The MacNeil/Lehrer Report; Smoking - Fifteen Years Later

JIM LEHRER: Good evening. The evidence is now overwhelming that there is a connection between smoking and several deadly diseases, particularly cancer and heart disease. That was the major conclusion of a new Surgeon General`s report issued today, the fifteenth anniversary of that original Surgeon General`s report which first warned of the health hazards of smoking. The new 1,200-page report sounds the alarm particularly to the dangers of smoking to women, teenagers, and even the unborn children of smoking mothers, among others. It also laments the fact that no universally successful method has yet been found to help people quit smoking. The tobacco industry attacked the report immediately, before it was even issued, in fact, claiming that the scientific evidence is still not conclusive, and accused the government, particularly Secretary of Health, Education and Welfare Joseph Califano, oœ staging a publicity stunt. Tonight, with the Surgeon General and a tobacco industry spokesman, the new report and a flavor of the debate about it. Robert MacNeil is on assignment; Charlayne Hunter-Gault is in New York. Charlayne?

CHARLAYNE HUNTER-GAULT: Jim, the government`s drive against smoking has been going on since 1964. If it were a prize fight you could look on this as the fifteenth round. The government hasn`t scored a knockout, but it has won some rounds on points. The first was the opening round fifteen years ago when the Surgeon General`s report linked smoking to cancer. That led to the now-familiar health warning on every cigarette pack. Thus far thirty million Americans have quit smoking; but fifty-four million still smoke. Among men, the rate plummeted from fifty-three percent to thirty-nine percent, but among women it remained constant at thirty percent. Despite a new strategy last year by Secretary Califano aimed largely at teenagers, the smoking rate among girls shot up to the same fifteen percent rate as boys. Round sixteen coming up. Jim?

LEHRER: In one corner, the Surgeon General of the United States, Dr. Julius Richmond, the man who compiled and issued today`s report. Dr. Richmond, what in your opinion is the report`s most important, most significant finding?

Dr. JULIUS RICHMOND: Well, I think first of all I would say that the report reinforces the first Surgeon General`s report of fifteen years ago, which pointed to the fact that smoking is the single most important preventable cause of death that we have. It goes beyond the first report in identifying the impact of smoking upon the health of women, and as women have continued to smoke over an extended period of time, we find that the mortality rate from lung cancer rises. I think it`s important to point out that among women cancer of the breast has been the largest cause of death from cancer, but lung cancer is beginning to approach that level, and our projections at the present time are that if women don`t decrease the smoking that they`re now doing, lung cancer will probably exceed breast cancer in that year.

LEHRER: Doctor, let me ask you this: is this an issue, in your opinion, for which there is no other side, that there is no question of the link between smoking and cancer and heart disease, as you`ve outlined and is outlined in the report?

RICHMOND: I think there is no question but what the evidence is overwhelming. Since the time of the first Surgeon General`s report there have been approximately 30,000 publications, approximately 4,000 of which are reviewed in the Surgeon General`s report, and...

LEHRER: I want you to hold that up, Doctor, so that everybody can see what a 1,200-page report looks like. Can we see that?

RICHMOND: Yes. And these are all published in professional scientific journals, and the consensus of the 100 scientists and reviewers of this report is that the evidence is stronger than ever.

LEHRER: One finding which particularly caught my eye was that ninety percent of the people who smoke have either tried unsuccessfully to quit or would like to quit, and yet no method has been found to help them -- at least, a universally successful method. What`s the problem?

RICHMOND: Well, I think the problem that we experience here is the problem that we have with most habituations. People become habituated, feel that some experience is pleasurable, and continue, and find it rather difficult then to interrupt. The fact is, however, that there have been some successes, as Charlayne has pointed out. The most vulnerable group in our society, the middle-aged man, seems to have gotten the message over the past decade, seems to have ceased smoking in considerable numbers, and now down to about thirty-seven percent, as contrasted with fifty-three percent some time ago.

LEHRER: What were the report`s findings as to why young people, despite all of the publicity since 1964, are still beginning to smoke?

RICHMOND: I think this is one thing the report points to as a problem. And clearly there is a lot in our culture that encourages smoking, and certainly the advertising for tobacco is, I suppose, in no small measure responsible for the fact that there is a good deal of encouragement, particularly for young people, to start smoking.

LEHRER: In general, do you feel that the tobacco industry itself has conducted itself in a responsible way since 1964?

