Document vVw3kzmgLY7KMj8YYV24GZ5qR

FILE NAME: Smoking (SMOK) DATE: 1955 Feb DOC#: SMOK023 DOCUMENT DESCRIPTION: Consumer Reports Results on Lab Tests of Cigarettes Here are tile results of CU's recent laboratory tests w . . T Yill filter-tip cigarettes give you less nicotine and tar than plain cigarettes? What about the 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 smoke? 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 smokers would like to have answers. But no answers, at least no reliable 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 brand-to-brand, and type-to-type differences in terms of nicotine and tar content. Since that time, however, many new king-size and filter-tip cigarettes have appeared on 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 tests of 37 brands of cigarettes, purchased in 28 cities throughout the country. They are of four broad types: regular size, filtered; regular size, unfiltered; king-size, filtered, and king-size, unfiltered. Within these types are cigarettes majle of American blends, and Turkish cigarettes; low nicotine, denicotinized, and mentholated smokes; regular-price, low-price, and premium- price; 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 Alden, 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 tpbacco 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 vary. And in most cases it does. v. . Of the 20 brands included in both CU's previous tests and the current tests, only John Alden and Sano regular were found to be unchanged in the nicotine content of their smoke. John Alden was lowest in nicotine content in' both series of tests; it averaged only 0.4 milligram of nicotine per cigarette in die 16 test.samples "smoked" by the laboratory apparatus. Sano regular also remained at its previously found low nicotine level, although it was not quite as low. as the recently introduced Sano king size with filter tip. Sanos are made of a denicotinized tobacco: that is, tobacco from which a large part of the nicotine has been extracted. Continued on next page CON SU M ER REPORTS 57 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 Camels increased from 1.9 milligrams to 313 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 Alden and Sano, was from about 1.5 milligrams (for L&M regulars) to 4 milligrams (for Old Gold king 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 tar content of the smoke; the results, therefore, are not strictly' comparable, with those obtained in 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 Alden, you can cat your nicotine intake down to 10% of that of the brand highest in nicotine. But the cigarette lowest in tar content (L&M regular) will still give you 40% 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, creped and uhcreped paper, asbestos fibers,-' or combinations of several of these materials. No laboratory tests were run to determine whether it was the filters, or other factors, that were responsible for high or low 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 less tar in the smoke of the filter-tip 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 w ere. several exceptions. The brands whose smoke yielded the HOW CU TESTS CIGARETTES 5 8 FEBRUARY 1955 The testing of a cigarette begins with the collection of its smoke. The cigarette is first fitted into a glass holder and then' "smoked" in the laboratory apparatus (left). The smoke drawn from the cigarene is collected in acidified alcohol in the flask (any smoke carried into the glass "train" is trapped in the two vials). Lowering the level, of the water in the vertical glass tube at th e end of the train by means of the bulb at the extreme right of this picture draws air through the cigarette. Each puff is made to last for two seconds and one puff is taken each minnte. Slightly more than two cubic inches (35 cubic centimeters) is taken in with each puff, and each cigarette is smoked down to a butt of just under an inch (23 m m .). In ClTs least tar were. all filter-tipped. Three of them--L&M regular, Sano king size, and the premium-priced du 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 well 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 there were several exceptions. Bang-size brands with filter Continued on next page tests, 16 samples of each brand were "smoked" in two runs of eight cigarettes each; the results of each run were determined separately and then averaged. After each run, the washings from the apparatus are added to the smoke solution in the collecting flask. One portion is steam dis tilled to isolate the nicotine; amounts are measured with an ultraviolet spectrophotometer (center). Chloroform is added to another portion of the smoke solution, which is then diluted with water. The tar is then extracted by vigor ous shaking, first from acid solution, then from alkaline solu tion, and the chloroform is then drained from separatory funnels. After this, the chloroform is boiled ofi and the tar residue, weighed on a chemical balance (above). RESULTS OF TESTS FOR NICOTINE AND TAR IN THE SMOKE FROM 3 7 BRANDS OF CIGARETTES Brands are listed iti order of increasing nicotine content of their smoke. A difference of a few milligrams in tar content is of no significance. BRAND AND TYPE MCtlftC NICfTME M SCMIMOKftCETPTEEX (NUMIAMf) ATVACRKAWBE SMOKEft* (Mt1UI6lACRREUITUE) JO H N ALDEN Low nicotine tobacco 0.4 John Alden Tobacco SAN O Denicotinized (KF) 1.0 United States Tobacco SAN O Denicotinized U LA M (F ) Liggett & Myers 1.5 DU M AURIER (F) Columbia Tobacco 1.7 YO RK SH IRE Larus & Bro. 1.7 M U R A D P. Lorillard 1.8 KENT (F) P. Lorillard 2.0 YORKSHIRE (K) 2.0 CHESTERFIELD Liggett & Myers 2A DU M AURIER (KF) 2A REGENT (KF) Riggio Tobacco 2.4 PARLIAM EN T (F) Philip Morris 2.4 LAM (KF) 2A HERBERT TAREYTOH (KF) American Tobacco . 2A PARLIAM ENT (KF) 2.6 CHESTERFIELD (K) 2.7. PH ILIP M ORRIS Philip Morris 2.7 LU CK Y STRIKE American-Tobacco . 