HOW COULD THEY DARE TO DO THAT? I WONDERED.

THE ANSWER WAS ... THEY JUST DID.

AND THEY FLAUNTED THEIR ABILITY TO BUY THEIR WAY INTO
THE MARKETPLACE OF IDEAS AND POLLUTE IT WITH THEIR

FALSE AND DEADLY INFORMATION.

I DO NOT BELIEVE THE UNITED STATES WILL EVER AGAIN BE A
GOOD MARKET FOR TOBACCO PRODUCTS. THE CURVE IS GOING

DOWN AND ACCELERATING.

26
BUT IF WE FEEL GOOD BECAUSE WE HAVE BEATEN THE
CIGARETTE INDUSTRY ON ITS OWN HOME TURE ... WE MUST
REALIZE THAT WE’VE DRIVEN THEM TO SCOUR THE REST OF THE

EARTH FOR NEW VICTIMS.

WHILE RECENT STATISTICS BRING US THE GOOD NEWS THAT
SMOKING IN THE UNITED STATES DROPPED ANOTHER 5% IN 1989,
WE ARE SADDENED AND OUTRAGED THAT AMERICAN TOBACCO

EXPORTS ROSE 20% LAST YEAR.

27
IN 1989 AMERICAN COMPANIES MADE 600 BILLION CIGARETTES;
100 BILLION OF THOSE CIGARETTES WENT OVERSEAS, OVER HALF

TO THE FAR EAST.

THE TOBACCO INDUSTRY -- AS YOU ALL KNOW, I AM SURE -- HAS
TARGETED THE LESS DEVELOPED AND DEVELOPING COUNTRIES
OF THE WORLD AS THEIR MOST PROMISING MARKETS FOR THE

1990s.

28
AS A RESULT, THOSE NATIONS ARE NOW BEGINNING TO
EXPERIENCE THE SAME RISE IN SMOKING-RELATED DISEASES
THAT WE EXPERIENCED A GENERATION AGO ... HEART DISEASE,
STROKE, AND CANCER OF THE LUNG, MOUTH, ESOPHAGUS, AND

STOMACH.

AS AN AMERICAN CITIZEN I AM APPALLED BY THIS CORPORATE
BEHAVIOR OF AMERICAN COMPANIES AND, FURTHER, I AM
SHOCKED BY THE OUR OWN GOVERNMENT’S SUPPORT OF SUCH

BEHAVIOR.

29
THIS EXPORT OF DEATH AND DISEASE HAS BEEN CARRIED OUT
WITH THE SUPPORT OF OUR TRADE REPRESENTATIVES, OUR
STATE DEPARTMENT, OUR COMMERCE DEPARTMENT, AND OUR
AGRICULTURE DEPARTMENT.

IT’S NOT A VERY PRETTY STORY. BUT THERE IT IS.

LAST FALL, IN MY LAST OFFICIAL ACT AS SURGEON GENERAL, I
WAS ONE OF MORE THAN 30 WITNESSES AT A PUBLIC HEARING
ON INVESTIGATION INITIATED UNDER SEC. 302 OF THE TRADE

ACT OF 1974.

30
I MADE MY POINT, AND CONCLUDED BY SAYING,

"IT IS THE HEIGHT OF HYPOCRISY FOR THE UNITED STATES,
IN OUR WAR AGAINST DRUGS, TO DEMAND THAT FOREIGN
NATIONS TAKE STEPS TO STOP THE EXPORT OF COCAINE TO
OUR COUNTRY WHILE AT THE SAME TIME WE EXPORT NICOTINE,
A DRUG JUST AS ADDICTIVE AS COCAINE TO THE REST OF

THE WORLD."

31
THIS NICOTINE DRUG CARTEL, THE TRANS-NATIONAL TOBACCO
COMPANIES TRAVEL FROM COUNTRY TO COUNTRY WITH A GREAT
DEAL OF CASH --NOT CREDITS, NOT PROMISES, BUT HARD, COLD
CASH. THEREF ORE IT IS VERY DIFFICULT FOR ANY GOVERNMENT
STRUGGLING TO GET ITS ECONOMY IN ORDER TO TURN AWAY

SUCH WELL-PAYING GUESTS.

