SPEECH

COUNTDOWN 2000
WASHINGTON, DC
AMERICAN LUNG ASSOCIATION

SEPTEMBER 11, 1990

C. EVERETT KOOP, MD

IF |

(6
GREETINGS, ETC.
IT IS A SPECIAL TREAT FOR ME TO BE YOUR SEND-OFF SPEAKER
TODAY. I FEEL FAMILIAR IN THIS ROLE, BECAUSE I'VE DONE IT

ONCE BEFORE, BUT NOW I FEEL MUCH MORE CONFIDENT.

IT WAS, REALLY, A SEND-OFF SPEECH TO THE ENTIRE COUNTRY

IN WHICH I FIRST CALLED FOR A SMOKE-FREE TETY IN

AMERICA BY THE YEAR 2000.
THAT WAS IN 1984, AT THE MEETING OF THE AMERICAN LUNG
ASSOCIATION AND THE AMERICAN THORACIC SOCIETY IN MIAMI.
BACK THEN, ONLY 6 YEARS AGO, A SMOKE-FREE SOCIETY BY THE
YEAR 2000 SEEMED LIKE A RADICAL IDEA.

I EVEN TOOK THE PRECAUTIONARY STEP OF HAVING MY SPEECH
TYPED OUTSIDE OF GOVERNMENT OFFICES, AND OF AVOIDING
THE NORMAL CLEARANCE PROCESS, SO CERTAIN WAS I THAT
SOME OFFICIAL BEHOLDEN TO THE TOBACCO INTERESTS WOULD

ATTEMPT TO SNUFF OUT THE IDEA.
BUT NOW IT IS VERY MUCH AN IDEA WHOSE TIME HAS COME.
AND WE HAVE A DECADE --JUST ENOUGH TIME TO SEE IT
HAPPEN,

JUST ENOUGH TIME TO MAKE IT HAPPEN.

AND YOU ARE THE PEOPLE WHO CAN MAKE IT HAPPEN.
WHEN I FIRST CALLED FOR A SMOKE-FREE SOCIETY BY 2000, I
SAID VERY CLEARLY THAT I WASN'T PROPOSING ANOTHER
GOVERNMENT PROGRAM. THIS WAS NOT GOING TO BE A PUBLIC
HEALTH SERVICE INITIATIVE...NOR WAS THIS GOING TO BE

ANOTHER PET PROJECT OF THE U.S. SURGEON GENERAL.

INSTEAD, I RAISED THE IDEA AS A CALL...A CALL FROM THE

SURGEON GENERAL TO THE PEOPLE OF THIS COUNTRY.
YOU MAY RECALL THAT I DESIGNATED CERTAIN GROUPS TO DO
CERTAIN THINGS: THE BOY SCOUTS, THE CAMPFIRE GIRLS,
RESPIRATORY THERAPISTS, THE COALITION ON SMOKING OR

HEALTH.

IN THE YEARS SINCE, EACH GROUP HAS RESPONDED, AND

RESPONDED GENEROUSLY.
AND I AM PARTICULARLY PLEASED WITH YOUR RESPONSE, YOUR
COMMITMENT, DEMONSTRATED SO CLEARLY DURING THE
COUNTDOWN 2000 CONFERENCE THESE LAST TWO DAYS.

I HOPE YOU PAY ATTENTION TO MY BRIEF REMARKS, BUT I ALSO
HOPE YOU HAVE ONE EYE ONE THE DOOR BECAUSE YOU ARE SO
EAGER TO GET OUT THERE AND TO APPLY WHAT YOU'VE

LEARNED TOGETHER HERE.
THE INITIAL CALL FOR A SMOKE-FREE SOCIETY HAS BEEN
STRENGTHENED BY THE RECEPTION AFFORDED A NUMBER OF
SURGEON GENERAL'S REPORTS ON SMOKING.

