Document 2qJjye23KZ9g6DG53Ym89gN1N

FILE NAME: Newspaper & Magazine Articles (NMA) DATE: 1955 DOC#: NMA002 DOCUMENT DESCRIPTION: Cigarettes Y Sa a M 3 ^ :x ^ ^ * - r~ ^ - - - - v d A xc'j . ^ ^ T k A are the results of CU's recent laboratory tests Wi f ill filter-tip cigarettes give you les3 nicotine and tar than plaits cigarettes? What about tLe king-size cigarette which "travels the smoke further/ or king size phis a filter? What about the cigarettes which use a low-nicotine tobacco, or a denicotinized tobacco-- is there really less nicotine in their smo.se? And the popular" brands-- how do they compare with the other brands on the market with regard to their nicotine and tar content? These are some of the questions to which 3taoker~ would like to save answers. But no answers, at least no reliai '.e ones, are to be found in the hazy, happy, healthy world of cigarette advertising. The purpose of this report is to provide some of the answers. In February 1953, CU reported on laboratory tests of 27 widely sold brands of cigarettes, and readers were informed of brmd-to-brand, and type-to-type differences in terms of nicotine and tar content Since that time, however, many new king-size and filter-dp cigarettes have appeared 01 the market, and some of the older brands have changed their lengths and their filters. CU's tests for nicotine and tar embrace the newcomers as well as the old standbys. The following report covers testa of 37 brands of cigarettes, purthased in 28 cities throughout the country. They are of four broad types: regular size, filtered; regular size, unfiltered; king-size, filtered, and Idng-size, uafilteretL Within these types are cigarettes majle of American blends, and Turkish cigarettes; low nicotine, denicotinized, and mentholated smokes; regular-price, low-price, and premiumprice; plain, and filter-tipped. Sixteen cigarettes of each brand (each from a different pack) were mechanically "smoked" in a laboratory apparatus in tests for nicotine and tar. The test results are summarized in the table on page 59. Apart from the obvious determinations of how the brands rank in nicotine and tar content, there "are a number of interesting conclusions which can be drawn from the figures. First of all, the test results indicate that the use of tobacco which is low in nico tine results in lower nicotine content in the smoke than regular tobacco even with a filter. John Aldat, a regular-size cigarette without a filter, had far less nicotine in its smoke than any other cigarette; this brand is made from a special low-nicotine tobacco. Additional information was provided by some check tests: for the five largest selling brands, not only the smoke but the tobacco itself was analyzed for nicotine content There was a direct correlation between the nicotine content of the smoke and of the tobacco in each case. Because crops of any given variety of tobacco vary in nicotine content from year to year, and from region to region, depending on such things as climatic and soil conditions, the nicotine in the smoke of the cigarettes made from these tobaccos can also be expected to \rary. And in most cases it does. Of the 20 brands included in both CITs previous tests and the current teats, only John Alden and Sana regular were found to be unchanged in the nicotine content of their smoke. John Alden was lowest in nicotine content in both serfs of tests; it averaged only 0.4 milligram of nicotine per cigarette in the 16 test.sampies " smoked" by the laboratory apparatus. Sana regular abo remained at its previously found low nicotine level although it was not quite as low as the recently introduced Sana king size with filter tip. Sanos are made of a denicotinized tobacco: that is, to b a c c o from which a large part of the nicotine has been extracted. Continued in next page CONSUMER REPORTS cigarettes LABORATORY TESTS Nearly all the other cigarettes tested for both this and the 1953 report were- higher In nicotine this time. The nico tine content in the smoke from Comets increased from 1.9 milligrams to 3.3 milligrams per cigarette; the regular-size Old Golds, Lucky Strikes, Philip Morris, and Chesterfields also rose in nicotine content, although not as sharply as Camels. The range in nicotine content, except for John. Aldert and Sano, was from about 1.5 milligrams (for L&M regulars) to 4 milligrams (for Old Gold icing size), and the range among the five most popular regular-size brands was even less, running from 2.3 milligrams to 3.3 milligrams. There is no generally accepted definition of the "tars" so much talked about in connection with smoking, and consequently no generally accepted method for their measurement in its new tests, CU utilized a modification of its previous test method to obtain what is believed to be a more precise determination of the tax content of the smoke; the results, therefore, are not strictly' comparable with those obtainedin the previous tests. The range in tar con tent among the 37 brands tested was not as great as the range in nicotine content By smoking John Alders, you can cut your nicotine intake down to 10% of that of the brand highest in nicotine. But the cigarett; lowest in tar content (L&M regular) will still give you ~,0% of the tar content of the smoke of the cigarettes highest in tar content. THE FILTER-TIP BRANDS Open up the filter tip of different cigarettes and you will find a variety of things--absorbent cotton, paper con taining activated carbon, cellulose acetate fibers, crep-ed and uncreped paper, asbestos fiber:.,' or combinations of severad of these materials. No laboratory tests were run to determine whether it was the filers, or other factors, that were responsible for high or lew nicotine content in each case. The main concern was with the final product-- the amount of nicotine and tar in the smoke. The test results indicate, however, that for a cigarette of given size there was in most cases ,es&Jar in the smoke of the filter-dp brands--on the average, about a third less. Within a given size too, the filter-tip cigarettes were also generally lower in nicotine content, although there were several exceptions. The brands whose smoke yielded the HOW GU TESTS CIGARETTES- 58 FEBRU A RY I 55 H ie testing of * cigarette begins with the collection of itii moke. The cigarette is first fitted ii to a glasu holder and then " smoked" in the laboratory tppssratus (left). Tbe smoke drawn from the cigarette is collected in acidified alcohol in the flask (any smoke carried into the glatns "train" is trapped in the two visthi . Lowering the level, of the water in the vertical glass tthe at the end of the train by means of the bnlb at the extreme right of thin picture draws air throngh tbe- cigare'te. Each puff is made to last for two seconds and one pub is taken each minute. Slightiy more than two cubic inches !3S cubic centimeters) is taken in with each puff, and e a ei cigarette is smoked down to a butt of just under an inch 123 m m .). In CU* east tar were all filter-tipped. Three of them---L&M regular, Sana king size, and the premium-priced da Maurier regular-- were .also below the 2 to 4 milligram range of nicotine content into which 80% of all brands tested fell. Kent, while relatively low in tar, did not fare so wed in holding down the nicotine in its smoke. In the 1953 survey, Kent was noted as having less nicotine than any other brand with the single exception of John Alden. The Kents which CU tested for this project had little edge in this respect over most of the other brands tested. Regardless of the effectiveness of filter tips in keeping nicotine and tars out of your lungs, they have some value in keeping bits of tobacco from getting into your month and they do afford a firmer butt. KING-SIZE CIGARETTES The smoke of king-size cigarettes contained, on the aver age, more nicotine and tar than the smoke of regular-size brands when" both were smoked down, to a butt of 23 millimeters (just under an inch), though here also mere were several exceptions. King-size brands with filter C ontinued on next pace teats, 16 samples oi esch brand were `Smoked'* in two mane of eight dgarettee each; the reetdts of each nm were determined separately and then averaged. After each ran, duet vrunhings from the apparent*) are added to the amoke solution in the collecting flaek* One portion is ateam dis tilled to isholate the nicotine; amounts are measured with am olinariolet spectrophotometer (center). Chloroform is added to another portion of the smoke solution, which is then dilated with water- The tar i* then extracted by rigor ous shaking, first from acid solution, then from alkaline solu tion, smd the chloroform is then drained from separatory funnel*. After this, the chloroform is boiled off and the txr reuidntiL weighed on a chemical balance (mlaore). R E S U L T S O F T E S T S FOR NICO TINE AN D TAR IN THE SM OKE FROM 3 7 BRAND: OF CIGARETTES Brands are listed in order of increasing nicotine content of their smoke. A difference of a fnc milligrams in tar content is of no significance. B itA N D A N D T Y P E IVfJMtig uam w w ua i m m cm am t [MULMKAMB) ittu d st UK HU tnieiQt Ptii in fo rm (u tujim M tL S ) JOH N ALDEN Low nicotine tobacco 0 .4 John Alden Tobacco U N O Denicotinized (KF) 1 .0 United Sutes Tobacco U N O Denicotimzed Id* LAM (F ) Liggett & Myers 5 - MAURI at (F ) Columbia Tobacco ..,1 -3 1 .7 ORKSHIRE Laras & Bro. 1 .7 MURAD P. LoriUard LS KENT (F ) P. Lorillard 2.0 YORKSHIRE (K) 2 .0 CHESTERFIELD Liggett & Myers 23 DU MAURI ER (KF) 23 RECENT (K F) Riggio Tobacco 24 PARLIAM ENT (F ) Philip Morris 24 U M (KF) 2.5 HERREKT TAKEYTON (KF) . American Tobacco 25 PARLIAMENT (KF) 26 CHESTERFIELD (K) 27. P W U ! M ORRIS Philip Morris 27 LUCR T STRIKE AmericaifTobacco . 