[Pages S5915-S5917]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

DR. DAVID A. KESSLER'S SPEECH ON TOBACCO

<bullet> 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.<bullet>

____________________