EEC | EEMA | General Observations |

This memorandum describes the status of the European Consultancy programme as of March 1, 1990. The memorandum generally (but not entirely) treats activities in the EEC and EEMA regions separately, but it is appropriate to recall that many consultants work in both regions, and that some are also substantially involved in consultancy activities in Asia, in many respects the programme is, and should be, genuinely worldwide, and should therefore be assessed on a worldwide basis, General observations an the status and future of the programme are included in the last section.

A. EEC

We believe that the consultancy programme in the EEC region is particularly vigorous and successful. We are convinced that it provides greater expertise, more spokesmen, more genuine scientific competence, greater flexibility, and better overall value for money than any other programme anywhere. The average level of skill and experience is higher than that of any other consultant group. The projects listed below illustrate those facts. Nonetheless, we of course recognise that a continual process of pruning, and reevaluation is always desirable, and we are actively eliminating those consultants who have proved unproductive, It must, however, be remembered that a broad range of skills' and backgrounds is essential for a successful programmer and that an equally broad range of political and scientific contacts is also critical. Further, our consultants are not on retainer, and therefore are not paid unless and until they actually perform work. As a result, a strong list of available consultants does not in fact mean the creation of unnecessary costs; it does mean wider choice and greater flexibility. We must continually prune in order to avoid needless costs, but at the same time we should not abandon potentially useful contacts.

1. Conferences

1. McGill. Some thirty European scientists from seven countries attended the McGill conference. They were by far the largest non-American group, and they participated fully in all the conference's sessions. They were also instrumental in obtaining sponsorships for the conference from several institutions in four European countries. Indeed, apart from the results of their efforts, there was only one other non-US sponsor, apart from McGill itself. Preparation for and participation in the McGill conference were a major foci of European activity.

2. Lisbon. Our European consultants have organised and will conduct a major scientific conference in Lisbon next month on indoor air quality in warm climates. More than 100 scientists from throughout the world will attend, including some from the Asian consulting group. Several dozen papers will be presented, many of them by our European consultants.

   The conference is sponsored by a Portuguese university and two international scientific groups -- all quite independent of the industry, and all made possible by our consultants.

   The papers will be published both in the form of conference proceedings and, more selectively, in a journal run by one of our consultants. The focus of the conference will not be tobacco; rather, the point of the conference is to show the insignificance of ETS by emphasising the genuine problems of air quality in warm climates, Some degree of "balance" in the presentation of the issues is of course necessary to; achieve persuasiveness, but the overall results will be positive and important.

   The Portuguese Minister of the Environment will officially open the conference, and the Portuguese government has given money to sponsor the attendance of Portuguese scientists. The conference should provide a very useful public discussion of the scientific facts about ETS and IAQ in a country where the political climate has become heavily anti-tobacco, and which has been pressing hard for anti-tobacco measures in the EC, We hope the conference may help to moderate those unfavourable efforts. The conference has been a major' focus of activity for our European consultants for more than a year, but we expect those results to be amply repaid.

3. Hanover. The proceedings of last year's Hanover conference have now been published. The conference included two of our consultants on its organising committee. one of its principal papers was an attack on the reliability of the diagnostic evidence underlying the claims about lung cancer, delivered by a third consultant.

4. Budapest. A major meeting of the Toxicology Forum will be held in Budapest in July, and will include a session on ETS organised by our consultants. The Forum brings together regulators, industry, and outside scientists. Budapest is of course an EEMA market, but some of the consultants involved are from the EC, and the meeting will involve scientists from throughout Europe. We expect the ETS session to provide an excellent forum for educating government regulators and others. The proceedings will be transcribed and available for use.

5. Milan. An important meeting of Italian physicians will be held in Milan in July, and two of out consultants will provide briefings on ETS and health issues. Several thousand physicians are expected to attend the conference.

6. Visby, Sweden. A toxicological meeting will be held in Visby in June, and will include sessions on nicotine. At least one of our EC consultants will attend, and will provide a paper. One of our Scandinavian consultants will also attend.