2.7 KENT (KF) 2.8 OLD GOLD (KF) P. Lorillard 2.9 W IN G S (K) Brown & Williamson 2.9 OLD GOLD 2.9 FA TIM A (K) Liggett & Myers' 2.9 V IC E R O Y (KF) Brown & Williamson 3.0 DUNHILL (K) Philip Morris 3.0 W INSTON (KF) R. J. Reynolds 3.1 HERBERT TAREYTON (K) 3.1 CAM EL' R. J. Reynolds 3.3 K 0 0 1 Brown & Williamson 3.4 PHILIP MORRIS (K) 3.4 PALL M ALL (K) American Tobacco ' 3.5 EM BASSY (K) P. Lorillard 3.7 KOOL (K) 3.7 RALEIGH (K1 Brown & Williamson 3.7 CAV ALIER (K) R. J.` Reynolds 3.8 OLD GOLD (K) 4.0 16 12 15 11 12 IS 21 12 18 17 16 19 14 18 19 . " 15 22 21 21 15 14 20 , 18 24 rl8 23 ' 20 22 20 . 20 26 26 24 23 25 26 25 K -- king size; F = filter Up; KF = long size with filter . tip. Where no letter follows name, brand is regular size. CO N SU M ER REPORTS 59 cigarettes LABORATORY: TESTS tips were also higher in nicotine and tar than* the regularsize 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 smoked 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 i t CIGARETTE PRICES Cigarette prices often vary from store to store. The fol lowing prices are representative of those paid by CU's shoppers in New York City. Murad, at 37(f was the most expensive brand tested, with Parliament and du Maurier ` (both regular- and king-sizes) close behind at 33ft. Other premium-priced brands included Kent, in both sizes, at 31, - arid Sano king-size, 30^. At the low end of the scale were Yorkshires (they averaged 17ft for the regular and 18ft for the king-size in Sears retail stores throughout the country), and Wings at 21ft. Nearly all other brands were priced at 24ff or 25^, with some filter-tip and king-size ' cigarettes at a penny or two more. John Alden, the brand lowest in nicotine, was 2 6 a pack. A NOTE ON FLAVOR * WHAT ABOUT CIGARS? '. CU made no attempt to evaluate flavor in any o f the . - Recent' medical literature has dealt largely with the cigarettes tested, but a note on this hotly disputed subject . hazards of cigarette smoking, but 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 this with mass tests-- :. information on nicotine and tar in cigar, smoke. A random that in blindfold tests most smokers can't tell the difference -- selection of 24 cigars--thin ones, fat ones, long ones, between one "popular" brand arid 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- v of each cigar was analyzed in the same manner, widely conceded that a reasonably sensitive smoker cart- On the average these cigars,.which gave about six times tell one from the other, and can distinguish all 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.c On a wieight-for-weight basis, the cigars had on the taste and habit. A number of smokers who tried the low- r average only orie-third^as much nicotine and one-fourth nicotine John Alden commented adversely on its flavor; as much tar iri their smoke, as cigarettes. The relationship however, those bent, on reducing their nicotinei intake: o f cigars to*cigarettes in this respect is shown below. NICOTINE AND TAR CONTENT OF SMOKE PER CIGARETTE NICOTINE AVERAGES* 0 1 2 MILUGRAMS rzfcSJRri * TAR AVERAGES MIUIGRAMS 5 10 15 20 ' 25 REGULAR WITH FILTER REGULAR WITH FILTER , , 1 2 REGULAR REGULAR'. KING SIZE WITH FILTER KING SIZE WITH FILTER KING SIZE KING SIZE-L c OVERALL OVERALL W a - i- . . CIGARS CIGARS *John Alden and Sano are not included. 60 FEBRUARY 1955 30 35 nm t i i . V-1: ft. J Hi ... -.i': #*. Medical reports have upset the cigarette business; regular ~ brands decline, as 19 new versions enter the retail arena -*~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, the revolution which turned it into the cigarette industry. The revolution consisted of 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 the 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 are 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 packs a year.for every American over the age of 15. (Almost 43 billion more cigarettes were sold tax-free, largely to the armed farces.)--In this one year, American consumers spent $4,300,000,000 for cigarettes alone. THE BIG SIX AND THE BIG 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 Five" have been: the American Tobacco Company (makers of Lucky Strike, PaU Mall, Herbert Tareyton), R. J. Rejmolds [Camel, Cavalier, Witiston), Liggett & Myers (Chesterfield, L&M, Fatima), Philip Morris (which, besides its namesake, also makes DunhiU and Parliament), and P. Lorillard (Old Gold, Kent, Embassy). In 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-- are much the biggest; they account for a whopping 75% of all 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 the 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 40 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 Chesterfields--came in first, with a combined total of 80% of the market. In effect, each of the five big companies was selling the American smoker one Continued on next page CONSUMER. REPORTS 6 t cigarettes THE INDUSTRY 62 FEBRUARY 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 mill;, meters long,-filled with a mixture of burley and flue-cured tobacco. Among the five brands there were, of course, dif ferences in the proportion of burley 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 trtlfe 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-brand advertising. So simple and standardized a prod uct did not permit any other kind of competition-- except, perhaps, in price. NO PRICE 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, Avalons and Marvels) which sold at 10^ a pack--3^ under the regular brands--and for a brief time in 1932 captured 22% of the m arket The big companies, which had raised their prices 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 kind of tobacco used in the cut-rate cigarettes and hoarded i t) This solidarity, in pricing among the dominant Big Three was condemned by the courts in 1946 as.collusion. But prices remained identical Competition in price was left to the retailers. By reducing their own margin of profit, the small retailers can reduce the price of cigarettes a cent or two per pack Thus, they can compete--but only against each other. When supermarkets or. drugstores cut the pre- , vailing local price, ,it is almost always by the same amount on all regular brands. What reason was there, after all,, for the big companies to lower their price? There was certainly no resistance by the