IN PARTICULAR, THE SURGEON GENERAL'S REPORTS ON
INVOLUNTARY SMOKING, AND ON NICOTINE ADDICTION WORKED
TOGETHER TO GIVE THE MILITANT ANTI-SMOKERS NEW AND

POWERFUL WEAPONS.
THE RECENT WIDELY PRAISED AND QUOTED STUDY OF EPA ON
ILL EFFECTS OF PASSIVE SMOKING SHOWS THE CAUSE IS BEING
TAKEN UP OUTSIDE THE HEALTHCARE AGENCIES, . .

ALTHOUGH I AM LESS THAN PLEASED BY THE STRANGE SILENCE
OF THE CURRENT SURGEON GENERAL, AND BY THE SECRETARY
OF HEALTH AND HUMAN SERVICES UNDERCUTTING HIS SEVERAL
STRONG ANTI-SMOKING STATEMENTS BY HIS TOLERATION OF

TOBACCO EXPORTS.
THE NONSMOKER WAS MERELY IRRITATED AT FIRST...THEN
BECAME ANNOYED...AND THEN TURNED MILITANT.

STUDIES INDICATING THAT PASSIVE SMOKING LED TO 46,000
DEATHS ANNUALLY (3,000 FROM LUNG CANCER, 11,000 FROM

OTHER CANCERS, 32,000 FROM HEART DISEASE) MADE THE NON-

 

SMOKER MILITANT ...AND SUCCESSFUL IN ACHIEVING CHANGES
IN SOCIAL CUSTOMS AND IN LOCAL AND STATE LAW.
NOW, AS MANY AS 425 COMMUNITIES HAVE ADOPTED

ORDINANCES RESTRICTING SMOKING IN PUBLIC

10
A MOST SATISFYING VICTORY IS THE AIRLINE SMOKING BAN
THAT BECAME EFFECTIVE LAST WINTER.

OF THE 16,000 DAILY FLIGHTS IN THE USA, ONLY 28 SLIP
THROUGH THE BAN, ALLOWING SMOKERS TO FOUL THE AIR.
AND NORTHWEST AIRLINES VOLUNTARILY KEEPS THE CABIN AIR
SMOKE-FREE ALL THE WAY TO HAWAII. OTHER AIRLINES --
ALASKA, DELTA, EASTERN, AND U.S. AIR-- HAVE ALSO EXTENDED

THE BAN BEYOND THE REQUIREMENTS OF THE LAW.

11
AND REMEMBER, LAST NOVEMBER A TOUGH LOCAL SMOKING
CONTROL ORDINANCE WAS APPROVED BY THE VOTERS IN
GREENSBORO, N.C, , IN SPITE OF HEAVY OPPOSITION BY

TOBACCO COMPANIES.

IF THE TOBACCO COMPANIES CAN BE BEATEN IN NORTH

CAROLINA, THEY CAN BE BEATEN ANYWHERE!

12
SMOKING HABITS HAVE CHANGED.

FIFTEEN YEARS AGO, AT MEDICAL MEETINGS, WHERE DOCTORS

SHOULD HAVE KNOWN BETTER, THE AIR WAS BLUE WITH SMOKE.

NOW YOU RARELY SEE A PHYSICIAN SMOKE;

IN 1964, BEFORE THE FIRST SURGEON GENERAL'S REPORT ON |

SMOKING, OVER HALF OF ADULT AMERICANS SMOKED.

13
WHEN I BECAME SURGEON GENERAL IN 1981, THE NUMBER HAD
DECLINED TO 33 PERCENT.

WHEN I LEFT OFFICE 8 YEARS LATER, THE NUMBER OF AMERICAN
SMOKERS HAD SHRUNK EVEN MORE, TO 26 PERCENT.

FEW THINGS GIVE ME AS MUCH SATISFACTION AS THAT
DRAMATIC DECREASE, FROM 33 PERCENT TO 26 PERCENT.

AND IT NOW APPEARS THAT DURING MY LAST YEAR IN OFFICE,

SMOKING DROPPED ANOTHER 4 PERCENT.