7. Switzerland. Our EC consultants are planning a major meeting in 1991 in Switzerland on indoor air quality issues. The conference will be sponsored by our new scientific society (see below), Indoor Air International. Like Lisbon, this will be an Important opportunity to put ETS issues into perspective. Like Visby, it is listed here because of the heavy involvement of EC consultants. Again, we expect attendees from throughout the world, numerous papers, and several significant publications. Planning for such sessions requires at least a year, given the issues involved, the need to prepare papers, and the congestion of the calendar for scientific meetings.

8. Windsor. Several advertising experts from Europe, the United-States and Canada participated in a two-day conference on advertising issues in January. The results will be published next month in a special issue of an advertising journal. Several of the pieces should provide very useful help on advertising questions,

9. Oslo meeting and workshop. See EEMA section.

10. Others. We ask our consultants to cover all substantial scientific conferences where they can usefully influence scientific and public opinion. They also attend many other conferences on their own, as part of their ordinary scientific activities. The conferences we ask them to attend are selected after approval from Dr Gaisch and with the advice of a small group of consultants, who serve as an informal scientific steering group. The job is a heavy one, and depends for its success upon a large group of consultants representing a wide range of disciplines.

2. Media appearances and related activities

1. Media briefings. Three of our EC consultants gave a successful media briefing on ETS and IAQ issues in Copenhagen last fall. They met with a group of reporters and succeeded in obtaining several useful stories. Written background papers were also given to the journalists, A similar briefing was given last week in Stockholm by one of our EC consultants and one of our Swedish consultants. Three consultants also gave a briefing to journalists in Brussels in October, following their presentations on IAQ aboard commercial aircraft to the international Flight Attendants Association, Yet another briefing is now being planned for France before union leaders. we now have a number of European consultants ready and able to give such briefings as and when needed throughout Europe, or indeed the world, As noted below, some of our European consultants have already spoken on ETS and IAQ in Asia.

2. Videos. Several European consultants will soon be film to provide the basis for two videos relating to ETS and indoor air quality.

3. Television. One of our consultants has been filmed twice in recent months discussing ETS. Another participated in an Italian television debate regarding ETS. Another provided a video-taped interview for use in the same debate.

4. Op-ed pieces and-popular magazine articles. One consultant has prepared an op-ed piece regarding advertising, which has been provided to Burson for possible use. Another consultant has drafted a piece on inflight air quality, which now is being revised. A third consultant has published two popular magazine articles regarding health Issues. A fourth has been interviewed by one of the popular English newspapers.

3. Litigation

1. Australia. Three European consultants (two English and one Swedish) are currently scheduled to testify in the Australian ETS advertisement litigation, The preparation of their testimony has been a substantial focus of their activities over the past several months. We expect one to testify in March and the others in May. A fourth consultant was scheduled to appear, and devoted substantial time to his preparations, but Australian counsel decided he was not needed.

2. Finland. At least one of our consultants is to provide testimony for the defendants in the Finnish litigation. There may be others, but we do not currently have a list of the anticipated witnesses.

4. Learned Society

Our consultants have created the world's only learned scientific society addressing questions of indoor air quality. The society (Indoor Air International) is seeking memberships from all those interested in IAQ issues throughout the world. It will soon have its own periodic newsletter, in which ETS and other IAQ issues will be discussed in a balanced fashion to an audience of regulators, scientists, building operators, etc. It will also have its own scientific journal, published by a major European publishing house, in which IAQ issues will again be addressed, The society will be self-supporting from its own dues. it already exists under the laws of Switzerland, and has its own executive director based in Brussels. The society will sponsor meetings and conferences, such as the one scheduled for Switzerland in 1991, and thus can serve as an independent and accepted source of ' ideas and research regarding IAQ to the public and the scientific community. it should be a major vehicle for reaching a variety of different audiences on IAQ issues. We are of course including Asian and American consultants in the society, so as to provide worldwide coverage of IAQ issues.

5. Consulting group

Our EC consultants have formed a consulting group called ARIA (Associates for Research in Indoor Air) that has its own brochure and-is offering consulting services to companies and governments on IAQ issues. The ARIA model has been followed on a smaller scale by Asian consultants. We hope both groups will extend the reach and effectiveness of our consultants' advice On IAQ matters.

