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Testimony on Smoking in Public Places and Places of Employment

Harold Varmus
President and Chief Executive Officer
Memorial Sloan-Kettering Cancer Center

Testimony on the Proposal to Amend the Administrative Code in Relation to the Prohibition of Smoking in Public Places and Places of Employment
New York City Council
October 10, 2002

Mr. Chairman:

I am Harold Varmus, the President of Memorial Sloan-Kettering Cancer Center in New York City, and I thank you for the opportunity to speak in support of Mayor Bloomberg's proposal to strengthen the city's prohibitions against smoking in public places and places of employment.

I appear here as a medical scientist with a long history of research on cancer and responsibility for institutions committed to the public's health. I received an M.D. degree at Columbia University's College of Physicians and Surgeons and trained in internal medicine at Presbyterian Hospital in New York City. For over thirty years, I have performed research, mostly at the University of California, San Francisco, on the genetic basis of cancer (work for which I shared the Nobel Prize in Medicine in 1989). I also served as Director of the National Institutes of Health for six years in the 1990s, and now run one of the nation's leading cancer centers, while continuing my research program.

Those of us who have devoted our professional lives to the conquest of disease recognize tobacco as the single most important and most controllable threat to human health in this country. The use of tobacco is addictive to smokers, and it exposes both smokers and bystanders, who share the environment with smokers, to a variety of mutagenic and acutely toxic substances. Extensive epidemiological studies document the contributions of these tobacco products to the causation of several types of cancers, most notably malignant tumors of the lung and oro-pharyngeal regions; without tobacco use, the rates of lung cancer -- the most common cause of cancer mortality for both men and women in this country -- would be reduced by about 80 percent and the incidence of cancer generally would be reduced by over a third. In addition, tobacco use is a major factor in chronic and acute cardiovascular diseases and in asthma, chronic obstructive pulmonary disease, and other disorders of the airway system.

Intensive efforts to reduce exposure to risks of tobacco must be a major component of any enlightened public health policy in an enlightened city like ours. The goals of such efforts are threefold: to reduce the initiation of smoking habits, to increase the likelihood of cessation, and to diminish exposure to smoke produced by others who are using tobacco.

Many methods have been shown to assist efforts to achieve these three goals. However, none is fully effective by itself, so it is important to make coordinated efforts directed at all three goals if maximum benefit is to be achieved.

We already know that such public health efforts have important benefits, and some of them have been dramatically documented in the United States. For example, reduced use of tobacco has significantly lowered lung cancer mortality rates in American men. But much more needs to be done.

The proposal to ban smoking in public facilities, including workplaces such as restaurants and bars, is an important component of such efforts. Numerous studies show that significant exposure to second hand smoke occurs in many kinds of work places, as well as households, and that a full ban on smoking in these settings is required to achieve a significant reduction in exposure. Studies published in rigorous medical journals show that smoke in the environment has detrimental physiological effects on cardiac function that can be directly measured, and improvements in respiratory health have been observed after establishment of smoke-free bars. In addition, significant reductions in cancer incidence can be predicted to follow reduction of exposure to second-hand smoke. It is also reasonable to assume that such restrictions will help promote cessation and inhibit initiation of smoking habits, although more studies need to be done to examine these assumptions.

Those who are employed by bars and restaurants are usually more heavily exposed than customers or owners to environmental tobacco smoke. Such workers are likely to be young, relatively poorly educated, and from disadvantaged communities. Fairness dictates that we should make particularly strong efforts to protect these workers from avoidable threats to their health that they might otherwise feel obliged to endure.

For all of these reasons, I strongly support the Mayor's proposal to amend the administrative code, and I urge you to support it too.

Thank you.