C/-j C";) IN r-11i (CV11 A Bjitish-American Tobacco Company publication forstaff. B -.‚ le 5P BATCo document for Legal Services : Health Canada 20 October 1999 Introduction This BAT document sets out to provide an informed and balanced view of the smoking and health issues. and of the related matters which concern us in the developing nations. Smoking is a comple?c subject and we who work in the tobacco industry are well aware of the controversial issues involved. A substantial body of scientific and medical opinion links smoking with various diseases on the basis of statistical association. Over the past 30 years, literature on the subject of smoking and health has become truly enormous- In terms of sheer volume. it probably far exceeds that on any other product in history, and even so, research continues today at a very high leveL Clearly the issues are not black and white. and simple cause and effect has not been proven. Indeed, there are some doctors and scientists who believe that the relationship is in fact a reflection of elements other than, or in addition to, smoking. The personality of smokers is cited, their diet. as well as their occupation and the effects of atmospheric pollution. Nevertheless, although the controversy is real. and will almost certainly continue for many years to come, many governments have adopted the view that cigarettes are a hazard to health. In many rapidly developing parts of the world. BAT plays a positive role in the agricultural development of countries. and not just in tobacco growing. The company's work will continue to serve the interests of farmers and tobacco traders as well as leaf growers, governments and of course consumers. Commercial life is never easy and there will always be new challenges to meet. I t is intended that this document will show how these challenges are being tackled in a responsible manner which reflects the high standards which form the basis of the company's success. I CD BATCo document for Legal Services : Health Canada 20 October 1999 r1r,11 ine and Health nd The debate about smoking and health began to develop in the 1930s. However, it was not until the 1950s that it became a subject for detailed medical and scientific investigation, primarily by means of epidemiology which is the statistical study of large groups of people in relation to the occurrence of disease. From the start, the maj or area of concern has been disease of the lung, predorninantly the highly-emotive disease of cancer but also emphysema and bronchitis. Many statistical studies have indicated that more smokers are likely SMOOP9 ba-ckgTou to suffer from lung illnesses than are non-smokers (1). In recent years, doctors have also identified a statistical relationship between heart disease and several life-style factors including smoking (2). A number of scientists however have questioned these views. It is a fact, for example, that even though tobacco consumption in Austria, Belgium and Finland is lower than in the USA, Canada and Australia, lung cancer rates are higher in the first three countries: for smoking to be the direct cause -of lung cancer, a higher incidence in the USA, Canada and I Australia would be expected. Although the mechanism by which cancer is triggered in any part of the human system is still not understood fully, the current hypothesis of many scientists is that it is caused by a number of contributory tl)OYJ- pg. 16f., 2 c1~ BATCo document for Legal Services : Health Canada 20 October 1999 elements and not just a single factor. Indeed, there area number of scientists who believe that exposure to chemicals or environmental pollution are contributory causes. Some aspects of personality are also cited as possible causal factors. While some scientists have associated cigarette smoking with heart disease, it is reasonably clear that a number of other factors including life-style, blood pressure, biochemistry, genetics and in particular, stress may be also involved. This evidence has been quoted here to show that although there is a statistical association between smoking and certain kinds of ill health, it has not been proven that these illnesses are actually caused by smoking. Any such assertion on causation therefore must necessarily be seen as an opinion and not a statement of proven fact. In the field of smoking and health BAT is attentive to the views and opinions of many medical and government authorities regarding the statistical association between smoking and certain diseases. The company has worked closely with such authorities in supporting research into a wide range of smoking-related subjects, and it will continue to do so. At the same time. consumer demand is moving away from full-flavoured cigarettes towards cigarettes with lower deliveries of tar and nicotine. In common with other major international cigarette companies, BAT has made considerable changes to its cigarette products in order to meet demand, and it will continue to make further changes worldwide, taking into account all relevant factors including scientific developments and consumer trends. 3 BATCo document for Legal Services : Health Canada 20 October 1999 what is cigarette smoke? Cigarette smoke is a collection of fine aerosol droplets suspended in a mixture of gases. Although scientists have identified more than 3000 compounds. albeit in the most minuscule quantities, attention has focused on three principal components: "Tar" is the condensate material collected in the laboratory from tobacco smoke, considered by many scientists to contain compounds. as yet not specified, which can cause cancerous cells to be either initiated or maintained and which can also irritate the respiratory system. Nicotine is a naturally-occurring substance formed almost exclusively in the tobacco plant. In the small quantities inhaled intermittently it can have a stimulating or relaxing effect on smokers depending on their moods (3). 