[Congressional Record Volume 146, Number 41 (Wednesday, April 5, 2000)]
[House]
[Pages H1847-H1849]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 THE NATION'S NUMBER ONE HEALTH PROBLEM

  The SPEAKER pro tempore (Mr. Isakson). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from Iowa (Mr. Ganske) is 
recognized for 60 minutes.
  Mr. GANSKE. Mr. Speaker, the number one public health problem facing 
the country today is the death and morbidity associated with the use of 
tobacco. Tonight, I want to discuss why the use of tobacco is so 
harmful, what the tobacco companies have known about the addictiveness 
of nicotine in tobacco, how tobacco companies have targeted children to 
get them addicted, what the Food and Drug Administration proposed, the 
Supreme Court's decision on FDA authority to regulate tobacco, and 
bipartisan legislation that will be introduced tomorrow in the House to 
give the Food and Drug Administration authority to regulate the 
manufacture and marketing of tobacco.
  Mr. Speaker, let me repeat. The number one health problem in the 
Nation today is tobacco use. It is well captured in this editorial 
cartoon that shows the Grim Reaper, Big Tobacco, with a cigarette in 
his hand, a consumer on the cigarette, and the title is

[[Page H1848]]

``Warning: The Surgeon General Is Right.''

                              {time}  2115

  Here is some cold data on this peril. It is undisputed that tobacco 
use greatly increases one's risk of developing cancer of the lungs, the 
mouth, the throat, the larynx, the bladder, and other organs. Mr. 
Speaker, 87 percent of lung cancer deaths and 30 percent of all cancer 
deaths are attributable to the use of tobacco products. Tobacco use 
causes heart attacks, strokes, emphysema, peripheral vascular disease, 
among many others.
  Mr. Speaker, more than 400,000 people die prematurely each year from 
diseases attributable to tobacco use in the United States alone. 
Tobacco really is the grim reaper.
  More people die each year from tobacco use in this country than die 
from AIDS, automobile accidents, homicides, suicides, fires, alcohol 
and illegal drugs combined. More people in this country die in one year 
from tobacco than all the soldiers killed in all of the wars this 
country has fought.
  Treatment of these diseases will continue to drain over $800 billion 
from the Medicare trust fund. The VA spends more than one-half billion 
dollars annually on in-patient care of smoking-related diseases. But 
these victims of nicotine addiction are statistics that have faces and 
names.
  Mr. Speaker, before coming to Congress, I practiced as a surgeon. I 
have held in these hands lungs filled with cancer and seen the effects 
of decreased lung capacity on those patients. Unfortunately, I have had 
to tell some of those patients that their lymphnodes had cancer in them 
and that they did not have very long to live.
  As a plastic and general surgeon, I have had to remove patients' 
cancerous jaws like this surgical specimen, showing a resection of a 
large portion of a patient's lower jaw. This, Mr. Speaker, is the 
result of chewing tobacco.
  The poor souls who have to have this type of surgery go around like 
the cartoon character Andy Gump. Many times they breathe from a 
tracheostomy. I have reconstructed arteries in legs in patients that 
are closed shut by tobacco and are causing gangrene, and I have had to 
amputate more than my share of legs that have gone too far for 
reconstruction.
  The other day, Mr. Speaker, I was talking to a vascular surgeon who 
is a friend of mine back in Des Moines, Iowa. His name is Bob Thompson. 
He looked pretty tired. I said Bob, you have been working pretty hard. 
He said Greg, yesterday I went to the operating room at about 7 in the 
morning, I operated on 3 patients, finished up about midnight, and 
every one of those patients I had to operate on to save their legs. I 
said, were they smokers, Bob? He said, you bet. And the last one that I 
operated on was a 38-year-old woman who would have lost her leg to 
atherosclerosis related to heavy tobacco use. I said, Bob, what do you 
tell those people? He said, Greg, I talk to every patient, every 
peripheral vascular patient that I have and I try to get them to stop 
smoking. I ask them a question. I say, if there were a drug available 
on the market that you could buy that would help you save your legs, 
that would help prevent your having to have coronary artery bypass 