27 KENT (KF) 28 OLD COLD (K F) P. Lorill*rd 29 W IN G S (K ) Brown & Williamson 29 OU COLD 29 FATIM A (K) Liggett & Myers VICEROY (K F) Brown & Williamson DUNHILL (K ) Philip Morris W IN STO N (KF) R, J. Reynolds HER1ERT TAR TYSON (K) CAMEL' R. J. Reynolds XOOL Brown & Williamson PH ILIP MORRIS (K) PALL MALL (K) American Tobacco EMKASSY (K ) P. Lorillard KOOl (K) RALEIGH ( K F Brown & Williamson CAVALIER (K ) R- J-' Reynolds OLD GOLD (K ) 29 3.0 3D 3.1 3.1 S3 3.4 3 .4 3*5 3.7 3.7 3.7 3.8 4 .0 16 1?. 15 11 12 15 21 12 18 17 16 19 14 18 19 . IS 22 2 1 21 15 14 20 ,, 18 24 18 23 20 - 22 20 20 26 26 24 23 25 26 25 K -- king site ; F =s filter tip ; iCF = king site vdtk filter tip. i f here no tetter follows name, brand is regular sire. C O N SU M ER REPORTS 59 cigarettes LABORATORY TESTS tips were also higher in nicotine and tar than-the regularsue filtered Brands. King-size cigarettes measure about 85 millimeters compared with about 70 millimeters for regular-length cigarettes. However, if you smoke the same length of a king-size cigarette as you do of a cigarette of regular size (that is, you leave a longer butt), the extra tobacco serves as an effective filter, and the total nicotine from the king-size cigarette will, under such conditions, generally be lower than from a regular-size cigarette. Not all king-size cigarettes tested were high in nicotine and tar when smokedi to usual butt size, however. The relatively low-priced Yorkshire king size (available only at Sears-Roebuck retail stores in larger cities) yielded only about as much nicotine as Kent regular, and less than any of the regular-size "popular" brands. Also lower in nicotine than the popular brands was Murad, a premium-priced, regular-size Turkish cigarette. Murad, however, had an above-average tar content ~~ without reducing their cigarette consumption might be willing to bear with John Alden's initially less-pleasing flavor in the hope that they would get to like it CIGARETTE PRICES Cigarette prices often vary from store to store. The fol lowing prices axe representative of hose paid by CU's shoppers in Nerw York City. Murad, ,<t 37(1 was the most expensive brand tested, with Parliatmni and du Manner "(both regular- and king-sizes) close Behind at 33#. Other premium-priced brands included Kent, in both sizes, at 31#, and Sana king-size, 30#. At the low end of the scale were Yorkshires (they averaged 17ft for the regular and 18# for the king-size in Sears retail stores throughout the country), and Wings at 21ft. Nearly a 1 other brands were priced at 24ft or 25#, with some filter-tip and king-size cigarettes at a'penny or two more. Joan Alden, the brand lowt st in nicotine, was 26# a pack. A MOTE ON FLAVOR * - - W HAT ABO UT CIGARS? '. CO made no attempt to evaluate flavor in any of' the Recent' medical literature has dear largely with the cigarettes tested, but a note on this hotly disputed subject hazards of cigarette smoking, hut little' has been said may be of some interest It is now pretty generally agreed about cigars. CU ran limited tests, to give readers some ---and CU has in the past verified thus with mass tests-- : information on nicotine and tar in cigsr smoke, A random that in blindfold tests moat smokers can't tell the difference - selection of 24 cigars--thin ones., fat ones, long ones, between one "popular" brand and another. The situation short ones-- were "smoked" in the same laboratory ap is a little different when it comes- to Turkish blends, special, paratus used in the cigarette tests, and. the collected, smoke tobaccos, or specially treated or flavored tobaccos. It is- of each cigar-was analyzed in the sane manner. widely conceded that a reasonably sensitive smoker catr* * . On the average these cigars,, -which gave uboot six times tell one from the other, and can distinguish afl of them as many- puffs as cigarettes, had in their smoke only about from the "popular" brands. The preference for one or an twice as much nicotine and one and a half times as much other of the flavor types seems to be a mixture of personal . tar. On a weight-for-weight basis, the ^cigars had on the taste and habit A number of smokers who tried the low- average only one-third^as much nicotine and one-fourth nicotine John Alden commented adversely on its flavor; " as much tax in their smoke as cagsrettss. The relationship however, those bent, on reducing their nicotine intake.' oF cigars to' cigarettes in this respect is shown below. NICOTINE AND TAR CONTENT' OF SMOKE PER CIGARETTE NICOTINE AVERAGES wane; BAMS o t x r y^k-WT^^. 4 TAR AVERAGES it REGULAR WITH FltTER REOTLAR REGULAR WITH FILTER - 12 REGULAR KING SIZE WITH FILTER KING SIZE OVERALL - KING SIZE WITH FILTER ' KING SIZE OVERALL ... CIGARS o t i i * bJohn Alden and Sana are not included. CIGARS ; A FEBRU A RY 1955 Ine Industry f T n "WT "T| Ht ^ Medical reports have upset the cigarette business; regular '*'**" 'IM. * brands decline, as 19 new versions enter the retail arena -A-he tobacco industry today is undergoing one of the greatest periods of change and upheaval since Americans first started smoking cigarettes before the. Civil War." This-was the sweeping judgment, as the year 1954 ended, of Lewis Gruber, vice-president in charge of sales for P. Lorillard, one of the "Big Six" tobacco companies which together manufacture more than 98% of the cigarettes sold in America. "Upheaval" is a startling word in the tobacco industry; two years ago it would have been almost unthinkable. The tobacco industry had its revolution 40 years ago, ths--revolution which turned it into the cigarette industry. The revolution consisted ) two fundamental changes in American habits, which began around the time of the first World War: first, a great increase in smoking, especially among women, as ihe social pressures against it were relaxed; and second, a switch to cigarettes from the older forms of tobacco--pipes, cigars, snuff, and chewing tobacco. This expanding consumer demand, shaped and standardized by a few companies, hoisted cigarettes to a retail position which was simple, secure and gigantic. Even by the massive standards of the American economy, cigarettes axe big business. In 1952--to date, the year of greatest total sales--some 395 billion ciga rettes were bought in the United States, an average of 187 paces a year, for every American over the age of 15. (Almost 43 billion more cigarettes were sold tax-free, largely to the armed forces.)-In this one year, Americat consumers spent 54,300,000,000 for cigarettes alone. . - TOE BIO SIX AMD THE_ BIO THREE Since the 1920s, the cigarette market has been increasingly -dominated by a few big companies. In the order of their total sales, the "Big Fite"' have been: the American Tobacco Company (makers of Lucky Strike, Pall MsQ, Herbert Tartsytan), R. J. Reynolds (Camel, Cavalier, IPinstori), Liggett & Myers (Chesterfield, L&M, Fatima), Philip Morris (which, besides its namesake, also makes DunJtiU and Parliament), and P. Lorillard (Old Gold, Kent, Embassy), fit 1954, .Brown & Williamson (Viceroy, KooL, Raleigh, Wings) rose to fourth position to make the Big Five the Big Six. The first three--American, Reynolds, and Liggett & Myers-- tire much the biggest; they account for a whopping 75% of til cigarettes sold in 1954, and are usually grouped in a super-king-size class as the "Big Three." Each of the big companies won its commanding share of tie market with one leader--Camels, Lucky Strikes, Chesterfields, Philip Morris, or Old Golds. Each of these brands was picked as a "leader" by its manufacturer and the leader got top priority, especially in the company's advertising budget Each company made a relentless effort to imprint one brand name on the consumer's mind, to make "Luckies'' or " Camels" his sole, automatic response to the idea of "cigarettes." These insistent, "Johnny One-Note" advertising campaigns have been going on for '10 years, and on a very large scale. The cigarette industry spends upwards of 65 million dollars a year on advertising. Among the 20 largest American advertisers have been four tobacco companies, along with such giants as Procter & Gamble,. 