THESE COMPANIES BUILD FACTORIES AND EMPLOY MANY
PEOPLE. THEY SPEND LARGE SUMS ON ADVERTISING AND
SPECIAL EVENTS. IN SOME AREAS THEY VIRTUALLY SUBSIDIZE

THE MEDIA.

32
IN MY VIEW THE SEVEN MAJOR TRANS-NATIONAL TOBACCO
COMPANIES --FOUR AMERICAN AND THREE BRITISH-- ARE
TOGETHER THE VERY MODEL OF A COLONIAL POWER. THEY
OSTENTATIOUSLY PUMP#@@ LARGE AMOUNTS OF MONEY INTO
THE ECONOMIES OF A POOR NATION, ONLY TO EXACT LARGER
SUMS OF WEALTH IN THE FORM OF CROPS, MANUFACTURED

GOODS, OR CASH.

33
UNFORTUNATELY THESE COMPANIES ALSO EXTRACT THE
PHYSICAL HEALTH OF THE PEOPLE OF EVERY COUNTRY THEY
COLONIZE. YOU CAN SEE IT IN THE RISING MORBIDITY AND
MORTALITY RATES FROM WESTERN SMOKING-RELATED

DISEASES.
THE ALARMING THING ABOUT THIS HABIT OF CIGARETTE

SMOKING IS THAT, WHEN IT INVADES A NEW MARKET, IT DOES

SO WITH IMMENSE SPEED AND IMPACT.

34
ACCORDING TO THE WORLD HEALTH ORGANIZATION, BETWEEN
1971 AND 1981 CIGARETTE CONSUMPTION INCREASED IN ASIA AND
LATIN AMERICA AT A RATE 30 PERCENT AHEAD OF THE RATE OF
POPULATION INCREASE ... IN AFRICA, IT ROSE 77 PERCENT AHEAD
OF THE RISE IN POPULATION.

THE PEOPLE’S REPUBLIC OF CHINA, FOR EXAMPLE, REPORTED
THAT 90 PERCENT OF ITS MEN SMOKE. ... PAPUA NEW GUINEA
REPORTED THAT 85 PERCENT OF ITS MEN NOW SMOKE... THE

PHILIPPINES, 78 PERCENT ... AND SO ON.

WHo, () Dorveé 4 Coof Jer!

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Fire tb Eatin” OF ECTGNEe C6 Ew ears * Jota prem
AND LISTEN CAREFULLY TO THIS: IN CHINA, WHERE COUPLES
ARE SUPPOSED TO HAVE ONLY 1 CHILD PER FAMILY, THERE ARE

AT THIS MOMENT AN ESTIMATED 50,000,000 CHILDREN WHO WILL

DIE PREMATURELY FROM SMOKING.

THE RECENT NEWS THAT IN 15 ASIAN COUNTRIES
COMMUNICABLE DISEASE WAS NO LONGER THE NUMBER ONE
PUBLIC HEALTH MENACE WAS NOT REALLY GOOD NEWS.
WHY?

BECAUSE IN THOSE ASIAN COUNTRIES TODAY, THE TOP THREE
CAUSES OF DEATH ARE -- CAN YOU GUESS? -- THE SAME THREE
SMOKING-RELATED CAUSES OF DEATH THAT PREVAIL HERE IN

THE UNITED STATES: HEART DISEASE, CANCER, AND STROKE.

36
IN OTHER WORDS, THE TOBACCO EPIDEMIC AND ITS LETHAL
CONSEQUENCES HAVE HIT ASIA ... AND -- THANKS TO OUR OWN

CIGARETTE INDUSTRY -- HAVE HIT ASIA HARD.
AND HERE’S WHERE WE DESERVE TO SQUIRM IN SHAME -- IN 10

OF 15 ASIAN COUNTRIES, AMERICAN CIGARETTES WERE THE

MOST COMMON KIND IMPORTED.

37
BUT THOSE AMERICAN CIGARETTES ARE A LITTLE DIFFERENT
OVERSEAS: FOR ONE THING, THEY DON’T CARRY THE SURGEON
GENERAL’S WARNING. AND FOR ANOTHER, MANY AMERICAN
CIGARETTES MANUFACTURED FOR EXPORT HAVE A HIGHER TAR
CONTENT AND ARE, THEREFORE, EVEN MORE DANGEROUS THAN
THE LOWER-TAR, FULLY-LABELLED PRODUCTS SOLD HERE IN

THE UNITED STATES.