14
BETWEEN 1964 AND 1985 APPROXIMATELY THREE-QUARTERS OF A
MILLION SMOKING-RELATED DEATHS WERE AVOIDED OR

POSTPONED BY DECISIONS TO QUIT OR NOT TO START SMOKING.

EACH POSTPONED DEATH REPRESENTED AN AVERAGE GAIN OF 2
DECADES OF LIFE EXPECTANCY.
NEARLY HALF OF ALL LIVING ADULTS WHO HAVE EVER SMOKED

HAVE QUIT.

15
BUT, SIMPLY QUITTING IS STILL NOT THE WAY MOST SMOKERS
STOP SMOKING.

I OFTEN BEGIN ONE OF MY LECTURES ON SMOKING WITH THE
REMINDER THAT

"A THOUSAND AMERICANS WILL STOP SMOKING TODAY....
THEIR FUNERALS WILL BE HELD WITHIN THE NEXT THREE OR

FOUR DAYS."

16
WHY DO I FEEL I HAVE TO SAY SOMETHING DRAMATIC TO GET
PEOPLE'S ATTENTION?

| I SHOULDN'T HAVE TO.

WHAT IS IT ABOUT TOBACCO THAT NUMBS THE AMERICAN

PEOPLE?
IF ANYTHING ELSE KILLED 390,000 OF OUR FELLOW-CITIZENS

EACH YEAR, THE PUBLIC WOULD DEMAND ACTION FROM OUR

GOVERNMENT.

17
INSTEAD, TOBACCO HAS, FROM THE BEGINNING, BEEN CODDLED
BY OUR GOVERNMENT.

THIS DISTINGUISHED AUDIENCE KNOWS ABOUT THAT.

AS A PHYSICIAN AND FORMER PUBLIC HEALTH OFFICER, I DON'T
WANT TO RAISE YOUR BLOOD PRESSURE --OR MAKE YOUR
BLOOD BOIL-- BY REVIEWING THE SORRY STORY IN GREAT

DETAIL.

18
BUT IN A FEW WORDS, I'LL REMIND YOU THAT TOBACCO HAS
BEEN ASSOCIATED NOT ONLY WITH DISEASE AND DEATH, BUT
ALSO WITH MONEY.

THAT, OF COURSE IS THE REASON FOR ITS SPECIAL TREATMENT
AND FOR ITS INTERNATIONAL POWER.

TOBACCO WAS THE CASH CROP THAT FINANCED THE AMERICAN
REVOLUTION --THOSE VIRGINIA PLANTERS FETCHED A GREATER
RETURN FOR TOBACCO LEAVES THAN DID THE HARDY NEW
ENGLANDERS WHO GREW PUMPKINS IN THE FIELDS AROUND

BOSTON.

19
CONGRESS HAS BEEN HELD HOSTAGE EVER SINCE.

DESPITE THE SINISTER ASSOCIATIONS, FIRST WITH SLAVERY, AND
LATER WITH CANCER AND HEART DISEASE, AMERICAN TOBACCO
HAS ENJOYED GOVERNMENT PROTECTION.

TOBACCO MONEY EXPLAINS THE RELUCTANCE OF CONGRESS TO
TOLERATE ANY REGULATION OF TOBACCO, SO IT HAS BEEN
DECLARED TO BE NEITHER A FOOD, NOR A DRUG, NORA
COSMETIC:

A LOOSE CANNON ON THE DECK OF SPACESHIP EARTH.

20
ANY SPEECH ON SMOKING BECOMES A "GOOD NEWS/BAD NEWS"

STORY.

THE GOOD NEWS IS THAT WE ARE --AT LAST, AND SLOWLY--

WINNING THE WAR AGAINST TOBACCO.

THE BAD NEWS IS THAT THERE ARE MANY BATTLES STILL TO

FIGHT.

21
FIRST, SOME OF THE GOOD NEWS.

THE NON-SMOKERS ARE ON THE OFFENSIVE, AND THEY ARE
WINNING.