6. Europe in Asia

Several of our European consultants have been deeply involved in helping to create the group of Asian consultants. One European has made several lengthy visits to Asia and has been the principal discoverer and recruiter of the Asian consultants. Several of the consultants have also been substantially involved in informing the Asians about ETS issues, as well as in providing other briefings an those issues in Asia. This has involved the loss of large blocks of time from their work in Europe, but the consultants involved are delighted that the Asian group has proved to be a successful offspring of their European programme. Nonetheless, we of course hope that, as time goes on, the Asian programme will require steadily smaller infusions of European time and effort.

7. Publications

Many recent or anticipated publications are indicated by the projects described above, but there are numerous others. Among them are the following.

1. ETS book. Several consultants are continuing to work on a book relating to ETS and health. It is designed for nonspecialists including scientific journalists and regulators. The manuscripts are largely drafted, but one delay has recently been the completion of the publishing contract. Thanks to the help of Bradley Brooks, this is now essentially complete, and the project should move quickly forward. The book will include chapters regarding lung and other cancers, reproductive issues, respiratory questions, IAQ, etc.

2. IAQ book. Several consultants have nearly completed the editing and preparation of a major new textbook on IAQ issues, to be published by Cambridge University Press. Virtually all the manuscripts from more than 20 authors are complete. We expect this to be the leading world text on IAQ issues, and hope that it will be used by students, regulators and others throughout the world. It should be published by late Spring.

3. Follies and Fallacies in Medicine. One consultant has published a book exposing the vagaries of medical truisms, including those relating to tobacco. It has been very favourably reviewed in a number of scientific and medical journals, and is addressed both to a lay 11 audience and to medical students and physicians. It is a clever and entertaining way of suggesting that medical "certainties" are frequently without genuine scientific basis.

4. Toxicological text. Another consultant has published a major toxicological text that should help to refocus and revise toxicological practice and thought, including thought relating to the Investigation of tobacco-related issues.

5. Other forthcoming papers.
   1. ETS and cervical cancer. This forthcoming article will show the fallacy of the claims about ETS and cervical I cancer, and will be suitable for use with the media as well as scientific audiences. It will be presented at Lisbon and available in April.
   2. ETS and IAQ. This paper will review the health aspects of IAQ placing the various claims about ETS into perspective. It will also be presented nted in Lisbon, and again will be suitable for lay or media use.
   3. IAQ and ventilation. This is a paper by one of the principals of Healthy Buildings International, and again will show the insignificance of ETS in the creation of IAQ problems. It is also a Lisbon paper.
   4. IAQ regulations. This paper will summarise IAQ standards and regulations, particularly in the European Community, but also elsewhere in the world. It will also evaluate the various regulatory steps now under consideration by the RC. This too will be delivered at the Lisbon conference.
   5. ETS exposure markers. One of our Scandinavian consultants will deliver a paper in Lisbon on nicotine in hair as a marker of ETS exposure. His research may provide a very useful means of Measuring the extent of such exposure.
   6. Lung cancer and autopsy evidence. One of our consultants is awaiting the publication by a leading French medical journal of a major paper on this issue. The paper very helpfully attacks the reliability of the evidence regarding ETS and lung cancer.
   7. Lancet. One of our consultants is an editor of Ms Very influential British medical Journal, and is continuing to publish numerous reviews, editorials and comments on ETS and other issues.
   8. Response to Scottish lung cancer - paper. One consultant recently - published the principal response to an important paper an ETS and lung cancer in parts of Scotland. His response successfully showed the methodological deficiencies of the Scots paper. The latter received wide publicity, and a response was urgently needed to redress the situation.
   9. Presentation of the results of IAQ monitoring in Switzerland. Two English consultants are preparing a journal article presenting the results of the IAQ monitoring in Swiss buildings by ACVA and LINK. The piece is designed to provide a more general appraisal of such problems in light of the Swiss results. It will very usefully supplement the publicity given directly to the ACVA study by FTR.
   10. Others. There are numerous other - forthcoming papers, including others to be delivered in Lisbon and other conferences.