consumer. The market for cigarettes kept on expand ing, despite a series of price hikes, which, in the last 20 i years, have raised the price per pack of the big selling brands from 13 to 25. In fact, it was during this same period of inflation and higher federal cigarette taxes that the industry scored its most spectacular gains. Between 1932 and 1952, the number of cigarettes sold almost quadrupled, and industry spokesmen were confidently pre-. dieting sales rises of 4% to 6% a year. At the beginning of 1953, then, the industry seemed to be safe against any upset: 1952 had been the peak year for sales; cigaretteswere ah "essential" to a vast, and ap parently growing, sector of American life; the market was dominated 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: X A series of reports which, according to the scientists and statisticians who prepared them, imply that there is a 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 4.6% is expected to he shown for 1954. 3 A big change-over by smokers from "regular" brands to king-size cigarettes (85 millimeters long), and a marked shift to those with some kind of filter tip. 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 --and the consumer? THE CANCER SCARE The industry'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 Cigarette Tars." This medical report was quickly "translated" for the public by an out burst of stories in newspapers and such mass-circulation magazines as Life and Time. Oh 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, warehousers, 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. Jackson Memorial 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 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 scares'!, which have blown over in the past. But business and trade journals generally agree that during the last year and a half 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 E. A. DarT, president of Reynolds, accused the American Cancer Society of at tempting "to destroy the tobacco industry." INDUSTRY HEALTH CLAIMS The industry does not admit in public that "health" publicity may have caused the unprecedented drop in ciga rette sales. But critics dose to the industry-- for example, in the advertising trade journals---have said 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 claims" in their ads. For a generation, the companies have been insisting, in big red letters, that their particular brand had "less nicotine," was "less irritating," " guarded against throat 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 m ay have given the smoker temporary confidence in one brand, but they also implied that cigarettes in general were distasteful, probably harmful, and certainly a "problem." When the Continued o n next page CO N SU M ER REPORTS. 63 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 published, 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 is uneasiness among American smokers is confirmed by the heavy sale of Herbert Brean's book, "How to Stop Smoking,"-pub lished by Vanguard Press in 1951. By the end of last year, about 500,000 copies had 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 smoking, but it does show that a lot of them are interested in doing so. THE NEW LOOK IN CIGARETTES 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 an otherwise shrinking market For the last seven years, the tobacco industry has watched the demand for the Big Three brands--Camels, Luckies, 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 Mall, 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 ket. By 1953, the Pall Mall share had quadrupled to 12.4%, and this 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 vcith its old leader, Lucky Strike, it was more than regaining it on PaU 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 smokes of their own--Cavalier (Reynolds), Fatima (Lig gett & Myers), Dunhill (Philip' Morris), and Embassy (Lorillard). MORE KINGS APPEAR Three years ago, Liggett & Myers 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 cigarette, in the famil iar white and gold package. In 1953, three other old favorites also appeared in the "new look"-- 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, the number of smokers who want king size is growing--whether it is because they feel they are getting more health protection, a.lnore "distinguished" look, or just a longer smoke for their money. In 1953, the year when total cigarette sales first fell, extra-length brands had grown to almost 26% of the market, as against 18.5% in 1952. Last year, the 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 filter-tipped; in 1953, the number more than doubled, to 3.4%; when the returns for 1954 are in, experts estimate that the filter brands will have 10%, and possibly 12%, of the total market Lorillard's Lewis Gruber flatly predicts that within two more years, 40 of every 100 smokers will be smoking filtered cigarettes, most of them king size. WHAT IS A FILTER TIP? - "What is this "revolutionary" product? 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 the filters are made of finely creped (crinkled) paper, ab sorbent cotton, and cellulose-acetate fibers, either alone or in combination. Some have added "purifying agents," such as Herbert Tareytons activated charcoal; and Kent's patented Micronite, an asbestos-like substance. Filter cigarettes are not new; they have been on the American market for some time in Parliament and Du Maurier, which sold at a premium price (32^ or more Continued on next page CHANGES IN THE CIGARETTE MARKET The tables- on the facing page show how the cigarette market has changed in two years. The halftone areas backing the tables show the trend, not exact percentages: the figures for 1954 include estimates for the last months of the year and do not distinguish betw*n regular- and king-size filter-tip brands \ (A FEBRUARY 1955 S A L E S OF C I G A R E T T E S 19 5 2 REGULAR SIZE: 8 1 .5 6 % OF THE v MARKET 19 5 4 REGULAR SIZE: . 