'General Motors, General Foods, and Ford. And their advertising paid off; by 1947, the five leading cigarettes held more than 92% of the market. In this "win-or-losewith one" race, the Big Three entries-- Luckies, Camel, and Clusterfields-- came in first, with a combined total of 80% of the market. In effect, each o the five b ig com panies was selling the A m erican sm oker on e Cominued o next (Xigv C O N SU M ER REPORTS & cigarettes THE INDUSTRY t z FEBRU A RY 1955 product--and, basically, their five products were the same. In simplifying the cigarette market, the big companies had also standardized it: whatever its name, the "American cigarette" was a plain cylinder of thin paper, 70 milli meters long, -filled with a mixture of aurley and flue-cured tobacco. Among the five brands there were, of course, dif ferences in the proportion of hurley to flue-cured, in.the small amounts of Turkish tobacco mixed with this basic filler, in added flavorings, and in "processing." The result ing differences in taste and quality of smoke were sup posed to be, the basis for the consumer's brand loyalty. It is trd<s that many smokers believe in these "differences," and can describe them, usually in vague terms, though they may frequently contradict each other as to which brand is "mild," which is "strong," which "hurts my throat," etc. Blindfold tests indicate, however, that most smokers cannot tell, by taste alone, whether they are smok ing their favorite big-name brand, or another. Neverthe less, the "differences" have been stressed vociferously in big-bra ..i advertising. So simple and standardized a prod uct did not permit any other kind of competition---except, perhaps, in price. NO PRIC E COMPETITION Despite their almost frantic appeals for public acceptance, however, the big brands have never tried to compete in price. When one of the Big Three has moved its price up or down, the other companies have promptly done the same. In the depths of the depression, smaller tobacco companies launched cut-rate brands (such as Wings, .Avcdorts and Marvels) which sold at 1<V a pack---5^' under the regular brands--and for a brief time in 1932 captured 22% of the market. The big companies, which had raised their price in .1931, answered this challenge by a uniform price drop.. (According to testimony in a successful federal antitrust suit against them, they also bought up the land of tobacco used in the cut-rate cigarettes and hoarded it) This solidarity, in pricing among the dominant Big Three was condemned by the courts in XSM6 a s .collusion. But prices remained identical. Competition in price was left to the retailers. By reducing their ovm margin of profit, the small retailers can reduce the price oi cigarettes a cent or two per pack. Thus, they can compete---but only against each other. When supermarkets o r drugstores cut the pre, vailing local price, it is almost always by the same amount on all regular brands. What reason was there, after alfi. fer the b i g c o m p a n i e s to lower their price? There was certa nly no resistance b y the consumer. The market for cigarettes kept on e x p a n d ing, despite a series of price hikes, which, in th e l a s t 2 0 years, have raised the price per p a c e of th e b i g s e llin g brands from 13fi to 25^. In fact, it was during this s a m e period of inflation and higher federa cigarette taxes t h a t the industry scored its most spectacular gains. B e tw e e n 1932 and 1952, the number of cigarettes sold a lm o s t quadrupled, and industry spokesmen w ere , c o n fid e n tly p re dicting sales rises of 4% to 6% a y e a r . jK T .Ni ijsistant Direct y-Otj ^CAu-j-r-o S tatistca At: the beginning of 1953, then, the industry seemed to be safe against any upset: 1952 had been the peak year for sales; cigarettes-were an "essential" to a vast, and ap parently growing, sector of American life; the market was dominates! by a few prosperous companies, selling their product at a standard price, and with half-a-dozen brands which bore a comforting resemblance to one another. What has happened, in only two years, to cause so much concern in the industry? Briefly, three developments of major importance to the consumer: 1 A series- of reports which, according to the scientists and statisticians who prepared them, imply that there is &significant association between the rising incidence of lung cancer and the smoking of cigarettes. 2 For two years running, a significant drop in the number of cigarettes sold--the first since 1932; in 1953, cigarette consumption fell by 2.9%, and another drop of about A6% is expected to be shown for 1954. A big change-over by smokers from "regular" branda to kmg-sixe cigarettes (85 millimeters long), and a marked shift to those with some kind of filter dp. Since these three developments all took place during roughly the same period of time, the big question is: are they related? The recent "health" attacks on cigarette smoking are evaluated in a special report on pages 67 to 73. The point here is: what effect have they had on-the industry " iind the consumer? THE CANCER SCARE The indnstry's first reaction came after the publication in December 1953 of the report by Dr. Ernest L. Wynder and Dr. Evarts A. Graham, "Experimental Production of Carcinoma, [cancer] with Ggarette Tars." This medical report was quickly "translated" for the public by an out burst of stories in newspapers and such mass-circulation nmgaxmes as Life and Time. On January 4, 1954, a fullpage advertisement in 448 newspapers announced the for mation of the Tobacco industry Research Committee to investigate the relation of tobacco to health- The Com mittee's members were 14 tobacco companies and associa tions--growers, warefaonsers, and manufacturers-- and included all the Big Six, with the exception of Liggett & Myers, The Committee followed up the ad by naming a scientific advisory council headed by Dr. Clarence Cook Little, founder and director of the Roscoe B. JacksonMemorial Laboratory at Bar Harbor, Maine. Since then, the TIRC has not been publicly active. Dr. Little's occasional statements have followed the "wait-andsee" line taken in the first ad, namely, that no single cause of lung cancer has been established, and that there is no proof of a cause-and-effect relationship between smoking and lung cancer. In November of last year, the TIRC made its first six grants (totaling $82,000) for research projects involving the composition of tobacco, the physiology of Cigarettes Found to Raise Death Rate in Men SO to 70 'AN FRANi RENCX XL DA'!, ECS Vl>r Hrr*rt TU. Tgirette smolh-ra^rma 50 as smokers, and other pertinent subjects. Industry spokesmen have followed the "not proven" 'line. They imply that the current medical controversy is .only the latest in a long series of "health stares" which have blown over in the past. But business and trade journals generally agree that during the last yesr and a hall the cigarette business has received the most damaging publicity in its history. And last November, this was virtually con firmed by one of the Big Three, when EL A- Darr, president of Reynolds, accused the American Car eer Society of at tempting "to destroy the tobacco industy." IN D U ST R Y HEALTH CLAIMS The industry does not admit in public that "health" publicity may have caused the unprecedented drop in ciga rette sales. But critics close to the industry--for example, in the advertising trade journals--have static! flatly that it is fear which is causing Americans to turn away from cigarettes. They also say that the companies themselves are largely to blame. Long before the current medical attacks, the companies were building up suspicion in the consumer by the discredited "health chim s" in their ads. For a generation, the companies have been insisting, in big red letters, that their particular brand la d "less nicotine," was "less irritating," "guarded against tlnroat scratch," was "safe in your T-zone," and so on, to the outer limits of the copywriter's imagination and the Federal Trade Commis sion's patience. Such medicine-show claims may have given the smoker temporary confidence iri one brand, but they also implied that cigarettes in general were distasteful, probably harmful, and certainly a "problem." When the CorUinuad on n e xt page C O -S U M E R REPORTS 43 cigarettes THE INDUSTRY scientists came along with their charges against cigarettes, the smoker was ready to accept them, SALES TUMBLE There is no way to determine what lasting effect the recent "health" attacks have had on the consumer. But there is pretty convincing evidence that the Graham-Wynder report made a strong first impression. In January and February, 1954, the first two months after the report was publish!, cigarette sales went down 9% and 17% below the figures for the same months in 1953. In May and June, however, sales moved up 2% and 8% respectively- over 1953. After the American Cancer Society's life-expectancy survey reported by Drs. Hammond and Horn in late June, sales again turned down. All- in all, sales were off nearly 4% for the first nine months. That there L uneasiness among American smokers is confirmed by tne heavy sale of.HerbertJBrean's book, "How to Stop Smoking,"-pub lished by Vanguard Press in 1951. By the end of last year, abottt 500,000 copies bad been sold, 425,000 of them in the paper-backed edition put out by Pocket Books. This sale does not prove, of course,, that Americans in large numbers are actually giving up amoldng, but it does show that a lot of them are interested in doing so. T H E N E W LO O K BN C IG A R E T T E S The industry may appear sluggish, or just cautious, in its reaction to the medical attacks, but it has a lot of merchandising fight left, as shown by its quick response to the new consumer demand for king sizes and filter tips. Last year, at least 19 new brands, or new versions of old brands, came on the market All of these new cigarettes were either king size or filter tip, and 11 of them were both. This is "fast service" indeed