A smoking-and-health article in yesterday's Post reported incorrectly that one of every three Americans continues to smoke cigarettes. Actually, the figure is one of every three adult Americans.
This is a report from the front lines of the battlefield where Joseph A. Califano Jr. is waging his ballyhooed war on cigarette smoking.
Califano, the nation's chief health overseer as secretary of health, education and welfare, is winning a few, losing a few and standing still on a few.
While the latest surgeon general's report, unveiled last Thursday by Califano, shows that smoking is declining, some 54 million Americans continue their love-hate affair with the cigarette. That is, one of every three Americans smokes.
HEW's health statistics, relating some 320,000 heart and cancer deaths each year to smoking, continue to justify Califano's designation of the cigarette as "Public Health Enemy Number One."
Aside from increasing the antismoking budget to $30 million, most of his year-old campaign consisted of a series of efforts to enlist the help of others in government and business to limit smoking in public places. Califano has followed through on most of those steps, but the response -- minimal at best -- offer a less positive picture of progress.
Issues become obscured in most wars, and Calafano's campaign is no exception. It is a story of congressional and presidential politics blended with tobacco industry efforts to wield influence over public policy.
President Carter, from tobaccogrowing Georgia, is in the middle. His new budget will increase HEW's antismoking money. But last year he went to North Carolina, a major tobacco state, to talk about protecting the "health" of the industry and making tobacco use "even more safe than it has been in the past."
Congress has been no friendler to Califano's effort. The secretary's request for more money last year was granted, but not before tobacco state legislators gave him a through goingover and put some limits on how he could spend an extra $6 million for public education.
In the absence of a mobilized antismoking lobby, the tobacco industry and lawmakers from tobacco states long have enjoyed disproportionate influence on Capitol Hill. That showed up again last year in the wrangling.
Tobacco interests gave campaign money to more than a third of the House members. Tobacco state legislators, calling for still more research, argued the cause of thousands of small farm families who depend heavily on tobacco sales. They regularly outgun such antismoking luminaries as Sens. Edward M. Kennedy (D-Mass.) and Birch Bayh (D-Ind.).
Typical of the response to last week's surgeon general's report was that of Rep. Richardson Preyer (D-N.C.), who aspires to chairmanship of the House public health subcommittee. He said the report was based more on statistics than solid research.
"It is a situation where the congressional leaders on the important committees come from those tobacco states," said an HEW legislative official. "We got what we wanted last year, but we'll have a real fight on our hands this time. There has not been an organized constituency against smoking and it's not that hard for the tobacco industry to combat."
As if the politics were not enough, Califano's difficulties are underscored inside the HEW building at the foot of Capitol Hill.
There, some of his top lieutenants light up their filtertips without a second thought. Mocking anti-Califano bumperstickers, distributed by the tobacco industry, are displayed openly. Lower level bureaucrats in some offices have rebelled against his effort to limit smoking within the agency.
Califano's critics -- prosmoking and antismoking alike -- are screaming that he's doing too much or not enough.Tobacco people want him to go-pfft in a cloud of smoke. The most strident anticigarette people dismiss him as an ineffective overpromiser.
At HEW and in some other quarters, the view is more pragmatic. Given political difficulties, this thought goes, Califano has an effect on public opinion whenever he denounces smoking -- no matter how little he might spend.
The director of HEW's Office of Smoking and Health, John M. Pinney, like Califano a heavy smoker who reformed, said: "The secretary's goal and ours is to increase public awareness -- everything we do is weighed in terms of how it will achieve that goal.
"We have been successful, with the help of federal agencies and others on the outside in greatly heightening public awareness," Pinney said. "Our critics say we haven't been restrictive enough. But we have been very careful -- we don't want a smoker backlash and we don't want to adopt programs that will have a minimal payback."
Around the edges of the battlefield, Califano's critics flail away at him and at each other. A rapidly growing grass-roots national effort to pass antismoking laws and ordinances is being met with the well-financed opposition of the Tobacco Institute, which represents the major cigarette companies.
"I can't think of any lobby with a more devastating effect on public health than tobacco -- first, the cigarette manufacturers and second, the growers. When you consider the billions of dollars of health damage caused by cigarettes, it would be much cheaper to put the tobacco growers on a federal annuity," said Dr. Sidney Wolfe, head of Ralph Nader's Public Citizen Health Research Group.
Wolfe criticizes Califano for not having done more to protect nonsmokers from the health and nuisance aspects of cigarette smoke, but he agreed that the secretary is somewhat hamstrung by Congress and the White House.
"Carter is the problem," he said."Califano could consider it a victory if the president just stayed neutral. But he is undercut by his commander, running around to protect the tobacco industry."
Wolfe drew a comparison between federal programs to halt drug abuse and those to persuade smokers to quit.
"Organized crime, which profits from drugs, doesn't have a lobby. Therefore, a reasonable amount of money is spent on drug abuse -- something like $201 million in service programs this fiscal year to help addicts. Tobacco has a lobby and the same budget has around $6 million for smoking education. Thirty times more for drugs than tobacco. That's absurd," Wolfe said.
John Banzhaf, a George Washington University law professor who heads Action on Smoking and Health (ASH), another antitobacco group, is far more critical of Califano.
"We have felt that Califano could use the powers he has to regulate tobacco just as he regulates other dangerous products. We say regulate it, don't try to educate," Banzhaf said.
"Through the Food and Drug Administration he can regulate nicotine as a drug. He could regulate cigarette filters as medical devices.... Even simpler, he could use HEW's grantgiving powers to require health and educational institutions to have reasonable rules to protect the rights of nonsmokers," he said. "If he would do that, the impact on the rights of nonsmokers would be more dramatic than any$30 million he could spend."
For now, at least, the prospects of such actions are dim. Pinney said that HEW is reviewing tougher approaches -- higher excise taxes on tobacco, for example. But, he said, "We think the best bet is finding different ways of getting the message across. And we are concerned about finding ways of helping a smoker who has quit improve his chances of staying off cigarettes."
For its part, the Tobacco Institute continues to lash out at Califano as a crazed reformer, continues to reject scientific linkage of health problems with cigarettes and is intensifying its campaign to promote smoking as a personal-rights area in which the federal government has no business meddling.
"We are not aware of any data that shows that restrictive laws reduce cigarette consumption," said Walker Merryman of the institute. "Minnesota has the strictest laws of any state and there's nothing to show a drop in cigarette sales there."
"One of our missions is to allow our companies to operate in a free market.... If this antismoking effort is left unchecked, it could roll into some kind of prohibition movement. We tried that before [with alcohol] and it didn't work," he added.
There is no underestimating the power of the institute, which reportedly has more than doubled its budget to almost $5 million since 1973. Its influence goes far beyond the voices it has in Congress and the impact of its colorful advertising extolling tobacco.
The institute reaches into the deepest corners of the bureaucracy. Several years ago, for example, the Consumer Product Safety Commission, concerned about home fires caused by smoking, thought about requiring cigarettes to be manufactured with self-extinguishing characteristics. This idea sent the industry and its legislative friends into a frenzy.
Thus, Congress reasserted its original intention -- put in the law at the behest of tobacco state legislators -- that the commission was not to deal with tobacco in any way.
Still concerned about home fires, the commission now is moving toward adoption of a rule that would require all furniture fabrics to be fireproof. Inevitably, the cost of furniture will rise and the choice of fabrics will be more limited.
Of course, a smoker will have to pay more for his new sofa.But so will the other two-thirds of adult Americans who do not smoke cigarettes. And so it goes on the battlefield.