6 3 .2 2 % OF THE MARKET CAMEL (R. J. Reynolds) LUCKY STRIKE (American Tobacco) CHESTERFIELD (L iggett & Myers) PHILIP MORRIS 3 3 . (Philip. Morris) &OLD GOLD > i (P . Lori Ilard) '3 3 3 3 3 . ; 3 ` KOOL i (Brown & W illiamson) - RALEIGH (Brown & W illiamson) DOMINO, YORKSHIRE (Larus & Bro.) MARLBORO " * (Philip Morris) BILLIONS OF CIGARETTES .. ' 1 1 3 .7 ; % OF 3 , MARKET 3 , * J V ^ 2 6 .0 8 2 .2 6 5 .8 4 0 .4 , 18.8' , *'-53 " U<> > 15.1 3 9 .2 . '> 2 3 .6 5.4 " J , 11.5 2.6 -M 8 .3 1.9 2 .6 0.6 K ; .. -- ` .- ..',%. S.:* 0.5 0.1/% ^ S f'\C A M E L a !'% S:''-;; t . . .iK;,, (R . J. R eyn old s) LUCKY~ STRIKE (American Tobacco) P--t'}ve*r-,''',rx>' .3"^ ... v -v> . 35. CHESTERFIELD. .'13:" ' (L ig g e tt & M yers) *--- .w 1 PHILIP MORRIS ' . - (P hilip Morris) Vvh'v pU'!rUr~!<' f' " r 3 OLD GOLD'- ^ ` ^ , c T . P i " Lorillard)' iy , ,, . KOOL \ . (Brown & W illiam son) ' S A N O ^ S " 3 - 3 i. ' A3-..-" (U nited State Tobacco) MARLBORO ' 5 5 ; .. :333 : (P h ilip . M orris) EXPORT BRANDS --3 (B row n & W illiam son) - ALL' OTHERS '" BILLIONS OF CIBAHEnES ( % OF MARKET 89.8 2 2 .3 ` ?3" 65.2 . 3 .1 6 s 2 V ' - V - , >- w t 4 2 .0 ,'. 3 1 0 .4 3 3 - -24-8' t ^ S `: . 15.6t3|3|ft3.9 ''12.i3% ^'3.0% :'3',; - 0.4 ' 0.1 ? 0.3 " '"v ^ 0 .0 7 4.5 1.1 0a2 3^-^m**!*. 0 .0 5? PIEDMONT, SPUR ~ (L iggett & Myers) VIRGINIA ROUNDS y - --..(B e n so n &.He d g e s ) . v EXPORT BRANDS (Brown & W illiamson) ALL OTHERS 0.2 0.06 1 "'SjjsS 0.05-^3 -s'--Y<5&OL o.oi-Ia :,, 5 .3 0 .9 ' r -' 1 .2 , %3.' ` 0.2 ~ KING SIZE: 17% OF THE MARKET *ivw- 'rs?u!.*.tiiJn.,'^^<rtswa#' PALL MALL (American T obacco). , 454'-*;:.10^ HERBERTTAREYTON (American Tobacco) 12.8 Ci, i a i g L CHESTERFIELD (Liggett & Myers) ' 3 S .S ^ 'ljlI FATIMA (L iggett & Myers) , ` ' 3.---- ---L*&!& : CAVALIER (R. J . Reynolds) . - u i l ojs&tj DUNHILL* (Philip Morris) 3v 1.0 S^ 0 ^ :p 1 `.3 - EMBASSY(P. Lorillard) - 3 3 WINGS (Brown & W illiamson) . --*i > REGENT (Rlgglo Tobacco) .3 HOLIDAY, LORDS .(Larus & Bro.) " ~ 0.53 / 0^ FILT E R TIP : 1.3% OF THE MARKET vV/ICirErRoOn vY:/'(RBrro.w!.n. s& wWiimlli.aimMs.o.n. ) PARLIAMENT (Benson & Hedges) ts- -- EN CO RE(Unlted S tate s Tobacco) y~r KENT^P^Lorlllard). . * KING SIZE: 2 7 .0 6 % OF THE MARKET ` -*- ' ~'.v.X .t-" f PALL-. MALL. (American Tobacco) " 5 4 4 3 :13.5??- *- CHESTERFIELD (Liggett & Myers) 'X" 1 S J '/ ; , 3.8 > >,vAV' - HERBERTTAREYTON (American Tobacco): :JJL3,.3_ 2 ^ 3 ? - 5 PHILIP M ORRIS (Philip Morris) RALEIGH (Brown & Williamson) " tuFr** wiVC 2.0,"3 .,64J,T 1.6 ~ 3 OLD? GOLD (P. Lorillard) - 7^ ' { '',5.olS? CAVALIER (R; J . Reynolds) 1.0 DOMINO^; YORKSHIRE (Larus & Bro.): y -l ti3 |g ^ '. 0.6 : FATIMA (LIgsett & Myers) -- DUNHILL'(Philip Morris) . ,v 4 s ? i.o |^ '0^5- - 04,-3 ^EMBASSY (P ; Lorillard) - - o ji^ ,- 0.07:; : i-REGENT^RI^oTobacco)^?, .# ;? & > || f-07^ J h OLIDAYv LORDS (Larus & Bro.) -/'y-T/v Oa^W: 0.05;tf? 8 S i|w i NGSii(Broiwn & Williamson}- . / - V ? 04SI? 0-02/: F IL T E R T IP : 9 .6 4 % OF THE MARKET Sfl^W i?3$^5sy5V. - 2* : VICEROY (Brown & W illiamson) ^ -14.9/ V 3.7 J L&M (Liggett & M yers)' , _ --f - 7.713,, 1.9 ^ WINSTON (R. J . Reynolds) V 3 3 f T 7 # 1.9 iKENTSTPi--ljrlllard)oA- 1 O-Slffe ^PARLIAMENT (Philip Morris) f j s T ' j / f e l S f e W M . I h ERBERTTAREYTON (American T o b a c e e J S ^ U ^ O U ^ tM A R V E L :(S te p h a n o Bros.)'. ^ 6 S 4 t ! 5 /O L D GOLD (P. Lorillard) -fj'l R E G E N T *(R lggloT obacco)' -f=Vi -v* S..-00.042'iv f t ENCORE^United States Tobacco) ' od^g;- Statistxc* rtpnnUd frxrm Printersf Ink, December SI, 1951. Copyright 1951 bp Printers' Ink Publishing C04 /nc,, N. Y . COKSUMER REPORTS 65 THE INDUSTRY a pack in New York City,- where regular brands have been rather that "Cornels agree with more people than any other selling at 24# to 25#), and which took a distinctly ritzy cigarette" ), in their filter-tip advertising, they seem to be tone in their ads. As long ago as 1936, Brown & William working both sides of the street lest the smoker feel that son introduced the regular-size filter-tip Viceroys, at in protecting his health, he will not enjoy smoking. Thus only a cent or two above the price of regular,brands. Vice Tareyton's filter "holds back elements that can detract from roys and Parliaments divided most of the insignificant the pleasure of smoking," and Old Gold Filter Kings proffer filter-tip market until 1952. Then Lorillard offered Kents, "a treat you can tru st" Winston "the filter cigarette with a premium-priced filter-tip which was promoted and dis flavor . . . tastes good--like a cigarette should." tributed with big-brand energy. The Big Three made its The Federal Trade Commission has been trying for years first entry into the filter market in 1953, when Liggett & to temper the more blatant assertions of the cigarette ad Myers launched L&Ms, also at a premium price. vertisers, but if there has been any recent amelioration, THE FILTER BAND WAGON it has been the result of the industry "upheaval" rather -**' than of legislative or judicial action. In late 1952 and early The other big companies, which had stood aloof from 1953, the courts rejected FTC's claim that cigarettes should this "small-time" market, suddenly joined in the scramble come under the Federal Trade Commission A ct In Septem last year. In March, Philip Morris bought out Benson &. ber 1954, the FTC tried a different tack and submitted to Hedges--and its successful filter-tip brand, Parliaments. A . the cigarette companies a draft code of advertising stand month later, Reynolds started off with an exclusive king- ards. This code would be entirely voluntary and without size filter-tip Winston, which was described in ads. as the force of law. But though meetings have been held to "made by the makers of Camels," an appeal to old brand discuss it, no cigarette manufacturer has yet indicated his loyalties. Finally, in August, American Tobacco took the willingness to accept even this dilute regulation. field with a filter version of its king-size Tareyton, in the . same white package, but distinguished by thin red and HOW TO SELL CIGARETTES blue stripes across the lower left corner. Both these new Such, then, is the "upheaval" ; where does it leave the filter tips sold at 26#, the "popular" price for filter-tips. huge cigarette industry at the beginning of 1955? Filters have