for the restless or discontented smoker. It is also good business for the tobacco companies, since the "new look" cigarettes are the growing sector of ant otherwise shrinking market For the last seven years, the tobacco industry has wmtehed the demand for the Big Three brands-- Camels, LueMes, and Chesterfields--steadily contract In 1947, over 80% of all the cigarettes sold bore these familiar names. By 1953, the Big Three regulars' share of the mar ket had gone down to 58%. This 22% decline meant a loss in retail sales of about a billion dollars. The decline also made more striking the rise of Pall Mali, a king-size cigarette which American Tobacco brought out in 1939 at a "popular" price, and promoted heavily. By 1947, Pall Malls had attracted a modest 3.4% of the mar k e t By 1953, the Pall Mall share had quadrupled to 12.4%, and ihi* king-size entry had passed both Old Golds and Philip Morris to become the nation's fourth largest seller. In 1954, Pall Mall passed regular-size Chesterfields to be come the third largest seller. Although American Tobacco was losing business vfith its old leader, Lucky Strike, it was more than regaining it on Pall Mall and another king size, the cork-tipped Herbert Tareyton. This new way to balance sales did not escape the notice of rival companies, all of whom put out longer U FEBRU A RY 1955 smokes of their own--Cavalier (Reynolds), Fatima (Li^. gett & Myers), Dunhill (Philip Morris), and Embassy (Lorillard). MORE KINGS APPEAR Three years ago, Liggett & Myer: made another conces sion to the king-size demand. It offered Chesterfield smokers a choice between king size and regular size, under the same brand name. The king-size Chesterfields were marketed as merely a longer version of the old ugarette, in tbe famil iar white and gold package, in :953, three other old favorites also appeared in the "new ook"--- Philip Morris, Old Gold and Raleigh. Raleigh smokers were given no choice about going king size; the regular-length Raleigh was taken off the market Clearly, tbe number of smokers-who want long size is growing-- whether it is because they feel they are getting more health protection, a. tnore "distinguished" look, or just a longer smoke for their money. In 1953, the year when total cigarette sales first fell, extra-length brands bad grown to almost 26% of tbe mar ket, as against 18.5% in 1952, Last year, tbe figure jumped again, to an esti mated 30%. The king-size conversion has been gathering momentum for some time, but with the impact of cancer fears, the' change to filter tips was abrupt, a .real "rush," In 1952, only 1.4% of the cigarettes- sold were iiter-tippd; in 1953, the number more than doubled, to 3.4%; when tbe returns for 1954 are in, experts estimate that the filter brands will have 10%, and possibly 12%, of the total market Lorillaxd's Lewis Gruber flatly predicts that within two mere years, 40 of every 100 smokers wil. be smoking filtered cigarettes, most of them king size. W H A T IS A FILTER TIPT -- What i3 this "revolutionary" proluct? It is simply a cigarette in which about one-half inch of the butt has been filled with a filtering substance instead of tobacco. Most of tbe filters are made of finely creped (crinkled) paper, ab sorbent cotton, and cellulose-acetate ibers, either adone or in combination. Some have added "purifying agents," such as Herbert Tareyton's activated charcoal, and Kent's patented Micronite, an asbestos-like substance. Filter cigarettes are not new; they have been ort the American market for some time in Parliament and Du Maurierf which sold at a premium price (32^ or more Continued on whxX p-oge CHANGES IN TH E C IG A R ET T E M A R K E T The tables on the facing page show how the cigarette market has changed in two ytanc The halftone areas backing the tables show the trend, not exact percentages: the figures for 1954 include estimates for tbe last months of the year and do not distinguish between regular- ana king-size filter-tip brands S A L E S OF C I G A R E T T E S .1 9 5 2 REGULAR SIZE: 8 1 . 5 6 % O F' T H E ' M A R K E T 19 5 4 . REGULAR SIZE:. 6 3 . 2 2 % O f T H E M A R K E T CAMEL - (R , J. R eynolds) LUCKY STRIKE (American Tobacco) BILLIONS 0F CICAKETTE5 1 1 3 .7 8X 2 % or MARKET : , 28 .0 ... ' 1 8 . 8 - ; ~ 1 ' SILUQHS OF Elei BETTt % 8f iaarkt . . CAMEL ( R. J. R eynolds) 9 .8 2X 3 LUCKY STRIKE (A m erican Tobacco) R S.2- . - J L 6 .2 '-- CHESTERFIELD ' !-W . ( L i g g e t t & M y e r s ) P H IL IP M O R R IS X .(P h ilip M o rris) OLD GOLD ' <P. L ori Ilard ). KOOL ' (Brown & W illiam son) R A LEIG H ' (Brown & W illiam son) .D O M IN O , Y O R K S H IR E (L am #- & B ra .) fW ARLRORO (P h ilip ) M o rris) 6S .8 . 4 0 .4 * XL 6 11 .5 8 .3 2LrS Oo - / .X ' is : i - . . : 9 . 2 ,, : - . S .4 2 .6 ' 2 .9 ; ** ' S f) 0 .1 .'."'c h e s t e r f ie l d . (L igjgett & M yers) X - PHILIP MORRIS ( P h i l i p "M o r r is ) .''T J L D GOLD - - . . - ( P ; Lori Hard) L ' 3*.. . : . KOOL ; - - (B row n & W illiam son) " : SA N O ^-V ' : (U n ited S ta te T obacco) MARLBORO . (P h ilip M orris) - EXPORT BRANDS _ ^ ( Brown & W illiam son)- ; -~T---- *; ' ,*v"' . - ALL OTHERS ; 4 2 . t> _ 1 0 . 4 : . * .---ri'/6 . 2 : . - 'c 2 S .6 -V ".'X3.9 _ . .'.. ' - ' a i - T 3 . 0 - ' = " 'l -x x .:' 0 . 4 . ." -. o . s , . . . -. .. ^ : - x - . ' 9.3 '' - ' O .0 Y . "> - - . : - X . . 4 .S ; u r -.; - .. ' . 2 ' ",J .,X c 0 . 0 S ' PIE D M O N T , SPU R ( L ig g e tt & W tyers) - '- T T 0 .2 o .o sT K IN G SIZ E : 2 7.06% OF TH E M ARKET V 1BW W IA R O U N D S A/ -(Bw- s m &.~. .Hdges)- 'EXFORT BRANDS ' (B raw n & W illiam son) - 0 . 0 6 ' 0 . 0 1 2 _ *" '- ':'M . - : / i ;. S - 3 i* 2 . $. M X OTHERS ' . 0 . 9 ' v-r ' "0. 2 ' " v;. . ' . ; ... - THE MARKET -.....-- - w . PALL MALL (AmortenTM T obaras) 4S3 ' . ' HERIBERTTAREYTON (Am orican Tobacco) IX * ' 2 j r L ) CHESTERFIELD (U ggott A M jw i) F A T IM A ( U e t t A M yers) ; -' -. r i - j j j X <U"X> CAVALIER (R, J. Roynelda) DUNH ILL (Philip M orris) , U `. 0 3 : "v LO ' V 0 2 : EM BASSY. (P . Lot-Ward) - ' r ` - .X L flJL X 0 2 W IN G S '(B ro w n A W illia m so n ) . " .U r : . - L 0 . 7 ^ : U ' i j JME6KNT (RtcKie T obaeco) 0 3 5 ~ OJTrJ] H O L ID A Y , LORDS (L aras A Bn.) ' V ' T '^ O J " ; ' - O ^ ^ g F IL T E R T IP s 1.3% OF THE MARKET- m--a? TTvnoiw -r*~r...-1*-`-- -^w A- -vr - . - VICOtOY'OKrawn & W ltllam eon ) psP-tb.-iSS# SUrSfl . m U A B C N T (m a HlCn ) : T - ...ILSST- 0.4IS EWCRE. (U nited S tate* Tab) : - K E N T (P L L o r tlla r d )........... - - .. 0 3 ' - " 029t: NX PA L L M A LL (Am eHcwi Tobacco) . : L ; ' iX S ' --j..-.' C H E S T E R F IE L D ( L I n e t i &- M yom ) -.... XSLX-L' S3' H E R B E R T TAR EYTO N (American T oba e r a ) I H K ' 2JS - '> P H I L I P M O R R IS (P h ilip Morris) '* -'21, 2;.-.. 2.0^ RA LEIG H ' (Brawn A W illiam son) - L s ~ r ' . - :L . T OLD G OLD (P. LoriUard) .'\'y ' "$3.v -. i 3 , 0 . . C A V A L IE R '(R. J . R eynolds) . 43.;-; US/- - _ . D O M IN O ; Y O R K S H IR E ( L a ra s & Era.) . -C.Z X X v : 0J-- : . .. FATIM A (U ggatt A M yws) - ) - D U N H IL L (P hilip Morris) ' , ;( U l'-T- 2 S - L d U j r JL..r: -;;:;j EMBASSY (P. L e rilU rd ). - / S 3 "X # 3 7 : ' (.Xi. REGENT (R ig a lo T o b a c c o ) . / . -'/ H O LID A Y ;. LO R D S (L aras & Bn.) -, - r 7'. e3 / X #37T - e2rL; tt.os:X X ^ W I N G S (Brawn & W illiam son)-/.' K'i war1 F IL T E R T I P : 9 .6 4 % OF T H E M ARKET S ;.V IC ER O Y :(B w b W illia m so n )-.: .-IL X '.X '3.7-' - ' 2 2 LAM ( U i n t t A M y ) - - ' rjnt- -ci-:- 7.7 US ^.7. ' X r r W INSTON (R. J . Reynolds) US : ' E K D I t : ( N L a r tlla rd ))^ <- X X X - ; -j.-;.- X-SX*: t r X (PARLIAM ENT (P h ilip Morris) /H E R B E R T TAREYTON (A m erican ' O.c:'-';.. o t o p i s QJl -T S M ARVEL (S tsp h an o Bros.). -OLD- GOLD (P. Lorlllsrd) . ,'~V SA ':.p ~ "0T3--.-X..',':. ZU-g.Lir-t;e! . ... - R E G E N T riR lM te T o b a c c o ) r--.- 0-1 -D U .; f e / L E N C O R E '(U n ited S tate* T obacco) . . X c ^ ^ O X ^ O .K Z .