[Congressional Record Volume 141, Number 70 (Monday, May 1, 1995)]
[Senate]
[Pages S5915-S5917]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                DR. DAVID A. KESSLER'S SPEECH ON TOBACCO

 Mr. SIMON. Mr. President, recently, I had a chance to read a 
speech by Dr. David A. Kessler, the Commissioner of the Food and Drug 
Administration, to the Columbia University Law School.
  I have been very favorably impressed by Dr. Kessler's commitment and 
doggedness over the years. My colleagues will recall that he was an 
appointee of President George Bush, and when Bill Clinton became 
President, I urged him to retain David Kessler, and I am pleased that 
he has done so.
  His talk to the Columbia University Law School was about tobacco and 
specifically about young people and tobacco. He describes nicotine 
addiction as ``a pediatric disease.''
  What tobacco companies are clearly trying to do, and unfortunately 
doing successfully, is to make smoking attractive to young people.
  My wife and I recently took a vacation, at our own expense, I hasten 
to add, to Portugal and Spain, and the percentage of young people who 
smoke in those two countries, as well as in the rest of the world, 
unquestionably is higher than it is in the United States. But more 
young people are smoking in the United States, and according to Dr. 
Kessler, 7 out of 10 who smoke, report that they regret having started.
  He does not mention in his remarks something I have read elsewhere, 
and that is someone who is a cigarette smoker is much more likely to 
get involved in hard drugs.
  An area where I have some concerns is his comment on advertising.
  I believe the Federal Government has to move very cautiously when it 
comes to first amendment matters.
  It does seem to me, however, that it is only realistic and fair to 
ask the advertisers to warn more effectively about the dangers of 
cigarettes.
  We require this of the manufacturer of other products.
  The speech by Dr. Kessler is something we should be taking extremely 
seriously, and I ask that the speech be printed in the Record.
  The speech follows:
                   Remarks by David A. Kessler, M.D.

       It is easy to think of smoking as an adult problem. It is 
     adults who die from tobacco related diseases. We see adults 
     light up in a restaurant or bar. We see a colleague step 
     outside for a cigarette break.
       But this is a dangerously short-sighted view.
       It is as if we entered the theater in the third act--after 
     the plot has been set in motion, after the stage has been 
     set. For while the epidemic of disease and death from smoking 
     is played out in adulthood, it begins in childhood. If there 
     is one fact that I need to stress today, it is that a person 
     who hasn't started smoking by age 19 is unlikely to ever 
     become a smoker. Nicotine addiction begins when most tobacco 
     users are teenagers, so let's call this what it really is: a 
     pediatric disease.
       Each and every day another three thousand teenagers become 
     smokers. Young people are the tobacco industry's primary 
     source of new customers in this country, replacing adults who 
     have either quit or died. An internal document of a Canadian 
     tobacco company, an affiliate of a tobacco company in the 
     United States, states the case starkly:
       ``If the last ten years have taught us anything, it is that 
     the [tobacco] industry is dominated by the companies who 
     respond most effectively to the needs of the younger 
     smokers.''
       If we could affect the smoking habits of just one 
     generation, we could radically reduce the incidence of 
     smoking-related death and disease, and a second unaddicted 
     generation could see nicotine addition go the way of smallpox 
     and polio.
       The tobacco industry has argued that the decision to smoke 
     and continue to smoke is a free choice made by an adult. But 
     ask a smoker when he or she began to smoke. Chances are you 
     will hear the tale of a child.
       It's the age-old story, kids sneaking away to experiment 
     with tobacco, trying to smoke without coughing, without 
     getting dizzy, and staring at themselves in a mirror just to 
     see how smooth and sophisticated they can look.
       The child learns the ritual. It is a ritual born partly out 
     of a childish curiosity, partly out of a youthful need to 
     rebel, partly out of a need to feel accepted, and wholly 
     without regard for danger. It is a ritual that often, 
     tragically, lasts a lifetime. And it is a ritual that can cut 
     short that lifetime.