RICHMOND: Well, I think they`ve done some things that are, I think, quite responsible. Following the `64 report they established a research program and, particularly, funded the Education and Research Foundation of the American Medical Association -- which, you may recall, last summer summarized its findings; and I might just parenthetically add that its findings are very much supportive of the kinds of findings that are in this report. And indeed, this report draws in no small measure on that report. So that I think that in that sense they are responsible. They have also funded other kinds of research. I think that some of the personal attacks on the Secretary, who has responsibilities as a public official -- he is the Secretary of Health, Education and Welfare -- I would regard as unfortunate.

LEHRER: All right; thank you, Doctor. On the other side of the debate is of course the tobacco industry, and that industry is represented here tonight by Walker Merryman of the Tobacco Institute, which is the industry`s trade association. Mr. Merryman, first, you heard what Dr. Richmond said, that your industry`s attacks on Secretary Califano are unfortunate. The reports in the press conference yesterday really did get personal, accused him of being a self-righteous zealot and all kinds of things like that. Do you feel that what Dr. Richmond has come up with today is the result of a personal vendetta of some kind launched by Secretary Califano?

WALKER MERRYMAN: Well, I think it`s clear over the past twelve months and more what the Secretary`s own personal view of the tobacco industry -- calling us sinister -- and smoking, is. I don`t think it was particularly out of character for us to regard those as attacks, so I think that in a sense this whole issue has been drawn down to a political rather than a scientific level, and I have to regret that, because only in a scientific forum are we going to solve the controversies that remain.

LEHRER: All right. Then let`s go to the scientific forum. Is it your industry`s position that there is no scientific evidence linking smoking to these diseases, particularly cancer and heart disease?

MERRYMAN: There is evidence, Jim, and it does link, statistically at least, smoking with these diseases; but we regard it as not conclusive and not proof of the cause-and-effect relationship that the tobacco industry has been researching independently since 1954, a full ten years before the first Surgeon General`s report. We began giving money to research facilities to try to solve these questions.

LEHRER: Do you agree it`s overwhelming, to use Dr. Richmond`s term?

MERRYMAN: Well, I`d like to refer if I might to an internal HEW memorandum which turned up in the news media about a year ago, which said that reaching scientific consensus could be difficult, however, because of the controversial nature of several of the issues involved. And I think that statement made a little over a year ago still stands today.

LEHRER: Well, then, what are you suggesting in terms of Dr. Richmond? Let`s move politics. Dr. Richmond is a physician, he`s the Surgeon General of the United States. His name is on this 1,200-page report, and the government has continued to say this now for -- what would be their motives for telling the American people that the evidence is overwhelming that they should quit smoking? Why would they do that?

MERRYMAN: I have no doubt that Dr. Richmond is sincere in his beliefs, and there are many sincere men and women of science who disagree with his judgment. I simply think that it`s proper for people to hear both sides of it and then make a rational judgment based on the information. I`m not here to try to convince anybody to start smoking or discourage anybody from quitting. In my view that`s your business; that`s a personal decision, and after having received the information you can make that judgment. You don`t need me or anybody else looking over your shoulder to tell you how to act.

LEHRER: The industry has funded, as Dr. Richmond and you have said, for years now scientific research. I assume, though, that the industry would not support efforts to find a better way to help people quit smoking, is that correct?

MERRYMAN: That`s being done by others and taken care of quite well by them. Of course, the tobacco industry is interested in selling cigarettes, and our member companies do that for a living. And we`re happy to allow others to engage in that research if they so desire. I think that it`s pretty clear that no one really has any clear, concrete idea of what it is that makes people start smoking, although there are some psychological theories; and because individuals are different, I don`t think you`ll ever find one type of program which would get everybody to quit.

LEHRER: Finally, and briefly, Mr. Merryman, is the industry concerned at all about the fact of young people starting to smoke at an early age, or is that just part of good marketing? Obviously you want to sell your product.

MERRYMAN: Jim, that`s been an extraordinary concern of ours for a long time, because it`s my view and the industry`s view that smoking is not for kids. It`s always been an adult custom, socially and historically, and I think there are good reasons for maintaining that custom today. Because of the allegations we heard today about the product -- its alleged health hazard -- it`s not a judgment that kids can make. In 1963 the industry even stopped doing any promotional activities on college campuses. No sampling, no advertising in even college newspapers. We want to make sure that this is something that`s reserved for adults; we don`t think it`s for kids.

LEHRER: All right; thank you. Charlayne?

