159 



course of its investigation. In a letter yesterday, however, which I 

 am releasing today, I agreed to a special accommodation to address 

 Mr. Sandefur's concerns. In Friday's hearing, the subcommittee 

 will limit the subject matter of the hearing to Mr. Sandefur's pre- 

 vious testimony before the subcommittee, to documents he volun- 

 tarily provides this subcommittee, and to information provided in 

 recent news reports. 



Brown and Williamson and other tobacco executives will receive 

 fair treatment by this subcommittee, but they will not receive spe- 

 cial treatment. 



I want to recognize other members of the subcommittee for com- 

 ments they wish to make and call on Mr. Bliley first. 



Mr. Bliley. Mr. Chairman, I wish to join you in welcoming Mr. 

 Califano to this subcommittee. I am always pleased to hear from 

 former Cabinet officials about their work in other administrations. 

 I know that being an administration official is often a thankless 

 task. Individuals who take on these positions deserve our thanks 

 for their years of public service, and I think we can all benefit from 

 the insights former officials can bring us after they leave office. 



Mr. Califano, today you are providing the committee a study 

 which purports to show the cost of substance abuse to the Medicare 

 program. If one turns to the methods section of your report, it is 

 clear that the key factor determining your estimates is the esti- 

 mate of the relative risk factor for acquiring a given disease. 



Clearly, the relative risk factor presented in terms of a percent- 

 age is the foundation of your entire study. The important question 

 then is, how did you determine the risk factors for a given disease 

 or condition? 



Here is what you say on pages 12 and 13 of your May 1994 re- 

 port in the methods section. 'When possible we selected studies 

 that were targeted at the elderly population. However, we found 

 that the elderly population is not often the focus of medical or epi- 

 demiological research. In lieu of elderly specific relative risks, we 

 use relative risks for the general adult population." 



My understanding of this statement is that very little epidemio- 

 logic data exists on the efiects of tobacco, alcohol, or drugs on the 

 elderly population, of those 65 years and older. Therefore, you cal- 

 culated your risk factors on studies which were based on the gen- 

 eral population. 



Let's look at an example, coronary artery disease. This disease 

 affects many of the elderly for multiple reasons, many of them cen- 

 tering on diet. However, in your study you attribute 64 percent of 

 all coronary artery disease to substance abuse. Possibly this risk 

 factor was calculated from a study of individuals much younger, 

 say from 25 to 45 years of age, and among this age cohort this may 

 be an accurate estimate of the risk of substance abuse for coronary 

 artery disease. However, to then take this number and generalize 

 it to the elderly population makes no sense. 



If one looks at the elderly population, it is possible that 64 per- 

 cent of coronary artery disease is attributed to high fat diets. 

 Therefore, Mr. Califano, I want you to please make available to 

 this committee the specific studies on which each of your risk as- 

 sessments on pages 17-20 are based. Additionally, I want an age 