surgery, that would significantly decrease your chances of having lung 
cancer or losing your larynx, would you buy that drug? And every one of 
those patients say, you bet I would buy that drug, and I would spend a 
lot of money for it. You know what he says to those patients then? He 
says, well, you know what? You can save an awful lot of money by 
quitting smoking and it will do exactly the same thing as that magical 
drug would have done.
  Mr. Speaker, my mother and father were both smokers and they are only 
alive today because coronary artery bypass surgery saved their lives.
  I will never forget the thromboangiitis obliterans patients I treated 
at VA hospitals who were addicted to the tobacco that caused them to 
thrombose one finger and one toe after another. I remember one patient 
who had lost both lower legs, all the fingers on his left-hand, and all 
the fingers on his right hand, except his index finger. Why? Because 
the tobacco caused those little blood vessels to clot shut. This 
patient, even though he knew that if he stopped smoking, it would stop 
his disease, he had devised a little wire cigarette holder with a loop 
on it to fit around his one remaining finger so that he could smoke.
  Statistics do show the magnitude of this problem. Over a recent 8-
year period, tobacco use by children increased 30 percent. More than 3 
million American children and teenagers now smoke cigarettes. Every 30 
seconds a child in the United States becomes a regular smoker. In 
addition, more than 1 million high school boys use smokeless chewing 
tobacco, primarily as a result of advertising, focusing on flavored 
brands and youth-oriented themes. For heaven's sakes, Mr. Speaker, we 
got rid of the tobacco spittoons in this place a long time ago, and we 
now have 1 million kids working on developing the type of cancer that 
would result in surgical resection of half of their jaw.
  The sad fact is, Mr. Speaker, that each day, 3,000 kids start 
smoking, many of them not even teenagers, younger than teenagers, and 
1,000 out of those 3,000 kids will have their lives shortened because 
of tobacco. So why did it take a life-threatening heart attack to get 
my parents to quit smoking? I nagged on them all the time, but it took 
a near death experience to get them to quit. Why would not my patient 
with one finger, the only finger he had left, quit smoking? Why do 
fewer than one in 7 adolescents quit smoking, even though 70 percent 
regret starting.
  I say to my colleagues, it is sadly because of the addictive 
properties of the drug nicotine in tobacco. The addictiveness of 
nicotine has become public knowledge, public knowledge only in recent 
years as a result of painstaking scientific research that demonstrates 
that nicotine is similar to amphetamines, nicotine is similar to 
cocaine, nicotine is similar to morphine in causing compulsive drug-
seeking behavior. In fact, Mr. Speaker, there is a higher percentage of 
addiction among tobacco users than among users of cocaine or heroin. 
But recent tobacco industry deliberations show that the tobacco 
industry had long-standing knowledge of nicotine's affects. It is clear 
that tobacco company executives committed perjury before the Committee 
on Commerce just a few years ago when they raised their right hands, 
they took an oath to tell the truth, and then they denied that tobacco 
and nicotine was addicting.
  Internal tobacco company documents dating back to the early 1960s 
show that the tobacco companies knew of the addicting nature of 
nicotine, but withheld those studies from the Surgeon General. A 1978 
Brown & Williamson memo stated, ``Very few customers are aware of the 
effects of nicotine; i.e., its addictive nature, and that nicotine is a 
poison.'' A 1983 Brown & Williamson memo stated, ``Nicotine is the 
addicting agent in cigarettes.''
  Indeed, the industry knew that there was a threshold dose of nicotine 
necessary to maintain addiction, and a 1980 Lorilard document 
summarized the goals of an internal task force whose purpose was not to 
avert addiction, but to maintain addiction. Quote: ``Determine the 
minimal level of nicotine that will allow continued smoking. We 
hypothesize that below some very low nicotine level, diminished 
physiologic satisfaction cannot be compensated for by psychologic 
satisfaction. At that point, smokers will quit or return to higher tar 
and nicotine brands.''