8. Political and scientific contacts.

Such contacts can be suggested only in general terms, and only by illustration. One consultant is, for example, the advisor to a particularly relevant committee of the House of Commons. One is the executive director of a leading scientific society that considers workplace and related issues. Several are advisors to the European Community on scientific matters. Several have been members of the working groups of the International Agency for Research in Cancer. Those groups "rate" the cancer risks of various substances and products. Through their efforts, for example, we were able to give General Foods considerable information about IARC's evaluation of coffee as a possible risk factor for cancer. One consultant is a medical advisor to several Middle Eastern governments. Another has numerous other governmental contacts throughout the world, including those who persuaded the Portuguese Minister of the Environment to open the Lisbon conference. Still another is medical consultant to several British companies. others hold major professorships in leading universities and technical schools.

9. Research

This has not in the past been one of our principal points of emphasis, but hopefully the New York meeting in January will lead to a more coherent and better directed research programme. One of our European consultants prepared analyses of the potential areas of possible research for the New York meeting. His work should help provide the basis for an improved research programme. Our current programme: includes the following projects.

1. Nicotine and its progeny. One of our consultants is conducting research into the physical and chemical characteristics of nicotine and its progeny. Dr. Gaisch expects this to provide an excellent basis for future nicotine research.

2. Bird keeping. The keeping of pet birds appears to be a major risk factor for lung cancer -- a far more serious factor than anyone has ever alleged ETS to be. Two consultants have guided research on this issue conducted by others in Holland. A significant scientific paper 'was the result. Another consultant, plus one of the first two, has been investigating the same issue in Scotland, where pet birdkeeping is a very common hobby.

3. Lung cancer data in France. Several consultants in France, with assistance from one of our English consultants, have been examining data regarding lung and bladder cancer in Burgundy, to determine if a suitable paper is feasible, Considerable preliminary work has been completed.

4. Autopsy data. One of our English consultants is examining the feasibility of using autopsy data In Hungary to attack the reliability of lung cancer diagnoses. This would in turn greatly undermine the claims about ETS and lung cancer. Hungary was until recently almost the only country where autopsies were commonly conducted, so it could well be a unique source of potentially important information.

5. EEC Cost 613 projects. The European Community sponsors a great number and variety of IAQ research projects under the general title of "Cost 613". One of our consultants already is conducting such a project. Another consultant has undertaken to ascertain the status and direction of as many as possible of the other potentially relevant projects. We are also pursuing the status of such projects through our own contacts at the Commission.

6. Other EC research. Several of out consultants are awaiting a response from the commission to a longstanding proposal to give the Community advice on IAQ issues. We hope the creation of IAI and ARIA will provide more effective devices for the provision of such advice, and thus for increasing the influence of our consultants upon scientific thinking throughout the EC.

B. EEMA

As described above, many projects in EEMA markets are included in the EC portion of this report because they also involve numerous EC-based consultants. The media briefings in Copenhagen and Stockholm, as well as the 1991 IAQ conference in Switzerland, are useful examples. Nonetheless those projects also have involved, or will involve, consultants based in EEMA markets. in addition to the projects described above, the following are recent or current projects relevant to EEMA countries.

1. Swedish Allergy Commission.
   Our Scandinavian consultants are preparing a statement of scientific! facts to be presented either- ' by PM or by the Swedish NMA to the Swedish government to respond to ETS claims made recently by the Swedish Allergy Commission. The consultants' statement will provide scientific support for the industry's response to the Commission.

2. Nicotine in hair as a marker of the ETS exposure
   As noted above, a paper on this subject will be presented in Lisbon by one of our Scandinavian consultants. In addition, Dr. Gaisch has approved the funding of a continuation of the study through 1990.

3. Norwegian ETS workshop and conference.
   A scientific conference and workshop will be held in October 1990 in Oslo regarding ETS, at which several prominent Scandinavian anti-smoking scientists will appear. At Stig Carlson's request, we have asked several of our consultants to appear at the meeting, They will answer the opposing claims and provide balance both to the workshop discussions and to any resulting publicity. The conference will be a major Nordic event, but we expect our coverage of it to be substantial and effective.

4. Swedish social insurance awards involving ETS.
   One of our consultants has for some time been engaged in an analysis of the medical records relating to all of the ETS awards granted under the Swedish social insurance programme. He has completed that analysis, and a draft article for I ~ publication in an international social insurance journal has been prepared. The article Is now being revised, but a final version should soon be available for prompt publication.