HUNTER-GAULT: One new aspect of today`s smoking report is that youngsters who smoke may suffer more immediate harm than adults. Three students from the High School of Performing Arts volunteered to talk with us tonight. They are Johanna Markson, a junior; Tracy Kolis and Michael Page, both seniors. Let me just ask, starting with you, Johanna, do these findings that we`ve been talking about all evening scare you -- the harmful effects of smoking?

JOHANNA MARKSON: No, because I don`t know enough about them. I`ve never really been shown or explained to.

HUNTER-GAULT: Do they scare you, Tracy?

TRACY KOLIS: No, because they seem very distant from me, because I`ve never had anyone in my family or anyone I`ve known at all who has suffered from cancer of any sort.

HUNTER-GAULT: Do you believe them, Michael?

MICHAEL PAGE: They don`t affect me, either, because I feel that I don`t feel the effect that cigarettes may cause as of now, being that I smoke, and it doesn`t really scare me that much.

HUNTER-GAULT: How much do you smoke?

PAGE: About two cigarettes or three cigarettes a day.

HUNTER-GAULT: How did you get starting smoking, Johanna? You`re fifteen, right? How long have you been smoking, and what started you?

MARKSON: I`ve been smoking for about three years, and I started because I started a new school and all the girls there were smoking, and to get in with the crowd I joined them.

HUNTER-GAULT: And how much do you smoke a day?

MARKSON: It depends on where I am, but usually eight cigarettes, something like that.

HUNTER-GAULT: Was it the girls who persuaded you, Tracy, or your parents, or just what caused you to start smoking -- the model of your parents?

KOLIS: I think it was my older sister, because she had been smoking.

HUNTER-GAULT: Do your parents smoke?

KOLIS: Yes, both of them do. My mother quit recently, though. And I think that it was the effect. Some of it was because of spite, I guess, because they wouldn`t stop smoking, so I would start. It`s like cutting off your nose to spite your face. And I now realize it was silly, but at the moment it seemed cool to do.

HUNTER-GAULT: How about you, Michael?

PAGE: It was the curiosity of smoking. I`d seen everybody smoking cigarettes, and it was like...

HUNTER-GAULT: Including members of your family?

PAGE: Yes, members of my family.

HUNTER-GAULT: Parents, older brother, sisters?

PAGE: Yes. And I wondered, how would it be to take a cigarette, so I took my first puff, which led on to many other puffs.

HUNTER-GAULT: But you told me you started smoking, I think, earlier, at fourteen, and then you stopped.

PAGE: Yes. It was, like I said, the curiosity which I took my first cigarette, and the effects that it caused was tremendous, the dizziness and the nauseated feeling that I had; so I stopped. I made a promise to myself that I would stop. But as I got older I figured I would try it again, because it was the fad, as they would say.

HUNTER-GAULT: Did you have the same effects when you started over again?

PAGE: Yes, but it was not as severe as the first time. When I started again at sixteen, it didn`t really affect me as much as when I was fourteen. It`s pretty -- it just makes me dizzy now, you know?

And that`s why I slacked down, it was my New Year`s resolution to stop. But...(laughs).

HUNTER-GAULT: Can you stop? I mean, could you stop now if you wanted to?

PAGE: Yes, I think so.

HUNTER-GAULT: Let`s see, New Year`s was January first, we`re about in the middle now. How much have you cut down?

PAGE: Well, before New Year`s I was smoking about eight cigarettes a day, but now I`m down to three. So I think I`ve improved the situation pretty well.

HUNTER-GAULT: Johanna, do you think you could stop if you wanted to?

MARKSON: Well, it`s very hard because it`s become a habit with me. It`s not really a habit, it`s just that if I have friends over we sit down and we have cigarettes, and a lot of my friends do smoke, so when they`re smoking I feel like having one. And that happened to me because I did quit, but I started again because I came back to school and everybody around me was smoking.

HUNTER-GAULT: Do you get any enjoyment out of it, or is it just because everybody else around...

MARKSON: No, it used to be because everybody else did, but now sometimes I do enjoy it, or if I`m watching TV, and I have to do something with my hands, so I smoke a cigarette.

HUNTER-GAULT: What happens to you, Tracy, when you try to quit?

KOLIS: Well, I get very agitated and irritated, and I get very upset about it because I really don`t want to in some ways. I enjoy smoking very much, and I`m saying it`s not fair that it could cause me a serious illness when I really enjoy it very much. I did at first start be cause of various reasons -- being cool, everyone else did it -- but now I really, not need one, but I desire one after a meal; it`s satisfying for me. It`s satisfaction.