I'M SURE YOUR SESSIONS HAVE PROVIDED MANY EXAMPLES OF
VICTORIES, LARGE AND SMALL.

HOSPITAL STAFFS ARE DEMANDING THAT THEIR FACILITIES BE

MADE SMOKE-FREE.

22
WORKING PEOPLE ARE ASKING FOR SMOKE-FREE

ENVIRONMENTS WHERE THEY WORK.

IN 1980 ONLY 16 PERCENT OF AMERICAN COMPANIES HAD A
SMOKING POLICY; BY LAST YEAR 68 PERCENT HAD SMOKING
POLICIES. IN 1988 1 OUT OF 4 COMPANIES BANNED ALL
SMOKING, AND JUST ONE YEAR LATER THE FIGURE WAS 38

PERCENT.

23
PROFESSIONAL PEOPLE ARE HANGING THOSE "THANK YOU FOR

NOT SMOKING SIGNS" IN THEIR WAITING ROOMS.

AND HOUSEHOLDERS ARE TACKING UP THE SAME SIGN OVER

THEIR FRONT DOORBELLS.

24
JUST LAST SPRING, UNIVERSITIES LIKE HARVARD, C.U.N.Y.,
SOUTHERN ILLINOIS TOOK THE EXEMPLARY STEP OF DIVESTING
TOBACCO STOCKS, OFTEN IN RESPONSE TO STUDENT PROTEST. ...
A GOOD TREND.

LET'S KEEP UP THIS PRESSURE ON THEM.

25
I CANNOT NEGLECT THIS OPPORTUNITY TO SAY THAT THE
COOPERATIVE EFFORTS OF THE AMERICAN LUNG ASSOCIATION,
THE AMERICAN HEART ASSOCIATION, THE AMERICAN CANCER
SOCIETY IN WORKING TOWARD A CURRICULUM AGAINST
SMOKING THAT WOULD GRADUATE A HIGH SCHOOL CLASS IN
THE YEAR 2000 SMOKE-FREE HAS BEEN EXTRAORDINARILY

REWARDING.

26
I'VE PARTICIPATED IN THE PROGRAMS FOR THE FIRST AND
SECOND GRADES, AND I'M VERY ENCOURAGED ABOUT HOW
MUCH THESE YOUNGSTERS KNOW, AND HOW SERIOUSLY THEY
TAKE THEIR PLEDGE TO TURN THEIR BACKS ON ANYONE WHO

OFFERS THEM A CIGARETTE, NOW AND IN THE FUTURE.

27
SO, I WANTED TO START OUT WITH THE GOOD NEWS, REMINDING

US OF HOW FAR WE HAVE COME, REMINDING US OF BATTLES

WON.

BUT THERE IS STILL A LONG WAY TO GO.

THERE ARE STILL BATTLES TO BE FOUGHT.

THERE IS STILL PLENTY OF BAD NEWS.

28
EVEN IN THE UNITED STATES, EVEN WITH ALL THE PROGRESS WE
HAVE MADE, SMOKING IS STILL THE SINGLE MOST DEADLY
"HABIT" ... ASSOCIATED WITH HIGHER MORTALITY AND ILLNESS
THAN DRUGS, AUTOMOBILES, AND AIDS COMBINED.

ALL THE AIDS PATIENTS WHO HAVE DIED SINCE WE KNEW ABOUT
THE DISEASE, 9 YEARS, EQUALS THE SMOKING DEATHS OF ONLY

4 MONTHS.

29
THE NUMBERS OF DEATHS ANNUALLY ATTRIBUTABLE TO
SMOKING HAVE RISEN WITH EACH SURGEON GENERAL'S REPORT.
SO, EVEN THOUGH WE'VE MADE PROGRESS, AS A SOCIETY WE'RE
STILL BURDENED WITH THE TREMENDOUS AMOUNT OF
SUFFERING AND HARDSHIP THAT GOES ALONG WITH ALL THESE
DEATHS...