1 t can increase the heart rate slightly before its rapid conversion into other compounds in the body. Carbon monoxide is a by-product of most combustion processes. The gas can be absorbed from the environment into which it is discharged mainly by industrial and vehicle emissions. Carbon monoxide is toxic in large amounts because it affects the oxygen-carrying capacity of the blood. It is usually thought, however, that healthy individuals are well able to tolerate the effects of carbon monoxide absorbed either from the normal environment or after the inhalation of cigarette smoke. The 1981 report of the US Surgeon General commented, "Carbon monoxide has been impugned as a harmful constituent of cigarette smoke, There is no evidence available, however. that permits a determination of changes in the risk of diseases due to variations in carbon monoxide levels". When the amount or "delivery" of smoke components is to be measured (to compare different cigarette brands for government tar tables. for example) the cigarettes are smoked in machines according to accepted international procedures. 0 3" Page 16f*-femn"~ 4 01- C__ X_ BATCo document for Legal Services: Health Canada 20 October 1999 i ne move to lower smoke deliveries The present day cigarette looks almost identiciltO the cigarette of the past, but considerable changes have been made in its composition. Many of the smoke components of early cigarettes have been greatly reduced in the average modern products and indeed. a range of ultra-low delivery cigarettes is now being introduced. The extent to which delivery levels have changed over the past two decades is illustrated by the table on page 6. Lower Delivery Products The cigarette delivery levels have fallen considerably over the past 20 years. and the average cigarette is now very different from that on sale in 1960. In addition, there are prcAucts currently available which have at least 30 times less tar than the typical 1960 cigarette. This change in smoke deliveries has come about in two significant stages. First, the introduction of filters in the early 1960s which removed some of the "tar" in the smoke. The second major change came in the 1970s with more porous cigarette paper and the ventilation of filter tippings to allow the entry of air and dilute the smoke that reaches the smoker. These developments, together with changes in the selection of tobaccos, have tended to overlap in time. The dramatic reduction in smoke deliveries over the past 20 years in the UK is shown by the chart on page 7. 0 5 CD 1 ~_1. CI BATCo docurnent for Legal Services : Health Canada 20 October 1999 0 0 CL 0 r+ Reduction in component delivery levels per cigarette 1960-1980 Delivery Levels per Cigarette (mg) (D 'Typical' 'Average' Examples of ultra-low SMOKE COMPONENTS before 1960 in 1980 delivery products available in 1980 in some markets T~VltgjnfA st & . yle cigare s.--, (D Tar 33 15 Nicotine 2 1.2 0.1 (D i Carbon Monoxide 20 15 1.5 :r ~'!L!Sblend style cf#~r~ttes 0 Tar 43 15 1 CL I Nicotine 3 1.1 0.2 0 0 Carbon Monoxide 23 17 2 0 (D (0 9 0 9 / 1/, 1 rz, 0 1 0 0 Q 0 0 Q UK Market: Reduction in sales-weighted average"tar" mg/cig (D Sector Ta . mg/cig .1965 91) 34 - E~fimated average for ~re Hi h "tar" 32- CD (29 m&ig an*d over) 30 28- Middle to high ~br" (D 26 (23-28 mg/cig) 24 - 22 - A. (D Middle "tar" 11) 20 - X 07-22 mg/cig) 18 - 0 16 IN Low to middle utar" (11-16 mg/cig) 14- 12 - CL 11) 10- 555 SPECIAL MILD (9) 0 8 - - - - - - - - I BARCLAY (8) Low"tar 0 (0-10 Mg/cig) 6 - KENT (8) 4 POSITION OF SAT's CURRENT IF+ 1) K. I OW fAR BRAND% 0 2 0 19 1970 1975 1936. 1940 1950' 1960 ,1965 -4 n. Q, E,flects of lower delivery cigarettes Many medical authorities believe reduction in smoke deliveries to be responsible for the significant downward trend noted since 1968 in the occurrence of some diseases associated with smoking. It has been pointed out by Dr E L Wynder and Dr D Hoffmann of the American Health Foundation (4) that because of the very long induction periods of up to forty years believed to be associated with lung disease. any link between the presently observed reduction in incidence and a change in cigarette design could relate only to the early 1960s movement towards filtered cigarettes with reduced tar and nicotine deliveries. Any effects of the mid- 1970s trend towards ultra-low deliveries by means of ventilated tippings. porous paper and modified tobacco blends can be shown. maintain Wynder and Hoffman, only by future studies. _L jL jue, smoking habit Whiist smoking is clearly a habit for many people and comparable in many ways to the habits of coffee or tea drinking, it is not addictive in the normally accepted sense (5). The term "addiction" is defined as the need to take ever increasing doses of a material to produce a constant response. as with narcotics, the discontinuation of which causes physical withdrawal symptoms which are usually severe. 