       Many of us picture youngsters simply experimenting with 
     cigarettes. They try smoking like they try out the latest 
     fad--and often drop it just as quickly. But when you 
     recognize that many young people progress steadily from 
     experimentation to regular use, with addiction taking hold 
     within a few years, the image is far different, far more 
     disconcerting. Between one-third and one-half of adolescents 
     who try smoking even a few cigarettes soon become regular 
     smokers.
       What is perhaps most striking is that young people who 
     start smoking soon regret it. Seven out of 10 who smoke 
     report that they regret ever having started. But like adults, 
     they have enormous difficulty quitting. Certainly some 
     succeed, but three out of four young smokers have tried to 
     quit at least once and failed.
       Consider the experience of one 16-year-old girl, recently 
     quoted in a national magazine. She started to smoke when she 
     was eight because her older brother smoked. Today, she says: 
     ``Now, I'm stuck. I can't quit...It's so incredibly bad to 
     nic-fit, it's not even funny. When your body craves the 
     nicotine, it's just: `I need a cigarette.''
       In her own terms she has summarized the scientific findings 
     of the 1988 Surgeon General's report. That report concluded: 
     ``Cigarettes and other forms of tobacco are addicting'' and 
     ``Nicotine is the drug in tobacco that causes addiction.''
       Let there be no doubt that nicotine is an addictive 
     substance. Many studies have documented the presence of the 
     key addiction criteria relied on by major medical 
     organizations. These criteria include: highly-controlled or 
     compulsive use, even despite a desire, or repeated attempts 
     to quit; psychoactive effects on the brain; and drug-
     motivated behavior caused by the ``reinforcing'' effects of 
     the psychoactive substance. Quitting episodes followed by 
     relapse and withdrawal symptoms that can motivate further use 
     are some additional criteria of an addictive substance.
       Are young people simply unaware of the dangers associated 
     with smoking and nicotine addiction? No, not really. They 
     just do not believe that these dangers apply to them.
       For healthy young people, death and illness are just 
     distant rumors. And until they experience the grip of 
     nicotine addiction for themselves, they vastly underestimate 
     its 
     [[Page S5916]] power over them. They are young, they are 
     fearless, and they are confident that they will be able to 
     quit smoking when they want to, and certainly well before any 
     adverse health consequences occur.
       They are also wrong. We see that documented in papers 
     acquired from one company in a Canadian court case. A study 
     prepared for the company called ``Project 16'' describes
      how the typical youthful experimenter becomes an addicted 
     smoker within a few years.
       ``However intriguing smoking was at 11, 12, or 13, by the 
     age of 16 or 17 many regretted their use of cigarettes for 
     health reasons and because they feel unable to stop smoking 
     when they want to . . . Over half claim they want to quit. 
     However, they cannot quit any easier than adults can.''
       This sense of helplessness and regret was further tracked 
     in a subsequent study for the company called ``Project Plus/
     Minus.'' It was completed in 1982:
       ``[T]he desire to quit seems to come earlier now than ever 
     before, even prior to the end of high school. In fact, it 
     often seems to take hold as soon as the recent starter admits 
     to himself that he is hooked on smoking. However the desire 
     to quit and actually carrying it out, are two quite different 
     things, as the would-be quitter soon learns.''
       Unfortunately, youth smoking gives no sign of abating. 
     While the prevalence of smoking among adults has steadily 
     declined since 1964, the prevalence of smoking by young 
     people stalled for more than a decade and recently has begun 
     to rise. Between 1992 and 1993 the prevalence of smoking by 
     high school seniors increased from 17.2 percent to 19 
     percent. Smoking among college freshmen rose from 9 percent 
     in 1985 to 12.5 percent in 1994.
       And young people's addiction to nicotine is not limited to 
     smoking. Children's use of smokeless tobacco, such as snuff 
     and chewing tobacco, is also extensive. Today, of the seven 
     million people in this country who use smokeless tobacco, as 
     many as one in four is under the age of 19.
       This epidemic of youth addiction to nicotine has enormous 
     public health consequences. A casual decision at a young age 
     to use tobacco products can lead to addiction, serious 
     disease, and premature death as an adult. More than 400,000 
     smokers die each year from smoking-related illnesses.
