States and localities with their health service programs and to advise States on matters related to the public health (sec. 311, Public Health Service Act; 42 U.S.C. 243).

2. CONTROL PROGRAMS-STATE AND COMMUNITY

Within an overall annual appropriation authorization of $50 million, section 314(c) of the Public Health Service Act (42 U.S.C. 246(c)) provides for grants to assist States and their political subdivisions to establish and maintain public health services, including the conduct of demonstrations. Such State or local services and demonstrations may include control programs for diseases related to smoking that are not covered by such existing programs as those for cancer control now supported under this same authority. In addition, section 316, Public Health Service Act (42 U.S.C. Supp. 247a) authorizes appropriations of $10 million annually for project grants to States or other public or nonprofit agencies for studies and demonstrations looking to development of new or improved methods providing health services outside the hospital. Exploration of the effectiveness of community control programs related to smoking, including health educational services, could be supported under this authority.

3. RESEARCH AND STATISTICS

The conduct and support of research on any aspect of the relationship of smoking and health is authorized by section 301 of the act (42 U.S.C. 241) either through an appropriate institute of the National Institutes of Health; such as, the National Cancer Institute or the National Heart Institute, or through other existing units of the Service depending on the nature of the research project. In addition, the continuing, nationwide collection of statistical data on the nature, extent, duration, and economic impact of any illness or disability is authorized by section 305, Public Health Service Act (42 U.S.C. 242c). This is the basis for the national health survey which may thus include collection of data related to smoking and health.

The CHAIRMAN. Mr. Younger.

Mr. YOUNGER. Thank you, Mr. Chairman.

Dr. Terry, at the top of page 4, you say enacting specific regulatory authority to express those minimum standards. Do you have a recommendation on the minimum standards?

Dr. TERRY. No, sir; we do not have at this time.

Mr. YOUNGER. Why?

Dr. TERRY. Because the Department has not yet arrived at detailed conclusions as to what would be the proper standards to recommend to the Congress.

Mr. YOUNGER. Following up on the question of the chairman, as I understand it when the report came out, you intimated that within 60 days it would be all right for the committee to conduct hearings and you would be ready for them. Am I correct in that?

Dr. TERRY. Mr. Younger, I think you must appreciate the fact that I have the authority to speak only for the Public Health Service. We were ready then; we are ready now. This question of regulation, in our opinion, does not fall within the purview of the Public Health Service and, therefore, is not our direct responsibility, though we do feel that we con contribute in terms of a discussion of the needs in that direction.

Mr. YOUNGER. I thought you were expressing here the standard that you were going to recommend from your Department when you mentioned the minimum standards. Did you mean by that paragraph that you are referring to as standards that were going to be set by the Federal Trade Commission? You don't make a distinction there.

Dr. TERRY. The thing I am saying is that those have not been formulated by the Department to the degree where the Department is prepared to present them to you, Mr. Younger.

Mr. YOUNGER. On page 9, you mention evaluation of smoking withdrawal clinics. What do you have in mind as a smoking withdrawal clinic?

Dr. TERRY. I am talking about a type of operation in which physicians and/or other health personnel would assist individuals in discontinuing smoking and, at the same time, study their reactions and evaluate their response to this advice and assistance.

Mr. YOUNGER. Do you conclude that the smoking habit is comparable to the drug habit or to alcoholism and has to be treated in a clinic rather than a person's own willpower?

Dr. TERRY. We have not referred to this as an addiction, as it is very commonly used in relationship to addicting drugs, and in many instances, in relationship to alcohol. I think this is quite a different problem than either one of those, Mr. Younger.

Mr. YOUNGER. Would you operate your withdrawal clinics differently than the drug clinics?

Dr. TERRY. I think they would be operated in many varying ways in order to face up to the problem and determine what would be the most effective way of assisting an individual.

Mr. YOUNGER. On page 13 you are talking about your own Department. "Those who would like to control this cigarette consumption without necessarily giving it up completely." In other words, a little cigarette smoking is not bad?

Dr. TERRY. Our committee reported, Mr. Chairman, that there was a direct relationship between the amount of smoking and its effect upon health. Therefore, I think one must conclude from this that the less one smokes the less likely will there be health effects.

Mr. YOUNGER. Have you any standard as to how many cigarettes a day could be smoked and not interfere with your health?

Dr. TERRY. I have one standard and that is: No cigarettes, Mr. Younger.