MARKSON: I feel the same way about it.

HUNTER-GAULT: Michael?

PAGE: Yes, it sure seems to me today that everything causes cancer these days, and cigarettes, you know, haven`t really caused anyone any harm as far as I`ve known, so I don`t really reject the idea of smoking cigarettes as being severe to my health right now. Besides shortness of breath.

(Laughter.)

HUNTER-GAULT: What would it take to make you stop? I mean, what kind of argument or what kind of experience?

MARKSON: Proof

HUNTER-GAULT: Proof?

MARKSON: Real proof in front of me, and help.

HUNTER-GAULT: You mean these statistics just don`t do it for you.

MARKSON: Yeah, they don`t mean anything to me; I just need proof, I need people to help me and show me a way to stop because I don`t have that much self-control to just quit, you know. They say bite your nails or something else, but I already bite my nails, and...

(Laughter.)

MARKSON: ...there`s not much else for me to do.

HUNTER-GAULT: What about in school? Has anything happened in school, any of the teachers or any programs or any pressure from your peers to get you to stop? I mean, they allow you to smoke in class and in the halls?

MARKSON: Oh, no, they don`t, but we get around it. In any school I`ve been in we always get around it. It`s always been the bathrooms or outside or you sneak out the door and you smoke cigarettes.

HUNTER-GAULT: Do they apply any pressure to you anywhere in school?

PAGE: Not really, no.

HUNTER-GAULT: Your teachers don`t?

PAGE: Not really.

HUNTER-GAULT: How about your parents? Even though they smoke, when they see you smoking what kind of reaction do you get from them?

MARKSON: They ask me not to smoke, but my father smokes and he`s been doing it fora long time and he can`t tell me not to; but my mother quit and I do feel guilty when I smoke in front of her, but I want to know that this is what I do; I`m not hiding it from them.

HUNTER-GAULT: Tracy?

KOLIS: I was told to quit smoking because I was a bad influence on my younger sister.

HUNTER-GAULT: Does that bother you?

KOLIS: No. No, I really don`t feel that I have that much of an influence on her at all.

HUNTER-GAULT: What about the part of the report today that said that your smoke can cause particularly little kids to be affected in one way or another? Does that bother you, that you upset other people one way or the other, or may be dangerous?

PAGE: No, because I feel that adults may cause the same effect as we do, as we smoke a cigarette. They smoke cigarettes around their kids and they don`t think about the effect as I do. I know I think about it, that`s why I try to contain it. But parents really -- it should start with education in parents.

HUNTER-GAULT: Okay, you raise that. Just briefly -- you all seem to be opposed to the idea but you do it -- if you were in charge and could tell the policy makers what you think should be done, just very briefly, what do you think should be done, Johanna?

MARKSON: I think that we should be informed better in all the schools, and we should be given help. I mean, there are some people that just do it to do it, and if they find out ways to stop -- or people my age who want to stop -- I know I would like to. I mean, I just don`t have enough will power. But if I had help and if I knew more about everything, then maybe I would stop. But they just don`t...

HUNTER-GAULT: Help from within the school.

MARKSON: Yeah. And from the neighborhoods, things like that.

KOLIS: I feel that if cigarettes are so detrimental to our health that they should be banned, and I don`t see why they would put out this report for any other reason except for that. And I suppose the only other reason that the companies aren`t stopping it is because it`s a billion-dollar business. And I think that`s pretty sad if it depends on the health of millions. Why shouldn`t they not sell them? I mean, I think they should not sell them-or stop selling them.

HUNTER-GAULT: Michael?

PAGE: And it`s so easy to get a pack of cigarettes these days. But a youngster about any age could walk into a store and buy a pack of cigarettes. And with the influence that they see around in society, of course they would like to try it out of curiosity, as in my case. So it should be banned, yes, to little kids. Or harder to get, I think.

HUNTER-GAULT: So who do you blame the most for this problem, the government, the tobacco industry, your parents...?

MARKSON: Myself. I mean, it`s my fault I started, and I should have realized what I was doing. But it shouldn`t have been that easy for me to get a hold of, and I should have known more about it, at least.

HUNTER-GAULT: Michael?

PAGE: I feel that who should be blamed for this is really the parents. Parents should put more emphasis on the fact that cigarette smoking is bad. They always say, Don`t smoke. Don`t be like me, you know. Don`t smoke cigarettes. That`s all they really give you.