       Smoking kills more people each year in the United States 
     than AIDS, car accidents, alcohol, homicides, illegal drugs, 
     suicides and fires combined. And the real tragedy is that 
     these deaths from smoking are preventable.
       A year ago the FDA raised the question of whether the 
     Agency has a role in preventing this problem. FDA has 
     responsibility for the drugs, devices, biologics and food 
     used in this country. Over the last year we have been looking 
     at whether nicotine-containing tobacco products are drugs 
     subject to the requirements of the Federal Food, Drug, and 
     Cosmetic Act. Our study continues. But we already know this: 
     Nicotine is an addictive substance and the marketplace for 
     tobacco products is sustained by this addiction. And what is 
     striking is that it is young people who are becoming 
     addicted.
       Statements from internal documents by industry researchers 
     and executives show that they understood that nicotine is 
     addictive and how important it is to their product. Listen to 
     these statements made decades ago:
       ``We are, then, in the business of selling nicotine, an 
     addictive drug.''
       ``Think of the cigarette pack as a storage container for a 
     day's supply of nicotine. Think of the cigarette as a 
     dispenser for a dose of nicotine. Think of a puff of smoke as 
     the vehicle for nicotine.''
       And consider what a research group reported to one tobacco 
     company about starter smokers who assume they will not become 
     addicted:
       ``But addicted they do indeed become.''
       More recently, a former chief executive officer of a major 
     American tobacco company, told the Wall Street Journal: ``Of 
     course it's addictive. That's why you smoke . . .'' And a 
     former smokeless tobacco industry chemist was recently quoted 
     as saying: ``There used to be a saying at [the company] that 
     `There's a hook in every can' . . . [a]nd that hook is 
     nicotine.''
       Nevertheless, the industry publicly insists that smoking is 
     a choice freely made by adults. An advertisement by one of 
     the major tobacco companies that appeared in newspapers 
     across the country last year bore a headline that read 
     ``Where Exactly Is The Land of the Free?'' It suggests that 
     the government is interested in banning cigarettes--although 
     no one in government has advocated such a position. With some 
     40 million smokers addicted to nicotine, a ban would not be 
     feasible.
       The ad never addresses youth smoking. And it says ``. . . 
     The time has come to allow adults in this country to make 
     their own decisions of their own free will, without 
     Government control and excessive intervention.''
       But listen to the words of one smoker on the subject of 
     freedom and choice:
       ``Well, do you think I chose to smoke? Do you believe that 
     I took a cigarette and said, `I think I'll smoke this one and 
     then maybe four hundred thousand more?''
       She continues:
       ``Choice. That's a laugh. Within each day I make dozens--
     perhaps hundreds--of large and small choices. From morning 
     until bedtime, I pick and choose. I look at options and 
     decide. One thing I don't decide, however, is whether to 
     smoke. For me, a forty-seven-year old woman, that decision 
     was made nearly thirty years ago by a first-year college 
     student. And even she wasn't intending to make a lifelong 
     decision; she was just going to try one cigarette. And then 
     maybe just one more. Another and then another, and at some 
     point, she lost her power to choose. She had become addicted, 
     still believing she chose to smoke and denying the power and 
     impact of nicotine in her life. Belief in my power to choose, 
     and denial of how totally nicotine has stripped me of that 
     power, are my two greatest enemies.''
       We cannot adequately address this pediatric disease our 
     country faces without recognizing the important influences on 
     a young person's decision to smoke. One such influence is 
     industry advertising and promotion. It is important to 
     understand the effects of these practices on young people.
       In the last two decades, the amount of money the cigarette 
     industry has spent to advertise and promote its products has 
     dramatically risen. Despite a longstanding ban on broadcast 
     advertising, in 1992 alone the industry spent more than $5.2 
     billion. This makes it the second most heavily advertised 
     commodity in the United States, second only to automobiles.