THE PEOPLE OF AMERICA ARE STILL BURDENED WITH THE

ECONOMICS OF SMOKING.

30
CIGARETTE-RELATED ILLNESS AND DEATH COST AMERICANS $178
MILLION A DAY IN LOST WORKER PRODUCTION AND HOSPITAL
BILLS.

WE STILL HAVE TO COME UP WITH THE MONEY TO PAY THE
ANNUAL SMOKING-AND-HEALTH BILL OF OVER $39 BILLION.
THAT'S FOR PERSONNEL AND MEDICAL TECHNOLOGY AND
INSURANCE AND LOST WAGES...ALL THE REAL, BASIC COSTS

LEVELLED AGAINST US ALL BY DISEASE AND DISABILITY.

31
SOME 49 MILLION AMERICANS STILL SMOKE, SO OUR EDUCATION
CAMPAIGNS AND OUR SELF-HELP GROUPS MUST CONTINUE
THEIR GOOD WORK.

WE MUST GUARD AGAINST COMPLACENCY, AND WE MUST
INTENSIFY OUR EFFORTS TO ELIMINATE THE GREATEST CAUSE
OF PREVENTABLE DISEASE AND DEATH AFFLICTING OUR

SOCIETY.

32
AND THE TOBACCO INDUSTRY HAS NOT GIVEN UP.

EVEN THOUGH THE NUMBER OF AMERICAN SMOKERS DROPPED
BY ANOTHER 4 PERCENT LAST YEAR, TOBACCO COMPANY
PROFITS STILL RISE. EVEN THOUGH MOST AMERICANS WOULD
AGREE THAT SMOKING AS A FOOLISH, FILTHY HABIT DANGEROUS
TO EVERYONE, AMERICAN TOBACCO COMPANIES HAVE
INCREASED THEIR PROFITS BY SELLING OVERSEAS. CIGARETTE

EXPORTS EXPLODED IN THE MID-1980S, INCREASING 25% IN 1988.

33
TO BE PERFECTLY HONEST, I DID NOT ASSUME THE POSITION OF
SURGEON GENERAL WITH THE CLEAR INTENTION OF BEING SO
PRO-ACTIVE AN OPPONENT OF TOBACCO AS I HAVE BEEN. BUT
THEN I BEGAN TO STUDY IN SOME DEPTH THE
INCONTROVERTIBLE TRUTHS ABOUT THE HEALTH HAZARDS OF

SMOKING.

34
AND I MUST TELL YOU THAT I WAS AT FIRST DUMBFOUNDED AND
THEN PLAINLY FURIOUS AT THE TOBACCO INDUSTRY FOR
ATTEMPTING TO OBFUSCATE AND TRIVIALIZE THIS

EXTRAORDINARILY IMPORTANT PUBLIC HEALTH INFORMATION.

35
HOW COULD THE TOBACCO INDUSTRY DARE TO DISMISS AS
UNFOUNDED AND UNPROVEN THE ABSOLUTELY CLEAR
CONNECTION BETWEEN SMOKING AND HEART DISEASE ...
BETWEEN SMOKING AND DEATHS FROM STROKE ... BETWEEN
SMOKING AND CANCER OF THE LUNG, THE MOUTH, THE
ESOPHAGUS, AND OF THE STOMACH ... AND BETWEEN SMOKING
AND A DOZEN OR MORE SERIOUS, DEBILITATING, EXHAUSTING,

EXPENSIVE, AND HUMILIATING DISEASES?

36
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.

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37
(international starts here):

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.

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

TO THE FAR EAST.

38
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.

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.

39
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.

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.

40
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.

41
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."

42
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.

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.

43
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 ... IN JAPAN, WHERE 60 PERCENT OF
ADULT MEN SMOKE, SOME PEOPLE TOOK CHEER BECAUSE ONLY
7 PERCENT OF JAPANESE WOMEN SMOKED.