Mr. YOUNGER. Why do you say that you are going to control your own Department in cigarette consumption without necessarily giving it up completely? You are not asking them to give it up completely?

Dr. TERRY. I am not asking anybody to give it up completely, Mr. Younger. I am merely advising you and the rest of the country as a physician and in my responsible position.

The CHAIRMAN. Would the gentleman yield there?

Mr. YOUNGER. Yes; gladly, Mr. Chairman.

The CHAIRMAN. That raises a very interesting question. I want to say that any questions I might ask are no indication whatsoever that I am trying to raise implications. I think you are to be commended for all the effort you have made. Some of the suggestions you make also raise implications, in my judgment. Mr. Younger has just proposed a subject that raises a question in my mind. You say you are not trying to tell anybody what to do. A government with an agency as big and powerful as your agency can have tremendous influence in many ways, and a lot of power. You said in your statement, on page 9, that among other things, on this clearinghouse problem that you are suggesting, that your agency will conduct and support studies to determine the influence of professional medical and health personnel on their patients.

I think that would be a very interesting study. I would like to know what the report would be on that myself. I have heard a great deal about it. If it would be applicable to smoking, or as you say, to the attitudes and habits, that would be one thing. But if the influence happens to have any significant effect on this particular problem, obviously it would reach into many fields of activity, would it not?

Dr. TERRY. I presume such an interpretation could be made, Mr. Chairman.

The CHAIRMAN. You are trying to suggest here that you want authority and funds and staff to find out just how influential the doctors of the country are over their patients. Is that what you are suggesting?

Dr. TERRY. I think you are going beyond our intentions, Mr. Chairman. The thing that we are specifically referring to here is that we would like to know, and I think it is important to know in the development of our programs, that if a physician genuinely advises a patient to discontinue smoking, with a thousand such patients, what happens to those patients?

How many quit and why they quit.

The CHAIRMAN. I think it would be interesting if that information became available. There is no doubt about that. But it is also interesting that you tell us that your authority in the field arises out of certain authority which the Congress gave to the agency many years ago. What concerns me is that what you have in mind today is one thing, and it may look perfectly reasonable, desirable, and appropriate; but when such broad authority is extended then later on down the line we find Government agencies reaching back and saying here is what Congress said for us to do.

Just as it was with Mr. Roberts a moment ago. Only 4 years ago the Hazardous Substances Act was developed and there was no thought and I believe it was not even mentioned in the hearings or in the legislative history, yet here 4 years later arguments are made that that act covers cigarettes. That is the sort of thing that does cause me some concern with the regulatory agencies of the Government interpreting language so that it expands their broad general authority.

Mr. YOUNGER. Thank you, Mr. Chairman. I would like to have the record show also that my questions are not indicative of my smoking. I quit some 16 or 18 years ago.

I didn't need any clinic or anything else. I didn't need any advice from the reports of the Department. I just concluded that I would feel better and I quit after about 30 years of smoking every form of tobacco. That is not the point I am trying to get at.

Dr. TERRY. May I interrupt to compliment you upon your wisdom, sir?

Mr. YOUNGER. What I am wondering is in all of this program which you set out, how do you expect to get the cooperation? I am reminded of the very fine program that the administration set out and they were going to rehabilitate all of the rejectees of the draft. Now they find that the program has gone by the boards because only 172 percent of the rejectees of the draft were even interested in answering the Government's letter. They didn't want to be rehabilitated, apparently. How are you going to reach these people and get the program on the road to stop a habit which you say is very strong, when we can't even get the rejectees of the draft to respond for rehabilitation?

Dr. TERRY. I just say we certainly will not be successful in prevailing upon anyone to quit smoking who does not basically wish to quit smoking. I think we have the basic responsibility to disseminate the information upon which a person can make an individual judgment, and then beyond that I think we as well as the rest of the medical and health profession have a responsibility to try to help that individual to do something if he wishes to do it.

Mr. YOUNGER. You have done that in the report that is now published? You have given the facts to the public as to the ill effects of smoking?

Dr. TERRY. In the report of the Advisory Committee? I think we have, sir.

Mr. YOUNGER. But that is not enough in your opinion. You have to expand your activities.

Dr. TERRY. That is right. I think this is only one step in the procedure.

Mr. YOUNGER. That is all, Mr. Chairman. Thank you very much. The CHAIRMAN. Mr. Rogers of Texas.