       Tobacco advertising appears in print media, on billboards, 
     at point of sale, by direct mail, on an array of consumer 
     items such as hats, t-shirts, jackets, and lighters, and at 
     concerts and sporting events. The sheer magnitude of 
     advertising creates the impression among young people that 
     smoking is much more ubiquitous and socially acceptable than 
     it is. In studies, young smokers consistently overestimate 
     the percentage of people who smoke.
       In addition, tobacco industry advertising themes and images 
     resonate with young people. Advertising experts describe the 
     cigarette package as a ``badge'' product that adolescents 
     show to create a desired self image and to communicate that 
     image to others. As a retired leading advertising executive 
     has stated: ``When the teenagers loose [sic] the visual link 
     between the advertising and the point of sale . . . they will 
     loose [sic] much of the incentive to rebel against authority 
     and try smoking.''
       In recent years, the tobacco industry has been spending 
     more money on marketing and promotion and less on traditional 
     advertising. For example, it distributes catalogues of items 
     that can be obtained with proof of purchase coupons attached 
     to cigarette packs--such as Camel Cash and Marlboro Mile. 
     These coupons are exchanged for non tobacco consumer items 
     imprinted with product logos.
       These items have proven to be a big hit with children and 
     adolescents. Half of all adolescent smokers and one quarter 
     of non-smokers own at least one promotional item from a 
     tobacco company, according to a 1992 Gallup survey.
       Sponsorship of athletic, musical, sporting and other events 
     is another important way that the industry promotes its 
     product. This links tobacco products with the glamorous and 
     appealing worlds of sports and entertainment. And the logos 
     of their brands are viewed during televised events, despite 
     the federally mandated broadcast advertising ban.
       Make no mistake: All of this advertising and promotion is 
     chillingly effective. The three most heavily advertised 
     brands of cigarettes are Marlboro, Camel and Newport. A 
     recent study by the Centers for Disease Control and 
     Prevention found that 96 percent of underage smokers who 
     purchase their own cigarettes purchased one of those three 
     heavily advertised brands.
       The advertisements apparently have far less impact on 
     adults. By far, the most popular brand choices for adults are 
     the private label, price value, and plain package brands, 
     which rely on little or no imagery on their packaging or 
     advertising.
       Let me describe two campaigns to illustrate the effects 
     that advertising and marketing practices can have on young 
     people. One campaign gave new life to a cigarette brand with 
     an aging customer base. The other revitalized the dying 
     smokeless tobacco market.
       In the early 1980's, Camel cigarettes were smoked primarily 
     by men over 50, and
      commanded about 3 to 4 percent of the overall market. So the 
     company began to make plans to reposition Camel.
       The new advertising for Camel was designed to take 
     advantage of Camel's 75th birthday. The campaign featured the 
     cartoon character ``Joe Camel'' as its anthropomorphic 
     spokescamel who gave dating advice called ``smooth moves'' 
     and who eventually was joined by a whole gang of hip camels 
     at the watering hole.
       The campaign was variously described as irreverent, 
     humorous and sophomoric. But Joe Camel gave the company what 
     it wanted: a new vehicle to reposition the Camel brand with 
     more youth appeal.
       During the same time period, the company devised what it 
     called a Young Adult Smokers program--which went by the 
     acronym Y A S. The program was designed to appeal to the 18 
     to 24 age group, and more narrowly to the 18- to 20-year-old 
     audience. The program also had a tracking system to monitor 
     sales in these groups.
       Let me give you several facts about that program.
       [[Page S5917]] First, on January 10, 1990, a division 
     manager in Sarasota, Florida issued a memorandum describing a 
     method to increase the exposure and access to the Young Adult 
     Market for the Joe Camel campaign. The memorandum asked sales 
     representatives to identify stores within their areas that 
     ``are heavily frequented by young adult shoppers. These 
     stores can be in close proximity to colleges [, and] high 
     schools . . .'' The purpose of the memorandum was to make 
     sure that those stores were always stocked with items that 
     appeal to younger people--such as hats and tee shirts--
     carrying the Camel name and imagery.
