 -- PRODUCE A
SERVICE OF SOME KIND: THEY TEACH OR SELL OR HELP OR ADVISE.

WE KNOW A LITTLE BIT ABOUT THEIR OCCUPATIONAL HAZARDS: DRUG ABUSE
AMONG HEALTH WORKERS, EYE-STRAIN AMONG CLERICAL WORKERS, GASTRO-
ENTERITIS IN THE BANKING AND FINANCE INDUSTRIES, AND SO ON,
24

HOWEVER, A LACK OF MORE SPECIFIC INFORMATION OUGHT NOT TO DETER
US FROM GOING AHEAD AND SETTING UP SMOKING CESSATION PROGRAMS AND
NEGOTIATING ORDINANCES AND AGREEMENTS TO PROTECT NONSMOKERS FROM THE
EFFECTS OF SIDESTREAM SMOKING IN THE SERVICE INDUSTRY WORKPLACE,

I] ENCOURAGE EVERYONE HERE TO WORK FOR THESE THINGS...

NOT JUST TO BRING DOWN THE PRICE OF EMPLOYER FIRE AND HEALTH
INSURANCE PREMIUMS, ALTHOUGH THAT MIGHT HAPPEN...

NOT JUST TO REDUCE THE COSTS OF MAINTENANCE OF THE AVERAGE
WORKPLACE, ALTHOUGH THAT IS CERTAINLY A SIDE BENEFIT...
25

AND NOT TO MAKE US MORE COMPETITIVE WITH THE JAPANESE, ALTHOUGH --
WHO KNOWS? -- THAT MIGHT BE A BENEFIT AFTER ALL.

BUT YOU SHOULD DO IT BECAUSE THEY’RE THE RIGHT THINGS -- THE
LIFE-SAVING THINGS -- TO DO.

LET ME CLOSE MY REMARKS TODAY WITH THIS FINAL OBSERVATION,

YOU'RE AWARE, I AM SURE, OF THE ECONOMIC POWER OF THE CIGARETTE
INDUSTRY. IT ACCOUNTS FOR ABOUT 2,5 PERCENT OF THE NATION’S GROSS
NATIONAL PRODUCT, OR $60 BILLION, IT SPENDS $3 BILLION A YEAR JUST ON
ADVERTISING, THAT'S CLOSE TO $8 FOR EVERY PERSON IN THE UNITED

STATES. ..SMOKER AND NONSMOKER ALIKE.
26

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 NONSMOKER, THE CIGARETTE INDUSTRY.
FOR ALL ITS ENORMOUS ECONOMIC POWER, WILL, I’M POSITIVE. DISAPPEAR
OVER THE NEXT 20 YEARS,

WE ARE ALREADY SEEING THE DECLINE OF PER CAPITA CIGARETTE
CONSUMPTION...DOWN TO ITS LOWEST LEVELS SINCE 1944,.,,A TREND THAT
LOOKS LIKE IT’S STRAIGHT-LINE BUT DOWN.

DESPITE MERGERS AND BUY-OUTS INVOLVING FOOD COMPANIES, THE
CIGARETTE INDUSTRY IS NOT -- AND WILL NEVER AGAIN BE -- A GROWTH
INDUSTRY.
2/

SO I THINK WE‘RE WINNING, THE AMERICAN PEOPLE ARE WINNING, WITH
THE HELP OF THEIR LAST FOUR SURGEONS GENERAL, INCLUDING ME.

OUR MOTIVATION HAS BEEN TO PROTECT THE PUBLIC HEALTH,

OUR TOOLS HAVE BEEN BIOMEDICAL SCIENCE, PUBLIC EDUCATION. AND THE
LAW,

ONE EFFECT WILL SURELY BE THE ACHIEVEMENT OF A SMOKE-FREE SOCIETY
BY THE YEAR 2000 -- WHICH IS A GOAL I SET FOR OUR COUNTRY 2 YEARS
AGO. BUT A SECOND EFFECT MAY BE THE DECLINE AND FALL OF A MAJOR
ECONOMIC FORCE IN OUR SOCIETY.
28

I SINCERELY HOPE THAT THE MEN AND WOMEN WHO RUN THE CIGARETTE
COMPANIES ARE DOING THEIR HOMEWORK. I HOPE THEY’RE BEGINNING T0
"THINK THE UNTHINKABLE”... THAT IS, 1 HOPE THEYRE PREPARING THEM-
SELVES FOR THE KIND OF ROLE THEY ALSO CAN PLAY IN A COUNTRY THAT IS
SMOKE-FREE,

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 LIFE...NOT THE KIND
THAT INVITES DEATH.

THANK YOU,

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