38
35 A

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PEYELINE Whpow Tv Néfxt Ze pmponT CobMeo.
NOW, LET ME MAKE SURE YOU UNDERSTAND WHAT I JUST SAID.
I SAID THAT SOME AMERICAN CIGARETTE MANUFACTURERS -- AS

KNOWLEDGE-ABLE AS I AM, CONCERNING THE HEALTH RISKS OF

Dg
SMOKING -- KNOWINGLY PRODUCE A MORE HARMFUL

CIGARETTE FOR EXPORT THAN THEY PRODUCE FOR DOMESTIC

consumption. GE |} Am EMGeRa580 AS aH

AMencnN ~ RAD | low THERE AhE mMicctows OFF

DECEWS FOLKS Whe FES FE SATE HHL,

OUR EXPORT OF TOBACCO PRODUCTS Isa MORAL OUTRAGE,

Not swe

39
SD IT IS ALSO FOOLISH.

WE MUST CONVINCE OUR GOVERNMENT THAT THERE IS NO
SENSE IN PLANNING FOR THE LONG-TERM ECONOMIC HEALTH
OF A FOREIGN SOCIETY A) PROVIDING THAT SOCIETY WITH
FOREIGN AID G37 FHE-ONE-HAND, IF THE PHYSICAL HEALTH OF
THE PEOPLE OF THAT SOCIETY IS FUNDAMENTALLY

ENDANGERED DURING THAT SAME LONG TERM.

AGAINST THIS INTERNATIONAL OFFENSIVE OF THE TOBACCO
FIRMS
THE INTERNATIONAL COMMUNITY IS FIGHTING BACK, EVEN

THOUGH THEIR RESOURCES ARE SLIGHT.

40
THE WORLD HEALTH ORGANIZATION IS TO BE CONGRATULATED
FOR CONFRONTING HEAD-ON THE TOBACCO INDUSTRY’S BRAZEN
CHALLENGE TO THE PHYSICAL WELL-BEING OF MILLIONS UPON

MILLIONS OF THE WORLD’S MEN, WOMEN, AND CHILDREN.

THE CIGARETTE SMOKING EPIDEMIC BEING WHAT IT IS -- A
CROSS BETWEEN PUBLIC HEALTH AND INTERNATIONAL
COMMERCE -- WE FIND, COUNTRY-BY-COUNTRY, THAT THE
STRONGEST OPPONENTS ARE OFTEN CONSUMERS AS WELL AS

PHYSICIANS.

41
IN FACT, THE I.0.C.U., OR INTERNATIONAL ORGANIZATION OF
CONSUMERS UNIONS -- NOT A U.N. GROUP, BY THE WAY -- HAS A
SEPARATE ANTI-SMOKING SUB-GROUP THAT GOES BY THE NAME
OF "ACTION GROUPS TO HALT THE ADVERTISING AND

SPONSORSHIP OF TOBACCO" -- OR "AGHAST."

ONE OF "AGHAST’S" KEY ACTIVITIES IS TO SUPPORT THE WORLD
HEALTH ORGANIZATION’S ANNUAL "WORLD NO-TOBACCO DAY".
AFFILIATED MEMBERS OF "AGHAST" -- MOSTLY NATIONAL
CONSUMER COUNCILS -- HAVE HAD ROUSING AND SUCCESSFUL
"NO SMOKING DAYS" IN PLACES LIKE FIJI, HONG KONG, INDIA,

MALAYSIA, AND THAILAND.

42
IF THIS SOUNDS SUSPICIOUSLY LIKE OUR OWN "GREAT
AMERICAN SMOKE-OUT," WHICH WE SPONSOR HERE EVERY YEAR
IN NOVEMBER, THAT’S BECAUSE IT IS.

AND I’M PLEASED TO SAY THAT OUR P.H.S. OFFICE ON SMOKING
AND HEALTH HAVE HAD SOMETHING TO DO WITH SPREADING

THE IDEA TO OUR FRIENDS OVERSEAS.

43
THE IDEA OF A SMOKE-FREE SOCIETY IS GETTING SERIOUS

CONSIDERATION IN ISRAEL AND GREAT BRITAIN, FOR EXAMPLE.