       A Wall Street Journal article revealed the contents of this 
     letter and it also contained the company's response that the 
     memo was a mistake. The company said the mistake had been 
     corrected and explained that the manager had violated company 
     policy by targeting high school students. However, on April 
     5, 1990, another division manager, this time in Oklahoma, 
     sent a memo to all areas sales representatives and chain 
     service representatives in parts of Oklahoma. The memo refers 
     to what it calls ``Retail Young Adult Smoker Retailer 
     Account[s]'' and goes on to say:
       ``The criteria for you to utilize in identifying these 
     accounts are as follows: (1) . . . calls located across from, 
     adjacent to [or] in the general vicinity of the High Schools 
     . . .''
       Second, an additional element of its Camel campaign was 
     known as FUBYAS--FUBYAS--an acronym for First Usual Brand 
     Young Adult Smokers. The company's own research in the 1980's 
     revealed a noteworthy behavior among smokers: the brand that 
     they use when they first become regular smokers is the brand 
     that smokers stay with for years. There is a great deal of 
     brand loyalty among smokers.
       Third, the next slide shows the effect of the YAS or young 
     adult smoker campaign. Prior to the campaign, about 2 to 3 
     percent of smokers under the age of 18 named Camel as their 
     brand. By 1989, a year into the campaign, Camel's share of 
     underage smokers had risen to 8.1 percent and within a few 
     years it had grown to at least 13 percent. During this same 
     period, Camel's share of the adult market barely moved from 
     its four percent market share.
       The campaign succeeded in resurrecting the moribund Camel 
     brand. But it also managed to create an icon recognizable to 
     even the youngest children. Two studies, one by an 
     independent researcher and one company funded, found that 
     children as young as three to six easily recognize Joe Camel 
     and know that he is associated with cigarettes. The company's 
     researcher found that children were as familiar with Joe 
     Camel as they were with Ronald McDonald. This fact is 
     significant because children this young get most of their 
     product information from television advertising. But 
     cigarettes have not been advertised on television since 1970.
       The campaign was clearly very effective with the target 
     group--the YAS smokers. But it was also effective with the 
     younger, under 18 smokers.
       The second example of industry promotion concerns the 
     largest smokeless tobacco company in America. It was also 
     trying to revive the declining market for its product. By 
     1970, these products were used predominantly by men over 50. 
     Young males had the lowest usage.
       The company set about to redesign its products and refocus 
     its advertising and promotion to target younger people, 
     especially younger men. Its high-nicotine delivery products 
     were apparently not well tolerated by new users. But as part 
     of the redesign, it developed low-nicotine delivery snuff 
     products in easy to use teabag-like pouches. Company 
     documents indicate that these products were developed to 
     create ``starter'' brands that would attract new users who 
     could not tolerate the higher-nicotine delivery products.
       A cherry-flavored product was also developed. In fact, one 
     former company sales
      representative was quoted in the Wall Street Journal as 
     saying that the cherry product ``is for somebody who likes 
     the taste of candy, if you know what I'm saying.''
       The documents also show that the company set out to produce 
     a range of products with low, medium, and high nicotine 
     deliveries. One document shows that the company expected its 
     customers to ``graduate'' upward through the range of 
     nicotine deliveries. This chart, prepared by its marketing 
     department shows the hierarchy of products, with arrows going 
     from Skoal Bandits (the teabags), through Happy Days and 
     Skoal Long Cuts, and ultimately to Copenhagen--the company's 
     highest nicotine delivery product.
       The idea behind the advertising and marketing strategy was 
     captured in a statement a few years earlier, in 1968, by a 
     company vice president:
       ``We must sell the use of tobacco in the mouth and appeal 
     to young people . . . we hope to start a fad.''
       The company's reliance on the graduation process can also 
     be seen in a company document that depicts a ``bullseye'' 
     chart. This chart shows the company's plan to advertise, 
     promote, and provide free samples of the lower nicotine 
     delivery products to new users. The highest nicotine products 
     were to be advertised only to current users, and only in a 
     highly focused manner.