-g - ittt4c<i nrfrrnU4/rosi Priote-ri' lek, DcrmktrJ. $S. Copprpki /95 Pri*t*rt' Ix /`JwA'titff Co., In. N. Y. CON SUM ER REPORTS 5 cigarettes THE INDUSTRY a pack in New York City,, where regular brands have been selling at 2Xi to 25^), and which took a dlstinctlv ritzv tone in their ads. As long ago as 1936, Brown & William son introduced the regular-size filter-tip Viceroys, at only a cent or two above the price of regular brands. Vice roys and Parliaments divided most of the insignificant filter-tip market until 1952. Then Lorillard offered Kents, a premium-priced filter-tip which was. promoted and dis tributed with big-brand energy. The Big Three made its first entry into the filter market in 1953, when Liggett & Myers launched L&Ms, also at a premium price. T H E FILTER BAND WAGON The other big companies, which had stood aloof from this "small-time" market, suddenly joined in the scramble last year. In March, Philip Morris bought out Benson &. Hedges-- and its successful filter-tip brand, Parliaments. A . . month, later,-Reynolds started off with an exclusive kingsize filter-tip Winston, which was described in ads as "made by the makers of C a m e l s an appeal to old brand loyalties. Finally, in August, American' Tobacco took the field with a filter version of its king-size Tareyton, in the m e white package, but distinguished by thin red and blue stripes across the lower left corner. Both these new filter tips sold at 26fi, the "popular" price for filter-tips. Filters have restored price-competition to the industry, if only temporarily. In March, the price of L&M was cut by 4#, dropping both the regular and new king-size style', out of the premium class and into the popular arena. Kent,-. which Lorillard says can never compete oh the lower price level because of the high cost of its Micronite filter, went ; to king sire. Some observers thought this was indirect price competition, as well as an invitation to smokers of king-size brands. Parliaments, another premium product,. . showed its sensitivity to the price factor in September by. cutting the price on its king size by 2f. TH E PR IC E OF FILTERS Price competition thus far has not brought filter-tips down to the price level of regulars and some king sizes. `"Popular price" for filter-tip brands still means around 26^, a cent or two more than the "popular price" for plain cigarettes- Leaf tobacco accounts for about half the cost of a cigarette, and it is doubtful that the material in the aver age filter costs any more than the tobacco it replaces. Putting the two elements--filter and tobacco--together in one cigarette, however, is a more complicated process. (The trade magazine Sales Management reports that Lorillard had to import machinery from Europe to produce the first Kents.) Also, the industry claims the production machinery for filter cigarettes is slower and more subject to mishaps. One big-company executive says that a regular machine can turn out around 1200 cigarettes a minute, but that he has yet to hear of a filter-tip machine doing better than 750. Though the cigarette companies have subdued the scarehead health advertising of the regular brands (the ads no longer proclaim that "more doctors smoke Camels" but rather that "Camels agree with more people than any other cigarette" ), in their filter-tip advertising, they seem to be working both sides of the street lest h e smoker feel that in protecting his health, he will not enjoy smoking. Thus Tareyton s filter "holds back elements that can detract from the pleasure of smoking," and Old Gold Filter Kings proffer "a treat you can trust." Winston "the filter cigarette with flavor . . . tastes good--like a cigarette should." The Federal Trade Commission has been trying for years to temper the more blatant assertions of the cigarette ad vertisers, hut if there has been any recent amelioration, it has been the result of the industry "upheaval" rather than of legislative or judicial action. Ii late 1952 and early 1953, the courts rejected FTC's claim tliat cigarettes should come under th Federal Trade Commis; ion Act. In Septem ber 1954, the FTC tried a different tack and submitted to the cigarette companies a draft code of"advertising stand ards. This code would be entirely voluntary and without the force of law. But though meetings have been held to discus '.t, no cigarette manufacturer Lis yet indicated his willingness to accept even this dilute regulation. HOW TO SELL CIGARETTES Such, then, is the "upheaval" ; where does it leave the huge cigarette industry at the beginning of 1955? Cigarettes are still the major product of the industry. Some of the medical reports which condemn cigarettes also tend to exonerate pipes and cigars, but thus far there has been only a minor rise in the sale of these two forms of tobacco. In the near future, the companies must make up their losses on regular brands with increased sales of filter-tipped and idng-size brands. - The manufacturers niust get their new products in front oi as many consumers as possible, as quickly as possible. Distribution of a number of brands can be costly; and diffi cult. Retailers complain at the extra space for new brands which must be found on their crowded shelves and coun ters, at the extra bookkeeping, at the ira . dollars tied up in their inventories of slow-selling items. Space is also a major problem for the estimated 500,000 cigarette vending machines in the United States. Heretofore, most vending machines had tea columns, and could sell, at most, ten different brands. To offer their customers even a minimum sampling of the present array, the vendors have to install two machines in one location, or else invest in the new 20-column type. Differences in price are also a problem for the machine distributors, since the machines can be paid only in standard coins. The consumer's taste is changing fast, and no manufac turer can be. sure what direction it will take. In 1953, 21 brands were listed as "significant" (that is, as selling over a billion cigarettes a year) ; by July 19t)4, the number had gone up to 30. Each company will have to make hard deci sions on which of its brands to push, wldctt to modify, and which, perhaps, to discard- The mdrntrr senems to feel that already there are too many varieties on the market to sur vive, and that a " weeding out" is inevitable. U FEBR U A RY 1955 Medical Aspects vey of current medical knowledge on the relationship en the smoking of cigarettes and cancer of the lung FJ i --<4very year for about 30 years the frequency of cancer of the lung as a cause of death has progressively increased. Today many serious medical investigators are convinced that the increase in frequency of lung cancer is closely related to the smoking of cigarettes. The concern with cigarettes as a medicr] problem bas called forth other research to determine the relation between smoking and heart trouble; smoking and peptic ulcer; the particular ingredients in tobacco-which may be harmful; the extent to which cutting down on tobacco' intake wifl diminish the . risk of disease; and the j sychological and physiological el ects of the tobacco habit. But it is the relation between cancer of the lung and smoking which has' stirred up the most controversy. Regular cigarette smoking is believed by such leading American surgeons as Dr. Evarts Graham and Dr. Alton Ochsner, by investigators and physicians in medical schools and health departments, and by the American C anr Society; Jo be-amr important or major factor contributing to the development of cancer of the lung.' Many physicians in private practice are apparently convinced that the relation between regular cigarette smoking and cancer of the lung is now proved. They have discontinued their otra cigarette smoking and also advise their patients to cut out or cut down their smoking. . The tobacco industry has met the challenge in part by setting up a medical re search program of its own, headed by Dr. Clarence Cook .Little-of the'Em cee B. Jackson Memorial Laboratory, Bar Harbor, Maine. This project is still too new to have yielded'any significant data, and its formatioB has been criticised aai resem bling burglar-financed research toward the perfection of a. eruckproof safti How ever, several independent criticisms of the cigarette theory of lung cancerLave been advanced by outstanding investigators, the foremost being Dr.- W. CL-Hiiepetv Chief of the Environmental Cancer Section of the National Cancer-1 restitute in Bethesda, Maryland. Dr. Hueper and some other experts regard the evidence linking lung can cer and cigarette smoking as insufficient or contradictory, and the theory generally as not proven. No one has claimed that regular cigarette smoking is ike cause of. lung cancer. Many factors or "causes" can operate to produce cancer. Many "carcinogens""- -- cancer-producing agents--pervade our environment Those who consider smoking an important or major factor contributing to the development cf'cancer of the lung say merely that tobacco smoke inhaled into the lungs is one of the carcinogens and possibly the most important Since World War I thoracic surgeons and physicians specia[king in diseases of the lung have been impressed by the frequency with which th;y have encountered cancer of the lung among patients who gave a history of-heavy cigarette smoking. When this association between smoking and lung cancer became so common that it could no longer be ignored, and when statistics indicated ths t cancer of the lung was becoming a leading cause of death in men, groups of investigators in the United States, England end other countries began to study 1) whether the increase in the frequency of lung cancer was real or apparent, and 2) whether its association with regular cigarette smoking was more than coincidence. Prior to 1900, cancer of the- lung was infrequently recorded in post-mortem studies and erven more rarely diagnosed during life. After 1900 with the increasing use of chest X rays and the bronchoscope, cancer of the lung began to be diagnosed C ontinued on next page C CN SU M ER. REPORTS 17 cigarettes MEDICAL ASPECTS more frequently and to be observed more regularly in post mortems. Although the progressive increase in the inci dence of cancer of the lung has not been the same in differ ent countries, the disease is now recognized as a leading cause of death on all continents and in every country, or at least wherever there are adequate diagnostic and patho logical facilities and where vital statistics are gathered. Some'doctors argued at first that the increase in reported attses of cancer of the lung merely reflected an