HOWEVER, 26 PERCENT OF JAPANESE FEMALE HIGH SCHOOL

STUDENTS HAVE BECOME SMOKERS.

44
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,

45
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.

46
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.

47
NOW, LET ME MAKE SURE YOU UNDERSTAND WHAT I JUST SAID.
I SAID THAT SOME AMERICAN CIGARETTE MANUFACTURERS -- AS
KNOWLEDGEABLE AS I AM, CONCERNING THE HEALTH RISKS OF
SMOKING -- KNOWINGLY PRODUCE A MORE HARMFUL
CIGARETTE FOR EXPORT THAN THEY PRODUCE FOR DOMESTIC

CONSUMPTION.

48
CIGARETTES WILL SOON BECOME THE PRIMARY CAUSE OF
DEATH WORLDWIDE. NOW 2.5 MILLION DIE ANNUALLY FROM
CIGARETTES; IN 2050 CIGARETTES, IF THE TRENDS CONTINUE
WILL KILL 12.5 MILLION ANNUALLY.

(international stops here).

49
OUR EXPORT OF TOBACCO PRODUCTS IS A MORAL OUTRAGE.
AND 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 AND PROVIDING THAT SOCIETY WITH
FOREIGN AID ON THE ONE HAND, IF THE PHYSICAL HEALTH OF
THE PEOPLE OF THAT SOCIETY IS FUNDAMENTALLY

ENDANGERED DURING THAT SAME LONG TERM.

50
THE INTERNATIONAL POWER AND PROFITS OF THE TOBACCO
INDUSTRY MAKE MORE DIFFICULT OUR TASK IN REACHING A
SMOKE-FREE SOCIETY BY 2000. WE AMERICANS MUST CONDUCT
THE BATTLE AGAINST THE TOBACCO GIANTS 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.

51
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 EFFORTS, AND

PREVAIL.

52
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.

53
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.

THERE IS NO MONETARY INCENTIVE FOR PHYSICIANS TO TREAT

SMOKING.

54
ALTHOUGH STATES REQUIRE INSURANCE COVERAGE FOR
ALCOHOL AND DRUG TREATMENT, NO STATE REQUIRES
COVERAGE FOR NICOTINE CESSATION PROGRAMS, EVEN THOUGH

THE HEALTH COST OF NICOTINE ADDICTION IS 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.

55
THEY SAY THEY USUALLY DON'T COVER PREVENTIVE PROGRAMS.

WHAT SENSE DOES IT MAKES TO SPEND $150,000 ON THE
TERMINAL CANCER ILLNESS OF ONE OF THEIR INSURED, 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.

56
WE ALSO NEED TO WEAKEN THE INTERNATIONAL TOBACCO
INDUSTRY BY ELIMINATING CIGARETTE ADVERTISING, HERE AND

ABROAD.

THE ADS HAVE BEEN BANNED FROM AMERICAN TELEVISION,
THANK GOD, --ALTHOUGH THEY ARE SNEAKING BACK THROUGH
VIDEOS-- BUT CIGARETTE ADVERTISING STILL ASSAULTS OUR
SOCIETY IN PRINT AND BILLBOARDS.

THE TOBACCO INDUSTRY SPENDS $4,000 PER MINUTE ON

PROMOTION ($2.5 BILLION A YEAR).

57
ONLY THE GROTESQUE ECONOMIC POWER OF THE
INTERNATIONAL TOBACCO COMPANIES CAN SUSTAIN THIS
OUTRAGE, AS THEY USE ECONOMIC BLACKMAIL TO INTIMIDATE

PUBLISHERS AND GOVERNMENTS.

I AM PARTICULARLY DISTURBED BY CIGARETTE ADVERTISING
THAT TARGETS VULNERABLE GROUPS WITHIN OUR POPULATION
AND ABROAD.