       This product development and marketing strategy has been 
     extremely successful in recruiting new users. Use of 
     smokeless tobacco products has risen dramatically since the 
     1970's. Moist snuff sales tripled from 1972 to 1991 and use 
     by 18 to 19-year-old boys increased 1,500 percent from 1970 
     to 1991.
       The Camel and smokeless campaigns demonstrate how marketing 
     and promotion targeted at younger tobacco users can also 
     reach children and adolescents. And those young people who 
     choose to smoke have easy access to the products. Tobacco 
     products are among the most widely available consumer 
     products in America, available in virtually every gas 
     station, convenience store, drug store, and grocery store. 
     And though every state in the country prohibits the sale of 
     cigarettes to those who are underage, study after study 
     demonstrates that these laws are widely ignored. Teenagers 
     can purchase tobacco products with little effort--and they 
     know it. A 1990 survey by the National Cancer Institute found 
     that eight out of 10 ninth graders said it would be easy for 
     them to buy their own cigarettes. By some estimates, at least 
     as many as 255 million packs are sold illegally to minors 
     each year.
       Younger smokers are more likely to buy their cigarettes 
     from vending machines, where they can make their purchases 
     quickly, often unnoticed by adults. The vending machine 
     industry's own study found that 13-year-olds are 11 times 
     more likely to buy cigarettes from vending machines than 17-
     year olds. The 1994 Surgeon General's Report examined nine 
     studies on vending machine sales and found that underage 
     persons were able to buy cigarettes 82 to 100 percent of the 
     time.
       But the easy access does not stop with vending machines. 
     Self-service displays allow buyers to help themselves to a 
     pack of cigarettes or a can of smokeless with minimal contact 
     with a sales clerk. This makes it easier for an underage 
     person to buy tobacco products.
       I've told you today that 90 percent of those who smoke 
     began to do so as children
      and teenagers. I've told you that most of them become 
     addicted and that 7 out of 10 wish they could quit. I've 
     told you that the tobacco industry spends more than $5 
     billion a year to advertise and promote an addictive 
     product and it uses cartoon characters, tee shirts and 
     other gimmicks that appeal to children. I've told you that 
     one company went so far as to develop a young adult 
     smoker's program which, intentional or not, increased 
     cigarette sales to children.
       Some may choose to ignore these facts. Some will continue 
     to insist that the issue is an adult's freedom of choice. 
     Nicotine addiction begins as a pediatric disease. Yet our 
     society as a whole has done little to discourage this 
     addiction in our youth. We must all recognize this fact and 
     we must do more to discourage this addiction in our youth.
       A comprehensive and meaningful approach to preventing 
     future generations of young people from becoming addicted to 
     nicotine in tobacco is needed. Any such approach should: 
     First, reduce the many avenues of easy access to tobacco 
     products available to children and teenagers; second, get the 
     message to our young people that nicotine is addictive, and 
     that tobacco products pose serious health hazards--and not 
     just for someone else; and third reduce the powerful imagery 
     in tobacco advertising and promotion that encourages young 
     people to begin using tobacco products.
       These types of actions have been advocated by many public 
     health experts and organizations, including most recently the 
     Institute of Medicine which recently issued a report on 
     smoking and children. And a recent public opinion poll 
     sponsored by the Robert Wood Johnson Foundation showed 
     widespread public support for measures to reduce smoking by 
     young people.
       When it comes to health, we Americans are an impatient 
     people. We venerate the deliberate, cautious scientific 
     method but we yearn for instant cures. We grow restless 
     waiting years or even months for answers, yet today I am 
     telling you to look to the next generation.
       Certainly some of the forty million addicted adult smokers 
     in this country will succeed in quitting. Every addictive 
     substance has some who are able to break its grip, and we 
     should do all we can to support those who want to quit. But 
     let us not fool ourselves. To succeed, we must fix our gaze 
     beyond today's adults.
       Of course we all want freedom for our children. But not the 
     freedom to make irreversible decisions in childhood that 
     result in devastating health consequences for the future. 
     Addiction is freedom denied. We owe it to our children to 
     help them enter adulthood free from addiction. Our children 
     are entitled to a lifetime of choices, not a lifelong 
     addiction.
     

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