Mr. ROGERS of Texas. Dr. Terry, with relationship to your conclusions about cigarette smoking, is it your personal feeling that a law should be passed prohibiting the shipment of tobacco in interstate commerce?

Dr. TERRY. No, sir.

Mr. ROGERS of Texas. Do you feel that it is very seriously detrimental to the health of any one who uses it?

Dr. TERRY. I think there is a definite and significant risk to the health of anyone who smokes cigarettes.

Mr. ROGERS of Texas. But I believe you stated that there is still a lot of things that we don't know in this picture?

Dr. TERRY. That is right.

Mr. ROGERS of Texas. And will require more research. I notice that most of your statement is confined to cigarette smoking, which I presume has to do with inhalation?

Dr. TERRY. Yes, sir.

Mr. ROGERS of Texas. In the research that has been performed have you done any research on tobacco in any form, that is, including tobacco, the use of snuff, pipe tobacco, cigarette tobacco, or is this research confined primarily to cigarettes?

Dr. TERRY. Mr. Rogers, the Advisory Committee report does not represent individual research that was done by the Committee during the time they were making the study. It represents a comprehensive review of the world's medical literature on the subject, a compilation of this literature and an evaluation of it. There are aspects that were studied by the Committee which have to do with cigar smoking, pipe smoking, including chewing tobacco and snuff.

Mr. ROGERS of Texas. This attention has been centered on cigarette smoking in this particular situation we are in now, is that right?

Dr. TERRY. That is right. It has been centered there because of all of the converging evidence brought together by the Committee, the most significantly incriminating had to do with cigarette smoking rather than the other types of the use of tobacco.

Mr. ROGERS of Texas. I am not expert on it but it is my understanding that you also inhale snuff?

Dr. TERRY. It depends on how you use it. There are several different ways. People sniff snuff and may inhale some. On the other hand the most common practice in this country is not to sniff it but to place it in the lower front teeth and lower lip where it is allowed to gradually dissolve over a period of time.

Mr. ROGERS of Texas. You have not reached any conclusion whether this practice, including chewing tobacco, is detrimental?

Dr. TERRY. No, sir, we have not.

Mr. ROGERS of Texas. Would the same be true with regard to cigars that, we will say, are not inhaled?

Dr. TERRY. This is difficult to try to evaluate, when you say cigars are not inhaled. The Committee in reviewing the literature available on the smoking of pipes and cigars could find only a slightly higher overall mortality rate and only slightly higher incidence of certain types of diseases. So the Committee did not feel that there was adequate evidence upon which they could incriminate cigar smoking and pipe smoking as clearly as they could and as they did cigarettes.

Mr. ROGERS of Texas. Would that indicate the paper was more to blame than the tobacco?

Dr. TERRY. I think the main thing it indicates is that we need to know a lot more about this particular subject, as well as to why people react differently to cigarette smoking. It is pretty generally recognized that with most people who never smoke cigarettes or rarely smoke cigarettes, when they smoke either a pipe or cigar they do not inhale very much.

Mr. ROGERS of Texas. Isn't it a fact, too, that there is a tremendous number of people who smoke cigarettes rather than cigars, pipes, or chew tobacco?

Dr. TERRY. Yes; this is true.

Mr. ROGERS of Texas. Was that taken into consideration?

Dr. TERRY. Yes; this was done on a ratio basis.

Mr. ROGERS of Texas. The point is this. You feel that the report you have from this literature provides definite evidence for the conclusion that cigarette smoking is detrimental to the health of the individual.

Dr. TERRY. Yes, sir; or may be to any one individual.

Mr. ROGERS of Texas. That is what I was coming to. Isn't it a fact, Doctor, that drinking whisky is detrimental?

Dr. TERRY. I would hesitate to make that broad statement. It depends on how much you drink, when you drink, and so forth and so on. Certainly alcohol in the form of whisky or any others may be very detrimental to health.

Mr. ROGERS of Texas. It might affect one individual differently from another, might it not?

Dr. TERRY. Some difference; yes, sir.

Mr. ROGERS of Texas. In other words, a slight amount of alcohol could cause some people to become ill, while it might take 2 quarts to make someone else ill?

Dr. TERRY. I will accept your judgment on that, sir.

Mr. ROGERS of Texas. I am asking for information.

Dr. TERRY. Certainly, as you well know, Mr. Rogers, there is quite a difference to the individual tolerance to alcohol; yes.