improve ment in diagnostic techniques. But the recorded increase in cancer of the lung is greater in males than in females (from two men for every woman in 1933 to 1936 to an esti mated ten for one today), and it is hard to believe that physicians are better able to diagnose lung cancer in men than in women. TH E INCREASE IN LUNG CANCER During 1951, nearly 20,(XX) deaths in the United States wer* attributed to cancer of the lung----1.3% of all deaths during that year, and 9.2% of all deaths charged to cancer. According to Dr. Charles Cameron, medical director of the American Cancer Society, "Cancer of the lung is show ing' the most rapid increase ever ascribed to any nonitsfadiotis disease in medical history." Since cancer of the long usually starts in the surface lining of the bronchial 'tohea of the lung, the carcinogens-most be those that are ! inluiltwl into the bronchial tabes and lungs. Among suspect nhttled materials are industrial fumes'; industrial and do mestic "soot'derived from coal and fuel oil furnaces; exhttuatis- from internal combustion machines (gasoline and" - d iead ); asphalt or bituminous road surface dust: and . DEA TH R A T E S FO R SE L E C T E D D IS E A S E S . AMONG W HITE U . S . MALES tobacco smoke. All these materials are believed to have cancer-inducing properties. THE SEARCH FOR CA USES Up to this point there is no disagreement among the health experts. The controversy starts when doctors esti mate the relative importance of these environmental mate rials in causing cancer of the lung. The conflicting reports so far released have been based on az imal experiments, on medical studies in human beings, and on statistical analyses. The cancer-inducing effects of industrial and other air pollutants have been studied experiir entally in laboratory animals. These experiments have yielded conflicting data, particularly because of the difficult) of finding mmnrotU which develop lung tumors comparable to those in roan. Experiments with the smoke of tobacco and cigarette paper have also yielded inconclusive data. One group of experi ments showed that benzpyrene, a cher meal long known for its carcinogenic effects, is not only present in the smoke from'cigarette paper, but-can actually cause cancer of the lung in certain strains of mice. This report has been highly publicized especially by those who would like to sec the cancer onus removed from tobacco itself. In general, animal experiments have been of doubtful value to investigators of human lung cancer. Dr. Cameron says: "The problems of carcinogeaex.s [bright of cancer] . . . are extremely complex and far rc in understood w yet; What will cause cancer in one specie t will not necesaarily cause it in another. What -will cans am eer in one tisane of a given animal will not necessarily cause it in another tissue of the same anim al. Thus it is conceivable that tobacco smoke does contain an agent which is carcinogenic for the lungs of human beings. It may not bs so for the lungs o r any other tissue of a mouse, or a guinea pig, or at dog. Here it is. appropriate to point out that no one has ever succeeded in producing cancer in an experimental animal with chromium or any chromium-containing compounds, yet the statistical evidence that chrom ates can came cancer of the lung in workers occupation!; r exposed to them is conceded by everyone." While man has held his own, or bettered his position, against many fatal diseases, lung cancer deaths have risen sharply STATISTICAL EVIDENCE Since actual experimentation on Ifring, human beings is ruled out by the nature of the disease, researcher have fallen back on a technique known in public health as "epidemiology." Broadly speaking, epidemiology deals with the mass behavior of all diseases, not just acute epi demic infectious diseases. Statistical evidence is always a very important part of the study of Ihe epidemiology of a disease. According to Dr. Leonid S. Snegireff, Associate Professor of Cancer Control of the H arvard School of Pub lic Health: "The epidemiologist often finds puzzling situa tions which he can solve by applying epidemiological prin ciples without first knowing all the detailed pieces of the puzzle. For example, experience w ith m any diseases shows that exact knowledge of the specific agent w hich causes a given disease process is not essentia, for the achievem ent 6 FEBRU A RY 1955 of effective control over morbidity and mortality in a par ticular disease." Thus, to cite a few examples, the last ma jor cholera epidemic in Crt Britain was brought under control in 1866 by appropriate measures of sanitation and purification of water supply-- L7 years before Dr. Koch isolated the cholera vibrio germ. The precise cause of rheumatic fever is not known, yet there are effective meas ures for controlling the disease. The precise cause of dental c a s ts Is not known, yet there is no doubt that fluoridation of the water supply can help control the disorder. It is not necessary to await the isolation and identification of all the carcinogenic agents in our environment, to point the way to halt the rapid increase in the mortality from cancer of the'long. 0 all possible environmental carcinogens, tobac co smoke is one of the few that the individual can controL According ta .Dr. Morton Levin, Assistant Commissioner for Medical Services of New York State and a leading stu dent of the epidemiology of cancer oi the ltirig, "There is already more than enough evidence incriminating cigarette smoking to justify advising the. public to stop smoking cigarettes as a means of lowering the incidence of lung atnew " (Problems in the Study of Occupation and Smok ing in Relation to Lung Cancer, Drs. Morton L. Levin et L October II, 1954). This point of view is sharwl by others, here and abroad. What is the statistical evidence of a causal relationship between smoking and cancer of the lung? Since 1950 more Aim' dozen independent studies have reported-a dispro portionately high percentage of heavy*- cigarette smokers utmosig long cancer patients. Most of these studies ere what Smknown as "case-history" or "retrospective" studies. The fcb*oc intake of patients in whom cancer, of the lung has ukeiy been diagnosed is compared with that of control group (non-cancer patients) representative of the popula tion from which the cancer patients were drawn. All these utodies have been interpreted as demonstrating a greater EssMty to cancer of the lung in regular cigarette smokers, to ewncer of the lip in regular pipe smokers, and to cancer of the mouth in -regular cigar smokers-- a liability that saemuies with the quantities smoked. Because of certain weaknesses in the design of retrotigMsetivi! or case-history studies, the American Cancer So ciety, the British. Research Council and individual investi gator have also undertaken statistical studies by the "prospective" or "population" method. Preliminary reports of the studies of the American Cancer Society and Ac British Medical Research Council are available and they confirm in their broad features the results of the casehistory studies. From all these studies, says Dr. Alexander G. Gilliam of the National Cancer Institute, "It may now . . . be regarded as an established fact that white, male cig arette smokers in England and the United States suffer a substantially greater risk to cancer of the lung than nonsmokers, The evidence from other countries is less con vincing end complete and no substantial data bearing di rectly on this question are yet available for non-white pop- Deapite higher cigarette caesusaptioa ia the U-IL,. the death- rafas from cancer of the lung, larjnox, and emus ia higher in EagLmd ulation or for female population," Hoti,ever, 'according to Dr. H ueper, a world-renowned author! t>- on environmental carcinogens, "the cigarette theory is almost -entirely based oh statistical data having at best circus nstantiai value and being in part of questionable origin." (Address -.before American Pharmaceutical Manufacturers Association, De cember 10, 1954.) In support of the cigarette smoke tbisis it ia stated tbaifc both in England and in Ac United States an increase of . per capita cigarette consumption, particularly by men, has generally paralleled Ae trend of mortality in cancer of Ac lung. This evidence is, however, disputed by Dr. Hueper and oAers. Dr. Hueper points out A rt Ae age-adjusted rate of increase in Ae frequency of lun y cancer deaths was greater between 1914 and 1930 time between'1931 and 1944. He believes Aat Ae rapid increase in cigarette smok ing during Ae Thirties and Forties should have given Ae later period a greater increase in lima cancer fatalities if - cigarette smoking were a significant factor. Women as a group did not begin o smoke cigarettes regularly until well after World War I. Since Aeo Acre has been a relatively greater increase m limoking by women than by men, but Ae relative increase A lung cancer has C ontinued on next page C O N SU M E R REPORTS &V cigarettes MEDICAL ASPECTS been fax greater in the male. This inconsistency in the cigarette hypothesis has been ."explained" on the basis of seat differences in susceptibility to cancer of the lung. How ever, Dr. Hueper's'studies of lung cancer in different coun tries show different ratios of women to men subjects