HERE IN AMERICA THE CIGARETTE ADVERTISERS HAVE SET

THEIR SIGHTS ON YOUNG PEOPLE, WOMEN, AND ‘MINORITIES.

58
CIGARETTE FIRMS MANIPULATE MINORITIES, WOMEN, AND
YOUNG PEOPLE BECAUSE THESE PEOPLE HAVE THE STRONGEST
ASPIRATIONS TO CHANGE THEIR STATUS.

SO THESE ADS ASSOCIATE SMOKING WITH MAKING IT...

THEY ASSOCIATE SMOKING WITH A HIGHER ECONOMIC STATUS

(WHEN REALLY HIGHER INCOME GROUPS ARE NOW SMOKING

LESS).

59
WE KNOW THAT THOSE WITH MORE EDUCATION TEND TO QUIT
MORE READILY. "THE MORE YOU KNOW, THE LESS YOU SMOKE."
BUT TOBACCO ADVERTISERS ASSOCIATE SMOKING --CONTRARY
TO ALL EVIDENCE-- WITH ROBUST ACTIVITY, ATHLETICS, SOCIAL
ACCEPTABILITY, BUSINESS AND SEXUAL SUCCESS, OUTDOOR

LEISURE, AND EVEN GOOD HEALTH.

60
ONE OF THE MORE OUTRAGEOUS ADVERTISING SLOGANS IS ONE
CIGARETTE COMPANY'S "ALIVE WITH PLEASURE" THEME.
THIS IS CLEARLY AN EFFORT TO UNDERMINE THE SURGEON

GENERAL'S WARNING ON EACH PACK.

TRUTH IN ADVERTISING SHOULD REQUIRE, NOT "ALIVE WITH

PLEASURE", BUT "DYING IN AGONY".

61
IN THE ADVERTISING WARS YOU HEAR A LOT ABOUT PROOF.

THE TOBACCO COMPANIES SAY THAT IT HAS NOT BEEN PROVEN
THAT ADVERTISING INCREASES CIGARETTE SMOKING.

OF COURSE, THE COMPLEXITY OF THIS ISSUE OF HUMAN
BEHAVIOR WILL PROBABLY PRECLUDE THE ESTABLISHMENT OF A
SCIENTIFIC PROOF OF A CAUSAL LINK.

BUT TO MY MIND THE BURDEN OF PROOF SHOULD BE ON THE
TOBACCO INDUSTRY TO SHOW THAT ADVERTISING DOES NOT
INCREASE CONSUMPTION OF A PRODUCT THAT WE KNOW LEADS

TO DEATH WHEN USED AS INTENDED.

62
IN THE 1850s JOHN SNOW ENDED THE CHOLERA EPIDEMIC IN
LONDON BY REMOVING THE HANDLE OF THE BROAD STREET
WATER PUMP, 30 YEARS BEFORE THE BACTERIUM CAUSING

CHOLERA WAS DISCOVERED.

FORTUNATELY HE DID NOT NEED TO CONTEND WITH A CHOLERA
INSTITUTE THAT DEMANDED THE PUMP KEEP WORKING UNTIL IT
WAS PROVEN THAT WATER FROM THE PUMP WAS CAUSING THE

CHOLERA.

63
FOR ALL THEIR TALK ABOUT "FREEDOM", TOBACCO INTERESTS

ARE GREAT ENEMIES OF FREEDOM.

FAR FROM BELIEVING IN FREE SPEECH, TOBACCO ADVERTISERS
USE THEIR ECONOMIC CLOUT TO FORCE PUBLISHERS NOT TO
PRINT ARTICLES ABOUT THE REAL CONSEQUENCES OF SMOKING.
CIGARETTE ADVERTISING, FAR FROM ALLOWING FREE CHOICE,
ACTUALLY UNDERMINES FREE CHOICE.

NICOTINE ADDICTS DO NOT ENJOY FREE CHOICE.

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LET'S BE UP-FRONT ABOUT THE SPECIAL CHALLENGE FACING
TOBACCO ADVERTISERS:

MOST PEOPLE WHO USE THEIR PRODUCT WOULD RATHER NOT
USE IT.