5. ETS book.
   With our encouragement, a Scandinavian physician is now preparing a short book in lay language regarding ETS and health. The manuscript should be complete in the next several weeks, The final product should be useful throughout the Nordic region or, in translation, elsewhere.

6. Finnish meeting.
   The Scandinavian consultants will meet privately in May with two prominent Finnish chest physicians to ascertain their views and the status of their research programmes, in hopes of influencing those views more favourably to ETS.

7. Inflight air quality.
   As a supplement to last year's SAS study published by three of our Scandinavian consultants, two of the scientists are preparing a journal article containing suggestions to airlines and aircraft manufacturers for improving inflight air quality without banning smoking. For this purpose, they are taking advice from one of our English consultants who is knowledgeable about airline ventilation systems. The paper is scheduled to be completed next month.

8. EEMA attendees at the Lisbon conference.
   PM personnel in the Middle East have been encouraged to send prominent scientists and government representatives to the Lisbon conference, where they can be informally briefed by our consultants regarding ETS and IAQ issues. The same invitation has been given to PM-Espana, which is sending three physicians.

9. Swiss advertising threat.
   We have provided materials from economic literature to FTR in support of their opposition to a proposed Swiss referendum regarding tobacco advertising. We will also provide the Windsor materials when they appear, and have offered to provide consultants to meet with Swiss officials as and when such meetings appear useful.

10. Health risk perceptions survey.
    One of Scandinavian consultants, who has been heavily involved in measuring differences in popular and governmental perceptions of health risks in the United States, has offered to conduct similar work in Europe. The point of the research would be to show how popular conceptions of health risks are often actually misconceptions, when compared to expert scientific evaluations. We have asked for a suitable proposal and protocol to determine the project's desirability.

11. Media briefings.
    As described above, two such briefings have already been held in Scandinavia. our Scandinavian consultants are prepared to do others, and we hope one can soon be scheduled in Finland. Other locations in Europe are equally feasible. In addition, our Scandinavian consultants have already testified before the Magnusson Commission in Sweden, which is investigating various anti-smoking measures.

12. Others.
    Our Scandinavian consultants have participated, or will participate, in virtually all of the conferences described in the EEC portion of this report, as well as the proposed ETS and IAQ videos, the Australian litigation, and many of the other projects described in connection with the EEC.

C. General Observations

We believe the consultancy programmes in the EEC and EEMA regions continue to provide an important, indeed indispensable, tool for the industry in reaching public, scientific and governmental audiences. The programmes are strengthened by their size and diversity. The needs for consulting services are substantial and different, and those needs could only be met by groups comparable to those that now exist in the EEC and EEMA regions. There is a continuing need for care and discretion in the groups' activities both to minimise costs and to protect their usefulness, but we believe such care and discretion are now being used. With proper management, the programmes can continue to be cost effective.

One ingredient is never in excess. We have regularly received very helpful guidance from PM as to how best to use the consultants - where your needs are, and how those needs can best be met. We are grateful for that help, but we can continually use more. You know your problems better than we do, and your local representatives can offer valuable guidance as to what will actually work in their markets. The consultancy programmes can do their jobs effectively only if such guidance continues to be provided in a timely way.

We also believe that the consultancy programmes must increasingly be viewed as parts of a single, overlapping worldwide effort. Science is inherently international, and our programme must be no less so. The important role of Europeans in Asia is one example, and the Montreal and Lisbon conferences are others. Further the programme cannot remain static. Just as we must continually eliminate unproductive consultants, so too we must continue to seek new consultants to satisfy new needs. This is particularly true in light of the increasing demand for scientists with, particular linguistic skills and backgrounds.

In addition to the consultancy programmes themselves, we continue to provide assistance to the two regions on a great variety of corporate affairs projects -- research, briefing memoranda, and other matters -- some of which do not directly involve the consultants. The consultants do, however, contribute significantly to those efforts by providing information, scientific guidance, useful political and scientific contacts, and other help. In that sense, much of what we do for the regions is related to, and greatly assisted by, the consultancy programmes.

Covington & Burling London

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