1411-5) 9" p~g, 16 to, ~Ie-cm a CD Co BATCo document for Legal Services: Health Canada 20 October 1999 I Passive smoking Passive smoking is a term used by some to describe the exposure of non-smokers to tobacco smoke in air around them. It has been argued that passive smoking is anti-social and constitutes a health hazard to the non-smoker. Much has been made of this argument in the smoking controversy and the "rights of the non-smoker" have been advocated on trains. buses, aeroplanes and in other public places. In "Smoking and Health". the 1979 report of the US Surgeon General, it is concluded that "healthy non-smokers exposed to cigarette smoke have little or no physiological response to the smoke and what response does occur may be due to psychological factors". T~v~ recently-published studies. however, one conducted in Japan and the other in G reece, have suggested that non- smoking wives of smoking husbands have an increased risk of disease when compared with non-smoking wives of non- smoking husbands. However, the conclusions of the Surgeon General received strong support in June 1981 when the American Cancer Society announced that its own much larger study of married women showed that, " non-smoking women married to cigarette smokers have little if any increased risk of getting lung cancer compared to non-smoking women whose husbands also do not smoke". The results were in fact drawn from two studies spanning a period of 171/2 years and a sample of 523.000 people. Smoking is recognised to cause annoyance to some non- smokers. It is, therefore, a matter of common courtesy that smokers should continue to show consideration for others. 9 0 1 C--, 11~z BATCo. document for Legal Services : Health Canada 20 October 1999 Smoking by pregnant women One of the most emotional allegations against smoking is that it can affect the unborn child. These suggestions are based upon statistical findings that smoking by the mother can lead to reduced birth weight or impaired development of the child. although socio-economic factors such as personality. diet. occupation and inherited characteristics may also be involved. Additional light has been cast on this subject by a recent study by the New York State Department of Mental Hygiene. Interviews with 233 mothers have shown that the babies of those who smoked during pregnancy, although smaller at birth than those of mothers who did not smoke were indistinguishable in physical and mental development by the age of ten 16). Nonetheless, just as mothers-to-be are recommended to reduce their alcohol consumption and their use of non- prescribed medicines during pregnancy, many doctors also advise them to eliminate or reduce their smoking habits. 0 (6) seepage J 6 for references. 10 C' CD BATCo document for Legal Services : Health Canada 20 October 1999 Smoking and children As millions of adults smoke, it is inevitable that children become aware of smoking from an early age and in some cases want to copy adult behaviour. Consequently, there is a pressure on smokers to give up the custom in order to prevent chfldren starting. As with other customs and activities which might involve risk. smoking should be a choice for adults for they are able to weigh any consideration of risk against the benefits they perceive from smoking. The industry supports the view that children should not be encouraged to smoke. For this reason. BAT and other major tobacco companies have adopted a policy of neither promoting their products to children nor of making cigarettes attractive to them. Whypeople smoke The custom of smoking has been practised for centuries by societies world wide and the motivation is hard to establish. Many psychologists believe. however, that whilst smokers gain enjoyment from the taste, smoking has other positive aspects. It enables smokers to adjust their alertness to a level which is appropriate to their circumstances (3). Thus, smoking can be helpful to someone who is performing monotonous tasks over long periods. I t has been shown too that when they smoke, many smokers are better able to cope with stress and to ignore distractions. Their efficiency in learning and memory processes is also improved (7). It is generally thought to be the nicotine in tobacco smoke which is responsible for these effects. Q) (77 - p~g, 16 f., ~f-c- 11 CD BATCo document for Legal Services : Health Canada 20 October 1999 Starting to smoke. Numerous research studies have sought to establish why people start to smoke but none has identified advertising as the primary motivation. One major UK study, the Metra Report, concluded in 1980 that advertising does not affect the total amount of cigarettes sold - it is influential only in encouraging smokers to change brands. Expert opinion and practical research show the strongest influence to be the example of other smokers. They may be members of the same family, friends and acquaintances, teachers and indeed representatives of the many groups that an individual encounters in the course of the day. -L ne UK tobacco industry Worldwide. of course. there are hundreds of millions who enjoy the pleasure of tobacco. In the United Kingdom. almost half the adult population chooses to smoke and the tobacco industry employs more than 40,000 people directly. A far greater number is involved in the distribution and retailing of tobacco products, and the total is probably in excess of 500,000. Apart from employment, the tobacco business provides more than14000 million to the Government each year in taxation. This sum is more than one third of all expenditure on health and personal social services. In addition. the tobacco sector contributes nearly 1300 million annually to the UK's export earnings. The UK tobacco industry has always demonstrated its readiness to co-operate with Government and many millions of pounds are spent by the industry each year to fund research into the effect of smoking and into the development of new products. 