with lung cancer. It seems most unlikely, says Dr. Hueper, that such differences can he attributed to fluctuations in in tensity of any one single factor, such as-cigarette smoking. It ams more plausible, says Dr. Hueper, to attribute the see.clifftsrences in cancer of the. lung to differences in ex posure to carcinogens present in air polluted with indus trial wastes, gasoline fumes, etc., with which men have more daily contact than women. Dr, Hueper contends that a real and progressive increase in lung cancer began to be noted in most industrial coun tries at the turn of the century before cigarette smoking had become an important habit The progressive increase in long cancer has continued in all industrialized countries, hut the rate has varied in different countries, states, prov inces, communities and population groups. These differ ences in the incidence of the disease cannot Dr. Hueper nays, be explained by the degree and spread of the ciga rette- h ab it It -can be more reasonably explained, he says, ' by a study of the growth of industry and transportation in different countries and by an analysis of the multitude of . carcinogenic agents released into the air. Carcinogenic mfiterimls are believed -to be present in effuents of domestic imd industrial furnaces, exhaust of gasoline and diesel en gines, dust from rubber tires and asphalted and oiled roads --in other words, in the air breathed by residents and workers in urban-industrial regions. Thus the marked and growing predominance of males among lung cancer victims could be traced to the following factors; 1 Males are more extensively employed than females in occupations where known or suspected atmospheric car-, cinogens are produced and used, end they work in such jobs more consistently over longer periods of their lives. 2 Males predominate in outdoor occupation*, esnoecmlly in urban areas, where they are exposed to carcinogenic pollutants contained in the general atmosphere. 3 Males far more often than females perform heavy physical labor requiring deep and rapid breathing; and consequent greater penetration of air pollutants into the lungs. 4 Males more often than females work through the entire span of their occupational lives within urban areas with proven carcinogenic atmospheric pollution, while females ter .'to remain in the cleaner residential areas. All studies have shown a remarkable! drop in lung eamcer incidence when the researchers turn from urban-induatrialized areas to rural districts. English studies as well as those, of Drs. Hammond and Horn of the American Cancer Society explain these differences on the ground that ciga rette smoking is more common amt ng urban than among rural residents. Dr. Hueper and others, however, believe The possible sources of cancer-causing dements in the U. S. show the same ^ort of Increase as lung cancer mortality 70 FEBRU A RY 1955 Death from lung cancer is greater among males (solid lines) than females (dots) and in the city than in the country (1950) that urban air---polluted with carcinogens derived from industry, transportation, etc.---is the greater villain. l u n g c a n c e r in in d u s t r ia l w o r k e r s Dr. Hueper has shown that the incidence of lung cancer is highest among certain industrial workers, especially those in non-ferrous metals, transportation, rubber and plastics, iron and steel. Many industrial workers are ex posed to fumes and vapors of chromium, nickel, arsenic, coal tars, petroleum oils, furnace soot and mineral pig ments; all of which have known carcinogenic properties. The English lung cancer rate is considerably higher thtm of the United States, although the English smoke 30% fewer cigarettes p e r .capita than Americans. This obser vation, which appears to undermine the cigarette theory, hm been argued away on the assumption that Americans do not smoke cigarettes to the very end, while the English, for economic reasons, do. A group of Austrian doctors has pointed out that lung cancer mortality is at different rates in Upper Austria, Kaernten, Steirmark, and Tirol, al though the four provinces show approximately the same per capita consumption of cigarettes, .The doctors suggest that the high lung cancer mortality among the people liv ing along the northern slope of the Alps may.be related to climatic-atmospheric conditions such as winds bringing the industrially polluted air of Vienna into the valleys of the northern alpine regions. Similar observations have been re ported on the possible role of prevailing winds in altering the relative frequency of lung cancer in different areas of fit English Midlands. The Austrian doctors, moreover, found that lung cancer mortality rates in communities located along main highways, whore the atmosphere was polluted with exhaust fumes and dust from asphalted roads, were double those of villages and towns far away from heavy traffic. Few proponents of the cigarette smoke theory will'claim that all the differences between town and country can or need be explained on the basis of differences in cigarette smoking. They agree that urban residence imposes a more unstained and intense exposure to atmospheric pollutants, and that some of these poffutants might of themselves in duce the disease. Should the present population studies in England and America demonstrate that the relative risk of cancer of the lung is substantially greater in rural smokers than in rural non-smokers, and that the absolute risk in rural non-smokers of the two countries is the same, then the cigarette hypothesis would be very greatly strengthened. According to Dr. Gilliam, another question that must be answered by current studies is why there i3 so much varia tion in the incidence of cancer of the lung in different large cities of 100,000 or more population. "It is difficult to be lieve," says Dr. Gilliam, "that smoking habits in our large cities are sufficiently different to account for variations of this magnitude." It is hoped that these and other questions w ill he an- swered, at least partly, by population and other studies presently in progress. At this time, one cannot take issue with the statement of the Board of Directors of the American Cancer Society that "available evidence indicates an association between smok ing, particularly cigarette smoking, and lung cancer. . . However, it has not yet been established that this associa tion is more significant than the parallel association of lung cancer with atmospheric pollution. Exposure to atmos pheric pollution can be controlled only by vigorous com munity action. Smoking, however, is a factor over which the individual can exercise personal controL In February 1954, in written re ply to a question asked in th* British House of Commons, the Minister of Health stated: "The Standing Advisory Committee oc. Cancer and Radiotherapy had been considering the relationship between smoking; and lung cancer for-three year. As a result of -preliminary urmstigations, a panel under the chairmanship of thy Government Actuary war set up in 1953. The committee, having-considered the report of the panel and reviewed the other evidence available, were now of opinion: L it must be regarded as established :hat there is a relationship between 'smoking and cancer of the lung: , 2. Though there is a strong presumption that, the relationship is cauaaL, there is evidence that the rtlationship is cot a simple one, since: (a) the evidence in support of the pnaenee in tobaectHemoke o a coranogenie agent, causing cancer of the lung in not yet certain; - (b) the statistical evidence indicate (hah it is unlikely that the increase in the incidence of cancer of the lung is due entirely to increases in tnnoking; (c) the difference in incidence between urban and rural areas and between different towns, suggest;; that other factors may be operating--eqp, atmospheric pollution, occupational mb. 3. Although no immediate dramatic foil m death rate* could be expected if molting ceased, since the development of Itsng cancer, may be the- result of factor opera! tag over many years, amt! though no reliable quantitative estimates can be made of the effect of smoking on the incidence of cancer of the lung, it ill de sirable that young people should be warned of the risks apparent ly attendant on'excessive smoking. It would appear that the risk increases with the amount smoked, particularly of cigarettes." Although "excessive" smoking is usuaEy defined as more than one pack a day, susceptibility co the effects of tobacco varies widely. A half pack may be excessive for one per son and moderate for another. THE BRITISH ANSW ER ' It is interesting to note in passing how the British to bacco companies have met the challenge of .lung cancer. Instead of setting up their own study, they have offered about $700,000 to the British Medical Research Council, the leading medical body in the country, to develop an objective research program on the relation between lung cancer and environmental carcinogens. If there is doubt as to whether regular sm oking is a m ajor contributory cause of cancer of the lung, there is none about the causal relation between sm ok in g and "chronic C ontinued on next page C O N SU M ER REPORTS 7.1 cigarettes MED,CALAsPECTs bronchitis or cigarette cough." This is a cough which tends to be worst when one rises in the morning and often produces a considerable amount of thick sputum. Such a cough* of course, is not necessarily due to smoking. Persons with a chronic cough should have a physical examination and chest X ray. Every adult should have a chest X ray at least once a year; heavy smokers should have chest X rays twice a year. Other tests* such as bronchoscopy and cytologic&l smear studies o the sputum, are often recom mended by physicians when the patient reports spitting blood; suffers repeated attacks of " pneumonia" ; or experi ence delayed healing of "pneumonia." E FFE C T S ON .OTHER ORGANS At & conference at Cornell Medical Center fDecember 1953), Dr. Graydon Boyd, specialist in diso_:c of the nose, and throat and Associate Professor of Surgery at New York University Medical School said, apropos the effect- of smoking on the nose and throat: "I think as far as prevalence of symptoms is concerned, there are more in the nose and throat than from any other effect of tobacco. 