  Mr. Speaker, we also know that for the past 30 years, the tobacco 
industry manipulated the form of nicotine in order to increase the 
percentage of ``free base'' nicotine delivered to smokers. As a 
naturally occurring base, and I have to say, Mr. Speaker, that this 
takes me back to my medical school biochemistry, nicotine favors the 
salt form at low pH levels, and the ``free base'' form at higher pHs.
  So what does that mean? Well, the free base nicotine crosses the 
alveoli of the lungs faster than the bound form, thus giving the smoker 
a greater kick, just like the druggie who free bases cocaine, and the 
tobacco companies knew that very well. A 1966 British American tobacco 
report noted, ``It would appear that the increased smoker response is 
associated with nicotine reaching the brain more quickly. On this 
basis, it appears reasonable to assume that the increased response of a 
smoker to the smoke with a higher amount of extractable nicotine, not 
synonymous

[[Page H1849]]

with, but similar to free-base nicotine, may be either because this 
nicotine reaches the brain in a different chemical form, or because it 
reaches the brain more quickly.''
  Tobacco industry scientists were well aware of the effect of pH on 
the speed of absorption and on the physiologic response. A 1973, 1973 
R.J. Reynolds report stated, ``Since the unbound nicotine is very much 
more active physiologically and much faster acting than bound nicotine, 
the smoke at a high pH seems to be strong in nicotine.''