restored price-competition to the industry, . Cigarettes are still the major product of the industry. if only temporarily. In March, the price of L&M was cut Some of the medical reports which condemn cigarettes also by 4#, dropping both the regular and new king-size style' tend to exonerate pipes and cigars, but thus far there has out of the premium class and into the popular arena. Kent,... been only a minor rise in the sale of these two forms of which Lorillard says can never compete on the lower price tobacco. In the near future, the companies must make up level because of the high cost of its Micronite filter, went - their losses on regular brands with increased sales of to king size. Some observers thought this was indirect . filter-tipped and king-size brands. price competition, as well as an invitation to smokers of - The manufacturers nfust get their new products in front king-size brands. Parliaments, another premium product, ; oi. as many consumers as possible, as quickly as possible. showed its sensitivity to the price factor in September byt Distribution of a number of brands can be costly; and diffi cutting the price on its king size by 2#. <. cult. Retailers complain at the extra space for new brands THE PRICE OF FILTERS which must be found on their crowded shelves and coun ters, at the extra bookkeeping, at the. extra dollars tied up Price competition thus far has not brought filter-tips . in their inventories of slow-selling items. Space is also a down to the price level of regulars and some king sizes. major problem for the estimated 500,000 cigarette vending "Popular price" for filter-tip brands still means around machines in the United States. Heretofore, most vending 26#, a cent or two more than the "popular price" for plain machines had ten columns, and could sell, at most, ten cigarettes. Leaf tobacco accounts for about half the cost of different brands. To offer their customers even a minimum a cigarette, and it is doubtful that the material in the aver sampling of the present array, the vendors have to install age filter costs any more than the tobacco it replaces. two machines in one location, or else invest in the new Putting the two elements--filter and tobacco--together in 20-column type.' Differences in price are also a problem one cigarette, however, is a more complicated process. (The .for the machine distributors, since the machines can be trade magazine Sales Management reports that Lorillard paid only in standard coins. had to import machinery from Europe to produce the first The consumer's taste is changing fast, and no manufac Kents.) Also, the industry claims the production machinery turer can be. sure what direction it will take. In 1953, .21 for filter cigarettes is slower and more subject to mishaps. brands were listed as "significant" (that is, as selling over One big-company executive says that a regular machine can a billion cigarettes a year); by July 1954, the number had turn out around 1200 cigarettes a minute, but that he has gone up to 30. Each company will have to make hard deci yet to hear of a filter-tip machine doing better than 750. sions on which of its brands to push, which to modify, and Though the cigarette companies have subdued the scare- which, perhaps, to discard. The industry seems to feel that head health advertising of the regular brands (the ads no already there are too many varieties on the market to sur longer proclaim that "more doctors smoke Camels" but vive, and that a "weeding out" is inevitable. 4 4 FEBRUARY 1955 of current medical knowledge on the relationship the smoking of cigarettes and cancer of the lung very 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 medical problem, has 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 will diminish the risk of disease; and the psychological and physiological effects 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 mecfieal schools and health departments, and by the American Cancer Society; .to be ati 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 own 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'Roscoe B. Jackson Memorial Laboratory, Bar Harbor, Maine. This project is still too new to have yielded'any significant data, and its formation has been criticized as resem bling burglar-financed research toward the perfection of a. crackproof safe. How ever, several independent criticisms of the cigarette theory of lung cancer have, been advanced by outstanding investigators, the foremost being Dr. W. C. Hueper, Chief of the Environmental Cancer Section of the National Cancer Institute in Bethesda, Maryland. Dr. Hueper and some other experts regard the evidence linking lung cah-' cer and cigarette smoking as insufficient or contradictory', and the theory generally as not proven. No one has claimed that regular cigarette smoking is the 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 of 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 specializing in diseases of the lung have been impressed by the frequency with which they 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 that cancer of the lung was becoming a leading cause of death in men, groups of investigators in the United States, England and 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 even more rarely diagnosed during life. After 1900, with the increasing use of chest X rays and the bronchoscope, cancer of the lung began to he diagnosed Continued on next page CO N SU M ER REPORTS 67 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 cases 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. THE INCREASE IN LUNG CANCER During 1951, nearly 20,000 deaths in the United States were 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 noninfectious disease in medical history.