HUNTER-GAULT: Thank you. We have to move on. Jim?

LEHRER: Dr. Richmond, what those three teenagers are saying, are those typical, based on the findings of the report?

RICHMOND: Yes, I think they`re quite typical, Jim, and I might congratulate them on how perceptive they are and how articulate they are.

LEHRER: Anything you`d like to say to them?

RICHMOND: Yes, I think I would like to indicate to them that they have done a very good job of portraying the problems related to smoking, the pressures. And I think that there are three kinds of issues that they`ve brought up. One, peer pressure in particular, which is very important to teenagers wanting to be part of a group, and if the group is smoking, to want to join it; experiment, at any rate, with joining it. The second which they dwelt on, I thought, very, very well is the whole matter of parental influence and other adult influences -- very significant; and they kept coming back to that as a very repetitive theme, and I think it`s a very important issue. Sociologists have studied that problem and find that when parents don`t smoke there is a greater tendency for their children not to smoke, and vice-versa. The third point, which they illustrate very well in their comments, is the teenager s difficulty in thinking about the future in long-range terms; and they talk about the fact that they know there are ultimate health hazards but the health hazards don`t appear to them to be immediate and therefore they don`t take them that seriously. I would say to the two young women, Johanna and Tracy, that we do know a good deal now about the effects of smoking by the mother on the unborn baby, and also the fact that smoking does tend to produce some complications of pregnancy in greater numbers than for non-smoking mothers, and I think this is important to bear in mind, for, as I think they indicate, it may well be easier for them to think of stopping now than it might be much later after their habit is very well ingrained.

LEHRER: Mr. Merryman, what is your reaction to what they had to say, and what message would you have for them?

MERRYMAN: Well, I think there are two or three things that are fairly clear here. First of all that virtually everyone has heard the message about the Surgeon General`s warning and the asserted health hazard. HEW itself, in its Smoking Digest, says more people are familiar and know what the Surgeons General`s warning means than are familiar with the free press, free worship and free speech guarantees of the First Amendment. So it`s clear that government has performed what it perceives is its obligation here to give people information. The question is then, what is government`s role beyond that? Should government take some other kind of action to try to make sure you make what it believes is the right decision? I don`t think so.

The second thing I think is fairly clear from what these young people have said is that they understand the influences that may have operated to make them start smoking in the first place: peer pressure, attitude at school, and parents. Those are the three things that sociologists have pretty much agreed operate, and not cigarette advertising. John Pinney, who`s the director of the Office of Smoking and Health, said just last year that in this area cigarette advertising is not the culprit when it comes to young people smoking.

LEHRER: Let`s ask them quickly very specifically, Johanna, Tracy and Michael, did cigarette advertising affect your decision to smoke or decision to continue to smoke in any way? Tracy?

KOLIS: Has it affected my decision? No, not at all.

LEHRER: Michael?

PAGE: No.

LEHRER: Johanna?

MARKSON: No.

LEHRER: Okay. Go ahead.

MERRYMAN: Well, I think those are the things that have been brought out in this conversation, both between you and Dr. Richmond and the young people - - some things that perhaps people haven`t really readily grasped and understood in the past: that people have the information, and that as individuals we can make our own choices. And I don`t think further government intervention into that decision-making process is warranted.

LEHRER: Johanna, do you have any questions you would like to ask either Mr. Merryman or Dr. Richmond?

MARKSON: I want to know from both of you -- this question can be answered by either -- if you had children my age, would it bother you if they smoked?

LEHRER: Mr. Merryman?

MERRYMAN: Yes, because I don`t think it`s something that young people ought to be making a decision about; as I said before, I think it`s something for adults.

LEHRER: Dr. Richmond?

RICHMOND: Yes, it would concern me because I know the impact it would have on health, and I do have two sons now grown up and I`m pleased to say that they don`t smoke.

LEHRER: Michael, do you have a quick question for the two gentlemen?

PAGE: Yes, I would like to know, do either one of you smoke?

LEHRER: Do either one of you smoke?

MERRYMAN: I do. It`s not a condition of employment, but I do.

LEHRER: Dr. Richmond?

RICHMOND: No, I don`t smoke, and never have.

LEHRER: All right, we have to leave it there. Charlayne and Tracy and Michael and Johanna, thank you very much in New York. Gentlemen here, thank you. We`ll see you tomorrow night. I`m Jim Lehrer. Thank you and good night.