IVE TRAVELED TO BOTH COUNTRIES TO BE PART OF THE

EFFORT.

BUT SO FAR THESE EFFORTS ARE TOO SMALL TO BLUNT THE

TOBACCO OFFENSIVE. THEY ARE TOO WEAK TO LOOSEN

TOBACCO’S ECONOMIC GRIP ON THE WORLD.

44
SO, WHAT CAN WE DO?

I'M SURE THAT IN THE SESSIONS TO FOLLOW, YOU WILL HEAR
AND THEN DISCUSS A NUMBER OF VERY SPECIFIC SUGGESTIONS.

PLL OFFER JUST A FEW.

OUR CONFERENCE THEME RECOGNIZES THE GLOBAL

CHARACTER OF THE STRUGGLE AGAINST SMOKING AND THE

POWER OF THE TOBACCO INTERESTS.

45
WE AMERICANS MUST CONDUCT THE BATTLE ON THE HOME

FRONT AS WELL AS OVERSEAS.

HERE AT HOME, WHILE WE WORK THROUGH THE LEGISLATIVE
AND REGULATORY PROCESS TO CHANGE AMERICAN TRADE
POLICIES, WE MUST CONTINUE THE ECONOMIC PRESSURE

AGAINST THE TOBACCO COMPANIES IN THE UNITED STATES.

. 46
EVEN THOUGH THE TIDE IS RUNNING AGAINST THEM, WE
CANNOT GIVE THEM A RESPITE.

WE MUST CONTINUE THE MOMENTUM TOWARD A SMOKE-FREE
SOCIETY BY THE YEAR 2000.

OUR EDUCATIONAL EFFORTS ARE SUCCESSFUL, AND THEY MUST

BE EXPANDED.

WE MUST TARGET INDIVIDUAL ISSUES, FOCUS OUR EFF ORTS, AND

PREVAIL.

47
IN SOME CRITICAL AREAS THERE IS STILL LITTLE MORE THAN
LIP SERVICE PAID TO STOPPING SMOKING.

FOR EXAMPLE, MEDICAL SCHOOL CURRICULA SPEND TOO
LITTLE TIME ON ADDICTION AND THE WAYS THAT DOCTORS CAN
TEACH THEIR PATIENTS HOW TO STOP SMOKING.

THE SAD FACT IS PROBABLY ONE HALF THE DOCTORS IN
AMERICA FAIL TO PROVIDE ADVICE AGAINST SMOKING, EVEN
THOUGH WE KNOW THAT A DOCTOR’S ADVICE IS THE SINGLE

MOST EFFECTIVE STIMULUS TO STOP SMOKING.

48
THERE IS NO MONETARY INCENTIVE FOR PHYSICIANS TO TREAT
SMOKING. ALTHOUGH STATES REQUIRE INSURANCE COVERAGE
FOR ALCOHOL AND DRUG TREATMENT, NO STATE OFFERS
COVERAGE FOR NICOTINE CESSATION PROGRAMS, EVEN THOUGH

THE HEALTH COST OF NICOTINE ADDICTION ON MUCH HIGHER.

FOLLOWING THE SURGEON GENERAL’S REPORT OF 1988, THERE
WAS CLEAR EVIDENCE OF THE SKYROCKETING COST OF HEALTH
CARE, AND YET THE HEALTH INSURANCE INDUSTRY HAS

RESPONDED LIKE NERO.

49
THEY SAY THEYUSUALLY DON’T COVER PREVENTIVE PROGRAMS.
WHAT SENSE DOES IT MAKES TO SPEND $150,000 ON THE
TERMINAL CANCER ILLNESS OF ONE OF THEIR IN SURED, BUT
NOT BE WILLING TO FORK OVER ABOUT $200 TO GET THE SPOUSE
OF THAT PERSON TO STOP SMOKING AND PREVENT THE SAME

DISEASE DOWN THE ROAD?

WITH OVER 90% OF THE SMOKERS WANTING TO QUIT, IT IS AN
OUTRAGE THAT THEIR IS NOT LEGISLATION REQUIRING
REIMBURSEMENT FOR APPROVED SMOKING CESSATION

PROGRAMS.

50