-" Since cancer of the lung usually starts in the surface lining of the bronchial tubes of the lung, the carcinogens must be those that are 1 inhaled into the bronchial tubes and lungs. Among suspect inhaled materials are industrial fumes; industrial and do mestic soot derived from coal and fuel oil furnaces; ex hausts from internal combustion machines (gasoline and\ - diesel) ; asphalt or bituminous road surface dust; and . DEATH RATES FOR SELECTED DISEASES AMONG WHITE U.' S . MALES - tobacco smoke. All these materials are believed to have cancer-inducing properties. THE SEARCH FOR CAUSES 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 animal experiments, on medical studies in human beings, and on statistical analyses. The cancer-inducing effects of industrial and other air pollutants have been studied experimentally in laboratory animals. These experiments have yielded conflicting data, particularly because of the difficulty of finding animals which develop lung tumors comparable to those in man. Experiments with the smoke of tobacco and cigarette paper have also yielded inconclusive data. One group of. experi ments showed that benzpyrene, a chemical 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 see 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 carcinogenesis [origin of cancer] . . . are extremely complex and far from understood as yet. What will cause cancer in one species will not necessarily cause it in another. What will cause cancer in one tissue of a given animal will not necessarily cause it in another tissue of tile same animal. Thus it is conceivable that tobacco smoke does contain an agent which is carcinogenic for the lungs of Human beings. It may not be so for the lungs o r any other tissue of a mouse, or a guinea pig, or a 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 chromates can cause cancer of the lung in workers occupationally 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 living human beings is ruled out by the nature of the disease, researchers 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 the epidemiology of a disease. According to Dr. Leonid S. Snegireff, Associate Professor of Cancer Control of the Harvard School of Pub lic Health: "The epidemiologist often finds puzzling situa tions which he can so(ve by applying epidemiological prin ciples without first knowing all the detailed pieces of the puzzle. For example, experience with many diseases shows that exact knowledge of the specific agent which causes a given disease process is not essential for the achievement 66 FEBRUARY 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 Great Britain was brought under control in 1866 by appropriate measures of sanitation and purification of water supply--17 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 caries 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 lung. Of all possible environmental carcinogens, tobac co smoke is one of the few that the individual can controL According to Dr. Morton Levin, Assistant Commissioner for Medical Services of New York State and a leading stu dent of the epidemiology of cancer ol the lung, "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 cancer" (Problems in the Study of Occupation and Smok- ing in Relation to Lung:Cancer, Drs. Morton L. Levin et aL October 11, 1954). This point of view is shared by others, here and abroad. . What is the statistical evidence of a causal relationship between smoking and cancer of the lung? Since 1950 more than' a dozen independent studies have reported a dispro portionately high percentage of heavy cigarette smokers among lung cancer patients. Most of these studies are what is known as "case-history" or "retrospective" studies. The ' tobacco intake of patients in whom cancer of the lung has already been diagnosed is compared with that of control groups (non-cancer patients) representative of the popula tion from which the cancer patients were drawn. All these studies have been interpreted as demonstrating a greater liability to cancer of the lung in regular cigarette smokers, to cancer of the lip in regular pipe smokers, and to cancer of the mouth in-regular cigar smokers--a liability that increases with the quantities smoked. Because of certain weaknesses in the design of.retro spective or case-history studies, the American Cancer So ciety, the British. Research Council and individual investi gators have also undertaken statistical studies by the ' "prospective" or "population" method. Preliminary reports of the studies of the American Cancer Society and the British Medical Research Council are available and they confirm in their broad features the results of the case- history 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 non- smokers. The evidence from other countries is less con vincing and complete and no substantial data bearing di rectly On this question are yet available for non-white pop- Despite higher cigarette consumption in the U S .,.th e death rate from cancer of the lung, larynx, and.sinuses is higher in England illation- or for female population." However, according to Dr. Hueper, a world-renowned authority on environmental carcinogens, "the cigarette theory is almost entirely based oh statistical data having at best circumstantial value and being in part of questionable origin." (Address before American Pharmaceutical Manufacturers Association, De cember 10, 1954.) In support of the cigarette smoke thesis it is stated that both in England and in the United States ian increase of per capita cigarette consumption, particularly by men, has generally paralleled the trend of mortality in cancer of the lung. This evidence is, however, disputed b y Dr. Hueper and others. Dr. Hueper points out that the age-adjusted rate of increase in the frequency of lung cancer deaths was greater between 1914 and 1930 than between 1931 and 1944. He believes that the rapid increase in cigarette smok ing during the Thirties and Forties should have given-the later period a greater increase in lung cancer fatalities if cigarette smoking were a significant factor. Women, as a group did not begin to smoke cigarettes regularly until well after World War I. Since then there has been a relatively greater increase in smoking by women than by men, but the relative increase in lung cancer has Continued on next page CON SU M ER REPORTS 69 cigarettes MEDICAL ASPECTS been far greater in the male. This inconsistency in the cigarette hypothesis has been ."explained" on the basis of sex 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 be attributed to fluctuations in in.tensity of any one single factor, such as- cigarette smoking. If seems .more plausible, says Dr. Hueper, to attribute the sex.differences 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 lung cancer has continued in all industrialized countries, - but 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 says, be explained by the degree and spread of the ciga rette habit. 