'Of 18 leading otolaryngologists interviewed prior to this meeting, 100% believed tobacco smoking to.be irritating to fflow and throat." Smoking is also believed to have a clows relation to chronic laryngitis and larynx tumors. Smoke not only irritates the respiratory tract; it con tains chemicals that- can affect other organs by toxic and poambly by allergic effects. The most'important of these chesnicaJs'is nicotine,.which acts on the nervous system in a variety of ways. One effect appears to be a tranquilizing srntkm on the higher nervous centers. Nicotine also has important effects on the blood vessels and the heart. Patients with Buerger's: disease (thromho-angiitis oblit erans) m u st.give up . smoking of any kind--cigarette, cagsir, or pipe--if they are to avoid gangrene. Even a single cigarette can produce a recurrence or an aggravation of the disease. Even if smoke is not inhaled and the nicotine therefore not absorbed from the lungs, much of it is ab sorbed from the mouth. The effect of smoking on Buerger's disease may be due to the capacity of nicotine, absorbed from smoke, to came spasm or constriction of the walls of the blood vessels; or to an allergic sensitivity of the per son to some ingredient of tobacco. Many doctors also pro hibit smoking of any kind in ordinary arteriosclerosis of the vessels of the extremities; in eye disorders associated with spasm of the blood, vessels of the retina, and in Ray naud's disease, a disorder in which there is intermittent impairment of circulation in the fingers' or toes. Smoking tends to cause a constriction of the blood vessels in many people but it is not known how much of this effect is due to the toxic action of nicotine; how much to allergy to tobacco products; and how much to nerve reflexes induced fey smoke in the mouth and the lungs. Smoking has also been known to cause extra heart beats aiad rapid heart heat. H ow h a rm fu l th ese toxic sid e effects are, can be determined only by the physician. Some physicians believe that smoking has a harmful effect on the coronary arteries of the heart and can aggra vate coronary artery disease--today the greatest killer of Americans. Their view received unexpected support from the population studies of the American Cancer Society. Drs. Hammond and Horn of the Society, reported that in their study of 187,000 men between the ages of 50 and 69, heavy smokers had a death rate from coronary, artery disease twice as high as men who had never smoked. "Even light cigarette smokers were somewhat affected On the other hand, cigar and pipe smoking seemed to have little or no influence on death rates. from the disease." These findings, if confirmed may mean that cigarette smoking imposes an added burden on Ihe coronary artery circulation and the work of the heart. An alternative ex planation is-that nervous or .psycholtjjpical factors which predispose to the use of tobacco aggravate existing coro nary artery disease. Some physicians believe that moderate smoking has no adverse effect on the normal heart or on coronary artery disease. In December, 1954 the Board of Directors of the American Heart Association, cognizant of the importance of the problem and the paucity of reliable data, approved the following statement relating to tais subject;: "The American Heart Association is seriously interested in any possible relationship between smoking a id heart disease. A committee is currently-studying the problem. As soon as clear evidence is available a statement will be forthcoming." DO FILTERS PROTECT? . Manufacturers-of filter-type cigarette s have Implied in their advertising that such cigarettes add a- safety factor, protecting-smokers from the effects of nicotine, tar and other materials in smoke. According' to Dr. Irving S. Wright, past president of the American Heart Association and a leading authority on vascular--heart and blood ves sels-- diseases, "There is absolutely no svrdence that there is any protection in terms oi vascular disease from these brands; on the other hand there is quite strong evidence that such protection is completely lackmg." According to Dr: Wright, this statement holds true for all types of filter cigarettes. ' Filters do reduce the inhalation of tars and other ma terials in smoke, and conceivably may reduce the intake of carcinogenic materials. However, Dr. E.mest L. Wynder of the Memorial Hospital, New York's lead mg cancer hospital, points out that, "As long as we do not snow what the car cinogenic material is we do not know whether the filter will remove any or all of this material," The effect of smoking on gastrointestinal function and on patients with ulcer of the stomach or duodenum has not received the attention it deserves, Drs. Batterman and Ehrenfeld of New York University School of Medicine, re ported in 1949 that while tobacco smoking is not a factor in the caxisc of peptic ulcer, sm oking 'iu n y result in func tional disturbances which may simulate organic disease or 72 FEBRU A RY 1955 aggravate . . . functional or organic disease. It is particu larly the person with an active peptic ulcer who is likely to be harmed by smoke. His response to active treatment will he much less satisfactory than that of the patient who gives up smoking entirely." These views are also shared by leading specialists in gastro-intestinal diseases. It has not been shown that low-nicodne or filter-type cigarettes reduce the damage of smoking in persons with active stom ach or duodenal ulcer. SUMM ING UP 1 gamming up the evidence, it seems established' that 'smoking is harmful in vascular disorders of the extremities and the eyes; and in active peptic ulcer. Inhaling smoke is also definitely irritating to the nose, throat and larynx. The evidence is inconclusive with respect to the effects of smok ing on athletic ability, and on heart disorders. As for cancer of the lung, the most reasonable view at this time relates its phenomenal and alarming rise in frequency in industrial countries partly to the diffusion into the air of carcinogens derived from industry and im p o rta tio n , partly to unusual exposures to carcinogens in many occupations, and- partly to excessive cigarette smoking. The control of respiratory or lung cancer would appear to require a three-pronged effort by individuals, communities, industries and voluntary health agencies (iiaotefa as the American Cancer Society) against I) air pol lution, 2) occupational exposure and 3) excessive cigarette amoving. How significant a factor regular cigarette smok ing M in contributing to lung cancer remains to he detantmnecL Until more conclusive evidence is reported, it would seem prudent to reduce cigarette smoking to less ihitn a half pack a day or to smoke a pipe or cigars in mod eration, There is no conclusive evidence that smoking ow-mcotine, or filter, or king-size cigarettes offers substan tial protection to those with disorders which are known to he aggravated by smoking. What can be said for the smoking habit? All living organisms are characterized by the property of "irritability." When an organism receives a stimulus, it reacts by a discharge of energy. Homan beings are exposed to tiw enormous number of stimuli in their environment Among the most important of these are the stresses and Btrains of modern society--of family, occupation and community tensions. To contend with these tension stimuli, to find relief from them, man has adopt! a number of habits, including smoking. Reaching for a cigarette, light ing i t holding it in the mouth, inhaling and blowing out clouds of smoke are motor activities that relieve tensions. Tobacco also provides at least one chemical, nicotine, which appears to have a tranquillizing effect on the nervous system. These effects may be so valuable to some individ uals that they will willingly risk whatever harm may be associated with the habit. On the other hand; there are many for whom these risks are not worthwhile and who should therefore cut out or cut down on their smoking. POSSIBLE INDUSTRIAL CAUSES OF LUNG CANCER The tremendous growth of industry, no less than the in creases in cigarette smoking,, ha* p iraileled the rise in lung cancer mortality. Many industrial waste products contain known carcinogens capable of polluting the air C O N SU M E R REPORTS 73