                              {time}  2130

  Therefore, the amount of free nicotine in the smoke may be used for 
at least a partial measure of the physiologic strength of the 
cigarette.''
  Indeed, Mr. Speaker, Phillip Morris commenced the use of ammonia in 
their Marlboro brand in the mid 1960s in order to raise the pH of its 
cigarettes, and it subsequently emerged as the leading national brand.
  By reverse engineering, other manufacturers caught onto Phillip 
Morris' nicotine manipulation. And they copied it. The tobacco industry 
hid the fact that nicotine was an addicting drug for a long time, even 
though they privately called cigarettes ``nicotine delivery devices.''
  Claude E. Teague, Junior, assistant director of research at RJR, said 
in a 1972 RJR memo, ``In a sense, the tobacco industry may be thought 
of as being a specialized, highly ritualized and stylized segment of 
the pharmaceutical industry. Tobacco products uniquely contain and 
deliver nicotine, a potent drug with a variety of physiologic effects. 
Thus, a tobacco product is, in essence, a vehicle for the delivery of 
nicotine designed to deliver the nicotine in a generally acceptable and 
attractive form. Our industry is then based upon the design, 
manufacture, and sale of attractive forms of nicotine.''
  A 1972 Phillip Morris document summarized an industry conference 
attended by 25 tobacco scientists from England, Canada, and the United 
States: ``The majority of conferees would accept the proposition that 
nicotine is the active constituent of tobacco smoke. The cigarette 
should be conceived not as a product, but as a package.'' Then they 
said, ``The product is nicotine.''
  Mr. Speaker, does anyone believe that the tobacco CEOs who testified 
before Congress that tobacco was not addicting were telling the truth?
  Mr. Speaker, most adult smokers start smoking before the age of 18. 
This political cartoon shows big tobacco over here lighting up one 
cigarette from the other, and one cigarette says, ``Victims'' and the 
other cigarette that is about ready to start is ``Kids.'' The title of 
the cartoon: ``Chain smoker.''
  As I said, Mr. Speaker, most adult smokers start smoking before the 
age of 18. That has been known by the tobacco industry and its 
marketing divisions for decades. A report to the board of directors of 
RJR on September 30, 1974, entitled ``1975 Marketing Plans 
Presentation, Hilton Head, September 30, 1974,'' said that one of the 
key opportunities to accomplish the goal of reestablishing RJR's market 
share was to ``increase our young adult franchise. First, let's look at 
the growing importance of this young adult group in the cigarette 
market. In 1960, this young adult market,'' and this is the clincher, 
what did they call the young adult market, young adult? The 14 to 24 
age group.
  They say, ``This represented 21 percent of our population. They will 
represent 27 percent of the population in 1975, and they represent 
tomorrow's cigarette business.''
  An adult, Mr. Speaker? They are 14-year-olds, pretty young adults. In 
a 1980 RJR document entitled ``MDD Report on Teenager Smokers Ages 14 
Through 17,'' a future RJR CEO G.H. Long wrote to the CEO at that time, 
E.A. Horrigan, Junior.
  In that document, Long laments the loss of market share of 14-to-17-
year-old smokers to Marlboro, and says, ``Hopefully, our various 
planned activities that will be implemented this fall will aid in some 
way in reducing or correcting those trends.'' The trends were they were 
losing market share in the 14-to-17-year-old age group.
  Mr. Speaker, the industry has indisputably focused on ways to get 
children to smoke: in surveys for Phillip Morris in 1974 in which 
children 14 or younger were interviewed about their smoking behavior; 
or how about the Phillip Morris document which bragged, ``Marlborough 
dominates in the 17 and younger category, capturing over 50 percent of 
this market.''
  Mr. Speaker, when Joe Camel is associated with cigarettes by 30 
percent of 3-year-olds and nearly 90 percent of 5-year-olds, we know 
that marketing efforts directed at children are very successful.
  Here is another political cartoon. We have a billboard. It says, 
``Joe Camel says, cancer is cool.'' We have an antismoking advocate 
saying, ``Huh, not exactly the honest disclosure we were hoping for.''
  Mr. Speaker, children that begin smoking at age 15 have twice the 
incidence of lung cancer as those who start smoking at the age of 25. 
For those youngsters who start at such an early age and have twice the 
incidence of cancer, for them Joe Cool becomes Joe Chemo, pulling 
around his bottle of chemotherapy.
  If that is not enough, it should not be overlooked that nicotine is 
an introductory drug, as smokers are 15 times more likely to become an 
alcoholic, to become addicted to hard drugs, or to develop a problem 
with gambling.
  Mr. Speaker, in response to this, the Food and Drug Administration in 
August of 1996 issued regulations aimed at reducing smoking in children 
on the basis that nicotine is addicting, it is a drug, manufacturers 
have marketed that drug to children, and tobacco is deadly. Most people 
by now are familiar with those regulations. They received a lot of 
press at the time. It is hard to think, Mr. Speaker, that 4 years have 
gone by since those regulations came out.
  Those regulations said, tobacco companies would be restricted from 
advertising aimed at children, that retailers would need to do a better 
job of making sure they were not selling cigarettes to children, that 
the FDA would oversee tobacco companies' manipulation of nicotine.
  But the tobacco companies challenged those regulations, and they 
ended up taking it all the way to the Supreme Court. Just 2 weeks ago, 
Justice Sandra Day O'Connor, in writing for the majority, five to four, 
held that Congress had not granted the FDA authority to regulate 
tobacco.
  However, her closing sentences in that opinion bear reading: ``By no 
means do we,'' and this is the Supreme Court, ``question the 
seriousness of the problem that the FDA has sought to address. The 
agency has amply demonstrated that tobacco use, particularly among 
children and adolescents, poses perhaps the most significant threat to 
public health in the United States.''
  Justice O'Connor is practically begging Congress to grant the FDA 
authority to regulate tobacco. Therefore, Mr. Speaker, tomorrow the 
gentleman from Michigan (Mr. Dingell) and I will introduce our 
bipartisan bill The FDA Tobacco Authorities Amendment Act. I call on my 
colleagues from both sides of the aisle to cosponsor this bill and join 
us for a press conference on the Triangle at noon.
  Our bill simply says that FDA has authority to regulate tobacco, that 
the 1996 tobacco regulations will be law. This is not a tax bill. This 
is not a liability bill. This is not a prohibition bill. This has 
nothing to do with the tobacco settlement from the attorneys general.
  This bill simply recognizes the facts: tobacco and nicotine are 
addicting. Tobacco kills over 400,000 people in this country each year. 
Tobacco companies have and are targeting children to make them addicted 
to smoking. The FDA should have congressional authority to regulate 
this drug and those delivery devices.

                          ____________________