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 materials are believed-to be present in effuents of domestic and 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, and they work in such jobs more consistently over longer periods of their lives. 2 Males predominate in outdoor occupations, especially 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 tend'to remain in the cleaner residential areas. All studies have sbown a remarkable drop in lung cancer incidence when the researchers turn from urban-industrialized 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 among urban than among rural residents. Dr. Hueper and others, however, believe The possible sources of cancer-causing elements in the U. S. show the same sort of increase as lung cancer mortality 7 0 FEBRUARY 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. LUNG CANCER IN INDUSTRIAL W ORKERS 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 than of the United States, although the English smoke 30% fewer cigarettes per capita than Americans. This obser vation, which appears to undermine the cigarette theory, has 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, Kaemten, 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 the English Midlands. The Austrian doctors, moreover, found that lung cancer mortality rates in communities located along main highways, where 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 sustained and intense exposure to atmospheric pollutants, and that some of these pollutants 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 is so much varia tion in the incidence of cancer of the lung in different large cities of 100,1)00 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 o f this magnitude." It-is hoped that these and other questions will be an swered, at feast 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 reply to a question asked in the British House of Commons, the Minister of Health stated: "The Standing Advisory Committee on Cancer and Radiotherapy had been considering' the relationship between, smoking and lung cancer for three years. As a result of preliminary investigations, -a panel under the chairmanship of the Government Actuary was set up in' 1953. The committee, having-considered the report 'of - the panel and reviewed the other evidence available, were now of opinion: - .' 1. It must be regarded as established that there is a relationship between`smoking and cancer of the lung. 2. Though there is a strong presumption that, the relationship is ' causal, there is evidence that the relationship :is not a simple one, since: (a) the evidence in support of the presence in tobacco-smoke of a carcinogenic agent, causing cancer of the lung is not yet certain; . (b) the statistical evidence indicates that it is unlikely that the increase in the incidence of cancer of the lung is due' entirely to increases in smoking;. (c) the difference in incidence between urban and rural areas and between different towns, suggests that other factors may be operating--e^., atmospheric pollution, occupational risks. 3. Although no immediate dramatic fall in death rates could be . expected if smoking ceased, since the development of lung cancer may be the- result of factors operating over many years, and though no reliable quantitative estimates can he made of the effect of smoking on the incidence of cancer of the lung, it is de sirable that young people should be warned of the risks apparent ly attendant on' excessive smoking. I t would appear that the risk increases with the amount smoked, particularly of cigarettes." Although "excessive" smoking is usually defined as more than one pack a day, susceptibility to the effects of tobacco varies widely. A half pack may be excessive for one per son and moderate for another. THE BRITISH ANSWER ; It is interesting to note in passing how the British to bacco companies have met the challenge of.Jung 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 smoking is a major contributory cause of capcer of the lung, there is none about the causal relation between smoking and "chronic Continued on next page C O N S U M E R REPORTS 7,1 cigarettes MEDICAL ASPECTS 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 cytological smear studies of the sputum, are often recom, mended by physicians when the patient reports spitting blood; suffers repeated attacks of "pneumonia" ; or experi ences delayed healing of "pneumonia." EFFECTS O N :OTHER ORGIANS . . . At a conference at Cornell Medical Center (December v. 1953), Dr. Graydon Boyd, specialist in diseases of the nose and throat and Associate Professor of Surgery at New York University Medical School said, apropos the effects 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 nose and throat." Smoking is also believed to have a close 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 possibly by allergic effects. The most important of these chemicals' is nicotine*, which acts on the nervous system in a variety of ways. One effect appears to be a tranquilizing action on the higher nervous centers. Nicotine also has important effects on the blood vessels and the heart. Patients with Buerger's ; disease (thfombo-ahgiitis oblit erans) m u st.give up . smoking of any kind--cigarette, cigar, 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 cause 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 by smoke in the mouth and the lungs. Smoking has also been known to cause extra heart beats and rapid heart beat. How harmful these toxic side 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 the coronary artery circulation and the work of the heart. An alternative ex planation is that nervous or psychological 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 this subject: "The American Heart Association is seriously interested in any possible relationship between smoking and 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 cigarettes 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 evidence 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 lacking." According to Dr: Wright, this statement holds true for all types of filter cigarettes. 