Public policy on smoking and health: toward a smoke-free generation by the year 2000. A statement of a working group to the Subcommittee on Smoking of the American Heart Association.

On May 20, 1984, the Surgeon General challenged the health community to work toward attainment of a smoke-free society by the year 2000. The leadership of the nation's three major voluntary organizations joined numerous associations of health professionals in accepting the challenge. The Subcommittee on Smoking of the American Heart Association (AHA) has concluded that attaining this objective requires the development and implementation of public policies designed to facilitate the transition from a smoking to a nonsmoking society. To study the relevant issues and recommend appropriate policies, the subcommittee commissioned a working group of distinguished experts in the field of smoking and health to prepare a policy statement. The statement, published here, has received the enthusiastic endorsement of the Subcommittee on Smoking and the leadership of the AHA. The working group discusses and recommends four policies: Increase the federal cigarette excise tax. Eliminate or restrict tobacco advertising and other forms of promotion. Assure the rights of nonsmokers to clean air through legislative means. Identify mechanisms to ease and assist the transition of tobacco farmers to other crops or careers.

Promotion of tobacco products: issues and policy options.

During the past year, several prominent voluntary health organizations and professional medical associations have called for a ban on all forms of promotion of tobacco products. The proposal raises complex issues, ranging from determination of the effects of tobacco promotion to assessment of the constitutionality of banning advertising of a legal product. We identify the issues that underlie the concern of health professionals, review evidence addressing these issues, and describe and discuss frequently mentioned policy options, especially the ban proposal.

Smoking and health.

Although cigarette smoking is the number one public health problem in the United States, physicians have failed to take the lead either in convincing youngsters not to begin smoking or in aiding adults to quit smoking. To be most effective and convincing in combating the smoking epidemic, practicing physicians must have the same basic fund of knowledge about the short- and long-term consequences of smoking as they do about other commonly encountered medical problems. By acting on such knowledge and adopting a definite set of attitudes and activities in their offices and with patients, physicians can make a significant contribution to their patients and to the entire community in which they practice.

Increasing life span; changing disease patterns; changing life styles: the role of government.

Much progress has been achieved over the past twenty years in informing the American people of the hazards of cigarette smoking. Over thirty million Americans have quit smoking cigarettes; many have quit as a result of social pressure--cigarette smoking becoming less socially acceptable. The average cigarette has less than half as much tar and less than half as much nicotine as its predecessor cigarettes a quarter century ago. Moreover, most American cigarettes today are filtered. We still do not know why people begin or why they continue to smoke. I would urge the Committee on Problems of Drug Dependence to add tobacco--as you've added alcohol--to your agenda for research, for cooperative studies, and for an annual update. You should examine and speculate upon the reasons why 53,000,000 Americans' dependence on tobacco has attracted so little attention from scientists with knowledge and expertise such as yours. And when you have the answers, I hope you will utilize those answers to attract more research and appropriate action to our number one public health problem and our number one drug dependence problem.

An analysis of a multiple-drug program in the treatment of patients with advanced breast cancer utilizing 5-fluorouracil, cyclophosphamide, and prednisone with or without vincristine.

Ninety patients with advanced breast cancer received a polychemotherapeutic program composed of 5-fluorouracil, cyclophosphamide, and prednisone with or without vincristine as a control group in a series of four consecutive Phase II clinical trials of new drug programs. Objective regression rates were 59% without vincristine and 46% with vincristine. Projected mean length of regressions exceeds 1 year. Site of dominant disease, disease-free interval, or performance scale score (if score was 0, 1, or 2, ECOG scale) failed to influence response rates; decreasing response rates were noted as the length of time increased after menopause. No advantage existed in patients experiencing severe myelosuppression (nadir leukocyte count of less than 1,500/mm), and appreciable response rates occurred without significant myelosuppression. The addition of vincristine to the regimen failed to increase the response rates, and only increased toxicity. The program as outlined is reasonably tolerable and effective for this group of patients with advanced breast cancer.