AS MANY AS 90% WISH TO QUIT.

MANY TOUGH IT OUT, BREAK THEIR ADDICTION, AND SUCCEED IN
QUITTING.

THE ADVERTISERS NEED TO REPLENISH THE DIMINISHING
SUPPLY OF TOBACCO USERS:

REMEMBER THOSE 1,000 SMOKERS WHO DIE EVERY DAY.

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ANOTHER ISSUE OF PUBLIC POLICY WHERE WE CAN ATTACK THE

TOBACCO INDUSTRY CONCERNS CIGARETTE VENDING MACHINES.

HERE IS ANOTHER EXAMPLE OF THE CODDLED CIGARETTE

COMPANIES.

IT IS ILLEGAL TO SELL BOTH ALCOHOL AND CIGARETTES TO

MINORS. THAT IS BECAUSE ALCOHOL AND NICOTINE ARE THE

TWO MAJOR LEGAL ADDICTING DRUGS IN OUR SOCIETY.

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WE WOULD NEVER TOLERATE SELLING ALCOHOLIC BEVERAGES
IN VENDING MACHINES, BUT SOMEHOW WE TOLERATE

CIGARETTE VENDING MACHINES.

IT IS SAD EVIDENCE OF OUR FAILURE TO TAKE SERIOUSLY THE
DANGERS OF SELLING THIS ADDICTING DRUG NICOTINE TO
MINORS.

AND MANY MINORS ARE BUYING THEIR CIGARETTES THROUGH

VENDING MACHINES.

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IN SPITE OF ALL OUR EDUCATIONAL EFFORTS, 3,000 TEENS A DAY
TAKE UP SMOKING. AND THEY START YOUNG. OF HIGH SCHOOL

SENIORS WHO SMOKE, 75 PERCENT STARTED IN 9TH GRADE.

THE CIGARETTE VENDING MACHINES SHOULD BE THE NEXT

TARGET IN THE CRUSADE AGAINST SMOKING.

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WE NEED TO FOCUS OUR ENERGY ON SPECIFIC ISSUES, TO

CHOOSE OUR BATTLES, AND WIN THEM ONE BY ONE.

I'M SURE YOUR SESSIONS HAVE STRESSED THE NEED TO
DEVELOPE DIFFERENT STRATEGIES AND TACTICS TO ADDRESS
THE VARIATIONS IN TOBACCO USE ACCORDING TO GEOGRAPHY

AND GENDER.

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FINALLY, I WANT TO STRESS THE POWER OF OUR GREATEST
WEAPON: THE POPULAR RESOURCES THAT CAN BE TAPPED BY

MORAL SUASION.

WHEN I WAS YOUR SURGEON GENERAL, I FREQUENTLY SAID
THAT I HAD NEITHER POWER NOR BUDGET.

THAT WAS CERTAINLY TRUE, FOR I HAD ONLY A TINY STAFF AND -
-IN WASHINGTON TERMS-- A TINY BUDGET, ENOUGH TO KEEP US

IN PAPER CLIPS AND PHOTOCOPIES.

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BUT I THINK I WAS ABLE TO ACCOMPLISH A LARGE AGENDA

SOLELY THROUGH THE POWER OF MORAL SUASION.

IN THE RIGHT HANDS, AND IN ENOUGH HANDS, MORAL SUASION
CAN OVERCOME OBDURATE BUREAUCRACIES, ENTRENCHED
ECONOMIC POWER, AND THE INCREASINGLY DESPERATE

TOBACCO COMPANIES.

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I MAY HAVE HUNG UP THE UNIFORM OF THE SURGEON GENERAL,

BUT I HAVEN'T RETIRED FROM THE FIGHT AGAINST SMOKING.

TOGETHER, WE CAN WIN IT.

LET'S GET GOING.

THANK YOU.

HHEELFEF

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