1 : Filters do reduce the inhalation of tars and other ma terials in smoke, and conceivably may reduce the intake of carcinogenic materials. However, Dr. Ernest L. Wynder of the Memorial Hospital, New York's leading cancer hospital, points out that, "As long as we do not know 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 gastro-intestinal 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 cause of peptic ulcer, smoking "may result in func tional disturbances which may simulate organic disease or 7 2 FEBRUARY 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 be much less satisfactory than that of the patient who gives up smokhng entirely." These views are also shared leading specialists in gastro-intestinal diseases. It has not been shown that low-nicotine or filter-type cigarettes reduce the damage of smoking in persons with active stom,i'.h or duodenal ulcer. SUMMING UP In summing 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 dsn definiti ly irritating to the nose, throat and larynx. The sidence is inconclusive with respect to the effects of smokng 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 requency in industrial countries partly to the diffusion 'to the air of carcinogens derived from industry and -ansportation, partly to unusual exposures to carcinogens many occupations, and partly to excessive cigarette 'making. The control of respiratory or lung cancer would npear to require a three-pronged effort by individuals, 'immunities, industries and voluntary health agencies uch as the American Cancer Society) against I) air pol- .lion, 2) occupational exposure and 3) excessive cigarette 'king. How significant a factor regular cigarette smokis in contributing to lung cancer remains to be de'p ined. Until more conclusive evidence is reported, it lid seem prudent to reduce cigarette smoking to less an a half pack a day or to smoke a pipe or cigars in mod i'ion. There is no conclusive evidence that smoking "nicotine, or filter, or king-size cigarettes offers substan>1 protection to those with disorders which are known to aggravated by smoking. \\ Hat can be said jor the smoking habit? -Ml living organisms are characterized by the property "irrita b ilit\W h e n an organism receives a stimulus, it 'i*1.- by a discharge of energy. Human beings are exposed an enormous number of stimuli in their environment. ' g the most important of these are the stresses and of modern society--of family, occupation and itnunity tensions. To contend with these tension stimuli, H'd relief from them, man has adopted a number of oils, including smoking. Reaching for a cigarette, lightit, holding it in the mouth, inhaling and blowing out ids of smoke are motor activities that relieve tensions, haf.co also provides at least one chemical, nicotine, Hi appears to have a tranquillizing effect on the nervous m. These effects may be so valuable to some individ- that they will willingly risk whatever harm may be ated with the habit. On the other hand, there are ny for whom these risks are not worthwhile and who 'd therefore cut out or cut down on their smoking. r*WB POSSIBLE INDUSTRIAL CAUSES OF LUNG CANCER ' '<rn:7^=;e=f`-avw> CHROMATES FROM m ... CHROME ORE SMELTING, , PLATING, PIGMENTS, PAINTS, ( ^ INKS AND ABRASIVES NICKEL CARBONYL FROM NICKEL ORE REFINING, PLATING AND BUFFING ARSENIC FROM j ARSENIC MINING, SMELTING, PESTICIDES i ASBESTOS FROM ASBESTOS MINING, r .PROCESSING AND WEAVING % fAR FUMES FROM TAR MANUFACTURING, COKE CtVEN SERVICING ASPHALT DUST FROM ! V -ASPHALT PITCH, SOOT. ROADS RADICOrAa nCiTuImVEm iDnUinSgT, FROM URANIUM REFINING .1 PC ; $-: yq WkiiiVc;q;>Ar; , : -. U-' fv.- - )* i&aSjfaltiiidigt. The trem endous growth of industry, no less than the in creases in cigarette smoking, has paralleled the rise in lung cancer mortality. Many industrial waste products contain known carcinogens capable of polluting the air CON SU M ER REPORTS 73 i/o ( o b n < i -w , y , i1! Ml ik: is;' ir{HMt - u i u.: ( m-. '!; . I) i iJi'S*. d 'li IV 1 *;p M>Ai:1 aiphMV.-.11 II I!' I: ! I U ! ,' i (' H - j;. ji i' , i'l-T lb 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 be 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-nicotine or filter-type cigarettes ' reduce the damage of smoking in persons with active stom ach or duodenal ulcer. SUMMING UP In summing 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 lie 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 transportation, 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 (such as the American Cancer Society) against 1) air pol lution, 2) occupational exposure and 3) excessive cigarette smoking. How significant a factor regular cigarette smok ing is in contributing to lung cancer remains to be de termined. Until more conclusive evidence is reported, it would seem prudent to reduce cigarette smoking to less than a half pack a day or to smoke a pipe or cigars in mod eration. There is no conclusive evidence that smoking low-nicotine, or filter, or king-size cigarettes offers substan tial protection to those with disorders which are known to be 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. Human beings are exposed to an enormous number of stimuli in their environment. Among the most important of these are the stresses and strains of modem society--of family; occupation and community tensions. To contend with these tension stimuli, to find relief from them, man has adopted a number of habits, including smoking. Reaching for a cigarette, light ing it, 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,, has paralleled the rise in lung cancer mortality. Many industrial waste products contain known carcinogens capable of polluting the a'ir CO N SU M E R REPORTS 73