Subject: Koop's Stature Is Likely to Add Force to Report on Smoking as Addiction Date: Published: 5/13/88 138 lines Source: WALL STREET JOURNAL. Copyright Dow Jones & Co. Inc. Surgeon General Koop's Stature Is Likely to Add Force to Report on Smoking as Addiction --- By Ed Bean Staff Reporter of The Wall Street Journal On Monday morning, Surgeon General C. Everett Koop is expected to issue a powerful indictment of tobacco with the release of a report that characterizes smoking as a drug addiction. The report, an annual study mandated by Congress, probably won't contain any new research and can only suggest legal or regulatory initiatives. But it is likely to become a common reference work on doctors' shelves, and already it's sending ripples of elation through the ranks of tobacco's foes, who hope to use it in their legislative assault on the industry. The idea that tobacco use is a clinical addiction isn't new. However, Dr. Koop will give it added legitimacy at a time when his leadership in the AIDS crisis has established him as perhaps the nation's most highly regarded health advocate. "When the surgeon general puts his Good Housekeeping seal of approval on a set of scientific facts, it is beyond reproach," says Jay Winsten, assistant dean of the Harvard School of Public Health. "This helps change the way people view smoking -- from a nasty habit to an addiction," adds Michael Pertschuk, a former chairman of the Federal Trade Commission who advises anti-tobacco groups on legal strategy. "That's a paradigm that changes a whole range of responses. The more you think of cigarettes as a dangerous drug, the more you're going to treat them as a dangerous drug." Walker Merryman, head of the Tobacco Institute, an industry trade group, says he's "expecting the worst." Not surprisingly, Mr. Merryman doesn't agree with Dr. Koop's addiction thesis. "I've not heard of anybody holding up a liquor store or mugging an old lady to get the money to buy cigarettes," he says. But he concedes that anything the surgeon general says about tobacco will become almost canonical to many people. As a federal official whose greatest power is the power of speech, Dr. Koop might not seem much of a match for an industry that has thus far triumphed in every product-liability lawsuit brought against it. He has just five employees in his office, and he borrows specialists from other federal agencies to research such issues as smoking and AIDS. His only real authority comes from moral suasion. By statute, the surgeon general's main duties are modest: compiling reports on health crises and advising the nation on health policy. The holder of the post reports only to an assistant secretary of Health and Human Services. Because of these limitations, some of the more retiring surgeons general have worked in relative obscurity. But those who have chosen to seize the spotlight have had a hand in initiating and framing public-health debates. It was the first report on smoking -- in 1964 -- by then Surgeon General Luther Terry that helped to convince most people about the dangers of smoking and eventually prompted Congress to require health warnings on cigarette packs. Dr. Koop's 1986 report, which dealt with the danger of secondhand smoke to nonsmokers, led the way to a host of prohibitions against smoking in public places, including the smoking bans on certain airline flights. His report on the dangers of smokeless tobacco prompted Congress to require that product to carry a health warning. The surgeon general's office also has a history of understanding how to play to the press. Dr. Terry carefully set the stage for his first smoking report by wrapping it in plain brown paper stamped "Secret" before handing it out at a press conference. Dr. Koop refuses to appear on any television show with a tobacco-industry representative -- because, colleagues say, he doesn't think the evidence on smoking's hazards is something to be debated. The 71-year-old Dr. Koop, the first surgeon general in modern times to insist on wearing his ceremonial gold-braided admiral's uniform, is well suited to such a public position. A world-renowned pediatric surgeon who three times successfully separated Siamese twins, he has also been one of the pro-life movement's most articulate crusaders. He toured the country on an anti-abortion campaign in the late 1970s, telling audiences that liberal abortion attitudes could result in the "beginnings of the political climate that led to Auschwitz." Largely because of such credentials, North Carolina Republican Sen. Jesse Helms, a pro-lifer who is also tobacco's best friend in Congress, shepherded his nomination through the Senate in 1981. So controversial were Dr. Koop's pro-life views that apparently no one thought to ask his opinion about tobacco. If there were any doubts where he stood on tobacco, however, Dr. Koop dispelled them shortly after assuming office, when he declared that smoking was "the most important public-health issue of our time." In the past few years, Dr. Koop has garnered most of his attention from his efforts to educate the nation about AIDS, but tobacco remains a high priority. Dr. Koop declines to talk about the new report, but its content was revealed earlier this month in remarks made by another federal official. Ronald Davis, director of the federal Office on Smoking and Health, told a television panel: "We've been saying for many years that nicotine is an addicting drug, just like cocaine, just like heroin... . But this report ... looks at the evidence in far greater detail than we've ever looked at it before." It's not known just how far Dr. Koop will go Monday in lumping nicotine use in with illicit drug addiction. Some speculate, for instance, that he will ask that tobacco be given greater emphasis in the Just Say No campaign promoted to schoolchildren. Donald McDonald, the president's adviser on drug-abuse policy, says he wouldn't object to that. He calls tobacco, along with alcohol and marijuana, "gateway drugs" that for teenagers can be precursors to the use of such hard drugs as heroin and crack, a potent form of cocaine. Apart from any specific applications, the new report will give a big lift to the legislative agenda of tobacco's foes. If they can get congressmen to start thinking of tobacco as a drug, they're confident they can bring an avalanche of regulation down on the industry over the next few years. Among other things, they say they'd like to ban all advertising and promotion of tobacco, bring it under the jurisdiction of the Food and Drug Administration, require disclosure of toxic flavor additives, ban vending-machine sales to keep cigarettes away from children and require a label that warns of addiction. "Five years ago, when we said smoking was an addiction, we got laughed at," says Matthew Myers, director of the Coalition on Smoking or Health, an umbrella group of lobbyists. "This ups the ante dramatically." [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]