12 011 f BATCo document for Legal Services: Health Canada 20 October 19.99 BAT in the third world Now grown in about 120 countries. tobacco is an agricultural commodity of great economic importance in many rapidly developing parts of the world. I a the early 1960s, the developing countries accounted for 5 2 per cent of world tobacco output. In 1977, this proportion had risen to 60 per cent and the Food and Agriculture Organisation (FAO) has pointed out recently that net exports from these nations has risen by nearly four per cent annually over the past decade. Earnings from the export of tobacco from the Third World now exceeds US$1200 million annually and indicates the importance of the crop to many developing nations. Tobacco cultivation provides a livelihood for an immense number of farmers, their families and other workers. BAT itself is a source of technical, agricultural, commercial and management training. Moreover, the company has done?nuch to help farmers in developing parts of the world to increase production of food crops as well as tobacco through the 13 BATCo document for Legal Services : Health Canada 20 October 1999 application of new agricultural techniques and improved land utilisation. In tobacco areas increased yields of food crops have been recorded since the early 1960s. This achievement is of considerable value, and especially in territories where food production is a national priority. In a number of countries. BAT encourages tree planting as a means of helping to overcome the fuel problems that beset many emergent nations. In Brazil, for example, BAT has planted 115 million trees since 1960. In Kenya, the company has established tree nurseries in all tobacco growing areas. In addition to the foreign exchange earnings provided for developing countries by tobacco exports, the taxes levied on tobacco also represent an important source of government revenue. For all these reasons. tobacco is widely supported or controlled by governments in both industrialised and emergent nations. At this point we may note that a major criticism levelled at the tobacco industry is that whilst it has substantially reduced the tar levels of cigarettes on sale in the developed countries, it has continued to sell higher delivery products in some other parts of the world. The answer to this criticism is that the levels of BAT's international brands are substantially the same world wide and the tar level of local brands is steadily being reduced in line with, and at the rate of. the growing customer preference for milder products. It should be noted. however, that the smoker in many developing countries has traditionally preferred a stronger taste in cigarettes than is customary in Europe or the USA - and also that his consumption has often been very much lower. Tastes are continuing to change in the developing world but the smoker's progress from higher to lower tar cigarettes is necessarily gradual. It is only by making progressive modifications in cigarette design. as BAT is doing internationally, and by marketing wider ranges of products. that the smoker will have increasing choice in selecting the product he prefers. As in the industrialised nations, BAT's policies on advertising and promotion in the developing countries aim to ensure that campaigns which appeal to you th are avoided. that advertising does not make exaggerated claims and that the character of promotional activity remains acceptable to local communities. 14 BATCo document for Legal Services : Health Canada 20 October 1999 Incondusion There have been dramatic changes in the development of cigarettes over the past 20 years and the new generation of low tar products is vastly different from the high tar cigarettes of the 1960s. There is a strong belief by many medical authorities that these product changes have been responsible for significant reductions in recent years in the occurrence of diseases which have been associated with smoking. The indications are that increasing numbers of smokers will start or continue to choose lower tar brands. Despite the continuing controversy as to cause and effect. BAT will vigorously pursue the low delivery development programme. In the rapidly-developing parts of the world. we have many millions of customers and our presence is a resource of considerable value to governments. Tobacco is the company's primary interest. but we are also active in other fields: food production and afforestation are only two examples of the way in which BAT people are helping certain nations to overcome some of the difficult problems of development. BAT has a valuable role in the world and is in good shape to further develop this role effectively and profitably. 15 C 1 BATCo document for Legal Services : Health Canada 20 October 1999 0 :1- References 1. PL Doll and R. Peto. British Medical Journal. December 25, 1976. 2. Royal College of Physicians-and the British Cardiac Society. Prevention of coronary heart disease, 1976. 3. Heather Ashton and co-workers in Smoking Behaviour, Physiological and Psychological Influences, Churchill Livingston, 1978. 4. E. L. Wynder and D. Hoffmann, American Journal of Public Health. November 1980. 5. G. L. Mangan and J. Golding in Smoking Behaviour, Physiological and Psychological Influences. Churchill Livingston. 1978. 6. M. M. Lefkowitz, Developmental Psychology Vol 17,1981. 7. K. Wesnes and D. M. Warburton in Smoking Behaviour, Physiological and Psychological Influences, Churchill Livingston. 1978. 0- 16 CZ 01 BATCo document for Legal Services : Health Canada 20 October 1999